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<meta name="DC.Title" content="Clinical Correlates of White Matter Blood Flow Perfusion Changes in Sturge-Weber Syndrome: A Dynamic MR Perfusion-Weighted Imaging Study" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2540" />
<meta name="DC.Date" content="2011-08-01" />
<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: Low brain tissue perfusion due to abnormal venous drainage is thought to be a central mechanism of brain damage in SWS. Here, HR-PWI was used to quantify WM perfusion abnormalities and to correlate these with brain atrophy and clinical variables.

MATERIALS AND METHODS: Fourteen children (age range, 0.8–10.0 years) with unilateral SWS underwent MR imaging examinations, including HR-PWI. rCBV, rCBF, and MTT in the affected WM and in contralateral homotopic WM were measured. AI for each perfusion parameter was correlated with age, brain atrophy, and motor and seizure variables as well as IQ.

RESULTS: Increased perfusion was seen in the affected hemisphere in 5 children and decreased perfusion in 9 children. Brain atrophy was more severe in the low-perfusion group ( P = .01) and was related to both CBF-AI and CBV-AI ( r = −0.69, P = .007; r = −0.64, P = .014, respectively). Older children had lower CBV values on the affected side ( r = −0.62, P = .02). Longer duration of epilepsy was related to lower CBF (more negative CBF-AI, r = −0.58, P = .03) and low CBV ( r = −0.55, P = .04) on the affected side. Lower perfusion was associated with more frequent seizures (rCBF-AI: r = −0.56, P = .04; rCBV-AI: r = −0.63, P = .02).

CONCLUSIONS: Increased perfusion in the affected cerebral WM may indicate an early stage of SWS without severe brain atrophy. Decreased perfusion is associated with frequent seizures, long duration of epilepsy, and brain atrophy.

