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

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.

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.

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.

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.