Institute of Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Cerebrovasc Dis. 2010;29(1):62-7. doi: 10.1159/000256648. Epub 2009 Nov 10.
Hyperdense arteries in cranial CT of acute stroke patients have been described as a sign for acute ischemia in various brain-feeding arteries. However, only 1 case of a hyperdense anterior cerebral artery sign (HACAS) has been published to date. In this study, the frequency and association of HACAS with clinical symptoms and outcome are described.
Our radiological databases were searched for patients with infarcts in the territory of the anterior cerebral artery (ACA). Only patients who received an initial CT and a follow-up CT or MRI were included. The presence of a HACAS was rated by 2 independent observers using the Cohen kappa-statistics. Further data recorded were early ischemic signs, final size of infarct, symptoms, initial NIHSS (National Institute of Health Stroke Scale) score, latency between symptom onset and initial CT, etiology, modified Rankin Scale (mRS) score at discharge and secondary hemorrhage.
A HACAS could be visualized in 11/24 patients (46%). Interobserver agreement was substantial with Cohen's kappa = 0.66. Patients with a HACAS had a significantly higher NIHSS score (9.45 +/- 8.41; median: 8) than those without (3.69 +/- 2.09; median: 4). A HACAS was visible more frequently when the CT was performed early (<2.5 h after symptom onset). There was no correlation with single symptoms, size of infarct, etiology, mRS or the tendency to hemorrhage.
HACAS is associated with a higher NIHSS score. It is an early sign of ischemia which can be reversible over time. It can be helpful in the detection of ischemia in the territory of the ACA.
在急性脑卒中患者的颅脑 CT 中，动脉高密度影已被描述为各种脑供血动脉急性缺血的征象。然而，迄今为止，仅发表了 1 例大脑前动脉高密度征（HACAS）的病例。本研究描述了 HACAS 的频率及其与临床症状和预后的关系。
我们在放射学数据库中搜索大脑前动脉（ACA）区域梗死的患者。仅纳入接受初始 CT 和随访 CT 或 MRI 的患者。两名独立观察者使用 Cohen kappa 统计评估 HACAS 的存在。记录的其他数据包括早期缺血征象、梗死最终大小、症状、初始 NIHSS（国立卫生研究院卒中量表）评分、症状发作与初始 CT 之间的潜伏期、病因、出院时改良 Rankin 量表（mRS）评分和继发性出血。
11/24 例（46%）患者可观察到 HACAS。观察者间一致性较好，Cohen kappa = 0.66。有 HACAS 的患者 NIHSS 评分（9.45 +/- 8.41；中位数：8）显著高于无 HACAS 的患者（3.69 +/- 2.09；中位数：4）。当 CT 检查时间较早（症状发作后<2.5 小时）时，HACAS 更易观察到。HACAS 与单个症状、梗死大小、病因、mRS 或出血倾向无相关性。
HACAS 与 NIHSS 评分较高有关。它是一种早期缺血征象，随着时间的推移可能会逆转。它有助于检测 ACA 区域的缺血。
