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Proximal and Distal Hyperattenuating Middle Cerebral Artery Signs at CT: Different Prognostic Implications¹

¹ From the Department of Radiology (D.M.S., D.R.R., W.P.T.M.M., J.v.d.G.), Department of Neurology (L.J.K.), and the Julius Center for Patient Oriented Research (P.J.N.), University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. Received June 8, 2001; revision requested August 1; revision received August 30; accepted October 1. Address correspondence to J.v.d.G. (e-mail: j.vandergrond@azu.nl).

PURPOSE: To determine whether a proximal (M1-segment) or distal (M2- and/or M3-segment) hyperattenuating middle cerebral artery (MCA) sign in patients with ischemic infarction in the territory of the MCA indicates a worse short-term prognosis than that in patients without a hyperattenuating MCA sign.

MATERIALS AND METHODS: We retrospectively reviewed the records of 352 patients who were diagnosed with ischemic brain infarction in the territory of the MCA. Of these patients, 186 patients met our final criteria and were included in this study. Nonenhanced computed tomography (CT) was performed for the entire brain, with a 5-mm section thickness in all patients, within 24 hours after symptom onset. The presence and location of a hyperattenuating MCA sign was correlated with neurologic deficit at discharge from the hospital (ie, short-term prognosis) by using the ² test to detect differences between patient groups.

RESULTS: Patients with a hyperattenuating MCA sign at CT have a worse short-term prognosis than do patients without a hyperattenuating MCA sign (P < .05). Patients with a proximal hyperattenuating MCA sign have a significantly (P < .01) worse short-term prognosis than do patients with a distal hyperattenuating MCA sign.

CONCLUSION: A proximal hyperattenuating MCA sign is a reliable predictor of poor short-term prognosis in patients who experience acute stroke.

© RSNA, 2002

Index terms: Arteries, middle cerebral, 174.4312, 174.4352 • Brain, infarction, 174.4352 • Cerebral blood vessels, abnormalities, 174.4312, 174.4352

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