HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2232011094v1 223/2/384    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yoon, H.-K. Articles by Chang, Y. W. Search for Related Content PubMed PubMed Citation Articles by Yoon, H.-K. Articles by Chang, Y. W.

"Ivy Sign" in Childhood Moyamoya Disease: Depiction on FLAIR and Contrast-enhanced T1-weighted MR Images¹

¹ From the Departments of Radiology (H.K.Y., Y.W.C.) and Neurosurgery (H.J.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul 135-710, Korea. Received June 25, 2001; revision requested July 11; revision received October 12; accepted October 22. Address correspondence to H.J.S. (e-mail: hjshin@smc.samsung.co.kr).

PURPOSE: To compare contrast material–enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images with or without gadolinium in depicting the leptomeningeal ivy sign in children with moyamoya disease.

MATERIALS AND METHODS: Twenty-nine sets of FLAIR and postcontrast T1-weighted MR images were available in 19 consecutive children with primary moyamoya disease confirmed with conventional and MR angiography. Contrast-enhanced FLAIR MR images also were available in 15 sets. Two pediatric radiologists reviewed FLAIR and postcontrast T1-weighted images in separate sessions for the leptomeningeal ivy sign and assigned a rating of "present," "absent," or "equivocal" by consensus. Unenhanced and contrast-enhanced FLAIR MR images were compared side by side to determine which better depicted leptomeningeal high signal intensities.

RESULTS: Postcontrast T1-weighted MR images revealed the leptomeningeal ivy sign in 40 hemispheres (frequency of visualization, 71% [40 of 56 hemispheres]), whereas unenhanced FLAIR MR images depicted it in 26 hemispheres (frequency of visualization, 46% [26 of 56 hemispheres]). An equivocal rating was given in 21 hemispheres versus in 11 on FLAIR and postcontrast T1-weighted images, respectively. FLAIR and postcontrast T1-weighted images agreed in 40 hemispheres. There was no case with a positive rating on FLAIR images when postcontrast T1-weighted images were negative. Unenhanced FLAIR MR imaging was superior to contrast-enhanced FLAIR imaging in seven hemispheres, whereas enhanced FLAIR was better in four of 28 hemispheres. In the remaining 17, findings with each sequence were similar.

CONCLUSION: Contrast-enhanced T1-weighted images are better than FLAIR images for depicting the leptomeningeal ivy sign in moyamoya disease.

© RSNA, 2002

Index terms: Moyamoya disease, 17.7213 • Cerebral blood vessels, MR, 17.121416, 17.12142 • Cerebral blood vessels, stenosis or obstruction, 17.7213

This article has been cited by other articles:

				N. J. Ullrich, R. Robertson, D. D. Kinnamon, R. M. Scott, M. W. Kieran, C. D. Turner, S. N. Chi, L. Goumnerova, M. Proctor, N. J. Tarbell, et al. Moyamoya following cranial irradiation for primary brain tumors in children Neurology, March 20, 2007; 68(12): 932 - 938. [Abstract] [Full Text] [PDF]

				J Gaa and S Weidauer Unusual differential diagnosis of leptomeningeal enhancement: moyamoya disease J. Neurol. Neurosurg. Psychiatry, August 1, 2004; 75(8): 1170 - 1170. [Full Text] [PDF]

				J. Takanashi, H. Suzuki, A.J. Barkovich, K. Sugita, N. Saeki, E. Kobayashi, K. Fujii, and Y. Kohno Medullary streaks: Dilated medullary vessels in chronic ischemia in children Neurology, August 26, 2003; 61(4): 583 - 584. [Full Text] [PDF]