AI
:   asymmetry index
AIc
:   calculated asymmetry index
AIs
:   hemispheric perfusion parameter
Amr
:   age at MR examination
Asz
:   age at first seizure
BA
:   brain atrophy
CBF
:   cerebral blood flow
CBV
:   cerebral blood volume
Cont
:   contralateral (to angioma)
HR-PWI
:   high-resolution perfusion-weighted imaging
Ipsi
:   ipsilateral
IQ
:   intelligence quotient
MTT
:   mean transit time
PET
:   positron-emission tomography
PHT
:   phenytoin
PWI
:   perfusion-weighted imaging
rCBF
:   relative cerebral blood flow
rCBV
:   relative cerebral blood volume
rHP
:   relative high perfusion
rLP
:   relative low perfusion
rMTT
:   relative mean transit time
ROI
:   region of interest
SPECT
:   single-photon emission CT
SPIN
:   Signal intensity Process in Neuroimaging
SWS
:   Sturge-Weber syndrome
T1WI
:   T1-weighted imaging
T2WI
:   T2-weighted imaging
WM
:   white matter" />
<meta name="DC.Contributor" content="Y. Miao" />
<meta name="DC.Contributor" content="C. Juhász" />
<meta name="DC.Contributor" content="J. Wu" />
<meta name="DC.Contributor" content="B. Tarabishy" />
<meta name="DC.Contributor" content="Z. Lang" />
<meta name="DC.Contributor" content="M.E. Behen" />
<meta name="DC.Contributor" content="Z. Kou" />
<meta name="DC.Contributor" content="Y. Ye" />
<meta name="DC.Contributor" content="H.T. Chugani" />
<meta name="DC.Contributor" content="J. Hu" />
<meta name="article:published_time" content="2011-08-01" />
<meta name="article:section" content="Pediatrics" />
<meta name="citation_title" content="Clinical Correlates of White Matter Blood Flow Perfusion Changes in Sturge-Weber Syndrome: A Dynamic MR Perfusion-Weighted Imaging Study" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Low brain tissue perfusion due to abnormal venous drainage is thought to be a central mechanism of brain damage in SWS. Here, HR-PWI was used to quantify WM perfusion abnormalities and to correlate these with brain atrophy and clinical variables.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Fourteen children (age range, 0.8–10.0 years) with unilateral SWS underwent MR imaging examinations, including HR-PWI. rCBV, rCBF, and MTT in the affected WM and in contralateral homotopic WM were measured. AI for each perfusion parameter was correlated with age, brain atrophy, and motor and seizure variables as well as IQ.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Increased perfusion was seen in the affected hemisphere in 5 children and decreased perfusion in 9 children. Brain atrophy was more severe in the low-perfusion group (&lt;i&gt;P&lt;/i&gt; = .01) and was related to both CBF-AI and CBV-AI (&lt;i&gt;r&lt;/i&gt; = −0.69, &lt;i&gt;P&lt;/i&gt; = .007; &lt;i&gt;r&lt;/i&gt; = −0.64, &lt;i&gt;P&lt;/i&gt; = .014, respectively). Older children had lower CBV values on the affected side (&lt;i&gt;r&lt;/i&gt; = −0.62, &lt;i&gt;P&lt;/i&gt; = .02). Longer duration of epilepsy was related to lower CBF (more negative CBF-AI, &lt;i&gt;r&lt;/i&gt; = −0.58, &lt;i&gt;P&lt;/i&gt; = .03) and low CBV (&lt;i&gt;r&lt;/i&gt; = −0.55, &lt;i&gt;P&lt;/i&gt; = .04) on the affected side. Lower perfusion was associated with more frequent seizures (rCBF-AI: &lt;i&gt;r&lt;/i&gt; = −0.56, &lt;i&gt;P&lt;/i&gt; = .04; rCBV-AI: &lt;i&gt;r&lt;/i&gt; = −0.63, &lt;i&gt;P&lt;/i&gt; = .02).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Increased perfusion in the affected cerebral WM may indicate an early stage of SWS without severe brain atrophy. Decreased perfusion is associated with frequent seizures, long duration of epilepsy, and brain atrophy.&lt;/p&gt;" />
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<meta name="twitter:title" content="Clinical Correlates of White Matter Blood Flow Perfusion Changes in Sturge-Weber Syndrome: A Dynamic MR Perfusion-Weighted Imaging Study" />
<meta name="twitter:card" content="summary_large_image" />
<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/32/7.cover.gif" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Low brain tissue perfusion due to abnormal venous drainage is thought to be a central mechanism of brain damage in SWS. Here, HR-PWI was used to quantify WM perfusion abnormalities and to correlate these with brain atrophy and clinical variables.

MATERIALS AND METHODS: Fourteen children (age range, 0.8–10.0 years) with unilateral SWS underwent MR imaging examinations, including HR-PWI. rCBV, rCBF, and MTT in the affected WM and in contralateral homotopic WM were measured. AI for each perfusion parameter was correlated with age, brain atrophy, and motor and seizure variables as well as IQ.

RESULTS: Increased perfusion was seen in the affected hemisphere in 5 children and decreased perfusion in 9 children. Brain atrophy was more severe in the low-perfusion group ( P = .01) and was related to both CBF-AI and CBV-AI ( r = −0.69, P = .007; r = −0.64, P = .014, respectively). Older children had lower CBV values on the affected side ( r = −0.62, P = .02). Longer duration of epilepsy was related to lower CBF (more negative CBF-AI, r = −0.58, P = .03) and low CBV ( r = −0.55, P = .04) on the affected side. Lower perfusion was associated with more frequent seizures (rCBF-AI: r = −0.56, P = .04; rCBV-AI: r = −0.63, P = .02).

CONCLUSIONS: Increased perfusion in the affected cerebral WM may indicate an early stage of SWS without severe brain atrophy. Decreased perfusion is associated with frequent seizures, long duration of epilepsy, and brain atrophy.

