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<meta name="DC.Title" content="Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8212" />
<meta name="DC.Date" content="2024-04-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2024 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Carotid siphon calcification might contribute to the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum through increased arterial flow pulsatility. This study aimed to compare intracranial artery flow pulsatility, brain volumes, and small-vessel disease markers between patients with pseudoxanthoma elasticum and controls and the association between arterial calcification and pulsatility in pseudoxanthoma elasticum.

MATERIALS AND METHODS: Fifty patients with pseudoxanthoma elasticum and 40 age- and sex-matched controls underwent 3T MR imaging, including 2D phase-contrast acquisitions for flow pulsatility in the assessment of ICA and MCA and FLAIR acquisitions for brain volumes, white matter lesions, and infarctions. All patients with pseudoxanthoma elasticum underwent CT scanning to measure siphon calcification. Flow pulsatility (2D phase-contrast), brain volumes, white matter lesions, and infarctions (3D T1 and 3D T2 FLAIR) were compared between patients and controls. The association between siphon calcification and pulsatility in pseudoxanthoma elasticum was tested with linear regression models.

RESULTS: Patients with pseudoxanthoma elasticum (mean age, 57 [SD, 12] years; 24 men) had significantly higher pulsatility indexes (1.05; range, 0.94–1.21 versus 0.94; range, 0.82–1.04; P  = .02), lower mean GM volumes (597 [SD, 53] mL versus 632 [SD, 53] mL; P  &lt; .01), more white matter lesions (2.6; range, 0.5–7.5 versus 1.1; range, 0.5–2.4) mL; P  = .05), and more lacunar infarctions (64 versus 8, P  = .04) than controls (mean age, 58 [SD, 11] years; 20 men). Carotid siphon calcification was associated with higher pulsatility indexes in patients with pseudoxanthoma elasticum (β = 0.10; 95% CI, 0.01–0.18).

CONCLUSIONS: Patients with pseudoxanthoma elasticum have increased intracranial artery flow pulsatility and measures of small-vessel disease. Carotid siphon calcification might underlie the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum.

