Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease

Postoperative change in the misery perfusion area in the bypass-established hemisphere. The proportion of stage II area on the bypass-established hemisphere (A) is significantly lower than that on the contralateral hemisphere (B) (P = .0088).

Adult Moyamoya disease. Data from a 25-year-old female patient who had a right transient ischemic attack. She underwent direct bypass surgery on the left cerebral hemisphere. MR imaging of the preoperative (A) and postoperative (B) views shows a decrease in the ivy sign in the left MCA territory after bypass surgery. MRA of the preoperative (C) and postoperative (D) views shows increased flow-related enhancement via left superficial temporal arteries to the left MCA region after surgery. Quantitative analysis of preoperative (E) and postoperative (F) basal/ACZ stress brain perfusion SPECT. The lower 4 columns show 3D stereotactic surface projection format view sets of resting CBF, Diamox CBF, VR, and staging by a JET study from the top. VR is impaired preoperatively in most of the left MCA territory (E). Both VR and staging in the left MCA territory have improved postoperatively (F).