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Unilateral Hemispheric Proliferation of Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease Correlates Highly with Ipsilateral Hemispheric Decrease of Cerebrovascular Reserve

Unilateral Hemispheric Proliferation of Ivy Sign on Fluid-Attenuated Inversion Recovery Images in... This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1679v1 30/9/1709 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kawashima, M. Articles by Matsushima, T. Search for Related Content PubMed PubMed Citation Articles by Kawashima, M. Articles by Matsushima, T. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 30:1709-1716, October 2009 © 2009 American Society of Neuroradiology BRAIN Unilateral Hemispheric Proliferation of Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease Correlates Highly with Ipsilateral Hemispheric Decrease of Cerebrovascular Reserve M. Kawashima a , T. Noguchi b , Y. Takase a , T. Ootsuka b , N. Kido b and T. Matsushima a a From the Departments of Neurosurgery (M.K., Y.T., T.M.) b Radiology (T.N., T.O., N.K.), Faculty of Medicine, Saga University, Saga, Japan. Please address correspondence to Masatou Kawashima, MD, PhD, Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501 Japan; e-mail: MasatouAzu@aol.com BACKGROUND AND PURPOSE: An ivy sign is considered to represent diffuse leptomeningeal collaterals found on fluid-attenuated inversion recovery (FLAIR) images of patients with Moyamoya disease. We evaluated the correlation between unilateral ivy proliferation in a hemisphere and cerebrovascular hemodynamic status to learn the clinical significance of the ivy sign. MATERIALS AND METHODS: A total of 35 patients with Moyamoya disease were included. Correlation between ivy dominance on FLAIR images and hemodynamic status with use of iodine 123 N -isopropyl-p-iodoamphetamine ( 123 I-IMP) single-photon emission CT (SPECT) was evaluated. RESULTS: Distributional differences of ivy signs between both hemispheres were observed in 22 (64.7%) of 34 patients with a positive ivy sign, all of whom showed decreased vascular reserve/reactivity in the ivy-dominant hemisphere (IDH). The proportion of the stage II (misery perfusion) area to IDH was higher than that in the ivy less-dominant hemisphere (ILDH) in the quantitative analysis. The mean vascular reserve was lower in IDH than ILDH. There were 15 of 22 patients who had bypass surgery on IDH because of transient ischemic attack from ischemia of IDH. Patients with symmetric ivy distributions showed a variety of hemodynamic status. MR angiography (MRA) stage of IDH (2.95 ± 0.39) was higher compared with ILDH (2.60 ± 0.50; P < .05). Regional arteriocapillary circulation time ratio in IDH was longer compared with ILDH ( P < .05). Ivy proliferation decreased in 10 (55.6%) of 18 patients who underwent bypass surgery during the follow-up period. CONCLUSIONS: Unilateral hemispheric ivy proliferation correlated highly with the existence of an ipsilateral decreased vascular reserve associated with the development of leptomeningeal collaterals in patients with Moyamoya disease. Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Unilateral Hemispheric Proliferation of Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease Correlates Highly with Ipsilateral Hemispheric Decrease of Cerebrovascular Reserve

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A1679
Publisher site
See Article on Publisher Site

Abstract

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1679v1 30/9/1709 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kawashima, M. Articles by Matsushima, T. Search for Related Content PubMed PubMed Citation Articles by Kawashima, M. Articles by Matsushima, T. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 30:1709-1716, October 2009 © 2009 American Society of Neuroradiology BRAIN Unilateral Hemispheric Proliferation of Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease Correlates Highly with Ipsilateral Hemispheric Decrease of Cerebrovascular Reserve M. Kawashima a , T. Noguchi b , Y. Takase a , T. Ootsuka b , N. Kido b and T. Matsushima a a From the Departments of Neurosurgery (M.K., Y.T., T.M.) b Radiology (T.N., T.O., N.K.), Faculty of Medicine, Saga University, Saga, Japan. Please address correspondence to Masatou Kawashima, MD, PhD, Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501 Japan; e-mail: MasatouAzu@aol.com BACKGROUND AND PURPOSE: An ivy sign is considered to represent diffuse leptomeningeal collaterals found on fluid-attenuated inversion recovery (FLAIR) images of patients with Moyamoya disease. We evaluated the correlation between unilateral ivy proliferation in a hemisphere and cerebrovascular hemodynamic status to learn the clinical significance of the ivy sign. MATERIALS AND METHODS: A total of 35 patients with Moyamoya disease were included. Correlation between ivy dominance on FLAIR images and hemodynamic status with use of iodine 123 N -isopropyl-p-iodoamphetamine ( 123 I-IMP) single-photon emission CT (SPECT) was evaluated. RESULTS: Distributional differences of ivy signs between both hemispheres were observed in 22 (64.7%) of 34 patients with a positive ivy sign, all of whom showed decreased vascular reserve/reactivity in the ivy-dominant hemisphere (IDH). The proportion of the stage II (misery perfusion) area to IDH was higher than that in the ivy less-dominant hemisphere (ILDH) in the quantitative analysis. The mean vascular reserve was lower in IDH than ILDH. There were 15 of 22 patients who had bypass surgery on IDH because of transient ischemic attack from ischemia of IDH. Patients with symmetric ivy distributions showed a variety of hemodynamic status. MR angiography (MRA) stage of IDH (2.95 ± 0.39) was higher compared with ILDH (2.60 ± 0.50; P < .05). Regional arteriocapillary circulation time ratio in IDH was longer compared with ILDH ( P < .05). Ivy proliferation decreased in 10 (55.6%) of 18 patients who underwent bypass surgery during the follow-up period. CONCLUSIONS: Unilateral hemispheric ivy proliferation correlated highly with the existence of an ipsilateral decreased vascular reserve associated with the development of leptomeningeal collaterals in patients with Moyamoya disease. Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Oct 1, 2009

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