Abstract
The purpose of this study was to determine whether 5-mm axial CT images can sufficiently depict the hyperdense middle cerebral artery (MCA) sign in patients with acute brain ischemia. Materials and Methods: A retrospective review of 92 cases of ischemic brain infarction confirmed nine patients showing hyperdense MCA signs. CT images were acquired on a 64-slice helical scanner. Images were reconstructed into contiguous 5-mm axial, coronal and sagittal datasets. The first CT scan images of the patients with hyperdense MCA signs and an equal number of CT scans without hyperdense MCA signs inserted at random were analyzed in a blinded review. The presence of the hyperdense MCA sign in M1 segments was recorded. Round regions of interest (ROI) were placed over the M1 segments of the MCAs and the attenuation values in Hounsfield units (HU) were measured on the sagittal and axial images. Results: Nine patients showed a hyperdense MCA sign. They consisted of 4 male and 5 female (mean age, 74.3 years; age range, 45 - 88 years). On the blinded review, hyperdense MCA signs were detected on axial images in 7 patients. In four of the 7 patients, the hyperdense MCA sign was more conspicuous on sagittal images than that on axial images. Hyperdense MCA sign was detected on sagittal images of all 9 patients and exclusive to the sagittal images in two patients. The ROI study showed higher attenuation for the affected MCA on sagittal images (46 - 65 HU) than that on axial images (36 - 54 HU). Conclusion: In patients with acute brain ischemia, 5-mm axial CT images cannot sufficiently depict the hyperdense MCA sign. Sagittal images may be superior to axial images for identifying the sign.
Highlights
Over the last three decades, the hyperdense middle cerebral artery (MCA) sign has been confirmed as an indicator of acute ischemic change [1,2,3,4]
The multirow-detector CT (MDCT) allows some advantages in multiplaner reformation (MPR), maximum intensity projection (MIP), volume-rendered reconstruction, and three-dimensional reconstruction (3D) [10]
On the blind review, we confirmed the presence of hyperdense MCA sign on axial images in 7 (77.8%) patients, on coronal images in 6 (66.7%) patients, and on sagittal images in all 9 (100%) patients
Summary
Over the last three decades, the hyperdense middle cerebral artery (MCA) sign has been confirmed as an indicator of acute ischemic change [1,2,3,4]. This sign is useful in the diagnosis of MCA occlusion, and as a predictor of prognosis and treatment [2,3,4,5,6]. Since the development of multirow-detector CT (MDCT), the advantages of helical acquisition modality and multirow-detector technology have increased, for example, higher image quality, reduced irradiation and shortened acquisition time [7,8]. Sometimes we notice that we can find the hyperdense MCA sign more in sagittal views than axial views
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