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<meta name="HW.identifier" content="/ajnr/early/2017/11/09/ajnr.A5423.atom" />
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<meta name="DC.Title" content="Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5423" />
<meta name="DC.Date" content="2017-11-09" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2018 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Amyotrophic lateral sclerosis is a neurodegenerative disease involving the upper and lower motor neurons. In amyotrophic lateral sclerosis, pathologic changes in the primary motor cortex include Betz cell depletion and the presence of reactive iron-loaded microglia, detectable on 7T MR images as atrophy and T2*-hypointensity. Our purposes were the following: 1) to investigate the signal hypointensity-to-thickness ratio of the primary motor cortex as a radiologic marker of upper motor neuron involvement in amyotrophic lateral sclerosis with a semiautomated method at 3T, 2) to compare 3T and 7T results, and 3) to evaluate whether semiautomated measurement outperforms visual image assessment.

MATERIALS AND METHODS: We investigated 27 patients and 13 healthy subjects at 3T, and 19 patients and 18 healthy subjects at 7T, performing a high-resolution 3D multiecho T2*-weighted sequence targeting the primary motor cortex. The signal hypointensity-to-thickness ratio of the primary motor cortex was calculated with a semiautomated method depicting signal intensity profiles of the cortex. Images were also visually classified as “pathologic” or “nonpathologic” based on the primary motor cortex signal intensity and thickness.

RESULTS: The signal hypointensity-to-thickness ratio of the primary motor cortex was greater in patients than in controls ( P &lt; .001), and it correlated with upper motor neuron impairment in patients (ρ = 0.57, P &lt; .001). The diagnostic accuracy of the signal hypointensity-to-thickness ratio was high at 3T (area under the curve = 0.89) and even higher at 7T (area under the curve = 0.94). The sensitivity of the semiautomated method (0.81) outperformed the sensitivity of the visual assessment (0.56–0.63) at 3T.

CONCLUSIONS: The signal hypointensity-to-thickness ratio of the primary motor cortex calculated with a semiautomated method is suggested as a radiologic marker of upper motor neuron burden in patients with amyotrophic lateral sclerosis. This semiautomated method may be useful for improving the subjective radiologic evaluation of upper motor neuron pathology in patients suspected of having amyotrophic lateral sclerosis.

ALS
:   amyotrophic lateral sclerosis
HS
:   healthy subjects
M1
:   primary motor cortex
ROC
:   receiver operating characteristic
SH/Thk
:   signal hypointensity-to-thickness ratio
UMN
:   upper motor neuron" />
<meta name="DC.Contributor" content="G. Donatelli" />
<meta name="DC.Contributor" content="A. Retico" />
<meta name="DC.Contributor" content="E. Caldarazzo Ienco" />
<meta name="DC.Contributor" content="P. Cecchi" />
<meta name="DC.Contributor" content="M. Costagli" />
<meta name="DC.Contributor" content="D. Frosini" />
<meta name="DC.Contributor" content="L. Biagi" />
<meta name="DC.Contributor" content="M. Tosetti" />
<meta name="DC.Contributor" content="G. Siciliano" />
<meta name="DC.Contributor" content="M. Cosottini" />
<meta name="article:published_time" content="2017-11-09" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Amyotrophic lateral sclerosis is a neurodegenerative disease involving the upper and lower motor neurons. In amyotrophic lateral sclerosis, pathologic changes in the primary motor cortex include Betz cell depletion and the presence of reactive iron-loaded microglia, detectable on 7T MR images as atrophy and T2*-hypointensity. Our purposes were the following: 1) to investigate the signal hypointensity-to-thickness ratio of the primary motor cortex as a radiologic marker of upper motor neuron involvement in amyotrophic lateral sclerosis with a semiautomated method at 3T, 2) to compare 3T and 7T results, and 3) to evaluate whether semiautomated measurement outperforms visual image assessment.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We investigated 27 patients and 13 healthy subjects at 3T, and 19 patients and 18 healthy subjects at 7T, performing a high-resolution 3D multiecho T2*-weighted sequence targeting the primary motor cortex. The signal hypointensity-to-thickness ratio of the primary motor cortex was calculated with a semiautomated method depicting signal intensity profiles of the cortex. Images were also visually classified as “pathologic” or “nonpathologic” based on the primary motor cortex signal intensity and thickness.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The signal hypointensity-to-thickness ratio of the primary motor cortex was greater in patients than in controls (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001), and it correlated with upper motor neuron impairment in patients (ρ = 0.57, &lt;i&gt;P&lt;/i&gt; &amp;lt; .001). The diagnostic accuracy of the signal hypointensity-to-thickness ratio was high at 3T (area under the curve = 0.89) and even higher at 7T (area under the curve = 0.94). The sensitivity of the semiautomated method (0.81) outperformed the sensitivity of the visual assessment (0.56–0.63) at 3T.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The signal hypointensity-to-thickness ratio of the primary motor cortex calculated with a semiautomated method is suggested as a radiologic marker of upper motor neuron burden in patients with amyotrophic lateral sclerosis. This semiautomated method may be useful for improving the subjective radiologic evaluation of upper motor neuron pathology in patients suspected of having amyotrophic lateral sclerosis.&lt;/p&gt;" />
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<meta name="twitter:title" content="Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Amyotrophic lateral sclerosis is a neurodegenerative disease involving the upper and lower motor neurons. In amyotrophic lateral sclerosis, pathologic changes in the primary motor cortex include Betz cell depletion and the presence of reactive iron-loaded microglia, detectable on 7T MR images as atrophy and T2*-hypointensity. Our purposes were the following: 1) to investigate the signal hypointensity-to-thickness ratio of the primary motor cortex as a radiologic marker of upper motor neuron involvement in amyotrophic lateral sclerosis with a semiautomated method at 3T, 2) to compare 3T and 7T results, and 3) to evaluate whether semiautomated measurement outperforms visual image assessment.

