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<meta name="DC.Title" content="Rim and Flame Signs: Postgadolinium MRI Findings Specific for Non-CNS Intramedullary Spinal Cord Metastases" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3292" />
<meta name="DC.Date" content="2013-04-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: No highly specific MR imaging features distinguishing ISCMs from primary cord masses have been described. Our purpose was to retrospectively compare peripheral enhancement features on postgadolinium MR imaging of ISCMs with primary intramedullary cord masses.

MATERIALS AND METHODS: A consecutive group of patients with firmly diagnosed ISCM (45 patients with 64 ISCMs) and a comparison group with consecutive pathologically proved primary intramedullary spinal cord masses (64 patients with 64 primary spinal cord masses: ependymoma, astrocytoma, hemangioblastoma, ganglioglioma, and cavernous malformation) were included. MR images were evaluated for 2 specific signs on postgadolinium images: a “rim” sign (more intense thin rim of peripheral enhancement around an enhancing lesion) and “flame” sign (ill-defined flame-shaped region of enhancement at the superior/inferior lesion margins). The frequency of rim and/or flame signs in ISCMs and primary cord masses was compared (χ2 test). For ISCMs, the maximal dimension of the enhancing lesion was correlated with the presence of rim or flame signs ( t test).

RESULTS: Rim and flame signs, alone and in combination, were seen more frequently in ISCMs than in primary cord masses ( P &lt; .0001 for each). Specificity and sensitivity, respectively, for diagnosing ISCMs among spinal cord masses on a per-patient basis were the following: rim sign, 97%, 47%; flame sign, 97%, 40%; at least 1 sign, 94%, 60%; and both signs concurrently, 100%, 27%. In the ISCM group, the presence of either a rim or flame sign correlated with a larger measured maximum enhancing lesion size ( P = .0065 and P = .0012, respectively).

CONCLUSIONS: The rim and flame signs are common in and specific for ISCM and are rare in primary spinal cord masses.

ABR
:   American Board of Radiology
ISCM
:   intramedullary spinal cord metastasis
WHO
:   World Health Organization" />
<meta name="DC.Contributor" content="J.B. Rykken" />
<meta name="DC.Contributor" content="F.E. Diehn" />
<meta name="DC.Contributor" content="C.H. Hunt" />
<meta name="DC.Contributor" content="L.J. Eckel" />
<meta name="DC.Contributor" content="K.M. Schwartz" />
<meta name="DC.Contributor" content="T.J. Kaufmann" />
<meta name="DC.Contributor" content="J.T. Wald" />
<meta name="DC.Contributor" content="C. Giannini" />
<meta name="DC.Contributor" content="C.P. Wood" />
<meta name="article:published_time" content="2013-04-01" />
<meta name="article:section" content="Spine" />
<meta name="citation_title" content="Rim and Flame Signs: Postgadolinium MRI Findings Specific for Non-CNS Intramedullary Spinal Cord Metastases" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;No highly specific MR imaging features distinguishing ISCMs from primary cord masses have been described. Our purpose was to retrospectively compare peripheral enhancement features on postgadolinium MR imaging of ISCMs with primary intramedullary cord masses.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A consecutive group of patients with firmly diagnosed ISCM (45 patients with 64 ISCMs) and a comparison group with consecutive pathologically proved primary intramedullary spinal cord masses (64 patients with 64 primary spinal cord masses: ependymoma, astrocytoma, hemangioblastoma, ganglioglioma, and cavernous malformation) were included. MR images were evaluated for 2 specific signs on postgadolinium images: a “rim” sign (more intense thin rim of peripheral enhancement around an enhancing lesion) and “flame” sign (ill-defined flame-shaped region of enhancement at the superior/inferior lesion margins). The frequency of rim and/or flame signs in ISCMs and primary cord masses was compared (χ&lt;sup&gt;2&lt;/sup&gt; test). For ISCMs, the maximal dimension of the enhancing lesion was correlated with the presence of rim or flame signs (&lt;i&gt;t&lt;/i&gt; test).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Rim and flame signs, alone and in combination, were seen more frequently in ISCMs than in primary cord masses (&lt;i&gt;P&lt;/i&gt; &amp;lt; .0001 for each). Specificity and sensitivity, respectively, for diagnosing ISCMs among spinal cord masses on a per-patient basis were the following: rim sign, 97%, 47%; flame sign, 97%, 40%; at least 1 sign, 94%, 60%; and both signs concurrently, 100%, 27%. In the ISCM group, the presence of either a rim or flame sign correlated with a larger measured maximum enhancing lesion size (&lt;i&gt;P&lt;/i&gt; = .0065 and &lt;i&gt;P&lt;/i&gt; = .0012, respectively).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The rim and flame signs are common in and specific for ISCM and are rare in primary spinal cord masses.&lt;/p&gt;" />
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<meta name="twitter:title" content="Rim and Flame Signs: Postgadolinium MRI Findings Specific for Non-CNS Intramedullary Spinal Cord Metastases" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: No highly specific MR imaging features distinguishing ISCMs from primary cord masses have been described. Our purpose was to retrospectively compare peripheral enhancement features on postgadolinium MR imaging of ISCMs with primary intramedullary cord masses.