AI
:   asymmetry index
AIc
:   calculated asymmetry index
AIs
:   hemispheric perfusion parameter
Amr
:   age at MR examination
Asz
:   age at first seizure
BA
:   brain atrophy
CBF
:   cerebral blood flow
CBV
:   cerebral blood volume
Cont
:   contralateral (to angioma)
HR-PWI
:   high-resolution perfusion-weighted imaging
Ipsi
:   ipsilateral
IQ
:   intelligence quotient
MTT
:   mean transit time
PET
:   positron-emission tomography
PHT
:   phenytoin
PWI
:   perfusion-weighted imaging
rCBF
:   relative cerebral blood flow
rCBV
:   relative cerebral blood volume
rHP
:   relative high perfusion
rLP
:   relative low perfusion
rMTT
:   relative mean transit time
ROI
:   region of interest
SPECT
:   single-photon emission CT
SPIN
:   Signal intensity Process in Neuroimaging
SWS
:   Sturge-Weber syndrome
T1WI
:   T1-weighted imaging
T2WI
:   T2-weighted imaging
WM
:   white matter" />
<meta name="og-title" property="og:title" content="Clinical Correlates of White Matter Blood Flow Perfusion Changes in Sturge-Weber Syndrome: A Dynamic MR Perfusion-Weighted Imaging Study" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/32/7/1280" />
<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: Low brain tissue perfusion due to abnormal venous drainage is thought to be a central mechanism of brain damage in SWS. Here, HR-PWI was used to quantify WM perfusion abnormalities and to correlate these with brain atrophy and clinical variables.

MATERIALS AND METHODS: Fourteen children (age range, 0.8–10.0 years) with unilateral SWS underwent MR imaging examinations, including HR-PWI. rCBV, rCBF, and MTT in the affected WM and in contralateral homotopic WM were measured. AI for each perfusion parameter was correlated with age, brain atrophy, and motor and seizure variables as well as IQ.

RESULTS: Increased perfusion was seen in the affected hemisphere in 5 children and decreased perfusion in 9 children. Brain atrophy was more severe in the low-perfusion group ( P = .01) and was related to both CBF-AI and CBV-AI ( r = −0.69, P = .007; r = −0.64, P = .014, respectively). Older children had lower CBV values on the affected side ( r = −0.62, P = .02). Longer duration of epilepsy was related to lower CBF (more negative CBF-AI, r = −0.58, P = .03) and low CBV ( r = −0.55, P = .04) on the affected side. Lower perfusion was associated with more frequent seizures (rCBF-AI: r = −0.56, P = .04; rCBV-AI: r = −0.63, P = .02).

CONCLUSIONS: Increased perfusion in the affected cerebral WM may indicate an early stage of SWS without severe brain atrophy. Decreased perfusion is associated with frequent seizures, long duration of epilepsy, and brain atrophy.

