Hyperdense middle cerebral artery sign in large cerebral infarction

Area of Science:

• Neurology
• Radiology
• Stroke Medicine

Background:

• Hemorrhagic transformation (HT) is a significant complication of large cerebral infarctions.
• Identifying reliable imaging biomarkers for HT is crucial for patient management and outcome prediction.
• The hyperdense middle cerebral artery sign (HMCAS) is a potential early indicator of ischemic stroke.

Purpose of the Study:

• To investigate whether the hyperdense middle cerebral artery sign (HMCAS) serves as an imaging biomarker for hemorrhagic transformation (HT).
• To evaluate the association between HMCAS and functional outcomes in patients with large cerebral infarctions.
• To assess the role of HMCAS in patients who did not receive thrombolytic therapy.

Main Methods:

• Retrospective analysis of clinical and imaging data from 312 patients with large cerebral infarction without thrombolytic therapy.
• Patients were categorized into HMCAS (n=121) and non-HMCAS (n=168) groups for comparison.
• Statistical analyses, including logistic regression, were used to determine associations between HMCAS, HT, and outcomes.

Main Results:

• The HMCAS group exhibited a higher incidence of HT (28.7%), atrial fibrillation, high homocysteine, and admission NIHSS scores.
• HMCAS patients had significantly lower ASPECTS scores and higher rates of PH-2 and 3-month mRS scores.
• Multiple logistic regression confirmed HMCAS as an independent predictor of HT (adjusted OR=2.762) and identified HMCAS length as a marker for HT.

Conclusions:

• The hyperdense middle cerebral artery sign (HMCAS) is an independent imaging biomarker for predicting hemorrhagic transformation (HT) in large cerebral infarctions.
• The duration of HMCAS is also associated with the risk of HT and lower ASPECTS scores in affected patients.
• These findings highlight HMCAS as a valuable tool for risk stratification in stroke patients.