MATERIALS AND METHODS: A consecutive group of patients with firmly diagnosed ISCM (45 patients with 64 ISCMs) and a comparison group with consecutive pathologically proved primary intramedullary spinal cord masses (64 patients with 64 primary spinal cord masses: ependymoma, astrocytoma, hemangioblastoma, ganglioglioma, and cavernous malformation) were included. MR images were evaluated for 2 specific signs on postgadolinium images: a “rim” sign (more intense thin rim of peripheral enhancement around an enhancing lesion) and “flame” sign (ill-defined flame-shaped region of enhancement at the superior/inferior lesion margins). The frequency of rim and/or flame signs in ISCMs and primary cord masses was compared (χ2 test). For ISCMs, the maximal dimension of the enhancing lesion was correlated with the presence of rim or flame signs ( t test).

RESULTS: Rim and flame signs, alone and in combination, were seen more frequently in ISCMs than in primary cord masses ( P &lt; .0001 for each). Specificity and sensitivity, respectively, for diagnosing ISCMs among spinal cord masses on a per-patient basis were the following: rim sign, 97%, 47%; flame sign, 97%, 40%; at least 1 sign, 94%, 60%; and both signs concurrently, 100%, 27%. In the ISCM group, the presence of either a rim or flame sign correlated with a larger measured maximum enhancing lesion size ( P = .0065 and P = .0012, respectively).

CONCLUSIONS: The rim and flame signs are common in and specific for ISCM and are rare in primary spinal cord masses.

ABR
:   American Board of Radiology
ISCM
:   intramedullary spinal cord metastasis
WHO
:   World Health Organization" />
<meta name="og-title" property="og:title" content="Rim and Flame Signs: Postgadolinium MRI Findings Specific for Non-CNS Intramedullary Spinal Cord Metastases" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/34/4/908" />
<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: No highly specific MR imaging features distinguishing ISCMs from primary cord masses have been described. Our purpose was to retrospectively compare peripheral enhancement features on postgadolinium MR imaging of ISCMs with primary intramedullary cord masses.

MATERIALS AND METHODS: A consecutive group of patients with firmly diagnosed ISCM (45 patients with 64 ISCMs) and a comparison group with consecutive pathologically proved primary intramedullary spinal cord masses (64 patients with 64 primary spinal cord masses: ependymoma, astrocytoma, hemangioblastoma, ganglioglioma, and cavernous malformation) were included. MR images were evaluated for 2 specific signs on postgadolinium images: a “rim” sign (more intense thin rim of peripheral enhancement around an enhancing lesion) and “flame” sign (ill-defined flame-shaped region of enhancement at the superior/inferior lesion margins). The frequency of rim and/or flame signs in ISCMs and primary cord masses was compared (χ2 test). For ISCMs, the maximal dimension of the enhancing lesion was correlated with the presence of rim or flame signs ( t test).

RESULTS: Rim and flame signs, alone and in combination, were seen more frequently in ISCMs than in primary cord masses ( P &lt; .0001 for each). Specificity and sensitivity, respectively, for diagnosing ISCMs among spinal cord masses on a per-patient basis were the following: rim sign, 97%, 47%; flame sign, 97%, 40%; at least 1 sign, 94%, 60%; and both signs concurrently, 100%, 27%. In the ISCM group, the presence of either a rim or flame sign correlated with a larger measured maximum enhancing lesion size ( P = .0065 and P = .0012, respectively).

CONCLUSIONS: The rim and flame signs are common in and specific for ISCM and are rare in primary spinal cord masses.

