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<meta name="DC.Title" content="A Randomized Trial Comparing 2 Techniques of Balloon Kyphoplasty and Curette Use for Obtaining Vertebral Body Height Restoration and Angular-Deformity Correction in Vertebral Compression Fractures due to Osteoporosis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3363" />
<meta name="DC.Date" content="2013-03-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2013 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Vertebral compression fractures often result in pain and vertebral deformity. We compared 2 different balloon kyphoplasty techniques both using intraoperative curettage.

MATERIALS AND METHODS: Adults 50 years of age or older with osteoporosis and 1 acute VCF were randomized to undergo bilateral BKP in which the curette was used first ( n = 57) followed by inflatable bone tamps or in which IBTs were used first, followed by curettage and a second IBT inflation ( n = 55).

RESULTS: Mean procedure duration was 33.5 and 36.8 minutes, and fluoroscopy duration was 3.8 and 3.7 minutes for the CF and IBTF groups, respectively. Two-thirds of VCFs were wedge-shaped, and one-half had dynamic mobility. Anterior height restored postoperatively was 2.28 mm (95% CI, 1.49–3.08 mm; P &lt; .001) and 2.78 mm (95% CI, 1.89–3.66 mm; P &lt; .001) for CF and IBTF groups, representing ∼35% and 39% of lost height restored, but group differences were not significant ( P = .4). Intraoperative anterior height gain attributed to dynamic mobility was 2.96 mm (95% CI, 1.92–4.00 mm; P &lt; .001) and 3.05 mm (95% CI, 2.10–4.00 mm; P &lt; .001); additional height attributed to IBT inflation was 1.09 mm (95% CI, 0.77–1.41 mm; P &lt; .001) and 1.25 mm (95% CI, 0.68–1.82 mm; P &lt; .001), representing a 37% and 41% increase. There was no significant height loss on IBT removal and cementation. Both groups had improved pain and ambulation. Asymptomatic leakage occurred in 15% of VCFs. There was 1 nonserious device-related hematoma (IBTF group). One new clinical VCF occurred in each group, but they were not device-related.

CONCLUSIONS: Both techniques resulted in significant vertebral body height and pain improvement. Procedure and adverse event data demonstrated safe curette use in conjunction with balloon kyphoplasty procedures.

BKP
:   balloon kyphoplasty
CF
:   curette-first
CI
:   confidence interval
IBT
:   inflatable bone tamp
IBTF
:   IBT-first
IQR
:   interquartile range
VCF
:   vertebral compression fracture" />
<meta name="DC.Contributor" content="L. Bastian" />
<meta name="DC.Contributor" content="F. Schils" />
<meta name="DC.Contributor" content="J.B. Tillman" />
<meta name="DC.Contributor" content="G. Fueredi" />
<meta name="article:published_time" content="2013-03-01" />
<meta name="article:section" content="Spine" />
<meta name="citation_title" content="A Randomized Trial Comparing 2 Techniques of Balloon Kyphoplasty and Curette Use for Obtaining Vertebral Body Height Restoration and Angular-Deformity Correction in Vertebral Compression Fractures due to Osteoporosis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Vertebral compression fractures often result in pain and vertebral deformity. We compared 2 different balloon kyphoplasty techniques both using intraoperative curettage.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Adults 50 years of age or older with osteoporosis and 1 acute VCF were randomized to undergo bilateral BKP in which the curette was used first (&lt;i&gt;n&lt;/i&gt; = 57) followed by inflatable bone tamps or in which IBTs were used first, followed by curettage and a second IBT inflation (&lt;i&gt;n&lt;/i&gt; = 55).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Mean procedure duration was 33.5 and 36.8 minutes, and fluoroscopy duration was 3.8 and 3.7 minutes for the CF and IBTF groups, respectively. Two-thirds of VCFs were wedge-shaped, and one-half had dynamic mobility. Anterior height restored postoperatively was 2.28 mm (95% CI, 1.49–3.08 mm; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001) and 2.78 mm (95% CI, 1.89–3.66 mm; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001) for CF and IBTF groups, representing ∼35% and 39% of lost height restored, but group differences were not significant (&lt;i&gt;P&lt;/i&gt; = .4). Intraoperative anterior height gain attributed to dynamic mobility was 2.96 mm (95% CI, 1.92–4.00 mm; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001) and 3.05 mm (95% CI, 2.10–4.00 mm; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001); additional height attributed to IBT inflation was 1.09 mm (95% CI, 0.77–1.41 mm; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001) and 1.25 mm (95% CI, 0.68–1.82 mm; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001), representing a 37% and 41% increase. There was no significant height loss on IBT removal and cementation. Both groups had improved pain and ambulation. Asymptomatic leakage occurred in 15% of VCFs. There was 1 nonserious device-related hematoma (IBTF group). One new clinical VCF occurred in each group, but they were not device-related.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Both techniques resulted in significant vertebral body height and pain improvement. Procedure and adverse event data demonstrated safe curette use in conjunction with balloon kyphoplasty procedures.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2013/03/01" />
<meta name="citation_mjid" content="ajnr;34/3/666" />
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<meta name="citation_reference" content="citation_journal_title=Osteoporosis international :  a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA;citation_journal_abbrev=Osteoporos Int;citation_author=MK. Shindle;citation_author=MJ. Gardner;citation_author=J. Koob;citation_title=Vertebral height restoration in osteoporotic compression fractures: kyphoplasty balloon tamp is superior to postural correction alone.;citation_pages=1815-1819;citation_volume=17;citation_year=2006;citation_issue=12;citation_pmid=16983458;citation_doi=10.1007/s00198-006-0195-x" />
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<meta name="twitter:title" content="A Randomized Trial Comparing 2 Techniques of Balloon Kyphoplasty and Curette Use for Obtaining Vertebral Body Height Restoration and Angular-Deformity Correction in Vertebral Compression Fractures due to Osteoporosis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Vertebral compression fractures often result in pain and vertebral deformity. We compared 2 different balloon kyphoplasty techniques both using intraoperative curettage.

