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<meta name="DC.Title" content="MRI-Based Brain Volume Scoring in Cerebral Malaria is Externally Valid and Applicable to Lower-Resolution Images" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8098" />
<meta name="DC.Date" content="2024-01-12" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Children with cerebral malaria have an elevated risk of mortality and neurologic morbidity. Both mortality and morbidity are associated with initially increased brain volume on MR imaging, as graded by the Brain Volume Score, a subjective ordinal rating scale created specifically for brain MRIs in children with cerebral malaria. For the Brain Volume Score to be more widely clinically useful, we aimed to determine its independent reproducibility and whether it can be applicable to lower-resolution MRIs.

MATERIALS AND METHODS: To assess the independent reproducibility of the Brain Volume Score, radiologists not associated with the initial study were trained to score MRIs from a new cohort of patients with cerebral malaria. These scores were then compared with survival and neurologic outcomes. To assess the applicability to lower-resolution MRI, we assigned Brain Volume Scores to brain MRIs degraded to simulate a very-low-field (64 mT) portable scanner and compared these with the original scores assigned to the original nondegraded MRIs.

RESULTS: Brain Volume Scores on the new cohort of patients with cerebral malaria were highly associated with outcomes (OR for mortality = 16, P  &lt; .001). Scoring of the simulated degraded images remained consistent with the Brain Volume Scores assigned to the original higher-quality (0.35 T) images (intraclass coefficients &gt; 0.86).

CONCLUSIONS: Our findings demonstrate that the Brain Volume Score is externally valid in reproducibly predicting outcomes and can be reliably assigned to lower-resolution images.

BVS
:   Brain Volume Score
CM
:   cerebral malaria" />
<meta name="DC.Contributor" content="Manu S. Goyal" />
<meta name="DC.Contributor" content="Lorenna Vidal" />
<meta name="DC.Contributor" content="Karen Chetcuti" />
<meta name="DC.Contributor" content="Cowles Chilingulo" />
<meta name="DC.Contributor" content="Khalid Ibrahim" />
<meta name="DC.Contributor" content="Jeffrey Zhang" />
<meta name="DC.Contributor" content="Dylan S. Small" />
<meta name="DC.Contributor" content="Karl B. Seydel" />
<meta name="DC.Contributor" content="Nicole O’Brien" />
<meta name="DC.Contributor" content="Terrie E. Taylor" />
<meta name="DC.Contributor" content="Douglas G. Postels" />
<meta name="article:published_time" content="2024-01-11" />
<meta name="article:section" content="PEDIATRIC NEUROIMAGING" />
<meta name="citation_title" content="MRI-Based Brain Volume Scoring in Cerebral Malaria is Externally Valid and Applicable to Lower-Resolution Images" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Children with cerebral malaria have an elevated risk of mortality and neurologic morbidity. Both mortality and morbidity are associated with initially increased brain volume on MR imaging, as graded by the Brain Volume Score, a subjective ordinal rating scale created specifically for brain MRIs in children with cerebral malaria. For the Brain Volume Score to be more widely clinically useful, we aimed to determine its independent reproducibility and whether it can be applicable to lower-resolution MRIs.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;To assess the independent reproducibility of the Brain Volume Score, radiologists not associated with the initial study were trained to score MRIs from a new cohort of patients with cerebral malaria. These scores were then compared with survival and neurologic outcomes. To assess the applicability to lower-resolution MRI, we assigned Brain Volume Scores to brain MRIs degraded to simulate a very-low-field (64 mT) portable scanner and compared these with the original scores assigned to the original nondegraded MRIs.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Brain Volume Scores on the new cohort of patients with cerebral malaria were highly associated with outcomes (OR for mortality = 16, &lt;i&gt;P &lt;/i&gt;&amp;lt; .001). Scoring of the simulated degraded images remained consistent with the Brain Volume Scores assigned to the original higher-quality (0.35 T) images (intraclass coefficients &amp;gt; 0.86).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Our findings demonstrate that the Brain Volume Score is externally valid in reproducibly predicting outcomes and can be reliably assigned to lower-resolution images.&lt;/p&gt;" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Children with cerebral malaria have an elevated risk of mortality and neurologic morbidity. Both mortality and morbidity are associated with initially increased brain volume on MR imaging, as graded by the Brain Volume Score, a subjective ordinal rating scale created specifically for brain MRIs in children with cerebral malaria. For the Brain Volume Score to be more widely clinically useful, we aimed to determine its independent reproducibility and whether it can be applicable to lower-resolution MRIs.

MATERIALS AND METHODS: To assess the independent reproducibility of the Brain Volume Score, radiologists not associated with the initial study were trained to score MRIs from a new cohort of patients with cerebral malaria. These scores were then compared with survival and neurologic outcomes. To assess the applicability to lower-resolution MRI, we assigned Brain Volume Scores to brain MRIs degraded to simulate a very-low-field (64 mT) portable scanner and compared these with the original scores assigned to the original nondegraded MRIs.

