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<meta name="DC.Title" content="Restriction Spectrum Imaging Improves Risk Stratification in Patients with Glioblastoma" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5099" />
<meta name="DC.Date" content="2017-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2017 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: ADC as a marker of tumor cellularity has been promising for evaluating the response to therapy in patients with glioblastoma but does not successfully stratify patients according to outcomes, especially in the upfront setting. Here we investigate whether restriction spectrum imaging, an advanced diffusion imaging model, performed after an operation but before radiation therapy, could improve risk stratification in patients with newly diagnosed glioblastoma relative to ADC.

MATERIALS AND METHODS: Pre-radiation therapy diffusion-weighted and structural imaging of 40 patients with glioblastoma were examined retrospectively. Restriction spectrum imaging and ADC-based hypercellularity volume fraction (restriction spectrum imaging–FLAIR volume fraction, restriction spectrum imaging–contrast-enhanced volume fraction, ADC-FLAIR volume fraction, ADC–contrast-enhanced volume fraction) and intensities (restriction spectrum imaging—FLAIR 90th percentile, restriction spectrum imaging–contrast-enhanced 90th percentile, ADC-FLAIR 10th percentile, ADC–contrast-enhanced 10th percentile) within the contrast-enhanced and FLAIR hyperintensity VOIs were calculated. The association of diffusion imaging metrics, contrast-enhanced volume, and FLAIR hyperintensity volume with progression-free survival and overall survival was evaluated by using Cox proportional hazards models.

RESULTS: Among the diffusion metrics, restriction spectrum imaging–FLAIR volume fraction was the strongest prognostic metric of progression-free survival ( P = .036) and overall survival ( P = .007) in a multivariate Cox proportional hazards analysis, with higher values indicating earlier progression and shorter survival. Restriction spectrum imaging—FLAIR 90th percentile was also associated with overall survival ( P = .043), with higher intensities, indicating shorter survival. None of the ADC metrics were associated with progression-free survival/overall survival. Contrast-enhanced volume exhibited a trend toward significance for overall survival ( P = .063).

CONCLUSIONS: Restriction spectrum imaging–derived cellularity in FLAIR hyperintensity regions may be a more robust prognostic marker than ADC and conventional imaging for early progression and poorer survival in patients with glioblastoma. However, future studies with larger samples are needed to explore its predictive ability.

CE
:   contrast-enhanced
CPH
:   Cox proportional hazards
FLAIR-HI
:   FLAIR hyperintensity
GBM
:   glioblastoma
HC
:   hypercellularity
HR
:   hazard ratio
MRSI
:   MR spectroscopic imaging
PFS
:   progression-free survival
OS
:   overall survival
RSI
:   restriction spectrum imaging
RT
:   radiation therapy
vf
:   volume fraction
vol
:   volume" />
<meta name="DC.Contributor" content="A.P. Krishnan" />
<meta name="DC.Contributor" content="R. Karunamuni" />
<meta name="DC.Contributor" content="K.M. Leyden" />
<meta name="DC.Contributor" content="T.M. Seibert" />
<meta name="DC.Contributor" content="R.L. Delfanti" />
<meta name="DC.Contributor" content="J.M. Kuperman" />
<meta name="DC.Contributor" content="H. Bartsch" />
<meta name="DC.Contributor" content="P. Elbe" />
<meta name="DC.Contributor" content="A. Srikant" />
<meta name="DC.Contributor" content="A.M. Dale" />
<meta name="DC.Contributor" content="S. Kesari" />
<meta name="DC.Contributor" content="D.E. Piccioni" />
<meta name="DC.Contributor" content="J.A. Hattangadi-Gluth" />
<meta name="DC.Contributor" content="N. Farid" />
<meta name="DC.Contributor" content="C.R. McDonald" />
<meta name="DC.Contributor" content="N.S. White" />
<meta name="article:published_time" content="2017-05-01" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="Restriction Spectrum Imaging Improves Risk Stratification in Patients with Glioblastoma" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;ADC as a marker of tumor cellularity has been promising for evaluating the response to therapy in patients with glioblastoma but does not successfully stratify patients according to outcomes, especially in the upfront setting. Here we investigate whether restriction spectrum imaging, an advanced diffusion imaging model, performed after an operation but before radiation therapy, could improve risk stratification in patients with newly diagnosed glioblastoma relative to ADC.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Pre-radiation therapy diffusion-weighted and structural imaging of 40 patients with glioblastoma were examined retrospectively. Restriction spectrum imaging and ADC-based hypercellularity volume fraction (restriction spectrum imaging–FLAIR volume fraction, restriction spectrum imaging–contrast-enhanced volume fraction, ADC-FLAIR volume fraction, ADC–contrast-enhanced volume fraction) and intensities (restriction spectrum imaging—FLAIR 90th percentile, restriction spectrum imaging–contrast-enhanced 90th percentile, ADC-FLAIR 10th percentile, ADC–contrast-enhanced 10th percentile) within the contrast-enhanced and FLAIR hyperintensity VOIs were calculated. The association of diffusion imaging metrics, contrast-enhanced volume, and FLAIR hyperintensity volume with progression-free survival and overall survival was evaluated by using Cox proportional hazards models.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Among the diffusion metrics, restriction spectrum imaging–FLAIR volume fraction was the strongest prognostic metric of progression-free survival (&lt;i&gt;P&lt;/i&gt; = .036) and overall survival (&lt;i&gt;P&lt;/i&gt; = .007) in a multivariate Cox proportional hazards analysis, with higher values indicating earlier progression and shorter survival. Restriction spectrum imaging—FLAIR 90th percentile was also associated with overall survival (&lt;i&gt;P&lt;/i&gt; = .043), with higher intensities, indicating shorter survival. None of the ADC metrics were associated with progression-free survival/overall survival. Contrast-enhanced volume exhibited a trend toward significance for overall survival (&lt;i&gt;P&lt;/i&gt; = .063).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Restriction spectrum imaging–derived cellularity in FLAIR hyperintensity regions may be a more robust prognostic marker than ADC and conventional imaging for early progression and poorer survival in patients with glioblastoma. However, future studies with larger samples are needed to explore its predictive ability.&lt;/p&gt;" />
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<meta name="twitter:title" content="Restriction Spectrum Imaging Improves Risk Stratification in Patients with Glioblastoma" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: ADC as a marker of tumor cellularity has been promising for evaluating the response to therapy in patients with glioblastoma but does not successfully stratify patients according to outcomes, especially in the upfront setting. Here we investigate whether restriction spectrum imaging, an advanced diffusion imaging model, performed after an operation but before radiation therapy, could improve risk stratification in patients with newly diagnosed glioblastoma relative to ADC.

