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<meta name="DC.Title" content="Percentage Insula Ribbon Infarction of &amp;gt;50% Identifies Patients Likely to Have Poor Clinical Outcome Despite Small DWI Infarct Volume" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4091" />
<meta name="DC.Date" content="2015-01-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2015 by American Journal of Neuroradiology. 
Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Large admission DWI infarct volume (&gt;70 mL) is an established marker for poor clinical outcome in acute stroke. Outcome is more variable in patients with small infarcts (&lt;70 mL). Percentage insula ribbon infarct correlates with infarct growth. We hypothesized that percentage insula ribbon infarct can help identify patients with stroke likely to have poor clinical outcome, despite small admission DWI lesion volumes.

MATERIALS AND METHODS: We analyzed the admission NCCT, CTP, and DWI scans of 55 patients with proximal anterior circulation occlusions on CTA. Percentage insula ribbon infarct (&gt;50%, ≤50%) on DWI, NCCT, CT-CBF, and CT-MTT were recorded. DWI infarct volume, percentage DWI motor strip infarct, NCCT-ASPECTS, and CTA collateral score were also recorded. Statistical analyses were performed to determine accuracy in predicting poor outcome (mRS &gt;2 at 90 days).

RESULTS: Admission DWI of &gt;70 mL and DWI–percentage insula ribbon infarct of &gt;50% were among significant univariate imaging markers of poor outcome ( P &lt; .001). In the multivariate analysis, DWI–percentage insula ribbon infarct of &gt;50% ( P = .045) and NIHSS score ( P &lt; .001) were the only independent predictors of poor outcome. In the subgroup with admission DWI infarct of &lt;70 mL ( n = 40), 90-day mRS was significantly worse in those with DWI–percentage insula ribbon infarct of &gt;50% ( n = 9, median mRS = 5, interquartile range = 2–5) compared with those with DWI–percentage insula ribbon infarct of ≤50% ( n = 31, median mRS = 2, interquartile range = 0.25–4, P = .036). In patients with admission DWI infarct of &gt;70 mL, DWI–percentage insula ribbon infarct did not have added predictive value for poor outcome ( P = .931).

CONCLUSIONS: DWI–percentage insula ribbon infarct of &gt;50% independently predicts poor clinical outcome and can help identify patients with stroke likely to have poor outcome despite small admission DWI lesion volumes.

