European Radiology

, Volume 28, Issue 8, pp 3413–3421 | Cite as

Presence of multi-segment clot sign on dynamic CT angiography: a predictive imaging marker of recanalisation and good outcome in acute ischaemic stroke patients

  • Feina Shi
  • Zhicai Chen
  • Xiaoxian Gong
  • Meixia Zhang
  • David S. Liebeskind
  • Min Lou
Computed Tomography



To investigate the value of multi-segment clot (MSC) sign on dynamic CT angiography (CTA) in predicting recanalisation and outcome after reperfusion therapy in acute ischaemic stroke (AIS) with large artery occlusion (LAO).


We retrospectively reviewed data of anterior circulation LAO patients from a prospectively collected database for consecutive AIS patients who underwent perfusion CT (CTP) before treatment. MSC sign was defined as the presence of multiple segments on dynamic CTA derived from CTP data. Good outcome was defined as modified Rankin score 0–3 at 90 days.


A total of 181 LAO patients were enrolled. MSC sign was present in 73 (40.3%) patients. When compared with patients without MSC sign, patients with MSC sign had a significantly higher rate of recanalisation (76.7% versus 56.5%, p = 0.005) and good outcome (67.1% versus 51.0%, p = 0.035). Multivariable logistic regression analyses showed that MSC sign was an independent predictor for both recanalisation (OR [95% CI] = 2.237 [1.069–4.681]; p = 0.033) and good outcome (OR [95% CI] = 2.715 [1.154–6.388]; p = 0.022) after adjustment.


The MSC sign is a good indicator for recanalisation and good outcome after reperfusion therapy in anterior circulation LAO patients.

Key Points

• MSC sign was present in about 40% acute anterior circulation LAO patients.

• MSC sign is a predictor for recanalisation after reperfusion treatment.

• Patients with MSC sign have a better outcome.


Stroke Computed tomography angiography Biomarkers Brain infarction Prognosis 



Acute ischaemic stroke


Arterial occlusive lesion


CT angiography


Perfusion CT


Second European-Australasian acute stroke study


Haemorrhagic infarction


Haemorrhagic transformation


Large artery occlusion


Modified Rankin scale

MSC sign

Multi-segment clot sign


National Institute of Health stroke scale


Onset-to-imaging time


Onset-to-needle time


Parenchymal haemorrhage


Red blood cells


Susceptibility-weighted imaging



This study has received funding by the National Natural Science Foundation of China (grant numbers 81622017, 81471170 and 81601017), Science Technology Department of Zhejiang Province (grant number 2017C04G1360592) and Natural Science Foundation of Zhejiang Province (grant number LQ16H090003).

Compliance with ethical standards


The scientific guarantor of this publication is Min Lou.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Stroke, European Radiology and European Journal of Neurology.


• retrospective

• observational study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of NeurologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
  2. 2.UCLA Stroke CenterUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Zhejiang University Brain Research InstituteZhejiangChina

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