March 10, 2011

Hyperdense Middle Cerebral Artery Sign

Axial CT image (narrow window) shows a hyperdense left MCA, representing an intraluminal thrombus.

Hyperdense MCA Sign
  • Visualization of high density middle cerebral artery due to presence of intraluminal thrombus
  • Specific sign for thrombotic MCA occlusion, but it is not sensitive
  • Associated with poor prognosis and higher risk of hemorrhage if thrombolyzed
  • Early resolution indicates successful reperfusion and favorable outcome after thrombolysis

Imaging Differentials
  • Intraluminal thrombus
  • High hematocrit (usually bilateral)
  • Calcified plaque (usually bilateral)

Rabinstein AA, Resnick SJ. Practical Imaging in Stroke: a Case-based Approach, 2009.

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