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<meta name="DC.Title" content="Atherosclerotic Carotid Stenoses of Apical versus Body Lesions in High-Risk Carotid Stenting Patients" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2000" />
<meta name="DC.Date" content="2010-06-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Different lesion locations in the atherosclerotic carotid bulb stenosis have not been clearly defined. We sought to evaluate 2 locations of carotid bulb stenosis in high-risk patients and to determine the relationship of each location to atherosclerotic risk factors and clinical features.

MATERIALS AND METHODS: Atherosclerotic carotid plaques of apical versus body lesions, defined according to the area and extent of plaque involvement, were retrospectively analyzed in 200 consecutive high-risk patients who underwent carotid stent placement because of ≥50% symptomatic stenosis. We evaluated interobserver concordance and assessed each type of lesion relative to 13 atherosclerotic risk factors, mode of symptom presentation, infarct pattern, procedure-related factors, and clinical outcomes, by univariate and multivariable logistic regression analysis.

RESULTS: Interobserver concordance showed good agreement for differentiating apical and body lesions (κ = 0.745). Univariate analysis revealed that apical lesions ( n = 108, 54%) were associated with pseudo-occlusion ( P = .027), older age ( P = .073), and alcohol intake ( P = .080), whereas body lesions ( n = 92, 46%) were associated with hyperlipidemia ( P = .001), a wedge-shaped cortical infarct pattern ( P = .057), and hyperperfusion syndrome ( P = .083). Multivariable logistic regression analysis adjusted by age revealed that hyperlipidemia ( P = .002; OR, 3.462; 95% CI, 1.595–7.515) and hyperperfusion ( P = .026; OR, 6.727; 95% CI, 1.261–35.894) were independent predictors of body-type lesions.

CONCLUSIONS: Atherosclerotic carotid bulb stenosis was found to have 2 distinct locations, body and apical. Hyperlipidemia and cortical wedge-shaped infarcts were more frequently associated with body than with apical stenosis at the time of presentation.

CCA
:   common carotid artery
CI
:   confidence interval
ECA
:   external carotid artery
FEV
:   forced expiratory volume
ICA
:   internal carotid artery
mRS
:   modified Rankin scale
OR
:   odds ratio
NASCET
:   North American Symptomatic Carotid Endarterectomy Trial
NIHSS
:   National Institutes of Health Stroke Scale
WSS
:   wall shear stress" />
<meta name="DC.Contributor" content="S.-T. Park" />
<meta name="DC.Contributor" content="J.K. Kim" />
<meta name="DC.Contributor" content="K.H. Yoon" />
<meta name="DC.Contributor" content="S.-O. Park" />
<meta name="DC.Contributor" content="S.W. Park" />
<meta name="DC.Contributor" content="J.S. Kim" />
<meta name="DC.Contributor" content="S.J. Kim" />
<meta name="DC.Contributor" content="D.C. Suh" />
<meta name="article:published_time" content="2010-06-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Atherosclerotic Carotid Stenoses of Apical versus Body Lesions in High-Risk Carotid Stenting Patients" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Different lesion locations in the atherosclerotic carotid bulb stenosis have not been clearly defined. We sought to evaluate 2 locations of carotid bulb stenosis in high-risk patients and to determine the relationship of each location to atherosclerotic risk factors and clinical features.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Atherosclerotic carotid plaques of apical versus body lesions, defined according to the area and extent of plaque involvement, were retrospectively analyzed in 200 consecutive high-risk patients who underwent carotid stent placement because of ≥50% symptomatic stenosis. We evaluated interobserver concordance and assessed each type of lesion relative to 13 atherosclerotic risk factors, mode of symptom presentation, infarct pattern, procedure-related factors, and clinical outcomes, by univariate and multivariable logistic regression analysis.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Interobserver concordance showed good agreement for differentiating apical and body lesions (κ = 0.745). Univariate analysis revealed that apical lesions (&lt;i&gt;n&lt;/i&gt; = 108, 54%) were associated with pseudo-occlusion (&lt;i&gt;P&lt;/i&gt; = .027), older age (&lt;i&gt;P&lt;/i&gt; = .073), and alcohol intake (&lt;i&gt;P&lt;/i&gt; = .080), whereas body lesions (&lt;i&gt;n&lt;/i&gt; = 92, 46%) were associated with hyperlipidemia (&lt;i&gt;P&lt;/i&gt; = .001), a wedge-shaped cortical infarct pattern (&lt;i&gt;P&lt;/i&gt; = .057), and hyperperfusion syndrome (&lt;i&gt;P&lt;/i&gt; = .083). Multivariable logistic regression analysis adjusted by age revealed that hyperlipidemia (&lt;i&gt;P&lt;/i&gt; = .002; OR, 3.462; 95% CI, 1.595–7.515) and hyperperfusion (&lt;i&gt;P&lt;/i&gt; = .026; OR, 6.727; 95% CI, 1.261–35.894) were independent predictors of body-type lesions.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Atherosclerotic carotid bulb stenosis was found to have 2 distinct locations, body and apical. Hyperlipidemia and cortical wedge-shaped infarcts were more frequently associated with body than with apical stenosis at the time of presentation.&lt;/p&gt;" />
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<meta name="twitter:title" content="Atherosclerotic Carotid Stenoses of Apical versus Body Lesions in High-Risk Carotid Stenting Patients" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Different lesion locations in the atherosclerotic carotid bulb stenosis have not been clearly defined. We sought to evaluate 2 locations of carotid bulb stenosis in high-risk patients and to determine the relationship of each location to atherosclerotic risk factors and clinical features.

