Published Online
on October 30, 2003

A more recent version of this article appeared on November 1, 2003

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Submitted on May 23, 2003
Accepted on June 26, 2003

Validation of Computed Tomographic Middle Cerebral Artery "Dot" Sign. An Angiographic Correlation Study

Megan C. Leary MD^*; Chelsea S. Kidwell MD; J. Pablo Villablanca MD; Sidney Starkman MD; Reza Jahan MD; Gary R. Duckwiler MD; Y. Pierre Gobin MD; Steven Sykes BS; Kristi J. Gough BA; Katrina Ferguson BA; Jennifer N. Llanes BS; Rinat Masamed BS; Margaret Tremwel MD, PhD; Bruce Ovbiagele MD; Paul M. Vespa MD; Fernando Vinuela MD; and Jeffrey L. Saver MD

From the Department of Neurology, Division of Stroke and Cerebrovascular Disease, Beth Israel Deaconess Medical Center, Boston, Mass (M.C.L.); Stroke Center (C.S.K., S. Starkman, R.J., G.R.D., S. Sykes, K.J.G., K.F., J.N.L., R.M., M.T., B.O., P.M.V., F.V., J.L.S.) and Departments of Neurology (C.S.K., S. Starkman, K.J.G., K.F., J.N.L., R.M., M.T., B.O., J.L.S.), Neuroradiology (J.P.V., R.J., G.R.D., F.V.), Emergency Medicine (S. Starkman), and Neurosurgery (P.M.V.), University of California at Los Angeles Medical Center; and Departments of Radiology and Neurosurgery, Weill Cornell Medical College, New York, NY (P.G., P.M.V.).

^* To whom correspondence should be addressed. E-mail: mleary{at}bidmc.harvard.edu.

Background and Purpose--The middle cerebral artery (MCA) "dot" sign consists of hyperdensity of an arterial structure, seen as a dot in the sylvian fissure. The MCA dot sign has been proposed to indicate thrombosis of M2 or M3 MCA branches, analogous to the hyperdense middle cerebral artery (HMCA) sign indicating M1 thrombosis. The MCA dot sign has not been validated previously against the gold standard of conventional cerebral angiography.

Methods--Noncontrast CT scans and immediately subsequent cerebral angiograms from 54 acute stroke patients within 8 hours of symptom onset were analyzed. CT films were inspected for the MCA dot sign and HMCA sign. Vascular findings on CT were compared with findings at angiography.

Results--Mean patient age was 71 years; median National Institutes of Health Stroke Scale score was 16.5. Mean time from symptom onset to CT was 125 minutes, and that from CT to angiography was 117 minutes. All patients had arterial occlusion at angiography. Of the anterior circulation occlusions, M1 occlusions were noted in 28 patients, isolated M2 in 15, and isolated M3 in 4. One definite MCA dot sign was observed in 16.7% of patients, and an HMCA sign was observed in 13.9%. MCA dot sign performance in predicting the presence of M2 or M3 clot at angiography was as follows: sensitivity 38%, specificity 100%, positive predictive value 100%, negative predictive value 68%, and overall accuracy 73%.

Conclusions--The MCA dot sign is a highly specific and moderately sensitive indicator of acute thrombus in the M2/M3 MCA branches, as validated by catheter angiography. The MCA dot sign is a useful additional acute stroke CT marker.

Key words: cerebral angiography • infarction, middle cerebral artery • middle cerebral artery • radiography, interventional • stroke, acute

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