ABR
:   American Board of Radiology
ISCM
:   intramedullary spinal cord metastasis
WHO
:   World Health Organization" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node12309--7" data-node-nid="12309" id="top-node-12309--8226870264" data-pisa="ajnr;34/4/908" data-pisa-master="ajnr;ajnr.A3292" data-apath="/ajnr/34/4/908.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">Rim and Flame Signs: Postgadolinium MRI Findings Specific for Non-CNS Intramedullary Spinal Cord Metastases</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.B. Rykken</span>, <span class="highwire-citation-author" data-delta="1">F.E. Diehn</span>, <span class="highwire-citation-author" data-delta="2">C.H. Hunt</span>, <span class="highwire-citation-author" data-delta="3">L.J. Eckel</span>, <span class="highwire-citation-author" data-delta="4">K.M. Schwartz</span>, <span class="highwire-citation-author" data-delta="5">T.J. Kaufmann</span>, <span class="highwire-citation-author" data-delta="6">J.T. Wald</span>, <span class="highwire-citation-author" data-delta="7">C. Giannini</span> and <span class="highwire-citation-author" data-delta="8">C.P. Wood</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 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">908-915; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3292 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12309--8226870264" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.B. Rykken </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Division of Neuroradiology (J.B.R., F.E.D., C.H.H., L.J.E., K.M.S., T.J.K., J.T.W., C.P.W.)</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.%2BRykken%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=Rykken%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.%2BRykken%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.E. Diehn </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Division of Neuroradiology (J.B.R., F.E.D., C.H.H., L.J.E., K.M.S., T.J.K., J.T.W., C.P.W.)</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.E.%2BDiehn%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=Diehn%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.E.%2BDiehn%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">C.H. Hunt </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Division of Neuroradiology (J.B.R., F.E.D., C.H.H., L.J.E., K.M.S., T.J.K., J.T.W., C.P.W.)</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=C.H.%2BHunt%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=Hunt%20C&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%3AC.H.%2BHunt%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">L.J. Eckel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Division of Neuroradiology (J.B.R., F.E.D., C.H.H., L.J.E., K.M.S., T.J.K., J.T.W., C.P.W.)</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.J.%2BEckel%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=Eckel%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.J.%2BEckel%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">K.M. Schwartz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Division of Neuroradiology (J.B.R., F.E.D., C.H.H., L.J.E., K.M.S., T.J.K., J.T.W., C.P.W.)</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=K.M.%2BSchwartz%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=Schwartz%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AK.M.%2BSchwartz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">T.J. Kaufmann </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Division of Neuroradiology (J.B.R., F.E.D., C.H.H., L.J.E., K.M.S., T.J.K., J.T.W., C.P.W.)</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=T.J.%2BKaufmann%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=Kaufmann%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.J.%2BKaufmann%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">J.T. Wald </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Division of Neuroradiology (J.B.R., F.E.D., C.H.H., L.J.E., K.M.S., T.J.K., J.T.W., C.P.W.)</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.T.%2BWald%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=Wald%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.T.%2BWald%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">C. Giannini </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Pathology (C.G.), Mayo Clinic, Rochester, Minnesota.</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=C.%2BGiannini%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=Giannini%20C&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%3AC.%2BGiannini%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-8"><div class="author-tooltip-name">C.P. 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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.B.</span> <span class="nlm-surname">Rykken</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">F.E.</span> <span class="nlm-surname">Diehn</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">C.H.</span> <span class="nlm-surname">Hunt</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">L.J.</span> <span class="nlm-surname">Eckel</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">K.M.</span> <span class="nlm-surname">Schwartz</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">T.J.</span> <span class="nlm-surname">Kaufmann</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">J.T.</span> <span class="nlm-surname">Wald</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Giannini</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">C.P.</span> <span class="nlm-surname">Wood</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 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">908-915; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3292 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.B.</span> <span class="nlm-surname">Rykken</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">F.E.</span> <span class="nlm-surname">Diehn</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">C.H.</span> <span class="nlm-surname">Hunt</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">L.J.</span> <span class="nlm-surname">Eckel</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">K.M.</span> <span class="nlm-surname">Schwartz</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">T.J.</span> <span class="nlm-surname">Kaufmann</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">J.T.</span> <span class="nlm-surname">Wald</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Giannini</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">C.P.</span> <span class="nlm-surname">Wood</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 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">908-915; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3292 </span></div>
  
  
  
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