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<meta name="DC.Title" content="Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5955" />
<meta name="DC.Date" content="2019-02-01" />
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<meta name="DC.Description" content="BACKGROUND: The underlying mechanism of action of flow diverters is believed to be the induction of aneurysm thrombosis and simultaneous endothelial cell growth along the device struts, thereby facilitating aneurysm exclusion from the circulation. Although extensive attention has been paid to the role of altered cerebrovascular hemodynamics using computational fluid dynamics analyses, relatively less emphasis has been placed on the role of the vascular endothelium in promoting aneurysm healing.

PURPOSE: Our aim was to systematically review all available literature investigating the mechanism of action of flow diverters in both human patients and preclinical models.

DATA SOURCES: A systematic search of PubMed, Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, and the Web of Science electronic data bases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

STUDY SELECTION: We selected articles assessing the role of endothelialization in flow-diverter treatment of cerebral aneurysms, including both preclinical and clinical studies.

DATA ANALYSIS: Ten articles were eligible for inclusion in this review. Two assessed endothelialization in human patients, while the other 8 used preclinical models (either rabbits or pigs).

DATA SYNTHESIS: Methods used to assess endothelialization included optical coherence tomography and scanning electron microscopy.

LIMITATIONS: A limitation was the heterogeneity of studies.

CONCLUSIONS: Current data regarding the temporal relationship to flow-diverter placement has largely been derived from work in preclinical animal models. Whether these cells along the device struts originate from adjacent endothelial cells or are the result of homing of circulating endothelial progenitor cells is equivocal.

Ang-1
:   angiopoietin-1
CD31
:   cluster of differentiation 31
CD34
:   cluster of differentiation 34
EPCs
:   endothelial progenitor cells
PED
:   Pipeline Embolization Device
PRISMA
:   Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Tie2
:   cell-surface receptor that binds and is activated by the angiopoietins" />
<meta name="DC.Contributor" content="K. Ravindran" />
<meta name="DC.Contributor" content="M.M. Salem" />
<meta name="DC.Contributor" content="A.Y. Alturki" />
<meta name="DC.Contributor" content="A.J. Thomas" />
<meta name="DC.Contributor" content="C.S. Ogilvy" />
<meta name="DC.Contributor" content="J.M. Moore" />
<meta name="article:published_time" content="2019-02-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND:&lt;/h3&gt;
&lt;p&gt;The underlying mechanism of action of flow diverters is believed to be the induction of aneurysm thrombosis and simultaneous endothelial cell growth along the device struts, thereby facilitating aneurysm exclusion from the circulation. Although extensive attention has been paid to the role of altered cerebrovascular hemodynamics using computational fluid dynamics analyses, relatively less emphasis has been placed on the role of the vascular endothelium in promoting aneurysm healing.&lt;/p&gt;&lt;h3&gt;PURPOSE:&lt;/h3&gt;
&lt;p&gt;Our aim was to systematically review all available literature investigating the mechanism of action of flow diverters in both human patients and preclinical models.&lt;/p&gt;&lt;h3&gt;DATA SOURCES:&lt;/h3&gt;
&lt;p&gt;A systematic search of PubMed, Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, and the Web of Science electronic data bases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.&lt;/p&gt;&lt;h3&gt;STUDY SELECTION:&lt;/h3&gt;
&lt;p&gt;We selected articles assessing the role of endothelialization in flow-diverter treatment of cerebral aneurysms, including both preclinical and clinical studies.&lt;/p&gt;&lt;h3&gt;DATA ANALYSIS:&lt;/h3&gt;
&lt;p&gt;Ten articles were eligible for inclusion in this review. Two assessed endothelialization in human patients, while the other 8 used preclinical models (either rabbits or pigs).&lt;/p&gt;&lt;h3&gt;DATA SYNTHESIS:&lt;/h3&gt;
&lt;p&gt;Methods used to assess endothelialization included optical coherence tomography and scanning electron microscopy.&lt;/p&gt;&lt;h3&gt;LIMITATIONS:&lt;/h3&gt;
&lt;p&gt;A limitation was the heterogeneity of studies.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Current data regarding the temporal relationship to flow-diverter placement has largely been derived from work in preclinical animal models. Whether these cells along the device struts originate from adjacent endothelial cells or are the result of homing of circulating endothelial progenitor cells is equivocal.&lt;/p&gt;" />
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<meta name="twitter:title" content="Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review" />
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<meta name="twitter:description" content="BACKGROUND: The underlying mechanism of action of flow diverters is believed to be the induction of aneurysm thrombosis and simultaneous endothelial cell growth along the device struts, thereby facilitating aneurysm exclusion from the circulation. Although extensive attention has been paid to the role of altered cerebrovascular hemodynamics using computational fluid dynamics analyses, relatively less emphasis has been placed on the role of the vascular endothelium in promoting aneurysm healing.

