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

Kawashima, Masatou; Noguchi, Tomoyuki; Takase, Yukinori; Ootsuka, T.; Kido, N.; Matsushima, Toshio

doi:10.3174/ajnr.a1679

Cited by 41 publications

(47 citation statements)

References 12 publications

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“…The FVH seen represents diffuse leptomeningeal collaterals, and its presence varies immensely from patient to patient and even intrahemispherically in the same patient. Particular to Moyamoya disease is the finding of Kawashima et al 18 that unilateral FVH indicated decreased vascular reserve and a potentially higher risk of ischemia.…”

Section: Epidemiology Of Fvhmentioning

confidence: 99%

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Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: An Important Imaging Marker for Cerebrovascular Disease

Azizyan

Sanossian²,

Mogensen³

et al. 2010

AJNR Am J Neuroradiol

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SUMMARY:Vascular hyperintensities have been noted on FLAIR sequences obtained in the setting of acute stroke and intracranial steno-occlusive disease. The presence of FVHs likely represents disordered blood flow, often from collaterals distal to arterial occlusion or stenosis. As opposed to other vessel signs seen in arterial insufficiency, FVH is unique in that it does not represent thrombus, but rather sluggish or disordered blood flow through vessels. This review will discuss the diagnostic and prognostic value of FVH and its impact on clinical decision-making.ABBREVIATIONS: DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; FVH ϭ FLAIR vascular hyperintensity; GRE-BA ϭ gradient-echo susceptibility vessel blooming artifacts; HMCAS ϭ hyperdense MCA sign seen on CT; HVS ϭ hyperintense vessel sign; MCA ϭ middle cerebral artery; MRA ϭ MR angiography; MRI ϭ MR imaging; NIHSS ϭ National Institutes of Health Stroke Scale; PWI ϭ perfusion-weighted imaging; rtPA ϭ recombinant tissue plasminogen activator; TOF ϭ time of flight; TIA ϭ transient ischemic attacks A dvances in MR imaging have allowed better characterization of tissue and vessel status in cerebrovascular diseases, including acute stroke. Although the particular MR imaging sequences used for evaluation of stroke vary among institutions, FLAIR sequences are usually obtained. FLAIR sequences have a high sensitivity and specificity for the evaluation of brain parenchyma pathology and the subarachnoid spaces. 1,2One frequently encountered imaging finding in acute ischemic stroke is high signal intensity within blood vessels on FLAIR sequences (Fig 1). We aimed to review the current understanding of the etiology, physiology, and clinical significance of FVH. This underappreciated neuroimaging sign may have important clinical implications.In the past decade, FVHs have been associated with largevessel occlusion 3-7 or stenosis. 8 This finding has been termed "FVH," "hyperintense vessel sign," "hyperintense vessels on FLAIR," and the "ivy sign" (Table). For this review, it will be referred to exclusively as FVH. FVHs are described as focal, tubular, or serpentine hyperintensities seen, often transiently, in the subarachnoid space against the relative hypointensity of CSF. As opposed to other vessel signs seen in arterial insufficiency, FVH is unique in that it does not represent thrombus but rather is a representation of the sluggish or disordered blood flow through vessels, most often leptomeningeal collaterals.9,10 Its presence indicates regions of abnormal blood flow and potentially salvageable brain tissue in acute stroke. This review will discuss the diagnostic and prognostic value of FVH and its impact on clinical decision-making. Identification of FVHThe key to identification of FVH is to be aware of its appearance and of the clinical conditions in which it appears with greater frequency. Although the most frequent location is within the Sylvian fissure, FVH has been noted within distal branches of the anterior, middle, and posteri...

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Section: Epidemiology Of Fvhmentioning

confidence: 99%

“…18 FVH is best characterized in the setting of acute ischemic stroke, and Kamran et al 4 noted it to be present in Յ10% of MR imaging studies in this population. When the authors evaluated only the MR images obtained within 24 hours of neurologic symptom onset, FVH was noted in 45% of cases.…”

Section: Epidemiology Of Fvhmentioning

confidence: 99%

Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: An Important Imaging Marker for Cerebrovascular Disease

Azizyan

Sanossian²,

Mogensen³

et al. 2010

AJNR Am J Neuroradiol

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“…2 On FLAIR sequences, the ivy sign has been defined as a continuous linear or punctate leptomeningeal high signal intensity along the cortical sulci and subarachnoid space. 3 This enhancement mechanism is considered to represent a retrograde slow flow of engorged pial vasculature toward an ischemic area via leptomeningeal collaterals. [1][2][3][4] We recently reported that unilateral hemispheric ivy proliferation is highly correlated with an ipsilateral decrease in VR that is associated with the development of leptomeningeal collaterals in patients with Moyamoya disease.…”

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confidence: 99%

“…3 This enhancement mechanism is considered to represent a retrograde slow flow of engorged pial vasculature toward an ischemic area via leptomeningeal collaterals. [1][2][3][4] We recently reported that unilateral hemispheric ivy proliferation is highly correlated with an ipsilateral decrease in VR that is associated with the development of leptomeningeal collaterals in patients with Moyamoya disease. 3 In addition, ivy proliferation was found to decrease in 10 of 18 patients (55.6%) who underwent bypass surgery during the follow-up period.…”

mentioning

confidence: 99%

“…[1][2][3][4] We recently reported that unilateral hemispheric ivy proliferation is highly correlated with an ipsilateral decrease in VR that is associated with the development of leptomeningeal collaterals in patients with Moyamoya disease. 3 In addition, ivy proliferation was found to decrease in 10 of 18 patients (55.6%) who underwent bypass surgery during the follow-up period. 3 The aim of our study was to evaluate postoperative changes in ivy signs on FLAIR after cerebral revascularization and to correlate a decrease in ivy signs with postoperative hemodynamic status in the bypass-established hemisphere, focusing especially on VR, which was measured by 123 I-IMP SPECT with ACZ challenge in patients with Moyamoya disease.…”

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confidence: 99%

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

Kawashima¹,

Noguchi²,

Takase³

et al. 2010

AJNR Am J Neuroradiol

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Editorial for “Pre‐Surgical Magnetic Resonance Imaging Indicators of Revascularization Response in Adults With Moyamoya Vasculopathy”

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2022

Magnetic Resonance Imaging

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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

Cited by 41 publications

References 12 publications

Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: An Important Imaging Marker for Cerebrovascular Disease

Fluid-Attenuated Inversion Recovery Vascular Hyperintensities: An Important Imaging Marker for Cerebrovascular Disease

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

Editorial for “Pre‐Surgical Magnetic Resonance Imaging Indicators of Revascularization Response in Adults With Moyamoya Vasculopathy”

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