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<meta name="DC.Title" content="Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2124" />
<meta name="DC.Date" content="2010-10-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The “ivy” sign that is identified on FLAIR images in patients with Moyamoya disease is considered to be leptomeningeal collaterals. The aim of our study was to evaluate the correlation between postoperative decrease in ivy sign and cerebral hemodynamic status in the bypass-established hemisphere.

MATERIALS AND METHODS: Twenty-two patients with Moyamoya disease were enrolled. Postoperative changes in the ivy sign on FLAIR images were examined in each patient after bypass surgery. The correlation between postoperative changes in the ivy sign and hemodynamic status was examined in 10 patients by using SPECT.

RESULTS: Of the 22 preoperative ivy-positive patients, 21 showed decreased ivy signs on the operative side. Average intervals between the operation day and the date when the decreased or vanished ivy sign was first recognized were 157.6 days in patients who underwent direct bypass and 212.2 days in patients who underwent indirect bypass. A postoperative decrease in ivy signs was found to be significantly correlated with an improved hemodynamic status of the surgically treated hemisphere, resulting in a postoperative increase in regional vascular reserve and a decreased proportion of the misery perfusion area ( P &lt; .01).

CONCLUSIONS: Postoperative changes in the ivy sign can be used as a marker for identifying improved hemodynamics and also for testing the effectiveness of cerebral revascularization.

ACZ
:   acetylzolamide
CBF
:   cerebral blood flow
FLAIR
:   fluid-attenuated inversion recovery
Inf
:   inferior
123I-IMP
:   iodine-123- N -isopropyl-p-iodoamphetamine
IV
:   intravenous
JET
:   Japanese Extracranial-Intracranial Bypass Trial
L
:   left
Lt La
:   left lateral
MCA
:   middle cerebral artery
MRA
:   MR angiography
MRI
:   MR imaging
PET
:   positron-emission tomography
postope.
:   postoperative
preope.
:   preoperative
R
:   right
Rt Lat
:   right lateral
STA-MCA
:   superficial temporal artery−middle cerebral artery
rCBF
:   regional CBF
Rest
:   resting
rVR
:   regional VR
SPECT
:   single-photon emission CT
Sup
:   superior
VR
:   vascular reserve" />
<meta name="DC.Contributor" content="M. Kawashima" />
<meta name="DC.Contributor" content="T. Noguchi" />
<meta name="DC.Contributor" content="Y. Takase" />
<meta name="DC.Contributor" content="Y. Nakahara" />
<meta name="DC.Contributor" content="T. Matsushima" />
<meta name="article:published_time" content="2010-10-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE: &lt;/h3&gt;
&lt;p&gt;The “ivy” sign that is identified on FLAIR images in patients with Moyamoya disease is considered to be leptomeningeal collaterals. The aim of our study was to evaluate the correlation between postoperative decrease in ivy sign and cerebral hemodynamic status in the bypass-established hemisphere.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS: &lt;/h3&gt;
&lt;p&gt;Twenty-two patients with Moyamoya disease were enrolled. Postoperative changes in the ivy sign on FLAIR images were examined in each patient after bypass surgery. The correlation between postoperative changes in the ivy sign and hemodynamic status was examined in 10 patients by using SPECT.&lt;/p&gt;&lt;h3&gt;RESULTS: &lt;/h3&gt;
&lt;p&gt;Of the 22 preoperative ivy-positive patients, 21 showed decreased ivy signs on the operative side. Average intervals between the operation day and the date when the decreased or vanished ivy sign was first recognized were 157.6 days in patients who underwent direct bypass and 212.2 days in patients who underwent indirect bypass. A postoperative decrease in ivy signs was found to be significantly correlated with an improved hemodynamic status of the surgically treated hemisphere, resulting in a postoperative increase in regional vascular reserve and a decreased proportion of the misery perfusion area (&lt;i&gt;P&lt;/i&gt; &amp;lt; .01).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS: &lt;/h3&gt;
&lt;p&gt;Postoperative changes in the ivy sign can be used as a marker for identifying improved hemodynamics and also for testing the effectiveness of cerebral revascularization.&lt;/p&gt;" />
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<meta name="twitter:title" content="Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The “ivy” sign that is identified on FLAIR images in patients with Moyamoya disease is considered to be leptomeningeal collaterals. The aim of our study was to evaluate the correlation between postoperative decrease in ivy sign and cerebral hemodynamic status in the bypass-established hemisphere.

MATERIALS AND METHODS: Twenty-two patients with Moyamoya disease were enrolled. Postoperative changes in the ivy sign on FLAIR images were examined in each patient after bypass surgery. The correlation between postoperative changes in the ivy sign and hemodynamic status was examined in 10 patients by using SPECT.

