scholarly journals The Hyperdense Middle Cerebral Artery Sign in Drip-and-Ship Models of Acute Stroke Management

2020 ◽  
Vol 10 (1) ◽  
pp. 36-43
Author(s):  
Lise Jodaitis ◽  
Noémie Ligot ◽  
Rudy Chapusette ◽  
Thomas Bonnet ◽  
Nicolas Gaspard ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Clinical Data ◽  
Cerebral Artery ◽  
Imaging Modality ◽  
Interobserver Reliability ◽  
False Positive Rate ◽  
Stroke Management ◽  
Contrast Enhanced Ct ◽  
Hyperdense Middle Cerebral Artery

Background: Large vessel occlusion (LVO) leads to debilitating stroke and responds modestly to recombinant tissue plasminogen activator (rt-TPA). Early thrombectomy improves functional outcomes in selected patients with proximal occlusion but it is not available in all medical facilities. The best imaging modality for triage in an acute stroke setting in drip-and-ship models is still the subject of debate. Objectives: We aimed to assess the diagnostic value of millimeter-sliced noncontrast computed tomography (NCCT) hyperdense middle cerebral artery sign (HMCAS) in itself or associated with clinical data for early detection of LVO in drip-and-ship models of acute stroke management. Methods: NCCT of patients admitted to the Erasme Hospital, ULB, Brussels, Belgium, for suspicion of acute ischemic stroke between January 1 and July 31, 2017, were collected. Patients with brain hemorrhages were excluded, leading to 122 cases. The presence of HMCAS on NCCT was determined via visual assessment by 6 raters blinded to all other data. An independent rater assessed the presence of LVO on digital subtraction angiography imaging or contrast-enhanced CT angiography (CTA). The sensitivity, false-positive rate (FPR), and accuracy of HMCAS and the dot sign to detect LVO were calculated. The interobserver agreement of HMCAS was assessed using Gwet’s AC1 coefficient. Then, on a separate occasion, the first 2 observers rereviewed all NCCT provided with clinical clues. The sensitivity, FPR, and accuracy of HMCAS were recalculated. Results: HMCAS was found in 21% of the cases and a dot sign was found in 9%. The mean HMCAS sensitivity was 62% (95% CI 45–79%) and its accuracy was 86% (95% CI 79–92%) for detecting LVO. The interobserver reliability coefficient was 80% for HMCAS. Combined with clinical information, HMCAS sensitivity increased to 81% (95% CI 68–94; p = 0.041) and accuracy increased to 91% (95% CI 86–96%). Conclusion: When clinical data are provided, detection of HMCAS on thinly sliced NCCT could be enough to decide on transfer for thrombectomy in drip-and-ship models of acute stroke management, especially in situations where CTA is less available and referral centers for thrombectomy fewer and further apart.

scholarly journals Correlation of Neurologic Dysfunction with CT Findings in Early Acute Stroke

1999 ◽  
Vol 26 (3) ◽  
pp. 182-189 ◽  
Author(s):  
J.N. Scott ◽  
A.M. Buchan ◽  
R.J. Sevick
Keyword(s):  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Symptom Onset ◽  
Symptom Duration ◽  
Lentiform Nucleus ◽  
Neurologic Dysfunction ◽  
Ischemic Change ◽  
Neurologic Disability ◽  
Hyperdense Middle Cerebral Artery

Objective:To determine the frequency of early computed tomographic (CT) findings of ischemia and their relationship to symptom duration and neurologic dysfunction within 3 hours of ischemic stroke.Methods:The CT scans of 39 acute stroke patients were evaluated for signs of early ischemic change within 3 hours of symptom onset and without knowledge of the patient’s neurologic deficit or results of a 24 hour follow-up post-thrombolysis CT. Early CT signs of acute ischemic change or thromboembolism were hypoattenuation of the insular ribbon, obscuration of the lentiform nucleus, cortical hypodensity/effacement, and hyperdense middle cerebral artery sign.Results:Signs of acute ischemic change were seen on the baseline scan in 25/39 patients (64%). Hypoattenuation of the insular ribbon was seen in 11 patients, obscuration of the lentiform nucleus in 13, cortical hypodensity/effacement in 13, and hyperdense middle cerebral artery sign in 7. The prevalence of early ischemic signs was directly associated with increasing neurologic disability at the time of presentation. No clear relationship existed between symptom duration and the presence of CT signs.Conclusion:Evidence of cerebral ischemia is frequently seen on CT within 3 hours of symptom onset. The degree of neurologic disability correlates with CT signs of ischemia.

