Division of Neuropaediatrics, Hospital for Children and Adolescents, University Leipzig, Leipzig, Germany.
Department of Pediatric Radiology, University Leipzig, Leipzig, Germany.
Neuropediatrics. 2020 Aug;51(4):241-244. doi: 10.1055/s-0040-1708546. Epub 2020 Mar 31.
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."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.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.
烟雾病的特征是颈内动脉末端及其近端分支的双侧、慢性进行性狭窄。血管造影中的“烟雾状”动脉侧支循环外观赋予了该病名称。“常春藤征”是该病不太为人知的磁共振成像（MRI）模式。软脑膜侧支在对比增强 T1 加权图像和液体衰减反转恢复序列中表现为脑表面弥漫性信号增强，“就像被常春藤覆盖一样”。我们报告了 3 例烟雾病患者，他们的“常春藤征”在初始脑 MRI 中已经存在，但被误诊。只有在重复 MRI 后才做出正确诊断。通过三个病例研究，我们描述了将“常春藤征”作为 MRI 模式进行解释的困难。了解“常春藤征”可能会有所帮助，尤其是在易患烟雾病的疾病中。如果存在这种 MRI 模式，应考虑烟雾病，并应添加磁共振血管造影。