RESULTS: Of the 22 preoperative ivy-positive patients, 21 showed decreased ivy signs on the operative side. Average intervals between the operation day and the date when the decreased or vanished ivy sign was first recognized were 157.6 days in patients who underwent direct bypass and 212.2 days in patients who underwent indirect bypass. A postoperative decrease in ivy signs was found to be significantly correlated with an improved hemodynamic status of the surgically treated hemisphere, resulting in a postoperative increase in regional vascular reserve and a decreased proportion of the misery perfusion area ( P &lt; .01).

CONCLUSIONS: Postoperative changes in the ivy sign can be used as a marker for identifying improved hemodynamics and also for testing the effectiveness of cerebral revascularization.

ACZ
:   acetylzolamide
CBF
:   cerebral blood flow
FLAIR
:   fluid-attenuated inversion recovery
Inf
:   inferior
123I-IMP
:   iodine-123- N -isopropyl-p-iodoamphetamine
IV
:   intravenous
JET
:   Japanese Extracranial-Intracranial Bypass Trial
L
:   left
Lt La
:   left lateral
MCA
:   middle cerebral artery
MRA
:   MR angiography
MRI
:   MR imaging
PET
:   positron-emission tomography
postope.
:   postoperative
preope.
:   preoperative
R
:   right
Rt Lat
:   right lateral
STA-MCA
:   superficial temporal artery−middle cerebral artery
rCBF
:   regional CBF
Rest
:   resting
rVR
:   regional VR
SPECT
:   single-photon emission CT
Sup
:   superior
VR
:   vascular reserve" />
<meta name="og-title" property="og:title" content="Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/9/1713" />
<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: The “ivy” sign that is identified on FLAIR images in patients with Moyamoya disease is considered to be leptomeningeal collaterals. The aim of our study was to evaluate the correlation between postoperative decrease in ivy sign and cerebral hemodynamic status in the bypass-established hemisphere.

MATERIALS AND METHODS: Twenty-two patients with Moyamoya disease were enrolled. Postoperative changes in the ivy sign on FLAIR images were examined in each patient after bypass surgery. The correlation between postoperative changes in the ivy sign and hemodynamic status was examined in 10 patients by using SPECT.

RESULTS: Of the 22 preoperative ivy-positive patients, 21 showed decreased ivy signs on the operative side. Average intervals between the operation day and the date when the decreased or vanished ivy sign was first recognized were 157.6 days in patients who underwent direct bypass and 212.2 days in patients who underwent indirect bypass. A postoperative decrease in ivy signs was found to be significantly correlated with an improved hemodynamic status of the surgically treated hemisphere, resulting in a postoperative increase in regional vascular reserve and a decreased proportion of the misery perfusion area ( P &lt; .01).

CONCLUSIONS: Postoperative changes in the ivy sign can be used as a marker for identifying improved hemodynamics and also for testing the effectiveness of cerebral revascularization.

