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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Y. Shinohara</span> and <span class="highwire-citation-author" data-delta="1">T. Ogawa</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">December 2017,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E104; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5364 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-57358--61308876548" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Y. Shinohara </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Division of Radiology
Department of Pathophysiological and Therapeutic Science
Faculty of Medicine
Tottori University
Yonago, Japan</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=Y.%2BShinohara%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=Shinohara%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BShinohara%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/0000-0001-6586-4086" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Shinohara</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">T. Ogawa </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Division of Radiology
Department of Pathophysiological and Therapeutic Science
Faculty of Medicine
Tottori University
Yonago, Japan</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.%2BOgawa%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=Ogawa%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"><a href="/search/author1%3AT.%2BOgawa%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/0000-0001-8986-8452" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Ogawa</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We appreciate the comments from Drs Shin and Kim regarding our publication, “Perfusion MR Imaging Using a 3D Pulsed Continuous Arterial Spin-Labeling Method for Acute Cerebral Infarction Classified as Branch Atheromatous Disease Involving the Lenticulostriate Artery Territory.”<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup></p><p id="p-2">It is well-established that branch atheromatous disease (BAD) is a risk factor for early neurologic deterioration (END).<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a><a id="xref-ref-3-1" class="xref-down-link" href="#ref-3"><span>⇓</span></a><a id="xref-ref-4-1" class="xref-down-link" href="#ref-4"><span>⇓</span></a>–<a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a></sup> Jeong et al<sup><a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a></sup> reported that the baseline NIHSS score in patients with a single small subcortical infarction, including BAD, cannot predict END, whereas another article showed that the baseline NIHSS score in patients with BAD can predict END.<sup><a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a></sup> Therefore, we focused on the initial MR imaging findings of lenticulostriate artery (LSA)-type BAD in comparison with the baseline NIHSS score. To our knowledge, only a few reports thus far have referred to the association between DWI infarct volume and clinical outcome in patients having radiologically defined LSA-type BAD.<sup><a id="xref-ref-4-2" class="xref-bibr" href="#ref-4">4</a>,<a id="xref-ref-5-2" class="xref-bibr" href="#ref-5">5</a></sup> Because the clinical entity, including the radiologic definition of BAD, remains uncertain, further investigations are needed to prove the relationship between the imaging characteristics of BAD and END.<sup><a id="xref-ref-5-3" class="xref-bibr" href="#ref-5">5</a></sup></p><p id="p-3">Regarding the collinearity between asymmetry index of the contralateral cerebellar hemisphere (crossed cerebellar diaschisis, AI<sub>CCD</sub>) on 3D-arterial spin-labeling (ASL) and DWI infarct volume, we also considered that it would be better to perform multivariable regression analysis to clarify the relationship. However, our sample size was not large enough to obtain reliable statistical data. The Pearson correlation coefficient was used to compare the admission NIHSS score with each AI<sub>CCD</sub> and infarct volume for the same reason. These decisions about the methods were based on statistical consultation with a specialist.</p><p id="p-4">In addition, we previously reported the correlation between AI<sub>CCD</sub> on 3D-ASL and the initial NIHSS score in patients with cardioembolic infarction (CE, <em>n</em> = 44) and large-artery atherosclerosis (LAA, <em>n</em> = 38) as well as LSA-type BAD at the 46th Annual Meeting of the Japanese Society of Neuroradiology, February 17–19, 2017, Tokyo, Japan. Our findings revealed that there was no significant correlation between AI<sub>CCD</sub> and the initial NIHSS score in CE or LAA (<em>r</em> = 0.147, <em>P</em> = .340; <em>r</em> = 0.086, <em>P</em> = .606, respectively). Although LSA-type BAD usually affects the pyramidal tract at the corona radiata or internal capsule, easily resulting in a remote effect along the corticopontocerebellar pathway, the ischemic lesions of CE and LAA might be more variable depending on the collateral status or vascular territories compared with the LSA-type BAD.</p><p id="p-5">Finally, as noted by Drs Shin and Kim, the main message of our study was that acute LSA-type BAD can show crossed cerebellar diaschisis on 3D-ASL and there is a significant correlation between the degree of perfusion asymmetry of crossed cerebellar diaschisis and initial neurologic severity. Further studies are warranted to validate the relationship between AI<sub>CCD</sub> and neurologic outcome, including follow-up NIHSS score, and to clarify the collinearity between AI<sub>CCD</sub> and baseline lesion volume with a larger sample size.