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<meta name="DC.Title" content="Prolonged Microgravity Affects Human Brain Structure and Function" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6249" />
<meta name="DC.Date" content="2019-11-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Widespread brain structural changes are seen following extended spaceflight missions. The purpose of this study was to investigate whether these structural changes are associated with alterations in motor or cognitive function.

MATERIALS AND METHODS: Brain MR imaging scans of National Aeronautics and Space Administration astronauts were retrospectively analyzed to quantify pre- to postflight changes in brain structure. Local structural changes were assessed using the Jacobian determinant. Structural changes were compared with clinical findings and cognitive and motor function.

RESULTS: Long-duration spaceflights aboard the International Space Station, but not short-duration Space Shuttle flights, resulted in a significant increase in total ventricular volume (10.7% versus 0%, P &lt; .001, n = 12 versus n = 7). Total ventricular volume change was significantly associated with mission duration ( r = 0.72, P = .001, n = 19) but negatively associated with age ( r = −0.48, P = .048, n = 19). Long-duration spaceflights resulted in significant crowding of brain parenchyma at the vertex. Pre- to postflight structural changes of the left caudate correlated significantly with poor postural control; and the right primary motor area/midcingulate correlated significantly with a complex motor task completion time. Change in volume of 3 white matter regions significantly correlated with altered reaction times on a cognitive performance task (bilateral optic radiations, splenium of the corpus callosum). In a post hoc finding, astronauts who developed spaceflight-associated neuro-ocular syndrome demonstrated smaller changes in total ventricular volume than those who did not (12.8% versus 6.5%, n = 8 versus n = 4).

CONCLUSIONS: While cautious interpretation is appropriate given the small sample size and number of comparisons, these findings suggest that brain structural changes are associated with changes in cognitive and motor test scores and with the development of spaceflight-associated neuro-optic syndrome.

CDS
:   code substitution
CPT
:   continuous performance
%ΔVV
:   percentage total ventricular volume change
FTT
:   Functional Task Test
ISS
:   International Space Station
LSAH
:   Lifetime Surveillance of Astronaut Health
NASA
:   National Aeronautics and Space Administration
PVE
:   partial volume estimation
SANS
:   spaceflight-associated neuro-ocular syndrome
WinSCAT
:   Spaceflight Cognitive Assessment Tool for Windows" />
<meta name="DC.Contributor" content="D.R. Roberts" />
<meta name="DC.Contributor" content="D. Asemani" />
<meta name="DC.Contributor" content="P.J. Nietert" />
<meta name="DC.Contributor" content="M.A. Eckert" />
<meta name="DC.Contributor" content="D.C. Inglesby" />
<meta name="DC.Contributor" content="J.J. Bloomberg" />
<meta name="DC.Contributor" content="M.S. George" />
<meta name="DC.Contributor" content="T.R. Brown" />
<meta name="article:published_time" content="2019-11-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Prolonged Microgravity Affects Human Brain Structure and Function" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Widespread brain structural changes are seen following extended spaceflight missions. The purpose of this study was to investigate whether these structural changes are associated with alterations in motor or cognitive function.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Brain MR imaging scans of National Aeronautics and Space Administration astronauts were retrospectively analyzed to quantify pre- to postflight changes in brain structure. Local structural changes were assessed using the Jacobian determinant. Structural changes were compared with clinical findings and cognitive and motor function.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Long-duration spaceflights aboard the International Space Station, but not short-duration Space Shuttle flights, resulted in a significant increase in total ventricular volume (10.7% versus 0%, &lt;i&gt;P&lt;/i&gt; &amp;lt; .001, &lt;i&gt;n&lt;/i&gt; = 12 versus &lt;i&gt;n&lt;/i&gt; = 7). Total ventricular volume change was significantly associated with mission duration (&lt;i&gt;r&lt;/i&gt; = 0.72, &lt;i&gt;P&lt;/i&gt; = .001, &lt;i&gt;n&lt;/i&gt; = 19) but negatively associated with age (&lt;i&gt;r&lt;/i&gt; = −0.48, &lt;i&gt;P&lt;/i&gt; = .048, &lt;i&gt;n&lt;/i&gt; = 19). Long-duration spaceflights resulted in significant crowding of brain parenchyma at the vertex. Pre- to postflight structural changes of the left caudate correlated significantly with poor postural control; and the right primary motor area/midcingulate correlated significantly with a complex motor task completion time. Change in volume of 3 white matter regions significantly correlated with altered reaction times on a cognitive performance task (bilateral optic radiations, splenium of the corpus callosum). In a post hoc finding, astronauts who developed spaceflight-associated neuro-ocular syndrome demonstrated smaller changes in total ventricular volume than those who did not (12.8% versus 6.5%, &lt;i&gt;n&lt;/i&gt; = 8 versus &lt;i&gt;n&lt;/i&gt; = 4).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;While cautious interpretation is appropriate given the small sample size and number of comparisons, these findings suggest that brain structural changes are associated with changes in cognitive and motor test scores and with the development of spaceflight-associated neuro-optic syndrome.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="D.R. Roberts" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)" />
<meta name="citation_author_institution" content="bDepartment of Neurosciences (D.R.R.)" />
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<meta name="twitter:title" content="Prolonged Microgravity Affects Human Brain Structure and Function" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Widespread brain structural changes are seen following extended spaceflight missions. The purpose of this study was to investigate whether these structural changes are associated with alterations in motor or cognitive function.