PURPOSE: Our aim was to systematically review all available literature investigating the mechanism of action of flow diverters in both human patients and preclinical models.

DATA SOURCES: A systematic search of PubMed, Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, and the Web of Science electronic data bases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

STUDY SELECTION: We selected articles assessing the role of endothelialization in flow-diverter treatment of cerebral aneurysms, including both preclinical and clinical studies.

DATA ANALYSIS: Ten articles were eligible for inclusion in this review. Two assessed endothelialization in human patients, while the other 8 used preclinical models (either rabbits or pigs).

DATA SYNTHESIS: Methods used to assess endothelialization included optical coherence tomography and scanning electron microscopy.

LIMITATIONS: A limitation was the heterogeneity of studies.

CONCLUSIONS: Current data regarding the temporal relationship to flow-diverter placement has largely been derived from work in preclinical animal models. Whether these cells along the device struts originate from adjacent endothelial cells or are the result of homing of circulating endothelial progenitor cells is equivocal.

Ang-1
:   angiopoietin-1
CD31
:   cluster of differentiation 31
CD34
:   cluster of differentiation 34
EPCs
:   endothelial progenitor cells
PED
:   Pipeline Embolization Device
PRISMA
:   Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Tie2
:   cell-surface receptor that binds and is activated by the angiopoietins" />
<meta name="og-title" property="og:title" content="Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/40/2/295" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND: The underlying mechanism of action of flow diverters is believed to be the induction of aneurysm thrombosis and simultaneous endothelial cell growth along the device struts, thereby facilitating aneurysm exclusion from the circulation. Although extensive attention has been paid to the role of altered cerebrovascular hemodynamics using computational fluid dynamics analyses, relatively less emphasis has been placed on the role of the vascular endothelium in promoting aneurysm healing.

PURPOSE: Our aim was to systematically review all available literature investigating the mechanism of action of flow diverters in both human patients and preclinical models.

DATA SOURCES: A systematic search of PubMed, Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, and the Web of Science electronic data bases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

STUDY SELECTION: We selected articles assessing the role of endothelialization in flow-diverter treatment of cerebral aneurysms, including both preclinical and clinical studies.

DATA ANALYSIS: Ten articles were eligible for inclusion in this review. Two assessed endothelialization in human patients, while the other 8 used preclinical models (either rabbits or pigs).

DATA SYNTHESIS: Methods used to assess endothelialization included optical coherence tomography and scanning electron microscopy.

LIMITATIONS: A limitation was the heterogeneity of studies.

CONCLUSIONS: Current data regarding the temporal relationship to flow-diverter placement has largely been derived from work in preclinical animal models. Whether these cells along the device struts originate from adjacent endothelial cells or are the result of homing of circulating endothelial progenitor cells is equivocal.

