PMID- 14593125 OWN - NLM STAT- MEDLINE DCOM- 20031125 LR - 20191210 IS - 1524-4628 (Electronic) IS - 0039-2499 (Linking) VI - 34 IP - 11 DP - 2003 Nov TI - Validation of computed tomographic middle cerebral artery "dot"sign: an angiographic correlation study. PG - 2636-40 AB - 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. FAU - Leary, Megan C AU - Leary MC AD - Department of Neurology, Division of Stroke and Cerebrovascular Disease, Palmer 125, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, Mass 02215, USA. mleary@bidmc.harvard.edu FAU - Kidwell, Chelsea S AU - Kidwell CS FAU - Villablanca, J Pablo AU - Villablanca JP FAU - Starkman, Sidney AU - Starkman S FAU - Jahan, Reza AU - Jahan R FAU - Duckwiler, Gary R AU - Duckwiler GR FAU - Gobin, Y Pierre AU - Gobin YP FAU - Sykes, Steven AU - Sykes S FAU - Gough, Kristi J AU - Gough KJ FAU - Ferguson, Katrina AU - Ferguson K FAU - Llanes, Jennifer N AU - Llanes JN FAU - Masamed, Rinat AU - Masamed R FAU - Tremwel, Margaret AU - Tremwel M FAU - Ovbiagele, Bruce AU - Ovbiagele B FAU - Vespa, Paul M AU - Vespa PM FAU - Vinuela, Fernando AU - Vinuela F FAU - Saver, Jeffrey L AU - Saver JL LA - eng GR - K23 02088/PHS HHS/United States GR - K24 NS 02092-01/NS/NINDS NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PT - Validation Study DEP - 20031030 PL - United States TA - Stroke JT - Stroke JID - 0235266 SB - IM MH - Acute Disease MH - Adult MH - Aged MH - Aged, 80 and over MH - *Cerebral Angiography MH - Cohort Studies MH - Female MH - Humans MH - Infarction, Middle Cerebral Artery/*diagnostic imaging MH - Intracranial Thrombosis/*diagnostic imaging MH - Male MH - Middle Aged MH - Middle Cerebral Artery/*diagnostic imaging MH - Observer Variation MH - Predictive Value of Tests MH - Prognosis MH - Radiography, Interventional MH - Sensitivity and Specificity MH - Severity of Illness Index MH - Time Factors MH - Tomography, X-Ray Computed/*standards EDAT- 2003/11/01 05:00 MHDA- 2003/12/03 05:00 CRDT- 2003/11/01 05:00 PHST- 2003/11/01 05:00 [pubmed] PHST- 2003/12/03 05:00 [medline] PHST- 2003/11/01 05:00 [entrez] AID - 01.STR.0000092123.00938.83 [pii] AID - 10.1161/01.STR.0000092123.00938.83 [doi] PST - ppublish SO - Stroke. 2003 Nov;34(11):2636-40. doi: 10.1161/01.STR.0000092123.00938.83. Epub 2003 Oct 30.