Comprehensive analysis of the high density of middle cerebral artery sign in hyperacute cerebral infarction
LIN Hui-hua1, WANG Rui-fang2, NING Qing-ling1, XU Zhi-hua1, YANG Ben-qiang3,#br# ZHANG Meng-zhi1, CAI Xiao-nan3, HOU Jie1, DUAN Yang3
1. Jinzhou Medical University, General Hospital of Shenyang Military Region Command Training Base for Graduate,
Shenyang 110016, China; 2. Department of Radiology, Liaoning General Hospital of Armed Police, Shenyang 110034, China;
3. Department of Radiology, General Hospital of Shenyang Military Region Command of PLA, Shenyang 110016, China
Abstract Objective: To explore objective criteria which are suitable for clinical application by comprehensive analysis of unilateral hyperdense middle cerebral artery sign(HMCAS) on non-enhanced computed tomography(NECT). Methods: One hundred sixteen patients with hyperacute cerebral infarction were retrospectively evaluated. The presence of HMCAS was evaluated between inter- and intra-observers. K value was calculated. The cut off value of MCA attenuation and MCA ratio(the affected side/the healthy side) in the HMCAS(+) and HMCAS(-) was measured through the ROC curve in all patients with hyperacute cerebral infarction. The sensitivity and specificity was analyzed. Results: The interobserver and intraobserver agreement were substantial(K value of 0.82 and 0.86, respectively) and increased to almost perfect(K value of 0.95) when the reader was provided with clinical information. MCA attenuation≥40 HU and MCA ratio≥1.2 was the best threshold for HMCAS recognition. When both MCA attenuation≥40 HU and MCA ratio≥1.2 were satisfied, sensitivity(91.23%) and specificity(100%) were the highest relative to other standards. Conclusion: It is effective and feasible to evaluate the unilateral HMCAS on NECT images by combining with clinical history. MCA attenuation≥40 HU and MCA ratio≥1.2 was the best threshold for HMCAS recognition, which is suitable for application in daily clinical practice.
[1]Paliwal PR, Ahmad A, Shen L, et al. Persistence of hyperdense middle cerebral artery sign on follow-up CT scan after intravenous thrombolysis is associated with poor outcome[J]. Cerebrovasc Dis, 2012, 33(5): 446-452.
[2]Li Q, Davis S, Mitchell P, et al. Proximal hyperdense middle cerebral artery sign predicts poor response to thrombolysis[J]. PloS one, 2014, 9(5): e96123.
[3]Leys D, Pruvo JP, Godefroy O, et al. Prevalence and significance of hyperdense middle cerebral artery in acute stroke[J]. Stroke, 1992, 23(3): 317-324.
[4]Aries MJH, Uyttenboogaart M, Koopman K, et al. Hyperdense middle cerebral artery sign and outcome after intravenous thrombolysis for acute ischemic stroke[J]. J Neurol Sci, 2009, 285(1): 114-117.
[5]Kharitonova T, Ahmed N, Thorén M, et al. Hyperdense middle cerebral artery sign on admission CT scan-prognostic significance for ischaemic stroke patients treated with intravenous thrombolysis in the safe implementation of thrombolysis in Stroke International Stroke Thrombolysis Register[J]. Cerebrovasc Dis, 2009, 27(1): 51-59.
[6]Koo CK, Teasdale E, Muir KW. What constitutes a true hyperdense middle cerebral artery sign?[J]. Cerebrovasc Dis, 2000, 10(6): 419-423.
[7]Abul-Kasim K, Selariu E, Brizzi M, et al. Hyperdense middle cerebral artery sign in multidetector computed tomography: definition, occurrence, and reliability analysis[J]. Neurol India, 2009, 57(2): 143.
[8]Landis JR, Koch GG. The measurement of observer agreement for categorical data[J]. Biometrics, 1977, 33(1): 159-174.
[9]Gacs G, Fox AJ, Barnett HJ, et al. CT visualization of intracranial arterial thromboembolism[J]. Stroke, 1983, 14(5): 756-762.
[10]Clark W, Lutsep H, Barnwell S, et al. Penumbra pivotal stroke trial investigators: the penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease[J]. Stroke, 2009, 40(8): 2761.
[11]Liebeskind DS, Sanossian N, Yong WH, et al. CT and MRI early vessel signs reflect clot composition in acute stroke[J]. Stroke, 2011, 42(5): 1237-1243.
[12]von Kummer R, Meyding-Lamade U, Forsting M, et al. Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk[J]. AJNR, 1994, 15(1): 9-15.
[13]Wolpert SM, Bruckmann H, Greenlee R, et al. Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group[J]. AJNR, 1993, 14(1): 3-13.
[14]Flacke S, Urbach H, Keller E, et al. Middle cerebral artery(MCA) susceptibility sign at susceptibility-based perfusion MR imaging: clinical importance and comparison with hyperdense MCA sign at CT[J]. Radiology, 2000, 215(2): 476-482.
[15]Kim EY, Lee SK, Kim DJ, et al. Detection of thrombus in acute ischemic stroke: value of thin-section noncontrast-computed tomography[J]. Stroke, 2005, 36(12): 2745-2747.
2018, Vol. 29 
