case_images: PMC11090599_01
case_images: Radiological findings of a 13-year-old girl with moyamoya disease (Case 1). (a) Right internal carotid angiography demonstrated typical findings of moyamoya disease, including severe stenosis of the supraclinoid portion of the internal carotid artery and the horizontal portions of the anterior and middle cerebral arteries. (b) Left internal carotid angiography also showed very similar findings. Note the markedly dilated perforating arteries on both sides. (c) Single photon emission computed tomography (SPECT) demonstrated cerebral blood flow reduction in the internal carotid artery territories on both sides. (d) Fluid-attenuated inversion recovery (FLAIR) image showed the "patchy" hyperintensity lesions (arrows) in the periventricular white matter and also the "striated" hyperintensity lesions (arrowheads) in the periventricular white matter. The "striated" lesions appear to radiate from the lateral ventricles. (e) These hyperintensity lesions on FLAIR image cannot be detected on T1- weighted MRI. (f) Diffusion-weighted MRI did not identify them. (g) Cerebral blood flow almost normalized 6 months after combined bypass surgery on both sides. (h) The "striated" hyperintensity lesions completely disappeared 6 months after surgery. (i) The "patchy" hyperintensity lesions regressed 6 months after surgery and further diminished 12 months after surgery(arrows)
case_images: SNI-15-131-g001.jpg
case_images: PMC11090599_01_SNI-15-131-g001.jpg
case_images: F1
case_images: The perforating arteries were markedly dilated [Figures 1a and b]. N-isopropyl-I-123-p-iodoamphetamine (123I-IMP) single-photon emission computed tomography (SPECT) showed cerebral blood flow (CBF) reduction in the ICA territories on both sides [Figure 1c]. T1-weighted MRI demonstrated multiple flow voids due to the dilated perforating arteries [Figure 1d]. FLAIR images showed the WMH lesions on both sides [Figure 1e]. The WMH lesions included anatomically two morphologies, including "patchy (arrows)" and "striated (arrowheads)" patterns [Figure 1e]. Diffusion-weighted MRI found no abnormality in the white matter [Figure 1f]. CBF was restored to the normal level [Figure 1g]. Follow-up MRI revealed that the "striated" WMH lesions disappeared and the "patchy" WMH lesions diminished six months after surgery [Figure 1h], followed by further reduction of the "patchy" WMH lesions 12 months after surgery [Figure 1i].
case_images: PMC11090599_02
case_images: Radiological findings of a 10-year-old girl with moyamoya disease (Case 2). (a) Right nternal carotid angiography demonstrated typical findings of moyamoya disease, including severe stenosis of the supraclinoid portion of the internal carotid artery and the horizontal portions of the anterior and middle cerebral arteries. (b) Left internal carotid angiography also showed very similar findings. Note the markedly dilated perforating arteries on both sides. (c) Single photon emission computed tomography (SPECT) demonstrated cerebral blood flow reduction in the frontal lobe on both sides. (d)Fluid-attenuated inversion recovery (FLAIR) image showed the "patchy" hyperintensity lesions (arrows) in the subcortical white matter and also the "striated" hyperintensity lesions (arrowheads) in the periventricular white matter. The "striated" lesions appear to radiate from the lateral ventricles. (e) Cerebral blood flow almost normalized 5 months after combined bypass surgery on both sides. (f) The "striated" hyperintensity lesions completely disappeared 5 months after surgery. The "patchy" hyperintensity lesions disappeared in the frontal pole on both sides 5 months after surgery, but was still observed in the left frontal subcortex (arrow). (g) The lesion completely disappeared 12 months after surgery
case_images: SNI-15-131-g002.jpg
case_images: PMC11090599_02_SNI-15-131-g002.jpg
case_images: F2
case_images: The perforating arteries were markedly dilated [Figures 2a and b]. 123I-IMP SPECT showed CBF reduction in the ICA territories on both sides [Figure 2c]. The WMH lesions included morphologically two patterns: "Patchy" and "striated" patterns [Figure 2d]. The postoperative course was uneventful, and CBF improved to the normal level [Figure 2e]. Follow-up MRI revealed that the "striated" WMH lesions disappeared, and the "patchy" WMH lesions diminished five months after surgery [Figure 2f]. The "patchy" WMH lesions disappeared 12 months after surgery [Figure 2g].
case_images: PMC11090599_03
case_images: Radiological findings of a 22-year-old male with moyamoya disease (Case 3). (a) MR angiography demonstrated typical findings of moyamoya disease, including severe stenosis of the supraclinoid portion of the internal carotid artery on both sides. (b) Single photon emission computed tomography (SPECT) demonstrated cerebral blood flow reduction in the cerebral hemispheres on both sides. (c) Fluid-attenuated inversion recovery (FLAIR) image showed the "patchy" hyperintensity lesions (arrows) in the right periventricular white matter and also the "striated" hyperintensity lesions (arrowheads) in the right periventricular white matter. The "striated" lesions appear to radiate from the right lateral ventricles. Note cerebral infarction in the left occipital lobe.(d) Cerebral blood flow almost normalized 4 months after combined bypass surgery on both sides, except for the left occipital lobe. (e) The "striated" hyperintensity lesions completely disappeared 4 months after surgery. The "patchy" hyperintensity lesions regressed 4 months after surgery. (f) But, they were still observed in the right side 12 months after surgery (arrow).
case_images: SNI-15-131-g003.jpg
case_images: PMC11090599_03_SNI-15-131-g003.jpg
case_images: F3
case_images: Magnetic resonance angiography showed severe stenosis of the terminal portion of the bilateral ICA and the left posterior cerebral artery [Figure 3a]. 123I-IMP SPECT showed CBF reduction in the whole cerebral hemispheres on both sides [Figure 3b]. FLAIR images demonstrated the WMH lesions in the right subcortical and periventricular white matter, including the "patchy" and "striated" lesions [Figure 3c]. Cerebral hemodynamics were restored to normal levels except in the areas of cerebral infarction four months after surgery [Figure 3d]. Follow-up MRI showed that the "striated" WMH lesions completely disappeared and the "patchy" WMH lesions diminished four months after surgery [Figure 3e], followed by a further decrease in the volume of "patchy" WHM lesions 12 months after surgery [Figure 3f].