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<meta name="DC.Title" content="DSC Perfusion MRI–Derived Fractional Tumor Burden and Relative CBV Differentiate Tumor Progression and Radiation Necrosis in Brain Metastases Treated with Stereotactic Radiosurgery" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7501" />
<meta name="DC.Date" content="2022-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2022 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Differentiation between tumor and radiation necrosis in patients with brain metastases treated with stereotactic radiosurgery is challenging. We hypothesized that MR perfusion and metabolic metrics can differentiate radiation necrosis from progressive tumor in this setting.

MATERIALS AND METHODS: We retrospectively evaluated MRIs comprising DSC, dynamic contrast-enhanced, and arterial spin-labeling perfusion imaging in subjects with brain metastases previously treated with stereotactic radiosurgery. For each lesion, we obtained the mean normalized and standardized relative CBV and fractional tumor burden, volume transfer constant, and normalized maximum CBF, as well as the maximum standardized uptake value in a subset of subjects who underwent FDG-PET. Relative CBV thresholds of 1 and 1.75 were used to define low and high fractional tumor burden.

RESULTS: Thirty subjects with 37 lesions (20 radiation necrosis, 17 tumor) were included. Compared with radiation necrosis, tumor had increased mean normalized and standardized relative CBV ( P  = .002) and high fractional tumor burden (normalized, P  = .005; standardized, P  = .003) and decreased low fractional tumor burden (normalized, P = .03; standardized, P = .01). The area under the curve showed that relative CBV (normalized = 0.80; standardized = 0.79) and high fractional tumor burden (normalized = 0.77; standardized = 0.78) performed the best to discriminate tumor and radiation necrosis. For tumor prediction, the normalized relative CBV cutoff of ≥1.75 yielded a sensitivity of 76.5% and specificity of 70.0%, while the standardized cutoff of ≥1.75 yielded a sensitivity of 41.2% and specificity of 95.0%. No significance was found with the volume transfer constant, normalized CBF, and standardized uptake value.

CONCLUSIONS: Increased relative CBV and high fractional tumor burden (defined by a threshold relative CBV of ≥1.75) best differentiated tumor from radiation necrosis in subjects with brain metastases treated with stereotactic radiosurgery. Performance of normalized and standardized approaches was similar.