The Location of Pretreatment Hyperdense Middle Cerebral Artery Sign Predicts the Outcome of Intraarterial Thrombectomy for Acute Stroke

2014 ◽  
Vol 25 (2) ◽  
pp. 263-268 ◽  
Author(s):  
Shumei Man ◽  
Muhammad Shazam Hussain ◽  
Dolora Wisco ◽  
Irene L. Katzan ◽  
Junya Aoki ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Hyperdense Middle Cerebral Artery

scholarly journals Prevalence and significance of hyperdense middle cerebral artery in acute stroke.

Stroke ◽  
1992 ◽  
Vol 23 (3) ◽  
pp. 317-324 ◽  
Author(s):  
D Leys ◽  
J P Pruvo ◽  
O Godefroy ◽  
P Rondepierre ◽  
X Leclerc
Keyword(s):  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Hyperdense Middle Cerebral Artery

scholarly journals Hyperdense middle cerebral artery sign in large cerebral infarction

2021 ◽  
Author(s):  
Jie Hou ◽  
Yu Sun ◽  
Yang Duan ◽  
Libo Zhang ◽  
Dengxiang Xing ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Hyperdense Middle Cerebral Artery

Stroke etiologic subtype may influence the rate of hyperdense middle cerebral artery sign disappearance after intravenous thrombolysis

2016 ◽  
Vol 43 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Stefano Forlivesi ◽  
Paolo Bovi ◽  
Giampaolo Tomelleri ◽  
Nicola Micheletti ◽  
Monica Carletti ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Hyperdense Middle Cerebral Artery

Hyperdense middle cerebral artery: incidence and quantitative significance

1989 ◽  
Vol 31 (4) ◽  
pp. 312-315 ◽  
Author(s):  
T. A. Tomsick ◽  
T. G. Brott ◽  
C. P. Olinger ◽  
W. Barsan ◽  
J. Spilker ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Hyperdense Middle Cerebral Artery

Abstract P575: Impaired Distal Perfusion Predicts In-Hospital Outcome in Patients With Symptomatic Middle Cerebral Artery Stenosis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Adam H De Havenon ◽  
Tristan Honda ◽  
Jason D Hinman ◽  
Radoslav I Raychev ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Perfusion Imaging ◽  
Imaging Modality ◽  
Surrogate Marker ◽  
Length Of Hospital Stay ◽  
Continuous Variable ◽  
Mr Perfusion ◽  
Distal Perfusion

Background: Perfusion imaging is increasingly used to risk stratify patients with symptomatic intracranial stenosis. Length of hospital stay (LOS) in patients with ischemic stroke is a surrogate marker of increased morbidity. We aim to determine the association between perfusion delay on T max (< 4 sec, 4-6 sec, and > 6 sec) on perfusion weighted imaging and LOS in patients with symptomatic middle cerebral artery (MCA) stenosis. Methods: We included consecutive patients with left MCA stenosis admitted with ischemic stroke or TIA <7 days from onset who underwent perfusion imaging (CT or MR perfusion) processed with RAPID software. We excluded patients with core infarct ≥ 30 mL. Perfusion mismatch was divided into three groups: mismatch volume ≥ 15 mL based on T max > 6 sec delay, mismatch volume ≥ 15 mL based on T max 4-6 sec delay, and neither of the above mismatch patterns. The primary outcome was LOS, both as a continuous variable and categorical (≥ 7 days (prolonged LOS) vs. <7 days). Results: 179 out of 194 patients met the inclusion criteria; mean age was 70.2 ± 15.4 years, 53.1% were women, median (IQR) NIHSS was 4 (1-9); 83.2% underwent MR perfusion; 38.5% had a mismatch volume ≥ 15 mL based on T max > 6 sec and 31.3% had a mismatch volume ≥ 15 mL based on T max 4-6 sec and the median (IQR) LOS was 4 days (2-8). After adjusting for age and NIHSS, T max > 6 sec mismatch definition was associated with prolonged LOS (OR 2.90 95% CI 1.06-8.18; p=0.039) but T max 4-6 sec definition was not (OR 1.45 95% CI 0.46-4.58, p=0.528), without any interaction based on perfusion imaging modality (p interaction = 0.568). We found similar associations when LOS was considered as a continuous variable for T max > 6 sec (β coefficient=2.01, 95% CI 0.05-3.97, p=0.044) and T max 4-6 sec (β coefficient=1.24, 95% CI -0.85-3.34, p=0.244). In receiver operating curves, the optimal mismatch volume for T max > 6 sec was 10 mL (sensitivity 0.61 and specificity 0.63) whereas for T max 4-6 sec it was 39 mL (sensitivity 0.61 specificity 0.56). Conclusion: In patients with recently symptomatic MCA stenosis, the T max > 6 sec definition for mismatch, but not T max 4-6 sec, is associated with prolonged LOS. Prospective studies are needed to validate our findings and define the optimal mismatch threshold in patients with symptomatic MCA stenosis.

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