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<meta name="DC.Title" content="High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques" />
<meta name="DC.Identifier" content="10.3174/ajnr.A0950" />
<meta name="DC.Date" content="2008-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Plaque morphologic features have been suggested as a complement to luminal narrowing measurements for assessing the risk of stroke associated with carotid atherosclerotic disease, giving rise to the concept of “vulnerable plaque.” The purpose of this study was to evaluate the ability of multidetector-row CT angiography (CTA) to assess the composition and characteristics of carotid artery atherosclerotic plaques with use of histologic examination as the gold standard.

MATERIALS AND METHODS: Eight patients with transient ischemic attacks who underwent carotid CTA and “en bloc” endarterectomy were enrolled in a prospective study. An ex vivo micro-CT study of each endarterectomy specimen was obtained, followed by histologic examination. A systematic comparison of CTA images with histologic sections and micro-CT images was performed to determine the CT attenuation associated with each component of the atherosclerotic plaques. A computer algorithm was subsequently developed that automatically identifies the components of the carotid atherosclerotic plaques, based on the density of each pixel. A neuroradiologist's reading of this computer analysis was compared with the interpretation of the histologic slides by a pathologist with respect to the types and characteristics of the carotid plaques.

RESULTS: There was a 72.6% agreement between CTA and histologic examination in carotid plaque characterization. CTA showed perfect concordance for calcifications. A significant overlap between densities associated with lipid-rich necrotic core, connective tissue, and hemorrhage limited the reliability of individual pixel readings to identify these components. However, CTA showed good correlation with histologic examination for large lipid cores (κ = 0.796; P &lt; .001) and large hemorrhages (κ = 0.712; P = .102). CTA performed well in detecting ulcerations (κ = 0.855) and in measuring the fibrous cap thickness ( R 2 = 0.77; P &lt; .001).

CONCLUSION: The composition of carotid atherosclerotic plaques determined by CTA reflects plaque composition defined by histologic examination." />
<meta name="DC.Contributor" content="M. Wintermark" />
<meta name="DC.Contributor" content="S.S. Jawadi" />
<meta name="DC.Contributor" content="J.H. Rapp" />
<meta name="DC.Contributor" content="T. Tihan" />
<meta name="DC.Contributor" content="E. Tong" />
<meta name="DC.Contributor" content="D.V. Glidden" />
<meta name="DC.Contributor" content="S. Abedin" />
<meta name="DC.Contributor" content="S. Schaeffer" />
<meta name="DC.Contributor" content="G. Acevedo-Bolton" />
<meta name="DC.Contributor" content="B. Boudignon" />
<meta name="DC.Contributor" content="B. Orwoll" />
<meta name="DC.Contributor" content="X. Pan" />
<meta name="DC.Contributor" content="D. Saloner" />
<meta name="article:published_time" content="2008-05-01" />
<meta name="article:section" content="HEAD &amp;amp; NECK" />
<meta name="citation_title" content="High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques" />
<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;b&gt;BACKGROUND AND PURPOSE:&lt;/b&gt; Plaque morphologic features have been suggested as a complement to luminal narrowing measurements for assessing the risk of stroke associated with carotid atherosclerotic disease, giving rise to the concept of “vulnerable plaque.” The purpose of this study was to evaluate the ability of multidetector-row CT angiography (CTA) to assess the composition and characteristics of carotid artery atherosclerotic plaques with use of histologic examination as the gold standard.&lt;/p&gt;&lt;p&gt;&lt;b&gt;MATERIALS AND METHODS:&lt;/b&gt; Eight patients with transient ischemic attacks who underwent carotid CTA and “en bloc” endarterectomy were enrolled in a prospective study. An ex vivo micro-CT study of each endarterectomy specimen was obtained, followed by histologic examination. A systematic comparison of CTA images with histologic sections and micro-CT images was performed to determine the CT attenuation associated with each component of the atherosclerotic plaques. A computer algorithm was subsequently developed that automatically identifies the components of the carotid atherosclerotic plaques, based on the density of each pixel. A neuroradiologist9s reading of this computer analysis was compared with the interpretation of the histologic slides by a pathologist with respect to the types and characteristics of the carotid plaques.&lt;/p&gt;&lt;p&gt;&lt;b&gt;RESULTS:&lt;/b&gt; There was a 72.6% agreement between CTA and histologic examination in carotid plaque characterization. CTA showed perfect concordance for calcifications. A significant overlap between densities associated with lipid-rich necrotic core, connective tissue, and hemorrhage limited the reliability of individual pixel readings to identify these components. However, CTA showed good correlation with histologic examination for large lipid cores (κ = 0.796; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001) and large hemorrhages (κ = 0.712; &lt;i&gt;P&lt;/i&gt; = .102). CTA performed well in detecting ulcerations (κ = 0.855) and in measuring the fibrous cap thickness (&lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.77; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001).&lt;/p&gt;&lt;p&gt;&lt;b&gt;CONCLUSION:&lt;/b&gt; The composition of carotid atherosclerotic plaques determined by CTA reflects plaque composition defined by histologic examination.&lt;/p&gt;" />
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<meta name="twitter:title" content="High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Plaque morphologic features have been suggested as a complement to luminal narrowing measurements for assessing the risk of stroke associated with carotid atherosclerotic disease, giving rise to the concept of “vulnerable plaque.” The purpose of this study was to evaluate the ability of multidetector-row CT angiography (CTA) to assess the composition and characteristics of carotid artery atherosclerotic plaques with use of histologic examination as the gold standard.