MATERIALS AND METHODS: We investigated 27 patients and 13 healthy subjects at 3T, and 19 patients and 18 healthy subjects at 7T, performing a high-resolution 3D multiecho T2*-weighted sequence targeting the primary motor cortex. The signal hypointensity-to-thickness ratio of the primary motor cortex was calculated with a semiautomated method depicting signal intensity profiles of the cortex. Images were also visually classified as “pathologic” or “nonpathologic” based on the primary motor cortex signal intensity and thickness.

RESULTS: The signal hypointensity-to-thickness ratio of the primary motor cortex was greater in patients than in controls ( P &lt; .001), and it correlated with upper motor neuron impairment in patients (ρ = 0.57, P &lt; .001). The diagnostic accuracy of the signal hypointensity-to-thickness ratio was high at 3T (area under the curve = 0.89) and even higher at 7T (area under the curve = 0.94). The sensitivity of the semiautomated method (0.81) outperformed the sensitivity of the visual assessment (0.56–0.63) at 3T.

CONCLUSIONS: The signal hypointensity-to-thickness ratio of the primary motor cortex calculated with a semiautomated method is suggested as a radiologic marker of upper motor neuron burden in patients with amyotrophic lateral sclerosis. This semiautomated method may be useful for improving the subjective radiologic evaluation of upper motor neuron pathology in patients suspected of having amyotrophic lateral sclerosis.

ALS
:   amyotrophic lateral sclerosis
HS
:   healthy subjects
M1
:   primary motor cortex
ROC
:   receiver operating characteristic
SH/Thk
:   signal hypointensity-to-thickness ratio
UMN
:   upper motor neuron" />
<meta name="og-title" property="og:title" content="Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2017/11/09/ajnr.A5423" />
<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: Amyotrophic lateral sclerosis is a neurodegenerative disease involving the upper and lower motor neurons. In amyotrophic lateral sclerosis, pathologic changes in the primary motor cortex include Betz cell depletion and the presence of reactive iron-loaded microglia, detectable on 7T MR images as atrophy and T2*-hypointensity. Our purposes were the following: 1) to investigate the signal hypointensity-to-thickness ratio of the primary motor cortex as a radiologic marker of upper motor neuron involvement in amyotrophic lateral sclerosis with a semiautomated method at 3T, 2) to compare 3T and 7T results, and 3) to evaluate whether semiautomated measurement outperforms visual image assessment.

MATERIALS AND METHODS: We investigated 27 patients and 13 healthy subjects at 3T, and 19 patients and 18 healthy subjects at 7T, performing a high-resolution 3D multiecho T2*-weighted sequence targeting the primary motor cortex. The signal hypointensity-to-thickness ratio of the primary motor cortex was calculated with a semiautomated method depicting signal intensity profiles of the cortex. Images were also visually classified as “pathologic” or “nonpathologic” based on the primary motor cortex signal intensity and thickness.

RESULTS: The signal hypointensity-to-thickness ratio of the primary motor cortex was greater in patients than in controls ( P &lt; .001), and it correlated with upper motor neuron impairment in patients (ρ = 0.57, P &lt; .001). The diagnostic accuracy of the signal hypointensity-to-thickness ratio was high at 3T (area under the curve = 0.89) and even higher at 7T (area under the curve = 0.94). The sensitivity of the semiautomated method (0.81) outperformed the sensitivity of the visual assessment (0.56–0.63) at 3T.