MATERIALS AND METHODS: Adults 50 years of age or older with osteoporosis and 1 acute VCF were randomized to undergo bilateral BKP in which the curette was used first ( n = 57) followed by inflatable bone tamps or in which IBTs were used first, followed by curettage and a second IBT inflation ( n = 55).

RESULTS: Mean procedure duration was 33.5 and 36.8 minutes, and fluoroscopy duration was 3.8 and 3.7 minutes for the CF and IBTF groups, respectively. Two-thirds of VCFs were wedge-shaped, and one-half had dynamic mobility. Anterior height restored postoperatively was 2.28 mm (95% CI, 1.49–3.08 mm; P &lt; .001) and 2.78 mm (95% CI, 1.89–3.66 mm; P &lt; .001) for CF and IBTF groups, representing ∼35% and 39% of lost height restored, but group differences were not significant ( P = .4). Intraoperative anterior height gain attributed to dynamic mobility was 2.96 mm (95% CI, 1.92–4.00 mm; P &lt; .001) and 3.05 mm (95% CI, 2.10–4.00 mm; P &lt; .001); additional height attributed to IBT inflation was 1.09 mm (95% CI, 0.77–1.41 mm; P &lt; .001) and 1.25 mm (95% CI, 0.68–1.82 mm; P &lt; .001), representing a 37% and 41% increase. There was no significant height loss on IBT removal and cementation. Both groups had improved pain and ambulation. Asymptomatic leakage occurred in 15% of VCFs. There was 1 nonserious device-related hematoma (IBTF group). One new clinical VCF occurred in each group, but they were not device-related.

CONCLUSIONS: Both techniques resulted in significant vertebral body height and pain improvement. Procedure and adverse event data demonstrated safe curette use in conjunction with balloon kyphoplasty procedures.

BKP
:   balloon kyphoplasty
CF
:   curette-first
CI
:   confidence interval
IBT
:   inflatable bone tamp
IBTF
:   IBT-first
IQR
:   interquartile range
VCF
:   vertebral compression fracture" />
<meta name="og-title" property="og:title" content="A Randomized Trial Comparing 2 Techniques of Balloon Kyphoplasty and Curette Use for Obtaining Vertebral Body Height Restoration and Angular-Deformity Correction in Vertebral Compression Fractures due to Osteoporosis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/34/3/666" />
<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: Vertebral compression fractures often result in pain and vertebral deformity. We compared 2 different balloon kyphoplasty techniques both using intraoperative curettage.

MATERIALS AND METHODS: Adults 50 years of age or older with osteoporosis and 1 acute VCF were randomized to undergo bilateral BKP in which the curette was used first ( n = 57) followed by inflatable bone tamps or in which IBTs were used first, followed by curettage and a second IBT inflation ( n = 55).

RESULTS: Mean procedure duration was 33.5 and 36.8 minutes, and fluoroscopy duration was 3.8 and 3.7 minutes for the CF and IBTF groups, respectively. Two-thirds of VCFs were wedge-shaped, and one-half had dynamic mobility. Anterior height restored postoperatively was 2.28 mm (95% CI, 1.49–3.08 mm; P &lt; .001) and 2.78 mm (95% CI, 1.89–3.66 mm; P &lt; .001) for CF and IBTF groups, representing ∼35% and 39% of lost height restored, but group differences were not significant ( P = .4). Intraoperative anterior height gain attributed to dynamic mobility was 2.96 mm (95% CI, 1.92–4.00 mm; P &lt; .001) and 3.05 mm (95% CI, 2.10–4.00 mm; P &lt; .001); additional height attributed to IBT inflation was 1.09 mm (95% CI, 0.77–1.41 mm; P &lt; .001) and 1.25 mm (95% CI, 0.68–1.82 mm; P &lt; .001), representing a 37% and 41% increase. There was no significant height loss on IBT removal and cementation. Both groups had improved pain and ambulation. Asymptomatic leakage occurred in 15% of VCFs. There was 1 nonserious device-related hematoma (IBTF group). One new clinical VCF occurred in each group, but they were not device-related.

