Purpose: MR perfusion and SPECT are well known imaging to evaluate hemodynamic change after STA-MCA bypass. But their side effects and invasiveness make discomfort to patients. We evaluated “Ivy sign” and “spaghetti sign” on MR FLAIR in adult patients with Moyamoya disease and steno-occlusive disease performed STA-MCA bypass and compared it with result of SPECT and MR perfusion. 

Methods: We enrolled 49 patients and we compare the Ivy sign and spaghetti sign score on preoperative and postoperative MR FLAIR. The correlations between FLAIR images and hemodynamic status measured by and MR perfusion were evaluated. 

Results: Among 49 patients, 17 were treated with Moyamoya disease, and 32 were symptomatic steno-occlusive disease. Minimal and Positive Ivy and Spaghetti sign was seen in all. In Moyamoya group, Ivy signs score on MR FLAIR were improved (10 preoperative and 5 postoperative in ACA territory, 17 and 5 in anterior MCA territory, and 24 and 11 in the posterior MCA territory). In symptomatic steno-occlusive disease group, Spaghetti signs score on MR FLAIR were also improved. (12 preoperative and 7 postoperative in ACA territory, 23 and 10 in anterior MCA territory, 7 and 4 in posterior MCA territory). Like this result, CVR on SPECT was significantly increased in the sum of CVR in same regions after STA-MCA bypass.

Conclusion: As compared with conventional diagnostic modalities such as SPECT and MR perfusion images, Ivy sign and Spaghetti sign on MR FLAIR is considered as a useful indicator in detecting brain hemodynamic changes between preoperatively and postoperatively after STA-MCA bypass.

THE EFFICIENCY OF FLAIR IMAGES FOR HEMODYNAMIC CHANGE AFTER STA-MCA BYPASS WITH MOYAMOYA DISEASE AND SYMPTOMATIC STENO-OCCLUSIVE DISEASE