RESULTS: Brain Volume Scores on the new cohort of patients with cerebral malaria were highly associated with outcomes (OR for mortality = 16, P  &lt; .001). Scoring of the simulated degraded images remained consistent with the Brain Volume Scores assigned to the original higher-quality (0.35 T) images (intraclass coefficients &gt; 0.86).

CONCLUSIONS: Our findings demonstrate that the Brain Volume Score is externally valid in reproducibly predicting outcomes and can be reliably assigned to lower-resolution images.

BVS
:   Brain Volume Score
CM
:   cerebral malaria" />
<meta name="og-title" property="og:title" content="MRI-Based Brain Volume Scoring in Cerebral Malaria is Externally Valid and Applicable to Lower-Resolution Images" />
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<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: Children with cerebral malaria have an elevated risk of mortality and neurologic morbidity. Both mortality and morbidity are associated with initially increased brain volume on MR imaging, as graded by the Brain Volume Score, a subjective ordinal rating scale created specifically for brain MRIs in children with cerebral malaria. For the Brain Volume Score to be more widely clinically useful, we aimed to determine its independent reproducibility and whether it can be applicable to lower-resolution MRIs.

MATERIALS AND METHODS: To assess the independent reproducibility of the Brain Volume Score, radiologists not associated with the initial study were trained to score MRIs from a new cohort of patients with cerebral malaria. These scores were then compared with survival and neurologic outcomes. To assess the applicability to lower-resolution MRI, we assigned Brain Volume Scores to brain MRIs degraded to simulate a very-low-field (64 mT) portable scanner and compared these with the original scores assigned to the original nondegraded MRIs.

RESULTS: Brain Volume Scores on the new cohort of patients with cerebral malaria were highly associated with outcomes (OR for mortality = 16, P  &lt; .001). Scoring of the simulated degraded images remained consistent with the Brain Volume Scores assigned to the original higher-quality (0.35 T) images (intraclass coefficients &gt; 0.86).

CONCLUSIONS: Our findings demonstrate that the Brain Volume Score is externally valid in reproducibly predicting outcomes and can be reliably assigned to lower-resolution images.

