Hyperdense middle cerebral artery sign in multidetector computed tomography: definition, occurrence, and reliability analysis.
BACKGROUND
The hyperdense middle cerebral artery sign (HMCAS) is one of the early changes seen on the computed tomography in acute ischemic stroke of MCA territory.


OBJECTIVE
To evaluate the reliability of subjective evaluation of HMCAS on CT performed at multidetector CT (MDCT) and evaluated in the Picture Archiving Communication Systems, to define objective criteria for HMCAS and to find out if there are any predictors for the occurrence of HMCAS.


METHODS
CTs of 121 consecutive patients (mean age of 70 years) treated with thrombolytic therapy were retrospectively evaluated by two neuroradiologists both subjectively and objectively with respect to HMCAS.


RESULTS
HMCAS was subjectively found in 32% of study population. The interobserver and intraobserver agreement were substantial (K value of 0.69 and 0.80, respectively) and increased to almost perfect (K value of 0.86) when the reader provided with clinical information. The HMCAS was found twice as often in male patients. Patients with HMCAS were three years younger than those whose baseline CT did not show HMCAS. A 100% sensitivity achieved when objective criteria were defined as combination of MCA attenuation >or= 46 HU and MCA ratio > 1.2 (using oval ROIs) and MCA attenuation >or= 50 HU and MCA ratio of > 1.4 (using pixel sized ROIs).


CONCLUSIONS
Performing CT examinations on MDCT and assessment of the images in PACS might have contributed to improvement of the reliability of evaluating HMCAS on CT by enabling an objective evaluation of this sign with measurements of attenuation value in the course of MCA using oval or pixel sized ROIs as well as estimation of MCA ratio.
Faculty of Medicine, Section of Neuroradiology, Department of Radiology, University of Lund, Malmö University Hospital, Malmö, Sweden. kasim.abul-kasim@med.lu.se
Kasim
K
Abul-Kasim
Eufrozina
E
Selariu
Marco
M
Brizzi
Jesper
J
Petersson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000187:drug effects; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed / Q000379:methods
D005343:Fibrinolytic Agents