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<meta name="DC.Title" content="Blunt Cerebrovascular Injury: Are We Overscreening Low-Mechanism Trauma?" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8004" />
<meta name="DC.Date" content="2023-11-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2023 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Screening patients with trauma for blunt cerebrovascular injury with neck CTA is a common practice, but there remains disagreement regarding which patients should be screened. We reviewed adult blunt cerebrovascular injury data from a level 1 trauma center to investigate whether screening is warranted in low-mechanism trauma.

MATERIALS AND METHODS: We reviewed all neck CTAs performed on adult trauma patients in the emergency department during the 2019 calendar year. Clinical and imaging risk factors for blunt cerebrovascular injury, trauma mechanism, initial neck CTA interpretations, results from subsequent CTA and DSA studies, antiplatelet and anticoagulant treatments, and outcome data were recorded.

RESULTS: One thousand one hundred thirty-six neck CTAs met the inclusion criteria, of which 965 (85%) were interpreted as having negative findings; 125, as having indeterminate findings (11%); and 46, as having positive findings (4%). Review of subsequent imaging and clinical documentation led to classification of 40 indeterminate studies (32%) as true-positives and 85 (68%) as false-positives. Blunt cerebrovascular injury was identified in 77 (12.6%) cases meeting and in 9 (1.7%) cases not meeting the expanded Denver criteria. The subset of 204 low-mechanism trauma cases (ground-level falls, blunt assaults, and low-impact motor vehicle collisions) not meeting the expanded Denver criteria (18% of the entire data set) could have been excluded from screening with 1 questionable injury and 0 ischemic strokes missed and 12 false-positive cases prevented.

CONCLUSIONS: We advocate reservation of blunt cerebrovascular injury screening in low-mechanism trauma for patients meeting the expanded Denver criteria. Further research is needed to determine the behavior of indeterminate cases and to establish criteria for separating true-positive from false-positive findings.

BA
:   blunt assault
BCVI
:   blunt cerebrovascular injury
FP
:   false-positive
GLF
:   ground-level fall
MVC
:   motor vehicle collision
TP
:   true-positive" />
<meta name="DC.Contributor" content="Kevin D. Hiatt" />
<meta name="DC.Contributor" content="Raghav Agarwal" />
<meta name="DC.Contributor" content="Chesney S. Oravec" />
<meta name="DC.Contributor" content="Erica C. Johnson" />
<meta name="DC.Contributor" content="Nishk P. Patel" />
<meta name="DC.Contributor" content="Carol P. Geer" />
<meta name="DC.Contributor" content="Stacey Q. Wolfe" />
<meta name="DC.Contributor" content="Michael E. Zapadka" />
<meta name="article:published_time" content="2023-11-01" />
<meta name="article:section" content="Emergency Neuroradiology" />
<meta name="citation_title" content="Blunt Cerebrovascular Injury: Are We Overscreening Low-Mechanism Trauma?" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Screening patients with trauma for blunt cerebrovascular injury with neck CTA is a common practice, but there remains disagreement regarding which patients should be screened. We reviewed adult blunt cerebrovascular injury data from a level 1 trauma center to investigate whether screening is warranted in low-mechanism trauma.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We reviewed all neck CTAs performed on adult trauma patients in the emergency department during the 2019 calendar year. Clinical and imaging risk factors for blunt cerebrovascular injury, trauma mechanism, initial neck CTA interpretations, results from subsequent CTA and DSA studies, antiplatelet and anticoagulant treatments, and outcome data were recorded.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;One thousand one hundred thirty-six neck CTAs met the inclusion criteria, of which 965 (85%) were interpreted as having negative findings; 125, as having indeterminate findings (11%); and 46, as having positive findings (4%). Review of subsequent imaging and clinical documentation led to classification of 40 indeterminate studies (32%) as true-positives and 85 (68%) as false-positives. Blunt cerebrovascular injury was identified in 77 (12.6%) cases meeting and in 9 (1.7%) cases not meeting the expanded Denver criteria. The subset of 204 low-mechanism trauma cases (ground-level falls, blunt assaults, and low-impact motor vehicle collisions) not meeting the expanded Denver criteria (18% of the entire data set) could have been excluded from screening with 1 questionable injury and 0 ischemic strokes missed and 12 false-positive cases prevented.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;We advocate reservation of blunt cerebrovascular injury screening in low-mechanism trauma for patients meeting the expanded Denver criteria. Further research is needed to determine the behavior of indeterminate cases and to establish criteria for separating true-positive from false-positive findings.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2023/11/01" />
<meta name="citation_mjid" content="ajnr;44/11/1296" />
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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.A8004" />
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<meta name="citation_volume" content="44" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="Emergency Neuroradiology" />
<meta name="citation_firstpage" content="1296" />
<meta name="citation_lastpage" content="1301" />
<meta name="citation_author" content="Kevin D. Hiatt" />
<meta name="citation_author_institution" content="aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina" />
<meta name="citation_author_institution" content="bDepartment of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist" />
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<meta name="citation_author" content="Raghav Agarwal" />
<meta name="citation_author_institution" content="aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina" />
<meta name="citation_author_orcid" content="https://orcid.org/0009-0002-5802-5377" />
<meta name="citation_author" content="Chesney S. Oravec" />
<meta name="citation_author_institution" content="aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina" />
<meta name="citation_author_institution" content="cDepartment of Neurological Surgery (C.S.O., S.Q.W.), Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina" />
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<meta name="citation_author" content="Erica C. Johnson" />
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<meta name="twitter:title" content="Blunt Cerebrovascular Injury: Are We Overscreening Low-Mechanism Trauma?" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Screening patients with trauma for blunt cerebrovascular injury with neck CTA is a common practice, but there remains disagreement regarding which patients should be screened. We reviewed adult blunt cerebrovascular injury data from a level 1 trauma center to investigate whether screening is warranted in low-mechanism trauma.

