PMC8247715_01
(a) Initial magnetic resonance angiography (MRA) showed stenosis in the terminal portion of the bilateral internal carotid artery. (b) MRA performed after 1 year revealed progression of stenosis in the right middle cerebral artery. (c and d) Single-photon emission computed tomography with iodine-123 iodoamphetamine revealed preserved cerebral blood flow and a significant decrease in vascular reserve in the right hemisphere.
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F1
He was diagnosed with moyamoya disease based on magnetic resonance angiography (MRA) results [Figure 1a] and was then referred to the neurosurgical department of our hospital. Right middle cerebral artery (MCA) stenosis progressed during the 1-year follow-up [Figure 1b]. Single-photon emission computed tomography with iodine-123 iodoamphetamine (123I-IMP SPECT) revealed preserved cerebral blood flow (CBF) and a significant decrease in vascular reserve in the right hemisphere [Figure 1c and d].
(a) Magnetic resonance angiography revealed good angiogenesis from the external carotid system to the right cerebral hemisphere and progression of stenosis in the left middle cerebral artery. (b and c) Single-photon emission computed tomography with iodine-123 iodoamphetamine showed preserved cerebral blood flow and a significant decrease in vascular reserve in the left hemisphere.
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F2
MRA revealed good angiogenesis from the external carotid system to the right cerebral hemisphere and progression of stenosis in the left MCA [Figure 2a]. 123I-IMP SPECT showed preserved CBF and a significant decrease in vascular reserve in the left hemisphere [Figure 2b and c].
(a and b) Six months after the initial surgery, susceptibility-weighted imaging (SWI) revealed the absence of cerebral microbleeds (CMBs) in the left hemisphere. (c and d) Nine months after the initial surgery, SWI showed three de novo CMBs in the left hemisphere (white arrows).
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F3
T2*WI and SWI revealed the absence of CMBs in the left hemisphere [Figure 3a and b]. However, three de novo CMBs were identified after 3 months [Figure 3c and d].
Anteroposterior (a) and lateral (b) views on the left internal carotid angiography revealed the absence of cerebral aneurysm. Left internal carotid angiography (a) and three-dimension reconstruction angiography (c) revealed the abnormal collaterals from the anterior choroidal artery form periventricular anastomosis, which continued to the middle cerebral artery through the medullary artery (red arrowheads).
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F4
No cerebral aneurysm was detected on digital subtraction angiography of the left internal carotid and left vertebral arteries [Figure 4a and b]. The abnormal collaterals from the anterior choroidal artery form periventricular anastomosis, which continued to the MCA through the medullary artery [Figure 4a-c].
(a) Magnetic resonance angiography (MRA) showed good angiogenesis from the external carotid system to the bilateral cerebral hemispheres. (b and c) Susceptibility-weighted imaging revealed no additional de novo cerebral microbleeds 1 year after surgery. Postoperative MRA (e) revealed shrinkage of the anterior choroidal artery and disappearance of abnormal collaterals (white arrowheads) compared to preoperative MRA (d).
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F5
The symptom disappeared completely after surgery, and magnetic resonance imaging showed good angiogenesis from the external carotid system to the left cerebral hemisphere [Figure 5a]. No additional de novo CMBs were identified 1 year after surgery [Figure 5b and c]. Further, MRA revealed shrinkage of the anterior choroidal artery and disappearance of abnormal collaterals [Figure 5d and e].