Tuesday 21 February 2012

IVY sign in major vessel stenosis

A  7yo patient came for MRI Brain with history ... no need to mention here as it was not specific and i am sure it was not related to patient's imaging findings. 
Only Axial FLAIR images of patient were abnormal with a subtle finding. Rest of the MRI study including Diffusion and GRE were absolutely normal.
Guess !! the finding.
Faint serpigenous high signal in right peri sylvian cortical sulci are the cortical branches of right MCA with sluggish flow attributed to IVY sign.
and that's his angio... 
Click image to enlarge. 
3 D TOF Non contrast MR Angiography of brain shows severe right MCA proximal main stem stenosis with sparsity of cortical branches of right MCA compared to left. 

'IVY' sign
Normally cortical branches of major intra cranial vessels which travel along hemispheric cortical sulci are not visualised on FLAIR.
Due to any reason if the flow in these cortical branches hampered, the slow flow in these cortical branches or the cortical collaterals developed thereby , reflect high signal on FLAIR, relatively higher than that of adjacent normal isointense brain parenchyma and seen as serpigenous hyperintensities in the region of cortical sulci on FLAIR attributed to IVY sign. 

IVY sign is reported in following conditions.
Moya Moya disease or major intra cranial vessel stenosis lead to cortical branches with slow flow or development of collaterals with sluggish flow.
Early ischemia thrombus in cortical branches may reflect high signal on FLAIR

To see similar cases with other causes of IVY sign : Click here

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