PT  - JOURNAL ARTICLE
AU  - T A Tomsick
AU  - T G Brott
AU  - A A Chambers
AU  - A J Fox
AU  - M F Gaskill
AU  - R R Lukin
AU  - C W Pleatman
AU  - J G Wiot
AU  - E Bourekas
TI  - Hyperdense middle cerebral artery sign on CT: efficacy in detecting middle cerebral artery thrombosis.
DP  - 1990 May 01
TA  - American Journal of Neuroradiology
PG  - 473--477
VI  - 11
IP  - 3
4099  - http://www.ajnr.org/content/11/3/473.short
4100  - http://www.ajnr.org/content/11/3/473.full
SO  - Am. J. Neuroradiol.1990 May 01; 11
AB  - 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.