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<meta name="DC.Title" content="Optimizing Small, Low-Risk, Unruptured Intracranial Aneurysm Treatment Using Game Theory" />
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<meta name="DC.Description" content="SUMMARY: The incidental diagnosis of unruptured intracranial aneurysms has been increasing in the past several decades. A significant proportion represent small, low-risk, unruptured intracranial aneurysms for which there is equipoise on whether to offer treatment or conservative management. Given this uncertainty, patients may not always be comfortable with their physicians’ recommendations. Herein, we use game theory to study the interactions between physicians and patients to determine how conflict and cooperation affect the management of small, low-risk, unruptured intracranial aneurysms. We constructed a game theory model of the interaction between physicians and patients with respect to decision-making for a small, low-risk, unruptured intracranial aneurysm in an asymptomatic patient when there is perceived equipoise between whether to treat or manage conservatively. Assuming that both the physician and patient are rational and eliciting individual patient preferences is not practical, the physician should play the game based on an ex ante probability of meeting a patient with a certain type of preference. This recommendation means that the expectations of the physician regarding the patient’s preferences should guide the decision to offer treatment or conservative management as a first option for a small, asymptomatic, low-risk, unruptured intracranial aneurysm for which there is clinical equipoise.

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<meta name="DC.Contributor" content="A.T. Boltyenkov" />
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<meta name="DC.Contributor" content="A. Malhotra" />
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<meta name="DC.Contributor" content="T.G. White" />
<meta name="DC.Contributor" content="G. Martinez" />
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<meta name="citation_title" content="Optimizing Small, Low-Risk, Unruptured Intracranial Aneurysm Treatment Using Game Theory" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;SUMMARY:&lt;/h3&gt;
&lt;p&gt;The incidental diagnosis of unruptured intracranial aneurysms has been increasing in the past several decades. A significant proportion represent small, low-risk, unruptured intracranial aneurysms for which there is equipoise on whether to offer treatment or conservative management. Given this uncertainty, patients may not always be comfortable with their physicians’ recommendations. Herein, we use game theory to study the interactions between physicians and patients to determine how conflict and cooperation affect the management of small, low-risk, unruptured intracranial aneurysms. We constructed a game theory model of the interaction between physicians and patients with respect to decision-making for a small, low-risk, unruptured intracranial aneurysm in an asymptomatic patient when there is perceived equipoise between whether to treat or manage conservatively. Assuming that both the physician and patient are rational and eliciting individual patient preferences is not practical, the physician should play the game based on an &lt;i&gt;ex ante&lt;/i&gt; probability of meeting a patient with a certain type of preference. This recommendation means that the expectations of the physician regarding the patient’s preferences should guide the decision to offer treatment or conservative management as a first option for a small, asymptomatic, low-risk, unruptured intracranial aneurysm for which there is clinical equipoise.&lt;/p&gt;" />
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<meta name="twitter:description" content="SUMMARY: The incidental diagnosis of unruptured intracranial aneurysms has been increasing in the past several decades. A significant proportion represent small, low-risk, unruptured intracranial aneurysms for which there is equipoise on whether to offer treatment or conservative management. Given this uncertainty, patients may not always be comfortable with their physicians’ recommendations. Herein, we use game theory to study the interactions between physicians and patients to determine how conflict and cooperation affect the management of small, low-risk, unruptured intracranial aneurysms. We constructed a game theory model of the interaction between physicians and patients with respect to decision-making for a small, low-risk, unruptured intracranial aneurysm in an asymptomatic patient when there is perceived equipoise between whether to treat or manage conservatively. Assuming that both the physician and patient are rational and eliciting individual patient preferences is not practical, the physician should play the game based on an ex ante probability of meeting a patient with a certain type of preference. This recommendation means that the expectations of the physician regarding the patient’s preferences should guide the decision to offer treatment or conservative management as a first option for a small, asymptomatic, low-risk, unruptured intracranial aneurysm for which there is clinical equipoise.

CM
:   conservative management
p 
:   probability
T
:   treatment
UIA
:   unruptured intracranial aneurysm" />
<meta name="og-title" property="og:title" content="Optimizing Small, Low-Risk, Unruptured Intracranial Aneurysm Treatment Using Game Theory" />
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<meta name="og-description" property="og:description" content="SUMMARY: The incidental diagnosis of unruptured intracranial aneurysms has been increasing in the past several decades. A significant proportion represent small, low-risk, unruptured intracranial aneurysms for which there is equipoise on whether to offer treatment or conservative management. Given this uncertainty, patients may not always be comfortable with their physicians’ recommendations. Herein, we use game theory to study the interactions between physicians and patients to determine how conflict and cooperation affect the management of small, low-risk, unruptured intracranial aneurysms. We constructed a game theory model of the interaction between physicians and patients with respect to decision-making for a small, low-risk, unruptured intracranial aneurysm in an asymptomatic patient when there is perceived equipoise between whether to treat or manage conservatively. Assuming that both the physician and patient are rational and eliciting individual patient preferences is not practical, the physician should play the game based on an ex ante probability of meeting a patient with a certain type of preference. This recommendation means that the expectations of the physician regarding the patient’s preferences should guide the decision to offer treatment or conservative management as a first option for a small, asymptomatic, low-risk, unruptured intracranial aneurysm for which there is clinical equipoise.

