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<meta name="HW.identifier" content="/ajnr/39/7/1239.atom" />
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<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="Imaging Differences between Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis: A Multi-Institutional Study in Japan" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5663" />
<meta name="DC.Date" content="2018-07-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2018 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: Both clinical and imaging criteria must be met to diagnose neuromyelitis optica spectrum disorders and multiple sclerosis. However, neuromyelitis optica spectrum disorders are often misdiagnosed as MS because of an overlap in MR imaging features. The purpose of this study was to confirm imaging differences between neuromyelitis optica spectrum disorders and MS with visually detailed quantitative analyses of large-sample data.

MATERIALS AND METHODS: We retrospectively examined 89 consecutive patients with neuromyelitis optica spectrum disorders (median age, 51 years; range, 16–85 years; females, 77; aquaporin 4 immunoglobulin G–positive, 93%) and 89 with MS (median age, 36 years; range, 18–67 years; females, 68; relapsing-remitting MS, 89%; primary-progressive MS, 7%; secondary-progressive MS, 2%) from 9 institutions across Japan (April 2008 to December 2012). Two neuroradiologists visually evaluated the number, location, and size of all lesions using the Mann-Whitney U test or the Fisher exact test.

RESULTS: We enrolled 79 patients with neuromyelitis optica spectrum disorders and 87 with MS for brain analysis, 57 with neuromyelitis optica spectrum disorders and 55 with MS for spinal cord analysis, and 42 with neuromyelitis optica spectrum disorders and 14 with MS for optic nerve analysis. We identified 911 brain lesions in neuromyelitis optica spectrum disorders, 1659 brain lesions in MS, 86 spinal cord lesions in neuromyelitis optica spectrum disorders, and 102 spinal cord lesions in MS. The frequencies of periventricular white matter and deep white matter lesions were 17% and 68% in neuromyelitis optica spectrum disorders versus 41% and 42% in MS, respectively (location of brain lesions, P &lt; .001). We found a significant difference in the distribution of spinal cord lesions between these 2 diseases ( P = .024): More thoracic lesions than cervical lesions were present in neuromyelitis optica spectrum disorders (cervical versus thoracic, 29% versus 71%), whereas they were equally distributed in MS (46% versus 54%). Furthermore, thoracic lesions were significantly longer than cervical lesions in neuromyelitis optica spectrum disorders ( P = .001), but not in MS ( P = .80).

CONCLUSIONS: Visually detailed quantitative analyses confirmed imaging differences, especially in brain and spinal cord lesions, between neuromyelitis optica spectrum disorders and MS. These observations may have clinical implications.

