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      <div class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="ajnr;ajnr.A8257" data-atom-uri="/ajnr/45/8/E34.atom" data-request-view="full"></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Regarding “Transarterial Embolization of Anterior Cranial Fossa Dural AVFs as a First-Line Approach: A Single-Center Study”</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Xin Su</span>, <span class="highwire-citation-author" data-delta="1">Yongjie Ma</span>, <span class="highwire-citation-author" data-delta="2">Zihao Song</span>, <span class="highwire-citation-author" data-delta="3">Hongqi Zhang</span>, <span class="highwire-citation-author" data-delta="4">Peng Zhang</span> and <span class="highwire-citation-author" data-delta="5">Ming Ye</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">August 2024,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E34; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8257 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-109262--61047121994" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Xin Su </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of NeurosurgeryXuanwu Hospital, Capital Medical UniversityBeijing, China</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=Xin%2BSu%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=Su%20X&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%3AXin%2BSu%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/0009-0004-5324-2545" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Xin Su</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Yongjie Ma </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of NeurosurgeryXuanwu Hospital, Capital Medical UniversityBeijing, China</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=Yongjie%2BMa%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=Ma%20Y&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%3AYongjie%2BMa%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/0000-0001-8136-1753" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Yongjie Ma</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Zihao Song </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of NeurosurgeryXuanwu Hospital, Capital Medical UniversityBeijing, China</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=Zihao%2BSong%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=Song%20Z&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%3AZihao%2BSong%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/0000-0002-2899-257X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Zihao Song</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Hongqi Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of NeurosurgeryXuanwu Hospital, Capital Medical UniversityBeijing, China</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=Hongqi%2BZhang%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=Zhang%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%3AHongqi%2BZhang%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/0000-0001-8740-6828" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Hongqi Zhang</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Peng Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of NeurosurgeryXuanwu Hospital, Capital Medical UniversityBeijing, China</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=Peng%2BZhang%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=Zhang%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%3APeng%2BZhang%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/0000-0001-8344-101X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Peng Zhang</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Ming Ye </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of NeurosurgeryXuanwu Hospital, Capital Medical UniversityBeijing, China</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=Ming%2BYe%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=Ye%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%3AMing%2BYe%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/0000-0001-8148-8201" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Ming Ye</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We read the article by Puylaert et al<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> with interest. The authors presented 15 anterior cranial fossa dural arteriovenous fistulas (ACF DAVFs) in patients who underwent treatment using transarterial embolization (TAE) with <em>n</em>-BCA as a first-line treatment. Complete occlusion with TAE alone was reached in 69% of patients. In the 13 cases of ophthalmic artery (OphA) embolism, no related complications occurred. Copolymers (Onyx; Medtronic) are unfavorable in embolizing via the OphA because they require reflux to provide a forward push of the embolic agent, as opposed to <em>n</em>-BCA, which allows better control of reflux. In the authors’ opinion, the use of <em>n</em>-BCA is a reliable contributor to the relatively high rate of successful TAE without complications.</p><p id="p-2">However, we have some different viewpoints to express. A study found that Onyx had a significantly higher immediate and long-term occlusion rate than <em>n</em>-BCA.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> Compared with <em>n</em>-BCA, Onyx has a slower rate of delivery, allowing better control of the embolism as it travels from the artery to the dural vein. Onyx is cohesive and nonthrombogenic, improving lesion packing and reducing the risk of parenchymal venous occlusion. Slower delivery also enables the interventionalist to control and optimize the extent of artery-to-artery embolization.<sup><a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a></sup> Furthermore, Onyx is currently used in most DAVF treatments, while <em>n</em>-BCA is used in only a few cases.</p><p id="p-3">Our team recently published the largest single-center study on the treatment of ACF DAVFs with TAE.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a>,<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> In comparison with a 69% complete occlusion rate, our use of Onyx in conjunction with a balloon or <em>n</em>-BCA resulted in an immediate complete occlusion rate of 82.5% (33/40). There was only 1 case of retinal central artery ischemia, but the patient recovered well.