How to avoid false positive hyperdense middle cerebral artery sign detection in ischemic stroke

The ratio of hyperdense MCA CT density/contralateral density is a good tool to differentiate HMCAS from asymmetric hyperdensity not related to stroke. The threshold ≥1.16 provided 100% sensitivity and 97% specificity, whereas ≥1.22 provided 94% sensitivity and 100% specificity.