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<meta name="DC.Title" content="Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2378" />
<meta name="DC.Date" content="2011-04-01" />
<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: Differentiating treatment effects from RPT is a common yet challenging task in a busy neuro-oncologic pratice. PS probably represents a different aspect of angiogenesis and vasculature and can provide additional physiologic information about recurrent/progressive enhancing lesions. The purpose of the study was to use PS measured by using PCT to differentiate TIN from RPT in patients with previously irradiated brain tumor who presented with a recurrent/progressive enhancing lesion.

MATERIALS AND METHODS: Seventy-two patients underwent PCT for assessment of a recurrent/progressive enhancing lesion from January 2006 to November 2009. Thirty-eight patients who underwent surgery and histopathologic diagnosis were included in this analysis. Perfusion parameters such as PS, CBV, CBF, and MTT were obtained from the enhancing lesion as well as from the NAWM.

RESULTS: Of 38 patients, 11 were diagnosed with pure TIN and 27 had RPT. Patients with TIN showed significantly lower mean PS values than those with RPT (1.8 ± 0.8 versus 3.6 ± 1.6 mL/100 g/min; P value = .001). The TIN group also showed lower rCBV (1.2 ± 0.3 versus 2.1 ± 0.7; P value &lt; .001), lower rCBF (1.2 ± 0.5 versus 2.6 ± 1.7; P value = .004), and higher rMTT (1.4 ± 0.4 versus 1.0 ± 0.4; P value = .018) compared with the RPT group.

CONCLUSIONS: PCT and particularly PS can be used in patients with previously treated brain tumors to differentiate TIN from RPT. PS estimates can help increase the accuracy of PCT in differentiating these 2 entities.

BBB
:   blood-brain barrier
CBF
:   cerebral blood flow
CBV
:   cerebral blood volume
EBRT
:   external beam radiation therapy
FSRT
:   fractionated stereotactic radiation therapy
GTR
:   gross total resection
IMRT
:   intensity-modulated radiation therapy
IV
:   intravenous
MTT
:   mean transit time
NAWM
:   normal-appearing white matter
PCT
:   perfusion CT
PCV
:   procarbazine, chloroethyl-cyclohexyl-nitrosourea and vincristine
PS
:   permeability surface area product
PSR
:   percentage signal-intensity recovery
rCBF
:   relative CBF
rCBV
:   relative CBV
rMTT
:   relative MTT
ROC
:   receiver operating characteristic analysis
rPSR
:   relative PSR
RPT
:   recurrent/progressive tumor
RT
:   radiation therapy
SRS
:   stereotactic radio-surgery
STR
:   subtotal resection
TIN
:   treatment-induced necrosis
TMZ
:   Temozolomide
VEGF
:   vascular endothelial growth factor
WHO
:   World Health Organization" />
<meta name="DC.Contributor" content="R. Jain" />
<meta name="DC.Contributor" content="J. Narang" />
<meta name="DC.Contributor" content="L. Schultz" />
<meta name="DC.Contributor" content="L. Scarpace" />
<meta name="DC.Contributor" content="S. Saksena" />
<meta name="DC.Contributor" content="S. Brown" />
<meta name="DC.Contributor" content="J.P. Rock" />
<meta name="DC.Contributor" content="M. Rosenblum" />
<meta name="DC.Contributor" content="J. Gutierrez" />
<meta name="DC.Contributor" content="T. Mikkelsen" />
<meta name="article:published_time" content="2011-04-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Differentiating treatment effects from RPT is a common yet challenging task in a busy neuro-oncologic pratice. PS probably represents a different aspect of angiogenesis and vasculature and can provide additional physiologic information about recurrent/progressive enhancing lesions. The purpose of the study was to use PS measured by using PCT to differentiate TIN from RPT in patients with previously irradiated brain tumor who presented with a recurrent/progressive enhancing lesion.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Seventy-two patients underwent PCT for assessment of a recurrent/progressive enhancing lesion from January 2006 to November 2009. Thirty-eight patients who underwent surgery and histopathologic diagnosis were included in this analysis. Perfusion parameters such as PS, CBV, CBF, and MTT were obtained from the enhancing lesion as well as from the NAWM.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Of 38 patients, 11 were diagnosed with pure TIN and 27 had RPT. Patients with TIN showed significantly lower mean PS values than those with RPT (1.8 ± 0.8 versus 3.6 ± 1.6 mL/100 g/min; &lt;i&gt;P&lt;/i&gt; value = .001). The TIN group also showed lower rCBV (1.2 ± 0.3 versus 2.1 ± 0.7; &lt;i&gt;P&lt;/i&gt; value &amp;lt; .001), lower rCBF (1.2 ± 0.5 versus 2.6 ± 1.7; &lt;i&gt;P&lt;/i&gt; value = .004), and higher rMTT (1.4 ± 0.4 versus 1.0 ± 0.4; &lt;i&gt;P&lt;/i&gt; value = .018) compared with the RPT group.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;PCT and particularly PS can be used in patients with previously treated brain tumors to differentiate TIN from RPT. PS estimates can help increase the accuracy of PCT in differentiating these 2 entities.&lt;/p&gt;" />
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<meta name="twitter:title" content="Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?" />
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<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/32/4.cover.gif" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Differentiating treatment effects from RPT is a common yet challenging task in a busy neuro-oncologic pratice. PS probably represents a different aspect of angiogenesis and vasculature and can provide additional physiologic information about recurrent/progressive enhancing lesions. The purpose of the study was to use PS measured by using PCT to differentiate TIN from RPT in patients with previously irradiated brain tumor who presented with a recurrent/progressive enhancing lesion.