IQR
:   interquartile range
PIRI
:   percentage insula ribbon infarct" />
<meta name="DC.Contributor" content="V.M. Timpone" />
<meta name="DC.Contributor" content="M.H. Lev" />
<meta name="DC.Contributor" content="S. Kamalian" />
<meta name="DC.Contributor" content="L.T. Morais" />
<meta name="DC.Contributor" content="A.M. Franceschi" />
<meta name="DC.Contributor" content="L. Souza" />
<meta name="DC.Contributor" content="P.W. Schaefer" />
<meta name="article:published_time" content="2015-01-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Percentage Insula Ribbon Infarction of &amp;gt;50% Identifies Patients Likely to Have Poor Clinical Outcome Despite Small DWI Infarct Volume" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Large admission DWI infarct volume (&amp;gt;70 mL) is an established marker for poor clinical outcome in acute stroke. Outcome is more variable in patients with small infarcts (&amp;lt;70 mL). Percentage insula ribbon infarct correlates with infarct growth. We hypothesized that percentage insula ribbon infarct can help identify patients with stroke likely to have poor clinical outcome, despite small admission DWI lesion volumes.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We analyzed the admission NCCT, CTP, and DWI scans of 55 patients with proximal anterior circulation occlusions on CTA. Percentage insula ribbon infarct (&amp;gt;50%, ≤50%) on DWI, NCCT, CT-CBF, and CT-MTT were recorded. DWI infarct volume, percentage DWI motor strip infarct, NCCT-ASPECTS, and CTA collateral score were also recorded. Statistical analyses were performed to determine accuracy in predicting poor outcome (mRS &amp;gt;2 at 90 days).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Admission DWI of &amp;gt;70 mL and DWI–percentage insula ribbon infarct of &amp;gt;50% were among significant univariate imaging markers of poor outcome (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001). In the multivariate analysis, DWI–percentage insula ribbon infarct of &amp;gt;50% (&lt;i&gt;P&lt;/i&gt; = .045) and NIHSS score (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001) were the only independent predictors of poor outcome. In the subgroup with admission DWI infarct of &amp;lt;70 mL (&lt;i&gt;n&lt;/i&gt; = 40), 90-day mRS was significantly worse in those with DWI–percentage insula ribbon infarct of &amp;gt;50% (&lt;i&gt;n&lt;/i&gt; = 9, median mRS = 5, interquartile range = 2–5) compared with those with DWI–percentage insula ribbon infarct of ≤50% (&lt;i&gt;n&lt;/i&gt; = 31, median mRS = 2, interquartile range = 0.25–4, &lt;i&gt;P&lt;/i&gt; = .036). In patients with admission DWI infarct of &amp;gt;70 mL, DWI–percentage insula ribbon infarct did not have added predictive value for poor outcome (&lt;i&gt;P&lt;/i&gt; = .931).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;DWI–percentage insula ribbon infarct of &amp;gt;50% independently predicts poor clinical outcome and can help identify patients with stroke likely to have poor outcome despite small admission DWI lesion volumes.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2015/01/01" />
<meta name="citation_mjid" content="ajnr;36/1/40" />
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<meta name="citation_author" content="V.M. Timpone" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts." />
<meta name="citation_author" content="M.H. Lev" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts." />
<meta name="citation_author" content="S. Kamalian" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts." />
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<meta name="citation_author_institution" content="aFrom the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts." />
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<meta name="citation_author_institution" content="aFrom the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts." />
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<meta name="citation_author_institution" content="aFrom the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts." />
<meta name="citation_author" content="P.W. Schaefer" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts." />
<meta name="citation_reference" content="citation_journal_title=AJNR Am J Neuroradiol;citation_title=Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke;citation_volume=33;citation_year=2012;citation_pmid=22383238;citation_doi=10.3174/ajnr.A2985" />
<meta name="citation_reference" content="citation_journal_title=Stroke;citation_title=Combining acute diffusion-weighted imaging and mean transmit time lesion volumes with National Institutes of Health Stroke Scale score improves the prediction of acute stroke outcome;citation_volume=41;citation_year=2010;citation_pmid=20595665;citation_doi=10.1161/STROKEAHA.110.582874" />
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<meta name="twitter:title" content="Percentage Insula Ribbon Infarction of &amp;gt;50% Identifies Patients Likely to Have Poor Clinical Outcome Despite Small DWI Infarct Volume" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Large admission DWI infarct volume (&gt;70 mL) is an established marker for poor clinical outcome in acute stroke. Outcome is more variable in patients with small infarcts (&lt;70 mL). Percentage insula ribbon infarct correlates with infarct growth. We hypothesized that percentage insula ribbon infarct can help identify patients with stroke likely to have poor clinical outcome, despite small admission DWI lesion volumes.

MATERIALS AND METHODS: We analyzed the admission NCCT, CTP, and DWI scans of 55 patients with proximal anterior circulation occlusions on CTA. Percentage insula ribbon infarct (&gt;50%, ≤50%) on DWI, NCCT, CT-CBF, and CT-MTT were recorded. DWI infarct volume, percentage DWI motor strip infarct, NCCT-ASPECTS, and CTA collateral score were also recorded. Statistical analyses were performed to determine accuracy in predicting poor outcome (mRS &gt;2 at 90 days).