MATERIALS AND METHODS: Atherosclerotic carotid plaques of apical versus body lesions, defined according to the area and extent of plaque involvement, were retrospectively analyzed in 200 consecutive high-risk patients who underwent carotid stent placement because of ≥50% symptomatic stenosis. We evaluated interobserver concordance and assessed each type of lesion relative to 13 atherosclerotic risk factors, mode of symptom presentation, infarct pattern, procedure-related factors, and clinical outcomes, by univariate and multivariable logistic regression analysis.

RESULTS: Interobserver concordance showed good agreement for differentiating apical and body lesions (κ = 0.745). Univariate analysis revealed that apical lesions ( n = 108, 54%) were associated with pseudo-occlusion ( P = .027), older age ( P = .073), and alcohol intake ( P = .080), whereas body lesions ( n = 92, 46%) were associated with hyperlipidemia ( P = .001), a wedge-shaped cortical infarct pattern ( P = .057), and hyperperfusion syndrome ( P = .083). Multivariable logistic regression analysis adjusted by age revealed that hyperlipidemia ( P = .002; OR, 3.462; 95% CI, 1.595–7.515) and hyperperfusion ( P = .026; OR, 6.727; 95% CI, 1.261–35.894) were independent predictors of body-type lesions.

CONCLUSIONS: Atherosclerotic carotid bulb stenosis was found to have 2 distinct locations, body and apical. Hyperlipidemia and cortical wedge-shaped infarcts were more frequently associated with body than with apical stenosis at the time of presentation.

CCA
:   common carotid artery
CI
:   confidence interval
ECA
:   external carotid artery
FEV
:   forced expiratory volume
ICA
:   internal carotid artery
mRS
:   modified Rankin scale
OR
:   odds ratio
NASCET
:   North American Symptomatic Carotid Endarterectomy Trial
NIHSS
:   National Institutes of Health Stroke Scale
WSS
:   wall shear stress" />
<meta name="og-title" property="og:title" content="Atherosclerotic Carotid Stenoses of Apical versus Body Lesions in High-Risk Carotid Stenting Patients" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/6/1106" />
<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: Different lesion locations in the atherosclerotic carotid bulb stenosis have not been clearly defined. We sought to evaluate 2 locations of carotid bulb stenosis in high-risk patients and to determine the relationship of each location to atherosclerotic risk factors and clinical features.

MATERIALS AND METHODS: Atherosclerotic carotid plaques of apical versus body lesions, defined according to the area and extent of plaque involvement, were retrospectively analyzed in 200 consecutive high-risk patients who underwent carotid stent placement because of ≥50% symptomatic stenosis. We evaluated interobserver concordance and assessed each type of lesion relative to 13 atherosclerotic risk factors, mode of symptom presentation, infarct pattern, procedure-related factors, and clinical outcomes, by univariate and multivariable logistic regression analysis.

RESULTS: Interobserver concordance showed good agreement for differentiating apical and body lesions (κ = 0.745). Univariate analysis revealed that apical lesions ( n = 108, 54%) were associated with pseudo-occlusion ( P = .027), older age ( P = .073), and alcohol intake ( P = .080), whereas body lesions ( n = 92, 46%) were associated with hyperlipidemia ( P = .001), a wedge-shaped cortical infarct pattern ( P = .057), and hyperperfusion syndrome ( P = .083). Multivariable logistic regression analysis adjusted by age revealed that hyperlipidemia ( P = .002; OR, 3.462; 95% CI, 1.595–7.515) and hyperperfusion ( P = .026; OR, 6.727; 95% CI, 1.261–35.894) were independent predictors of body-type lesions.

