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<meta name="DC.Title" content="Non-contrast MRI Surveillance of Craniopharyngiomas using a balanced steady state free precession (bSSFP) sequence" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8439" />
<meta name="DC.Date" content="2024-08-09" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Contrast-enhanced MRI (CEMRI) is a commonly used imaging modality for craniopharyngioma surveillance; however, it carries risks such as allergic reaction and gadolinium deposition. This study evaluates the efficacy of non-contrast enhanced MRI (NCMRI) with a balanced steady state free precession (bSSFP) sequence compared with CEMRI T1-weighted imaging for craniopharyngioma surveillance.

MATERIALS AND METHODS: 29 craniopharyngioma patients (16 female/13 male, mean age=21.5± 4.3 years) with CEMRIs including a bSSFP sequence were evaluated. For each patient, 2 blinded neuroradiologists compared the dimensions of residual craniopharyngioma on noncontrast and contrast-enhanced sequences. Tumor volume and solid/cystic component measurements were evaluated using paired t-tests. Diagnostic confidence levels for NC-and CE evaluations were measured using a 3-point scale (2=confident,1=adequate,0=unsure). Analyses of tumor involvement of cranial nerves and adjacent vasculature and diagnostic confidence were performed using Fisher’s exact and chi-square tests.

RESULTS: No significant difference was observed between residual tumor volumes in both studies (18.86±21.67 cm3 vs 17.64±23.85 cm3, p=0.55) and measurements of dominant solid component volume, number of cystic components, and largest cystic component volume (2.71±3.47 cm3 vs 3.95±5.51 cm3, p=0.10; 2.5±1.5 vs 2.9±1.5, p=0.10; 7.61±13.41 vs 6.84±13.37 cm3, p=0.22, respectively). Tumoral involvement of cranial nerves II (p=0.64), III (p=0.42), and adjacent vasculature (p=0.05) showed no significant differences in detection. Diagnostic confidence was comparable evaluating cranial nerve II, vascular structures, and third ventricle (p&gt;0.05) involvement. Higher levels of confidence were observed with bSSFP sequences for detection of cranial nerve III involvement (p=0.0001) and with ce-T1W for cavernous sinus involvement (p=0.02).

CONCLUSIONS: NCMRI techniques using a bSSFP sequence provides similar characterization of craniopharyngiomas as contrast enhanced techniques.

