Identification of Sulcal Hyperintense Vessel (Vessel Wall MR Ivy Sign) in Adult Moyamoya Disease with High-resolution Vessel Wall Imaging : A Pilot Study.

IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Journal of Korean Neurosurgical Society Pub Date : 2025-01-10 DOI:10.3340/jkns.2024.0096
Ju In Park, Jae Seong Hong, Jiwook Ryu, Kyung Mi Lee, Ho Geol Woo, Seok Keun Choi
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Abstract

Objective: The leptomeningeal ivy sign is a distinctive finding of moyamoya disease (MMD), characterized by a linear high signal intensity along the cortical sulci on contrast-enhanced T1 magnetic resonance imaging (MRI) and fluid-attenuated inversion-recovery MRI. We recently identified a similar linear enhancement along the cortical sulci using gadolinium-enhanced vessel wall MRI (VWMR) in patients with MMD. The aim of this study was to introduce the concept of the "VWMR ivy sign (VIS)".

Methods: Eighteen MMD patients underwent gadolinium-enhanced VWMR. We identified the VIS in gadolinium-enhanced VWMR, represented by a linear high intensity along the cortical sulci. The VIS was assessed by comparing pre and postcontrast T1 black blood sequences on VWMR and was investigated in the precentral, central, and postcentral sulci. "VIS scores" were calculated by the sum of VIS in the three sulci, ranged from 0 to 3. We compared the VIS scores according to different stroke presentations (non-stroke, ischemic stroke, and hemorrhagic stroke). The inter-modality agreement for identifying VIS and fluid-attenuated inversion-recovery (FLAIR)/cortical sulci on contrast-enhanced T1 MRI (CEMR) ivy sign was determined using Cohen's kappa statistics.

Results: The VIS scores were significantly different among the three groups (P = 0.004). The VIS scores in both the ischemic and hemorrhagic groups were significantly higher than those in the non-stroke group (ischemic vs. non-stroke, P = 0.009; hemorrhagic vs. non-stroke, P = 0.004). After adjusting for age and sex using the non-stroke group as a reference group, the VIS scores were significantly higher in the ischemic and hemorrhagic groups (P=0.046, OR 8.27, 95% CI 1.03-66.19 and P=0.039, OR 7.78, 95% CI 1.11-54.48, respectively). Inter-modality agreement between VIS and FLAIR ivy sign was substantial, perfect, and substantial in the precentral, central, and postcentral sulci, respectively (precentral sulcus, κ=0.609, 95% CI=0.213-1; central sulcus, κ=1; and postcentral sulcus, κ=0.769, 95% CI=0.475-1). Inter-modality agreement between the VIS and CEMR ivy sign was substantial in the precentral, central, and postcentral sulci, respectively (precentral sulcus, κ=0.727, 95% CI=0.384-1; central sulcus, κ=0.609, 95% CI=0.384-1; and postcentral sulcus, κ=0.649, 95% CI=0.310-0.998).

Conclusion: This preliminary series introduces the concept of VIS, possibly indicating slow and retrograde flow of sulcal vessels via leptomeningeal collaterals. Future studies are needed to develop an optimal scoring system for VIS and establish its clinical correlation with stroke presentations in MMD patients.

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用高分辨率血管壁成像识别成人烟雾病的沟高信号血管(血管壁MR常青藤征):一项初步研究
目的:薄脑膜常春藤征是烟雾病(MMD)的一种独特表现,其特征是在T1增强磁共振成像(MRI)和液体衰减反转恢复MRI上沿皮质沟呈线性高信号强度。我们最近使用钆增强血管壁MRI (VWMR)在烟雾病患者中发现了类似的沿皮质沟的线性增强。本研究的目的是介绍“VWMR常春藤标志(VIS)”的概念。方法:18例烟雾病患者行钆增强VWMR。我们在钆增强VWMR中确定了VIS,其表现为沿皮质沟的线性高强度。通过比较对比前后的T1黑血VWMR序列来评估VIS,并在中心前、中心和中心后沟进行研究。“VIS评分”由三个沟的VIS之和计算,范围从0到3。我们根据不同的卒中表现(非卒中、缺血性卒中和出血性卒中)比较VIS评分。使用Cohen's kappa统计确定对比增强T1 MRI (CEMR)常春藤征象识别VIS和液体衰减反转恢复(FLAIR)/皮质沟的模态一致性。结果:三组患者VIS评分差异有统计学意义(P = 0.004)。缺血组和出血性组VIS评分均显著高于非卒中组(缺血组vs.非卒中组,P = 0.009;出血性与非卒中,P = 0.004)。在调整年龄和性别后,以非卒中组为参照组,缺血组和出血性组的VIS评分明显更高(P=0.046, OR 8.27, 95% CI 1.03-66.19, P=0.039, OR 7.78, 95% CI 1.11-54.48)。VIS和FLAIR青藤征象之间的模态一致性显著、完美,在中央前沟、中央沟和中央后沟分别显著(中央前沟,κ=0.609, 95% CI=0.213-1;中央沟,κ=1;中央后沟,κ=0.769, 95% CI=0.475-1)。在中央前沟、中央沟和中央后沟,VIS和CEMR ivy信号之间的模态一致性显著(中央前沟,κ=0.727, 95% CI=0.384-1;中央沟,κ=0.609, 95% CI=0.384-1;中央后沟,κ=0.649, 95% CI=0.310 ~ 0.998)。结论:这个初步的系列介绍了VIS的概念,可能表明通过小脑膜侧支的沟血管缓慢和逆行流动。未来的研究需要开发一个最佳的VIS评分系统,并建立其与烟雾病患者卒中表现的临床相关性。
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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
109
审稿时长
3-8 weeks
期刊介绍: The Journal of Korean Neurosurgical Society (J Korean Neurosurg Soc) is the official journal of the Korean Neurosurgical Society, and published bimonthly (1st day of January, March, May, July, September, and November). It launched in October 31, 1972 with Volume 1 and Number 1. J Korean Neurosurg Soc aims to allow neurosurgeons from around the world to enrich their knowledge of patient management, education, and clinical or experimental research, and hence their professionalism. This journal publishes Laboratory Investigations, Clinical Articles, Review Articles, Case Reports, Technical Notes, and Letters to the Editor. Our field of interest involves clinical neurosurgery (cerebrovascular disease, neuro-oncology, skull base neurosurgery, spine, pediatric neurosurgery, functional neurosurgery, epilepsy, neuro-trauma, and peripheral nerve disease) and laboratory work in neuroscience.
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Cement-Augmented Pedicle Screw Fixation in Patients with Osteoporosis : Safety, Efficacy and Complications. A Successful Control of the Intraoperative Bleeding from McConnell's Artery during Fully Endoscopic Resection of Planum Sphenoidale Meningioma Using Bone Chip and Bioglue : A Case Report. Aneurysm at the Trunk of the Medial-Type Persistent Trigeminal Artery Associated with Facial Pain : A Rare Case Report. Comparison of Clazosentan and Nimodipine on Vasospasm and Vasospasm-Related Outcomes after Aneurysmal Subarachnoid Hemorrhage : A Post-hoc Propensity Score-Matched Analysis of Six Randomized Clinical Trials. Identification of Sulcal Hyperintense Vessel (Vessel Wall MR Ivy Sign) in Adult Moyamoya Disease with High-resolution Vessel Wall Imaging : A Pilot Study.
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