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<meta name="DC.Title" content="A Longitudinal Analysis of Early Lesion Growth in Presymptomatic Patients with Cerebral Adrenoleukodystrophy" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7250" />
<meta name="DC.Date" content="2021-10-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Cerebral adrenoleukodystrophy is a devastating neurological disorder caused by mutations in the ABCD1 gene. Our aim was to model and compare the growth of early cerebral lesions from longitudinal MRIs obtained in presymptomatic patients with progressive and arrested cerebral adrenoleukodystrophy using quantitative MR imaging–based lesion volumetry.

MATERIALS AND METHODS: We retrospectively quantified and modeled the longitudinal growth of early cerebral lesions from 174 MRIs obtained from 36 presymptomatic male patients with cerebral adrenoleukodystrophy. Lesions were manually segmented using subject-specific lesion-intensity thresholding. Volumes were calculated and plotted across time. Lesion velocity and acceleration were calculated between sequentially paired and triplet MRIs, respectively. Linear mixed-effects models were used to assess differences in growth parameters between progressive and arrested phenotypes.

RESULTS: The median patient age was 7.4 years (range, 3.9–37.0 years). Early-stage cerebral disease progression was inversely correlated with age (ρ = −0.6631, P &lt; .001), early lesions can grow while appearing radiographically stable, lesions undergo sustained acceleration in progressive cerebral adrenoleukodystrophy (β = 0.10 mL/month2 [95% CI, 0.05−0.14 mL/month2], P &lt; .001), and growth trajectories diverge between phenotypes in the presymptomatic time period.

CONCLUSIONS: Measuring the volumetric changes in newly developing cerebral lesions across time can distinguish cerebral adrenoleukodystrophy phenotypes before symptom onset. When factored into the overall clinical presentation of a patient with a new brain lesion, quantitative MR imaging–based lesion volumetry may aid in the accurate prediction of patients eligible for therapy.

CALD
:   cerebral adrenoleukodystrophy
HSCT
:   hematopoietic stem cell transplantation
LS
:   Loes score
t
:   time-zero" />
<meta name="DC.Contributor" content="E.J. Mallack" />
<meta name="DC.Contributor" content="G. Askin" />
<meta name="DC.Contributor" content="S. van de Stadt" />
<meta name="DC.Contributor" content="P.A. Caruso" />
<meta name="DC.Contributor" content="P.L. Musolino" />
<meta name="DC.Contributor" content="M. Engelen" />
<meta name="DC.Contributor" content="S.N. Niogi" />
<meta name="DC.Contributor" content="F.S. Eichler" />
<meta name="article:published_time" content="2021-10-01" />
<meta name="article:section" content="Pediatrics" />
<meta name="citation_title" content="A Longitudinal Analysis of Early Lesion Growth in Presymptomatic Patients with Cerebral Adrenoleukodystrophy" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Cerebral adrenoleukodystrophy is a devastating neurological disorder caused by mutations in the &lt;i&gt;ABCD1&lt;/i&gt; gene. Our aim was to model and compare the growth of early cerebral lesions from longitudinal MRIs obtained in presymptomatic patients with progressive and arrested cerebral adrenoleukodystrophy using quantitative MR imaging–based lesion volumetry.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively quantified and modeled the longitudinal growth of early cerebral lesions from 174 MRIs obtained from 36 presymptomatic male patients with cerebral adrenoleukodystrophy. Lesions were manually segmented using subject-specific lesion-intensity thresholding. Volumes were calculated and plotted across time. Lesion velocity and acceleration were calculated between sequentially paired and triplet MRIs, respectively. Linear mixed-effects models were used to assess differences in growth parameters between progressive and arrested phenotypes.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The median patient age was 7.4 years (range, 3.9–37.0 years). Early-stage cerebral disease progression was inversely correlated with age (ρ = −0.6631, &lt;i&gt;P&lt;/i&gt; &amp;lt; .001), early lesions can grow while appearing radiographically stable, lesions undergo sustained acceleration in progressive cerebral adrenoleukodystrophy (β = 0.10 mL/month&lt;sup&gt;2&lt;/sup&gt; [95% CI, 0.05−0.14 mL/month&lt;sup&gt;2&lt;/sup&gt;], &lt;i&gt;P&lt;/i&gt; &amp;lt; .001), and growth trajectories diverge between phenotypes in the presymptomatic time period.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Measuring the volumetric changes in newly developing cerebral lesions across time can distinguish cerebral adrenoleukodystrophy phenotypes before symptom onset. When factored into the overall clinical presentation of a patient with a new brain lesion, quantitative MR imaging–based lesion volumetry may aid in the accurate prediction of patients eligible for therapy.&lt;/p&gt;" />
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<meta name="twitter:title" content="A Longitudinal Analysis of Early Lesion Growth in Presymptomatic Patients with Cerebral Adrenoleukodystrophy" />
<meta name="twitter:card" content="summary_large_image" />
<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/42/10.cover-source.jpg" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Cerebral adrenoleukodystrophy is a devastating neurological disorder caused by mutations in the ABCD1 gene. Our aim was to model and compare the growth of early cerebral lesions from longitudinal MRIs obtained in presymptomatic patients with progressive and arrested cerebral adrenoleukodystrophy using quantitative MR imaging–based lesion volumetry.

