title: Decrease in leptomeningeal ivy sign on fluid-attenuated inversion recovery images after cerebral revascularization in patients with Moyamoya disease.
abstract: OBJECTIVE
  The "ivy" sign that is identified on FLAIR images in patients with Moyamoya disease is considered to be leptomeningeal collaterals. The aim of our study was to evaluate the correlation between postoperative decrease in ivy sign and cerebral hemodynamic status in the bypass-established hemisphere.
  
  
  METHODS
  Twenty-two patients with Moyamoya disease were enrolled. Postoperative changes in the ivy sign on FLAIR images were examined in each patient after bypass surgery. The correlation between postoperative changes in the ivy sign and hemodynamic status was examined in 10 patients by using SPECT.
  
  
  RESULTS
  Of the 22 preoperative ivy-positive patients, 21 showed decreased ivy signs on the operative side. Average intervals between the operation day and the date when the decreased or vanished ivy sign was first recognized were 157.6 days in patients who underwent direct bypass and 212.2 days in patients who underwent indirect bypass. A postoperative decrease in ivy signs was found to be significantly correlated with an improved hemodynamic status of the surgically treated hemisphere, resulting in a postoperative increase in regional vascular reserve and a decreased proportion of the misery perfusion area (P < .01).
  
  
  CONCLUSIONS
  Postoperative changes in the ivy sign can be used as a marker for identifying improved hemodynamics and also for testing the effectiveness of cerebral revascularization.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan. m996kawa@cc.saga-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Kawashima
authors.forename: T
authors.initials: T
authors.lastname: Noguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Takase
authors.forename: Y
authors.initials: Y
authors.lastname: Nakahara
authors.forename: T
authors.initials: T
authors.lastname: Matsushima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002548:Cerebral Revascularization / Q000379:methods*; D002555:Cerebrospinal Fluid / Q000166:cytology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008578:Meninges / Q000473:pathology*; D008875:Middle Aged; D009072:Moyamoya Disease / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Ann Nucl Med. 2004 Feb;18(1):13-21
references.pmid: 15072179
references.citation: Neurosurgery. 1995 Nov;37(5):1009-12
references.pmid: 8559324
references.citation: AJNR Am J Neuroradiol. 1999 Nov-Dec;20(10):1836-8
references.pmid: 10588105
references.citation: J Nucl Med. 1992 Aug;33(8):1579-85
references.pmid: 1634959
references.citation: Neuroradiology. 1997 Jun;39(6):406-10
references.pmid: 9225318
references.citation: J Nucl Med. 1994 Dec;35(12):2019-30
references.pmid: 7989987
references.citation: Eur Neurol. 2007;57(2):75-9
references.pmid: 17179708
references.citation: AJNR Am J Neuroradiol. 2001 Apr;22(4):632-6
references.pmid: 11290469
references.citation: Ann Nucl Med. 2009 Jan;23(1):33-41
references.pmid: 19205836
references.citation: Acta Neurochir (Wien). 2000;142(3):269-76
references.pmid: 10819257
references.citation: J Clin Invest. 1948 Jul;27(4):476-83
references.pmid: 16695568
references.citation: J Neurol. 2006 May;253(5):631-5
references.pmid: 16362529
references.citation: AJNR Am J Neuroradiol. 2009 Oct;30(9):1709-16
references.pmid: 19713323
references.citation: Neurosurgery. 1992 Sep;31(3):401-5
references.pmid: 1407421
references.citation: AJNR Am J Neuroradiol. 2009 Mar;30(3):564-8
references.pmid: 19022866
references.citation: Stroke. 2003 Sep;34(9):2279-84
references.pmid: 12881609
references.citation: AJNR Am J Neuroradiol. 2009 May;30(5):930-5
references.pmid: 19246527
references.citation: Neuroradiology. 1999 May;41(5):342-6
references.pmid: 10379591