RESULTS: Admission DWI of &gt;70 mL and DWI–percentage insula ribbon infarct of &gt;50% were among significant univariate imaging markers of poor outcome ( P &lt; .001). In the multivariate analysis, DWI–percentage insula ribbon infarct of &gt;50% ( P = .045) and NIHSS score ( P &lt; .001) were the only independent predictors of poor outcome. In the subgroup with admission DWI infarct of &lt;70 mL ( n = 40), 90-day mRS was significantly worse in those with DWI–percentage insula ribbon infarct of &gt;50% ( n = 9, median mRS = 5, interquartile range = 2–5) compared with those with DWI–percentage insula ribbon infarct of ≤50% ( n = 31, median mRS = 2, interquartile range = 0.25–4, P = .036). In patients with admission DWI infarct of &gt;70 mL, DWI–percentage insula ribbon infarct did not have added predictive value for poor outcome ( P = .931).

CONCLUSIONS: DWI–percentage insula ribbon infarct of &gt;50% independently predicts poor clinical outcome and can help identify patients with stroke likely to have poor outcome despite small admission DWI lesion volumes.

IQR
:   interquartile range
PIRI
:   percentage insula ribbon infarct" />
<meta name="og-title" property="og:title" content="Percentage Insula Ribbon Infarction of &amp;gt;50% Identifies Patients Likely to Have Poor Clinical Outcome Despite Small DWI Infarct Volume" />
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<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Large admission DWI infarct volume (&gt;70 mL) is an established marker for poor clinical outcome in acute stroke. Outcome is more variable in patients with small infarcts (&lt;70 mL). Percentage insula ribbon infarct correlates with infarct growth. We hypothesized that percentage insula ribbon infarct can help identify patients with stroke likely to have poor clinical outcome, despite small admission DWI lesion volumes.

MATERIALS AND METHODS: We analyzed the admission NCCT, CTP, and DWI scans of 55 patients with proximal anterior circulation occlusions on CTA. Percentage insula ribbon infarct (&gt;50%, ≤50%) on DWI, NCCT, CT-CBF, and CT-MTT were recorded. DWI infarct volume, percentage DWI motor strip infarct, NCCT-ASPECTS, and CTA collateral score were also recorded. Statistical analyses were performed to determine accuracy in predicting poor outcome (mRS &gt;2 at 90 days).

RESULTS: Admission DWI of &gt;70 mL and DWI–percentage insula ribbon infarct of &gt;50% were among significant univariate imaging markers of poor outcome ( P &lt; .001). In the multivariate analysis, DWI–percentage insula ribbon infarct of &gt;50% ( P = .045) and NIHSS score ( P &lt; .001) were the only independent predictors of poor outcome. In the subgroup with admission DWI infarct of &lt;70 mL ( n = 40), 90-day mRS was significantly worse in those with DWI–percentage insula ribbon infarct of &gt;50% ( n = 9, median mRS = 5, interquartile range = 2–5) compared with those with DWI–percentage insula ribbon infarct of ≤50% ( n = 31, median mRS = 2, interquartile range = 0.25–4, P = .036). In patients with admission DWI infarct of &gt;70 mL, DWI–percentage insula ribbon infarct did not have added predictive value for poor outcome ( P = .931).

CONCLUSIONS: DWI–percentage insula ribbon infarct of &gt;50% independently predicts poor clinical outcome and can help identify patients with stroke likely to have poor outcome despite small admission DWI lesion volumes.

