Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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The Usefulness of the Ivy Sign on Fluid-Attenuated Intensity Recovery Images in Improved Brain Hemodynamic Changes after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in Adult Patients with Moyamoya Disease

  • Lee, Jung Keun (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Yoon, Byul Hee (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Chung, Seung Young (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Park, Moon Sun (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Kim, Seong Min (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Lee, Do Sung (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University)
  • Received : 2013.06.13
  • Accepted : 2013.10.16
  • Published : 2013.10.28
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Abstract

Objective : MR perfusion and single photon emission computerized tomography (SPECT) are well known imaging studies to evaluate hemodynamic change between prior to and following superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis in moyamoya disease. But their side effects and invasiveness make discomfort to patients. We evaluated the ivy sign on MR fluid attenuated inversion recovery (FLAIR) images in adult patients with moyamoya disease and compared it with result of SPECT and MR perfusion images. Methods : We enrolled twelve patients (thirteen cases) who were diagnosed with moyamoya disease and underwent STA-MCA anastomosis at our medical institution during a period ranging from September of 2010 to December of 2012. The presence of the ivy sign on MR FLAIR images was classified as Negative (0), Minimal (1), and Positive (2). Regions were classified into four territories: the anterior cerebral artery (ACA), the anterior MCA, the posterior MCA and the posterior cerebral artery. Results : Ivy signs on preoperative and postoperative MR FLAIR were improved (8 and 4 in the ACA regions, 13 and 4 in the anterior MCA regions and 19 and 9 in the posterior MCA regions). Like this result, the cerebrovascular reserve (CVR) on SPECT was significantly increased in the sum of CVR in same regions after STA-MCA anastomosis. Conclusion : After STA-MCA anastomosis, ivy signs were decreased in the cerebral hemisphere. As compared with conventional diagnostic modalities such as SPECT and MR perfusion images, the ivy sign on MR FLAIR is considered as a useful indicator in detecting brain hemodynamic changes between preoperatively and postoperatively in adult moyamoya patients.

