PMC3475882_01
Preoperative neuro-radiologic examinations and postoperative MR-angiography. (a-d) Left internal carotid artery angiograms; (a) anterior-posterior view, (b) lateral view, (c) 123I-IMP SPECT at rest, and (d) MR-angiography. (e) MR angiography on postoperative Day 1 revealed the patent STA-MCA anastomosis (arrow)
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F1
MR imaging showed rapid progression of the previously identified stenosis and small white matter ischemic lesions in the bilateral frontal areas. 123I-IMP-SPECT showed decreased CBF in the bilateral ACA and MCA territories and 123I-IMP-SPECT with acetazolamide showed markedly impaired vascular reactivity bilaterally  [Figure 1].
The postoperative clinical course and the changes in CBF detected with 123I-IMP SPECT. POD: postoperative days. Arrows indicate the regions of hyperperfusion. The scale of the x-axis in each symptom revealed two grades; maximum (100% height), and incomplete improvement containing over 1 day (50% height)
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F2
POD 4, 123I-IMP-SPECT showed a significant increase in CBF in the left basal ganglia  [Figure 2]. Postoperative MRI showed a patent STA-MCA bypass and no evidence of new ischemic changes.