</p><div class="section ref-list" id="ref-list-1"><h2 class="">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><div class="cit ref-cit ref-journal" id="cit-38.12.E104.1" data-doi="10.3174/ajnr.A5247"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Shinohara</span>  <span class="cit-name-given-names">Y</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kato</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kuya</span>  <span class="cit-name-given-names">K</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Perfusion MR imaging using a 3D pulsed continuous arterial spin-labeling method for acute cerebral infarction classified as branch atheromatous disease involving the lenticulostriate artery territory</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2017</span> 
<span class="cit-month">Jun</span> 
<span class="cit-day">8</span>. <span class="cit-comment">[Epub ahead of print]</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A5247</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>28596191</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIzOC84LzE1NTAiO3M6NDoiYXRvbSI7czoyMToiL2FqbnIvMzgvMTIvRTEwNC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E104.2" data-doi="10.1161/STROKEAHA.114.007466"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Jeong</span>  <span class="cit-name-given-names">HG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kim</span>  <span class="cit-name-given-names">BJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Yang</span>  <span class="cit-name-given-names">MH</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Neuroimaging markers for early neurologic deterioration in single small subcortical infarction</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">46</span>:<span class="cit-fpage">687</span>–<span class="cit-lpage">91</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1161/STROKEAHA.114.007466</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>25677600</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjg6IjQ2LzMvNjg3IjtzOjQ6ImF0b20iO3M6MjE6Ii9ham5yLzM4LzEyL0UxMDQuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E104.3" data-doi="10.1016/j.jns.2009.08.065"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Yamamoto</span>  <span class="cit-name-given-names">Y</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ohara</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hamanaka</span>  <span class="cit-name-given-names">M</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Predictive factors for progressive motor deficits in penetrating artery infarctions in two different arterial territories</span>. <abbr class="cit-jnl-abbrev">J Neurol Sci</abbr> <span class="cit-pub-date">2010</span>;<span class="cit-vol">288</span>:<span class="cit-fpage">170</span>–<span class="cit-lpage">74</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1016/j.jns.2009.08.065</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>19836756</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.jns.2009.08.065&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=19836756&amp;link_type=MED&amp;atom=%2Fajnr%2F38%2F12%2FE104.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E104.4" data-doi="10.3995/jstroke.28.504"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Moriya</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Adachi</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Goto</span>  <span class="cit-name-given-names">J</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Relationship between MRI findings and outcome in supratentorial branch atheromatous disease (BAD)</span>. <abbr class="cit-jnl-abbrev">Nosotchu</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">28</span>:<span class="cit-fpage">504</span>–<span class="cit-lpage">09</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3995/jstroke.28.504</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.3995/jstroke.28.504&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></div></div></li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a><div class="cit ref-cit ref-journal" id="cit-38.12.E104.5" data-doi="10.1159/000442577"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Petrone</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Nannoni</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Del Bene</span>  <span class="cit-name-given-names">A</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Branch atheromatous disease: a clinically meaningful, yet unproven concept</span>. <abbr class="cit-jnl-abbrev">Cerebrovasc Dis</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">41</span>:<span class="cit-fpage">87</span>–<span class="cit-lpage">95</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1159/000442577</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>26671513</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1159/000442577&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=26671513&amp;link_type=MED&amp;atom=%2Fajnr%2F38%2F12%2FE104.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2017 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 38</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 12 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Dec 2017 </div></div>
      
      
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