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. 2021 Apr 6;42(12):5433–5439. doi: 10.1007/s10072-021-05221-2

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 2 — Brain MRI studies with MRA and arterial spin labeling (ASL) perfusion acquired before (a–c) and 1 year after surgery (d–f). a Axial FLAIR image reveals linear high signal intensity along the cortical sulci in both cerebral hemispheres, in keeping with diffuse prominent leptomeningeal collaterals. b Arterial MRA shows bilateral moyamoya vasculopathy with stenosis of distal portion of both internal carotid arteries (arrows), severe stenosis of right middle cerebral artery, posterior circulation involvement, and basal moyamoya collateralization (asterisk). c ASL perfusion map reveals hypoperfusion of both middle cerebral artery territories, in particular of the right frontal lobe and left parietal lobe. d Axial FLAIR image after surgery demonstrates resolution of the leptomeningeal collaterals. e Postoperative MRA demonstrate development of pial collateralization in the sites of surgical revascularization (arrowheads). f ASL perfusion map unravels marked improvement of the CBF in the middle cerebral artery territories after surgery (thick arrows). Color bar indicates ml/min/100 g for ASL-CBF.