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. 2021 Apr;10(4):1100–1116. doi: 10.21037/tp-20-205

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2021 Translational Pediatrics. All rights reserved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

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Moyamoya syndrome in a 14 years old girl. Axial T2WI (A and B) demonstrate prominence of flow voids in the suprasellar cistern with significant narrowing of the ICA bilaterally. There are also multiple perforators noted in the basal ganglia and thalami. Coronal FLAIR image (C) shows the characteristic ‘ivy sign’ (arrows). TOF MR angiogram (D and E: MIP images) demonstrates bilateral distal carotid and A1 stenosis, as well as reduced M1 flow. There are numerous leptomeningeal collaterals. TOF, time of flight.