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<meta name="DC.Title" content="Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4225" />
<meta name="DC.Date" content="2015-02-05" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability ( K trans, VL) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized K trans would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors.

MATERIALS AND METHODS: Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters ( K trans, VL) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. K trans and VL were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics.

RESULTS: Interobserver agreement was strong as shown in regression analysis ( R 2 &gt; 0.84) and intraclass correlation (intraclass correlation coefficient &gt;0.92), indicating that the K trans can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA ( P &lt; .001). Regression analysis demonstrated a significant trend toward an increased K trans with increasing aneurysm size ( P &lt; .001). Logistic regression showed that K trans also predicted risk in anatomic ( P = .02) and combined anatomic/clinical ( P = .03) groups independent of size.

CONCLUSIONS: We report the first evidence of dynamic contrast-enhanced MR imaging–modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, K trans was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms.

### Abbreviations

DCE
:   dynamic contrast-enhanced
IA
:   intracranial aneurysm
ISUIA
:   International Study of Unruptured Intracranial Aneurysms
K trans
:   contrast-transfer coefficient
VL
:   fractional volume of extravascular extracellular space per unit tissue" />
<meta name="DC.Contributor" content="P. Vakil" />
<meta name="DC.Contributor" content="S. Ansari" />
<meta name="DC.Contributor" content="C.G. Cantrell" />
<meta name="DC.Contributor" content="C.S. Eddleman" />
<meta name="DC.Contributor" content="F.H. Dehkordi" />
<meta name="DC.Contributor" content="J. Vranic" />
<meta name="DC.Contributor" content="M.C. Hurley" />
<meta name="DC.Contributor" content="H.H. Batjer" />
<meta name="DC.Contributor" content="B. Bendok" />
<meta name="DC.Contributor" content="T.J. Carroll" />
<meta name="article:published_time" content="2015-02-05" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability (&lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt;, V&lt;sub&gt;L&lt;/sub&gt;) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized &lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt; would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters (&lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt;, V&lt;sub&gt;L&lt;/sub&gt;) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. &lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt; and V&lt;sub&gt;L&lt;/sub&gt; were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Interobserver agreement was strong as shown in regression analysis (&lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; &amp;gt; 0.84) and intraclass correlation (intraclass correlation coefficient &amp;gt;0.92), indicating that the &lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt; can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001). Regression analysis demonstrated a significant trend toward an increased &lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt; with increasing aneurysm size (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001). Logistic regression showed that &lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt; also predicted risk in anatomic (&lt;i&gt;P&lt;/i&gt; = .02) and combined anatomic/clinical (&lt;i&gt;P&lt;/i&gt; = .03) groups independent of size.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;We report the first evidence of dynamic contrast-enhanced MR imaging–modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, &lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt; was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2015/02/05" />
<meta name="citation_mjid" content="ajnr;ajnr.A4225v1" />
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<meta name="citation_full_html_url" content="http://ajnr-stage2.stage.highwire.org/content/early/2015/02/05/ajnr.A4225.full" />
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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.A4225" />
<meta name="citation_pmid" content="25655875" />
<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="INTERVENTIONAL" />
<meta name="citation_access" content="all" />
<meta name="citation_author" content="P. Vakil" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="S. Ansari" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="C.G. Cantrell" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="C.S. Eddleman" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="F.H. Dehkordi" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="J. Vranic" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="M.C. Hurley" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="H.H. Batjer" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="B. Bendok" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="T.J. Carroll" />
<meta name="citation_author_institution" content="From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_fulltext_world_readable" content="" />
<meta name="twitter:title" content="Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability ( K trans, VL) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized K trans would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors.

MATERIALS AND METHODS: Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters ( K trans, VL) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. K trans and VL were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics.

