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<meta name="DC.Title" content="The Cochlea in Branchio-Oto-Renal Syndrome: An Objective Method for the Diagnosis of Offset Cochlear Turns" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7653" />
<meta name="DC.Date" content="2022-11-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2022 by American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: An “unwound” or “offset” cochlea has been described as a characteristic imaging feature in patients with branchio-oto-renal syndrome, and recently recognized to be associated in particular to those with EYA1 gene mutations. Determination of this feature has traditionally relied on subjective visual assessment. Our aim was to establish an objective assessment method for cochlear offset (the cochlear turn alignment ratio) and determine an optimal cutoff turn alignment ratio value that separates individuals with EYA1 -branchio-oto-renal syndrome from those with SIX1 -branchio-oto-renal syndrome and healthy controls.

MATERIALS AND METHODS: Temporal bone CT or MR imaging from 40 individuals with branchio-oto-renal syndrome and 40 controls was retrospectively reviewed. Cochlear offset was determined visually by 2 independent blinded readers and then quantitatively via a standardized technique yielding the cochlear turn alignment ratio. The turn alignment ratio values were compared between cochleae qualitatively assessed as “not offset” and “offset.” Receiver operating characteristic analysis was used to determine the ability of the turn alignment ratio to differentiate between these populations and an optimal cutoff turn alignment ratio value. Cochlear offset and turn alignment ratio values were analyzed for each branchio-oto-renal syndrome genotype subpopulation and for controls.

RESULTS: The turn alignment ratio can accurately differentiate between cochleae with and without an offset ( P  &lt; .001). The optimal cutoff value separating these populations was 0.476 (sensitivity = 1, specificity = 0.986, J = 0.986). All except 1 cochlea among the EYA1 -branchio-oto-renal syndrome subset and all with unknown genotype branchio-oto-renal syndrome had a cochlear offset and a turn alignment ratio of &lt;0.476. All except 1 cochlea among the SIX1 -branchio-oto-renal syndrome subset and all controls had no offset and a turn alignment ratio of &gt;0.476.

CONCLUSIONS: There is a statistically significant difference in turn alignment ratios between offset and nonoffset cochleae, with an optimal cutoff of 0.476. This cutoff value allows excellent separation of EYA1 -branchio-oto-renal syndrome from SIX1 -branchio-oto-renal syndrome and from individuals without branchio-oto-renal syndrome or sensorineural hearing loss. The turn alignment ratio is a reliable and objective metric that can aid in the imaging evaluation of branchio-oto-renal syndrome.

