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FIG 4. 4-year-old boy examined for increased head circumference and engorgement of superficial veins of the scalp.
A, 3D time-of-flight MR angiogram suggests moya-moya disease with bilateral supraclinoid carotid stenosis (arrows). The good flow distally in the middle cerebral arteries was puzzling.
B, CTCVI scan reveals patent proximal middle cerebral arteries as well as distal internal carotid arteries. Multiple small arteriovenous fistulas were also seen and confirmed at angiography. The MR signal loss was most likely related to the extremely high flow.
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