Open Access Research article

Automated vs manual delineations of regions of interest- a comparison in commercially available perfusion MRI software

Ivana Galinovic1*, Ann-Christin Ostwaldt2, Carina Soemmer3, Helena Bros1, Benjamin Hotter1, Peter Brunecker1 and Jochen B Fiebach1

Author Affiliations

1 Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

2 International Graduate Program Medical Neurosciences, Charite-Universitätsmedizin, Berlin, Luisenstrasse 56, 10117, Berlin, Germany

3 Charité-Universitätsmedizin, Berlin, Charitéplatz 1, 10117, Berlin, Germany

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BMC Medical Imaging 2012, 12:16  doi:10.1186/1471-2342-12-16

Published: 18 July 2012



In perfusion magnetic resonance imaging a manual approach to delineation of regions of interest is, due to rater bias and time intensive operator input, clinically less favorable than an automated approach would be. The goal of our study was to compare the performances of these approaches.


Using Stroketool, PMA and Perfscape/Neuroscape perfusion maps of cerebral blood flow, mean transit time and Tmax were created for 145 patients with acute ischemic stroke. Volumes of hypoperfused tissue were calculated using both a manual and an automated protocol, and the results compared between methods.


The median difference between the automatically and manually derived volumes was up to 210 ml in Perfscape/Neuroscape, 123 ml in PMA and 135 ml in Stroketool. Correlation coefficients between perfusion volumes and radiological and clinical outcome were much lower for the automatic volumes than for the manually derived ones.


The agreement of the two methods was very poor, with the automated use producing falsely exaggerated volumes of hypoperfused tissue. Software improvements are necessary to enable highly automated protocols to credibly assess perfusion deficits.

Magnetic resonance imaging; Perfusion MRI; Acute ischemic stroke