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A 49-year-old woman with a 20-year history of migraine with aura was referred for an MRI during a period of symptom aggravation. Imaging revealed bilateral occlusion of the internal carotid arteries (ICA) and M1 segments of the middle cerebral arteries (MCA), along with extensive bilateral collateral development characteristics of Moyamoya disease and bilateral frontal periventricular lacunar infarcts. Digital subtraction angiography (DSA) confirmed these findings showing predominant filling via bilateral hypertrophic external carotid artery to internal carotid (EC-IC) anastomoses at the skull base level, confirming a definitive diagnosis of Moyamoya disease). The patient was subsequently referred for estimation of the cerebrovascular reserve capacity (CVR) using acetazolamide and [15O]H2O PET/CT for absolute measurements of the regional cerebral blood flow (rCBF), which revealed extensive and globally reduced supratentorial CVR, ranging from near 0% til 20%. The patient later underwent bilateral EC-IC bypass surgery.

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Case 52: PET Imaging in Neuro-Vascular Disease

  • 章节

  • 发表日期：

    2025年

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  • Ian Law,
  • Thomas C. Truelsen,
  • Ulrich Lindberg,
  • Thomas L. Andersen

摘要

A 49-year-old woman with a 20-year history of migraine with aura was referred for an MRI during a period of symptom aggravation. Imaging revealed bilateral occlusion of the internal carotid arteries (ICA) and M1 segments of the middle cerebral arteries (MCA), along with extensive bilateral collateral development characteristics of Moyamoya disease and bilateral frontal periventricular lacunar infarcts. Digital subtraction angiography (DSA) confirmed these findings showing predominant filling via bilateral hypertrophic external carotid artery to internal carotid (EC-IC) anastomoses at the skull base level, confirming a definitive diagnosis of Moyamoya disease). The patient was subsequently referred for estimation of the cerebrovascular reserve capacity (CVR) using acetazolamide and [15O]H2O PET/CT for absolute measurements of the regional cerebral blood flow (rCBF), which revealed extensive and globally reduced supratentorial CVR, ranging from near 0% til 20%. The patient later underwent bilateral EC-IC bypass surgery.