MATERIALS AND METHODS: Seventy-two patients underwent PCT for assessment of a recurrent/progressive enhancing lesion from January 2006 to November 2009. Thirty-eight patients who underwent surgery and histopathologic diagnosis were included in this analysis. Perfusion parameters such as PS, CBV, CBF, and MTT were obtained from the enhancing lesion as well as from the NAWM.

RESULTS: Of 38 patients, 11 were diagnosed with pure TIN and 27 had RPT. Patients with TIN showed significantly lower mean PS values than those with RPT (1.8 ± 0.8 versus 3.6 ± 1.6 mL/100 g/min; P value = .001). The TIN group also showed lower rCBV (1.2 ± 0.3 versus 2.1 ± 0.7; P value &lt; .001), lower rCBF (1.2 ± 0.5 versus 2.6 ± 1.7; P value = .004), and higher rMTT (1.4 ± 0.4 versus 1.0 ± 0.4; P value = .018) compared with the RPT group.

CONCLUSIONS: PCT and particularly PS can be used in patients with previously treated brain tumors to differentiate TIN from RPT. PS estimates can help increase the accuracy of PCT in differentiating these 2 entities.

BBB
:   blood-brain barrier
CBF
:   cerebral blood flow
CBV
:   cerebral blood volume
EBRT
:   external beam radiation therapy
FSRT
:   fractionated stereotactic radiation therapy
GTR
:   gross total resection
IMRT
:   intensity-modulated radiation therapy
IV
:   intravenous
MTT
:   mean transit time
NAWM
:   normal-appearing white matter
PCT
:   perfusion CT
PCV
:   procarbazine, chloroethyl-cyclohexyl-nitrosourea and vincristine
PS
:   permeability surface area product
PSR
:   percentage signal-intensity recovery
rCBF
:   relative CBF
rCBV
:   relative CBV
rMTT
:   relative MTT
ROC
:   receiver operating characteristic analysis
rPSR
:   relative PSR
RPT
:   recurrent/progressive tumor
RT
:   radiation therapy
SRS
:   stereotactic radio-surgery
STR
:   subtotal resection
TIN
:   treatment-induced necrosis
TMZ
:   Temozolomide
VEGF
:   vascular endothelial growth factor
WHO
:   World Health Organization" />
<meta name="og-title" property="og:title" content="Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/32/4/658" />
<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: Differentiating treatment effects from RPT is a common yet challenging task in a busy neuro-oncologic pratice. PS probably represents a different aspect of angiogenesis and vasculature and can provide additional physiologic information about recurrent/progressive enhancing lesions. The purpose of the study was to use PS measured by using PCT to differentiate TIN from RPT in patients with previously irradiated brain tumor who presented with a recurrent/progressive enhancing lesion.

MATERIALS AND METHODS: Seventy-two patients underwent PCT for assessment of a recurrent/progressive enhancing lesion from January 2006 to November 2009. Thirty-eight patients who underwent surgery and histopathologic diagnosis were included in this analysis. Perfusion parameters such as PS, CBV, CBF, and MTT were obtained from the enhancing lesion as well as from the NAWM.