IQR
:   interquartile range
PIRI
:   percentage insula ribbon infarct" />
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      <h1 class="highwire-cite-title" id="page-title">Percentage Insula Ribbon Infarction of &gt;50% Identifies Patients Likely to Have Poor Clinical Outcome Despite Small DWI Infarct Volume</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">V.M. Timpone</span>, <span class="highwire-citation-author" data-delta="1">M.H. Lev</span>, <span class="highwire-citation-author" data-delta="2">S. Kamalian</span>, <span class="highwire-citation-author" data-delta="3">L.T. Morais</span>, <span class="highwire-citation-author" data-delta="4">A.M. Franceschi</span>, <span class="highwire-citation-author" data-delta="5">L. Souza</span> and <span class="highwire-citation-author" data-delta="6">P.W. Schaefer</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">January 2015,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">40-45; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4091 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-13960--647780862" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">V.M. Timpone </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, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.</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=V.M.%2BTimpone%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=Timpone%20V&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%3AV.M.%2BTimpone%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">M.H. Lev </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, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.</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=M.H.%2BLev%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=Lev%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.H.%2BLev%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">S. Kamalian </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, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.</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=S.%2BKamalian%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=Kamalian%20S&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%3AS.%2BKamalian%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.T. Morais </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, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.</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.T.%2BMorais%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=Morais%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.T.%2BMorais%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">A.M. Franceschi </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, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.</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=A.M.%2BFranceschi%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=Franceschi%20A&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%3AA.M.%2BFranceschi%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">L. Souza </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, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.</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.%2BSouza%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=Souza%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.%2BSouza%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">P.W. 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<p id="p-3"><strong>BACKGROUND AND PURPOSE:</strong> Large admission DWI infarct volume (&gt;70 mL) is an established marker for poor clinical outcome in acute stroke. Outcome is more variable in patients with small infarcts (&lt;70 mL). Percentage insula ribbon infarct correlates with infarct growth. We hypothesized that percentage insula ribbon infarct can help identify patients with stroke likely to have poor clinical outcome, despite small admission DWI lesion volumes.</p>
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<p id="p-4"><strong>MATERIALS AND METHODS:</strong> We analyzed the admission NCCT, CTP, and DWI scans of 55 patients with proximal anterior circulation occlusions on CTA. Percentage insula ribbon infarct (&gt;50%, ≤50%) on DWI, NCCT, CT-CBF, and CT-MTT were recorded. DWI infarct volume, percentage DWI motor strip infarct, NCCT-ASPECTS, and CTA collateral score were also recorded. Statistical analyses were performed to determine accuracy in predicting poor outcome (mRS &gt;2 at 90 days).</p>
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<p id="p-5"><strong>RESULTS:</strong> Admission DWI of &gt;70 mL and DWI–percentage insula ribbon infarct of &gt;50% were among significant univariate imaging markers of poor outcome (<em>P</em> &lt; .001). In the multivariate analysis, DWI–percentage insula ribbon infarct of &gt;50% (<em>P</em> = .045) and NIHSS score (<em>P</em> &lt; .001) were the only independent predictors of poor outcome. In the subgroup with admission DWI infarct of &lt;70 mL (<em>n</em> = 40), 90-day mRS was significantly worse in those with DWI–percentage insula ribbon infarct of &gt;50% (<em>n</em> = 9, median mRS = 5, interquartile range = 2–5) compared with those with DWI–percentage insula ribbon infarct of ≤50% (<em>n</em> = 31, median mRS = 2, interquartile range = 0.25–4, <em>P</em> = .036). In patients with admission DWI infarct of &gt;70 mL, DWI–percentage insula ribbon infarct did not have added predictive value for poor outcome (<em>P</em> = .931).</p>
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<p id="p-6"><strong>CONCLUSIONS:</strong> DWI–percentage insula ribbon infarct of &gt;50% independently predicts poor clinical outcome and can help identify patients with stroke likely to have poor outcome despite small admission DWI lesion volumes.</p>
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<h2 class="">ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">IQR<span class="def-item-dt-sep"></span></dt><dd>interquartile range<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">PIRI<span class="def-item-dt-sep"></span></dt><dd>percentage insula ribbon infarct</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2015 by American Journal of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/36/1/40.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. 36</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 1 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jan 2015 </div></div>
      
      
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      <div class="highwire-cite-title">Percentage Insula Ribbon Infarction of &gt;50% Identifies Patients Likely to Have Poor Clinical Outcome Despite Small DWI Infarct Volume</div>  
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    	<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">Jan 2015, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">40-45; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4091 </span></div>
  
  
  
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      <div class="highwire-cite-title">Percentage Insula Ribbon Infarction of &gt;50% Identifies Patients Likely to Have Poor Clinical Outcome Despite Small DWI Infarct Volume</div>  
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    	<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">Jan 2015, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">40-45; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4091 </span></div>
  
  
  
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