The Leptomeningeal "Ivy Sign" on Fluid-Attenuated Inversion Recovery MR Imaging in Moyamoya Disease: A Sign of Decreased Cerebral Vascular Reserve?

• Published in: American journal of neuroradiology : AJNR Vol. 30; no. 5; pp. 930 - 935
• Main Authors: Mori, N, Mugikura, S, Higano, S, Kaneta, T, Fujimura, M, Umetsu, A, Murata, T, Takahashi, S
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.05.2009; American Society of Neuroradiology
• Subjects: Adolescent; Adult; Biological and medical sciences; Brain; Brain Ischemia - complications; Brain Ischemia - pathology; Cerebral Arteries - pathology; Child; Child, Preschool; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Angiography - methods; Male; Medical sciences; Meningeal Arteries - pathology; Middle Aged; Moyamoya Disease - complications; Moyamoya Disease - pathology; Nervous system; Neurology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sensitivity and Specificity; Young Adult; Vascular disease; Nervous system diseases; Vasculitis; Radiodiagnosis; Systemic disease; Central nervous system; Inversion recovery; Cardiovascular disease; Sign; Nuclear magnetic resonance imaging; Takayashu arteritis; Encephalon
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1504

Moyamoya disease is an idiopathic occlusive cerebrovascular disorder with abnormal microvascular proliferation. We investigated the clinical utility of leptomeningeal high signal intensity (ivy sign) sometimes seen on fluid-attenuated inversion recovery images in Moyamoya disease. We examined the relationship between the degree of the ivy sign and the severity of the ischemic symptoms in 96 hemispheres of 48 patients with Moyamoya disease. We classified each cerebral hemisphere into 4 regions from anterior to posterior. In 192 regions of 24 patients, we examined the relationship between the degree of the ivy sign and findings of single-photon emission CT, including the resting cerebral blood flow (CBF) and cerebral vascular reserve (CVR). The degree of the ivy sign showed a significant positive relationship with the severity of the ischemic symptoms (P < .001). Of the 4 regions, the ivy sign was most frequently and prominently seen in the anterior part of the middle cerebral artery region. The degree of the ivy sign showed a negative relationship with the resting CBF (P < .0034) and a more prominent negative relationship with the CVR (P < .001). The leptomeningeal ivy sign indicates decreased CVR in Moyamoya disease.