Article Figures & Data
Figures
- Fig 1.
Regions of interest drawn in a PWI (A) and MTT map (B). The regions of interest were placed on cortical regions in the medial frontal lobe in the ACA distribution, in the posterior frontal lobe in the MCA distribution and in the occipital lobes in the PCA distribution as well as in the putamen in each cerebral hemisphere. To calculate the MTTs in the frontal lobes, as well as in the basal ganglia, an AIF (blue dot) was obtained from an ipsilateral MCA branch to represent anterior circulation. In calculating MTT in the occipital lobe, an AIF (yellow dot) was obtained from an ipsilateral PCA branch. This MTT map (B) was calculated with the AIF obtained from the right MCA branch.
- Fig 2.
A 10-year-old boy with Moyamoya disease who presented with weakness of the right upper extremity. Right internal carotid arteriogram in posterior-anterior projection (A) shows that the right proximal anterior cerebral artery is mildly stenotic (black arrow). No steno-occlusive change is found in the ICA or MCA. The right ICA is in stage 1. No Moyamoya vessels are seen. Left internal carotid arteriograms in posterior-anterior projection (B) show that the right distal ICA and the anterior and MCAs are occluded (white arrow). The left ICA is in stage 3. Marked Moyamoya vessels are seen, and peripheral branches of the anterior cerebral artery and MCA are opacified via the collateral vessels (black arrowhead). On the left vertebral arteriogram in posterior-anterior projection (C), no steno-occlusive change is found in the bilateral posterior cerebral artery. The bilateral posterior cerebral artery is in stage 1. Leptomeningeal collateral vessels from the left posterior cerebral artery to the anterior circulation are seen (white arrowhead). MTT map (D) shows the areas of prolonged mean MTT in the left frontal and temporal lobes. This map was calculated with the AIF obtained from a right MCA branch.
- Fig 3.
A 45-year-old woman with Moyamoya disease who presented with right thalamic hemorrhage. Right internal carotid arteriograms in posterior-anterior projection (A) demonstrated that the right ICA, anterior cerebral artery, and proximal MCA are occluded (large black arrow). The right ICA is in stage 4. Slightly developed Moyamoya vessels are seen around the distal ICA (black arrowhead). The distal MCA is visualized through the Moyamoya vessels. Left common carotid arteriogram in lateral projection (B) shows that the left ICA is completely occluded in its proximal portion (white arrowhead). The left internal ICA is in stage 6. Left vertebral arteriogram in posterior-anterior projection (C) shows severe stenosis in the bilateral posterior cerebral arteries (white arrows). Moyamoya vessels are seen in the posterior region of the brain base. Peripheral branches of bilateral posterior cerebral arteries are visualized through Moyamoya vessels. The bilateral posterior cerebral artery is in stage 3. MTT map (D) demonstrates extensive areas of prolonged MTT in bilateral cerebral hemispheres. This map was calculated with the AIF obtained from a right MCA branch.
Tables
Patient No./Age (y)/Sex Clinical Type Major Clinical Symptoms Duration from Onset of Disease Duration from Last TIA Infarct or Hemorrhage on MRL Image 1/5/M TIA Weakness of bilateral limbs 11 mo 2 mo Negative 2/6/F TIA Weakness of left limbs 1 y 3 mo Negative 3/7/F TIA Involuntary movement of right hand 10 mo 1 w Negative 4/9/F TIA Weakness of right limbs 2 y 3 mo Bilateral frontoparietal cortex 5/10/M TIA Weakness of right hand 5 mo 5 mo Negative 6/10/F TIA Weakness of left hand 5 y 4 mo Negative 7/11/F TIA Weakness of right limbs 1 y 1 mo Left frontal cortex, left basal ganglia 8/13/M TIA Weakness of bilateral lower limbs 10 y 4 mo Right frontal white matter 9/15/M TIA Weakness of bilateral limbs 7 y 1 y Right frontal cortex 10/17/M TIA Weakness of bilateral limbs 5 y 1 w Negative 11/17/F TIA Weakness of right limbs 3 y 1 mo Left frontotemporoparietal white matter 12/26/M H Headache 21 y — Bilateral frontoparietal white matter 13/28/F TIA Weakness of bilateral limbs 14 y 1 mo Negative 14/31/F H Weakness of right hand 3 y — Left basal ganglia 15/34/F None Hemorrhage of bilateral ocular fundus 7 y — Negative 16/36/F TIA Weakness of right limbs 2 mo 2 mo Left frontal cortex, left basal ganglia 17/37/F TIA Weakness of right hand 6 mo 1 mo Left frontoparietal white matter 18/41/F H Headache 4 mo — Right temporal subcortex 19/45/F H Headache 3 mo — Right thalamus 20/48/M TIA Weakness of bilateral limbs 22 y 1 wk Left frontal cortex, right basal ganglia Note.— TIA indicates transient ischemic attack; H, hemorrhagic.