MATERIALS AND METHODS: We retrospectively quantified and modeled the longitudinal growth of early cerebral lesions from 174 MRIs obtained from 36 presymptomatic male patients with cerebral adrenoleukodystrophy. Lesions were manually segmented using subject-specific lesion-intensity thresholding. Volumes were calculated and plotted across time. Lesion velocity and acceleration were calculated between sequentially paired and triplet MRIs, respectively. Linear mixed-effects models were used to assess differences in growth parameters between progressive and arrested phenotypes.

RESULTS: The median patient age was 7.4 years (range, 3.9–37.0 years). Early-stage cerebral disease progression was inversely correlated with age (ρ = −0.6631, P &lt; .001), early lesions can grow while appearing radiographically stable, lesions undergo sustained acceleration in progressive cerebral adrenoleukodystrophy (β = 0.10 mL/month2 [95% CI, 0.05−0.14 mL/month2], P &lt; .001), and growth trajectories diverge between phenotypes in the presymptomatic time period.

CONCLUSIONS: Measuring the volumetric changes in newly developing cerebral lesions across time can distinguish cerebral adrenoleukodystrophy phenotypes before symptom onset. When factored into the overall clinical presentation of a patient with a new brain lesion, quantitative MR imaging–based lesion volumetry may aid in the accurate prediction of patients eligible for therapy.

CALD
:   cerebral adrenoleukodystrophy
HSCT
:   hematopoietic stem cell transplantation
LS
:   Loes score
t
:   time-zero" />
<meta name="og-title" property="og:title" content="A Longitudinal Analysis of Early Lesion Growth in Presymptomatic Patients with Cerebral Adrenoleukodystrophy" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/42/10/1904" />
<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: Cerebral adrenoleukodystrophy is a devastating neurological disorder caused by mutations in the ABCD1 gene. Our aim was to model and compare the growth of early cerebral lesions from longitudinal MRIs obtained in presymptomatic patients with progressive and arrested cerebral adrenoleukodystrophy using quantitative MR imaging–based lesion volumetry.

MATERIALS AND METHODS: We retrospectively quantified and modeled the longitudinal growth of early cerebral lesions from 174 MRIs obtained from 36 presymptomatic male patients with cerebral adrenoleukodystrophy. Lesions were manually segmented using subject-specific lesion-intensity thresholding. Volumes were calculated and plotted across time. Lesion velocity and acceleration were calculated between sequentially paired and triplet MRIs, respectively. Linear mixed-effects models were used to assess differences in growth parameters between progressive and arrested phenotypes.

RESULTS: The median patient age was 7.4 years (range, 3.9–37.0 years). Early-stage cerebral disease progression was inversely correlated with age (ρ = −0.6631, P &lt; .001), early lesions can grow while appearing radiographically stable, lesions undergo sustained acceleration in progressive cerebral adrenoleukodystrophy (β = 0.10 mL/month2 [95% CI, 0.05−0.14 mL/month2], P &lt; .001), and growth trajectories diverge between phenotypes in the presymptomatic time period.

CONCLUSIONS: Measuring the volumetric changes in newly developing cerebral lesions across time can distinguish cerebral adrenoleukodystrophy phenotypes before symptom onset. When factored into the overall clinical presentation of a patient with a new brain lesion, quantitative MR imaging–based lesion volumetry may aid in the accurate prediction of patients eligible for therapy.