MATERIALS AND METHODS: Eight patients with transient ischemic attacks who underwent carotid CTA and “en bloc” endarterectomy were enrolled in a prospective study. An ex vivo micro-CT study of each endarterectomy specimen was obtained, followed by histologic examination. A systematic comparison of CTA images with histologic sections and micro-CT images was performed to determine the CT attenuation associated with each component of the atherosclerotic plaques. A computer algorithm was subsequently developed that automatically identifies the components of the carotid atherosclerotic plaques, based on the density of each pixel. A neuroradiologist's reading of this computer analysis was compared with the interpretation of the histologic slides by a pathologist with respect to the types and characteristics of the carotid plaques.

RESULTS: There was a 72.6% agreement between CTA and histologic examination in carotid plaque characterization. CTA showed perfect concordance for calcifications. A significant overlap between densities associated with lipid-rich necrotic core, connective tissue, and hemorrhage limited the reliability of individual pixel readings to identify these components. However, CTA showed good correlation with histologic examination for large lipid cores (κ = 0.796; P &lt; .001) and large hemorrhages (κ = 0.712; P = .102). CTA performed well in detecting ulcerations (κ = 0.855) and in measuring the fibrous cap thickness ( R 2 = 0.77; P &lt; .001).

CONCLUSION: The composition of carotid atherosclerotic plaques determined by CTA reflects plaque composition defined by histologic examination." />
<meta name="og-title" property="og:title" content="High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/29/5/875" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Plaque morphologic features have been suggested as a complement to luminal narrowing measurements for assessing the risk of stroke associated with carotid atherosclerotic disease, giving rise to the concept of “vulnerable plaque.” The purpose of this study was to evaluate the ability of multidetector-row CT angiography (CTA) to assess the composition and characteristics of carotid artery atherosclerotic plaques with use of histologic examination as the gold standard.

MATERIALS AND METHODS: Eight patients with transient ischemic attacks who underwent carotid CTA and “en bloc” endarterectomy were enrolled in a prospective study. An ex vivo micro-CT study of each endarterectomy specimen was obtained, followed by histologic examination. A systematic comparison of CTA images with histologic sections and micro-CT images was performed to determine the CT attenuation associated with each component of the atherosclerotic plaques. A computer algorithm was subsequently developed that automatically identifies the components of the carotid atherosclerotic plaques, based on the density of each pixel. A neuroradiologist's reading of this computer analysis was compared with the interpretation of the histologic slides by a pathologist with respect to the types and characteristics of the carotid plaques.

RESULTS: There was a 72.6% agreement between CTA and histologic examination in carotid plaque characterization. CTA showed perfect concordance for calcifications. A significant overlap between densities associated with lipid-rich necrotic core, connective tissue, and hemorrhage limited the reliability of individual pixel readings to identify these components. However, CTA showed good correlation with histologic examination for large lipid cores (κ = 0.796; P &lt; .001) and large hemorrhages (κ = 0.712; P = .102). CTA performed well in detecting ulcerations (κ = 0.855) and in measuring the fibrous cap thickness ( R 2 = 0.77; P &lt; .001).

