Skip to main content

Advertisement

SpringerLink
Log in

Role of multidetector CT in the recognition of hyperdense middle cerebral artery sign (HMCAS) in patients with acute cerebral ischaemia: correlation with DWI-MRI sequences and clinical data

  • Emergency Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to verify the sensitivity and specificity of the hyperdense middle cerebral artery sign (HMCAS) obtained by multidetector computed tomography (CT) in predicting acute stroke, using diffusion-weighted (DW) magnetic resonance imaging (MRI) as a reference. The location of the HMCAS, the extension of the ischaemic lesion and its prognostic value were also assessed.

Materials and methods

The CT examinations of 654 patients with symptoms related to acute cerebral stroke were retrospectively reviewed. DW-MRI confirmed recent stroke in 175 patients. Two expert neuroradiologists analysed the CT examinations of these patients in four phases. Sensitivity, specificity and interobserver reliability was evaluated. Patients were divided into three groups according to the HMCAS site (M1–M2–M3) and the Alberta Stroke Program Early CT Score (ASPECTS) on DW-MRI was calculated. The ASPECTS average score was correlated with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) at 3 months.

Results

In 41 patients, the presence of HMCAS was confirmed (71 % sensitivity; 100 % specificity; Interobserver reliability k, 84 %). An inverse correlation was found by comparing the ASPECTS and NIHSS scores (Rsq = −0.206). After logistic regression analysis, HMCAS was found to be independently associated with a poor outcome (mRS >2) at 3 months after adjusting for age, NIHSS on admission, risk factors and aetiology of stroke.

Conclusions

Our study demonstrated that HMCAS obtained with multidetector CT can be detected in more than 70 % of patients with large acute ischaemic lesion and it is an unfavourable prognostic sign.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gács G, Fox AJ, Barnett HJ, Vinuela F (1983) CT visualization of intracranial arterial thromboembolism. Stroke 14:756–762

    Article  PubMed  Google Scholar 

  2. Pressman BD, Tourje EJ, Thompson JR (1987) An early CT sign of ischemic infarction: increased density in a cerebral artery. AJR Am J Roentgenol 149:583–586

    Article  CAS  PubMed  Google Scholar 

  3. Tomsick TA, Brott TG, Olinger CP et al (1983) Hyperdense middle cerebral artery: incidence and quantitative significance. Neuroradiology 31:312–315

    Article  Google Scholar 

  4. Leys D, Pruvo JP, Godefroy O et al (1992) Prevalence and significance of hyperdense middle cerebral artery in acute stroke. Stroke 23:317–324

    Article  CAS  PubMed  Google Scholar 

  5. Von Kummer R, Meyding-Lamade U, Forsting M, Rosin L et al (1994) Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. AJNR Am J Neuroradiol 15:9–18

    Google Scholar 

  6. Wolpert SM, Bruckmann H, Greenlee R et al (1993) Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group. AJNR Am J Neuroradiol 14:3–13

    CAS  PubMed  Google Scholar 

  7. Flacke S, Urbach H, Keller E et al (2000) Middle cerebral artery (MCA) susceptibility sign at susceptibility-based perfusion MR imaging: clinical importance and comparison with hyperdense MCA sign at CT. Radiology 215:476–482

    Article  CAS  PubMed  Google Scholar 

  8. Kim EY, Lee SK, Kim DJ et al (2005) Detection of thrombus in acute ischemic stroke: value of thin-section noncontrast-computed tomography. Stroke 36:2745–2777

    Article  PubMed  Google Scholar 

  9. Bastianello S, Pierallini A, Colonnese C et al (1991) Hyperdense middle cerebralartery CT sign. Comparison with angiography in the acute phase of ischemic supratentorial infarction. Neuroradiology 33:207–211

    Article  CAS  PubMed  Google Scholar 

  10. Berge E, Nakstad PH, Sandset PM (2001) Large middle cerebral artery infarctions and the hyperdense middle cerebral artery sign in patients with atrial fibrillation. Acta Radiol 42:261–268

