%0 Journal Article %A M. Kawashima %A T. Noguchi %A Y. Takase %A Y. Nakahara %A T. Matsushima %T Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease %D 2010 %R 10.3174/ajnr.A2124 %J American Journal of Neuroradiology %P 1713-1718 %V 31 %N 9 %X BACKGROUND AND PURPOSE: The “ivy” sign that is identified on FLAIR images in patients with Moyamoya disease is considered to be leptomeningeal collaterals. The aim of our study was to evaluate the correlation between postoperative decrease in ivy sign and cerebral hemodynamic status in the bypass-established hemisphere. MATERIALS AND METHODS: Twenty-two patients with Moyamoya disease were enrolled. Postoperative changes in the ivy sign on FLAIR images were examined in each patient after bypass surgery. The correlation between postoperative changes in the ivy sign and hemodynamic status was examined in 10 patients by using SPECT. RESULTS: Of the 22 preoperative ivy-positive patients, 21 showed decreased ivy signs on the operative side. Average intervals between the operation day and the date when the decreased or vanished ivy sign was first recognized were 157.6 days in patients who underwent direct bypass and 212.2 days in patients who underwent indirect bypass. A postoperative decrease in ivy signs was found to be significantly correlated with an improved hemodynamic status of the surgically treated hemisphere, resulting in a postoperative increase in regional vascular reserve and a decreased proportion of the misery perfusion area (P < .01). CONCLUSIONS: Postoperative changes in the ivy sign can be used as a marker for identifying improved hemodynamics and also for testing the effectiveness of cerebral revascularization. ACZacetylzolamideCBFcerebral blood flowFLAIRfluid-attenuated inversion recoveryInfinferior123I-IMPiodine-123-N-isopropyl-p-iodoamphetamineIVintravenousJETJapanese Extracranial-Intracranial Bypass TrialLleftLt Laleft lateralMCAmiddle cerebral arteryMRAMR angiographyMRIMR imagingPETpositron-emission tomographypostope.postoperativepreope.preoperativeRrightRt Latright lateralSTA-MCAsuperficial temporal artery−middle cerebral arteryrCBFregional CBFRestrestingrVRregional VRSPECTsingle-photon emission CTSupsuperiorVRvascular reserve %U https://www.ajnr.org/content/ajnr/31/9/1713.full.pdf