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<meta name="DC.Title" content="Reliability of Functional and Diffusion MR Imaging Near Cerebral Cavernous Malformations" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7765" />
<meta name="DC.Date" content="2023-02-01" />
<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: Surgical resection of cerebral cavernous malformations close to eloquent regions frequently uses fMRI and DTI for surgical planning to best preserve neurologic function. This study investigates the reliability of fMRI and DTI near cerebral cavernous malformations.

MATERIALS AND METHODS: Consecutive patients with cerebral cavernous malformations undergoing presurgical fMRI and DTI mapping were identified. Each cerebral cavernous malformation was hand-contoured; 2 sequential 4-mm expansion shells (S1 and S2) were created, generating 2 ROIs and 2 contralateral controls. Fractional anisotropy and regional homogeneity measurements were then extracted from each ROI and compared with the contralateral controls. Reliability, accuracy, and precision were compared as appropriate.

RESULTS: Fifty-four patients were identified and included. Errors of fractional anisotropy were significantly lower than those of regional homogeneity in S1 and S2 ( P  &lt; .001), suggesting that fractional anisotropy is more reliable than regional homogeneity near cerebral cavernous malformations. Proximity to cerebral cavernous malformations worsened the reliability of regional homogeneity (S1 versus S2, P  &lt; .001), but not fractional anisotropy ( P = .24). While fractional anisotropy was not significantly biased in any ROI ( P  &gt; .05), regional homogeneity was biased toward lower signals in S1 and S2 ( P  &lt; .05), an effect that was attenuated with distance from cerebral cavernous malformations ( P  &lt; .05). Fractional anisotropy measurements were also more precise than regional homogeneity in S1 and S2 ( P  &lt; .001 for both).

CONCLUSIONS: Our findings suggest that hemosiderin-rich lesions such as cerebral cavernous malformations may lead to artifactual depression of fMRI signals and that clinicians and surgeons should interpret fMRI studies near cerebral cavernous malformations with caution. While fMRI is considerably affected by cerebral cavernous malformation–related artifacts, DTI appears to be relatively unaffected and remains a reliable imaging technique near cerebral cavernous malformations.

APE
:   absolute percentage error
BOLD
:   blood oxygen level–dependent
CCM
:   cerebral cavernous malformations
DVA
:   developmental venous anomalies
FA
:   fractional anisotropy
PE
:   percentage error
ReHo
:   regional homogeneity
S1
:   Shell1
S2
:   Shell2" />
<meta name="DC.Contributor" content="M. Colasurdo" />
<meta name="DC.Contributor" content="H. Chen" />
<meta name="DC.Contributor" content="R. Navarra" />
<meta name="DC.Contributor" content="E. Piccirilli" />
<meta name="DC.Contributor" content="A. Delli Pizzi" />
<meta name="DC.Contributor" content="V. Panara" />
<meta name="DC.Contributor" content="M. Caulo" />
<meta name="article:published_time" content="2023-02-01" />
<meta name="article:section" content="Functional" />
<meta name="citation_title" content="Reliability of Functional and Diffusion MR Imaging Near Cerebral Cavernous Malformations" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Surgical resection of cerebral cavernous malformations close to eloquent regions frequently uses fMRI and DTI for surgical planning to best preserve neurologic function. This study investigates the reliability of fMRI and DTI near cerebral cavernous malformations.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Consecutive patients with cerebral cavernous malformations undergoing presurgical fMRI and DTI mapping were identified. Each cerebral cavernous malformation was hand-contoured; 2 sequential 4-mm expansion shells (S1 and S2) were created, generating 2 ROIs and 2 contralateral controls. Fractional anisotropy and regional homogeneity measurements were then extracted from each ROI and compared with the contralateral controls. Reliability, accuracy, and precision were compared as appropriate.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Fifty-four patients were identified and included. Errors of fractional anisotropy were significantly lower than those of regional homogeneity in S1 and S2 (&lt;i&gt;P &lt;/i&gt;&amp;lt; .001), suggesting that fractional anisotropy is more reliable than regional homogeneity near cerebral cavernous malformations. Proximity to cerebral cavernous malformations worsened the reliability of regional homogeneity (S1 versus S2, &lt;i&gt;P &lt;/i&gt;&amp;lt; .001), but not fractional anisotropy (&lt;i&gt;P&lt;/i&gt; = .24). While fractional anisotropy was not significantly biased in any ROI (&lt;i&gt;P &lt;/i&gt;&amp;gt; .05), regional homogeneity was biased toward lower signals in S1 and S2 (&lt;i&gt;P &lt;/i&gt;&amp;lt; .05), an effect that was attenuated with distance from cerebral cavernous malformations (&lt;i&gt;P &lt;/i&gt;&amp;lt; .05). Fractional anisotropy measurements were also more precise than regional homogeneity in S1 and S2 (&lt;i&gt;P &lt;/i&gt;&amp;lt; .001 for both).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Our findings suggest that hemosiderin-rich lesions such as cerebral cavernous malformations may lead to artifactual depression of fMRI signals and that clinicians and surgeons should interpret fMRI studies near cerebral cavernous malformations with caution. While fMRI is considerably affected by cerebral cavernous malformation–related artifacts, DTI appears to be relatively unaffected and remains a reliable imaging technique near cerebral cavernous malformations.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2023/02/01" />
<meta name="citation_mjid" content="ajnr;44/2/150" />
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<meta name="citation_issn" content="0195-6108" />
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<meta name="citation_section" content="Functional" />
<meta name="citation_firstpage" content="150" />
<meta name="citation_lastpage" content="156" />
<meta name="citation_author" content="M. Colasurdo" />
<meta name="citation_author_institution" content="aFrom the Departments of Neuroscience, Imaging and Clinical Sciences (M.C., R.N., E.P., V.P., M.C.)" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-7823-3088" />
<meta name="citation_author" content="H. Chen" />
<meta name="citation_author_institution" content="cNational Institutes of Health (H.C.), Bethesda, Maryland" />
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<meta name="citation_author" content="R. Navarra" />
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<meta name="twitter:title" content="Reliability of Functional and Diffusion MR Imaging Near Cerebral Cavernous Malformations" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Surgical resection of cerebral cavernous malformations close to eloquent regions frequently uses fMRI and DTI for surgical planning to best preserve neurologic function. This study investigates the reliability of fMRI and DTI near cerebral cavernous malformations.

