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Ivy sign, misery perfusion, and asymptomatic moyamoya disease: FLAIR imaging and 15O-gas positron emission tomography

  • Clinical Article - Vascular
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Abstract

Background

The prevalence of ivy sign on fluid-attenuated inversion recovery (FLAIR) imaging in patients with asymptomatic moyamoya disease is unclear. The aim of this study was to clarify the incidence of ivy sign in these patients, as well as the correlation between MRI and 15O gas PET findings.

Methods

A retrospective analysis including 16 consecutive patients with asymptomatic moyamoya disease enrolled between 2001 and 2010 in a single center. FLAIR imaging at the initial visit was categorized as ivy sign present, negative, or equivocal. Hemodynamic and metabolic parameters were quantified in 11 of 16 patients by 15O-gas positron emission tomography, and the relationship between ivy sign and 15O-gas PET parameters was analyzed. Cerebrovascular events within the follow-up period (54 ± 28 months) were also examined.

Results

Five of 16 asymptomatic moyamoya patients (31.3 %) had positive ivy sign (6/30 hemispheres, 20 %). In 15O-gas PET examinations, 18 % of 22 hemispheres had elevated oxygen extraction fraction values that were significantly associated with positive ivy sign. Of these 16 asymptomatic moyamoya patients, six patients (37.5 %) underwent combined surgical revascularization. In this series, no patients experienced ischemic stroke, but one had intraventricular bleeding 1 year after surgery.

Conclusions

Ivy sign on FLAIR imaging is still not rare in patients with moyamoya disease, even when asymptomatic. Although optimal management is still under debate, ivy sign may be an indicator of misery perfusion, and patients with asymptomatic moyamoya disease and ivy sign on FLAIR imaging will benefit from more careful follow-up.

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Authors and Affiliations

  1. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan

    Sandra Vuignier, Masaki Ito, Kota Kurisu, Ken Kazumata, Naoki Nakayama, Hideo Shichinohe & Kiyohiro Houkin

  2. Department of Neurosciences, Geneva University, 24 Rue du Général-Dufour, Geneva 4, 1211, Switzerland

    Sandra Vuignier & Jozsef Zoltan Kiss

  3. Department of Neurosurgery, Otaru Municipal Medical Center, Nagahashi 3-11-1, Otaru, 047-0036, Japan

    Masaki Ito

  4. Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan

    Tohru Shiga & Nagara Tamaki

Authors
  1. Sandra Vuignier
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  2. Masaki Ito
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  3. Kota Kurisu
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  4. Ken Kazumata
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  5. Naoki Nakayama
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  6. Hideo Shichinohe
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  7. Tohru Shiga
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  8. Jozsef Zoltan Kiss
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  9. Nagara Tamaki
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  10. Kiyohiro Houkin
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Corresponding author

Correspondence to Masaki Ito.

Additional information

Sandra V and Masaki I contributed equally to the present manuscript.

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Vuignier, S., Ito, M., Kurisu, K. et al. Ivy sign, misery perfusion, and asymptomatic moyamoya disease: FLAIR imaging and 15O-gas positron emission tomography. Acta Neurochir 155, 2097–2104 (2013). https://doi.org/10.1007/s00701-013-1860-4

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  • DOI: https://doi.org/10.1007/s00701-013-1860-4

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