Acute occlusion of the middle cerebral artery: early evaluation with triphasic helical CT--preliminary results

To evaluate use of triphasic helical computed tomography (CT) for early diagnosis of occlusion and assessment of ischemia in cases of acute middle cerebral arterial occlusion.

Thirty-five patients with acute ischemia underwent triphasic helical CT within 6 hours after symptom onset. Early arterial, perfusion, and delayed phase CT scans were obtained 18, 30, and 80 seconds, respectively, after contrast material administration. Eighteen patients had proximal middle cerebral arterial occlusion diagnosed at magnetic resonance (MR) or digital subtraction angiography. Follow-up CT or MR imaging was performed in all patients. Two independent observers interpreted images for signs of arterial occlusion, collateral vessels, and the ischemic zone.

One observer found at least one of three signs in 17 of the 18 patients with occlusion, and the other found at least one sign in all 18: Early decreased arterial contrast enhancement was seen by both observers in 11 patients (kappa = 0.77), a nonenhancing arterial segment was seen by the two observers in 12 and 14 (kappa = 0.73), and delayed asymmetric arterial enhancement was seen in 13 and 16 (kappa = 0.49). Triphasic CT findings of the ischemic zone were consistent with follow-up CT or MR imaging findings in seven of 12 patients.

Triphasic helical CT is useful for early diagnosis of acute proximal middle cerebral arterial occlusion and assessment of the ischemic zone.