BOR
:   branchio-oto-renal syndrome
ROC
:   receiver operating characteristic
TAR
:   turn alignment ratio" />
<meta name="DC.Contributor" content="A.F. Juliano" />
<meta name="DC.Contributor" content="F. D’Arco" />
<meta name="DC.Contributor" content="J. Pao" />
<meta name="DC.Contributor" content="S. Picariello" />
<meta name="DC.Contributor" content="E. Clement" />
<meta name="DC.Contributor" content="G. Moonis" />
<meta name="DC.Contributor" content="C.D. Robson" />
<meta name="article:published_time" content="2022-11-01" />
<meta name="article:section" content="Head &amp;amp; Neck" />
<meta name="citation_title" content="The Cochlea in Branchio-Oto-Renal Syndrome: An Objective Method for the Diagnosis of Offset Cochlear Turns" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;An “unwound” or “offset” cochlea has been described as a characteristic imaging feature in patients with branchio-oto-renal syndrome, and recently recognized to be associated in particular to those with &lt;i&gt;EYA1&lt;/i&gt; gene mutations. Determination of this feature has traditionally relied on subjective visual assessment. Our aim was to establish an objective assessment method for cochlear offset (the cochlear turn alignment ratio) and determine an optimal cutoff turn alignment ratio value that separates individuals with &lt;i&gt;EYA1&lt;/i&gt;-branchio-oto-renal syndrome from those with &lt;i&gt;SIX1&lt;/i&gt;-branchio-oto-renal syndrome and healthy controls.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Temporal bone CT or MR imaging from 40 individuals with branchio-oto-renal syndrome and 40 controls was retrospectively reviewed. Cochlear offset was determined visually by 2 independent blinded readers and then quantitatively via a standardized technique yielding the cochlear turn alignment ratio. The turn alignment ratio values were compared between cochleae qualitatively assessed as “not offset” and “offset.” Receiver operating characteristic analysis was used to determine the ability of the turn alignment ratio to differentiate between these populations and an optimal cutoff turn alignment ratio value. Cochlear offset and turn alignment ratio values were analyzed for each branchio-oto-renal syndrome genotype subpopulation and for controls.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The turn alignment ratio can accurately differentiate between cochleae with and without an offset (&lt;i&gt;P &lt;/i&gt;&amp;lt; .001). The optimal cutoff value separating these populations was 0.476 (sensitivity = 1, specificity = 0.986, &lt;i&gt;J&lt;/i&gt; = 0.986). All except 1 cochlea among the &lt;i&gt;EYA1&lt;/i&gt;-branchio-oto-renal syndrome subset and all with unknown genotype branchio-oto-renal syndrome had a cochlear offset and a turn alignment ratio of &amp;lt;0.476. All except 1 cochlea among the &lt;i&gt;SIX1&lt;/i&gt;-branchio-oto-renal syndrome subset and all controls had no offset and a turn alignment ratio of &amp;gt;0.476.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;There is a statistically significant difference in turn alignment ratios between offset and nonoffset cochleae, with an optimal cutoff of 0.476. This cutoff value allows excellent separation of &lt;i&gt;EYA1&lt;/i&gt;-branchio-oto-renal syndrome from &lt;i&gt;SIX1&lt;/i&gt;-branchio-oto-renal syndrome and from individuals without branchio-oto-renal syndrome or sensorineural hearing loss. The turn alignment ratio is a reliable and objective metric that can aid in the imaging evaluation of branchio-oto-renal syndrome.&lt;/p&gt;" />
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<meta name="citation_author" content="J. Pao" />
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<meta name="twitter:title" content="The Cochlea in Branchio-Oto-Renal Syndrome: An Objective Method for the Diagnosis of Offset Cochlear Turns" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: An “unwound” or “offset” cochlea has been described as a characteristic imaging feature in patients with branchio-oto-renal syndrome, and recently recognized to be associated in particular to those with EYA1 gene mutations. Determination of this feature has traditionally relied on subjective visual assessment. Our aim was to establish an objective assessment method for cochlear offset (the cochlear turn alignment ratio) and determine an optimal cutoff turn alignment ratio value that separates individuals with EYA1 -branchio-oto-renal syndrome from those with SIX1 -branchio-oto-renal syndrome and healthy controls.

MATERIALS AND METHODS: Temporal bone CT or MR imaging from 40 individuals with branchio-oto-renal syndrome and 40 controls was retrospectively reviewed. Cochlear offset was determined visually by 2 independent blinded readers and then quantitatively via a standardized technique yielding the cochlear turn alignment ratio. The turn alignment ratio values were compared between cochleae qualitatively assessed as “not offset” and “offset.” Receiver operating characteristic analysis was used to determine the ability of the turn alignment ratio to differentiate between these populations and an optimal cutoff turn alignment ratio value. Cochlear offset and turn alignment ratio values were analyzed for each branchio-oto-renal syndrome genotype subpopulation and for controls.

RESULTS: The turn alignment ratio can accurately differentiate between cochleae with and without an offset ( P  &lt; .001). The optimal cutoff value separating these populations was 0.476 (sensitivity = 1, specificity = 0.986, J = 0.986). All except 1 cochlea among the EYA1 -branchio-oto-renal syndrome subset and all with unknown genotype branchio-oto-renal syndrome had a cochlear offset and a turn alignment ratio of &lt;0.476. All except 1 cochlea among the SIX1 -branchio-oto-renal syndrome subset and all controls had no offset and a turn alignment ratio of &gt;0.476.

