title: 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.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.
authors.forename: Jung Keun
authors.initials: JK
authors.lastname: Lee
authors.forename: Byul Hee
authors.initials: BH
authors.lastname: Yoon
authors.forename: Seung Young
authors.initials: SY
authors.lastname: Chung
authors.forename: Moon Sun
authors.initials: MS
authors.lastname: Park
authors.forename: Seong Min
authors.initials: SM
authors.lastname: Kim
authors.forename: Do Sung
authors.initials: DS
authors.lastname: Lee
keywords: Adult moyamoya; Ivy sign; MR FLAIR; STA-MCA anastomosis