PMC9272477_01
A & B - Axial MRI images, on the diffusion weighted imaging (DWI) and apparent
diffusion coefficient (ADC) sequences show restricted diffusion involving mainly the
left anterior cerebral artery (ACA) territory (white arrows). Also note presence of
internal watershed acute infarcts. C - Axial FLAIR image showing corresponding
hyperintensity of the involved left ACA territory. Also note internal watershed
hyperintensity of varying ages, mostly acute. D - Post gadolinium vessel wall imaging
(black-blood sequence) MRI image, in coronal section, showing enhancement and
thickening of the wall of the left internal carotid artery (ICA) (white circle),
compared to the right. Also note inhomogeneity of the luminal hypointensity,
indicative of slow/stagnant blood flow. E - Post gadolinium vessel wall imaging
(black-blood sequence) MRI image, in axial section, showing circumferential vessel
wall thickening and enhancement of the left carotid artery, as well as luminal
stenosis. F - Post gadolinium vessel wall imaging (black-blood sequence) MRI image, in
axial section, showing enhancement of the left ACA A1 segment (white arrow). G - Post
gadolinium vessel wall imaging (black-blood sequence) MRI image, in axial section,
showing intraluminal hyperintensity of the distal left ACA (white circle), indicative
of slow/stagnant flow. Note that the normal distal right ACA adjacent to it exhibits
normal intraluminal hypointensity consistent with normal flow. H - Time of flight MRA
image showing loss of signal intensity of the left internal carotid artery (ICA), with
faint signal intensities of the left ACA and middle cerebral artery (MCA).
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Some segments of the involved vessels also showed luminal hyperintensity [Figure 1].