title: Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease: Correlation with Clinical Severity and Old Brain Lesions.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kwon-Duk
authors.initials: KD
authors.lastname: Seo
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Suh
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ji Hwa
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sung Jun
authors.initials: SJ
authors.lastname: Ahn
authors.affiliation: Department of Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. kylee@yuhs.ac.|Severance Institute for Vascular and Metabolic Research, Seoul, Korea.
authors.forename: Kyung-Yul
authors.initials: KY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000378:metabolism / Q000473:pathology*; D002536:Cerebral Arteries / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008578:Meninges / Q000473:pathology*; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000473:pathology*; D012720:Severity of Illness Index; D020521:Stroke; D055815:Young Adult
keywords: FLAIR; MRI; Moyamoya disease; ivy sign; old lesion; supraclinoid carotid stenosis