Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease

Kawashima, Masatou; Noguchi, Tomoyuki; Takase, Yukinori; Nakahara, Yukiko; Matsushima, Toshio

doi:10.3174/ajnr.a2124

Cited by 45 publications

(44 citation statements)

References 17 publications

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“…It is unlikely that such abnormal intravascular signal intensity is due to thrombus extending along the entire course of the MCA [16]. Additionally, two recent studies showed that HVs on FLAIR were decreased or disappeared after cerebral revascularization, which again relates HVs to slow collateral flows [3,7]. Recently, a case report described a conspicuous gap in HVs on FLAIR, and angiography showed that the location of this gap corresponded to occlusive thrombus [17].…”

Section: Discussionmentioning

confidence: 99%

“…A more aggressive treatment strategy to achieve therapeutic revascularization may be needed in these patients. Moreover, postoperative changes in HVs can be used as a marker for identifying hemodynamic improvement [3,7]. However, further study is needed to confirm these potential applications.…”

Section: Discussionmentioning

confidence: 99%

“…On FLAIR sequence, HVs are described as the continuous linear or punctuated leptomeningeal hyperintensities running along the cortical sulci and subarachnoid space and contrasting against the relative hypointensity of cerebrospinal fluid [1]. Although the pathophysiological mechanisms underlying HVs are not fully understood, retrograde slow blood flows of engorged pial vasculature toward an ischemic area via leptomeningeal collaterals (LMCs) have been suggested as an explanation for HVs [2,3,4,5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

“…Hyperintense vessels (HVs) on fluid-attenuated inversion recovery (FLAIR) are frequently observed in the setting of acute stroke, intracranial steno-occlusive disease and moyamoya disease, and have been termed ‘FLAIR vascular hyperintensity’ and ‘ivy sign’ [1,2,3]. On FLAIR sequence, HVs are described as the continuous linear or punctuated leptomeningeal hyperintensities running along the cortical sulci and subarachnoid space and contrasting against the relative hypointensity of cerebrospinal fluid [1].…”

Section: Introductionmentioning

confidence: 99%

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Distal Hyperintense Vessels on Flair: A Prognostic Indicator of Acute Ischemic Stroke

et al. 2012

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Background: Hyperintense vessels (HVs) on fluid-attenuated inversion recovery (FLAIR) are frequently observed in acute ischemic stroke (AIS). The presence of HVs represents altered blood flow from collaterals distal to arterial occlusion or stenosis. This study aimed to evaluate the prognostic value of HVs in AIS. Methods: Fifty-four consecutive patients with acute middle cerebral artery occlusion were enrolled in the study. The location and extent of the HVs was determined by FLAIR. Clinical data were obtained and compared between patients with different grades of HVs. Additionally, the relationship between distal HVs and leptomeningeal collaterals (LMCs) was assessed using angiography. Results: HVs were observed in 41 (75.9%) of the 54 patients enrolled. The initial NIHSS score was lower (p < 0.001) and the infarction volume was smaller (p < 0.001) in patients with distal HVs. Adjusting of other factors, regression analysis revealed that distal HVs are an independent predictor of a favorable outcome at 90 days (p = 0.006; OR 0.049; 95% CI 0.006–0.420). Furthermore, the presence of distal HVs was correlated with the presence of LMCs. Conclusion: Distal HVs may be a marker for LMCs and act as a predictor of a favorable clinical outcome for patients with AIS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distal Hyperintense Vessels on Flair: A Prognostic Indicator of Acute Ischemic Stroke

et al. 2012

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“…The ivy sign has been shown to be more prominent in hemispheres with poorer visualization of the cortical branches of the middle cerebral artery (MCA) on MR angiography [4]. In addition, a greater prominence of the ivy sign indicates more severe ischemic symptoms, which were found to decrease on follow-up MR images after effective revascularization surgery [5,6]. In recent studies using single-photon emission computed tomography, ivy sign proliferation correlated with decreases in cerebrovascular reserve [6,7].…”

Section: Introductionmentioning

confidence: 99%

The Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease: Positron Emission Tomography Study

Kaku¹,

Iihara²,

Nakajima³

et al. 2013

Cerebrovasc Dis

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Background: The ivy sign is sometimes seen on fluid-attenuated inversion recovery (FLAIR) images in moyamoya disease (MMD). In recent studies using single-photon emission computed tomography, ivy sign proliferation correlated with decreases in cerebrovascular reserve. However, a decreased vascular reserve is not concrete. The purpose of this study was to evaluate the correlation between ivy sign proliferation and the findings of ¹⁵O gas positron emission tomography (PET). Methods: In 19 MMD patients (12 women, age 31-69 years) with ischemic symptoms, FLAIR magnetic resonance imaging and ¹⁵O gas PET were performed. We classified the middle cerebral artery (MCA) territory into 2 regions in each hemisphere, and the degree of the ivy sign (ivy sign score) in each region was classified into 3 grades (0-2), where grade 0 indicated an absence of the ivy sign, grade 1 indicated that the ivy sign was seen on less than half of the cortical surface in each region, and grade 2 indicated that the ivy sign was seen on more than half of the cortical surface. We examined the relationship among the ivy sign score, the severity of ischemic symptoms and PET parameters in 76 MCA regions of 19 patients. Results: Ivy sign scores of the regions were 0 (n = 19), 1 (n = 40), and 2 (n = 17). Total ivy sign score of a hemisphere increased as clinical symptoms became more severe. Cerebral blood flow (CBF) values were lower, cerebral blood volume (CBV) values were higher, and CBF/CBV values were lower than those of controls as symptoms became severe (p < 0.05). CBF and CBF/CBV values decreased and CBV values increased as the ivy sign score increased, and were significantly higher and lower, respectively, than control values (p < 0.05). No significant differences in cerebral metabolic rate of oxygen and oxygen extraction fraction were found between the 3 ivy sign scores. A positive correlation was found between ivy sign score and increases in CBV (p < 0.01), and a more obvious negative correlation was found between ivy sign score and decreases in CBF/CBV (p < 0.001). Conclusions: We evaluated the correlation between ivy sign proliferation and the findings of ¹⁵O gas PET. We suggested that ivy sign proliferation was associated with both dilated pial vasculature and the slow flow of developed leptomeningeal collaterals in patients with MMD.

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Pediatric Vascular Imaging Techniques and Clinical Applications

Conceição

Silva

Ramalho

2013

Vascular Imaging of the Central Nervous System

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Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease

Cited by 45 publications

References 17 publications

Distal Hyperintense Vessels on Flair: A Prognostic Indicator of Acute Ischemic Stroke

Distal Hyperintense Vessels on Flair: A Prognostic Indicator of Acute Ischemic Stroke

The Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease: Positron Emission Tomography Study

Pediatric Vascular Imaging Techniques and Clinical Applications

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