CT scan without intravenous contrast showing hyperdense aspect of the right middle cerebral artery, indicating thrombus within the vessel.
In medicine, the dense artery sign or hyperdense artery sign is an increased radiodensity of an artery as seen on computer tomography (CT) scans, and is a radiologic sign of early ischemic stroke.[1] In earlier studies of medical imaging in patients with strokes, it was the earliest sign of ischemic stroke in a significant minority of cases.[2] Its appearance portends a poor prognosis for the patient.[3][4]
The sign has been observed in the middle cerebral artery (MCA),[4] posterior cerebral artery (PCA),[5] vertebral artery,[2] and basilar artery;[6] these have been called the dense MCA sign, dense PCA sign, dense vertebral artery sign, and dense basilar artery sign, respectively.
Rarely, a hypodense artery sign can occur due to fat embolism.[7]
Cause
Through cerebral angiography, the sign has been demonstrated to correspond to embolic or atherosclerotic occlusion of an artery.[1] Specifically, the hyperdensity is thought to be due to calcification or hemorrhage associated with an atherosclerotic plaque.[1]
Identification
Identification of the dense artery sign is often based on subjective interpretation and false positives may occur. One study aiming to define criteria for the sign determined that measuring Hounsfield units on the CT scan could differentiate between the dense MCA sign associated with ischemic stroke and that caused by false positives.[8] Specifically, the combination of greater than 43 Hounsfield units and an MCA density ratio of greater than 1.2 was diagnostic of a dense MCA sign associated with acute ischemic stroke.[8]
^ abSchuknecht B, Ratzka M, Hofmann E (1990). "The "dense artery sign"--major cerebral artery thromboembolism demonstrated by computed tomography". Neuroradiology. 32 (2): 98–103. doi:10.1007/BF00588557. PMID 2398948.
^Zorzon M, Masè G, Pozzi-Mucelli F, et al. (1993). "Increased density in the middle cerebral artery by nonenhanced computed tomography. Prognostic value in acute cerebral infarction". Eur. Neurol. 33 (3): 256–9. doi:10.1159/000116949. PMID 8467850.
^ abLaunes J, Ketonen L (November 1987). "Dense middle cerebral artery sign: an indicator of poor outcome in middle cerebral artery area infarction". J. Neurol. Neurosurg. Psychiatry. 50 (11): 1550–2. doi:10.1136/jnnp.50.11.1550. PMC 1032575. PMID 3694213.
^Bettle N, Lyden PD (December 2004). "Thrombosis of the posterior cerebral artery (PCA) visualized on computed tomography: the dense PCA sign". Arch. Neurol. 61 (12): 1960–1. doi:10.1001/archneur.61.12.1960. PMID 15596621.
^Bodensteiner JB, Reitter BF, Sheth RD (September 1998). "Basilar artery occlusion and the dense artery sign in the newborn". Clin Pediatr (Phila). 37 (9): 551–4. doi:10.1177/000992289803700905. PMID 9773238.
^Lee TC, Bartlett ES, Fox AJ, Symons SP. The hypodense artery sign. American Journal of Neuroradiology. 2005 September; 26(8):2027-2029.
… negative temporal artery biopsies or there is lack of a temporal artery to biopsy. The superficial temporal arteries are palpated bilaterally to assess for patency and clinical signs of arteritis. A pulse …
… extracranial carotid artery aneurysm accounts for less than 1 percent of all arterial aneurysms and approximately 4 percent of peripheral artery aneurysms . Repair of extracranial carotid artery aneurysm represents …
… suggest a cause. Symptoms and signs of vascular and hematologic disease should be specifically solicited. As examples, contralateral sensory or motor symptoms suggest carotid artery disease, headache may suggest …
…pulmonary artery. If there is significant difficulty with visualization, a suprasternal notch view examining the transverse aortic arch will often show the right pulmonary artery or main pulmonary artery.… regurgitation – Severe pulmonic regurgitation will have a dense jet that rapidly decelerates so that regurgitant flow…
… Heavily calcified aortic arch ; Severe carotid tortuosity; Near occlusion of the carotid artery (ie, string sign) Inability to deploy a cerebral protection device ; Age >80; Many of the risk factors identified …
English Journal
Validation of the Simplified Stroke-Thrombolytic Predictive Instrument to Predict Functional Outcomes in Chinese Patients.
Wang C, Yang Y, Pan Y, Liao X, Huo X, Miao Z, Wang Y, Wang Y.
Stroke. 2018 Nov;49(11)2773-2776.
Background and Purpose- The simplified stroke-thrombolytic predictive instrument (s-Stroke-TPI) is useful for predicting the outcomes in thrombolysis-treated patients in Western populations. We aimed to validate its predictive value in Chinese patients. Methods- Data from thrombolysis implementation
Advanced analyses of computed tomography coronary angiography can help discriminate ischemic lesions.
Zhang JM, Shuang D, Baskaran L, Wu W, Teo SK, Huang W, Gobeawan L, Allen JC, Tan RS, Su X, Ismail NB, Wan M, Su B, Zou H, Low R, Zhao X, Chi Y, Zhou J, Su Y, Lomarda AM, Chin CY, Fam JM, Keng FYJ, Wong ASL, Tan JWC, Yeo KK, Wong PEH, Chin CT, Ho KW, Yap J, Kassab GS, Chua T, Koh TH, Tan SY, Lim ST, Zhong L.
International journal of cardiology. 2018 Sep;267()208-214.
Computed tomography coronary angiography (CTCA) image analysis enables plaque characterization and non-invasive fractional flow reserve (FFR) calculation. We analyzed various parameters derived from CTCA images and evaluated their associations with ischemia. 49 (61 lesions) patients underwent CTCA a
Herpes Simplex Virus Encephalitis: Atypical Presentation as a Right Middle Cerebral Artery Stroke.
Shoaib M, Kraus JJ, Khan MT.
Cureus. 2018 Jan;10(1)e2067.
Herpes simplex virus encephalitis (HSVE) is a medical emergency associated with high mortality and morbidity. Definitive diagnosis is established by history, clinical examination, neuroimaging studies, supportive electroencephalogram (EEG) findings, and cerebrospinal fluid (CSF) analysis. We report
The hyperdense MCA sign refers to focal increased density of the middle cerebral artery (MCA) on CT and is a direct visualization of thromboembolic material within the lumen. It is thus the earliest visible sign of MCA infarction as it is ...
Dense artery sign's wiki: In medicine, the dense artery sign or hyperdense artery sign is a radiologic sign seen on computer tomography (CT) scans suggestive of early ischemic stroke. In earlier studies of medical imaging in patients ...