AQP4-IgG
:   aquaporin 4 immunoglobulin G
BS
:   brain stem
DGM
:   deep gray matter
DWM
:   deep white matter
IQR
:   interquartile range
NMO
:   neuromyelitis optica
NMOSD
:   neuromyelitis optica spectrum disorders
PVWM
:   periventricular white matter
SCWM
:   subcortical white matter" />
<meta name="DC.Contributor" content="H. Tatekawa" />
<meta name="DC.Contributor" content="S. Sakamoto" />
<meta name="DC.Contributor" content="M. Hori" />
<meta name="DC.Contributor" content="Y. Kaichi" />
<meta name="DC.Contributor" content="A. Kunimatsu" />
<meta name="DC.Contributor" content="K. Akazawa" />
<meta name="DC.Contributor" content="T. Miyasaka" />
<meta name="DC.Contributor" content="H. Oba" />
<meta name="DC.Contributor" content="T. Okubo" />
<meta name="DC.Contributor" content="K. Hasuo" />
<meta name="DC.Contributor" content="K. Yamada" />
<meta name="DC.Contributor" content="T. Taoka" />
<meta name="DC.Contributor" content="S. Doishita" />
<meta name="DC.Contributor" content="T. Shimono" />
<meta name="DC.Contributor" content="Y. Miki" />
<meta name="article:published_time" content="2018-07-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Imaging Differences between Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis: A Multi-Institutional Study in Japan" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Both clinical and imaging criteria must be met to diagnose neuromyelitis optica spectrum disorders and multiple sclerosis. However, neuromyelitis optica spectrum disorders are often misdiagnosed as MS because of an overlap in MR imaging features. The purpose of this study was to confirm imaging differences between neuromyelitis optica spectrum disorders and MS with visually detailed quantitative analyses of large-sample data.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively examined 89 consecutive patients with neuromyelitis optica spectrum disorders (median age, 51 years; range, 16–85 years; females, 77; aquaporin 4 immunoglobulin G–positive, 93%) and 89 with MS (median age, 36 years; range, 18–67 years; females, 68; relapsing-remitting MS, 89%; primary-progressive MS, 7%; secondary-progressive MS, 2%) from 9 institutions across Japan (April 2008 to December 2012). Two neuroradiologists visually evaluated the number, location, and size of all lesions using the Mann-Whitney &lt;i&gt;U&lt;/i&gt; test or the Fisher exact test.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;We enrolled 79 patients with neuromyelitis optica spectrum disorders and 87 with MS for brain analysis, 57 with neuromyelitis optica spectrum disorders and 55 with MS for spinal cord analysis, and 42 with neuromyelitis optica spectrum disorders and 14 with MS for optic nerve analysis. We identified 911 brain lesions in neuromyelitis optica spectrum disorders, 1659 brain lesions in MS, 86 spinal cord lesions in neuromyelitis optica spectrum disorders, and 102 spinal cord lesions in MS. The frequencies of periventricular white matter and deep white matter lesions were 17% and 68% in neuromyelitis optica spectrum disorders versus 41% and 42% in MS, respectively (location of brain lesions, &lt;i&gt;P&lt;/i&gt; &amp;lt; .001). We found a significant difference in the distribution of spinal cord lesions between these 2 diseases (&lt;i&gt;P&lt;/i&gt; = .024): More thoracic lesions than cervical lesions were present in neuromyelitis optica spectrum disorders (cervical versus thoracic, 29% versus 71%), whereas they were equally distributed in MS (46% versus 54%). Furthermore, thoracic lesions were significantly longer than cervical lesions in neuromyelitis optica spectrum disorders (&lt;i&gt;P&lt;/i&gt; = .001), but not in MS (&lt;i&gt;P&lt;/i&gt; = .80).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Visually detailed quantitative analyses confirmed imaging differences, especially in brain and spinal cord lesions, between neuromyelitis optica spectrum disorders and MS. These observations may have clinical implications.&lt;/p&gt;" />
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<meta name="twitter:title" content="Imaging Differences between Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis: A Multi-Institutional Study in Japan" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Both clinical and imaging criteria must be met to diagnose neuromyelitis optica spectrum disorders and multiple sclerosis. However, neuromyelitis optica spectrum disorders are often misdiagnosed as MS because of an overlap in MR imaging features. The purpose of this study was to confirm imaging differences between neuromyelitis optica spectrum disorders and MS with visually detailed quantitative analyses of large-sample data.

MATERIALS AND METHODS: We retrospectively examined 89 consecutive patients with neuromyelitis optica spectrum disorders (median age, 51 years; range, 16–85 years; females, 77; aquaporin 4 immunoglobulin G–positive, 93%) and 89 with MS (median age, 36 years; range, 18–67 years; females, 68; relapsing-remitting MS, 89%; primary-progressive MS, 7%; secondary-progressive MS, 2%) from 9 institutions across Japan (April 2008 to December 2012). Two neuroradiologists visually evaluated the number, location, and size of all lesions using the Mann-Whitney U test or the Fisher exact test.

RESULTS: We enrolled 79 patients with neuromyelitis optica spectrum disorders and 87 with MS for brain analysis, 57 with neuromyelitis optica spectrum disorders and 55 with MS for spinal cord analysis, and 42 with neuromyelitis optica spectrum disorders and 14 with MS for optic nerve analysis. We identified 911 brain lesions in neuromyelitis optica spectrum disorders, 1659 brain lesions in MS, 86 spinal cord lesions in neuromyelitis optica spectrum disorders, and 102 spinal cord lesions in MS. The frequencies of periventricular white matter and deep white matter lesions were 17% and 68% in neuromyelitis optica spectrum disorders versus 41% and 42% in MS, respectively (location of brain lesions, P &lt; .001). We found a significant difference in the distribution of spinal cord lesions between these 2 diseases ( P = .024): More thoracic lesions than cervical lesions were present in neuromyelitis optica spectrum disorders (cervical versus thoracic, 29% versus 71%), whereas they were equally distributed in MS (46% versus 54%). Furthermore, thoracic lesions were significantly longer than cervical lesions in neuromyelitis optica spectrum disorders ( P = .001), but not in MS ( P = .80).

CONCLUSIONS: Visually detailed quantitative analyses confirmed imaging differences, especially in brain and spinal cord lesions, between neuromyelitis optica spectrum disorders and MS. These observations may have clinical implications.

