Ivy Sign: Usefulness in Diagnosis and Prognosis Prediction of Moyamoya Disease

Moyamoya disease can not be found commonly as a rare type compared to other vascular disease, such as aneurysm. However, it can not be ignored for its high fatality and disability rate. In addition, exact pathogenesis study of this disease is still on the way. The ivy sign is always observed in Moyamoya disease (MMD), but the clinical importance of this sign in MMD isn't clearly known. The main purpose of this research was to specifically investigate the clinical significance. The patients with Moyamoya disease were hospitalized from January 2016 to 2020, it's a retrospective cohort study to gather the baseline clinical and imaging study. In the analysis, univariate and multivariate logistic regression was utilized to testify whether ivy sign was independently associated with MMD characteristics, including cerebrovascular morphology, cerebral hemodynamics, cerebrovascular events and postoperative collateral formation (PCF). 156 patients were included with 312 hemispheres. AS for the result of multivariate logistic regression analysis, we could discover a fact that ivy sign was tightly connected to the Suzuki stage ≥IV(OR, 1.386; 95%CI, 1.055 - 1.822; p = 0.019), CBF (cerebral blood flow) decreased type (OR, 2.330; 95%CI, 1.733 - 3.133; p = 0.000), age acted as a protective factor for CBF(OR, 0.966; 95%CI, 0.946 - 0.986; p = 0.001), the elder was more likely associated with decreased CBF. ivy sign also played an significant role in Ischemic cerebrovascular events (OR, 5.653; 95%CI, 3.092 - 10.336; p = 0.003), their remarkable connection could be seen on the study. We could also find that ivy was closely connected to the good postoperative collateral formation (PCF) (OR, 2.830; 95%CI, 1.329 - 6.027; p = 0.007), we couldn't ignore that age was associated with good PCF as well (OR, 0.933; 95%CI, 0.882 - 0.987; p = 0.015). We could be more aware of the connection between ivy sign and Moyamoya disease form this study, to implement on diagnosis, treatment, prognosis more efficiently.