Hyperdense middle cerebral artery sign in large cerebral infarction

Abstract

Objectives To evaluate if the hyperdense middle cerebral artery sign (HMCAS) is an imaging biomarker for hemorrhagic transformation (HT) and the functional outcome of patients with large cerebral infarctions without thrombolytic therapy. Materials and Methods The clinical and imaging data of 312 patients with large cerebral infarction without thrombolytic therapy were retrospectively analyzed. They were divided into patients who presented with HMCAS (n = 121) and those who did not (non‐HMCAS[n = 168] patients), and the clinical data of the 2 groups were compared. This was a retrospective study. Results Of the 289 patients, 83(28.7%) developed HT. The incidence of atrial fibrillation, high homocysteine and admission NIHSS score at the time of admission was significantly higher in the HMCAS patients than in non‐HMCAS patients (p < .05). The ASPECTS was significantly lower in HMCAS patients (t = −5.835, p < .001). The incidence of PH‐2 and 3‐month mRS score was also statistically significant higher in HMCAS patients (χ2 = 3.971, p = .046; χ2 = 5.653, p < .001, respectively). A sub‐analysis showed HMCAS patients with HT were significantly older than non‐HMCAS patients with HT (t = 2.473, p = .015). The incidence of atrial fibrillation and the 3‐month mortality rate were higher in HMCAS patients with HT than in non‐HMCAS patients with HT (χ2 = 3.944, p = .047; χ2 = 6.043, p = .014, respectively). Multiple logistic regression analysis showed HT was independently associated with HMCAS (adjusted OR/95% CI/p = 2.762/1.571–4.854/p < .001) and admission NIHSS score (adjusted OR/95% CI/p = 1.081/1.026–1.139/0.003). And HMCAS with HT was independently associated with length of HMCAS (adjusted OR/95% CI/p = 1.216/1.076–1.374/0.002). Conclusions HMCAS in patients with a large cerebral infarction without thrombolytic therapy is an independent biomarker of HT. Length of HMCAS is also a marker of HT with lower ASPECTS in HMCAS patients.

Prediction model of early biomarkers of massive cerebral infarction caused by anterior circulation occlusion: Establishment and evaluation

“…In this study, results of logistic regression analysis showed that the HMCAS was not an independent predictor of MCI, though some relevant studies have shown a close relationship between the HMCAS and the dependent variable. After multiple CT, CTA, MRI, MRA, and autopsy examinations, the study confirmed that the HMCAS had low sensitivity (only 7.0%−69.0%) and high specificity (85.0%−100.0%) in the diagnosis of cerebral infarction ( 12 , 19 – 21 ). Cerebral infarction may be diagnosed if the HMCAS is present ( 14 , 22 ).…”

“…The earlier the CT examination is performed, the higher specificity and the lower sensitivity of its findings ( 13 – 16 ). In addition, obscuration of the lentiform nucleus appears within 4–6 h, and the HMCAS appears within 30 min of onset; these findings have a specificity of 85.0%−100.0% ( 12 , 17 , 18 ).…”

Proximal Hyperdense Middle Cerebral Artery Sign is Associated with Increased Risk of Hemorrhagic Transformation after Endovascular Thrombectomy: A Multi-center Retrospective Study

“…Our study that the presence of proximal HMCAS was independently associated with greater odds of HT in patients who receive EVT for acute MCA occlusion. The association between this sign and HT has also been demonstrated in large cerebral infarction patients without thrombolytic therapy and in patients who received IVT [11,12]. In addition, another two studies focusing on the prognostic value of HMCAS on treatment outcomes of EVT found that patients with HMCAS had a higher rate of sHT after the surgery despite statistical insigni cance [16,17].…”

“…In addition, another two studies focusing on the prognostic value of HMCAS on treatment outcomes of EVT found that patients with HMCAS had a higher rate of sHT after the surgery despite statistical insigni cance [16,17]. Previous studies have demonstrated that HMCAS on initial NCCT was associated with larger cerebral infarction volume measured by the "one-third of the MCA territory" principle or ASPECTS [9][10][11][12], which is established risk factor of HT after EVT [5][6][7]. In our study, patients with proximal HMCAS had lower ASPECTS on initial NCCT, and proximal HMCAS was independently associated with an increased risk of HT after being adjusted for potential confounders.…”

“…Hyperdense middle cerebral artery sign (HMCAS), de ned as an increased attenuation of the middle cerebral artery (MCA) on non-contrast computed tomography (NCCT), has been recognized as an indicator of thrombus obstructs the artery with a speci city of 95% [8]. This sign is associated with a more severe neurologic de cit and larger cerebral infarction [9][10][11][12], which are de nite failed to maintain the blood ow to the distal territory, stent placement would be considered. The main goal was to achieve modi ed thrombolysis in cerebral infarction (mTICI) 2b/3 grades.…”