RESULTS: Interobserver agreement was strong as shown in regression analysis ( R 2 &gt; 0.84) and intraclass correlation (intraclass correlation coefficient &gt;0.92), indicating that the K trans can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA ( P &lt; .001). Regression analysis demonstrated a significant trend toward an increased K trans with increasing aneurysm size ( P &lt; .001). Logistic regression showed that K trans also predicted risk in anatomic ( P = .02) and combined anatomic/clinical ( P = .03) groups independent of size.

CONCLUSIONS: We report the first evidence of dynamic contrast-enhanced MR imaging–modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, K trans was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms.

### Abbreviations

DCE
:   dynamic contrast-enhanced
IA
:   intracranial aneurysm
ISUIA
:   International Study of Unruptured Intracranial Aneurysms
K trans
:   contrast-transfer coefficient
VL
:   fractional volume of extravascular extracellular space per unit tissue" />
<meta name="og-title" property="og:title" content="Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2015/02/05/ajnr.A4225" />
<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: Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability ( K trans, VL) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized K trans would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors.

MATERIALS AND METHODS: Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters ( K trans, VL) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. K trans and VL were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics.

RESULTS: Interobserver agreement was strong as shown in regression analysis ( R 2 &gt; 0.84) and intraclass correlation (intraclass correlation coefficient &gt;0.92), indicating that the K trans can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA ( P &lt; .001). Regression analysis demonstrated a significant trend toward an increased K trans with increasing aneurysm size ( P &lt; .001). Logistic regression showed that K trans also predicted risk in anatomic ( P = .02) and combined anatomic/clinical ( P = .03) groups independent of size.

CONCLUSIONS: We report the first evidence of dynamic contrast-enhanced MR imaging–modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, K trans was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms.

### Abbreviations

DCE
:   dynamic contrast-enhanced
IA
:   intracranial aneurysm
ISUIA
:   International Study of Unruptured Intracranial Aneurysms
K trans
:   contrast-transfer coefficient
VL
:   fractional volume of extravascular extracellular space per unit tissue" />
<meta name="og-type" property="og:type" content="article" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">P. Vakil</span>, <span class="highwire-citation-author" data-delta="1">S. Ansari</span>, <span class="highwire-citation-author" data-delta="2">C.G. Cantrell</span>, <span class="highwire-citation-author" data-delta="3">C.S. Eddleman</span>, <span class="highwire-citation-author" data-delta="4">F.H. Dehkordi</span>, <span class="highwire-citation-author" data-delta="5">J. Vranic</span>, <span class="highwire-citation-author" data-delta="6">M.C. Hurley</span>, <span class="highwire-citation-author" data-delta="7">H.H. Batjer</span>, <span class="highwire-citation-author" data-delta="8">B. Bendok</span> and <span class="highwire-citation-author" data-delta="9">T.J. Carroll</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 2015,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4225 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-50957--61792409192" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">P. Vakil </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois.</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.%2BVakil%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=Vakil%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 last"><a href="/search/author1%3AP.%2BVakil%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">S. Ansari </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois.</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=S.%2BAnsari%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=Ansari%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BAnsari%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-2"><div class="author-tooltip-name">C.G. Cantrell </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois.</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=C.G.%2BCantrell%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=Cantrell%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.G.%2BCantrell%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">C.S. Eddleman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois.</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=C.S.%2BEddleman%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=Eddleman%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.S.%2BEddleman%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">F.H. Dehkordi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois.</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=F.H.%2BDehkordi%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=Dehkordi%20F&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%3AF.H.%2BDehkordi%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">J. Vranic </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois.</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.%2BVranic%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=Vranic%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.%2BVranic%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">M.C. Hurley </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (P.V., S.A., J.V., M.C.H., T.J.C.), Neurosurgery (B.B.), and Biomedical Engineering (P.V., C.G.C., T.J.C.), Northwestern University, Chicago, Illinois; Department of Neurological Surgery (C.S.E., H.H.B.), University of Texas-Southwestern, Dallas, Texas; and Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois.</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.C.%2BHurley%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=Hurley%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 last"><a href="/search/author1%3AM.C.%2BHurley%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-7"><div class="author-tooltip-name">H.H. 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