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Published in: Neuroradiology 10/2017

01-10-2017 | Diagnostic Neuroradiology

Mid-cervical flame-shaped pseudo-occlusion: diagnostic performance of mid-cervical flame-shaped extracranial internal carotid artery sign on computed tomographic angiography in hyperacute ischemic stroke

Authors: Supada Prakkamakul, Nantaporn Pitakvej, Netsiri Dumrongpisutikul, Sukalaya Lerdlum

Published in: Neuroradiology | Issue 10/2017

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Abstract

Purpose

Flame-shaped pseudo-occlusion of the extracranial internal carotid artery (ICA) is a flow-related phenomenon that creates computed tomographic angiography (CTA) and digital subtraction angiography (DSA) findings that mimic tandem intracranial-extracranial ICA occlusion or dissection. We aim to determine the diagnostic performance of mid-cervical flame-shaped extracranial ICA sign on CTA in hyperacute ischemic stroke patients.

Methods

We retrospectively included consecutive anterior circulation ischemic stroke patients presenting within 6 h of symptom onset who underwent 4D brain CTA and arterial-phase neck CTA using a 320-detector CT scanner during August 2012 to July 2015. Two blinded readers independently reviewed arterial-phase neck CTA and characterized the extracranial ICA configurations into mid-cervical flame-shaped, proximal blunt/beak-shaped, and tubular-shaped groups. 4D whole brain CTA was used as a reference standard for intracranial ICA occlusion detection. Diagnostic performance of the mid-cervical flame-shaped extracranial ICA sign and interobserver reliability were calculated.

Results

Of the 81 cases, 11 had isolated intracranial ICA occlusion, and 6 had true extracranial ICA occlusion. Mid-cervical flame-shaped extracranial ICA sign was found in 45.5% (5/11) of isolated intracranial ICA occlusions but none in the true extracranial ICA occlusion group. The sensitivity, specificity, PPV, NPV, and accuracy of the mid-cervical flame-shaped extracranial ICA sign for the detection of isolated intracranial ICA occlusion were 45.5, 100, 100, 92.1, and 92.6%, respectively. Interobserver reliability was 0.90.

Conclusion

The mid-cervical flame-shaped extracranial ICA sign may suggest the presence of isolated intracranial ICA occlusion and allow reliable exclusion of tandem extracranial-intracranial ICA occlusion in hyperacute ischemic stroke setting.
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Metadata
Title
Mid-cervical flame-shaped pseudo-occlusion: diagnostic performance of mid-cervical flame-shaped extracranial internal carotid artery sign on computed tomographic angiography in hyperacute ischemic stroke
Authors
Supada Prakkamakul
Nantaporn Pitakvej
Netsiri Dumrongpisutikul
Sukalaya Lerdlum
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
Neuroradiology / Issue 10/2017
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-017-1882-3

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