{
  "abstract": "Background Automated CT perfusion (CTP) software is widely used to select patients with large-vessel occlusion stroke for endovascular thrombectomy (EVT), yet treatment thresholds are often applied as if outputs from different platforms are interchangeable. This study compared RAPID and Brainomix CTP outputs in the same thrombectomy cohort.Methods We performed a retrospective observational study of patients with large vessel occlusion who underwent CTP imaging. Paired volumetric data were analyzed using both RAPID and Brainomix algorithms. Inter-platform agreement was assessed using intraclass correlation coefficients (ICC), Pearson correlation (r), and Bland-Altman analysis. A simplified threshold-based reclassification was performed using the volumetric core cutoffs from DEFUSE-3 (<70 mL) and DAWN (<50 mL); this assessed only the volumetric criterion and does not represent full reconstruction of trial eligibility.Results Our study found 328 EVT patients had complete paired outputs. Median core volumes were 4 mL (RAPID) vs 10 mL (Brainomix); median penumbra volumes 65 mL vs 80 mL. Core agreement was good (r=0.82; ICC=0.81) but showed systematic bias (RAPID - Brainomix: −4.9 mL) with wide 95% limits of agreement (−50.5 to +40.7 mL). Penumbra agreement was lower (r=0.77; ICC=0.74) with larger bias (−19.4 mL) and wide limits (−130.9 to +92.0 mL). Mismatch classification agreed in 91.5% (κ=0.52). Clinically significant core discrepancies occurred in 20.1%. Threshold-based reclassification at the DAWN (<50 mL) and DEFUSE-3 (<70 mL) volumetric cutoffs was discordant in 7.0% and 3.4% of patients, respectively.Conclusion RAPID and Brainomix correlate overall but are not interchangeable; systematic biases and wide limits of agreement can alter mismatch-based eligibility. Rigid CTP thresholds for EVT selection should be applied cautiously and integrated with broader clinical assessment.",
  "authors": [
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology Department, Beaumont Hospital, Dublin, Ireland"
      ],
      "name": "Paul McHugh"
    },
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology Department, Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Eimear Boylan"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Leinster, Ireland",
        "Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland"
      ],
      "name": "Seamus Looby"
    },
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology Department, Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Terence Farrell"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Emma Griffin"
    },
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology Department, Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Richard Bruen"
    },
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology Department, Beaumont Hospital, Dublin, Ireland"
      ],
      "name": "Hayley Briody"
    },
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology Department, Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Conor Brosnan"
    },
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology Department, Beaumont Hospital, Dublin, Leinster, Ireland",
        "Diagnostic and Interventional Neuroradiology Department, Basel Universiry Hospital, Basel, Switzerland"
      ],
      "name": "Victor Schulze Zachau"
    },
    {
      "affiliations": [
        "Department of Stroke medicine, Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Patricia Fearon"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Leinster, Ireland",
        "Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland"
      ],
      "name": "John Thornton"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Alan O’Hare"
    },
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology Department, Beaumont Hospital, Dublin, Ireland"
      ],
      "name": "Sarah Power"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Matthew Crockett"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland"
      ],
      "name": "Patrick Nicholson"
    }
  ],
  "title": "One scan, two answers: RAPID vs Brainomix agreement in thrombectomy patients",
  "uid": "c59ff4a5-c5e2-50d6-8008-b8837912382b"
}