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<meta name="DC.Title" content="Diagnostic Performance of TOF, 4D MRA, ASL and SWAN sequences in the Post-Radiosurgery Monitoring of Brain Arteriovenous Malformation: Systematic Review and Meta-Analysis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8420" />
<meta name="DC.Date" content="2024-07-18" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Brain Arteriovenous malformations (AVMs) are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurological deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment modality that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery. Currently, Digital Subtraction Angiography (DSA) stands as the preferred imaging modality. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aim to evaluate the efficacy of magnetic resonance imaging (MRI) sequences for monitoring brain AVMs after radiosurgery.

DATA SOURCE: A comprehensive search of PubMed, Scopus, Web of Science, and Embase databases was done and methodological quality assessment performed with the QUADAS-2 checklist diagnostic test accuracy.

DATA ANALYSIS AND SYNTHESIS: We utilized the bivariate random-effects meta-analysis model (BRMA) with STATA/MP 17 software for data analysis. No significant publication bias was detected.14 studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85%) and specificity (99%) in detecting residual AVMs. Different MRI sequences, including 3DTOF MRA, 4D-MRA, and ASL demonstrated varying diagnostic accuracies with area under the curve (AUC) of 0.92, 0.97, and 0.96 respectively. 4D-MRA exhibited a sensitivity of 72% and specificity of 99%, ASL showed a sensitivity of 90% and specificity of 92% while 3D-TOF MRA showed 90% sensitivity and 87% specificity.

LIMITATIONS: Meta-regression did not fully explain the sources of heterogeneity. Only one study assessed the SWAN method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results.

CONCLUSIONS: MRI sequences show acceptable diagnostic performance in post-radiosurgery monitoring of brain AVMs, with ASL and 4D-MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, Further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, taking into account their risk-benefit profile, with the potential to establish them as the recommended standard." />
<meta name="DC.Contributor" content="Shahriar Kolahi" />
<meta name="DC.Contributor" content="Mohammadreza Tahamtan" />
<meta name="DC.Contributor" content="Masoumeh Sarvari" />
<meta name="DC.Contributor" content="Diana Zarei" />
<meta name="DC.Contributor" content="Mahshad Afsharzadeh" />
<meta name="DC.Contributor" content="Kavous Firouznia" />
<meta name="DC.Contributor" content="David M. Yousem" />
<meta name="article:published_time" content="2024-07-18" />
<meta name="article:section" content="SYSTEMATIC REVIEW/META-ANALYSIS" />
<meta name="citation_title" content="Diagnostic Performance of TOF, 4D MRA, ASL and SWAN sequences in the Post-Radiosurgery Monitoring of Brain Arteriovenous Malformation: Systematic Review and Meta-Analysis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;ABSTRACT&lt;/h3&gt;
&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Brain Arteriovenous malformations (AVMs) are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurological deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment modality that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery. Currently, Digital Subtraction Angiography (DSA) stands as the preferred imaging modality. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aim to evaluate the efficacy of magnetic resonance imaging (MRI) sequences for monitoring brain AVMs after radiosurgery.&lt;/p&gt;&lt;h3&gt;DATA SOURCE:&lt;/h3&gt;
&lt;p&gt;A comprehensive search of PubMed, Scopus, Web of Science, and Embase databases was done and methodological quality assessment performed with the QUADAS-2 checklist diagnostic test accuracy.&lt;/p&gt;&lt;h3&gt;DATA ANALYSIS AND SYNTHESIS:&lt;/h3&gt;
&lt;p&gt;We utilized the bivariate random-effects meta-analysis model (BRMA) with STATA/MP 17 software for data analysis. No significant publication bias was detected.14 studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85%) and specificity (99%) in detecting residual AVMs. Different MRI sequences, including 3DTOF MRA, 4D-MRA, and ASL demonstrated varying diagnostic accuracies with area under the curve (AUC) of 0.92, 0.97, and 0.96 respectively. 4D-MRA exhibited a sensitivity of 72% and specificity of 99%, ASL showed a sensitivity of 90% and specificity of 92% while 3D-TOF MRA showed 90% sensitivity and 87% specificity.&lt;/p&gt;&lt;h3&gt;LIMITATIONS:&lt;/h3&gt;
&lt;p&gt;Meta-regression did not fully explain the sources of heterogeneity. Only one study assessed the SWAN method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;MRI sequences show acceptable diagnostic performance in post-radiosurgery monitoring of brain AVMs, with ASL and 4D-MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, Further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, taking into account their risk-benefit profile, with the potential to establish them as the recommended standard.&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="2024/07/18" />
<meta name="citation_mjid" content="ajnr;ajnr.A8420v1" />
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<meta name="citation_section" content="SYSTEMATIC REVIEW/META-ANALYSIS" />
<meta name="citation_author" content="Shahriar Kolahi" />
<meta name="citation_author_institution" content="From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland." />
<meta name="citation_author" content="Mohammadreza Tahamtan" />
<meta name="citation_author_institution" content="From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland." />
<meta name="citation_author" content="Masoumeh Sarvari" />
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<meta name="citation_author" content="Diana Zarei" />
<meta name="citation_author_institution" content="From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland." />
<meta name="citation_author" content="Mahshad Afsharzadeh" />
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<meta name="citation_author" content="Kavous Firouznia" />
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<meta name="citation_author" content="David M. Yousem" />
<meta name="citation_author_institution" content="From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland." />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Brain Arteriovenous malformations (AVMs) are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurological deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment modality that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery. Currently, Digital Subtraction Angiography (DSA) stands as the preferred imaging modality. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aim to evaluate the efficacy of magnetic resonance imaging (MRI) sequences for monitoring brain AVMs after radiosurgery.

