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<meta name="DC.Title" content="Segmentation of Brain Metastases Using Background Layer Statistics (BLAST)" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7998" />
<meta name="DC.Date" content="2023-10-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2023 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Accurate segmentation of brain metastases is important for treatment planning and evaluating response. The aim of this study was to assess the performance of a semiautomated algorithm for brain metastases segmentation using Background Layer Statistics (BLAST).

MATERIALS AND METHODS: Nineteen patients with 48 parenchymal and dural brain metastases were included. Segmentation was performed by 4 neuroradiologists and 1 radiation oncologist. K-means clustering was used to identify normal gray and white matter (background layer) in a 2D parameter space of signal intensities from postcontrast T2 FLAIR and T1 MPRAGE sequences. The background layer was subtracted and operator-defined thresholds were applied in parameter space to segment brain metastases. The remaining voxels were back-projected to visualize segmentations in image space and evaluated by the operators. Segmentation performance was measured by calculating the Dice-Sørensen coefficient and Hausdorff distance using ground truth segmentations made by the investigators. Contours derived from the segmentations were evaluated for clinical acceptance using a 5-point Likert scale.

RESULTS: The median Dice-Sørensen coefficient was 0.82 for all brain metastases and 0.9 for brain metastases of ≥10 mm. The median Hausdorff distance was 1.4 mm. Excellent interreader agreement for brain metastases volumes was found with an intraclass correlation coefficient = 0.9978. The median segmentation time was 2.8 minutes/metastasis. Forty-five contours (94%) had a Likert score of 4 or 5, indicating that the contours were acceptable for treatment, requiring no changes or minor edits.

CONCLUSIONS: We show accurate and reproducible segmentation of brain metastases using BLAST and demonstrate its potential as a tool for radiation planning and evaluating treatment response.

BL
:   background layer
BLAST
:   Background Layer Statistics
BM
:   brain metastases
DL
:   deep learning
DSC
:   Dice-Sørensen coefficient
HD
:   Hausdorff distance
ICC
:   intraclass correlation coefficient
IQR
:   interquartile range
SRS
:   stereotactic radiosurgery
TH
:   threshold" />
<meta name="DC.Contributor" content="Chris Heyn" />
<meta name="DC.Contributor" content="Alan R. Moody" />
<meta name="DC.Contributor" content="Chia-Lin Tseng" />
<meta name="DC.Contributor" content="Erin Wong" />
<meta name="DC.Contributor" content="Tony Kang" />
<meta name="DC.Contributor" content="Anish Kapadia" />
<meta name="DC.Contributor" content="Peter Howard" />
<meta name="DC.Contributor" content="Pejman Maralani" />
<meta name="DC.Contributor" content="Sean Symons" />
<meta name="DC.Contributor" content="Maged Goubran" />
<meta name="DC.Contributor" content="Anne Martel" />
<meta name="DC.Contributor" content="Hanbo Chen" />
<meta name="DC.Contributor" content="Sten Myrehaug" />
<meta name="DC.Contributor" content="Jay Detsky" />
<meta name="DC.Contributor" content="Arjun Sahgal" />
<meta name="DC.Contributor" content="Hany Soliman" />
<meta name="article:published_time" content="2023-10-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Segmentation of Brain Metastases Using Background Layer Statistics (BLAST)" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Accurate segmentation of brain metastases is important for treatment planning and evaluating response. The aim of this study was to assess the performance of a semiautomated algorithm for brain metastases segmentation using Background Layer Statistics (BLAST).&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Nineteen patients with 48 parenchymal and dural brain metastases were included. Segmentation was performed by 4 neuroradiologists and 1 radiation oncologist. K-means clustering was used to identify normal gray and white matter (background layer) in a 2D parameter space of signal intensities from postcontrast T2 FLAIR and T1 MPRAGE sequences. The background layer was subtracted and operator-defined thresholds were applied in parameter space to segment brain metastases. The remaining voxels were back-projected to visualize segmentations in image space and evaluated by the operators. Segmentation performance was measured by calculating the Dice-Sørensen coefficient and Hausdorff distance using ground truth segmentations made by the investigators. Contours derived from the segmentations were evaluated for clinical acceptance using a 5-point Likert scale.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The median Dice-Sørensen coefficient was 0.82 for all brain metastases and 0.9 for brain metastases of ≥10 mm. The median Hausdorff distance was 1.4 mm. Excellent interreader agreement for brain metastases volumes was found with an intraclass correlation coefficient = 0.9978. The median segmentation time was 2.8 minutes/metastasis. Forty-five contours (94%) had a Likert score of 4 or 5, indicating that the contours were acceptable for treatment, requiring no changes or minor edits.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;We show accurate and reproducible segmentation of brain metastases using BLAST and demonstrate its potential as a tool for radiation planning and evaluating treatment response.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2023/10/01" />
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<meta name="citation_author" content="Chris Heyn" />
<meta name="citation_author_institution" content="aFrom the Department of Medical Imaging (C.H., A.R.M., E.W., T.K., A.K., P.H., P.M., S.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada" />
<meta name="citation_author_institution" content="bSunnybrook Research Institute (C.H., A.R.M., M.G., A.M.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada" />
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<meta name="citation_author" content="Alan R. Moody" />
<meta name="citation_author_institution" content="aFrom the Department of Medical Imaging (C.H., A.R.M., E.W., T.K., A.K., P.H., P.M., S.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada" />
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<meta name="twitter:title" content="Segmentation of Brain Metastases Using Background Layer Statistics (BLAST)" />
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<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/44/10.cover-source.jpg" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Accurate segmentation of brain metastases is important for treatment planning and evaluating response. The aim of this study was to assess the performance of a semiautomated algorithm for brain metastases segmentation using Background Layer Statistics (BLAST).