MATERIALS AND METHODS: We reviewed all neck CTAs performed on adult trauma patients in the emergency department during the 2019 calendar year. Clinical and imaging risk factors for blunt cerebrovascular injury, trauma mechanism, initial neck CTA interpretations, results from subsequent CTA and DSA studies, antiplatelet and anticoagulant treatments, and outcome data were recorded.

RESULTS: One thousand one hundred thirty-six neck CTAs met the inclusion criteria, of which 965 (85%) were interpreted as having negative findings; 125, as having indeterminate findings (11%); and 46, as having positive findings (4%). Review of subsequent imaging and clinical documentation led to classification of 40 indeterminate studies (32%) as true-positives and 85 (68%) as false-positives. Blunt cerebrovascular injury was identified in 77 (12.6%) cases meeting and in 9 (1.7%) cases not meeting the expanded Denver criteria. The subset of 204 low-mechanism trauma cases (ground-level falls, blunt assaults, and low-impact motor vehicle collisions) not meeting the expanded Denver criteria (18% of the entire data set) could have been excluded from screening with 1 questionable injury and 0 ischemic strokes missed and 12 false-positive cases prevented.

CONCLUSIONS: We advocate reservation of blunt cerebrovascular injury screening in low-mechanism trauma for patients meeting the expanded Denver criteria. Further research is needed to determine the behavior of indeterminate cases and to establish criteria for separating true-positive from false-positive findings.

BA
:   blunt assault
BCVI
:   blunt cerebrovascular injury
FP
:   false-positive
GLF
:   ground-level fall
MVC
:   motor vehicle collision
TP
:   true-positive" />
<meta name="og-title" property="og:title" content="Blunt Cerebrovascular Injury: Are We Overscreening Low-Mechanism Trauma?" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/44/11/1296" />
<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: Screening patients with trauma for blunt cerebrovascular injury with neck CTA is a common practice, but there remains disagreement regarding which patients should be screened. We reviewed adult blunt cerebrovascular injury data from a level 1 trauma center to investigate whether screening is warranted in low-mechanism trauma.

MATERIALS AND METHODS: We reviewed all neck CTAs performed on adult trauma patients in the emergency department during the 2019 calendar year. Clinical and imaging risk factors for blunt cerebrovascular injury, trauma mechanism, initial neck CTA interpretations, results from subsequent CTA and DSA studies, antiplatelet and anticoagulant treatments, and outcome data were recorded.

RESULTS: One thousand one hundred thirty-six neck CTAs met the inclusion criteria, of which 965 (85%) were interpreted as having negative findings; 125, as having indeterminate findings (11%); and 46, as having positive findings (4%). Review of subsequent imaging and clinical documentation led to classification of 40 indeterminate studies (32%) as true-positives and 85 (68%) as false-positives. Blunt cerebrovascular injury was identified in 77 (12.6%) cases meeting and in 9 (1.7%) cases not meeting the expanded Denver criteria. The subset of 204 low-mechanism trauma cases (ground-level falls, blunt assaults, and low-impact motor vehicle collisions) not meeting the expanded Denver criteria (18% of the entire data set) could have been excluded from screening with 1 questionable injury and 0 ischemic strokes missed and 12 false-positive cases prevented.