CM
:   conservative management
p 
:   probability
T
:   treatment
UIA
:   unruptured intracranial aneurysm" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node95482--7" data-node-nid="95482" id="top-node-95482--81912096144" data-pisa="ajnr;43/2/176" data-pisa-master="ajnr;ajnr.A7392" data-apath="/ajnr/43/2/176.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">Practice Persepectives</span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Optimizing Small, Low-Risk, Unruptured Intracranial Aneurysm Treatment Using Game Theory</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">A.T. Boltyenkov</span>, <span class="highwire-citation-author" data-delta="1">J.J. Wang</span>, <span class="highwire-citation-author" data-delta="2">A. Malhotra</span>, <span class="highwire-citation-author" data-delta="3">J.M. Katz</span>, <span class="highwire-citation-author" data-delta="4">A.R. Dehdashti</span>, <span class="highwire-citation-author" data-delta="5">T.G. White</span>, <span class="highwire-citation-author" data-delta="6">G. Martinez</span>, <span class="highwire-citation-author" data-delta="7">A. Pandya</span> and <span class="highwire-citation-author" data-delta="8">P.C. Sanelli</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 2022,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">176-180; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7392 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-95482--81912096144" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">A.T. Boltyenkov </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Imaging Clinical Effectiveness and Outcomes Research (A.T.B., J.J.W., G.M., P.C.S.), Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Siemens Medical Solutions USA (A.T.B., G.M.), Malvern, Pennsylvania</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.T.%2BBoltyenkov%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=Boltyenkov%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.T.%2BBoltyenkov%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/0000-0002-1143-5750" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.T. Boltyenkov</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.J. Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Imaging Clinical Effectiveness and Outcomes Research (A.T.B., J.J.W., G.M., P.C.S.), Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, 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=J.J.%2BWang%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=Wang%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.%2BWang%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/0000-0002-6211-2572" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.J. Wang</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">A. Malhotra </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, New Haven, Connecticut</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.%2BMalhotra%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=Malhotra%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.%2BMalhotra%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/0000-0001-9223-6640" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Malhotra</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J.M. Katz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Departments of Radiology (J.M.K., P.C.S.)</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.%2BKatz%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=Katz%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.%2BKatz%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/0000-0002-8193-3683" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.M. Katz</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">A.R. Dehdashti </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Neurology (A.R.D., T.G.W.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York</div><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Neurosurgery (A.R.D., T.G.W.), Hofstra Northwell School of Medicine, Manhasset, 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=A.R.%2BDehdashti%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=Dehdashti%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.R.%2BDehdashti%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/0000-0002-9320-3098" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.R. Dehdashti</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">T.G. White </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Neurology (A.R.D., T.G.W.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York</div><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Neurosurgery (A.R.D., T.G.W.), Hofstra Northwell School of Medicine, Manhasset, 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=T.G.%2BWhite%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=White%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.G.%2BWhite%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/0000-0002-3604-4334" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.G. White</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">G. Martinez </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Imaging Clinical Effectiveness and Outcomes Research (A.T.B., J.J.W., G.M., P.C.S.), Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Siemens Medical Solutions USA (A.T.B., G.M.), Malvern, Pennsylvania</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.%2BMartinez%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=Martinez%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.%2BMartinez%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/0000-0003-4919-0733" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Martinez</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">A. Pandya </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>g</span>Department of Health Policy and Management (A.P.), Harvard T.H. Chan School of Public Health, 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.%2BPandya%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=Pandya%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.%2BPandya%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/0000-0002-6130-2286" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. 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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.T. Boltyenkov</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-2"><span class="name">J.J. Wang</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-3"><span class="name">A. Malhotra</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">J.M. Katz</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">d</a>, </li><li class="contributor" id="contrib-5"><span class="name">A.R. Dehdashti</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">e</a><span class="xref-sep">,</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">T.G. White</span><a id="xref-aff-5-2" class="xref-aff" href="#aff-5">e</a><span class="xref-sep">,</span><a id="xref-aff-6-2" class="xref-aff" href="#aff-6">f</a>, </li><li class="contributor" id="contrib-7"><span class="name">G. Martinez</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-8"><span class="name">A. Pandya</span><a id="xref-aff-7-1" class="xref-aff" href="#aff-7">g</a> and </li><li class="last" id="contrib-9"><span class="name">P.C. Sanelli</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-4-2" class="xref-aff" href="#aff-4">d</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Imaging Clinical Effectiveness and Outcomes Research (A.T.B., J.J.W., G.M., P.C.S.), Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Siemens Medical Solutions USA (A.T.B., G.M.), Malvern, Pennsylvania</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Department of Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, New Haven, Connecticut</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>d</sup>Departments of Radiology (J.M.K., P.C.S.)</address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address><sup>e</sup>Neurology (A.R.D., T.G.W.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York</address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address><sup>f</sup>Department of Neurosurgery (A.R.D., T.G.W.), Hofstra Northwell School of Medicine, Manhasset, New York</address></li><li class="aff"><a id="aff-7" name="aff-7"></a><address><sup>g</sup>Department of Health Policy and Management (A.P.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Artem Boltyenkov, PhD, <span class="addr-line">Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, 600 Community Dr, Suite 403, Manhasset, NY 11030</span>; e-mail: <span class="em-link"><span class="em-addr">artem.boltyenkov{at}siemens-healthineers.com</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/43/2/176.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-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">176-180; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7392 </span></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 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">176-180; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7392 </span></div>
  
  
  
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