PMC9345112_01
Coronal TSE T2-weighted image (a) shows the residual tumor mass that enchases the terminal ICAs. The coronal MIP reconstruction of TOF MR Angiography (b) shows lack of signal in the terminal part of the left ICA due to severe stenosis and slight reduction of signal in the distal MCA branches. The left ICA angiograms on frontal (c) and lateral (d) projections confirm the severe stenosis of the terminal part of the ICA, proximal M1, and A1 segments; slight evidence of basal moyamoya network is also observed. No significant narrowing is observed on the right ICA frontal angiogram (e).
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F1
A1 segments on the left side, with a contralateral hypoplastic A1 [Figure 1]. A brain positron emission tomography (PET) scan (H2150-WATER PET) defined an initial stage of RIMS.
PMC9345112_02
Coronal TSE T2-weighted (a) and axial b-1000 DWI images (b) in acute phase of shunt dysfunction show dilated ventricles (asterix in 2a) and acute ischemic changes on MCA and ACA cortical territories, with restricted diffusion, effaced sulci and scissures and cortical edema (arrowheads in 2a). Early postoperative images (c and d) show progressive improvement of cortical ischemic areas; new-onset deep ischemic lesions in basal ganglia are also observed (arrows).
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F2
MRI showed increment of ventricular size with restricted diffusion areas on diffusion-weighted images of distal territory of ICAs and left middle cerebral artery (MCA), compatible with acute ischemic injury [Figure 2].