<sup><a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a></sup> Currently at our center, <em>n</em>-BCA is primarily used as a remedial measure after Onyx embolization or for embolizing pial branches. Furthermore, techniques like the pressure cooker technique can help prevent embolic agent reflux, promoting fistula and proximal draining vein occlusion. Uncommon arterial access, such as the sphenopalatine artery, can also be used to treat ACF DAVFs.<sup><a id="xref-ref-4-2" class="xref-bibr" href="#ref-4">4</a></sup></p><p id="p-4">The use of <em>n</em>-BCA for the treatment of ACF DAVFs via the OphA is not a common treatment technique and may not have a reliable reference value for most medical centers.</p><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-financial-disclosure" id="fn-1"><p id="p-5"><a href="https://www.ajnr.org/sites/default/files/additional-assets/Disclosures/August%202024/0040.pdf">Disclosure forms</a> provided by the authors are available with the full text and PDF of this article at <a href="http://www.ajnr.org">www.ajnr.org</a>.</p></li></ul></div><div 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-45.8.E34.1" data-doi="10.3174/ajnr.A8092"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Puylaert</span>  <span class="cit-name-given-names">CA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">van den Berg</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Coert</span>  <span class="cit-name-given-names">BA</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Transarterial embolization of anterior cranial fossa dural AVFs as a first-line approach: a single-center study</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2024</span>;<span class="cit-vol">45</span>:<span class="cit-fpage">171</span>–<span class="cit-lpage">75</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A8092</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>38176732</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiI0NS8yLzE3MSI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci80NS84L0UzNC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-45.8.E34.2" data-doi="10.1136/neurintsurg-2011-010237"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Rabinov</span>  <span class="cit-name-given-names">JD</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Yoo</span>  <span class="cit-name-given-names">AJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ogilvy</span>  <span class="cit-name-given-names">CS</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas</span>. <abbr class="cit-jnl-abbrev">J Neurointerv Surg</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">5</span>:<span class="cit-fpage">306</span>–<span class="cit-lpage">10</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1136/neurintsurg-2011-010237</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>22550096</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTE6Im5ldXJpbnRzdXJnIjtzOjU6InJlc2lkIjtzOjc6IjUvNC8zMDYiO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvNDUvOC9FMzQuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-45.8.E34.3" data-doi="10.1136/jnis-2023-020408"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Su</span>  <span class="cit-name-given-names">X</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gao</span>  <span class="cit-name-given-names">Z</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ma</span>  <span class="cit-name-given-names">Y</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Transarterial embolization for anterior cranial fossa dural arteriovenous fistulas: a retrospective single-center study</span>. <abbr class="cit-jnl-abbrev">J Neurointerv Surg</abbr> <span class="cit-pub-date">2023</span> <span class="cit-month">Jul</span> <span class="cit-day">12</span> [<span class="cit-comment">Epub ahead of print</span>]<span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1136/jnis-2023-020408</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>37438103</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTE6Im5ldXJpbnRzdXJnIjtzOjU6InJlc2lkIjtzOjg6IjE2LzcvNjg0IjtzOjQ6ImF0b20iO3M6MTk6Ii9ham5yLzQ1LzgvRTM0LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-45.8.E34.4" data-doi="10.1016/j.wneu.2023.10.115"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Su</span>  <span class="cit-name-given-names">X</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ye</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ma</span>  <span class="cit-name-given-names">Y</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Trans-arterial embolization of anterior cranial fossa dural arteriovenous fistulas via the sphenopalatine artery: a technique report</span>. <abbr class="cit-jnl-abbrev">World Neurosurg</abbr> <span class="cit-pub-date">2024</span>;<span class="cit-vol">181</span>:<span 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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">Aug 2024, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E34; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8257 </span></div>
  
  
  
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      <div class="highwire-cite-title">Regarding “Transarterial Embolization of Anterior Cranial Fossa Dural AVFs as a First-Line Approach: A Single-Center Study”</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Xin</span> <span class="nlm-surname">Su</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Yongjie</span> <span class="nlm-surname">Ma</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Zihao</span> <span class="nlm-surname">Song</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Hongqi</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Peng</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Ming</span> <span class="nlm-surname">Ye</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">Aug 2024, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E34; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8257 </span></div>
  
  
  
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