The CT‐Defined Hyperdense Arterial Sign as a Marker for Acute Intracerebral Large Vessel Occlusion

• Published in: Journal of neuroimaging Vol. 28; no. 2; pp. 212 - 216
• Main Authors: Lim, Jaims, Magarik, Jordan A., Froehler, Michael T.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-03-2018
• Subjects: Aged; Aged, 80 and over; Arterial Occlusive Diseases - diagnostic imaging; Basilar Artery - diagnostic imaging; Brain Ischemia - diagnostic imaging; Cerebral blood flow; Computed tomography; CT angiography; Drugs; Female; Humans; hyperdense arterial sign; Ischemia; Male; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Neuroimaging; Occlusion; Patients; Predictive Value of Tests; Prospective Studies; Retrospective Studies; Sensitivity; Sensitivity analysis; Sensitivity and Specificity; Severity of Illness Index; Stroke; Stroke - diagnostic imaging; Tomography, X-Ray Computed - methods; Veins & arteries; vessel occlusion; CT angiography; Computed tomography; stroke; vessel occlusion; hyperdense arterial sign
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/jon.12484

ABSTRACT
Background and Purpose
To determine the sensitivity and specificity of the hyperdense artery sign (HAS) on thin‐slice non‐contrast computed tomography (NCCT), combined with brief clinical history, as an indicator for large vessel occlusion (LVO) in the setting of acute ischemic stroke.
Methods
Ninety‐nine LVO and 102 non‐LVO acute ischemic stroke patients were retrospectively identified from a prospective database at a single institution. After reviewing each patient's neurologic presentation based on his or her initial National Institute of Health Stroke Scale (NIHSS) and neurologic evaluation, all thin (1 mm) and thick (5 mm) NCCT scans were reviewed for the HAS. Analysis of sensitivity and specificity was conducted to determine the utility of the HAS sign as a reliable marker for LVO in acute ischemic stroke patients.
Results
Of the 99 LVO stroke patients, 66 HASs were identified on NCCT. Of the 102 non‐LVO patients, 18 false‐positive HASs were identified. The sensitivity and specificity of the HAS, respectively, was 67% and 82%. By anatomic distribution, the sensitivity of identifying basilar artery occlusions was 75%, and the sensitivity of identifying middle cerebral artery (MCA) M1 branch occlusions was 76%. Among patients with an NIHSS > 10, the sensitivity was 79%; whereas sensitivity was 50% if NIHSS was ≤ 10.
Conclusions
The HAS on thin‐slice NCCT has a reasonably high sensitivity and specificity for identifying LVO in acute ischemic stroke patients presenting with an NIHSS > 10 and suspected MCA M1 or basilar artery occlusion.