AQP4-IgG
:   aquaporin 4 immunoglobulin G
BS
:   brain stem
DGM
:   deep gray matter
DWM
:   deep white matter
IQR
:   interquartile range
NMO
:   neuromyelitis optica
NMOSD
:   neuromyelitis optica spectrum disorders
PVWM
:   periventricular white matter
SCWM
:   subcortical white matter" />
<meta name="og-title" property="og:title" content="Imaging Differences between Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis: A Multi-Institutional Study in Japan" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/39/7/1239" />
<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: Both clinical and imaging criteria must be met to diagnose neuromyelitis optica spectrum disorders and multiple sclerosis. However, neuromyelitis optica spectrum disorders are often misdiagnosed as MS because of an overlap in MR imaging features. The purpose of this study was to confirm imaging differences between neuromyelitis optica spectrum disorders and MS with visually detailed quantitative analyses of large-sample data.

MATERIALS AND METHODS: We retrospectively examined 89 consecutive patients with neuromyelitis optica spectrum disorders (median age, 51 years; range, 16–85 years; females, 77; aquaporin 4 immunoglobulin G–positive, 93%) and 89 with MS (median age, 36 years; range, 18–67 years; females, 68; relapsing-remitting MS, 89%; primary-progressive MS, 7%; secondary-progressive MS, 2%) from 9 institutions across Japan (April 2008 to December 2012). Two neuroradiologists visually evaluated the number, location, and size of all lesions using the Mann-Whitney U test or the Fisher exact test.

RESULTS: We enrolled 79 patients with neuromyelitis optica spectrum disorders and 87 with MS for brain analysis, 57 with neuromyelitis optica spectrum disorders and 55 with MS for spinal cord analysis, and 42 with neuromyelitis optica spectrum disorders and 14 with MS for optic nerve analysis. We identified 911 brain lesions in neuromyelitis optica spectrum disorders, 1659 brain lesions in MS, 86 spinal cord lesions in neuromyelitis optica spectrum disorders, and 102 spinal cord lesions in MS. The frequencies of periventricular white matter and deep white matter lesions were 17% and 68% in neuromyelitis optica spectrum disorders versus 41% and 42% in MS, respectively (location of brain lesions, P &lt; .001). We found a significant difference in the distribution of spinal cord lesions between these 2 diseases ( P = .024): More thoracic lesions than cervical lesions were present in neuromyelitis optica spectrum disorders (cervical versus thoracic, 29% versus 71%), whereas they were equally distributed in MS (46% versus 54%). Furthermore, thoracic lesions were significantly longer than cervical lesions in neuromyelitis optica spectrum disorders ( P = .001), but not in MS ( P = .80).

CONCLUSIONS: Visually detailed quantitative analyses confirmed imaging differences, especially in brain and spinal cord lesions, between neuromyelitis optica spectrum disorders and MS. These observations may have clinical implications.