AI
:   asymmetry index
AIc
:   calculated asymmetry index
AIs
:   hemispheric perfusion parameter
Amr
:   age at MR examination
Asz
:   age at first seizure
BA
:   brain atrophy
CBF
:   cerebral blood flow
CBV
:   cerebral blood volume
Cont
:   contralateral (to angioma)
HR-PWI
:   high-resolution perfusion-weighted imaging
Ipsi
:   ipsilateral
IQ
:   intelligence quotient
MTT
:   mean transit time
PET
:   positron-emission tomography
PHT
:   phenytoin
PWI
:   perfusion-weighted imaging
rCBF
:   relative cerebral blood flow
rCBV
:   relative cerebral blood volume
rHP
:   relative high perfusion
rLP
:   relative low perfusion
rMTT
:   relative mean transit time
ROI
:   region of interest
SPECT
:   single-photon emission CT
SPIN
:   Signal intensity Process in Neuroimaging
SWS
:   Sturge-Weber syndrome
T1WI
:   T1-weighted imaging
T2WI
:   T2-weighted imaging
WM
:   white matter" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Pediatrics</span></span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-series highwire-cite-metadata">F</span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Clinical Correlates of White Matter Blood Flow Perfusion Changes in Sturge-Weber Syndrome: A Dynamic MR Perfusion-Weighted Imaging Study</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Y. Miao</span>, <span class="highwire-citation-author" data-delta="1">C. Juhász</span>, <span class="highwire-citation-author" data-delta="2">J. Wu</span>, <span class="highwire-citation-author" data-delta="3">B. Tarabishy</span>, <span class="highwire-citation-author" data-delta="4">Z. Lang</span>, <span class="highwire-citation-author" data-delta="5">M.E. Behen</span>, <span class="highwire-citation-author" data-delta="6">Z. Kou</span>, <span class="highwire-citation-author" data-delta="7">Y. Ye</span>, <span class="highwire-citation-author" data-delta="8">H.T. Chugani</span> and <span class="highwire-citation-author" data-delta="9">J. Hu</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">August 2011,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1280-1285; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2540 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-11445--81493629857" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Y. Miao </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.%2BMiao%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=Miao%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.%2BMiao%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">C. 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Kou </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=Z.%2BKou%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=Kou%20Z&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%3AZ.%2BKou%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">Y. 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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">Y. Miao</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a>, </li><li class="contributor" id="contrib-2"><span class="name">C. Juhász</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-3"><span class="name">J. Wu</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-4"><span class="name">B. Tarabishy</span><a id="xref-aff-3-2" class="xref-aff" href="#aff-3">c</a>, </li><li class="contributor" id="contrib-5"><span class="name">Z. Lang</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-6"><span class="name">M.E. Behen</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-7"><span class="name">Z. Kou</span><a id="xref-aff-3-3" class="xref-aff" href="#aff-3">c</a>, </li><li class="contributor" id="contrib-8"><span class="name">Y. Ye</span><a id="xref-aff-3-4" class="xref-aff" href="#aff-3">c</a>, </li><li class="contributor" id="contrib-9"><span class="name">H.T. Chugani</span><a id="xref-aff-2-3" class="xref-aff" href="#aff-2">b</a> and </li><li class="last" id="contrib-10"><span class="name">J. Hu</span><a id="xref-aff-3-5" class="xref-aff" href="#aff-3">c</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 (Y.M., J.W., Z.L.), First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Departments of Pediatrics and Neurology (C.J., M.E.B., H.T.C.), Translational Imaging Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Department of Radiology (Y.M., B.T., Z.K., Y.Y., J.H.), Wayne State University, Detroit, Michigan</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Jiani Hu, MD, <span class="addr-line">Department of Radiology, Wayne State University, 3990 John R Rd, Detroit, MI 48202</span>; e-mail: <span class="em-link"><span class="em-addr">jhu{at}med/wayne.edu</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/32/7/1280.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-title">Clinical Correlates of White Matter Blood Flow Perfusion Changes in Sturge-Weber Syndrome: A Dynamic MR Perfusion-Weighted Imaging Study</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">Y.</span> <span class="nlm-surname">Miao</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Juhász</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Wu</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Tarabishy</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Z.</span> <span class="nlm-surname">Lang</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.E.</span> <span class="nlm-surname">Behen</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Z.</span> <span class="nlm-surname">Kou</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Ye</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">H.T.</span> <span class="nlm-surname">Chugani</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Hu</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">Aug 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1280-1285; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2540 </span></div>
  
  
  
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      <div class="highwire-cite-title">Clinical Correlates of White Matter Blood Flow Perfusion Changes in Sturge-Weber Syndrome: A Dynamic MR Perfusion-Weighted Imaging Study</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">Y.</span> <span class="nlm-surname">Miao</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Juhász</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Wu</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Tarabishy</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Z.</span> <span class="nlm-surname">Lang</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.E.</span> <span class="nlm-surname">Behen</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Z.</span> <span class="nlm-surname">Kou</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Ye</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">H.T.</span> <span class="nlm-surname">Chugani</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Hu</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">Aug 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1280-1285; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2540 </span></div>
  
  
  
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