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Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease: Correlation with Clinical Severity and Old Brain Lesions.

Seo KD, Suh SH, Kim YB, Kim JH, Ahn SJ, Kim DS, Lee KY - Yonsei Med. J. (2015)

Bottom Line: TIS was significantly different as follows: 4.86±2.55 in patients with nonspecific symptoms, 5.89±3.10 in patients with single TIA, 9.60±3.98 in patients with recurrent TIA and 8.37±3.39 in patients with complete stroke (p=0.003).TIS associated with old lesions was significantly higher than those not associated with old lesions (9.35±4.22 vs. 7.49±3.37, p=0.032).We found a significant correlation between DHI and motor symptoms (p=0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Leptomeningeal collateral, in moyamoya disease (MMD), appears as an ivy sign on fluid-attenuated inversion-recovery (FLAIR) images. There has been little investigation into the relationship between presentation of ivy signs and old brain lesions. We aimed to evaluate clinical significance of ivy signs and whether they correlate with old brain lesions and the severity of clinical symptoms in patients with MMD.

Materials and methods: FLAIR images of 83 patients were reviewed. Each cerebral hemisphere was divided into 4 regions and each region was scored based on the prominence of the ivy sign. Total ivy score (TIS) was defined as the sum of the scores from the eight regions and dominant hemispheric ivy sign (DHI) was determined by comparing the ivy scores from each hemisphere. According to the degree of ischemic symptoms, patients were classified into four subgroups: 1) nonspecific symptoms without motor weakness, 2) single transient ischemic attack (TIA), 3) recurrent TIA, or 4) complete stroke.

Results: TIS was significantly different as follows: 4.86±2.55 in patients with nonspecific symptoms, 5.89±3.10 in patients with single TIA, 9.60±3.98 in patients with recurrent TIA and 8.37±3.39 in patients with complete stroke (p=0.003). TIS associated with old lesions was significantly higher than those not associated with old lesions (9.35±4.22 vs. 7.49±3.37, p=0.032). We found a significant correlation between DHI and motor symptoms (p=0.001).

Conclusion: Because TIS has a strong tendency with severity of ischemic motor symptom and the presence of old lesions, the ivy sign may be useful in predicting severity of disease progression.

No MeSH data available.


Related in: MedlinePlus

Fluid-attenuated inversion-recovery MRI of 11-year-old child with recurrent left side motor weakness. The ivy score of the right hemisphere is 3 in the anterior and posterior MCA territory, 2 in the ACA territory, and 1 in the PCA territory. The ivy score of the left hemisphere is 2 in the ACA and posterior MCA territory, and 1 in the anterior MCA and PCA territory. ACA, anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery.
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Figure 1: Fluid-attenuated inversion-recovery MRI of 11-year-old child with recurrent left side motor weakness. The ivy score of the right hemisphere is 3 in the anterior and posterior MCA territory, 2 in the ACA territory, and 1 in the PCA territory. The ivy score of the left hemisphere is 2 in the ACA and posterior MCA territory, and 1 in the anterior MCA and PCA territory. ACA, anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery.

Mentions: In this study, ivy sign on FLAIR images was defined as increased signal intensity in the subarachnoid space to reflect maximally dilated pial vasculature.6 In order to evaluate ivy signs in each cerebral hemisphere, each cerebral hemisphere was divided into 4 regions along the anterior to posterior direction; we set regional boundaries at the anterior cerebral artery territory, the anterior half of the middle cerebral artery (MCA) territory, the posterior half of the MCA territory and the posterior cerebral artery (PCA) territory.6 Each region was scored (0-3 point scale) based on the prominence of ivy sign (Figs. 1 and 2): a score of 0 indicated an absence of ivy sign in the defined region; a score of 1 indicated the presence of ivy sign in less than one-third of the defined region; a score of 2 indicated that more than one-third of the region had ivy sign; and a score of 3 indicated that more than two-thirds of the region had ivy sign. The total ivy score (TIS, range of 0 to 24) was defined as the sum of the eight region scores, and the dominant hemispheric ivy sign (DHI) indicates which hemisphere demonstrated more intense amount of ivy sign and was determined by comparing the ivy scores of each hemisphere.


Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease: Correlation with Clinical Severity and Old Brain Lesions.

Seo KD, Suh SH, Kim YB, Kim JH, Ahn SJ, Kim DS, Lee KY - Yonsei Med. J. (2015)

Fluid-attenuated inversion-recovery MRI of 11-year-old child with recurrent left side motor weakness. The ivy score of the right hemisphere is 3 in the anterior and posterior MCA territory, 2 in the ACA territory, and 1 in the PCA territory. The ivy score of the left hemisphere is 2 in the ACA and posterior MCA territory, and 1 in the anterior MCA and PCA territory. ACA, anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541662&req=5

Figure 1: Fluid-attenuated inversion-recovery MRI of 11-year-old child with recurrent left side motor weakness. The ivy score of the right hemisphere is 3 in the anterior and posterior MCA territory, 2 in the ACA territory, and 1 in the PCA territory. The ivy score of the left hemisphere is 2 in the ACA and posterior MCA territory, and 1 in the anterior MCA and PCA territory. ACA, anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery.
Mentions: In this study, ivy sign on FLAIR images was defined as increased signal intensity in the subarachnoid space to reflect maximally dilated pial vasculature.6 In order to evaluate ivy signs in each cerebral hemisphere, each cerebral hemisphere was divided into 4 regions along the anterior to posterior direction; we set regional boundaries at the anterior cerebral artery territory, the anterior half of the middle cerebral artery (MCA) territory, the posterior half of the MCA territory and the posterior cerebral artery (PCA) territory.6 Each region was scored (0-3 point scale) based on the prominence of ivy sign (Figs. 1 and 2): a score of 0 indicated an absence of ivy sign in the defined region; a score of 1 indicated the presence of ivy sign in less than one-third of the defined region; a score of 2 indicated that more than one-third of the region had ivy sign; and a score of 3 indicated that more than two-thirds of the region had ivy sign. The total ivy score (TIS, range of 0 to 24) was defined as the sum of the eight region scores, and the dominant hemispheric ivy sign (DHI) indicates which hemisphere demonstrated more intense amount of ivy sign and was determined by comparing the ivy scores of each hemisphere.

Bottom Line: TIS was significantly different as follows: 4.86±2.55 in patients with nonspecific symptoms, 5.89±3.10 in patients with single TIA, 9.60±3.98 in patients with recurrent TIA and 8.37±3.39 in patients with complete stroke (p=0.003).TIS associated with old lesions was significantly higher than those not associated with old lesions (9.35±4.22 vs. 7.49±3.37, p=0.032).We found a significant correlation between DHI and motor symptoms (p=0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Leptomeningeal collateral, in moyamoya disease (MMD), appears as an ivy sign on fluid-attenuated inversion-recovery (FLAIR) images. There has been little investigation into the relationship between presentation of ivy signs and old brain lesions. We aimed to evaluate clinical significance of ivy signs and whether they correlate with old brain lesions and the severity of clinical symptoms in patients with MMD.

Materials and methods: FLAIR images of 83 patients were reviewed. Each cerebral hemisphere was divided into 4 regions and each region was scored based on the prominence of the ivy sign. Total ivy score (TIS) was defined as the sum of the scores from the eight regions and dominant hemispheric ivy sign (DHI) was determined by comparing the ivy scores from each hemisphere. According to the degree of ischemic symptoms, patients were classified into four subgroups: 1) nonspecific symptoms without motor weakness, 2) single transient ischemic attack (TIA), 3) recurrent TIA, or 4) complete stroke.

Results: TIS was significantly different as follows: 4.86±2.55 in patients with nonspecific symptoms, 5.89±3.10 in patients with single TIA, 9.60±3.98 in patients with recurrent TIA and 8.37±3.39 in patients with complete stroke (p=0.003). TIS associated with old lesions was significantly higher than those not associated with old lesions (9.35±4.22 vs. 7.49±3.37, p=0.032). We found a significant correlation between DHI and motor symptoms (p=0.001).

Conclusion: Because TIS has a strong tendency with severity of ischemic motor symptom and the presence of old lesions, the ivy sign may be useful in predicting severity of disease progression.

No MeSH data available.


Related in: MedlinePlus