ACZ
:   acetylzolamide
CBF
:   cerebral blood flow
FLAIR
:   fluid-attenuated inversion recovery
Inf
:   inferior
123I-IMP
:   iodine-123- N -isopropyl-p-iodoamphetamine
IV
:   intravenous
JET
:   Japanese Extracranial-Intracranial Bypass Trial
L
:   left
Lt La
:   left lateral
MCA
:   middle cerebral artery
MRA
:   MR angiography
MRI
:   MR imaging
PET
:   positron-emission tomography
postope.
:   postoperative
preope.
:   preoperative
R
:   right
Rt Lat
:   right lateral
STA-MCA
:   superficial temporal artery−middle cerebral artery
rCBF
:   regional CBF
Rest
:   resting
rVR
:   regional VR
SPECT
:   single-photon emission CT
Sup
:   superior
VR
:   vascular reserve" />
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      <h1 class="highwire-cite-title" id="page-title">Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. Kawashima</span>, <span class="highwire-citation-author" data-delta="1">T. Noguchi</span>, <span class="highwire-citation-author" data-delta="2">Y. Takase</span>, <span class="highwire-citation-author" data-delta="3">Y. Nakahara</span> and <span class="highwire-citation-author" data-delta="4">T. Matsushima</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">October 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1713-1718; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2124 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9841--6162324874" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. Kawashima </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.%2BKawashima%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=Kawashima%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.%2BKawashima%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">T. Noguchi </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=T.%2BNoguchi%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=Noguchi%20T&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%3AT.%2BNoguchi%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">Y. Takase </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=Y.%2BTakase%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=Takase%20Y&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%3AY.%2BTakase%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">Y. Nakahara </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=Y.%2BNakahara%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=Nakahara%20Y&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%3AY.%2BNakahara%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">T. Matsushima </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=T.%2BMatsushima%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=Matsushima%20T&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%3AT.%2BMatsushima%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<p id="p-1"><strong>BACKGROUND AND PURPOSE: </strong>The “ivy” sign that is identified on FLAIR images in patients with Moyamoya disease is considered to be leptomeningeal collaterals. The aim of our study was to evaluate the correlation between postoperative decrease in ivy sign and cerebral hemodynamic status in the bypass-established hemisphere.</p>
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<p id="p-2"><strong>MATERIALS AND METHODS: </strong>Twenty-two patients with Moyamoya disease were enrolled. Postoperative changes in the ivy sign on FLAIR images were examined in each patient after bypass surgery. The correlation between postoperative changes in the ivy sign and hemodynamic status was examined in 10 patients by using SPECT.</p>
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<p id="p-3"><strong>RESULTS: </strong>Of the 22 preoperative ivy-positive patients, 21 showed decreased ivy signs on the operative side. Average intervals between the operation day and the date when the decreased or vanished ivy sign was first recognized were 157.6 days in patients who underwent direct bypass and 212.2 days in patients who underwent indirect bypass. A postoperative decrease in ivy signs was found to be significantly correlated with an improved hemodynamic status of the surgically treated hemisphere, resulting in a postoperative increase in regional vascular reserve and a decreased proportion of the misery perfusion area (<em>P</em> &lt; .01).</p>
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<p id="p-4"><strong>CONCLUSIONS: </strong>Postoperative changes in the ivy sign can be used as a marker for identifying improved hemodynamics and also for testing the effectiveness of cerebral revascularization.</p>
</div></div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">ACZ<span class="def-item-dt-sep"></span></dt><dd>acetylzolamide<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CBF<span class="def-item-dt-sep"></span></dt><dd>cerebral blood flow<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">FLAIR<span class="def-item-dt-sep"></span></dt><dd>fluid-attenuated inversion recovery<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">Inf<span class="def-item-dt-sep"></span></dt><dd>inferior<span class="def-item-dd-sep"></span></dd><dt id="def-item-5"><sup>123</sup>I-IMP<span class="def-item-dt-sep"></span></dt><dd>iodine-123-<em>N</em>-isopropyl-p-iodoamphetamine<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">IV<span class="def-item-dt-sep"></span></dt><dd>intravenous<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">JET<span class="def-item-dt-sep"></span></dt><dd>Japanese Extracranial-Intracranial Bypass Trial<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">L<span class="def-item-dt-sep"></span></dt><dd>left<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">Lt La<span class="def-item-dt-sep"></span></dt><dd>left lateral<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">MCA<span class="def-item-dt-sep"></span></dt><dd>middle cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">MRA<span class="def-item-dt-sep"></span></dt><dd>MR angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">MRI<span class="def-item-dt-sep"></span></dt><dd>MR imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">PET<span class="def-item-dt-sep"></span></dt><dd>positron-emission tomography<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">postope.<span class="def-item-dt-sep"></span></dt><dd>postoperative<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">preope.<span class="def-item-dt-sep"></span></dt><dd>preoperative<span class="def-item-dd-sep"></span></dd><dt id="def-item-16">R<span class="def-item-dt-sep"></span></dt><dd>right<span class="def-item-dd-sep"></span></dd><dt id="def-item-17">Rt Lat<span class="def-item-dt-sep"></span></dt><dd>right lateral<span class="def-item-dd-sep"></span></dd><dt id="def-item-18">STA-MCA<span class="def-item-dt-sep"></span></dt><dd>superficial temporal artery−middle cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-19">rCBF<span class="def-item-dt-sep"></span></dt><dd>regional CBF<span class="def-item-dd-sep"></span></dd><dt id="def-item-20">Rest<span class="def-item-dt-sep"></span></dt><dd>resting<span class="def-item-dd-sep"></span></dd><dt id="def-item-21">rVR<span class="def-item-dt-sep"></span></dt><dd>regional VR<span class="def-item-dd-sep"></span></dd><dt id="def-item-22">SPECT<span class="def-item-dt-sep"></span></dt><dd>single-photon emission CT<span class="def-item-dd-sep"></span></dd><dt id="def-item-23">Sup<span class="def-item-dt-sep"></span></dt><dd>superior<span class="def-item-dd-sep"></span></dd><dt id="def-item-24">VR<span class="def-item-dt-sep"></span></dt><dd>vascular reserve</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/9/1713.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-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 31</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 9 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Oct 2010 </div></div>
      
      
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      <div class="highwire-cite-title">Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease</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">Kawashima</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Noguchi</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Takase</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Nakahara</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Matsushima</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">Oct 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1713-1718; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2124 </span></div>
  
  
  
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      <div class="highwire-cite-title">Decrease in Leptomeningeal Ivy Sign on Fluid-Attenuated Inversion Recovery Images after Cerebral Revascularization in Patients with Moyamoya Disease</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">Kawashima</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Noguchi</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Takase</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Nakahara</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Matsushima</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">Oct 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1713-1718; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2124 </span></div>
  
  
  
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