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Case Reports
. 2016 Feb;48(1):58-61.
doi: 10.5152/eurasianjmed.2015.14142.

Ivy Sign in Moyamoya Disease

Ali Kemal Sivrioglu  1 , Muzaffer Saglam  2 , Bulent Yildiz  3 , Vania Anagnostakou  4 , Osman Kizilkilic  5
Affiliations
Case Reports

Ivy Sign in Moyamoya Disease

Ali Kemal Sivrioglu et al. Eurasian J Med. 2016 Feb.

Abstract
in English, Turkish

Moyamoya disease is an idiopathic disease characterized by the progressive stenosis and collateral development of the distal internal carotid arteries. In this disease, several collateral vascular structures develop following stenosis and occlusion. The ivy sign is a characteristic Magnetic rezonance imaging (MRI) finding frequently encountered in patients with moyamoya. It can be observed both in post contrast T1-weighted images and Fluid attenuated inversion recovery (FLAIR) images. While this sign manifests in the form of contrasting on the cortical surfaces due to the formation of leptomeningeal collateral development and increased numbers of pial vascular webs on post contrast images, in FLAIR images it originates from the slow arterial flow in the leptomeningeal collateral vascular structures. In this case, we presented the Digital subtraction angiography (DSA) signs of moyamoya disease and "ivy sign" in MRI and its development mechanism in a 16 years old female patient.

Moyamoya hastalığı distal internal karotid arterlerin ilerleyici stenozu ve kollateral gelişimi ile karakterize idiyopatik bir hastalıktır. Bu hastalıkta, stenoz ve oklüzyonu takiben kollateral vasküler yapılar gelişir. Ivy bulgusu sıklıkla moyamoyalı hastalarda izlenen karakteristik Magnetik Rezonans Görüntüleme (MRG) bulgusudur. Bu bulgu kontrastlı T1-ağırlıklı ve Fluid attenuated inversion recovery (FLAIR) görüntülerde gözlemlenebilir. Ivy bugusu postkontrast görüntülerde leptomeningeal kolaterallerin gelişimi ve artan pial vasküler ağ nedeniyle oluşan kollateral yüzeylerde kontrastlanma şeklinde izlenirken, FLAIR görüntülerde leptomeningeal kollateral vasküler yapılarda yavaş arteriyel akım nedeniyle oluşur. Bu olguda, moyamoya hastalığının Digital subtraction angiography (DSA) bulgularını, MRG’de Ivy bulgusunu ve 16 yaşında kadın hastada bu bulgunun gelişim mekanizmasını sunduk.

Keywords: DSA; Ivy Sign; MRI; Moyamoya Disease.

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Figures

Figure 1. a, b.
Figure 1. a, b.
On axial FLAIR images, a) loss of volume in the right MCA irrigation area compatible with chronic infarct in the frontoparietal region (star) and signal increases compatible with the “ivy sign” in the left frontal lobe (arrows), b) signal increases compatible with the “ivy sign” in left frontal lobe (arrows) can be seen.
Figure 2. a, b.
Figure 2. a, b.
On axial post contrast T1 weighted MR imaging, (a) loss of volume in the right MCA irrigation area compatible with chronic infarct in the frontoparietal region (star), (b) volume loss in the left MCA irrigation area (star) in the temporal occipital region compatible with chronic infarct and in both images diffuse leptomeningeal contrasting (arrows) compatible with the “ivy sign” on sulcus surfaces being more prominent in the basal cisterns can be seen.
Figure 3. a, b.
Figure 3. a, b.
On posterior anterior DSA images, (a) right and (b) left ICA appears completely occluded from the ophthalmic segments. Decreased ICA calibrations are noteworthy (arrows). Common osteodural anastomosis draws attention from the external carotid artery to the internal carotid artery branches.
Figure 4. a, b.
Figure 4. a, b.
On the (a) posteroanterior and (b) lateral DSA images; with right vertebral artery injections, as being more prominent on the left, both MCA distal irrigation areas are restricted in this region by the developed collaterals (arrows) can be seen (star: cerebellar hemispheres).
See this image and copyright information in PMC

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