RESULTS: Of 38 patients, 11 were diagnosed with pure TIN and 27 had RPT. Patients with TIN showed significantly lower mean PS values than those with RPT (1.8 ± 0.8 versus 3.6 ± 1.6 mL/100 g/min; P value = .001). The TIN group also showed lower rCBV (1.2 ± 0.3 versus 2.1 ± 0.7; P value &lt; .001), lower rCBF (1.2 ± 0.5 versus 2.6 ± 1.7; P value = .004), and higher rMTT (1.4 ± 0.4 versus 1.0 ± 0.4; P value = .018) compared with the RPT group.

CONCLUSIONS: PCT and particularly PS can be used in patients with previously treated brain tumors to differentiate TIN from RPT. PS estimates can help increase the accuracy of PCT in differentiating these 2 entities.

BBB
:   blood-brain barrier
CBF
:   cerebral blood flow
CBV
:   cerebral blood volume
EBRT
:   external beam radiation therapy
FSRT
:   fractionated stereotactic radiation therapy
GTR
:   gross total resection
IMRT
:   intensity-modulated radiation therapy
IV
:   intravenous
MTT
:   mean transit time
NAWM
:   normal-appearing white matter
PCT
:   perfusion CT
PCV
:   procarbazine, chloroethyl-cyclohexyl-nitrosourea and vincristine
PS
:   permeability surface area product
PSR
:   percentage signal-intensity recovery
rCBF
:   relative CBF
rCBV
:   relative CBV
rMTT
:   relative MTT
ROC
:   receiver operating characteristic analysis
rPSR
:   relative PSR
RPT
:   recurrent/progressive tumor
RT
:   radiation therapy
SRS
:   stereotactic radio-surgery
STR
:   subtotal resection
TIN
:   treatment-induced necrosis
TMZ
:   Temozolomide
VEGF
:   vascular endothelial growth factor
WHO
:   World Health Organization" />
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      <h1 class="highwire-cite-title" id="page-title">Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">R. Jain</span>, <span class="highwire-citation-author" data-delta="1">J. Narang</span>, <span class="highwire-citation-author" data-delta="2">L. Schultz</span>, <span class="highwire-citation-author" data-delta="3">L. Scarpace</span>, <span class="highwire-citation-author" data-delta="4">S. Saksena</span>, <span class="highwire-citation-author" data-delta="5">S. Brown</span>, <span class="highwire-citation-author" data-delta="6">J.P. Rock</span>, <span class="highwire-citation-author" data-delta="7">M. Rosenblum</span>, <span class="highwire-citation-author" data-delta="8">J. Gutierrez</span> and <span class="highwire-citation-author" data-delta="9">T. Mikkelsen</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">April 2011,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">658-663; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2378 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9449--61541054336" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">R. Jain </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=R.%2BJain%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=Jain%20R&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%3AR.%2BJain%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. 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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Differentiating treatment effects from RPT is a common yet challenging task in a busy neuro-oncologic pratice. PS probably represents a different aspect of angiogenesis and vasculature and can provide additional physiologic information about recurrent/progressive enhancing lesions. The purpose of the study was to use PS measured by using PCT to differentiate TIN from RPT in patients with previously irradiated brain tumor who presented with a recurrent/progressive enhancing lesion.</p>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> Seventy-two patients underwent PCT for assessment of a recurrent/progressive enhancing lesion from January 2006 to November 2009. Thirty-eight patients who underwent surgery and histopathologic diagnosis were included in this analysis. Perfusion parameters such as PS, CBV, CBF, and MTT were obtained from the enhancing lesion as well as from the NAWM.</p>
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<p id="p-3"><strong>RESULTS:</strong> Of 38 patients, 11 were diagnosed with pure TIN and 27 had RPT. Patients with TIN showed significantly lower mean PS values than those with RPT (1.8 ± 0.8 versus 3.6 ± 1.6 mL/100 g/min; <em>P</em> value = .001). The TIN group also showed lower rCBV (1.2 ± 0.3 versus 2.1 ± 0.7; <em>P</em> value &lt; .001), lower rCBF (1.2 ± 0.5 versus 2.6 ± 1.7; <em>P</em> value = .004), and higher rMTT (1.4 ± 0.4 versus 1.0 ± 0.4; <em>P</em> value = .018) compared with the RPT group.</p>
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<p id="p-4"><strong>CONCLUSIONS:</strong> PCT and particularly PS can be used in patients with previously treated brain tumors to differentiate TIN from RPT. PS estimates can help increase the accuracy of PCT in differentiating these 2 entities.</p>
