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Updated: Sep 23, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Hyperintense middle cerebral artery sign using MRI
W W M Lam1, K S Wong, N M C So
1Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China. wynnie@cuhk.edu.hk
Aim:
To assess whether the presence of the hyperintense middle cerebral artery (MCA) sign, detected using magnetic resonance imaging (MRI), has any prognostic value in subacute infarction. The results were also compared with computed tomography (CT).
Materials And Methods:
Twenty-five consecutive patients with suspected subacute ischaemic stroke (6-48 h after onset of symptoms) underwent MRI and CT assessment. The incidence of intraluminal thrombus demonstrated by conventional T1 and T2-weighted images was assessed. The results were correlated with National Institutes of Health Stroke Scale (NIHSS).
Results:
Hyperintense MCA was identifiable on T1-weighted images in 77.8% patients, on T2-weighted images in 61.1% patients, and in 38.9% patients using CT. Patients with intraluminal thrombus identified by MRI had more severe stroke (mean NIHSS of 12.2+/-8.0 versus 4+/-3.2 respectively, p=0.003).
Conclusions:
The presence of hyperintense MCA by MRI is associated with higher NIHSS and may therefore have a prognostic value.
Insights
The hyperintense middle cerebral artery (MCA) sign on MRI indicates a worse prognosis in subacute stroke patients. This imaging marker correlates with higher National Institutes of Health Stroke Scale scores, suggesting its prognostic value.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Subacute ischemic stroke diagnosis and prognosis are critical for patient outcomes.
- Identifying reliable imaging biomarkers for stroke severity is an ongoing area of research.
Purpose of the Study:
- To evaluate the prognostic significance of the hyperintense middle cerebral artery (MCA) sign in subacute infarction.
- To compare the utility of magnetic resonance imaging (MRI) versus computed tomography (CT) in detecting this sign.
Main Methods:
- Twenty-five patients with suspected subacute ischemic stroke (6-48 hours post-symptom onset) underwent both MRI and CT.
- Conventional T1 and T2-weighted MRI sequences were used to identify intraluminal thrombus (hyperintense MCA sign).
- Results were correlated with the National Institutes of Health Stroke Scale (NIHSS) to assess stroke severity.
Main Results:
- The hyperintense MCA sign was detected by MRI in 77.8% (T1-weighted) and 61.1% (T2-weighted) of patients.
- CT identified the sign in only 38.9% of patients.
- Patients with MRI-detected intraluminal thrombus exhibited significantly higher mean NIHSS scores (12.2 ± 8.0) compared to those without (4 ± 3.2, p=0.003).
Conclusions:
- The presence of a hyperintense MCA sign on MRI is associated with increased stroke severity, as indicated by higher NIHSS scores.
- This MRI finding holds prognostic value for subacute ischemic stroke.
- MRI appears more sensitive than CT for detecting the hyperintense MCA sign in this context.