ICA Stage r 1 (n = 6) 2 (n = 3) 3 (n = 9) 4 (n = 13) 5 (n = 6) 6 (n = 3) Medial frontal 9.1 ± 3.1 10.8 ± 2.1 11.6 ± 2.9 13.8 ± 6.1 17.4 ± 3.3 14.7 ± 2.4 .52† Posterior frontal 8.6 ± 2.6 8.7 ± 1.0 11.8 ± 5.1 14.1 ± 5.0 20.0 ± 5.7 16.1 ± 4.8 .64‡ Occipital 9.3 ± 2.8 9.3 ± 1.0 10.8 ± 2.6 11.7 ± 3.3 18.9 ± 2.9 15.4 ± 6.3 .58‡ Basal ganglia 8.6 ± 2.8 7.4 ± 1.1 9.6 ± 2.9 10.7 ± 3.5 15.1 ± 3.8 14.4 ± 2.5 .58‡ Note.— MTT indicates mean transit time; ICA, internal carotid artery.
* , P < .05;
† , P < .01;
‡ , P < .001; based on Spearman rank correlation test.
PCA Stage r 1 (n = 32) 2 (n = 1) 3 (n = 5) 4 (n = 2) Medial frontal 11.9 ± 4.5 16.4 16.7 ± 2.6 20.2 ± 2.2 .56‡ Posterior frontal 11.5 ± 4.3 23.1 19.0 ± 4.6 24.6 ± 2.0 .60‡ Occipital 10.7 ± 2.8 14.5 18.0 ± 3.1 22.6 ± 0.2 .64‡ Basal ganglia 9.8 ± 3.2 14.4 13.1 ± 2.4 19.6 ± 1.0 .53‡ Note.— MTT indicates mean transit time; PCA, posterior cerebral artery.
* , P < .05;
† , P < .01;
‡ , P < 0.001; based on Spearman rank correlation test.
Moyamoya Vessels r 1 (n = 9) 2 (n = 22) 3 (n = 5) 4 (n = 4) Medial frontal 11.0 ± 3.7 12.4 ± 3.7 14.6 ± 7.9 19.0 ± 2.5 .35* Posterior frontal 11.3 ± 4.5 11.6 ± 3.8 16.4 ± 7.1 24.1 ± 1.5 .47† Occipital 12.0 ± 4.2 11.3 ± 3.8 13.2 ± 6.0 17.3 ± 3.8 .24 Basal ganglia 10.5 ± 3.5 10.2 ± 3.1 11.3 ± 6.6 14.7 ± 3.1 .15 Note.— MTT indicates mean transit time.
* , P < .05;
† , P < .01,
‡ , P < .001; based on Spearman rank correlation test.
LMA r 1 (n = 4) 2 (n = 8) 3 (n = 8) 4 (n = 20) Medial frontal 15.4 ± 5.8 13.0 ± 5.6 12.5 ± 5.3 12.8 ± 4.1 −.05 Posterior frontal 16.2 ± 10.0 15.1 ± 6.5 11.3 ± 4.4 13.0 ± 4.9 −.10 Occipital 15.3 ± 8.9 14.9 ± 5.2 10.7 ± 2.1 11.3 ± 2.9 −.22 Basal ganglia 13.7 ± 7.4 11.6 ± 3.4 9.5 ± 2.8 10.5 ± 3.3 −.16 Note.— MTT indicates mean transit time; LMA, leptomeningeal anastomosis.
*, P < .05; †, P < .01, ‡, P < .001; based on Spearman rank correlation test.
Medial Frontal Posterior Frontal Occipital Basal Ganglia ICA 0.47† 0.57‡ 0.58‡ 0.55‡ PCA 0.50† 0.66‡ 0.78‡ 0.59‡ Moyamoya vessels 0.46† 0.62‡ 0.32* 0.28 LMA −0.12 −0.19 −0.35* −0.23 Age 0.23 0.15 0.37* 0.38* Clinical type −0.01 −0.04 0.25 0.14 R2 0.45† 0.70‡ 0.73‡ 0.52‡ Note.— MTT indicates mean transit time; ICA, internal carotid artery; PCA, posterior cerebral artery; LMA, leptomeningeal anastomosis.
* , P < .05;
† , P < .01;
‡ , P < .001; based on multiple linear regression analysis.
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