Basilar artery occlusion: limited diagnostic performance of unenhanced CT

Analysis by V. Matarese

 

Patients with suspected stroke of the posterior cerebral circulation require rapid diagnosis so that that appropriate therapy can be initiated. Yet, since these patients are often admitted to community hospitals lacking advanced imaging capabilities, the first diagnostic examination is usually non-enhanced cranial CT. Thus, there is interest in identifying neurovascular imaging signs that permit a confident diagnosis of this condition. The hyperdense basilar artery (HBA) sign was previously found to be an accurate indicator of basilar artery thrombosis in a group of 95 patients with clinical signs of posterior circulation stroke [1]. The sign was assessed visually as an area of increased arterial density on unenhanced 16- or 64-detector-row CT images; images were rated subjectively on a scale from 1 (hyperdensity definitely absent) to 5 (definitely present) and a score of 4 or 5 indicated occlusion. To determine the generalizability of these findings, researchers from Munich evaluated the HBA sign in patients with confirmed basilar artery occlusion and in those without.

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