CALD
:   cerebral adrenoleukodystrophy
HSCT
:   hematopoietic stem cell transplantation
LS
:   Loes score
t
:   time-zero" />
<meta name="og-type" property="og:type" content="article" />
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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">Pediatrics</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">A Longitudinal Analysis of Early Lesion Growth in Presymptomatic Patients with Cerebral Adrenoleukodystrophy</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">E.J. Mallack</span>, <span class="highwire-citation-author" data-delta="1">G. Askin</span>, <span class="highwire-citation-author" data-delta="2">S. van de Stadt</span>, <span class="highwire-citation-author" data-delta="3">P.A. Caruso</span>, <span class="highwire-citation-author" data-delta="4">P.L. Musolino</span>, <span class="highwire-citation-author" data-delta="5">M. Engelen</span>, <span class="highwire-citation-author" data-delta="6">S.N. Niogi</span> and <span class="highwire-citation-author" data-delta="7">F.S. Eichler</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">October 2021,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">42 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1904-1911; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7250 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-93273--6914065399" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">E.J. Mallack </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 Neurology (E.J.M., P.L.M, F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Pediatrics (E.J.M.), Division of Child Neurology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York</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=E.J.%2BMallack%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=Mallack%20E&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%3AE.J.%2BMallack%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/0000-0002-2678-8807" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E.J. Mallack</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">G. Askin </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Population Health Sciences (G.A.), Division of Biostatistics</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=G.%2BAskin%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=Askin%20G&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%3AG.%2BAskin%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/0000-0001-5126-9809" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Askin</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S. van de Stadt </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Amsterdam Leukodystrophy Center (S.v.d.S, M.E.), Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands</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.%2Bvan%2Bde%2BStadt%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=van%20de%20Stadt%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.%2Bvan%2Bde%2BStadt%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/0000-0001-6910-3575" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. van de Stadt</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">P.A. Caruso </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Radiology (P.A.C.), Division of Neuroradiology, Harvard Medical School, Massachusetts General Hospital, 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=P.A.%2BCaruso%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=Caruso%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.A.%2BCaruso%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/0000-0003-3050-0957" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P.A. Caruso</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">P.L. Musolino </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 Neurology (E.J.M., P.L.M, F.S.E.), Harvard Medical School, Massachusetts General Hospital, 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=P.L.%2BMusolino%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=Musolino%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.L.%2BMusolino%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/0000-0001-8724-5649" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P.L. Musolino</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">M. Engelen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Amsterdam Leukodystrophy Center (S.v.d.S, M.E.), Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands</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.%2BEngelen%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=Engelen%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.%2BEngelen%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/0000-0002-5346-8497" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Engelen</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">S.N. Niogi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Radiology (S.N.N.), Weill Cornell Medicine, New York, New York</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Department of Radiology (S.N.N.), Weill Cornell Medicine, New York, New York</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.N.%2BNiogi%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=Niogi%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.N.%2BNiogi%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/0000-0002-6432-0017" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.N. Niogi</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">F.S. Eichler </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 Neurology (E.J.M., P.L.M, F.S.E.), Harvard Medical School, Massachusetts General Hospital, 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=F.S.%2BEichler%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=Eichler%20F&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%3AF.S.%2BEichler%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/0000-0001-6836-1089" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F.S. Eichler</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-42.10.1904.1" data-doi="10.1093/brain/120.8.1485"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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</li><li><span class="cit-auth"><span class="cit-name-surname">Moser</span>  <span class="cit-name-given-names">HW</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Loes</span>  <span class="cit-name-given-names">DJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Melhem</span>  <span class="cit-name-given-names">ER</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">X-linked adrenoleukodystrophy: overview and prognosis as a function of age and brain magnetic resonance imaging abnormality—a study involving 372 patients</span>. <abbr class="cit-jnl-abbrev">Neuropediatrics</abbr> <span class="cit-pub-date">2000</span>;<span class="cit-vol">31</span>:<span class="cit-fpage">227</span>–<span class="cit-lpage">39</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1055/s-2000-9236</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>11204280</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1055/s-2000-9236&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=11204280&amp;link_type=MED&amp;atom=%2Fajnr%2F42%2F10%2F1904.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000166286700002&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-42.10.1904.4" data-doi="10.1212/WNL.0000000000007294"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Liberato</span>  <span class="cit-name-given-names">AP</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mallack</span>  <span class="cit-name-given-names">EJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Aziz-Bose</span>  <span class="cit-name-given-names">R</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">MRI brain lesions in asymptomatic boys with X-linked adrenoleukodystrophy</span>. <abbr class="cit-jnl-abbrev">Neurology</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">92</span>:<span class="cit-fpage">e1698</span>–<span class="cit-lpage">1708</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1212/WNL.0000000000007294</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>30902905</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToibmV1cm9sb2d5IjtzOjU6InJlc2lkIjtzOjExOiI5Mi8xNS9lMTY5OCI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci80Mi8xMC8xOTA0LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a><div class="cit ref-cit ref-journal" id="cit-42.10.1904.5" data-doi="10.1212/01.WNL.0000079050.91337.83"><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. 42</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 10 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Oct 2021 </div></div>
      
      
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      <div class="highwire-cite-title">A Longitudinal Analysis of Early Lesion Growth in Presymptomatic Patients with Cerebral Adrenoleukodystrophy</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">Oct 2021, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">42 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1904-1911; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7250 </span></div>
  
  
  
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      <div class="highwire-cite-title">A Longitudinal Analysis of Early Lesion Growth in Presymptomatic Patients with Cerebral Adrenoleukodystrophy</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.J.</span> <span class="nlm-surname">Mallack</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Askin</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">van de Stadt</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">P.A.</span> <span class="nlm-surname">Caruso</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">P.L.</span> <span class="nlm-surname">Musolino</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Engelen</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.N.</span> <span class="nlm-surname">Niogi</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">F.S.</span> <span class="nlm-surname">Eichler</span></span></span></div>
  
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