BVS
:   Brain Volume Score
CM
:   cerebral malaria" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node105604--7" data-node-nid="105604" id="top-node-105604--8534834868" data-pisa="ajnr;ajnr.A8098v1" data-pisa-master="ajnr;ajnr.A8098" data-apath="/ajnr/early/2024/01/11/ajnr.A8098.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">PEDIATRIC NEUROIMAGING</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">MRI-Based Brain Volume Scoring in Cerebral Malaria is Externally Valid and Applicable to Lower-Resolution Images</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Manu S. Goyal</span>, <span class="highwire-citation-author" data-delta="1">Lorenna Vidal</span>, <span class="highwire-citation-author" data-delta="2">Karen Chetcuti</span>, <span class="highwire-citation-author" data-delta="3">Cowles Chilingulo</span>, <span class="highwire-citation-author" data-delta="4">Khalid Ibrahim</span>, <span class="highwire-citation-author" data-delta="5">Jeffrey Zhang</span>, <span class="highwire-citation-author" data-delta="6">Dylan S. Small</span>, <span class="highwire-citation-author" data-delta="7">Karl B. Seydel</span>, <span class="highwire-citation-author" data-delta="8">Nicole O’Brien</span>, <span class="highwire-citation-author" data-delta="9">Terrie E. Taylor</span> and <span class="highwire-citation-author" data-delta="10">Douglas G. Postels</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">January 2024,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8098 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-105604--8534834868" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Manu S. Goyal </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Mallinckrodt Institute of Radiology (M.S.G.), Washington University School of Medicine, St. Louis, Missouri</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=Manu%2BS.%2BGoyal%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=Goyal%20MS&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%3AManu%2BS.%2BGoyal%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/0000-0003-1970-4270" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Manu S. Goyal</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Lorenna Vidal </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Children’s Hospital of Philadelphia (L.V.), Philadelphia, Pennsylvania</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=Lorenna%2BVidal%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=Vidal%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%3ALorenna%2BVidal%2B" rel="nofollow" class="" data-icon-position="" 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Blantyre, Malawi</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=Cowles%2BChilingulo%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=Chilingulo%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"><a href="/search/author1%3ACowles%2BChilingulo%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/0000-0001-9929-6451" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Cowles Chilingulo</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Khalid Ibrahim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Radiology (K.C., C.C.), Queen Elizabeth Central Hospital, Blantyre, Malawi</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=Khalid%2BIbrahim%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=Ibrahim%20K&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%3AKhalid%2BIbrahim%2B" rel="nofollow" class="" data-icon-position="" 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Small </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Statistics and Data Science (J.Z., D.S.S.), The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania</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=Dylan%2BS.%2BSmall%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=Small%20DS&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%3ADylan%2BS.%2BSmall%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">Karl B. Seydel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>College of Osteopathic Medicine (K.B.S., T.E.T.), MI State University, East Lansing, Michigan</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi</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=Karl%2BB.%2BSeydel%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=Seydel%20KB&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%3AKarl%2BB.%2BSeydel%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/0000-0001-9859-9549" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Karl B. Seydel</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">Nicole O’Brien </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>g</span>Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi</div><div class='author-affiliation'><span class='nlm-sup'>h</span>Nationwide Children’s Hospital (N.O.), Division of Pediatric Critical Care, Columbus, Ohio</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=Nicole%2BO%E2%80%99Brien%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=O%E2%80%99Brien%20N&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%3ANicole%2BO%25E2%2580%2599Brien%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-9"><div class="author-tooltip-name">Terrie E. 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Kamuzu University of Health Sciences, Blantyre, Malawi</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=Terrie%2BE.%2BTaylor%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=Taylor%20TE&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%3ATerrie%2BE.%2BTaylor%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/0000-0001-7416-3986" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Terrie E. 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Kamuzu University of Health Sciences, Blantyre, Malawi</div><div class='author-affiliation'><span class='nlm-sup'>i</span>Division of Neurology (D.G.P.), The George Washington University, Children’s National Medical Center, Washington, DC</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=Douglas%2BG.%2BPostels%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=Postels%20DG&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%3ADouglas%2BG.%2BPostels%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/0000-0001-5815-0691" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Douglas G. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">Manu S. Goyal</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">Lorenna Vidal</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-3"><span class="name">Karen Chetcuti</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a><span class="xref-sep">,</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">d</a>, </li><li class="contributor" id="contrib-4"><span class="name">Cowles Chilingulo</span><a id="xref-aff-4-2" class="xref-aff" href="#aff-4">d</a>, </li><li class="contributor" id="contrib-5"><span class="name">Khalid Ibrahim</span><a id="xref-aff-4-3" class="xref-aff" href="#aff-4">d</a>, </li><li class="contributor" id="contrib-6"><span class="name">Jeffrey Zhang</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">e</a>, </li><li class="contributor" id="contrib-7"><span class="name">Dylan S. Small</span><a id="xref-aff-5-2" class="xref-aff" href="#aff-5">e</a>, </li><li class="contributor" id="contrib-8"><span class="name">Karl B. Seydel</span><a id="xref-aff-6-1" class="xref-aff" href="#aff-6">f</a><span class="xref-sep">,</span><a id="xref-aff-7-1" class="xref-aff" href="#aff-7">g</a>, </li><li class="contributor" id="contrib-9"><span class="name">Nicole O’Brien</span><a id="xref-aff-7-2" class="xref-aff" href="#aff-7">g</a><span class="xref-sep">,</span><a id="xref-aff-8-1" class="xref-aff" href="#aff-8">h</a>, </li><li class="contributor" id="contrib-10"><span class="name">Terrie E. Taylor</span><a id="xref-aff-6-2" class="xref-aff" href="#aff-6">f</a><span class="xref-sep">,</span><a id="xref-aff-7-3" class="xref-aff" href="#aff-7">g</a> and </li><li class="last" id="contrib-11"><span class="name">Douglas G. Postels</span><a id="xref-aff-7-4" class="xref-aff" href="#aff-7">g</a><span class="xref-sep">,</span><a id="xref-aff-9-1" class="xref-aff" href="#aff-9">i</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Mallinckrodt Institute of Radiology (M.S.G.), Washington University School of Medicine, St. Louis, Missouri</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Children’s Hospital of Philadelphia (L.V.), Philadelphia, Pennsylvania</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Department of Radiology (K.C.), Kamuzu University of Health Sciences, Blantyre, Malawi</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>d</sup>Department of Radiology (K.C., C.C.), Queen Elizabeth Central Hospital, Blantyre, Malawi</address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address><sup>e</sup>Department of Statistics and Data Science (J.Z., D.S.S.), The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania</address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address><sup>f</sup>College of Osteopathic Medicine (K.B.S., T.E.T.), MI State University, East Lansing, Michigan</address></li><li class="aff"><a id="aff-7" name="aff-7"></a><address><sup>g</sup>Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi</address></li><li class="aff"><a id="aff-8" name="aff-8"></a><address><sup>h</sup>Nationwide Children’s Hospital (N.O.), Division of Pediatric Critical Care, Columbus, Ohio</address></li><li class="aff"><a id="aff-9" name="aff-9"></a><address><sup>i</sup>Division of Neurology (D.G.P.), The George Washington University, Children’s National Medical Center, Washington, DC</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Manu S. Goyal, MD, <span class="addr-line">MSc, Campus Box 8131-50-5, 510 S. Kingshighway Blvd, St. Louis, MO 63110</span>; e-mail: <span class="em-link"><span class="em-addr">goyalm{at}wustl.edu</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/early/2024/01/11/ajnr.A8098.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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