Abstract
Leptomeningeal enhancement on postcontrast imaging has been reported in patients with moyamoya disease.1–4 Because it bears resemblance to creeping ivy, this phenomenon is referred to as ivy sign, and it was assumed to be associated with engorged pial vessels and slow flow.1–4 However, to our knowledge, the correlation between ivy sign and perfusion status has never been investigated. The aim of our study was to elucidate whether ivy sign is associated with altered perfusion. ### Methods. This study was approved by local institutional review boards. We identified five consecutive patients with moyamoya disease who visited our hospital (a tertiary university hospital) between October 2007 and September 2008. The diagnosis of moyamoya disease was made on the basis of clinical findings, brain MRI and magnetic resonance angiography, and conventional angiography according to the proposed criteria.5 Two of the 10 hemispheres were excluded. One patient had an acute ischemic stroke in the left middle cerebral artery territory, and another patient had unilateral disease. Therefore, eight hemispheres were finally analyzed. Brain MRI was performed with a 3.0-T magnetic resonance unit (3.0T Achieva, Philips Medical System, Best, the …
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