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<meta name="DC.Title" content="Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4746" />
<meta name="DC.Date" content="2016-07-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up.

MATERIALS AND METHODS: We selected patients with acute ischemic stroke due to proximal MCA occlusion. Patients underwent NCCT, single-phase CTA, and whole-brain CT perfusion/dynamic CTA within 9 hours after stroke onset. For each patient, a detailed assessment of the extent and velocity of arterial filling was obtained. Poor radiologic outcome was defined as an infarct volume of ≥70 mL. The association between collateral score and follow-up infarct volume was analyzed with Poisson regression.

RESULTS: Sixty-one patients with a mean age of 67 years were included. For all patients combined, the interval that contained the peak of arterial filling in both hemispheres was between 11 and 21 seconds after ICA contrast entry. Poor collateral status as assessed with dynamic CTA was more strongly associated with infarct volume of ≥70 mL (risk ratio, 1.9; 95% CI, 1.3–2.9) than with single-phase CTA (risk ratio, 1.4; 95% CI, 0.8–2.5). Four subgroups (good-versus-poor and fast-versus-slow collaterals) were analyzed separately; the results showed that compared with good and fast collaterals, a similar risk ratio was found for patients with good-but-slow collaterals (risk ratio, 1.3; 95% CI, 0.7–2.4).

CONCLUSIONS: Dynamic CTA provides a more detailed assessment of collaterals than single-phase CTA and has a stronger relationship with infarct volume at follow-up. The extent of collateral flow is more important in determining tissue fate than the velocity of collateral filling. The timing of dynamic CTA acquisition in relation to intravenous contrast administration is critical for the optimal assessment of the extent of collaterals.

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:   collateral score" />
<meta name="DC.Contributor" content="I.R. van den Wijngaard" />
<meta name="DC.Contributor" content="G. Holswilder" />
<meta name="DC.Contributor" content="M.J.H. Wermer" />
<meta name="DC.Contributor" content="J. Boiten" />
<meta name="DC.Contributor" content="A. Algra" />
<meta name="DC.Contributor" content="D.W.J. Dippel" />
<meta name="DC.Contributor" content="J.W. Dankbaar" />
<meta name="DC.Contributor" content="B.K. Velthuis" />
<meta name="DC.Contributor" content="A.M.M. Boers" />
<meta name="DC.Contributor" content="C.B.L.M. Majoie" />
<meta name="DC.Contributor" content="M.A.A. van Walderveen" />
<meta name="article:published_time" content="2016-07-01" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We selected patients with acute ischemic stroke due to proximal MCA occlusion. Patients underwent NCCT, single-phase CTA, and whole-brain CT perfusion/dynamic CTA within 9 hours after stroke onset. For each patient, a detailed assessment of the extent and velocity of arterial filling was obtained. Poor radiologic outcome was defined as an infarct volume of ≥70 mL. The association between collateral score and follow-up infarct volume was analyzed with Poisson regression.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Sixty-one patients with a mean age of 67 years were included. For all patients combined, the interval that contained the peak of arterial filling in both hemispheres was between 11 and 21 seconds after ICA contrast entry. Poor collateral status as assessed with dynamic CTA was more strongly associated with infarct volume of ≥70 mL (risk ratio, 1.9; 95% CI, 1.3–2.9) than with single-phase CTA (risk ratio, 1.4; 95% CI, 0.8–2.5). Four subgroups (good-versus-poor and fast-versus-slow collaterals) were analyzed separately; the results showed that compared with good and fast collaterals, a similar risk ratio was found for patients with good-but-slow collaterals (risk ratio, 1.3; 95% CI, 0.7–2.4).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Dynamic CTA provides a more detailed assessment of collaterals than single-phase CTA and has a stronger relationship with infarct volume at follow-up. The extent of collateral flow is more important in determining tissue fate than the velocity of collateral filling. The timing of dynamic CTA acquisition in relation to intravenous contrast administration is critical for the optimal assessment of the extent of collaterals.&lt;/p&gt;" />
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<meta name="twitter:title" content="Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up.

