Hyperattenuating Signs at Unenhanced CT Indicating Acute Vascular Disease

When a vascular disease is suspected, the focus is usually on morphologic features seen at contrast material-enhanced multidetector computed tomography (CT). However, unenhanced CT also plays an important role in revealing so-called hyperattenuating signs, which represent a slight increase in the focal attenuation of a vessel. Hyperattenuating signs are occasionally observed when an acute clot has formed in a vessel and can be seen in various vascular diseases, including acute arterial occlusion, acute arterial dissection, aneurysm rupture, and acute venous thrombosis. The attenuation of these signs tends to increase because the concentration of hemoglobin increases as water content decreases. Hyperattenuating signs are a transient phenomenon, as the attenuation gradually decreases. Therefore, they can serve as unique findings indicating an acute state. Although hyperattenuating signs are not well understood, recognition of these signs is important because they can help reveal serious acute vascular diseases even at unenhanced CT.