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Ivy Sign: Usefulness in Diagnosis and Prognosis Prediction of Moyamoya Disease
Yue Li1, Wanjiang Li2, Chunchao Xia2
1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Background:
Moyamoya disease (MMD) cannot be found commonly as a rare type compared with other vascular disease, such as aneurysm. However, it cannot be ignored for its high fatality and disability rates. In addition, exact pathogenesis study of this disease is still on the way. The ivy sign is always observed in MMD, but the clinical importance of this sign in MMD isn't clearly known. The main purpose of this research was to specifically investigate the clinical significance.
Methods:
In this retrospective cohort study to gather the baseline clinical and imaging study, the patients with MMD were hospitalized from January 2016 to 2020. In the analysis, univariate and multivariate logistic regression was used to testify whether ivy sign was independently associated with MMD characteristics including cerebrovascular morphology, cerebral hemodynamics, cerebrovascular events, and postoperative collateral formation (PCF).
Results:
We included 156 patients with 312 hemispheres. As for the result of multivariate logistic regression analysis, we could discover a fact that ivy sign was tightly connected to the Suzuki stage ≥IV (odds ratio [OR], 1.386; 95% confidence interval [CI], 1.055-1.822; P = 0.019), cerebral blood flow (CBF) decreased type (OR, 2.330; 95% CI, 1.733-3.133; P = 0.000), age acted as a protective factor for CBF (OR, 0.966; 95% CI, 0.946-0.986; P = 0.001), the elder was more likely associated with decreased CBF. Ivy sign also played a significant role in ischemic cerebrovascular events (OR, 5.653; 95% CI, 3.092-10.336; P = 0.003), their remarkable connection could be seen on the study. We could also find that ivy sign was closely connected to the good PCF (OR, 2.830; 95% CI, 1.329-6.027; P = 0.007), and we couldn't ignore the fact that age was associated with good PCF as well (OR, 0.933; 95% CI, 0.882-0.987; P = 0.015).
Discussion:
We could be more aware of the connection between ivy sign and Moyamoya disease from this study in order to implement diagnosis, treatment, and prognosis more efficiently.
Insights
The ivy sign is significantly associated with advanced Moyamoya disease (MMD) stages, reduced cerebral blood flow, and ischemic events. This finding aids in better diagnosis and prognosis for MMD patients.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Moyamoya disease (MMD) is a rare but serious cerebrovascular disorder with high fatality and disability rates.
- The clinical significance of the 'ivy sign,' often observed in MMD, remains unclear.
- Understanding MMD pathogenesis is crucial for effective management.
Purpose of the Study:
- To investigate the clinical significance of the ivy sign in Moyamoya disease.
- To determine the association between the ivy sign and MMD characteristics.
- To explore the relationship between the ivy sign and clinical outcomes.
Main Methods:
- Retrospective cohort study of 156 MMD patients (312 hemispheres) hospitalized between 2016 and 2020.
- Univariate and multivariate logistic regression analyses were employed.
- Associations were examined between the ivy sign and cerebrovascular morphology, hemodynamics, events, and postoperative collateral formation (PCF).
Main Results:
- The ivy sign was independently associated with advanced Suzuki stage (≥IV) and decreased cerebral blood flow (CBF).
- Older age was linked to decreased CBF and better postoperative collateral formation (PCF).
- The ivy sign significantly correlated with increased risk of ischemic cerebrovascular events and good PCF.
Conclusions:
- The ivy sign is a clinically significant indicator in Moyamoya disease.
- Awareness of the ivy sign's associations can improve MMD diagnosis, treatment, and prognosis.
- Further research into MMD pathogenesis and the ivy sign is warranted.
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