MATERIALS AND METHODS: Pre-radiation therapy diffusion-weighted and structural imaging of 40 patients with glioblastoma were examined retrospectively. Restriction spectrum imaging and ADC-based hypercellularity volume fraction (restriction spectrum imaging–FLAIR volume fraction, restriction spectrum imaging–contrast-enhanced volume fraction, ADC-FLAIR volume fraction, ADC–contrast-enhanced volume fraction) and intensities (restriction spectrum imaging—FLAIR 90th percentile, restriction spectrum imaging–contrast-enhanced 90th percentile, ADC-FLAIR 10th percentile, ADC–contrast-enhanced 10th percentile) within the contrast-enhanced and FLAIR hyperintensity VOIs were calculated. The association of diffusion imaging metrics, contrast-enhanced volume, and FLAIR hyperintensity volume with progression-free survival and overall survival was evaluated by using Cox proportional hazards models.

RESULTS: Among the diffusion metrics, restriction spectrum imaging–FLAIR volume fraction was the strongest prognostic metric of progression-free survival ( P = .036) and overall survival ( P = .007) in a multivariate Cox proportional hazards analysis, with higher values indicating earlier progression and shorter survival. Restriction spectrum imaging—FLAIR 90th percentile was also associated with overall survival ( P = .043), with higher intensities, indicating shorter survival. None of the ADC metrics were associated with progression-free survival/overall survival. Contrast-enhanced volume exhibited a trend toward significance for overall survival ( P = .063).

CONCLUSIONS: Restriction spectrum imaging–derived cellularity in FLAIR hyperintensity regions may be a more robust prognostic marker than ADC and conventional imaging for early progression and poorer survival in patients with glioblastoma. However, future studies with larger samples are needed to explore its predictive ability.

CE
:   contrast-enhanced
CPH
:   Cox proportional hazards
FLAIR-HI
:   FLAIR hyperintensity
GBM
:   glioblastoma
HC
:   hypercellularity
HR
:   hazard ratio
MRSI
:   MR spectroscopic imaging
PFS
:   progression-free survival
OS
:   overall survival
RSI
:   restriction spectrum imaging
RT
:   radiation therapy
vf
:   volume fraction
vol
:   volume" />
<meta name="og-title" property="og:title" content="Restriction Spectrum Imaging Improves Risk Stratification in Patients with Glioblastoma" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/38/5/882" />
<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: ADC as a marker of tumor cellularity has been promising for evaluating the response to therapy in patients with glioblastoma but does not successfully stratify patients according to outcomes, especially in the upfront setting. Here we investigate whether restriction spectrum imaging, an advanced diffusion imaging model, performed after an operation but before radiation therapy, could improve risk stratification in patients with newly diagnosed glioblastoma relative to ADC.

