title: Relationship between thrombus attenuation and different stroke subtypes.
abstract: BACKGROUND
  More insights in the etiopathogenesis of thrombi could be helpful in the treatment of patients with acute ischemic stroke. The aim of our study was to determine the relationship between presence of a hyperdense vessel sign and thrombus density with different stroke subtypes.
  
  
  METHODS
  We included 123 patients with acute ischemic anterior circulation stroke and a visible occlusion on CT-angiography caused by cardioembolism (n = 53), large artery atherosclerosis (n = 55), or dissection (n = 15). Presence or absence of a hyperdense vessel sign was assessed and thrombus density was measured in Hounsfield Units (HU) on non-contrast 1 mm thin slices CT. Subsequently, occurrence of hyperdense vessel sign and thrombus density (absolute HU and rHU (=HU thrombus/HU contralateral)) were related with stroke subtypes.
  
  
  RESULTS
  The presence of hyperdense vessel signs differed significantly among subtypes and was found in 45, 64 and 93 % of patients with cardioembolism, large artery atherosclerosis and dissection, respectively (p = 0.003). The mean HU and rHU (+95 % CI) of the thrombi in all vessels were respectively 56.1 (53.2-59.0) and 1.39 (1.33-1.45) in cardioembolism, 64.6 (62.2-66.9) and 1.59 (1.54-1.64) in large artery atherosclerosis and 76.4 (73.0-79.8) and 1.88 (1.79-1.97) in dissection (p < 0.0001). We found the same significant ranking order in the density of thrombi with hyperdense vessel signs (mean HU and rHU (+95 % CI), respectively): cardioembolism 61.3 (57.4-65.3) and 1.49 (57.4-65.3); large artery atherosclerosis 67.3 (64.9-69.7) and 1.65 (1.58-1.71); dissection 76.4 (72.6-80.1) and 1.89 (1.79-1.99, p < 0.0001).
  
  
  CONCLUSIONS
  Presence of a hyperdense vessel sign and thrombus density are related to stroke subtype.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP 01.132, 3584, CX, Utrecht, The Netherlands. jmniesten@gmail.com
authors.forename: J M
authors.initials: JM
authors.lastname: Niesten
authors.forename: I C
authors.initials: IC
authors.lastname: van der Schaaf
authors.forename: G J
authors.initials: GJ
authors.lastname: Biessels
authors.forename: A E
authors.initials: AE
authors.lastname: van Otterloo
authors.forename: T
authors.initials: T
authors.lastname: van Seeters
authors.forename: A D
authors.initials: AD
authors.lastname: Horsch
authors.forename: M J A
authors.initials: MJ
authors.lastname: Luitse
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: L J
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: W P T M
authors.initials: WP
authors.lastname: Mali
authors.forename: B K
authors.initials: BK
authors.lastname: Velthuis
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015984:Causality; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data