Sickle-cell disease without crisis [D57.1] / Moyamoya disease [I67.5], Reason for Study: ^Reason: hx of pial synangiosis. Eval vasculature History: none- surveillance imaging Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan. The right hemispheric sulci appear to be more prominent and gyri appear to be atrophic comparing to those of left hemisphere. These findings do not show significant interval change since prior scan.On FLAIR imaging, there are patchy high signal intensity on the right frontal lobe superior frontal gyrus which indicate chronic ischemic infarction. As well, there are multiple scattered and a bit confluent high signal intensities on bilateral periventricular white matter indicating possible non specific small vessel ischemic disease. Comparing to prior scan, the extent and approximate number of those high signal intensity lesions do not show any significant interval change.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate near total occlusion of the distal right ICA at the level of ICA terminus, without showing appreciable right MCA M1 segment. The left distal ICA also appears to be occluded with multiple small in-flow signals indicating collateral vessels. However, the left MCA M1 segment is reconstituted and the luminal diameter appears to be normal range. Comparing to prior scan, there is no significant interval change since prior scan.Bilateral posterior communicating arteries are patent and vertebrobasilar system appears to be normal
1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal chronic ischemic lesions and non specific ischemic lesions as described above, no change since prior scan.3. No significant interval change of bilateral distal ICA occlusion/near total occlusion with collateral vessels including the reconstitution of the left MCA with reasonable lumen size and non visualization of the right MCA M1 segment. Vertebrobasilar system appears to be within normal range.