MATERIALS AND METHODS: Pre-radiation therapy diffusion-weighted and structural imaging of 40 patients with glioblastoma were examined retrospectively. Restriction spectrum imaging and ADC-based hypercellularity volume fraction (restriction spectrum imaging–FLAIR volume fraction, restriction spectrum imaging–contrast-enhanced volume fraction, ADC-FLAIR volume fraction, ADC–contrast-enhanced volume fraction) and intensities (restriction spectrum imaging—FLAIR 90th percentile, restriction spectrum imaging–contrast-enhanced 90th percentile, ADC-FLAIR 10th percentile, ADC–contrast-enhanced 10th percentile) within the contrast-enhanced and FLAIR hyperintensity VOIs were calculated. The association of diffusion imaging metrics, contrast-enhanced volume, and FLAIR hyperintensity volume with progression-free survival and overall survival was evaluated by using Cox proportional hazards models.

RESULTS: Among the diffusion metrics, restriction spectrum imaging–FLAIR volume fraction was the strongest prognostic metric of progression-free survival ( P = .036) and overall survival ( P = .007) in a multivariate Cox proportional hazards analysis, with higher values indicating earlier progression and shorter survival. Restriction spectrum imaging—FLAIR 90th percentile was also associated with overall survival ( P = .043), with higher intensities, indicating shorter survival. None of the ADC metrics were associated with progression-free survival/overall survival. Contrast-enhanced volume exhibited a trend toward significance for overall survival ( P = .063).

CONCLUSIONS: Restriction spectrum imaging–derived cellularity in FLAIR hyperintensity regions may be a more robust prognostic marker than ADC and conventional imaging for early progression and poorer survival in patients with glioblastoma. However, future studies with larger samples are needed to explore its predictive ability.

CE
:   contrast-enhanced
CPH
:   Cox proportional hazards
FLAIR-HI
:   FLAIR hyperintensity
GBM
:   glioblastoma
HC
:   hypercellularity
HR
:   hazard ratio
MRSI
:   MR spectroscopic imaging
PFS
:   progression-free survival
OS
:   overall survival
RSI
:   restriction spectrum imaging
RT
:   radiation therapy
vf
:   volume fraction
vol
:   volume" />
<meta name="og-type" property="og:type" content="article" />
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      <h1 class="highwire-cite-title" id="page-title">Restriction Spectrum Imaging Improves Risk Stratification in Patients with Glioblastoma</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">A.P. Krishnan</span>, <span class="highwire-citation-author" data-delta="1">R. Karunamuni</span>, <span class="highwire-citation-author" data-delta="2">K.M. Leyden</span>, <span class="highwire-citation-author" data-delta="3">T.M. Seibert</span>, <span class="highwire-citation-author" data-delta="4">R.L. Delfanti</span>, <span class="highwire-citation-author" data-delta="5">J.M. Kuperman</span>, <span class="highwire-citation-author" data-delta="6">H. Bartsch</span>, <span class="highwire-citation-author" data-delta="7">P. Elbe</span>, <span class="highwire-citation-author" data-delta="8">A. Srikant</span>, <span class="highwire-citation-author" data-delta="9">A.M. Dale</span>, <span class="highwire-citation-author" data-delta="10">S. Kesari</span>, <span class="highwire-citation-author" data-delta="11">D.E. Piccioni</span>, <span class="highwire-citation-author" data-delta="12">J.A. Hattangadi-Gluth</span>, <span class="highwire-citation-author" data-delta="13">N. Farid</span>, <span class="highwire-citation-author" data-delta="14">C.R. McDonald</span> and <span class="highwire-citation-author" data-delta="15">N.S. White</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">May 2017,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">882-889; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5099 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-54375--61388344121" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">A.P. Krishnan </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.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=A.P.%2BKrishnan%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=Krishnan%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.P.%2BKrishnan%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/0000-0003-0193-2494" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.P. Krishnan</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">R. Karunamuni </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiation Medicine (R.K., T.M.S., J.A.H.-G., C.R.M.)</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=R.%2BKarunamuni%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=Karunamuni%20R&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%3AR.%2BKarunamuni%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/0000-0001-6918-0589" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Karunamuni</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">K.M. Leyden </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.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.%2BLeyden%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=Leyden%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"><a href="/search/author1%3AK.M.%2BLeyden%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/0000-0002-7994-5028" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K.M. Leyden</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">T.M. Seibert </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.W.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiation Medicine (R.K., T.M.S., J.A.H.-G., C.R.M.)</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.M.%2BSeibert%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=Seibert%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.M.%2BSeibert%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/0000-0002-4089-7399" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.M. Seibert</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">R.L. Delfanti </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiology (R.L.D., J.M.K., H.B., A.M.D., N.F., N.S.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=R.L.%2BDelfanti%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=Delfanti%20R&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%3AR.L.%2BDelfanti%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/0000-0002-2373-5419" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R.L. Delfanti</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">J.M. Kuperman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiology (R.L.D., J.M.K., H.B., A.M.D., N.F., N.S.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.M.%2BKuperman%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=Kuperman%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.M.%2BKuperman%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/0000-0002-7890-4785" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.M. Kuperman</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">H. Bartsch </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.W.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiology (R.L.D., J.M.K., H.B., A.M.D., N.F., N.S.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=H.%2BBartsch%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=Bartsch%20H&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%3AH.%2BBartsch%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/0000-0003-1486-4128" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Bartsch</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">P. Elbe </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.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=P.%2BElbe%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=Elbe%20P&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%3AP.%2BElbe%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/0000-0003-1717-240X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. Elbe</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">A. Srikant </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.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=A.%2BSrikant%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=Srikant%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.%2BSrikant%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/0000-0002-6126-2966" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Srikant</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">A.M. Dale </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.W.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiology (R.L.D., J.M.K., H.B., A.M.D., N.F., N.S.W.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Neurosciences (A.M.D., D.E.P.)</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.%2BDale%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=Dale%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.%2BDale%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-10"><div class="author-tooltip-name">S. Kesari </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Translational Neuro-Oncology and Neurotherapeutics (S.K.), John Wayne Cancer Institute and Pacific Neuroscience Institute at Providence Saint John's Health Center, Santa Monica, California.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BKesari%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=Kesari%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"><a href="/search/author1%3AS.%2BKesari%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/0000-0003-3772-6000" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Kesari</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">D.E. Piccioni </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Neurosciences (A.M.D., D.E.P.)</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.E.%2BPiccioni%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=Piccioni%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.E.%2BPiccioni%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/0000-0001-6006-0126" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.E. Piccioni</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">J.A. Hattangadi-Gluth </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiation Medicine (R.K., T.M.S., J.A.H.-G., C.R.M.)</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.A.%2BHattangadi-Gluth%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=Hattangadi-Gluth%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.A.%2BHattangadi-Gluth%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/0000-0001-8222-606X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.A. Hattangadi-Gluth</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">N. Farid </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.W.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiology (R.L.D., J.M.K., H.B., A.M.D., N.F., N.S.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=N.%2BFarid%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=Farid%20N&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%3AN.%2BFarid%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/0000-0002-0876-1934" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. Farid</a></li></ul></div><div class="author-tooltip-14"><div class="author-tooltip-name">C.R. McDonald </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.W.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Radiation Medicine (R.K., T.M.S., J.A.H.-G., C.R.M.)</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Psychiatry (C.R.M.), University of California, San Diego, La Jolla, California</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.R.%2BMcDonald%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=McDonald%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"><a href="/search/author1%3AC.R.%2BMcDonald%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/0000-0002-0721-5640" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C.R. McDonald</a></li></ul></div><div class="author-tooltip-15"><div class="author-tooltip-name">N.S. White </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Multimodal Imaging Laboratory (A.P.K., K.M.L., T.M.S., J.M.K., H.B., P.E., A.S., A.M.D., N.F., C.R.M., N.S.W.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiology (R.L.D., J.M.K., H.B., A.M.D., N.F., N.S.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=N.S.%2BWhite%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=White%20N&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%3AN.S.%2BWhite%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/0000-0003-4564-2237" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N.S. 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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 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 May 2017 </div></div>
      