ASL
:   arterial spin-labeling
AUC
:   area under the curve
DCE
:   dynamic contrast-enhanced
FTB
:   fractional tumor burden
K trans
:   volume transfer constant
max
:   maximum
nCBF
:   normalized CBF
nRCBV
:   normalized relative CBV
RCBV
:   relative CBV
RN
:   radiation necrosis
sRCBV
:   standardized relative CBV
SRS
:   stereotactic radiosurgery
SUV
:   standardized uptake value" />
<meta name="DC.Contributor" content="F. Kuo" />
<meta name="DC.Contributor" content="N.N. Ng" />
<meta name="DC.Contributor" content="S. Nagpal" />
<meta name="DC.Contributor" content="E.L. Pollom" />
<meta name="DC.Contributor" content="S. Soltys" />
<meta name="DC.Contributor" content="M. Hayden-Gephart" />
<meta name="DC.Contributor" content="G. Li" />
<meta name="DC.Contributor" content="D.E. Born" />
<meta name="DC.Contributor" content="Michael" />
<meta name="article:published_time" content="2022-05-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="DSC Perfusion MRI–Derived Fractional Tumor Burden and Relative CBV Differentiate Tumor Progression and Radiation Necrosis in Brain Metastases Treated with Stereotactic Radiosurgery" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Differentiation between tumor and radiation necrosis in patients with brain metastases treated with stereotactic radiosurgery is challenging. We hypothesized that MR perfusion and metabolic metrics can differentiate radiation necrosis from progressive tumor in this setting.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively evaluated MRIs comprising DSC, dynamic contrast-enhanced, and arterial spin-labeling perfusion imaging in subjects with brain metastases previously treated with stereotactic radiosurgery. For each lesion, we obtained the mean normalized and standardized relative CBV and fractional tumor burden, volume transfer constant, and normalized maximum CBF, as well as the maximum standardized uptake value in a subset of subjects who underwent FDG-PET. Relative CBV thresholds of 1 and 1.75 were used to define low and high fractional tumor burden.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Thirty subjects with 37 lesions (20 radiation necrosis, 17 tumor) were included. Compared with radiation necrosis, tumor had increased mean normalized and standardized relative CBV (&lt;i&gt;P &lt;/i&gt;= .002) and high fractional tumor burden (normalized, &lt;i&gt;P &lt;/i&gt;= .005; standardized, &lt;i&gt;P &lt;/i&gt;= .003) and decreased low fractional tumor burden (normalized, &lt;i&gt;P&lt;/i&gt; = .03; standardized, &lt;i&gt;P&lt;/i&gt; = .01). The area under the curve showed that relative CBV (normalized = 0.80; standardized = 0.79) and high fractional tumor burden (normalized = 0.77; standardized = 0.78) performed the best to discriminate tumor and radiation necrosis. For tumor prediction, the normalized relative CBV cutoff of ≥1.75 yielded a sensitivity of 76.5% and specificity of 70.0%, while the standardized cutoff of ≥1.75 yielded a sensitivity of 41.2% and specificity of 95.0%. No significance was found with the volume transfer constant, normalized CBF, and standardized uptake value.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Increased relative CBV and high fractional tumor burden (defined by a threshold relative CBV of ≥1.75) best differentiated tumor from radiation necrosis in subjects with brain metastases treated with stereotactic radiosurgery. Performance of normalized and standardized approaches was similar.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2022/05/01" />
<meta name="citation_mjid" content="ajnr;43/5/689" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A7501" />
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<meta name="citation_volume" content="43" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="Adult Brain" />
<meta name="citation_firstpage" content="689" />
<meta name="citation_lastpage" content="695" />
<meta name="citation_author" content="F. Kuo" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology, Division of Neuroimaging and Neurointervention (F.K., N.N.N., M.I.)" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0003-0655-4074" />
<meta name="citation_author" content="N.N. Ng" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology, Division of Neuroimaging and Neurointervention (F.K., N.N.N., M.I.)" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0003-0345-0093" />
<meta name="citation_author" content="S. Nagpal" />
<meta name="citation_author_institution" content="bDepartments of Neurology (Neuro-Oncology) (S.N.)" />
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<meta name="citation_author" content="E.L. Pollom" />
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<meta name="twitter:title" content="DSC Perfusion MRI–Derived Fractional Tumor Burden and Relative CBV Differentiate Tumor Progression and Radiation Necrosis in Brain Metastases Treated with Stereotactic Radiosurgery" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Differentiation between tumor and radiation necrosis in patients with brain metastases treated with stereotactic radiosurgery is challenging. We hypothesized that MR perfusion and metabolic metrics can differentiate radiation necrosis from progressive tumor in this setting.

MATERIALS AND METHODS: We retrospectively evaluated MRIs comprising DSC, dynamic contrast-enhanced, and arterial spin-labeling perfusion imaging in subjects with brain metastases previously treated with stereotactic radiosurgery. For each lesion, we obtained the mean normalized and standardized relative CBV and fractional tumor burden, volume transfer constant, and normalized maximum CBF, as well as the maximum standardized uptake value in a subset of subjects who underwent FDG-PET. Relative CBV thresholds of 1 and 1.75 were used to define low and high fractional tumor burden.

RESULTS: Thirty subjects with 37 lesions (20 radiation necrosis, 17 tumor) were included. Compared with radiation necrosis, tumor had increased mean normalized and standardized relative CBV ( P  = .002) and high fractional tumor burden (normalized, P  = .005; standardized, P  = .003) and decreased low fractional tumor burden (normalized, P = .03; standardized, P = .01). The area under the curve showed that relative CBV (normalized = 0.80; standardized = 0.79) and high fractional tumor burden (normalized = 0.77; standardized = 0.78) performed the best to discriminate tumor and radiation necrosis. For tumor prediction, the normalized relative CBV cutoff of ≥1.75 yielded a sensitivity of 76.5% and specificity of 70.0%, while the standardized cutoff of ≥1.75 yielded a sensitivity of 41.2% and specificity of 95.0%. No significance was found with the volume transfer constant, normalized CBF, and standardized uptake value.

