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The missing button sign as a tool for detecting proximal internal carotid artery occlusion

 Jun Young Choi  ;  Eun Jin Kim  ;  Ho Sung Kim  ;  In Soo Joo  ;  Kyoon Huh  ;  Phil Hyu Lee  ;  Ji Hoe Heo  ;  Hyo Suk Nam 
 Journal of Clinical Neuroscience, Vol.17(12) : 1506-1509, 2010 
Journal Title
 Journal of Clinical Neuroscience 
Issue Date
Carotid Artery Diseases/diagnostic imaging* ; Carotid Artery Diseases/pathology ; Carotid Artery, Internal/diagnostic imaging* ; Carotid Artery, Internal/pathology ; Cerebrovascular Disorders/diagnostic imaging* ; Cerebrovascular Disorders/pathology ; Humans ; Sensitivity and Specificity ; Tomography, X-Ray Computed
Acute stroke ; Carotid artery diseases ; CT scans
The aim of this study was to develop a simple and reliable sign for detecting proximal internal carotid artery occlusion (ICAO) using conventional CT scanning. The missing button sign (MBS) is defined as the absence of the ICA at the level of the foramen magnum on contrast-enhanced CT (CECT) scans. Two raters independently reviewed random CECT samples from consecutive patients with acute ischaemic stroke. A total of 399 patients with 798 carotid arteries were analysed. Rater A identified the MBS in 41 (5%) of the carotid arteries, and did not identify the MBS in 735 (92%) carotid arteries. Rater B identified the MBS in 45 (6%) of the arteries, and lack of the MBS in 731 (91%) arteries. The kappa value for agreement was 0.90 (95% CI 0.84-0.95). Compared with CT angiography, Rater A's sensitivity, specificity, positive predictive value, and negative predictive value for detecting proximal ICAO were 85%, 100%, 100%, and 99%, respectively, while Rater B's values were 87%, 99%, 93%, and 99%, respectively. This study indicated that the MBS on CECT scanning is both a consistent and specific tool for the early identification of proximal ICAO.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Lee, Phil Hyu(이필휴) ORCID logo https://orcid.org/0000-0001-9931-8462
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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