Computed tomography angiographic correlates of early computed tomography signs in acute ischemic stroke

Background and Purpose. Early computed tomography (CT) signs of stroke signify major arterial occlusion. CT angiogram (CTA) is useful in detecting major arterial occlusion and may help triaging patients for intra-arterial thrombolysis. The correlation between the early signs of stroke and arterial occlusion on CTA was studied. Methods. Consecutive patients with suspected acute anterior circulation ischemic stroke presenting within 6 hours of symptom onset underwent noncontrast CT of the head followed by CTA. The scans were later reviewed for evidence of early signs of stroke on CT scan and intracranial arterial occlusion on CTA. Results. Sixteen of 65 patients had arterial occlusion on CTA; 12 (75%) of these showed the early CT signs of stroke. All the early signs except M2 "dot" sign significantly correlated with middle cerebral artery (MCA) occlusion on CTA. Hyperdense MCA sign was the only independent predictor of a MCA occlusion. Conclusion. In a small sample, early CT signs of stroke strongly correlated with arterial occlusion, with hyperdense MCA sign being the most predictive of a MCA occlusion.