CONCLUSIONS: Increased relative CBV and high fractional tumor burden (defined by a threshold relative CBV of ≥1.75) best differentiated tumor from radiation necrosis in subjects with brain metastases treated with stereotactic radiosurgery. Performance of normalized and standardized approaches was similar.

ASL
:   arterial spin-labeling
AUC
:   area under the curve
DCE
:   dynamic contrast-enhanced
FTB
:   fractional tumor burden
K trans
:   volume transfer constant
max
:   maximum
nCBF
:   normalized CBF
nRCBV
:   normalized relative CBV
RCBV
:   relative CBV
RN
:   radiation necrosis
sRCBV
:   standardized relative CBV
SRS
:   stereotactic radiosurgery
SUV
:   standardized uptake value" />
<meta name="og-title" property="og:title" content="DSC Perfusion MRI–Derived Fractional Tumor Burden and Relative CBV Differentiate Tumor Progression and Radiation Necrosis in Brain Metastases Treated with Stereotactic Radiosurgery" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/43/5/689" />
<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: Differentiation between tumor and radiation necrosis in patients with brain metastases treated with stereotactic radiosurgery is challenging. We hypothesized that MR perfusion and metabolic metrics can differentiate radiation necrosis from progressive tumor in this setting.

MATERIALS AND METHODS: We retrospectively evaluated MRIs comprising DSC, dynamic contrast-enhanced, and arterial spin-labeling perfusion imaging in subjects with brain metastases previously treated with stereotactic radiosurgery. For each lesion, we obtained the mean normalized and standardized relative CBV and fractional tumor burden, volume transfer constant, and normalized maximum CBF, as well as the maximum standardized uptake value in a subset of subjects who underwent FDG-PET. Relative CBV thresholds of 1 and 1.75 were used to define low and high fractional tumor burden.

RESULTS: Thirty subjects with 37 lesions (20 radiation necrosis, 17 tumor) were included. Compared with radiation necrosis, tumor had increased mean normalized and standardized relative CBV ( P  = .002) and high fractional tumor burden (normalized, P  = .005; standardized, P  = .003) and decreased low fractional tumor burden (normalized, P = .03; standardized, P = .01). The area under the curve showed that relative CBV (normalized = 0.80; standardized = 0.79) and high fractional tumor burden (normalized = 0.77; standardized = 0.78) performed the best to discriminate tumor and radiation necrosis. For tumor prediction, the normalized relative CBV cutoff of ≥1.75 yielded a sensitivity of 76.5% and specificity of 70.0%, while the standardized cutoff of ≥1.75 yielded a sensitivity of 41.2% and specificity of 95.0%. No significance was found with the volume transfer constant, normalized CBF, and standardized uptake value.

CONCLUSIONS: Increased relative CBV and high fractional tumor burden (defined by a threshold relative CBV of ≥1.75) best differentiated tumor from radiation necrosis in subjects with brain metastases treated with stereotactic radiosurgery. Performance of normalized and standardized approaches was similar.