MATERIALS AND METHODS: Brain MR imaging scans of National Aeronautics and Space Administration astronauts were retrospectively analyzed to quantify pre- to postflight changes in brain structure. Local structural changes were assessed using the Jacobian determinant. Structural changes were compared with clinical findings and cognitive and motor function.

RESULTS: Long-duration spaceflights aboard the International Space Station, but not short-duration Space Shuttle flights, resulted in a significant increase in total ventricular volume (10.7% versus 0%, P &lt; .001, n = 12 versus n = 7). Total ventricular volume change was significantly associated with mission duration ( r = 0.72, P = .001, n = 19) but negatively associated with age ( r = −0.48, P = .048, n = 19). Long-duration spaceflights resulted in significant crowding of brain parenchyma at the vertex. Pre- to postflight structural changes of the left caudate correlated significantly with poor postural control; and the right primary motor area/midcingulate correlated significantly with a complex motor task completion time. Change in volume of 3 white matter regions significantly correlated with altered reaction times on a cognitive performance task (bilateral optic radiations, splenium of the corpus callosum). In a post hoc finding, astronauts who developed spaceflight-associated neuro-ocular syndrome demonstrated smaller changes in total ventricular volume than those who did not (12.8% versus 6.5%, n = 8 versus n = 4).

CONCLUSIONS: While cautious interpretation is appropriate given the small sample size and number of comparisons, these findings suggest that brain structural changes are associated with changes in cognitive and motor test scores and with the development of spaceflight-associated neuro-optic syndrome.

CDS
:   code substitution
CPT
:   continuous performance
%ΔVV
:   percentage total ventricular volume change
FTT
:   Functional Task Test
ISS
:   International Space Station
LSAH
:   Lifetime Surveillance of Astronaut Health
NASA
:   National Aeronautics and Space Administration
PVE
:   partial volume estimation
SANS
:   spaceflight-associated neuro-ocular syndrome
WinSCAT
:   Spaceflight Cognitive Assessment Tool for Windows" />
<meta name="og-title" property="og:title" content="Prolonged Microgravity Affects Human Brain Structure and Function" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/40/11/1878" />
<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: Widespread brain structural changes are seen following extended spaceflight missions. The purpose of this study was to investigate whether these structural changes are associated with alterations in motor or cognitive function.

MATERIALS AND METHODS: Brain MR imaging scans of National Aeronautics and Space Administration astronauts were retrospectively analyzed to quantify pre- to postflight changes in brain structure. Local structural changes were assessed using the Jacobian determinant. Structural changes were compared with clinical findings and cognitive and motor function.