MATERIALS AND METHODS: Consecutive patients with cerebral cavernous malformations undergoing presurgical fMRI and DTI mapping were identified. Each cerebral cavernous malformation was hand-contoured; 2 sequential 4-mm expansion shells (S1 and S2) were created, generating 2 ROIs and 2 contralateral controls. Fractional anisotropy and regional homogeneity measurements were then extracted from each ROI and compared with the contralateral controls. Reliability, accuracy, and precision were compared as appropriate.

RESULTS: Fifty-four patients were identified and included. Errors of fractional anisotropy were significantly lower than those of regional homogeneity in S1 and S2 ( P  &lt; .001), suggesting that fractional anisotropy is more reliable than regional homogeneity near cerebral cavernous malformations. Proximity to cerebral cavernous malformations worsened the reliability of regional homogeneity (S1 versus S2, P  &lt; .001), but not fractional anisotropy ( P = .24). While fractional anisotropy was not significantly biased in any ROI ( P  &gt; .05), regional homogeneity was biased toward lower signals in S1 and S2 ( P  &lt; .05), an effect that was attenuated with distance from cerebral cavernous malformations ( P  &lt; .05). Fractional anisotropy measurements were also more precise than regional homogeneity in S1 and S2 ( P  &lt; .001 for both).

CONCLUSIONS: Our findings suggest that hemosiderin-rich lesions such as cerebral cavernous malformations may lead to artifactual depression of fMRI signals and that clinicians and surgeons should interpret fMRI studies near cerebral cavernous malformations with caution. While fMRI is considerably affected by cerebral cavernous malformation–related artifacts, DTI appears to be relatively unaffected and remains a reliable imaging technique near cerebral cavernous malformations.

APE
:   absolute percentage error
BOLD
:   blood oxygen level–dependent
CCM
:   cerebral cavernous malformations
DVA
:   developmental venous anomalies
FA
:   fractional anisotropy
PE
:   percentage error
ReHo
:   regional homogeneity
S1
:   Shell1
S2
:   Shell2" />
<meta name="og-title" property="og:title" content="Reliability of Functional and Diffusion MR Imaging Near Cerebral Cavernous Malformations" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/44/2/150" />
<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: Surgical resection of cerebral cavernous malformations close to eloquent regions frequently uses fMRI and DTI for surgical planning to best preserve neurologic function. This study investigates the reliability of fMRI and DTI near cerebral cavernous malformations.

MATERIALS AND METHODS: Consecutive patients with cerebral cavernous malformations undergoing presurgical fMRI and DTI mapping were identified. Each cerebral cavernous malformation was hand-contoured; 2 sequential 4-mm expansion shells (S1 and S2) were created, generating 2 ROIs and 2 contralateral controls. Fractional anisotropy and regional homogeneity measurements were then extracted from each ROI and compared with the contralateral controls. Reliability, accuracy, and precision were compared as appropriate.