</div></div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">BBB<span class="def-item-dt-sep"></span></dt><dd>blood-brain barrier<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">CBV<span class="def-item-dt-sep"></span></dt><dd>cerebral blood volume<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">EBRT<span class="def-item-dt-sep"></span></dt><dd>external beam radiation therapy<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">FSRT<span class="def-item-dt-sep"></span></dt><dd>fractionated stereotactic radiation therapy<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">GTR<span class="def-item-dt-sep"></span></dt><dd>gross total resection<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">IMRT<span class="def-item-dt-sep"></span></dt><dd>intensity-modulated radiation therapy<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">IV<span class="def-item-dt-sep"></span></dt><dd>intravenous<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">MTT<span class="def-item-dt-sep"></span></dt><dd>mean transit time<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">NAWM<span class="def-item-dt-sep"></span></dt><dd>normal-appearing white matter<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">PCT<span class="def-item-dt-sep"></span></dt><dd>perfusion CT<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">PCV<span class="def-item-dt-sep"></span></dt><dd>procarbazine, chloroethyl-cyclohexyl-nitrosourea and vincristine<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">PS<span class="def-item-dt-sep"></span></dt><dd>permeability surface area product<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">PSR<span class="def-item-dt-sep"></span></dt><dd>percentage signal-intensity recovery<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">rCBF<span class="def-item-dt-sep"></span></dt><dd>relative CBF<span class="def-item-dd-sep"></span></dd><dt id="def-item-16">rCBV<span class="def-item-dt-sep"></span></dt><dd>relative CBV<span class="def-item-dd-sep"></span></dd><dt id="def-item-17">rMTT<span class="def-item-dt-sep"></span></dt><dd>relative MTT<span class="def-item-dd-sep"></span></dd><dt id="def-item-18">ROC<span class="def-item-dt-sep"></span></dt><dd>receiver operating characteristic analysis<span class="def-item-dd-sep"></span></dd><dt id="def-item-19">rPSR<span class="def-item-dt-sep"></span></dt><dd>relative PSR<span class="def-item-dd-sep"></span></dd><dt id="def-item-20">RPT<span class="def-item-dt-sep"></span></dt><dd>recurrent/progressive tumor<span class="def-item-dd-sep"></span></dd><dt id="def-item-21">RT<span class="def-item-dt-sep"></span></dt><dd>radiation therapy<span class="def-item-dd-sep"></span></dd><dt id="def-item-22">SRS<span class="def-item-dt-sep"></span></dt><dd>stereotactic radio-surgery<span class="def-item-dd-sep"></span></dd><dt id="def-item-23">STR<span class="def-item-dt-sep"></span></dt><dd>subtotal resection<span class="def-item-dd-sep"></span></dd><dt id="def-item-24">TIN<span class="def-item-dt-sep"></span></dt><dd>treatment-induced necrosis<span class="def-item-dd-sep"></span></dd><dt id="def-item-25">TMZ<span class="def-item-dt-sep"></span></dt><dd>Temozolomide<span class="def-item-dd-sep"></span></dd><dt id="def-item-26">VEGF<span class="def-item-dt-sep"></span></dt><dd>vascular endothelial growth factor<span class="def-item-dd-sep"></span></dd><dt id="def-item-27">WHO<span class="def-item-dt-sep"></span></dt><dd>World Health Organization</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/32/4/658.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. 32</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 4 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Apr 2011 </div></div>
      
      
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      <div class="highwire-cite-title">Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?</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">R.</span> <span class="nlm-surname">Jain</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Narang</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Schultz</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Scarpace</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Saksena</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Brown</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">J.P.</span> <span class="nlm-surname">Rock</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Rosenblum</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Gutierrez</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Mikkelsen</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">Apr 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">658-663; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2378 </span></div>
  
  
  
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      <div class="highwire-cite-title">Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?</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">R.</span> <span class="nlm-surname">Jain</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Narang</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Schultz</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Scarpace</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Saksena</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Brown</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">J.P.</span> <span class="nlm-surname">Rock</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Rosenblum</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Gutierrez</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Mikkelsen</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">Apr 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">658-663; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2378 </span></div>
  
  
  
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