Figure 4

Images from a female patient in her 40 s with moyamoya disease (Case 3, Suzuki stage: right, V; left VI, see (g,h)). (a) Gray matter map, (b) white matter map, (c) myelin-correlated map, (d) ¹²³I-IMP cerebral blood flow (resting state), (e) ¹²³I-IMP cerebral blood flow (acetazolamide challenging), (f) cerebrovascular reactivity, (g) MRA-MIP (anterior circulation), (h) MRA-MIP (posterior circulation). Volume fraction maps reveal each fraction. The gray matter is decreased in the left posterior cerebral arterial territory (red area: (a) 6.0%, (b) 3.2%, and (c) 1.0%). Resting cerebral blood flow is preserved, but the acetazolamide cerebral blood flow map is decreased in the same territory ((d) 0.98 and (e) 0.98, corrected by cerebellar hemisphere), and there is a moderate decrease in cerebrovascular reactivity ((f) –8.9%). The WAIS test reveals a low score (FSIQ 49). ¹²³I-IMP, iodine-123-N-isopropyl-p-iodoamphetamine; FSIQ, Full-Scale Intelligence Quotient; MRA-MIP, magnetic resonance angiography-maximum intensity projection; WAIS, Wechsler Adult Intelligence Scale.