AQP4-IgG
:   aquaporin 4 immunoglobulin G
BS
:   brain stem
DGM
:   deep gray matter
DWM
:   deep white matter
IQR
:   interquartile range
NMO
:   neuromyelitis optica
NMOSD
:   neuromyelitis optica spectrum disorders
PVWM
:   periventricular white matter
SCWM
:   subcortical white matter" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node61679--5" data-node-nid="61679" id="top-node-61679--6829338180" data-pisa="ajnr;39/7/1239" data-pisa-master="ajnr;ajnr.A5663" data-apath="/ajnr/39/7/1239.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Adult Brain</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Imaging Differences between Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis: A Multi-Institutional Study in Japan</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">H. Tatekawa</span>, <span class="highwire-citation-author" data-delta="1">S. Sakamoto</span>, <span class="highwire-citation-author" data-delta="2">M. Hori</span>, <span class="highwire-citation-author" data-delta="3">Y. Kaichi</span>, <span class="highwire-citation-author" data-delta="4">A. Kunimatsu</span>, <span class="highwire-citation-author" data-delta="5">K. Akazawa</span>, <span class="highwire-citation-author" data-delta="6">T. Miyasaka</span>, <span class="highwire-citation-author" data-delta="7">H. Oba</span>, <span class="highwire-citation-author" data-delta="8">T. Okubo</span>, <span class="highwire-citation-author" data-delta="9">K. Hasuo</span>, <span class="highwire-citation-author" data-delta="10">K. Yamada</span>, <span class="highwire-citation-author" data-delta="11">T. Taoka</span>, <span class="highwire-citation-author" data-delta="12">S. Doishita</span>, <span class="highwire-citation-author" data-delta="13">T. Shimono</span> and <span class="highwire-citation-author" data-delta="14">Y. Miki</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 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1239-1247; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5663 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-61679--6829338180" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">H. Tatekawa </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 Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, 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=H.%2BTatekawa%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=Tatekawa%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.%2BTatekawa%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="https://orcid.org/0000-0002-8050-4895" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Tatekawa</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S. Sakamoto </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 Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, 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=S.%2BSakamoto%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=Sakamoto%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.%2BSakamoto%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="https://orcid.org/0000-0003-4671-0342" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Sakamoto</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M. Hori </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (M.H.), Graduate School of Medicine, Juntendo University, Tokyo, 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=M.%2BHori%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=Hori%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.%2BHori%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="https://orcid.org/0000-0002-1791-8032" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Hori</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Y. Kaichi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Diagnostic Radiology (Y.K.), Graduate School and Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 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.%2BKaichi%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=Kaichi%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.%2BKaichi%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="https://orcid.org/0000-0001-6213-941X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Kaichi</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">A. Kunimatsu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Radiology (A.K.), Graduate School of Medicine, University of Tokyo, Tokyo, 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=A.%2BKunimatsu%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=Kunimatsu%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.%2BKunimatsu%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="https://orcid.org/0000-0002-7141-2585" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Kunimatsu</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">K. Akazawa </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Radiology (K.A., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 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=K.%2BAkazawa%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=Akazawa%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.%2BAkazawa%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="https://orcid.org/0000-0003-3646-1821" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Akazawa</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">T. Miyasaka </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Radiology (T.M.), Nara Medical University, Nara, 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.%2BMiyasaka%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=Miyasaka%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.%2BMiyasaka%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="https://orcid.org/0000-0002-0551-0929" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Miyasaka</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">H. Oba </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>g</span>Department of Radiology (H.O.), Teikyo University School of Medicine, Tokyo, 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=H.%2BOba%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=Oba%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.%2BOba%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="https://orcid.org/0000-0002-7295-5709" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Oba</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">T. Okubo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>h</span>Department of Radiology (T.O.), Teikyo University Chiba Medical Center, Chiba, 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.%2BOkubo%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=Okubo%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.%2BOkubo%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="https://orcid.org/0000-0002-9309-0396" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Okubo</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">K. Hasuo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>i</span>Department of Diagnostic Radiology (K.H.), National Center for Global Health and Medicine, Tokyo, 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=K.%2BHasuo%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=Hasuo%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.%2BHasuo%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="https://orcid.org/0000-0003-1247-8768" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Hasuo</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">K. Yamada </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Radiology (K.A., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 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=K.%2BYamada%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=Yamada%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.%2BYamada%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="https://orcid.org/0000-0002-8123-3935" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Yamada</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">T. Taoka </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>j</span>Department of Radiology (T.T.), Nagoya University Graduate School of Medicine, Nagoya, 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.%2BTaoka%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=Taoka%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.%2BTaoka%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="https://orcid.org/0000-0001-9227-0240" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Taoka</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">S. Doishita </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 Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, 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=S.%2BDoishita%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=Doishita%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.%2BDoishita%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="https://orcid.org/0000-0003-4789-8199" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Doishita</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">T. Shimono </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 Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, 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.%2BShimono%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=Shimono%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.%2BShimono%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="https://orcid.org/0000-0001-5847-6587" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Shimono</a></li></ul></div><div class="author-tooltip-14"><div class="author-tooltip-name">Y. Miki </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 Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, 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.%2BMiki%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=Miki%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.%2BMiki%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="https://orcid.org/0000-0003-0621-0044" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Miki</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" 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-39.7.1239.1" data-doi="10.1212/01.wnl.0000216139.44259.74"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 39</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 7 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jul 2018 </div></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">H.</span> <span class="nlm-surname">Tatekawa</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Sakamoto</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Hori</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Kaichi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Kunimatsu</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Akazawa</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Miyasaka</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Oba</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Okubo</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Hasuo</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Yamada</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Taoka</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Doishita</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Shimono</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Miki</span></span></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">H.</span> <span class="nlm-surname">Tatekawa</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Sakamoto</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Hori</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Kaichi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Kunimatsu</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Akazawa</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Miyasaka</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Oba</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Okubo</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Hasuo</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Yamada</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Taoka</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Doishita</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Shimono</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Miki</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">Jul 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1239-1247; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5663 </span></div>
  
  
  
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