CSVD
:   cerebral small-vessel disease
IEL
:   internal elastic lamina
LDL
:   low-density lipoprotein
PI
:   pulsatility index
PPi
:   inorganic pyrophosphate
PXE
:   pseudoxanthoma elasticum
RR
:   rate ratio
WML
:   white matter lesions" />
<meta name="DC.Contributor" content="J.W. Bartstra" />
<meta name="DC.Contributor" content="T. van den Beukel" />
<meta name="DC.Contributor" content="G. Kranenburg" />
<meta name="DC.Contributor" content="L.J. Geurts" />
<meta name="DC.Contributor" content="A.M. den Harder" />
<meta name="DC.Contributor" content="T. Witkamp" />
<meta name="DC.Contributor" content="J.M. Wolterink" />
<meta name="DC.Contributor" content="J.J.M. Zwanenburg" />
<meta name="DC.Contributor" content="E. van Valen" />
<meta name="DC.Contributor" content="H.L. Koek" />
<meta name="DC.Contributor" content="W.P.T.M. Mali" />
<meta name="DC.Contributor" content="P.A. de Jong" />
<meta name="DC.Contributor" content="J. Hendrikse" />
<meta name="DC.Contributor" content="W. Spiering" />
<meta name="article:published_time" content="2024-04-01" />
<meta name="article:section" content="Neurovascular/Stroke Imaging" />
<meta name="citation_title" content="Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Carotid siphon calcification might contribute to the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum through increased arterial flow pulsatility. This study aimed to compare intracranial artery flow pulsatility, brain volumes, and small-vessel disease markers between patients with pseudoxanthoma elasticum and controls and the association between arterial calcification and pulsatility in pseudoxanthoma elasticum.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Fifty patients with pseudoxanthoma elasticum and 40 age- and sex-matched controls underwent 3T MR imaging, including 2D phase-contrast acquisitions for flow pulsatility in the assessment of ICA and MCA and FLAIR acquisitions for brain volumes, white matter lesions, and infarctions. All patients with pseudoxanthoma elasticum underwent CT scanning to measure siphon calcification. Flow pulsatility (2D phase-contrast), brain volumes, white matter lesions, and infarctions (3D T1 and 3D T2 FLAIR) were compared between patients and controls. The association between siphon calcification and pulsatility in pseudoxanthoma elasticum was tested with linear regression models.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Patients with pseudoxanthoma elasticum (mean age, 57 [SD, 12] years; 24 men) had significantly higher pulsatility indexes (1.05; range, 0.94–1.21 versus 0.94; range, 0.82–1.04; &lt;i&gt;P &lt;/i&gt;= .02), lower mean GM volumes (597 [SD, 53] mL versus 632 [SD, 53] mL; &lt;i&gt;P &lt;/i&gt;&amp;lt; .01), more white matter lesions (2.6; range, 0.5–7.5 versus 1.1; range, 0.5–2.4) mL; &lt;i&gt;P &lt;/i&gt;= .05), and more lacunar infarctions (64 versus 8, &lt;i&gt;P &lt;/i&gt;= .04) than controls (mean age, 58 [SD, 11] years; 20 men). Carotid siphon calcification was associated with higher pulsatility indexes in patients with pseudoxanthoma elasticum (β = 0.10; 95% CI, 0.01–0.18).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Patients with pseudoxanthoma elasticum have increased intracranial artery flow pulsatility and measures of small-vessel disease. Carotid siphon calcification might underlie the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum.&lt;/p&gt;" />
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<meta name="twitter:title" content="Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Carotid siphon calcification might contribute to the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum through increased arterial flow pulsatility. This study aimed to compare intracranial artery flow pulsatility, brain volumes, and small-vessel disease markers between patients with pseudoxanthoma elasticum and controls and the association between arterial calcification and pulsatility in pseudoxanthoma elasticum.

MATERIALS AND METHODS: Fifty patients with pseudoxanthoma elasticum and 40 age- and sex-matched controls underwent 3T MR imaging, including 2D phase-contrast acquisitions for flow pulsatility in the assessment of ICA and MCA and FLAIR acquisitions for brain volumes, white matter lesions, and infarctions. All patients with pseudoxanthoma elasticum underwent CT scanning to measure siphon calcification. Flow pulsatility (2D phase-contrast), brain volumes, white matter lesions, and infarctions (3D T1 and 3D T2 FLAIR) were compared between patients and controls. The association between siphon calcification and pulsatility in pseudoxanthoma elasticum was tested with linear regression models.

RESULTS: Patients with pseudoxanthoma elasticum (mean age, 57 [SD, 12] years; 24 men) had significantly higher pulsatility indexes (1.05; range, 0.94–1.21 versus 0.94; range, 0.82–1.04; P  = .02), lower mean GM volumes (597 [SD, 53] mL versus 632 [SD, 53] mL; P  &lt; .01), more white matter lesions (2.6; range, 0.5–7.5 versus 1.1; range, 0.5–2.4) mL; P  = .05), and more lacunar infarctions (64 versus 8, P  = .04) than controls (mean age, 58 [SD, 11] years; 20 men). Carotid siphon calcification was associated with higher pulsatility indexes in patients with pseudoxanthoma elasticum (β = 0.10; 95% CI, 0.01–0.18).

CONCLUSIONS: Patients with pseudoxanthoma elasticum have increased intracranial artery flow pulsatility and measures of small-vessel disease. Carotid siphon calcification might underlie the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum.