ABBREVIATIONS: 3D DRIVE, 3-dimensional driven equilibrium; ACA, anterior cerebral artery; bSSFP, balanced steady-state free precession; ce-T1W, contrast-enhanced T1-weighted imaging; CN, cranial nerve; GTR, gross total resection; STR, subtotal resection" />
<meta name="DC.Contributor" content="Kelly Trinh" />
<meta name="DC.Contributor" content="Michael Tang" />
<meta name="DC.Contributor" content="Claire White-Dzuro" />
<meta name="DC.Contributor" content="Min Lang" />
<meta name="DC.Contributor" content="Karen Buch" />
<meta name="DC.Contributor" content="Sandra Rincon" />
<meta name="article:published_time" content="2024-08-09" />
<meta name="article:section" content="ORIGINAL RESEARCH" />
<meta name="citation_title" content="Non-contrast MRI Surveillance of Craniopharyngiomas using a balanced steady state free precession (bSSFP) sequence" />
<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;Contrast-enhanced MRI (CEMRI) is a commonly used imaging modality for craniopharyngioma surveillance; however, it carries risks such as allergic reaction and gadolinium deposition. This study evaluates the efficacy of non-contrast enhanced MRI (NCMRI) with a balanced steady state free precession (bSSFP) sequence compared with CEMRI T1-weighted imaging for craniopharyngioma surveillance.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;29 craniopharyngioma patients (16 female/13 male, mean age=21.5± 4.3 years) with CEMRIs including a bSSFP sequence were evaluated. For each patient, 2 blinded neuroradiologists compared the dimensions of residual craniopharyngioma on noncontrast and contrast-enhanced sequences. Tumor volume and solid/cystic component measurements were evaluated using paired t-tests. Diagnostic confidence levels for NC-and CE evaluations were measured using a 3-point scale (2=confident,1=adequate,0=unsure). Analyses of tumor involvement of cranial nerves and adjacent vasculature and diagnostic confidence were performed using Fisher’s exact and chi-square tests.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;No significant difference was observed between residual tumor volumes in both studies (18.86±21.67 cm&lt;sup&gt;3&lt;/sup&gt; vs 17.64±23.85 cm&lt;sup&gt;3&lt;/sup&gt;, p=0.55) and measurements of dominant solid component volume, number of cystic components, and largest cystic component volume (2.71±3.47 cm&lt;sup&gt;3&lt;/sup&gt; vs 3.95±5.51 cm&lt;sup&gt;3&lt;/sup&gt;, p=0.10; 2.5±1.5 vs 2.9±1.5, p=0.10; 7.61±13.41 vs 6.84±13.37 cm&lt;sup&gt;3&lt;/sup&gt;, p=0.22, respectively). Tumoral involvement of cranial nerves II (p=0.64), III (p=0.42), and adjacent vasculature (p=0.05) showed no significant differences in detection. Diagnostic confidence was comparable evaluating cranial nerve II, vascular structures, and third ventricle (p&amp;gt;0.05) involvement. Higher levels of confidence were observed with bSSFP sequences for detection of cranial nerve III involvement (p=0.0001) and with ce-T1W for cavernous sinus involvement (p=0.02).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;NCMRI techniques using a bSSFP sequence provides similar characterization of craniopharyngiomas as contrast enhanced techniques.&lt;/p&gt;&lt;p&gt;ABBREVIATIONS: 3D DRIVE, 3-dimensional driven equilibrium; ACA, anterior cerebral artery; bSSFP, balanced steady-state free precession; ce-T1W, contrast-enhanced T1-weighted imaging; CN, cranial nerve; GTR, gross total resection; STR, subtotal resection&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="2024/08/09" />
<meta name="citation_mjid" content="ajnr;ajnr.A8439v1" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="ORIGINAL RESEARCH" />
<meta name="citation_author" content="Kelly Trinh" />
<meta name="citation_author_institution" content="From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.)." />
<meta name="citation_author" content="Michael Tang" />
<meta name="citation_author_institution" content="From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.)." />
<meta name="citation_author" content="Claire White-Dzuro" />
<meta name="citation_author_institution" content="From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.)." />
<meta name="citation_author" content="Min Lang" />
<meta name="citation_author_institution" content="From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.)." />
<meta name="citation_author" content="Karen Buch" />
<meta name="citation_author_institution" content="From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.)." />
<meta name="citation_author" content="Sandra Rincon" />
<meta name="citation_author_institution" content="From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.)." />
<meta name="twitter:title" content="Non-contrast MRI Surveillance of Craniopharyngiomas using a balanced steady state free precession (bSSFP) sequence" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Contrast-enhanced MRI (CEMRI) is a commonly used imaging modality for craniopharyngioma surveillance; however, it carries risks such as allergic reaction and gadolinium deposition. This study evaluates the efficacy of non-contrast enhanced MRI (NCMRI) with a balanced steady state free precession (bSSFP) sequence compared with CEMRI T1-weighted imaging for craniopharyngioma surveillance.

MATERIALS AND METHODS: 29 craniopharyngioma patients (16 female/13 male, mean age=21.5± 4.3 years) with CEMRIs including a bSSFP sequence were evaluated. For each patient, 2 blinded neuroradiologists compared the dimensions of residual craniopharyngioma on noncontrast and contrast-enhanced sequences. Tumor volume and solid/cystic component measurements were evaluated using paired t-tests. Diagnostic confidence levels for NC-and CE evaluations were measured using a 3-point scale (2=confident,1=adequate,0=unsure). Analyses of tumor involvement of cranial nerves and adjacent vasculature and diagnostic confidence were performed using Fisher’s exact and chi-square tests.