CONCLUSIONS: Atherosclerotic carotid bulb stenosis was found to have 2 distinct locations, body and apical. Hyperlipidemia and cortical wedge-shaped infarcts were more frequently associated with body than with apical stenosis at the time of presentation.

CCA
:   common carotid artery
CI
:   confidence interval
ECA
:   external carotid artery
FEV
:   forced expiratory volume
ICA
:   internal carotid artery
mRS
:   modified Rankin scale
OR
:   odds ratio
NASCET
:   North American Symptomatic Carotid Endarterectomy Trial
NIHSS
:   National Institutes of Health Stroke Scale
WSS
:   wall shear stress" />
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      <h1 class="highwire-cite-title" id="page-title">Atherosclerotic Carotid Stenoses of Apical versus Body Lesions in High-Risk Carotid Stenting Patients</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S.-T. Park</span>, <span class="highwire-citation-author" data-delta="1">J.K. Kim</span>, <span class="highwire-citation-author" data-delta="2">K.H. Yoon</span>, <span class="highwire-citation-author" data-delta="3">S.-O. Park</span>, <span class="highwire-citation-author" data-delta="4">S.W. Park</span>, <span class="highwire-citation-author" data-delta="5">J.S. Kim</span>, <span class="highwire-citation-author" data-delta="6">S.J. Kim</span> and <span class="highwire-citation-author" data-delta="7">D.C. Suh</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">June 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1106-1112; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2000 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9908--81036838988" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S.-T. Park </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=S.-T.%2BPark%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=Park%20S&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%3AS.-T.%2BPark%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">J.K. Kim </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=J.K.%2BKim%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=Kim%20J&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%3AJ.K.%2BKim%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-2"><div class="author-tooltip-name">K.H. Yoon </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=K.H.%2BYoon%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=Yoon%20K&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%3AK.H.%2BYoon%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-3"><div class="author-tooltip-name">S.-O. Park </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=S.-O.%2BPark%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=Park%20S&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%3AS.-O.%2BPark%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-4"><div class="author-tooltip-name">S.W. Park </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=S.W.%2BPark%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=Park%20S&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%3AS.W.%2BPark%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-5"><div class="author-tooltip-name">J.S. Kim </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=J.S.%2BKim%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=Kim%20J&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%3AJ.S.%2BKim%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-6"><div class="author-tooltip-name">S.J. Kim </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=S.J.%2BKim%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=Kim%20S&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%3AS.J.%2BKim%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-7"><div class="author-tooltip-name">D.C. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">S.-T. Park</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">d</a>, </li><li class="contributor" id="contrib-2"><span class="name">J.K. Kim</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">e</a>, </li><li class="contributor" id="contrib-3"><span class="name">K.H. Yoon</span><a id="xref-aff-6-1" class="xref-aff" href="#aff-6">f</a>, </li><li class="contributor" id="contrib-4"><span class="name">S.-O. Park</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-5"><span class="name">S.W. Park</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-6"><span class="name">J.S. Kim</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a>, </li><li class="contributor" id="contrib-7"><span class="name">S.J. Kim</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a> and </li><li class="last" id="contrib-8"><span class="name">D.C. Suh</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Department of Radiology and Research Institute of Radiology (S.-T.P., S.-O.P., S.J.K., D.C.S.)</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Department of Cardiology (S.W.P.)</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Department of Neurology (J.S.K.), University of Ulsan, College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>d</sup>Department of Radiology (S.-T.P.), Soonchunhyang University Hospital, Yongsan-gu, Seoul, Korea</address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address><sup>e</sup>Department of Radiology (J.K.K.), Chung-Ang University College of Medicine, Seoul, Korea</address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address><sup>f</sup>Department of Mechanical Engreering (K.H.Y.), Dankook University, Suji-Gu, Yongin-Si, Gyeonggi-Do, Korea.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Dae Chul Suh, MD, <span class="addr-line">Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea</span>; e-mail: <span class="em-link"><span class="em-addr">dcsuh{at}amc.seoul.kr</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/6/1106.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.-T.</span> <span class="nlm-surname">Park</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.K.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">K.H.</span> <span class="nlm-surname">Yoon</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">S.-O.</span> <span class="nlm-surname">Park</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.W.</span> <span class="nlm-surname">Park</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">J.S.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.J.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">D.C.</span> <span class="nlm-surname">Suh</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1106-1112; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2000 </span></div>
  
  
  
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