ASL
:   arterial spin-labeling
AUC
:   area under the curve
DCE
:   dynamic contrast-enhanced
FTB
:   fractional tumor burden
K trans
:   volume transfer constant
max
:   maximum
nCBF
:   normalized CBF
nRCBV
:   normalized relative CBV
RCBV
:   relative CBV
RN
:   radiation necrosis
sRCBV
:   standardized relative CBV
SRS
:   stereotactic radiosurgery
SUV
:   standardized uptake value" />
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    <title>DSC Perfusion MRI–Derived Fractional Tumor Burden and Relative CBV Differentiate Tumor Progression and Radiation Necrosis in Brain Metastases Treated with Stereotactic Radiosurgery | American Journal of Neuroradiology</title>  
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node96947--5" data-node-nid="96947" id="top-node-96947--6720497706" data-pisa="ajnr;43/5/689" data-pisa-master="ajnr;ajnr.A7501" data-apath="/ajnr/43/5/689.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">Adult Brain</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">DSC Perfusion MRI–Derived Fractional Tumor Burden and Relative CBV Differentiate Tumor Progression and Radiation Necrosis in Brain Metastases Treated with Stereotactic Radiosurgery</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">F. Kuo</span>, <span class="highwire-citation-author" data-delta="1">N.N. Ng</span>, <span class="highwire-citation-author" data-delta="2">S. Nagpal</span>, <span class="highwire-citation-author" data-delta="3">E.L. Pollom</span>, <span class="highwire-citation-author" data-delta="4">S. Soltys</span>, <span class="highwire-citation-author" data-delta="5">M. Hayden-Gephart</span>, <span class="highwire-citation-author" data-delta="6">G. Li</span>, <span class="highwire-citation-author" data-delta="7">D.E. Born</span> and <span class="highwire-citation-author" data-delta="8">Michael</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">May 2022,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">689-695; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7501 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-96947--6720497706" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">F. Kuo </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, Division of Neuroimaging and Neurointervention (F.K., N.N.N., M.I.)</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.%2BKuo%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=Kuo%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.%2BKuo%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/0000-0003-0655-4074" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Kuo</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">N.N. Ng </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, Division of Neuroimaging and Neurointervention (F.K., N.N.N., M.I.)</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=N.N.%2BNg%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=Ng%20N&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%3AN.N.%2BNg%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/0000-0003-0345-0093" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N.N. Ng</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S. Nagpal </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Neurology (Neuro-Oncology) (S.N.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BNagpal%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=Nagpal%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.%2BNagpal%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/0000-0003-2965-9231" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Nagpal</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">E.L. Pollom </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiation Oncology (E.L.P., S.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=E.L.%2BPollom%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=Pollom%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.L.%2BPollom%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/0000-0003-2908-6293" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E.L. Pollom</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">S. Soltys </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiation Oncology (E.L.P., S.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=S.%2BSoltys%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=Soltys%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.%2BSoltys%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/0000-0002-5360-7063" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Soltys</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">M. Hayden-Gephart </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Neurosurgery (M.H.-G., G.L.)</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.%2BHayden-Gephart%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=Hayden-Gephart%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.%2BHayden-Gephart%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/0000-0003-2965-9231" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Hayden-Gephart</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">G. Li </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Neurosurgery (M.H.-G., G.L.)</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.%2BLi%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=Li%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.%2BLi%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/0000-0001-8372-0676" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Li</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">D.E. Born </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Pathology (D.E.B.), Stanford University, Stanford, California</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.E.%2BBorn%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=Born%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.E.%2BBorn%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/0000-0001-6102-512X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.E. Born</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name"> Michael <span class="nlm-suffix">Iv</span></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, Division of Neuroimaging and Neurointervention (F.K., N.N.N., M.I.)</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=%2BMichael%2B%3Cspan%2Bclass%3D%22nlm-suffix%22%3EIv%3C/span%3E" 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=Michael&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%3A%2BMichael%2BIv" 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/0000-0001-6794-7213" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for  Michael <span class="nlm-suffix">Iv</span></a></li></ul></div></div></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 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 May 2022 </div></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">F.</span> <span class="nlm-surname">Kuo</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">N.N.</span> <span class="nlm-surname">Ng</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Nagpal</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">E.L.</span> <span class="nlm-surname">Pollom</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Soltys</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Hayden-Gephart</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Li</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">D.E.</span> <span class="nlm-surname">Born</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-surname">Michael</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">May 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">689-695; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7501 </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">F.</span> <span class="nlm-surname">Kuo</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">N.N.</span> <span class="nlm-surname">Ng</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Nagpal</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">E.L.</span> <span class="nlm-surname">Pollom</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Soltys</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Hayden-Gephart</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Li</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">D.E.</span> <span class="nlm-surname">Born</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-surname">Michael</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">May 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">689-695; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7501 </span></div>
  
  
  
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