CONCLUSIONS: There is a statistically significant difference in turn alignment ratios between offset and nonoffset cochleae, with an optimal cutoff of 0.476. This cutoff value allows excellent separation of EYA1 -branchio-oto-renal syndrome from SIX1 -branchio-oto-renal syndrome and from individuals without branchio-oto-renal syndrome or sensorineural hearing loss. The turn alignment ratio is a reliable and objective metric that can aid in the imaging evaluation of branchio-oto-renal syndrome.

BOR
:   branchio-oto-renal syndrome
ROC
:   receiver operating characteristic
TAR
:   turn alignment ratio" />
<meta name="og-title" property="og:title" content="The Cochlea in Branchio-Oto-Renal Syndrome: An Objective Method for the Diagnosis of Offset Cochlear Turns" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/43/11/1646" />
<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: An “unwound” or “offset” cochlea has been described as a characteristic imaging feature in patients with branchio-oto-renal syndrome, and recently recognized to be associated in particular to those with EYA1 gene mutations. Determination of this feature has traditionally relied on subjective visual assessment. Our aim was to establish an objective assessment method for cochlear offset (the cochlear turn alignment ratio) and determine an optimal cutoff turn alignment ratio value that separates individuals with EYA1 -branchio-oto-renal syndrome from those with SIX1 -branchio-oto-renal syndrome and healthy controls.

MATERIALS AND METHODS: Temporal bone CT or MR imaging from 40 individuals with branchio-oto-renal syndrome and 40 controls was retrospectively reviewed. Cochlear offset was determined visually by 2 independent blinded readers and then quantitatively via a standardized technique yielding the cochlear turn alignment ratio. The turn alignment ratio values were compared between cochleae qualitatively assessed as “not offset” and “offset.” Receiver operating characteristic analysis was used to determine the ability of the turn alignment ratio to differentiate between these populations and an optimal cutoff turn alignment ratio value. Cochlear offset and turn alignment ratio values were analyzed for each branchio-oto-renal syndrome genotype subpopulation and for controls.

RESULTS: The turn alignment ratio can accurately differentiate between cochleae with and without an offset ( P  &lt; .001). The optimal cutoff value separating these populations was 0.476 (sensitivity = 1, specificity = 0.986, J = 0.986). All except 1 cochlea among the EYA1 -branchio-oto-renal syndrome subset and all with unknown genotype branchio-oto-renal syndrome had a cochlear offset and a turn alignment ratio of &lt;0.476. All except 1 cochlea among the SIX1 -branchio-oto-renal syndrome subset and all controls had no offset and a turn alignment ratio of &gt;0.476.

CONCLUSIONS: There is a statistically significant difference in turn alignment ratios between offset and nonoffset cochleae, with an optimal cutoff of 0.476. This cutoff value allows excellent separation of EYA1 -branchio-oto-renal syndrome from SIX1 -branchio-oto-renal syndrome and from individuals without branchio-oto-renal syndrome or sensorineural hearing loss. The turn alignment ratio is a reliable and objective metric that can aid in the imaging evaluation of branchio-oto-renal syndrome.

