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All lesions were confirmed through head MRI\/diffusion-weighted imaging within 48\u00a0h after CT. CT attenuation values of hypodense lesions and symmetrical control regions were measured. Additionally, CT attenuation value difference (\u0394HU) and ratio (Ratio<jats:sub>HU<\/jats:sub>) were calculated. One-way analysis of variance (ANOVA) was used to compare age and CT parameters (CT attenuation values, \u0394HU and Ratio<jats:sub>HU<\/jats:sub>) across the groups. Finally, receiver operating characteristic (ROC) analysis was performed to determine the cutoff values for distinguishing hypodense lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 167 lesions from 146 patients were examined. The CT attenuation values for AIS(<jats:italic>n<\/jats:italic>\u2009=\u200939), LA(<jats:italic>n<\/jats:italic>\u2009=\u200953), and OCI(<jats:italic>n<\/jats:italic>\u2009=\u200975) were 18.90\u2009\u00b1\u20096.40 HU, 17.53\u2009\u00b1\u20094.67 HU, and 11.90\u2009\u00b1\u20095.92 HU, respectively. The time interval between symptom onset and CT scans for AIS group was 32.21\u2009\u00b1\u200926.85\u00a0h. ANOVA revealed significant differences among the CT parameters of the hypodense lesion groups (all<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The AUC of CT values, \u0394HU, and Ratio<jats:sub>HU<\/jats:sub>for distinguishing AIS from OCI were 0.802, 0.896 and 0.878, respectively (all<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Meanwhile, the AUC for distinguishing OCI from LA was 0.789, 0.883, and 0.857, respectively (all<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Nevertheless, none of the parameters could distinguish AIS from LA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CT attenuation parameters can be utilized to differentiate between AIS and OCI or OCI and LA in indeterminate hypodense lesions on CT images. However, distinguishing AIS from LA remains challenging.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12880-024-01340-2","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T10:05:53Z","timestamp":1719396353000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Feasibility of CT attenuation values in distinguishing acute ischemic stroke, old cerebral infarction and leukoaraiosis"],"prefix":"10.1186","volume":"24","author":[{"given":"Yun","family":"Peng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunyuan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingzhi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutong","family":"Rao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruoyun","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lianggeng","family":"Gong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyu","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,6,26]]},"reference":[{"issue":"8","key":"1340_CR1","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1161\/CIRCULATIONAHA.116.025250","volume":"135","author":"W WANG","year":"2017","unstructured":"Wang W, Jiang B, Sun H, et al. 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