MATERIALS AND METHODS: We selected patients with acute ischemic stroke due to proximal MCA occlusion. Patients underwent NCCT, single-phase CTA, and whole-brain CT perfusion/dynamic CTA within 9 hours after stroke onset. For each patient, a detailed assessment of the extent and velocity of arterial filling was obtained. Poor radiologic outcome was defined as an infarct volume of ≥70 mL. The association between collateral score and follow-up infarct volume was analyzed with Poisson regression.

RESULTS: Sixty-one patients with a mean age of 67 years were included. For all patients combined, the interval that contained the peak of arterial filling in both hemispheres was between 11 and 21 seconds after ICA contrast entry. Poor collateral status as assessed with dynamic CTA was more strongly associated with infarct volume of ≥70 mL (risk ratio, 1.9; 95% CI, 1.3–2.9) than with single-phase CTA (risk ratio, 1.4; 95% CI, 0.8–2.5). Four subgroups (good-versus-poor and fast-versus-slow collaterals) were analyzed separately; the results showed that compared with good and fast collaterals, a similar risk ratio was found for patients with good-but-slow collaterals (risk ratio, 1.3; 95% CI, 0.7–2.4).

CONCLUSIONS: Dynamic CTA provides a more detailed assessment of collaterals than single-phase CTA and has a stronger relationship with infarct volume at follow-up. The extent of collateral flow is more important in determining tissue fate than the velocity of collateral filling. The timing of dynamic CTA acquisition in relation to intravenous contrast administration is critical for the optimal assessment of the extent of collaterals.

CS
:   collateral score" />
<meta name="og-title" property="og:title" content="Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/37/7/1231" />
<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: Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up.

MATERIALS AND METHODS: We selected patients with acute ischemic stroke due to proximal MCA occlusion. Patients underwent NCCT, single-phase CTA, and whole-brain CT perfusion/dynamic CTA within 9 hours after stroke onset. For each patient, a detailed assessment of the extent and velocity of arterial filling was obtained. Poor radiologic outcome was defined as an infarct volume of ≥70 mL. The association between collateral score and follow-up infarct volume was analyzed with Poisson regression.

RESULTS: Sixty-one patients with a mean age of 67 years were included. For all patients combined, the interval that contained the peak of arterial filling in both hemispheres was between 11 and 21 seconds after ICA contrast entry. Poor collateral status as assessed with dynamic CTA was more strongly associated with infarct volume of ≥70 mL (risk ratio, 1.9; 95% CI, 1.3–2.9) than with single-phase CTA (risk ratio, 1.4; 95% CI, 0.8–2.5). Four subgroups (good-versus-poor and fast-versus-slow collaterals) were analyzed separately; the results showed that compared with good and fast collaterals, a similar risk ratio was found for patients with good-but-slow collaterals (risk ratio, 1.3; 95% CI, 0.7–2.4).

CONCLUSIONS: Dynamic CTA provides a more detailed assessment of collaterals than single-phase CTA and has a stronger relationship with infarct volume at follow-up. The extent of collateral flow is more important in determining tissue fate than the velocity of collateral filling. The timing of dynamic CTA acquisition in relation to intravenous contrast administration is critical for the optimal assessment of the extent of collaterals.

