Radiology, Vol 207, 113-122, Copyright © 1998 by Radiological Society of North America

ARTICLES

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

DG Na, HS Byun, KH Lee, CS Chung, EY Kim, DW Ro, YK Jeong, HD Kim and SH Kim
Department of Radiology, College of Medicine, Sung Kyun Kwan University, Samsung Medical Center, Kangnam-Ku, Seoul, South Korea.

PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: Triphasic helical CT is useful for early diagnosis of acute proximal middle cerebral arterial occlusion and assessment of the ischemic zone.

This article has been cited by other articles:

				G. A. Christoforidis, Y. Mohammad, D. Kehagias, B. Avutu, and A. P. Slivka Angiographic Assessment of Pial Collaterals as a Prognostic Indicator Following Intra-arterial Thrombolysis for Acute Ischemic Stroke AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1789 - 1797. [Abstract] [Full Text] [PDF]

				S. J. Lee, K. H. Lee, D. G. Na, H. S. Byun, Y. B. Kim, Y.-M. Shon, S.-J. Cho, J. Lee, C.-S. Chung, and S.-C. Hong Multiphasic Helical Computed Tomography Predicts Subsequent Development of Severe Brain Edema in Acute Ischemic Stroke Arch Neurol, April 1, 2004; 61(4): 505 - 509. [Abstract] [Full Text] [PDF]

				M. Brozici, A. van der Zwan, and B. Hillen Anatomy and Functionality of Leptomeningeal Anastomoses: A Review Stroke, November 1, 2003; 34(11): 2750 - 2762. [Abstract] [Full Text] [PDF]

				K. H. Lee, S.-J. Cho, H. S. Byun, D. G. Na, N.-C. Choi, S. J. Lee, I.-S. Jin, T. G. Lee, and C.-S. Chung Triphasic Perfusion Computed Tomography in Acute Middle Cerebral Artery Stroke: A Correlation With Angiographic Findings Arch Neurol, July 1, 2000; 57(7): 990 - 999. [Abstract] [Full Text] [PDF]

				K. H. Lee, S. J. Lee, S.-J. Cho, D. G. Na, H. S. Byun, Y.-B. Kim, H.-J. Song, I.-S. Jin, and C.-S. Chung Usefulness of Triphasic Perfusion Computed Tomography for Intravenous Thrombolysis With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Arch Neurol, July 1, 2000; 57(7): 1000 - 1008. [Abstract] [Full Text] [PDF]

				J. R. Reichenbach, J. Röther, L. Jonetz-Mentzel, M. Herzau, A. Fiala, C. Weiller, and W. A. Kaiser Acute Stroke Evaluated by Time-to-Peak Mapping during Initial and Early Follow-up Perfusion CT Studies AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 1842 - 1850. [Abstract] [Full Text]