The hyperdense vessel sign in cerebral computed tomography: pearls and pitfalls

Chieng, Julian Sau Lian; Singh, Dinesh; Chawla, Ashish; Peh, Wilfred C. G.

doi:10.11622/smedj.2020074

Cited by 7 publications

(5 citation statements)

References 14 publications

(15 reference statements)

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“…As HVS is considered time-dependent with loss of density over time and is more frequently seen in proximal occlusion, we performed a subgroup analysis ( 25 , 26 , 40 ). Nevertheless, no correlation of HVS-appearance with LKW-imaging time and proximal occlusion was found in our study cohort.…”

Section: Discussionmentioning

confidence: 99%

“…HVS status was determined intrinsically on native CT at the location directly corresponding to the occlusion site on CT angiography. HVS was considered present in the case of local hyperdensity by co-locating the occluded artery with its contralateral homologue and the surrounding brain tissue ( Figures 1C , D ) ( 25 ). Interrater reliability between investigators, as determined by Cohen’s Kappa coefficient, was sustainable (0.770 for SVS and 0.610 for HVS).…”

Section: Methodsmentioning

confidence: 99%

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Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

et al. 2023

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Background and aimIdentification of paraneoplastic hypercoagulability in stroke patients helps to guide investigations and prevent stroke recurrence. A previous study demonstrated an association between the absence of the susceptibility vessel sign (SVS) on brain MRI and active cancer in patients treated with mechanical thrombectomy. The present study aimed to confirm this finding and assess an association between the absence of the hyperdense vessel sign (HVS) on head CT and active cancer in all stroke patients.MethodsSVS and HVS status on baseline imaging were retrospectively assessed in all consecutive stroke patients treated at a comprehensive stroke center between 2015 and 2020. Active cancer, known at the time of stroke or diagnosed within 1 year after stroke (occult cancer), was identified. Adjusted odds ratios (aOR) and their 95% confidence interval (CI) for the association between the thrombus imaging characteristics and cancer were calculated using multivariable logistic regression.ResultsOf the 2,256 patients with thrombus imaging characteristics available at baseline, 161 had an active cancer (7.1%), of which 36 were occult at the time of index stroke (1.6% of the total). The absence of SVS was associated with active cancer (aOR 3.14, 95% CI 1.45–6.80). No significance was reached for the subgroup of occult cancer (aOR 3.20, 95% CI 0.73–13.94). No association was found between the absence of HVS and active cancer (aOR 1.07, 95% CI 0.54–2.11).ConclusionThe absence of SVS but not HVS could help to identify paraneoplastic hypercoagulability in stroke patients with active cancer and guide patient care.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

et al. 2023

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“…The vascular structures CT finding is "hyperdense artery sign, hyperdense vessel sign" which means acute intraluminal clot obstructs in the intracranial arteries such as middle cerebral artery (MCA), internal carotid artery (ICA), basilar artery appears as high density of blood clot by CT along the course of that artery in linear or dot patterns (Figures 1 and 2). However, these findings have high specificity up to 90% but low sensitivity of approximately 30% [7][8][9]. Whenever encountered with hyperdense artery sign on NCCT brain, always correlation to clinical information as well as compare to the contralateral side and venous structures, such as transverse sigmoid sinus, superior sagittal sinus to reduce false-positive conditions That cause high density in the arteries, veins such as hemoconcentration condition.…”

Section: Stroke Mimic Conditionsmentioning

confidence: 99%

Neuroimaging in Common Neurological Diseases Treated by Anticoagulants

Chiewvit¹

2022

Neurophysiology - Networks, Plasticity, Pathophysiology and Behavior

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Stroke imaging/Cerebral Venous sinus thrombosis/Arterial dissecting disease in Head and Neck regions/Neurocomplication of anticoagulation therapy. Nowsday, anticoagulant drugs are common drugs used in daily practice for patients in neurology clinic. Anticoagulant treatment used for treated symptomatic patients as well as for prophylaxis therapy in asymptomatic patients. The purpose of this chapter based on the review of essential neuroimaging in the most common neurological conditions that benefit from treatment with anticoagulant drugs such as ischemic stroke, cerebral venous sinus thrombosis, and arterial dissecting disease of head and neck arteries and will be enclosed with neuroimaging in case of neurocomplication by anticoagulant therapy.

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“…The attenuation of an HAS has a positive correlation with the concentration of red blood cells (RBCs) in the thrombus [8]. HAS is one of the earliest signs of ischemic stroke and can be detected with high sensitivity and specificity, which indicates that the majority of patients with confirmed acute ischemic stroke show a visible hyperdensity on NCCT [9]. Additionally, thin slice reconstruction of NCCT improves HAS visibility [10].…”

Section: Introductionmentioning

confidence: 99%

“…However, there are only a few studies that address thrombus segmentation on CT scans. The main challenges in the thrombus segmentation task are (1) the small size of the thrombi compared to the entire brain, (2) the occasional existence of other highly attenuated vascular areas on NCCT that mimic HAS, such as calcified arteries, high hematocrit, and beam hardening artefacts [9], (3) lack of HAS on NCCT for thrombi with low concentrations of RBCs, and (4) over-estimation of thrombus on CTA due to insufficient collateral flow.…”

Section: Introductionmentioning

confidence: 99%

Fully Automated Thrombus Segmentation on CT Images of Patients with Acute Ischemic Stroke

et al. 2022

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Thrombus imaging characteristics are associated with treatment success and functional outcomes in stroke patients. However, assessing these characteristics based on manual annotations is labor intensive and subject to observer bias. Therefore, we aimed to create an automated pipeline for consistent and fast full thrombus segmentation. We used multi-center, multi-scanner datasets of anterior circulation stroke patients with baseline NCCT and CTA for training (n = 228) and testing (n = 100). We first found the occlusion location using StrokeViewer LVO and created a bounding box around it. Subsequently, we trained dual modality U-Net based convolutional neural networks (CNNs) to segment the thrombus inside this bounding box. We experimented with: (1) U-Net with two input channels for NCCT and CTA, and U-Nets with two encoders where (2) concatenate, (3) add, and (4) weighted-sum operators were used for feature fusion. Furthermore, we proposed a dynamic bounding box algorithm to adjust the bounding box. The dynamic bounding box algorithm reduces the missed cases but does not improve Dice. The two-encoder U-Net with a weighted-sum feature fusion shows the best performance (surface Dice 0.78, Dice 0.62, and 4% missed cases). Final segmentation results have high spatial accuracies and can therefore be used to determine thrombus characteristics and potentially benefit radiologists in clinical practice.

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The hyperdense vessel sign in cerebral computed tomography: pearls and pitfalls

Cited by 7 publications

References 14 publications

Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

Neuroimaging in Common Neurological Diseases Treated by Anticoagulants

Fully Automated Thrombus Segmentation on CT Images of Patients with Acute Ischemic Stroke

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