RESULTS: Fifty-four patients were identified and included. Errors of fractional anisotropy were significantly lower than those of regional homogeneity in S1 and S2 ( P  &lt; .001), suggesting that fractional anisotropy is more reliable than regional homogeneity near cerebral cavernous malformations. Proximity to cerebral cavernous malformations worsened the reliability of regional homogeneity (S1 versus S2, P  &lt; .001), but not fractional anisotropy ( P = .24). While fractional anisotropy was not significantly biased in any ROI ( P  &gt; .05), regional homogeneity was biased toward lower signals in S1 and S2 ( P  &lt; .05), an effect that was attenuated with distance from cerebral cavernous malformations ( P  &lt; .05). Fractional anisotropy measurements were also more precise than regional homogeneity in S1 and S2 ( P  &lt; .001 for both).

CONCLUSIONS: Our findings suggest that hemosiderin-rich lesions such as cerebral cavernous malformations may lead to artifactual depression of fMRI signals and that clinicians and surgeons should interpret fMRI studies near cerebral cavernous malformations with caution. While fMRI is considerably affected by cerebral cavernous malformation–related artifacts, DTI appears to be relatively unaffected and remains a reliable imaging technique near cerebral cavernous malformations.

APE
:   absolute percentage error
BOLD
:   blood oxygen level–dependent
CCM
:   cerebral cavernous malformations
DVA
:   developmental venous anomalies
FA
:   fractional anisotropy
PE
:   percentage error
ReHo
:   regional homogeneity
S1
:   Shell1
S2
:   Shell2" />
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      <h1 class="highwire-cite-title" id="page-title">Reliability of Functional and Diffusion MR Imaging Near Cerebral Cavernous Malformations</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. Colasurdo</span>, <span class="highwire-citation-author" data-delta="1">H. Chen</span>, <span class="highwire-citation-author" data-delta="2">R. Navarra</span>, <span class="highwire-citation-author" data-delta="3">E. Piccirilli</span>, <span class="highwire-citation-author" data-delta="4">A. Delli Pizzi</span>, <span class="highwire-citation-author" data-delta="5">V. Panara</span> and <span class="highwire-citation-author" data-delta="6">M. Caulo</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">February 2023,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">150-156; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7765 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-100967--642085635" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. Colasurdo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neuroscience, Imaging and Clinical Sciences (M.C., R.N., E.P., V.P., M.C.)</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.%2BColasurdo%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=Colasurdo%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.%2BColasurdo%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/0000-0002-7823-3088" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Colasurdo</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">H. Chen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>National Institutes of Health (H.C.), Bethesda, Maryland</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=H.%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 PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AH.%2BChen%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/0000-0003-2455-748X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Chen</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">R. Navarra </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neuroscience, Imaging and Clinical Sciences (M.C., R.N., E.P., V.P., M.C.)</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=R.%2BNavarra%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=Navarra%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%3AR.%2BNavarra%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/0000-0003-2520-1530" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Navarra</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">E. Piccirilli </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neuroscience, Imaging and Clinical Sciences (M.C., R.N., E.P., V.P., M.C.)</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.%2BPiccirilli%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=Piccirilli%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.%2BPiccirilli%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/0000-0003-3105-1292" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. Piccirilli</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">A. Delli Pizzi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Innovative Technologies in Medicine & Dentistry (A.D.P.), G. D’Annunzio University of Chieti, Pescara, Chieti, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BDelli%2BPizzi%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=Delli%20Pizzi%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BDelli%2BPizzi%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/0000-0002-2011-3753" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Delli Pizzi</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">V. Panara </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neuroscience, Imaging and Clinical Sciences (M.C., R.N., E.P., V.P., M.C.)</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=V.%2BPanara%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=Panara%20V&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%3AV.%2BPanara%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/0000-0001-9655-3926" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V. 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Caulo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neuroscience, Imaging and Clinical Sciences (M.C., R.N., E.P., V.P., M.C.)</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.%2BCaulo%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=Caulo%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.%2BCaulo%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/0000-0002-4507-2740" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. 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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 2 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Feb 2023 </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">M.</span> <span class="nlm-surname">Colasurdo</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Chen</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Navarra</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Piccirilli</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Delli Pizzi</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Panara</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Caulo</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">Feb 2023, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">150-156; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7765 </span></div>
  
  
  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2023, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">150-156; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7765 </span></div>
  
  
  
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