CSVD
:   cerebral small-vessel disease
IEL
:   internal elastic lamina
LDL
:   low-density lipoprotein
PI
:   pulsatility index
PPi
:   inorganic pyrophosphate
PXE
:   pseudoxanthoma elasticum
RR
:   rate ratio
WML
:   white matter lesions" />
<meta name="og-title" property="og:title" content="Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/45/4/386" />
<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: Carotid siphon calcification might contribute to the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum through increased arterial flow pulsatility. This study aimed to compare intracranial artery flow pulsatility, brain volumes, and small-vessel disease markers between patients with pseudoxanthoma elasticum and controls and the association between arterial calcification and pulsatility in pseudoxanthoma elasticum.

MATERIALS AND METHODS: Fifty patients with pseudoxanthoma elasticum and 40 age- and sex-matched controls underwent 3T MR imaging, including 2D phase-contrast acquisitions for flow pulsatility in the assessment of ICA and MCA and FLAIR acquisitions for brain volumes, white matter lesions, and infarctions. All patients with pseudoxanthoma elasticum underwent CT scanning to measure siphon calcification. Flow pulsatility (2D phase-contrast), brain volumes, white matter lesions, and infarctions (3D T1 and 3D T2 FLAIR) were compared between patients and controls. The association between siphon calcification and pulsatility in pseudoxanthoma elasticum was tested with linear regression models.

RESULTS: Patients with pseudoxanthoma elasticum (mean age, 57 [SD, 12] years; 24 men) had significantly higher pulsatility indexes (1.05; range, 0.94–1.21 versus 0.94; range, 0.82–1.04; P  = .02), lower mean GM volumes (597 [SD, 53] mL versus 632 [SD, 53] mL; P  &lt; .01), more white matter lesions (2.6; range, 0.5–7.5 versus 1.1; range, 0.5–2.4) mL; P  = .05), and more lacunar infarctions (64 versus 8, P  = .04) than controls (mean age, 58 [SD, 11] years; 20 men). Carotid siphon calcification was associated with higher pulsatility indexes in patients with pseudoxanthoma elasticum (β = 0.10; 95% CI, 0.01–0.18).

CONCLUSIONS: Patients with pseudoxanthoma elasticum have increased intracranial artery flow pulsatility and measures of small-vessel disease. Carotid siphon calcification might underlie the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum.