      
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      <div class="highwire-cite-title">Restriction Spectrum Imaging Improves Risk Stratification in Patients with Glioblastoma</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">A.P.</span> <span class="nlm-surname">Krishnan</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Karunamuni</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">K.M.</span> <span class="nlm-surname">Leyden</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.M.</span> <span class="nlm-surname">Seibert</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">R.L.</span> <span class="nlm-surname">Delfanti</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Kuperman</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Bartsch</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Elbe</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Srikant</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">A.M.</span> <span class="nlm-surname">Dale</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Kesari</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">D.E.</span> <span class="nlm-surname">Piccioni</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">J.A.</span> <span class="nlm-surname">Hattangadi-Gluth</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Farid</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">C.R.</span> <span class="nlm-surname">McDonald</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">N.S.</span> <span class="nlm-surname">White</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">882-889; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5099 </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">A.P.</span> <span class="nlm-surname">Krishnan</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Karunamuni</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">K.M.</span> <span class="nlm-surname">Leyden</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.M.</span> <span class="nlm-surname">Seibert</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">R.L.</span> <span class="nlm-surname">Delfanti</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Kuperman</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Bartsch</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Elbe</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Srikant</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">A.M.</span> <span class="nlm-surname">Dale</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Kesari</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">D.E.</span> <span class="nlm-surname">Piccioni</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">J.A.</span> <span class="nlm-surname">Hattangadi-Gluth</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Farid</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">C.R.</span> <span class="nlm-surname">McDonald</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">N.S.</span> <span class="nlm-surname">White</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">882-889; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5099 </span></div>
  
  
  
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