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De novo ivy sign indicates postoperative hyperperfusion in moyamoya disease

Nobutaka Horie1, Minoru Morikawa, Youichi Morofuji

  • 1From the Departments of Neurosurgery (N.H., Y.M., T.H., T.I., K.H., I.N.) and Radiology (M.M.), Nagasaki University School of Medicine, Nagasaki, Japan.

Stroke
|April 10, 2014
PubMed
Abstract

Insights

A new "ivy sign" on MRI after moyamoya disease (MMD) bypass surgery may indicate postoperative hyperperfusion. This finding is not always linked to pre-existing cerebral blood flow issues.

Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • The ivy sign on fluid-attenuated inversion recovery (FLAIR) MRI is a specific indicator in moyamoya disease (MMD).
  • It reflects reduced cerebral perfusion, enlarged pial vessels, and slow collateral flow.
  • Cerebral hyperperfusion is a common complication in MMD of unknown cause.

Purpose of the Study:

  • To investigate the characteristics of perioperative changes in the MMD ivy sign.
  • To correlate these changes with cerebral hyperperfusion following bypass surgery.

Main Methods:

  • Prospective study of MMD patients undergoing superior temporal artery-middle cerebral artery single bypass.
  • FLAIR MRI to assess the ivy sign preoperatively and on postoperative days 2 and 30.
  • Evaluation of the ivy sign alongside perioperative symptoms and cerebral hemodynamics via single-photon emission computed tomography (SPECT).

Main Results:

  • 32 out of 42 patients (58.2%) developed a de novo ivy sign on postoperative day 2, which resolved by day 30.
  • Patients with a de novo ivy sign had a higher incidence of SPECT-confirmed hyperperfusion and hyperperfusion syndrome.
  • No correlation was found between the de novo ivy sign and preoperative ivy sign or hemodynamics.
  • Multivariate analysis revealed a significant correlation between the de novo ivy sign and postoperative hyperperfusion.

Conclusions:

  • A de novo ivy sign post-bypass may signal postoperative hyperperfusion in MMD.
  • This sign's occurrence is not consistently linked to preoperative hemodynamic impairment.
  • Factors beyond preoperative cerebral hemodynamics may contribute to postoperative hyperperfusion in MMD.
Keywords:
moyamoya disease

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