CSVD
:   cerebral small-vessel disease
IEL
:   internal elastic lamina
LDL
:   low-density lipoprotein
PI
:   pulsatility index
PPi
:   inorganic pyrophosphate
PXE
:   pseudoxanthoma elasticum
RR
:   rate ratio
WML
:   white matter lesions" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node106841--5" data-node-nid="106841" id="top-node-106841--61775236035" data-pisa="ajnr;45/4/386" data-pisa-master="ajnr;ajnr.A8212" data-apath="/ajnr/45/4/386.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">Neurovascular/Stroke Imaging</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="ajnr;ajnr.A8212" data-atom-uri="/ajnr/45/4/386.atom" data-request-view="full"></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.W. Bartstra</span>, <span class="highwire-citation-author" data-delta="1">T. van den Beukel</span>, <span class="highwire-citation-author" data-delta="2">G. Kranenburg</span>, <span class="highwire-citation-author" data-delta="3">L.J. Geurts</span>, <span class="highwire-citation-author" data-delta="4">A.M. den Harder</span>, <span class="highwire-citation-author" data-delta="5">T. Witkamp</span>, <span class="highwire-citation-author" data-delta="6">J.M. Wolterink</span>, <span class="highwire-citation-author" data-delta="7">J.J.M. Zwanenburg</span>, <span class="highwire-citation-author" data-delta="8">E. van Valen</span>, <span class="highwire-citation-author" data-delta="9">H.L. Koek</span>, <span class="highwire-citation-author" data-delta="10">W.P.T.M. Mali</span>, <span class="highwire-citation-author" data-delta="11">P.A. de Jong</span>, <span class="highwire-citation-author" data-delta="12">J. Hendrikse</span> and <span class="highwire-citation-author" data-delta="13">W. Spiering</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">April 2024,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">386-392; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8212 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-106841--61775236035" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.W. Bartstra </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 (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.W.%2BBartstra%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=Bartstra%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 last"><a href="/search/author1%3AJ.W.%2BBartstra%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-1"><div class="author-tooltip-name">T. van den Beukel </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 (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2Bvan%2Bden%2BBeukel%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=van%20den%20Beukel%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.%2Bvan%2Bden%2BBeukel%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/0000-0003-3597-6217" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. van den Beukel</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">G. Kranenburg </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Vascular Medicine (G.K., W.S.), University Medical Center Utrecht, Utrecht University, the Netherlands</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.%2BKranenburg%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=Kranenburg%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 last"><a href="/search/author1%3AG.%2BKranenburg%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-3"><div class="author-tooltip-name">L.J. Geurts </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 (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands</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=L.J.%2BGeurts%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=Geurts%20L&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%3AL.J.%2BGeurts%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/0000-0002-5242-1259" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L.J. Geurts</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">A.M. den Harder </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 (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands</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.M.%2Bden%2BHarder%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=den%20Harder%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 last"><a href="/search/author1%3AA.M.%2Bden%2BHarder%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-5"><div class="author-tooltip-name">T. Witkamp </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 (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BWitkamp%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=Witkamp%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 last"><a href="/search/author1%3AT.%2BWitkamp%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-6"><div class="author-tooltip-name">J.M. Wolterink </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Applied Mathematics (J.M.W., E.v.V., H.L.K.), Technical Medical Centre, University of Twente, Enschede, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.M.%2BWolterink%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=Wolterink%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.M.%2BWolterink%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/0000-0001-5505-475X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.M. Wolterink</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">J.J.M. Zwanenburg </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 (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.J.M.%2BZwanenburg%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=Zwanenburg%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.J.M.%2BZwanenburg%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/0000-0002-4282-5719" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.J.M. Zwanenburg</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">E. van Valen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Applied Mathematics (J.M.W., E.v.V., H.L.K.), Technical Medical Centre, University of Twente, Enschede, the Netherlands</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Geriatrics (E.v.V., H.L.K.), University Medical Center Utrecht, Utrecht University, the Netherlands.</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.%2Bvan%2BValen%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=van%20Valen%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.%2Bvan%2BValen%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/0000-0001-7412-2404" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. van Valen</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">H.L. Koek </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Applied Mathematics (J.M.W., E.v.V., H.L.K.), Technical Medical Centre, University of Twente, Enschede, the Netherlands</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Geriatrics (E.v.V., H.L.K.), University Medical Center Utrecht, Utrecht University, the Netherlands.</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.L.%2BKoek%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=Koek%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 last"><a href="/search/author1%3AH.L.%2BKoek%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-10"><div class="author-tooltip-name">W.P.T.M. Mali </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 (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands</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=W.P.T.M.%2BMali%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=Mali%20W&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%3AW.P.T.M.%2BMali%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-11"><div class="author-tooltip-name">P.A. de Jong </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 (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands</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=P.A.%2Bde%2BJong%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=de%20Jong%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%3AP.A.%2Bde%2BJong%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/0000-0003-4840-6854" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P.A. de Jong</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">J. Hendrikse </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 (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BHendrikse%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=Hendrikse%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BHendrikse%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/0000-0001-6384-6140" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Hendrikse</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">W. Spiering </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Vascular Medicine (G.K., W.S.), University Medical Center Utrecht, Utrecht University, the Netherlands</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=W.%2BSpiering%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=Spiering%20W&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%3AW.%2BSpiering%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/0000-0002-2493-6407" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for W. Spiering</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-45.4.386.1" data-doi="10.1002/ajmg.a.33329"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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          <a href="/content/45/4" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">American Journal of Neuroradiology</span></a>      
      
        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 45</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 4 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Apr 2024 </div></div>
      
      
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      <div class="highwire-cite-title">Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum</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">Apr 2024, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">386-392; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8212 </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">Apr 2024, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">386-392; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8212 </span></div>
  
  
  
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