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References

  1. Baba T, Houkin K, Kuroda S : Novel epidemiological features of moyamoya disease. J Neurol Neurosurg Psychiatry 79 : 900-904, 2008 https://doi.org/10.1136/jnnp.2007.130666
  2. Cosnard G, Duprez T, Grandin C, Smith AM, Munier T, Peeters A : Fast FLAIR sequence for detecting, major vascular abnormalities during the hyperacute phase of stroke : a comparison with MR angiography. Neuroradiology 41 : 342-346, 1999 https://doi.org/10.1007/s002340050761
  3. Fujimura M, Mugikura S, Shimizu H, Tominaga T : Diagnostic value of perfusion-weighted MRI for evaluating postoperative alteration of cerebral hemodynamics following STA-MCA anastomosis in patients with moyamoya disease. No Shinkei Geka 34 : 801-809, 2006
  4. Fujiwara H, Momoshima S, Kuribayashi S : Leptomeningeal high signal intensity (ivy sign) on fluid-attenuated inversion-recovery (FLAIR) MR images in moyamoya disease. Eur J Radiol 55 : 224-230, 2005 https://doi.org/10.1016/j.ejrad.2004.11.009
  5. Gauvrit JY, Leclerc X, Girot M, Cordonnier C, Sotoares G, Henon H, et al. : Fluid-attenuated inversion recovery (FLAIR) sequences for the assessment of acute stroke : inter observer and intertechnique reproducibility. J Neurol 253 : 631-635, 2006 https://doi.org/10.1007/s00415-005-0075-x
  6. Ideguchi R, Morikawa M, Enokizono M, Ogawa Y, Nagata I, Uetani M : Ivy signs on FLAIR images before and after STA-MCA anastomosis in patients with Moyamoya disease. Acta Radiol 52 : 291-296, 2011 https://doi.org/10.1258/ar.2011.100367
  7. Iida H, Itoh H, Nakazawa M, Hatazawa J, Nishimura H, Onishi Y, et al. : Quantitative mapping of regional cerebral blood flow using iodine-123-IMP and SPECT. J Nucl Med 35 : 2019-2030, 1994
  8. Kawamura Y, Ashizaki M, Saida S, Sugimoto H : Usefulness of rate of increase in SPECT counts in one-daymethod of N-isopropyl-4-iodoamphetamine [123I] SPECT studies at rest and after acetazolamide challenge using amethod for estimating time-dependent distribution at rest. Ann Nucl Med 22 : 457-463, 2008 https://doi.org/10.1007/s12149-008-0134-3
  9. Kawashima M, Noguchi T, Takase Y, Nakahara Y, Matsushima T : Decrease in leptomeningeal ivy sign on fluid-attenuated inversion recovery images after cerebral revascularization in patients with moyamoya disease. AJNR Am J Neuroradiol 31 : 1713-1718, 2010 https://doi.org/10.3174/ajnr.A2124
  10. Kawashima M, Noguchi T, Takase Y, Ootsuka T, Kido N, Matsushima T : Unilateral hemispheric proliferation of ivy sign on FLAIR image in Moyamoya disease correlates highly with ipsilateral hemispheric decrease of cerebrovascular reserve. AJNR Am J Neuroradiol 30 : 1709-1716, 2009 https://doi.org/10.3174/ajnr.A1679
  11. Komiyama M, Nakajima H, Nishikawa M, Yasui T, Kitano S, Sakamoto H : Leptomeningeal contrast enhancement in moyamoya : its potential role in postoperative assessment of circulation through the bypass. Neuroradiology 43 : 17-23, 2001 https://doi.org/10.1007/s002340000342
  12. Lee SK, Kim DI, Jeong EK, Kim SY, Kim SH, In YK, et al. : Postoperative evaluation of moyamoya disease with perfusion-weighted MR imaging : initial experience. AJNR Am J Neuroradiol 24 : 741-747, 2003
  13. Maeda M, Tsuchida C : "Ivy sign" on fluid-attenuated inversion-recovery images in childhood moyamoya disease. AJNR Am J Neuroradiol 20 : 1836-1838, 1999
  14. Maeda M, Yamamoto T, Daimon S, Sakuma H, Takeda K : Arterial hyperintensity on fast fluid-attenuated inversion recovery images : a subtle finding for hyperacute stroke undetected by diffusion-weighted MR imaging. AJNR Am J Neuroradiol 22 : 632-636, 2001
  15. Mori N, Mugikura S, Higano S, Kaneta T, Fujimura M, Umetsu A, et al. : The leptomeningeal "ivy sign" on fluid-attenuated inversion recovery MR imaging in Moyamoya disease : a sign of decreased cerebral vascular reserve? AJNR Am J Neuroradiol 30 : 930-935, 2009 https://doi.org/10.3174/ajnr.A1504
  16. Mugikura S, Takahashi S, Higano S, Shirane R, Kurihara N, Furuta S, et al. : The relationship between cerebral infarction and angiographic characteristics in childhood moyamoya disease. AJNR Am J Neuroradiol 20 : 336-343, 1999
  17. Narisawa A, Fujimura M, Tominaga T : Efficacy of the revascularization surgery for adult-onset moyamoya disease with the progression of cerebrovascular lesions. Clin Neurol Neurosurg 111 : 123-126, 2009 https://doi.org/10.1016/j.clineuro.2008.09.022
  18. Noguchi K, Ogawa T, Inugami A, Fujita H, Hatazawa J, Shimosegawa E, et al. : MRI of acute cerebral infarction : a comparison of FLAIR and T2-weighted fast spin-echo imaging. Neuroradiology 39 : 406-410, 1997 https://doi.org/10.1007/s002340050433
  19. Ohta T, Tanaka H, Kuroiwa T : Diffuse leptomeningeal enhancement, "ivy sign," in magnetic resonance images of moyamoya disease in childhood. Case report. Neurosurgery 37 : 1009-1012, 1995 https://doi.org/10.1227/00006123-199511000-00024
  20. Ringelstein EB, Sievers C, Ecker S, Schneider PA, Otis SM : Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusions. Stroke 19 : 963-969, 1988 https://doi.org/10.1161/01.STR.19.8.963
  21. Ringelstein EB, Van Eyck S, Mertens I : Evaluation of cerebral vasomotor reactivity by various vasodilating stimuli : comparison of CO2 to acetazolamide. J Cereb Blood Flow Metab 12 : 162-168, 1992 https://doi.org/10.1038/jcbfm.1992.20
  22. Settakis G, Molnár C, Kerényi L, Kollár J, Legemate D, Csiba L, et al. : Acetazolamide as a vasodilatory stimulus in cerebrovascular diseases and in conditions affecting the cerebral vasculature. Eur J Neurol 10 : 609-620, 2003 https://doi.org/10.1046/j.1468-1331.2003.00675.x
  23. Tomsick TA, Khatri P, Jovin T, Demaerschalk B, Malisch T, Demchuk A, et al. : Equipoise among recanalization strategies. Neurology 74 : 1069-1076, 2010 https://doi.org/10.1212/WNL.0b013e3181d76b8f

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