MATERIALS AND METHODS: Nineteen patients with 48 parenchymal and dural brain metastases were included. Segmentation was performed by 4 neuroradiologists and 1 radiation oncologist. K-means clustering was used to identify normal gray and white matter (background layer) in a 2D parameter space of signal intensities from postcontrast T2 FLAIR and T1 MPRAGE sequences. The background layer was subtracted and operator-defined thresholds were applied in parameter space to segment brain metastases. The remaining voxels were back-projected to visualize segmentations in image space and evaluated by the operators. Segmentation performance was measured by calculating the Dice-Sørensen coefficient and Hausdorff distance using ground truth segmentations made by the investigators. Contours derived from the segmentations were evaluated for clinical acceptance using a 5-point Likert scale.

RESULTS: The median Dice-Sørensen coefficient was 0.82 for all brain metastases and 0.9 for brain metastases of ≥10 mm. The median Hausdorff distance was 1.4 mm. Excellent interreader agreement for brain metastases volumes was found with an intraclass correlation coefficient = 0.9978. The median segmentation time was 2.8 minutes/metastasis. Forty-five contours (94%) had a Likert score of 4 or 5, indicating that the contours were acceptable for treatment, requiring no changes or minor edits.

CONCLUSIONS: We show accurate and reproducible segmentation of brain metastases using BLAST and demonstrate its potential as a tool for radiation planning and evaluating treatment response.

BL
:   background layer
BLAST
:   Background Layer Statistics
BM
:   brain metastases
DL
:   deep learning
DSC
:   Dice-Sørensen coefficient
HD
:   Hausdorff distance
ICC
:   intraclass correlation coefficient
IQR
:   interquartile range
SRS
:   stereotactic radiosurgery
TH
:   threshold" />
<meta name="og-title" property="og:title" content="Segmentation of Brain Metastases Using Background Layer Statistics (BLAST)" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/44/10/1135" />
<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: Accurate segmentation of brain metastases is important for treatment planning and evaluating response. The aim of this study was to assess the performance of a semiautomated algorithm for brain metastases segmentation using Background Layer Statistics (BLAST).

MATERIALS AND METHODS: Nineteen patients with 48 parenchymal and dural brain metastases were included. Segmentation was performed by 4 neuroradiologists and 1 radiation oncologist. K-means clustering was used to identify normal gray and white matter (background layer) in a 2D parameter space of signal intensities from postcontrast T2 FLAIR and T1 MPRAGE sequences. The background layer was subtracted and operator-defined thresholds were applied in parameter space to segment brain metastases. The remaining voxels were back-projected to visualize segmentations in image space and evaluated by the operators. Segmentation performance was measured by calculating the Dice-Sørensen coefficient and Hausdorff distance using ground truth segmentations made by the investigators. Contours derived from the segmentations were evaluated for clinical acceptance using a 5-point Likert scale.

RESULTS: The median Dice-Sørensen coefficient was 0.82 for all brain metastases and 0.9 for brain metastases of ≥10 mm. The median Hausdorff distance was 1.4 mm. Excellent interreader agreement for brain metastases volumes was found with an intraclass correlation coefficient = 0.9978. The median segmentation time was 2.8 minutes/metastasis. Forty-five contours (94%) had a Likert score of 4 or 5, indicating that the contours were acceptable for treatment, requiring no changes or minor edits.

CONCLUSIONS: We show accurate and reproducible segmentation of brain metastases using BLAST and demonstrate its potential as a tool for radiation planning and evaluating treatment response.

