Hyperdense middle cerebral artery sign on CT: Efficacy in detecting middle cerebral artery thrombosis

T. A. Tomsick, T. G. Brott, A. A. Chambers, A. J. Fox, M. F. Gaskill, R. R. Lukin, C. W. Pleatman, J. G. Wiot, E. Bourekas

Research output: Contribution to journalArticlepeer-review

85 Scopus citations


The hyperdense middle cerebral artery sign is a CT predictor of the development of a large cerebral infarct. The limits of detectability were tested in a blinded, then unblinded analysis of CT scans from 25 acute stroke patients. In the initial blinded analysis, sign detection exhibited the following mean values: sensitivity, 78.5%; specificity, 93.4%; positive predictive value, 66%; negative predictive value, 96.4%; accuracy, 91.3%. Kappa statistics analysis indicated poor interobserver agreement (k = .38). Results of unblinded analysis were as follows: sensitivity, 69%; specificity, 94.4%; positive predictive value, 82.8%; negative predictive value, 88.7%; accuracy, 87.3%. There was fair unblinded interobserver agreement (k = .53). Unblinded analysis had a lower false-positive frequency and did not increase the number of true-positive determinations. We conclude that detection of the hyperdense middle cerebral artery sign on CT scans by multiple observers is a sensitive, accurate, and predictive indicator of middle cerebral artery thromboembolism.

Original languageEnglish (US)
Pages (from-to)473-477
Number of pages5
JournalAmerican Journal of Neuroradiology
Issue number3
StatePublished - Jan 1 1990

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology


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