Ang-1
:   angiopoietin-1
CD31
:   cluster of differentiation 31
CD34
:   cluster of differentiation 34
EPCs
:   endothelial progenitor cells
PED
:   Pipeline Embolization Device
PRISMA
:   Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Tie2
:   cell-surface receptor that binds and is activated by the angiopoietins" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node65931--5" data-node-nid="65931" id="top-node-65931--6317112040" data-pisa="ajnr;40/2/295" data-pisa-master="ajnr;ajnr.A5955" data-apath="/ajnr/40/2/295.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">Interventional</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">K. Ravindran</span>, <span class="highwire-citation-author" data-delta="1">M.M. Salem</span>, <span class="highwire-citation-author" data-delta="2">A.Y. Alturki</span>, <span class="highwire-citation-author" data-delta="3">A.J. Thomas</span>, <span class="highwire-citation-author" data-delta="4">C.S. Ogilvy</span> and <span class="highwire-citation-author" data-delta="5">J.M. Moore</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">February 2019,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">295-301; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5955 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-65931--6317112040" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">K. Ravindran </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</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.%2BRavindran%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=Ravindran%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.%2BRavindran%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/0000-0003-0349-1231" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Ravindran</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M.M. Salem </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</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.M.%2BSalem%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=Salem%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.M.%2BSalem%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/0000-0001-7644-2911" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.M. Salem</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">A.Y. Alturki </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</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.Y.%2BAlturki%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=Alturki%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.Y.%2BAlturki%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/0000-0003-0508-9609" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.Y. Alturki</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">A.J. Thomas </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</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.J.%2BThomas%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=Thomas%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.J.%2BThomas%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/0000-0003-4412-3152" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.J. Thomas</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">C.S. Ogilvy </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</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.S.%2BOgilvy%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=Ogilvy%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.S.%2BOgilvy%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/0000-0003-4600-8545" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C.S. Ogilvy</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">J.M. Moore </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</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.%2BMoore%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=Moore%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.%2BMoore%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/0000-0003-2385-6357" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.M. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND:</strong> The underlying mechanism of action of flow diverters is believed to be the induction of aneurysm thrombosis and simultaneous endothelial cell growth along the device struts, thereby facilitating aneurysm exclusion from the circulation. Although extensive attention has been paid to the role of altered cerebrovascular hemodynamics using computational fluid dynamics analyses, relatively less emphasis has been placed on the role of the vascular endothelium in promoting aneurysm healing.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>PURPOSE:</strong> Our aim was to systematically review all available literature investigating the mechanism of action of flow diverters in both human patients and preclinical models.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>DATA SOURCES:</strong> A systematic search of PubMed, Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, and the Web of Science electronic data bases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>STUDY SELECTION:</strong> We selected articles assessing the role of endothelialization in flow-diverter treatment of cerebral aneurysms, including both preclinical and clinical studies.</p></div><div id="sec-5" class="subsection"><p id="p-5"><strong>DATA ANALYSIS:</strong> Ten articles were eligible for inclusion in this review. Two assessed endothelialization in human patients, while the other 8 used preclinical models (either rabbits or pigs).</p></div><div id="sec-6" class="subsection"><p id="p-6"><strong>DATA SYNTHESIS:</strong> Methods used to assess endothelialization included optical coherence tomography and scanning electron microscopy.</p></div><div id="sec-7" class="subsection"><p id="p-7"><strong>LIMITATIONS:</strong> A limitation was the heterogeneity of studies.</p></div><div id="sec-8" class="subsection"><p id="p-8"><strong>CONCLUSIONS:</strong> Current data regarding the temporal relationship to flow-diverter placement has largely been derived from work in preclinical animal models. Whether these cells along the device struts originate from adjacent endothelial cells or are the result of homing of circulating endothelial progenitor cells is equivocal.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">Ang-1<span class="def-item-dt-sep"></span></dt><dd>angiopoietin-1<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CD31<span class="def-item-dt-sep"></span></dt><dd>cluster of differentiation 31<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">CD34<span class="def-item-dt-sep"></span></dt><dd>cluster of differentiation 34<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">EPCs<span class="def-item-dt-sep"></span></dt><dd>endothelial progenitor cells<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">PED<span class="def-item-dt-sep"></span></dt><dd>Pipeline Embolization Device<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">PRISMA<span class="def-item-dt-sep"></span></dt><dd>Preferred Reporting Items for Systematic Reviews and Meta-Analyses<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">Tie2<span class="def-item-dt-sep"></span></dt><dd>cell-surface receptor that binds and is activated by the angiopoietins</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2019 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/40/2/295.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 40</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 2 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Feb 2019 </div></div>
      
      
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      <div class="highwire-cite-title">Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review</div>  
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    	<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">Feb 2019, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">295-301; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5955 </span></div>
  
  
  
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