    Article  CAS  PubMed  Google Scholar 

  11. Pexman JH, Barber PA, Hill MD et al (2001) Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 22:1534–1542

    CAS  PubMed  Google Scholar 

  12. Weimar C, Ziegler A, Konig IR et al (2002) Predicting functional outcome and survival after acute ischemic stroke. J Neurol 249:888–895

    Article  PubMed  Google Scholar 

  13. Weimar C, Mieck T, Buchthal J et al (2005) Neurological worsening during the acute phase of ischemic stroke. Arch Neurol 62:393–397

    Article  PubMed  Google Scholar 

  14. Amarenco P, Bogousslavsky J, Kaplan LR et al (2009) Classification of stroke subtypes. Cerebrovasc Dis 27:493–501

    Article  CAS  PubMed  Google Scholar 

  15. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Article  Google Scholar 

  16. Wahlgren N, Ahmed N, Dávalos A, The SITS investigators et al (2007) Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 369:275–282

    Article  CAS  PubMed  Google Scholar 

  17. Barber PA, Demchuk AM, Hudon ME et al (2001) Hyperdense sylvian fissure MCA "dot" sign: a CT marker of acute ischemia. Stroke 32:84–88

    Article  CAS  PubMed  Google Scholar 

  18. Moulin T, Cattin F, Crepin-Leblond T et al (1994) Early CT signs in acute middle cerebral artery infarction: predictive value for subsequent infarct locations and out come. Neurology 47:366–375

    Article  Google Scholar 

  19. Somford DM, Nederkoorn PJ, Rutgers DR et al (2002) Proximal and distal hyperattenuating middle cerebral artery signs at CT: different prognostic implications. Radiology 223:667–671

    Article  PubMed  Google Scholar 

  20. Schuierer G, Huk W (1988) The unilateral hyperdense middle cerebral artery: an early CT-sign of embolism or thrombosis. Neuroradiology 30:120–122

    Article  CAS  PubMed  Google Scholar 

  21. Tomsick T, Brott T, Barsan W et al (1996) Prognostic value of the hyperdense middle cerebral artery sign and stroke scale score before ultraearly thrombolytic therapy. AJNR Am J Neuroradiol 17:79–85

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest

Romano Andrea, Biraschi Francesco, Tavanti Francesca, Beccia Mario, Dilisi Filomena, Castrignanò Antonella, Giuliani Giorgia, Pierallini Alberto, Fantozzi Luigi Maria, Rasura Maurizia, Bozzao Alessandro declare no conflict of interest.

Author information

Authors and Affiliations

  1. San Raffaele Foundation Rome, Rehabilitation Facility Ceglie Messapica, Progetto Merit RBNE08E8CZ, Rome, Italy

    Andrea Romano

  2. NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189, Rome, Italy

    Francesco Biraschi, Francesca Tavanti, Antonella Castrignanò, Giorgia Giuliani, Luigi Maria Fantozzi & Alessandro Bozzao

  3. Department of Radiology, IRCSS San Raffaele Pisana, Rome, Italy

    Alberto Pierallini

  4. NESMOS, Department of Neurology, S. Andrea Hospital, University Sapienza, Rome, Italy

    Mario Beccia, Filomena Dilisi & Maurizia Rasura

Authors
  1. Andrea Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Biraschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesca Tavanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Beccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Filomena Dilisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonella Castrignanò
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giorgia Giuliani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alberto Pierallini
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Luigi Maria Fantozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maurizia Rasura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alessandro Bozzao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesca Tavanti.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Romano, A., Biraschi, F., Tavanti, F. et al. Role of multidetector CT in the recognition of hyperdense middle cerebral artery sign (HMCAS) in patients with acute cerebral ischaemia: correlation with DWI-MRI sequences and clinical data. Radiol med 120, 222–227 (2015). https://doi.org/10.1007/s11547-014-0424-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-014-0424-x

Keywords

Search

Navigation