Ivy Sign in Moyamoya Disease: A Comparative Study of the FLAIR Vascular Hyperintensity Sign Against Contrast-Enhanced MRI

Wang, L.-X.; Wang, H.; Hao, Fangbin; Lv, Jin; Zhang, S.-H.; Han, Dong Sun; Bian, Xiaowei; Zhang, D.-K.; Lan, Yina; Wang, X.-R.; Wei, Meng-ting; Duan, Lian; Ma, Lin; Lou, Xin

doi:10.3174/ajnr.a7010

Cited by 10 publications

(7 citation statements)

References 24 publications

(27 reference statements)

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“…Although our study with 11 cases showed PAO safety, we must be aware that the fate of the patients may not fundamentally change because in this study, most patients had late-Suzuki stage MMD (stages IV, V, and VI) ( Tables 1 , 2 ), the prognosis was worse, PAO for the aneurysm only can bring a moment of peace, and extracranial-intracranial bypass may be necessary to improve brain flow perfusion ( 37 , 38 ).…”

Section: Discussionmentioning

confidence: 80%

Parent artery occlusion for ruptured aneurysms in moyamoya vessels or on collaterals

Zhou

2023

Front. Neurol.

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BackgroundAneurysms in moyamoya vessels or on collaterals are difficult to treat. Parent artery occlusion (PAO) via endovascular treatment (EVT) is often the last resort, but the safety and efficacy of this approach need to be evaluated.Materials and methodsA retrospective study was performed on patients admitted to our hospital who were diagnosed with unilateral or bilateral moyamoya disease (MMD) associated with ruptured aneurysms in moyamoya vessels or on collaterals. These aneurysms were treated with PAO, and the clinical outcome was recorded.ResultsEleven patients were aged 54.7 ± 10.4 years, and six patients were male (54.5%, 6/11). The aneurysms in 11 patients were single and ruptured, and the average size was 2.7 ± 0.6 mm. Three (27.3%, 3/11) aneurysms were located at the distal anterior choroidal artery, 3 (27.3%, 3/11) were at the distal lenticulostriate artery, 3 (27.3%, 3/11) were at the P2–3 segment of the posterior cerebral artery, 1 (9.1%, 1/11) was at the P4–5 segment of the posterior cerebral artery, and 1 was at the transdural location of the middle meningeal artery. Among the 11 aneurysms, PAO by coiling was performed on 7 (63.6%, 7/11), and Onyx casting was performed on 4 (36.4%, 4/11). Of 11 patients, 2 (18.2%, 2/11) suffered intraoperative hemorrhagic complications. During follow-up, all patients had good outcomes with a modified Rankin scale score of 0–2.ConclusionAs a last resort, the application of PAO with coiling or casting Onyx for ruptured aneurysms in moyamoya vessels or on collaterals may be safe with an acceptable clinical outcome. However, patients with MMD may not always achieve expected health outcomes, and PAO for the aneurysm can bring only temporary relief.

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Section: Discussionmentioning

confidence: 80%

Parent artery occlusion for ruptured aneurysms in moyamoya vessels or on collaterals

Zhou

2023

Front. Neurol.

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“…The degree of proximal stenosis may not be the only determinant of disease severity if the compensation through collateral vessels is adequate. The "ivy sign" on FLAIR is a presentation of leptomeningeal collaterals and has been reported to be related to clinical severity and hemodynamics [10] . According to the semiquantitative analysis of the manifestation of the "ivy sign" in different Suzuki's stages and the comparisons with collaterals shown on DSA, we found that there were 10.00% regions in the early stage, 56.88% in the midstage and 28.00% in the late stage with the "ivy sign"; there were 14.17% regions in the early stage, 70.31% in the mid-stage and 35.00% in the late stage with leptomeningeal collaterals on DSA.…”

Section: Discussionmentioning

confidence: 99%

Hybrid 18F-FDG PET/MRI can Improve the Evaluation of Adult Moyamoya Disease in a “one-stop” Measurement Model