BOR
:   branchio-oto-renal syndrome
ROC
:   receiver operating characteristic
TAR
:   turn alignment ratio" />
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      <h1 class="highwire-cite-title" id="page-title">The Cochlea in Branchio-Oto-Renal Syndrome: An Objective Method for the Diagnosis of Offset Cochlear Turns</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">A.F. Juliano</span>, <span class="highwire-citation-author" data-delta="1">F. D’Arco</span>, <span class="highwire-citation-author" data-delta="2">J. Pao</span>, <span class="highwire-citation-author" data-delta="3">S. Picariello</span>, <span class="highwire-citation-author" data-delta="4">E. Clement</span>, <span class="highwire-citation-author" data-delta="5">G. Moonis</span> and <span class="highwire-citation-author" data-delta="6">C.D. Robson</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 2022,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1646-1652; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7653 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-99651--837756915" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">A.F. Juliano </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 Radiology (A.F.J.), Massachusetts Eye and Ear, 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.F.%2BJuliano%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=Juliano%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.F.%2BJuliano%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/0000-0002-5088-5367" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.F. Juliano</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">F. D’Arco </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (F.D.), Great Ormond Street Hospital for Children, London, UK</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.%2BD%E2%80%99Arco%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=D%E2%80%99Arco%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.%2BD%25E2%2580%2599Arco%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/0000-0001-7396-591X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. D’Arco</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">J. Pao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiology (J.P.), Orlando Health, Orlando Regional Medical Center, Orlando, Florida</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.%2BPao%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=Pao%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.%2BPao%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/0000-0002-9424-932X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Pao</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">S. Picariello </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of General and Specialized Surgery for Women and Children (S.P.), University of Campania “Luigi Vanvitelli,” Naples, Italy</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Neuro-Oncology Unit (S.P.), Department of Paediatric Oncology, Santobono-Pausilipon Children’s Hospital, Naples, Italy</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.%2BPicariello%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=Picariello%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.%2BPicariello%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/0000-0001-5013-1138" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Picariello</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">E. Clement </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Clinical Genetics (E.C.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK</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.%2BClement%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=Clement%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.%2BClement%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/0000-0002-5562-6276" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">A.F. Juliano</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">F. D’Arco</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-3"><span class="name">J. Pao</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a>, </li><li class="contributor" id="contrib-4"><span class="name">S. Picariello</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">d</a><span class="xref-sep">,</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">e</a>, </li><li class="contributor" id="contrib-5"><span class="name">E. Clement</span><a id="xref-aff-6-1" class="xref-aff" href="#aff-6">f</a>, </li><li class="contributor" id="contrib-6"><span class="name">G. Moonis</span><a id="xref-aff-7-1" class="xref-aff" href="#aff-7">g</a> and </li><li class="last" id="contrib-7"><span class="name">C.D. Robson</span><a id="xref-aff-8-1" class="xref-aff" href="#aff-8">h</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Department of Radiology (A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Department of Radiology (F.D.), Great Ormond Street Hospital for Children, London, UK</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Department of Radiology (J.P.), Orlando Health, Orlando Regional Medical Center, Orlando, Florida</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>d</sup>Department of General and Specialized Surgery for Women and Children (S.P.), University of Campania “Luigi Vanvitelli,” Naples, Italy</address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address><sup>e</sup>Neuro-Oncology Unit (S.P.), Department of Paediatric Oncology, Santobono-Pausilipon Children’s Hospital, Naples, Italy</address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address><sup>f</sup>Department of Clinical Genetics (E.C.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK</address></li><li class="aff"><a id="aff-7" name="aff-7"></a><address><sup>g</sup>Department of Radiology (G.M.), NYU Langone Medical Center, New York, New York</address></li><li class="aff"><a id="aff-8" name="aff-8"></a><address><sup>h</sup>Department of Radiology (C.D.R.), Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Amy F. Juliano, MD, <span class="addr-line">Department of Radiology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA 02114</span>; e-mail: <span class="em-link"><span class="em-addr">amy_juliano{at}meei.harvard.edu;</span></span> <a href="https://mobile.twitter.com/amyfjuliano">@amyfjuliano</a></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/43/11/1646.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. 43</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 11 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Nov 2022 </div></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">Nov 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1646-1652; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7653 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">A.F.</span> <span class="nlm-surname">Juliano</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">F.</span> <span class="nlm-surname">D’Arco</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Pao</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Picariello</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Clement</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Moonis</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">C.D.</span> <span class="nlm-surname">Robson</span></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">Nov 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1646-1652; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7653 </span></div>
  
  
  
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