CONCLUSION: The composition of carotid atherosclerotic plaques determined by CTA reflects plaque composition defined by histologic examination." />
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<div id="hw-article-author-popups-top-node-8050--61525666603" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. Wintermark </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BWintermark%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wintermark%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.%2BWintermark%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S.S. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-29.5.875.1" data-doi="10.1056/NEJM199108153250701"><div class="cit-metadata"><cite><strong>Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. 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ref-other" id="cit-29.5.875.41" data-doi="10.1007/s00330-003-1889-5"><div class="cit-metadata"><cite>Becker CR, Nikolaou K, Muders M, et al. <strong>Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT.</strong> <span class="cit-source">Eur Radiol</span> <span class="cit-pub-date">2003</span>;<span class="cit-vol">13</span>:<span class="cit-fpage">2094</span>–98</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s00330-003-1889-5&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=12692681&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F5%2F875.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000185537700005&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-42-1" title="View reference 42 in text" id="ref-42">↵</a><div class="cit ref-cit ref-other" id="cit-29.5.875.42" data-doi="10.1161/01.STR.0000160749.61763.95"><div class="cit-metadata"><cite>Lovett JK, Redgrave JN, Rothwell PM. <strong>A critical appraisal of the performance, reporting, and interpretation of studies comparing carotid plaque imaging with histology.</strong> <span class="cit-source">Stroke</span> <span class="cit-pub-date">2005</span>;<span class="cit-vol">36</span>:<span class="cit-fpage">1091</span>–97</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjk6IjM2LzUvMTA4NSI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8yOS81Lzg3NS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-43-1" title="View reference 43 in text" id="ref-43">↵</a><div class="cit ref-cit ref-other" id="cit-29.5.875.43" data-doi="10.1161/01.CIR.92.5.1355"><div class="cit-metadata"><cite>Stary HC, Chandler AB, Dinsmore RE, et al. <strong>A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. 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id="ref-45">↵</a><div class="cit ref-cit ref-other" id="cit-29.5.875.45" data-doi="10.1161/01.CIR.101.21.2503"><div class="cit-metadata"><cite>Fayad ZA, Nahar T, Fallon JT, et al. <strong>In vivo magnetic resonance evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with transesophageal echocardiography.</strong> <span class="cit-source">Circulation</span> <span class="cit-pub-date">2000</span>;<span class="cit-vol">101</span>:<span class="cit-fpage">2503</span>–09</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImNpcmN1bGF0aW9uYWhhIjtzOjU6InJlc2lkIjtzOjExOiIxMDEvMjEvMjUwMyI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8yOS81Lzg3NS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-46-1" title="View reference 46 in text" id="ref-46">↵</a><div class="cit ref-cit ref-other" id="cit-29.5.875.46" data-doi="10.1161/01.CIR.0000028591.44554.F9"><div class="cit-metadata"><cite>Cai JM, Hatsukami TS, Ferguson MS, et al. <strong>Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging.</strong> <span class="cit-source">Circulation</span> <span class="cit-pub-date">2002</span>;<span class="cit-vol">106</span>:<span class="cit-fpage">1368</span>–73</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImNpcmN1bGF0aW9uYWhhIjtzOjU6InJlc2lkIjtzOjExOiIxMDYvMTEvMTM2OCI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8yOS81Lzg3NS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-47-1" title="View reference 47 in text" id="ref-47">↵</a><div class="cit ref-cit ref-other" id="cit-29.5.875.47" data-doi="10.1161/01.STR.0000196985.38701.0c"><div class="cit-metadata"><cite>Clarke SE, Beletsky V, Hammond RR, et al. <strong>Validation of automatically classified magnetic resonance images for carotid plaque compositional 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class="cit-metadata"><cite>Itskovich VV, Samber DD, Mani V, et al. <strong>Quantification of human atherosclerotic plaques using spatially enhanced cluster analysis of multicontrast-weighted magnetic resonance images.</strong> <span class="cit-source">Magn Reson Med</span> <span class="cit-pub-date">2004</span>;<span class="cit-vol">52</span>:<span class="cit-fpage">515</span>–23</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/mrm.20154&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15334569&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F5%2F875.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000223529200010&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-49-1" title="View reference 49 in text" id="ref-49">↵</a><div class="cit ref-cit ref-other" id="cit-29.5.875.49" data-doi="10.1016/j.mri.2004.08.020"><div class="cit-metadata"><cite>Adams GJ, Greene J, Vick GW 3rd, et al. <strong>Tracking regression and progression of atherosclerosis in human carotid arteries using high-resolution magnetic resonance imaging.</strong> <span class="cit-source">Magn Reson Imaging</span> <span class="cit-pub-date">2004</span>;<span class="cit-vol">22</span>:<span class="cit-fpage">1249</span>–58</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.mri.2004.08.020&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15607096&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F5%2F875.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a 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          <a href="/content/29/5" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">American Journal of Neuroradiology</span></a>      
      
        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 29</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">May 2008 </div></div>
      
      
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      <div class="highwire-cite-title">High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Wintermark</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.S.</span> <span class="nlm-surname">Jawadi</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.H.</span> <span class="nlm-surname">Rapp</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Tihan</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Tong</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">D.V.</span> <span class="nlm-surname">Glidden</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Abedin</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Schaeffer</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Acevedo-Bolton</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Boudignon</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Orwoll</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">X.</span> <span class="nlm-surname">Pan</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Saloner</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2008, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">29 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">875-882; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A0950 </span></div>
  
  
  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2008, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">29 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">875-882; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A0950 </span></div>
  
  
  
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