title: Proximal and distal hyperattenuating middle cerebral artery signs at CT: different prognostic implications.
abstract: OBJECTIVE
  To determine whether a proximal (M1-segment) or distal (M2- and/or M3-segment) hyperattenuating middle cerebral artery (MCA) sign in patients with ischemic infarction in the territory of the MCA indicates a worse short-term prognosis than that in patients without a hyperattenuating MCA sign.
  
  
  METHODS
  We retrospectively reviewed the records of 352 patients who were diagnosed with ischemic brain infarction in the territory of the MCA. Of these patients, 186 patients met our final criteria and were included in this study. Nonenhanced computed tomography (CT) was performed for the entire brain, with a 5-mm section thickness in all patients, within 24 hours after symptom onset. The presence and location of a hyperattenuating MCA sign was correlated with neurologic deficit at discharge from the hospital (ie, short-term prognosis) by using the chi(2) test to detect differences between patient groups.
  
  
  RESULTS
  Patients with a hyperattenuating MCA sign at CT have a worse short-term prognosis than do patients without a hyperattenuating MCA sign (P <.05). Patients with a proximal hyperattenuating MCA sign have a significantly (P <.01) worse short-term prognosis than do patients with a distal hyperattenuating MCA sign.
  
  
  CONCLUSIONS
  A proximal hyperattenuating MCA sign is a reliable predictor of poor short-term prognosis in patients who experience acute stroke.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: Diederik M
authors.initials: DM
authors.lastname: Somford
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Rutgers
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: Willem P T M
authors.initials: WP
authors.lastname: Mali
authors.forename: Jeroen
authors.initials: J
authors.lastname: van der Grond
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed