PMID- 37310055 OWN - NLM STAT- MEDLINE DCOM- 20231204 LR - 20240119 IS - 1933-0693 (Electronic) IS - 0022-3085 (Linking) VI - 139 IP - 6 DP - 2023 Dec 1 TI - The ivy sign as a radiological marker for follow-up of postoperative cerebral perfusion status in adult moyamoya disease. PG - 1697-1704 LID - 10.3171/2023.4.JNS23294 [doi] AB - OBJECTIVE: Little is known about the relationship between postoperative changes in cerebral perfusion and the ivy sign representing leptomeningeal collateral burden in moyamoya disease (MMD). This study aimed to investigate the usefulness of the ivy sign in evaluating cerebral perfusion status following bypass surgery in patients with adult MMD. METHODS: Two hundred thirty-three hemispheres in 192 patients with adult MMD undergoing combined bypass between 2010 and 2018 were retrospectively enrolled. The ivy sign was represented as the ivy score on FLAIR MRI in each territory of the anterior, middle, and posterior cerebral arteries. Ivy scores, as well as clinical and hemodynamic states on SPECT, were semiquantitatively compared both preoperatively and at 6 months after surgery. RESULTS: Clinical status improved at 6 months after surgery (p < 0.01). On average, ivy scores in whole and individual territories were decreased at 6 months (all p values < 0.01). Cerebral blood flow (CBF) postoperatively improved in three individual vascular territories (all p values