DATA SOURCE: A comprehensive search of PubMed, Scopus, Web of Science, and Embase databases was done and methodological quality assessment performed with the QUADAS-2 checklist diagnostic test accuracy.

DATA ANALYSIS AND SYNTHESIS: We utilized the bivariate random-effects meta-analysis model (BRMA) with STATA/MP 17 software for data analysis. No significant publication bias was detected.14 studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85%) and specificity (99%) in detecting residual AVMs. Different MRI sequences, including 3DTOF MRA, 4D-MRA, and ASL demonstrated varying diagnostic accuracies with area under the curve (AUC) of 0.92, 0.97, and 0.96 respectively. 4D-MRA exhibited a sensitivity of 72% and specificity of 99%, ASL showed a sensitivity of 90% and specificity of 92% while 3D-TOF MRA showed 90% sensitivity and 87% specificity.

LIMITATIONS: Meta-regression did not fully explain the sources of heterogeneity. Only one study assessed the SWAN method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results.

CONCLUSIONS: MRI sequences show acceptable diagnostic performance in post-radiosurgery monitoring of brain AVMs, with ASL and 4D-MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, Further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, taking into account their risk-benefit profile, with the potential to establish them as the recommended standard." />
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<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Brain Arteriovenous malformations (AVMs) are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurological deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment modality that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery. Currently, Digital Subtraction Angiography (DSA) stands as the preferred imaging modality. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aim to evaluate the efficacy of magnetic resonance imaging (MRI) sequences for monitoring brain AVMs after radiosurgery.

DATA SOURCE: A comprehensive search of PubMed, Scopus, Web of Science, and Embase databases was done and methodological quality assessment performed with the QUADAS-2 checklist diagnostic test accuracy.

DATA ANALYSIS AND SYNTHESIS: We utilized the bivariate random-effects meta-analysis model (BRMA) with STATA/MP 17 software for data analysis. No significant publication bias was detected.14 studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85%) and specificity (99%) in detecting residual AVMs. Different MRI sequences, including 3DTOF MRA, 4D-MRA, and ASL demonstrated varying diagnostic accuracies with area under the curve (AUC) of 0.92, 0.97, and 0.96 respectively. 4D-MRA exhibited a sensitivity of 72% and specificity of 99%, ASL showed a sensitivity of 90% and specificity of 92% while 3D-TOF MRA showed 90% sensitivity and 87% specificity.

LIMITATIONS: Meta-regression did not fully explain the sources of heterogeneity. Only one study assessed the SWAN method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results.

CONCLUSIONS: MRI sequences show acceptable diagnostic performance in post-radiosurgery monitoring of brain AVMs, with ASL and 4D-MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, Further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, taking into account their risk-benefit profile, with the potential to establish them as the recommended standard." />
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      <h1 class="highwire-cite-title" id="page-title">Diagnostic Performance of TOF, 4D MRA, ASL and SWAN sequences in the Post-Radiosurgery Monitoring of Brain Arteriovenous Malformation: Systematic Review and Meta-Analysis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Shahriar Kolahi</span>, <span class="highwire-citation-author" data-delta="1">Mohammadreza Tahamtan</span>, <span class="highwire-citation-author" data-delta="2">Masoumeh Sarvari</span>, <span class="highwire-citation-author" data-delta="3">Diana Zarei</span>, <span class="highwire-citation-author" data-delta="4">Mahshad Afsharzadeh</span>, <span class="highwire-citation-author" data-delta="5">Kavous Firouznia</span> and <span class="highwire-citation-author" data-delta="6">David M. Yousem</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">July 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8420; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8420 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-109102--6453557101" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Shahriar Kolahi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland.</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=Shahriar%2BKolahi%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=Kolahi%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%3AShahriar%2BKolahi%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">Mohammadreza Tahamtan </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland.</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=Mohammadreza%2BTahamtan%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=Tahamtan%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%3AMohammadreza%2BTahamtan%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">Masoumeh Sarvari </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland.</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=Masoumeh%2BSarvari%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=Sarvari%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%3AMasoumeh%2BSarvari%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">Diana Zarei </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland.</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=Diana%2BZarei%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=Zarei%20D&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%3ADiana%2BZarei%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">Mahshad Afsharzadeh </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland.</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=Mahshad%2BAfsharzadeh%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=Afsharzadeh%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%3AMahshad%2BAfsharzadeh%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">Kavous Firouznia </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland.</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=Kavous%2BFirouznia%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=Firouznia%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%3AKavous%2BFirouznia%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">David M. Yousem </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Departments of Radiology (S.K., M.T., D.Z., K.F.) and Endocrinology and Metabolism Research Center (M.S.), Tehran University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (M.A.), Isfahan University of Medical Sciences, Isfahan, Iran; and Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland.</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=David%2BM.%2BYousem%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=Yousem%20DM&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%3ADavid%2BM.%2BYousem%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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