Yuan

Yang

et al. 2023

Preprint

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Background Accurate measurement of cerebral blood flow (CBF), tissue function and viability are particularly significant and important to help neurosurgeons identify MMD patients who would benefit from surgical revascularization. The present study aimed to evaluate the application value of hybrid 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) in adult moyamoya disease (MMD) and its correlation with digital subtraction angiography (DSA) findings. Twenty-seven hospitalized adult MMD patients who underwent both hybrid 18F-FDG PET/MRI and DSA were enrolled in this study. The relative number of abnormal cerebral regional distributions of parameters derived from PET/MRI or DSA, including PET score, “ivy sign” score, ASL-CBF score, DSA irrigation score and the collateral score of each cerebral region in different Suzuki’s stages, were analyzed and compared with GraphPad Prism. The Spearman rank correlation test was performed to show the internal relationships among these parameters. The chi-square test was applied to assess the performance of MRI in the evaluation of collaterals and perfusion status using DSA as a reference method. Log-rank tests were used to identify independent indicators of regional glucose hypometabolism. Results The relative number of regions with a positive “ivy sign”, DSA collaterals, hypometabolism on PET, hypoperfusion on ASL-CBF or deficient DSA irrigation in hemispheres in the mid-stage and late stage were significantly different from those in the early stage (p < 0.05). The “ivy sign” score was positively related to the DSA collateral score (r = 0.6552, p < 0.05). The PET score was positively correlated with the ASL-CBF score (r = 0.685, p < 0.05) and the DSA irrigation score (r = 0.258, p < 0.05). The ASL-CBF score may be an independent indicator of brain regional glucose hypometabolism (p < 0.05). Conclusions Brain hybrid 18F-FDG PET/MRI can improve the evaluation of adult MMD patients in a “one-stop” measurement model. Simultaneously, the accuracy of PET and MRI findings can be validated against one another to provide more convincing objective evidence for the choice of the treatment strategy.

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“…The ivy sign grade of each hemisphere was de ned as follows: 0 (absence), 1 (less than half of the cortical surface), and 2 (more than half of the cortical surface). Ivy sign severity was classi ed as mild (grade 0-1) or severe (grade 2) 8, 12 . Two neuroradiologists reviewed the ivy sign independently without knowledge of the clinical information or DSA/CTP ndings.…”

Section: Imaging Analysis Mri Analysismentioning

confidence: 99%

“…Conventionally, we utilized Suzuki's angiographic stage 12 to stand for the situation of cerebral morphology. Based on the literature, Suzuki's angiographic stage was graded into 6 stages,≥4 stages represent severe disease.…”

Section: Cerebral Morphology Assessmentmentioning

confidence: 99%

“…Patients who had the experience of surgery were advised to return to the hospital to reinspect with DSA. It aimed at estimating the collateral formation with the Matsushima scale 12,13 (Fig. 2):Level A, more than 2/3 of the MCA distribution; Level B, between 2/3 and 1/3 of the MCA distribution; and Level C, slight or none.…”

Section: Postoperative Collateral Formation Assessmentmentioning

confidence: 99%

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Ivy sign in moyamoya disease

Xia

et al. 2022

Preprint

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Background: Moyamoya disease can not be found commonly as a rare type compared to other vascular diseases, such as intracranial aneurysms. However, it can not be ignored for its high fatality and disability rate. In addition, the exact pathogenesis study of this disease is still on the way. The ivy sign is always observed in moyamoya disease (MMD), but the clinical importance of this sign in MMD isn't known. The main purpose of this research was to specifically investigate the clinical significance. Methods: The patients with moyamoya disease were hospitalized from January 2016 to 2020, it’s a retrospective cohort study to gather the baseline clinical and imaging study. The study was approved by the Institutional Review Board and Ethics Committee of West China Hospital, Sichuan University (No. 2018-219), Informed consent was obtained from all individual participants included in the study，all experiments were performed in accordance with relevant guidelines and regulations. In the analysis, univariate and multivariate logistic regression was utilized to testify whether ivy sign was independently associated with MMD characteristics, including cerebrovascular morphology, cerebral hemodynamics, cerebrovascular events, and postoperative collateral formation (PCF). Results: 156 patients were included with 312 hemispheres (Table 1). As for the result of multivariate logistic regression analysis, we could discover a fact that ivy sign was tightly connected to the Suzuki stage ≥IV(OR,1.386;95%CI,1.055-1.822;p=0.019（Table2）), rCBF(cerebral blood flow) decreased type (OR,2.330;95%CI,1.733-3.133;p=0.000（Table3）), age acted as a protective factor for rCBF(OR, 0.966; 95%CI,0.946-0.986;p=0.001, the elder was more likely associated with decreased rCBF. ivy sign also played a significant role in Ischemic cerebrovascular events(OR,5.653;95%CI,3.092-10.336; p=0.003(Table5)), their remarkable connection could be seen in the study. We could also find that ivy was closely connected to good postoperative collateral formation (PCF)( OR,2.830;95%CI,1.329-6.027; p=0.007(Table4), we couldn't ignore that age was associated with good PCF as well(OR, 0.933;95%CI, 0.882-0.987; p=0.015). Discussion: We could be more aware of the connection between ivy signs and moyamoya disease from this study, to implement diagnosis, treatment, and prognosis more efficiently.

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Ivy Sign in Moyamoya Disease: A Comparative Study of the FLAIR Vascular Hyperintensity Sign Against Contrast-Enhanced MRI

Cited by 10 publications

References 24 publications

Parent artery occlusion for ruptured aneurysms in moyamoya vessels or on collaterals

Parent artery occlusion for ruptured aneurysms in moyamoya vessels or on collaterals

Hybrid 18F-FDG PET/MRI can Improve the Evaluation of Adult Moyamoya Disease in a “one-stop” Measurement Model

Ivy sign in moyamoya disease

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