CS
:   collateral score" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">I.R. van den Wijngaard</span>, <span class="highwire-citation-author" data-delta="1">G. Holswilder</span>, <span class="highwire-citation-author" data-delta="2">M.J.H. Wermer</span>, <span class="highwire-citation-author" data-delta="3">J. Boiten</span>, <span class="highwire-citation-author" data-delta="4">A. Algra</span>, <span class="highwire-citation-author" data-delta="5">D.W.J. Dippel</span>, <span class="highwire-citation-author" data-delta="6">J.W. Dankbaar</span>, <span class="highwire-citation-author" data-delta="7">B.K. Velthuis</span>, <span class="highwire-citation-author" data-delta="8">A.M.M. Boers</span>, <span class="highwire-citation-author" data-delta="9">C.B.L.M. Majoie</span> and <span class="highwire-citation-author" data-delta="10">M.A.A. van Walderveen</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">July 2016,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1231-1236; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4746 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14454--8491463877" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">I.R. van den Wijngaard </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Neurology (I.R.v.d.W., J.B.), Medical Center Haaglanden, the Hague, the Netherlands</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=I.R.%2Bvan%2Bden%2BWijngaard%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=van%20den%20Wijngaard%20I&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"><a href="/search/author1%3AI.R.%2Bvan%2Bden%2BWijngaard%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-3734-6086" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for I.R. van den Wijngaard</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">G. Holswilder </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.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=G.%2BHolswilder%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=Holswilder%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"><a href="/search/author1%3AG.%2BHolswilder%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9788-4345" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Holswilder</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M.J.H. Wermer </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (M.J.H.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=M.J.H.%2BWermer%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=Wermer%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"><a href="/search/author1%3AM.J.H.%2BWermer%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-6838-9521" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.J.H. Wermer</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J. Boiten </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Neurology (I.R.v.d.W., J.B.), Medical Center Haaglanden, the Hague, the Netherlands</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.%2BBoiten%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=Boiten%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"><a href="/search/author1%3AJ.%2BBoiten%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8850-8225" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Boiten</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">A. Algra </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, the Netherlands</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus</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.%2BAlgra%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=Algra%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"><a href="/search/author1%3AA.%2BAlgra%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-2858-5808" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. 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Dippel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>g</span>Department of Neurology (D.W.J.D.), Erasmus University Medical Center, Rotterdam, the Netherlands</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=D.W.J.%2BDippel%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=Dippel%20D&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"><a href="/search/author1%3AD.W.J.%2BDippel%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9234-3515" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.W.J. 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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">vol. 37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">no. 7 </span><span  class="highwire-cite-metadata-page-string highwire-cite-metadata">1231-1236 </span></div>
  
  
  
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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">I.R. van den Wijngaard</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">d</a>, </li><li class="contributor" id="contrib-2"><span class="name">G. Holswilder</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-3"><span class="name">M.J.H. Wermer</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-4"><span class="name">J. Boiten</span><a id="xref-aff-4-2" class="xref-aff" href="#aff-4">d</a>, </li><li class="contributor" id="contrib-5"><span class="name">A. Algra</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a><span class="xref-sep">,</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">e</a>, </li><li class="contributor" id="contrib-6"><span class="name">D.W.J. Dippel</span><a id="xref-aff-7-1" class="xref-aff" href="#aff-7">g</a>, </li><li class="contributor" id="contrib-7"><span class="name">J.W. Dankbaar</span><a id="xref-aff-6-1" class="xref-aff" href="#aff-6">f</a>, </li><li class="contributor" id="contrib-8"><span class="name">B.K. Velthuis</span><a id="xref-aff-6-2" class="xref-aff" href="#aff-6">f</a>, </li><li class="contributor" id="contrib-9"><span class="name">A.M.M. Boers</span><a id="xref-aff-8-1" class="xref-aff" href="#aff-8">h</a><span class="xref-sep">,</span><a id="xref-aff-9-1" class="xref-aff" href="#aff-9">i</a>, </li><li class="contributor" id="contrib-10"><span class="name">C.B.L.M. Majoie</span><a id="xref-aff-8-2" class="xref-aff" href="#aff-8">h</a> and </li><li class="last" id="contrib-11"><span class="name">M.A.A. van Walderveen</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.)</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Neurology (M.J.H.W.)</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, the Netherlands</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>d</sup>Department of Neurology (I.R.v.d.W., J.B.), Medical Center Haaglanden, the Hague, the Netherlands</address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address><sup>e</sup>Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus</address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address><sup>f</sup>Department of Radiology (J.W.D., B.K.V.), University Medical Center Utrecht, Utrecht, the Netherlands</address></li><li class="aff"><a id="aff-7" name="aff-7"></a><address><sup>g</sup>Department of Neurology (D.W.J.D.), Erasmus University Medical Center, Rotterdam, the Netherlands</address></li><li class="aff"><a id="aff-8" name="aff-8"></a><address><sup>h</sup>Departments of Radiology (A.M.M.B., C.B.L.M.M.)</address></li><li class="aff"><a id="aff-9" name="aff-9"></a><address><sup>i</sup>Biomedical Engineering and Physics (A.M.M.B.), Academic Medical Center, Amsterdam, the Netherlands.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Ido van den Wijngaard, MD, <span class="addr-line">Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands</span>; e-mail: <span class="em-link"><span class="em-addr">wijngaardido{at}gmail.com</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/37/7/1231.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-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">Jul 2016, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1231-1236; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4746 </span></div>
  
  
  
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