BL
:   background layer
BLAST
:   Background Layer Statistics
BM
:   brain metastases
DL
:   deep learning
DSC
:   Dice-Sørensen coefficient
HD
:   Hausdorff distance
ICC
:   intraclass correlation coefficient
IQR
:   interquartile range
SRS
:   stereotactic radiosurgery
TH
:   threshold" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node104244--5" data-node-nid="104244" id="top-node-104244--6123756961" data-pisa="ajnr;44/10/1135" data-pisa-master="ajnr;ajnr.A7998" data-apath="/ajnr/44/10/1135.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>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Segmentation of Brain Metastases Using Background Layer Statistics (BLAST)</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Chris Heyn</span>, <span class="highwire-citation-author" data-delta="1">Alan R. Moody</span>, <span class="highwire-citation-author" data-delta="2">Chia-Lin Tseng</span>, <span class="highwire-citation-author" data-delta="3">Erin Wong</span>, <span class="highwire-citation-author" data-delta="4">Tony Kang</span>, <span class="highwire-citation-author" data-delta="5">Anish Kapadia</span>, <span class="highwire-citation-author" data-delta="6">Peter Howard</span>, <span class="highwire-citation-author" data-delta="7">Pejman Maralani</span>, <span class="highwire-citation-author" data-delta="8">Sean Symons</span>, <span class="highwire-citation-author" data-delta="9">Maged Goubran</span>, <span class="highwire-citation-author" data-delta="10">Anne Martel</span>, <span class="highwire-citation-author" data-delta="11">Hanbo Chen</span>, <span class="highwire-citation-author" data-delta="12">Sten Myrehaug</span>, <span class="highwire-citation-author" data-delta="13">Jay Detsky</span>, <span class="highwire-citation-author" data-delta="14">Arjun Sahgal</span> and <span class="highwire-citation-author" data-delta="15">Hany Soliman</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 2023,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1135-1143; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7998 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-104244--6123756961" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Chris Heyn </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 Medical Imaging (C.H., A.R.M., E.W., T.K., A.K., P.H., P.M., S.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Sunnybrook Research Institute (C.H., A.R.M., M.G., A.M.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Chris%2BHeyn%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=Heyn%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AChris%2BHeyn%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/0000-0002-3226-5199" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Chris Heyn</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Alan R. Moody </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 Medical Imaging (C.H., A.R.M., E.W., T.K., A.K., P.H., P.M., S.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Sunnybrook Research Institute (C.H., A.R.M., M.G., A.M.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Alan%2BR.%2BMoody%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=Moody%20AR&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%3AAlan%2BR.%2BMoody%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/0000-0002-5221-4305" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Alan R. Moody</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Chia-Lin Tseng </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiation Oncology (C.-L.T., H.C., S.M., J.D., A.S., H.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Chia-Lin%2BTseng%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=Tseng%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AChia-Lin%2BTseng%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/0000-0002-3700-0886" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Chia-Lin Tseng</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Erin Wong </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 Medical Imaging (C.H., A.R.M., E.W., T.K., A.K., P.H., P.M., S.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Erin%2BWong%2B" target="_blank" class="" data-icon-position="" 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Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Tony%2BKang%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=Kang%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%3ATony%2BKang%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/0000-0002-5980-1940" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Tony Kang</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Anish Kapadia </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 Medical Imaging (C.H., A.R.M., E.W., T.K., A.K., P.H., P.M., S.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Anish%2BKapadia%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=Kapadia%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 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href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Pejman%2BMaralani%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=Maralani%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%3APejman%2BMaralani%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/0000-0001-9975-4379" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Pejman Maralani</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">Sean Symons </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 Medical Imaging (C.H., A.R.M., E.W., T.K., A.K., P.H., P.M., S.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Sean%2BSymons%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=Symons%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%3ASean%2BSymons%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/0000-0002-8025-9965" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Sean Symons</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">Maged Goubran </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Sunnybrook Research Institute (C.H., A.R.M., M.G., A.M.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Medical Biophysics (M.G., A.M.), University of Toronto, Toronto, Ontario, Canada</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=Maged%2BGoubran%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on 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class='author-affiliation'><span class='nlm-sup'>d</span>Department of Medical Biophysics (M.G., A.M.), University of Toronto, Toronto, Ontario, Canada</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=Anne%2BMartel%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=Martel%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%3AAnne%2BMartel%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/0000-0003-1375-5501" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Anne Martel</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">Hanbo Chen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiation Oncology (C.-L.T., H.C., S.M., J.D., A.S., H.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Hanbo%2BChen%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=Chen%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on 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A.S., H.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Jay%2BDetsky%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=Detsky%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%3AJay%2BDetsky%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/0000-0002-0117-6839" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Jay Detsky</a></li></ul></div><div class="author-tooltip-14"><div class="author-tooltip-name">Arjun Sahgal </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiation Oncology (C.-L.T., H.C., S.M., J.D., A.S., H.S.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada</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=Arjun%2BSahgal%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=Sahgal%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 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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">Chris</span> <span class="nlm-surname">Heyn</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Alan R.</span> <span class="nlm-surname">Moody</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Chia-Lin</span> <span class="nlm-surname">Tseng</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Erin</span> <span class="nlm-surname">Wong</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Tony</span> <span class="nlm-surname">Kang</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Anish</span> <span class="nlm-surname">Kapadia</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Peter</span> <span class="nlm-surname">Howard</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Pejman</span> <span class="nlm-surname">Maralani</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">Sean</span> <span class="nlm-surname">Symons</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">Maged</span> <span class="nlm-surname">Goubran</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">Anne</span> <span class="nlm-surname">Martel</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">Hanbo</span> <span class="nlm-surname">Chen</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">Sten</span> <span class="nlm-surname">Myrehaug</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">Jay</span> <span class="nlm-surname">Detsky</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">Arjun</span> <span class="nlm-surname">Sahgal</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">Hany</span> <span class="nlm-surname">Soliman</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2023, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1135-1143; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7998 </span></div>
  
  
  
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