CONCLUSIONS: The signal hypointensity-to-thickness ratio of the primary motor cortex calculated with a semiautomated method is suggested as a radiologic marker of upper motor neuron burden in patients with amyotrophic lateral sclerosis. This semiautomated method may be useful for improving the subjective radiologic evaluation of upper motor neuron pathology in patients suspected of having amyotrophic lateral sclerosis.

ALS
:   amyotrophic lateral sclerosis
HS
:   healthy subjects
M1
:   primary motor cortex
ROC
:   receiver operating characteristic
SH/Thk
:   signal hypointensity-to-thickness ratio
UMN
:   upper motor neuron" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">G. Donatelli</span>, <span class="highwire-citation-author" data-delta="1">A. Retico</span>, <span class="highwire-citation-author" data-delta="2">E. Caldarazzo Ienco</span>, <span class="highwire-citation-author" data-delta="3">P. Cecchi</span>, <span class="highwire-citation-author" data-delta="4">M. Costagli</span>, <span class="highwire-citation-author" data-delta="5">D. Frosini</span>, <span class="highwire-citation-author" data-delta="6">L. Biagi</span>, <span class="highwire-citation-author" data-delta="7">M. Tosetti</span>, <span class="highwire-citation-author" data-delta="8">G. Siciliano</span> and <span class="highwire-citation-author" data-delta="9">M. Cosottini</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2017,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5423 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-57036--61001440961" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">G. Donatelli </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 Translational Research and New Technologies in Medicine and Surgery (G.D., P.C., M. Cosottini)</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.%2BDonatelli%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=Donatelli%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"><a href="/search/author1%3AG.%2BDonatelli%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="http://orcid.org/0000-0002-5325-0746" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Donatelli</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">A. Retico </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>National Institute for Nuclear Physics (A.R.), Pisa Division, Pisa, 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.%2BRetico%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=Retico%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.%2BRetico%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="http://orcid.org/0000-0001-5135-4472" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Retico</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">E. Caldarazzo Ienco </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, 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=E.%2BCaldarazzo%2BIenco%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=Caldarazzo%20Ienco%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.%2BCaldarazzo%2BIenco%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="http://orcid.org/0000-0003-0134-5062" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. Caldarazzo Ienco</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">P. Cecchi </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 Translational Research and New Technologies in Medicine and Surgery (G.D., P.C., M. Cosottini)</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.%2BCecchi%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=Cecchi%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.%2BCecchi%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="http://orcid.org/0000-0003-2725-2657" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. 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Costagli, L.B., M.T.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, 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=M.%2BCostagli%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=Costagli%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.%2BCostagli%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="http://orcid.org/0000-0001-9073-1082" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. 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Frosini</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">L. Biagi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Imago7 Research Foundation (M. Costagli, L.B., M.T.), Pisa, Italy</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Laboratory of Medical Physics and Biotechnologies for Magnetic Resonance (M. Costagli, L.B., M.T.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, 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=L.%2BBiagi%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=Biagi%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.%2BBiagi%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="http://orcid.org/0000-0003-2159-439X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Biagi</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">M. Tosetti </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Imago7 Research Foundation (M. Costagli, L.B., M.T.), Pisa, Italy</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Laboratory of Medical Physics and Biotechnologies for Magnetic Resonance (M. Costagli, L.B., M.T.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, 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=M.%2BTosetti%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=Tosetti%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.%2BTosetti%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="http://orcid.org/0000-0002-2515-7560" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Tosetti</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">G. Siciliano </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, 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=G.%2BSiciliano%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=Siciliano%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"><a href="/search/author1%3AG.%2BSiciliano%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="http://orcid.org/0000-0001-8555-6013" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Siciliano</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">M. Cosottini </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 Translational Research and New Technologies in Medicine and Surgery (G.D., P.C., M. Cosottini)</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.%2BCosottini%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=Cosottini%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.%2BCosottini%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="http://orcid.org/0000-0001-9400-6574" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Cosottini</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-ajnr.A5423v1.1" data-doi="10.1080/146608200300079536"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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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">G.</span> <span class="nlm-surname">Donatelli</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Retico</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Caldarazzo Ienco</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Cecchi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Costagli</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Frosini</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Biagi</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Tosetti</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Siciliano</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Cosottini</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2017, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5423 </span></div>
  
  
  
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