RESULTS: Long-duration spaceflights aboard the International Space Station, but not short-duration Space Shuttle flights, resulted in a significant increase in total ventricular volume (10.7% versus 0%, P &lt; .001, n = 12 versus n = 7). Total ventricular volume change was significantly associated with mission duration ( r = 0.72, P = .001, n = 19) but negatively associated with age ( r = −0.48, P = .048, n = 19). Long-duration spaceflights resulted in significant crowding of brain parenchyma at the vertex. Pre- to postflight structural changes of the left caudate correlated significantly with poor postural control; and the right primary motor area/midcingulate correlated significantly with a complex motor task completion time. Change in volume of 3 white matter regions significantly correlated with altered reaction times on a cognitive performance task (bilateral optic radiations, splenium of the corpus callosum). In a post hoc finding, astronauts who developed spaceflight-associated neuro-ocular syndrome demonstrated smaller changes in total ventricular volume than those who did not (12.8% versus 6.5%, n = 8 versus n = 4).

CONCLUSIONS: While cautious interpretation is appropriate given the small sample size and number of comparisons, these findings suggest that brain structural changes are associated with changes in cognitive and motor test scores and with the development of spaceflight-associated neuro-optic syndrome.

CDS
:   code substitution
CPT
:   continuous performance
%ΔVV
:   percentage total ventricular volume change
FTT
:   Functional Task Test
ISS
:   International Space Station
LSAH
:   Lifetime Surveillance of Astronaut Health
NASA
:   National Aeronautics and Space Administration
PVE
:   partial volume estimation
SANS
:   spaceflight-associated neuro-ocular syndrome
WinSCAT
:   Spaceflight Cognitive Assessment Tool for Windows" />
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      <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">Prolonged Microgravity Affects Human Brain Structure and Function</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">D.R. Roberts</span>, <span class="highwire-citation-author" data-delta="1">D. Asemani</span>, <span class="highwire-citation-author" data-delta="2">P.J. Nietert</span>, <span class="highwire-citation-author" data-delta="3">M.A. Eckert</span>, <span class="highwire-citation-author" data-delta="4">D.C. Inglesby</span>, <span class="highwire-citation-author" data-delta="5">J.J. Bloomberg</span>, <span class="highwire-citation-author" data-delta="6">M.S. George</span> and <span class="highwire-citation-author" data-delta="7">T.R. Brown</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">November 2019,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1878-1885; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6249 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-71290--61858468836" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">D.R. Roberts </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurosciences (D.R.R.)</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.R.%2BRoberts%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=Roberts%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.R.%2BRoberts%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/0000-0002-6302-8233" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.R. Roberts</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D. Asemani </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)</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.%2BAsemani%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=Asemani%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.%2BAsemani%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/0000-0002-4398-6848" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D. Asemani</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">P.J. Nietert </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Public Health Sciences (P.J.N.)</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.J.%2BNietert%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=Nietert%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.J.%2BNietert%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/0000-0002-3933-4986" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P.J. Nietert</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M.A. Eckert </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Otolaryngology–Head and Neck Surgery (M.A.E.)</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.A.%2BEckert%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=Eckert%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.A.%2BEckert%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/0000-0001-9286-7717" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.A. Eckert</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">D.C. Inglesby </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)</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.C.%2BInglesby%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=Inglesby%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.C.%2BInglesby%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/0000-0001-7103-2809" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.C. Inglesby</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">J.J. Bloomberg </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>Neurosciences Laboratory (J.J.B.), NASA Johnson Space Center, Houston, Texas</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.J.%2BBloomberg%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=Bloomberg%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.J.%2BBloomberg%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/0000-0003-2774-2699" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.J. Bloomberg</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">M.S. George </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Psychiatry and Behavioral Sciences (M.S.G.), Medical University of South Carolina, Charleston, South Carolina</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Ralph H. Johnson VA Medical Center (M.S.G.), Charleston, South Carolina</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.S.%2BGeorge%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=George%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.S.%2BGeorge%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/0000-0003-1767-1815" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.S. 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Brown </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)</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.R.%2BBrown%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=Brown%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.R.%2BBrown%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/0000-0001-5789-7638" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.R. 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 40</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 11 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Nov 2019 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2019, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1878-1885; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6249 </span></div>
  
  
  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2019, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1878-1885; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6249 </span></div>
  
  
  
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