Hyperdense Artery Sign in Patients With Acute Ischemic Stroke–Automated Detection With Artificial Intelligence-Driven Software

Background: Hyperdense artery sign (HAS) on non-contrast CT (NCCT) can indicate a large vessel occlusion (LVO) in patients with acute ischemic stroke. We sought to evaluate automated HAS detection by commercial software and compared its performance to that of trained physicians against a reference standard.

Methods: Non-contrast CT scans from 154 patients with and without LVO proven by CT angiography (CTA) were independently rated for HAS by two blinded neuroradiologists and an AI-driven algorithm (Brainomix®). Sensitivity and specificity were analyzed; as a secondary analysis, clot length was automatically calculated by the software and compared with the manually outlined length on CTA as the reference standard.

Results: Among 154 patients, 84 (54.5%) had CTA-proven LVO. HAS on the correct side was detected with a sensitivity/specificity of 0.77/0.87 by the software, 0.80/0.97 by reader 1, and 0.93/0.71 by reader 2. The automated thrombus length estimate was in moderate agreement with the CTA-based reference (ICC 0.73).

Conclusion: Automated detection of HAS and estimation of thrombus length on NCCT by the tested software is feasible, with sensitivity and specificity comparable to that of trained neuroradiologists.