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Media type:
E-Article
Title:
The “Ivy-Sign” in Moyamoya Disease—From MRI Pattern to Diagnosis
Contributor:
Gburek-Augustat, Janina;
Sorge, Ina;
Merkenschlager, Andreas
imprint:
Georg Thieme Verlag KG, 2020
Published in:Neuropediatrics
Language:
English
DOI:
10.1055/s-0040-1708546
ISSN:
1439-1899;
0174-304X
Origination:
Footnote:
Description:
<jats:title>Abstract</jats:title><jats:p>Moyamoya disease (MMD) is characterized by bilateral, chronic progressive stenosis at the terminal portions of the internal carotid arteries and their proximal branches. The “smoke-like” appearance of the arterial collaterals in angiography gives the disease its name. The “ivy-sign” is the less-known magnetic resonance imaging (MRI) pattern of this disease. The leptomeningeal collaterals present as diffuse signal enhancement at the brain surface in contrast-enhanced T1-weighted image and fluid-attenuated inversion recovery sequences “as if overgrown with ivy.”</jats:p><jats:p>We report on three patients with MMD in whom the “ivy-sign” was already present but misinterpreted in the initial MRI of the brain. The correct diagnosis was made only after repeated MRI.</jats:p><jats:p>Using three case studies, we describe the difficulties in the interpretation of the “ivy-sign” as an MRI pattern. Knowledge of the “ivy-sign” can be helpful, especially in diseases predisposing to MMD. If this MRI pattern is present, MMD should be considered and MR angiography should be added.</jats:p>