CONCLUSIONS: We advocate reservation of blunt cerebrovascular injury screening in low-mechanism trauma for patients meeting the expanded Denver criteria. Further research is needed to determine the behavior of indeterminate cases and to establish criteria for separating true-positive from false-positive findings.

BA
:   blunt assault
BCVI
:   blunt cerebrovascular injury
FP
:   false-positive
GLF
:   ground-level fall
MVC
:   motor vehicle collision
TP
:   true-positive" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node104660--5" data-node-nid="104660" id="top-node-104660--6702344399" data-pisa="ajnr;44/11/1296" data-pisa-master="ajnr;ajnr.A8004" data-apath="/ajnr/44/11/1296.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">Emergency Neuroradiology</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Blunt Cerebrovascular Injury: Are We Overscreening Low-Mechanism Trauma?</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Kevin D. Hiatt</span>, <span class="highwire-citation-author" data-delta="1">Raghav Agarwal</span>, <span class="highwire-citation-author" data-delta="2">Chesney S. Oravec</span>, <span class="highwire-citation-author" data-delta="3">Erica C. Johnson</span>, <span class="highwire-citation-author" data-delta="4">Nishk P. Patel</span>, <span class="highwire-citation-author" data-delta="5">Carol P. Geer</span>, <span class="highwire-citation-author" data-delta="6">Stacey Q. Wolfe</span> and <span class="highwire-citation-author" data-delta="7">Michael E. Zapadka</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 2023,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1296-1301; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8004 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-104660--6702344399" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Kevin D. Hiatt </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist</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=Kevin%2BD.%2BHiatt%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=Hiatt%20KD&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%3AKevin%2BD.%2BHiatt%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/0000-0002-5241-8762" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Kevin D. Hiatt</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Raghav Agarwal </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina</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=Raghav%2BAgarwal%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=Agarwal%20R&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%3ARaghav%2BAgarwal%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/0009-0002-5802-5377" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Raghav Agarwal</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Chesney S. Oravec </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Neurological Surgery (C.S.O., S.Q.W.), Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina</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=Chesney%2BS.%2BOravec%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=Oravec%20CS&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%3AChesney%2BS.%2BOravec%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/0000-0002-4846-7860" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Chesney S. Oravec</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Erica C. Johnson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of General Surgery (E.C.J.), Virginia Commonwealth University Health, Richmond, Virginia.</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=Erica%2BC.%2BJohnson%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=Johnson%20EC&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 last"><a href="/search/author1%3AErica%2BC.%2BJohnson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Nishk P. Patel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina</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=Nishk%2BP.%2BPatel%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=Patel%20NP&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%3ANishk%2BP.%2BPatel%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/0009-0007-8128-7136" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Nishk P. Patel</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Carol P. Geer </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist</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=Carol%2BP.%2BGeer%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=Geer%20CP&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%3ACarol%2BP.%2BGeer%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/0000-0001-9624-0532" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Carol P. Geer</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Stacey Q. Wolfe </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Neurological Surgery (C.S.O., S.Q.W.), Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina</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=Stacey%2BQ.%2BWolfe%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=Wolfe%20SQ&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%3AStacey%2BQ.%2BWolfe%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/0000-0001-7603-2728" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Stacey Q. Wolfe</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">Michael E. Zapadka </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist</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=Michael%2BE.%2BZapadka%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=Zapadka%20ME&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%3AMichael%2BE.%2BZapadka%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/0000-0002-6080-9376" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Michael E. 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 44</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 11 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Nov 2023 </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 2023, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1296-1301; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8004 </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">Kevin D.</span> <span class="nlm-surname">Hiatt</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Raghav</span> <span class="nlm-surname">Agarwal</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Chesney S.</span> <span class="nlm-surname">Oravec</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Erica C.</span> <span class="nlm-surname">Johnson</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Nishk P.</span> <span class="nlm-surname">Patel</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Carol P.</span> <span class="nlm-surname">Geer</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Stacey Q.</span> <span class="nlm-surname">Wolfe</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Michael E.</span> <span class="nlm-surname">Zapadka</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 2023, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1296-1301; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8004 </span></div>
  
  
  
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