CONCLUSIONS: Both techniques resulted in significant vertebral body height and pain improvement. Procedure and adverse event data demonstrated safe curette use in conjunction with balloon kyphoplasty procedures.

BKP
:   balloon kyphoplasty
CF
:   curette-first
CI
:   confidence interval
IBT
:   inflatable bone tamp
IBTF
:   IBT-first
IQR
:   interquartile range
VCF
:   vertebral compression fracture" />
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    <title>A Randomized Trial Comparing 2 Techniques of Balloon Kyphoplasty and Curette Use for Obtaining Vertebral Body Height Restoration and Angular-Deformity Correction in Vertebral Compression Fractures due to Osteoporosis | American Journal of Neuroradiology</title>  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">L. Bastian</span>, <span class="highwire-citation-author" data-delta="1">F. Schils</span>, <span class="highwire-citation-author" data-delta="2">J.B. Tillman</span> and <span class="highwire-citation-author" data-delta="3">G. Fueredi</span> <span  class="highwire-citation-author last"><span class="nlm-on-behalf-of">on behalf of the SCORE Investigators</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">March 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">666-675; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3363 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12295--6972073065" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">L. Bastian </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Klinikum Leverkusen (L.B.), Leverkusen, Germany</div></span></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=L.%2BBastian%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=Bastian%20L&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%3AL.%2BBastian%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">F. Schils </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurosurgery (F.S.), Clinique Saint Joseph, Liège, Belgium</div></span></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=F.%2BSchils%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=Schils%20F&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%3AF.%2BSchils%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">J.B. Tillman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Medtronic Spine LLC (J.B.T.), Sunnyvale, California</div></span></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.B.%2BTillman%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=Tillman%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.B.%2BTillman%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">G. Fueredi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Aurora Memorial Hospital of Burlington (G.F.), Burlington, Wisconsin.</div></span></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=G.%2BFueredi%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=Fueredi%20G&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%3AG.%2BFueredi%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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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

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<div class="cit ref-cit ref-journal" id="cit-34.3.666.27" data-doi="10.1359/jbmr.2003.18.1.24"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">McKiernan</span>  <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Jensen</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Faciszewski</span>  <span class="cit-name-given-names">T</span></span></li></ol><cite>. <span class="cit-article-title">The dynamic mobility of vertebral compression fractures</span>. <abbr class="cit-jnl-abbrev">J Bone Miner Res</abbr> <span class="cit-pub-date">2003</span>;<span class="cit-vol">18</span>:<span class="cit-fpage">24</span>–<span class="cit-lpage">29</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1359/jbmr.2003.18.1.24&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=12510802&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F3%2F666.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000180015500005&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><span class="ref-label">28.</span><a class="rev-xref-ref" href="#xref-ref-28-1" title="View reference 28. in text" id="ref-28">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.666.28" data-doi="10.1007/s00198-006-0195-x"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Shindle</span>  <span class="cit-name-given-names">MK</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gardner</span>  <span class="cit-name-given-names">MJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Koob</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Vertebral height restoration in osteoporotic compression fractures: kyphoplasty balloon tamp is superior to postural correction alone</span>. <abbr class="cit-jnl-abbrev">Osteoporos Int</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">17</span>:<span class="cit-fpage">1815</span>–<span class="cit-lpage">19</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s00198-006-0195-x&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=16983458&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F3%2F666.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 34</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Mar 2013 </div></div>
      
      
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      <div class="highwire-cite-title">A Randomized Trial Comparing 2 Techniques of Balloon Kyphoplasty and Curette Use for Obtaining Vertebral Body Height Restoration and Angular-Deformity Correction in Vertebral Compression Fractures due to Osteoporosis</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">L.</span> <span class="nlm-surname">Bastian</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Schils</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.B.</span> <span class="nlm-surname">Tillman</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Fueredi</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">Mar 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">666-675; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3363 </span></div>
  
  
  
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      <div class="highwire-cite-title">A Randomized Trial Comparing 2 Techniques of Balloon Kyphoplasty and Curette Use for Obtaining Vertebral Body Height Restoration and Angular-Deformity Correction in Vertebral Compression Fractures due to Osteoporosis</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">L.</span> <span class="nlm-surname">Bastian</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Schils</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.B.</span> <span class="nlm-surname">Tillman</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Fueredi</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">Mar 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">666-675; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3363 </span></div>
  
  
  
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