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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

Box-and-whisker plot showing total ivy score in patients classified according to the severity of clinical symptoms (A) and dichotomized by severity for each group of patients (B). TIA, transient ischemic attack.
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Figure 3: Box-and-whisker plot showing total ivy score in patients classified according to the severity of clinical symptoms (A) and dichotomized by severity for each group of patients (B). TIA, transient ischemic attack.

Mentions: The ivy sign was observed in all moyamoya patients. Interobserver agreement was moderate to substantial for each brain region (Table 1). The TIS for all four subgroups were as follows; nonspecific symptoms=4.86±2.55, single TIA=5.89±3.10, recurrent TIA=9.60±3.98, and complete stroke=8.37±3.39 (Fig. 3A). There was a significant difference in TIS among the four subgroups (p=0.003). The TIS of the mild symptom group was lower than that of the severe symptom group (5.44±2.83 vs. 9.25±3.84, p<0.001) (Fig. 3B). After excluding the patients with nonspecific symptoms and bilateral motor symptoms, we analyzed the ivy score of motor symptom-related hemisphere in patients with unilateral symptoms, separately. The ivy scores of the patients in each group, according to the order listed above, were as follows: 2.75±1.17, 5.37±2.43, and 4.53±2.38 (p=0.006). There was a correlation between TIS and severity of motor symptom (p=0.016), but not between ivy score of motor symptom-related hemisphere and severity of motor symptom (p=0.098). Statistical model based on TIS was suitable to describe the severity of motor symptom (beta coefficient=0.109, p=0.047) whereas ivy score of motor symptom-related hemisphere was not suitable (p=0.422) in the ordinal regression analysis.


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)

Box-and-whisker plot showing total ivy score in patients classified according to the severity of clinical symptoms (A) and dichotomized by severity for each group of patients (B). TIA, transient ischemic attack.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Box-and-whisker plot showing total ivy score in patients classified according to the severity of clinical symptoms (A) and dichotomized by severity for each group of patients (B). TIA, transient ischemic attack.
Mentions: The ivy sign was observed in all moyamoya patients. Interobserver agreement was moderate to substantial for each brain region (Table 1). The TIS for all four subgroups were as follows; nonspecific symptoms=4.86±2.55, single TIA=5.89±3.10, recurrent TIA=9.60±3.98, and complete stroke=8.37±3.39 (Fig. 3A). There was a significant difference in TIS among the four subgroups (p=0.003). The TIS of the mild symptom group was lower than that of the severe symptom group (5.44±2.83 vs. 9.25±3.84, p<0.001) (Fig. 3B). After excluding the patients with nonspecific symptoms and bilateral motor symptoms, we analyzed the ivy score of motor symptom-related hemisphere in patients with unilateral symptoms, separately. The ivy scores of the patients in each group, according to the order listed above, were as follows: 2.75±1.17, 5.37±2.43, and 4.53±2.38 (p=0.006). There was a correlation between TIS and severity of motor symptom (p=0.016), but not between ivy score of motor symptom-related hemisphere and severity of motor symptom (p=0.098). Statistical model based on TIS was suitable to describe the severity of motor symptom (beta coefficient=0.109, p=0.047) whereas ivy score of motor symptom-related hemisphere was not suitable (p=0.422) in the ordinal regression analysis.

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