RESULTS: No significant difference was observed between residual tumor volumes in both studies (18.86±21.67 cm3 vs 17.64±23.85 cm3, p=0.55) and measurements of dominant solid component volume, number of cystic components, and largest cystic component volume (2.71±3.47 cm3 vs 3.95±5.51 cm3, p=0.10; 2.5±1.5 vs 2.9±1.5, p=0.10; 7.61±13.41 vs 6.84±13.37 cm3, p=0.22, respectively). Tumoral involvement of cranial nerves II (p=0.64), III (p=0.42), and adjacent vasculature (p=0.05) showed no significant differences in detection. Diagnostic confidence was comparable evaluating cranial nerve II, vascular structures, and third ventricle (p&gt;0.05) involvement. Higher levels of confidence were observed with bSSFP sequences for detection of cranial nerve III involvement (p=0.0001) and with ce-T1W for cavernous sinus involvement (p=0.02).

CONCLUSIONS: NCMRI techniques using a bSSFP sequence provides similar characterization of craniopharyngiomas as contrast enhanced techniques.

ABBREVIATIONS: 3D DRIVE, 3-dimensional driven equilibrium; ACA, anterior cerebral artery; bSSFP, balanced steady-state free precession; ce-T1W, contrast-enhanced T1-weighted imaging; CN, cranial nerve; GTR, gross total resection; STR, subtotal resection" />
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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: Contrast-enhanced MRI (CEMRI) is a commonly used imaging modality for craniopharyngioma surveillance; however, it carries risks such as allergic reaction and gadolinium deposition. This study evaluates the efficacy of non-contrast enhanced MRI (NCMRI) with a balanced steady state free precession (bSSFP) sequence compared with CEMRI T1-weighted imaging for craniopharyngioma surveillance.

MATERIALS AND METHODS: 29 craniopharyngioma patients (16 female/13 male, mean age=21.5± 4.3 years) with CEMRIs including a bSSFP sequence were evaluated. For each patient, 2 blinded neuroradiologists compared the dimensions of residual craniopharyngioma on noncontrast and contrast-enhanced sequences. Tumor volume and solid/cystic component measurements were evaluated using paired t-tests. Diagnostic confidence levels for NC-and CE evaluations were measured using a 3-point scale (2=confident,1=adequate,0=unsure). Analyses of tumor involvement of cranial nerves and adjacent vasculature and diagnostic confidence were performed using Fisher’s exact and chi-square tests.

RESULTS: No significant difference was observed between residual tumor volumes in both studies (18.86±21.67 cm3 vs 17.64±23.85 cm3, p=0.55) and measurements of dominant solid component volume, number of cystic components, and largest cystic component volume (2.71±3.47 cm3 vs 3.95±5.51 cm3, p=0.10; 2.5±1.5 vs 2.9±1.5, p=0.10; 7.61±13.41 vs 6.84±13.37 cm3, p=0.22, respectively). Tumoral involvement of cranial nerves II (p=0.64), III (p=0.42), and adjacent vasculature (p=0.05) showed no significant differences in detection. Diagnostic confidence was comparable evaluating cranial nerve II, vascular structures, and third ventricle (p&gt;0.05) involvement. Higher levels of confidence were observed with bSSFP sequences for detection of cranial nerve III involvement (p=0.0001) and with ce-T1W for cavernous sinus involvement (p=0.02).

CONCLUSIONS: NCMRI techniques using a bSSFP sequence provides similar characterization of craniopharyngiomas as contrast enhanced techniques.

ABBREVIATIONS: 3D DRIVE, 3-dimensional driven equilibrium; ACA, anterior cerebral artery; bSSFP, balanced steady-state free precession; ce-T1W, contrast-enhanced T1-weighted imaging; CN, cranial nerve; GTR, gross total resection; STR, subtotal resection" />
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    <title>Non-contrast MRI Surveillance of Craniopharyngiomas using a balanced steady state free precession (bSSFP) sequence | American Journal of Neuroradiology</title>  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Kelly Trinh</span>, <span class="highwire-citation-author" data-delta="1">Michael Tang</span>, <span class="highwire-citation-author" data-delta="2">Claire White-Dzuro</span>, <span class="highwire-citation-author" data-delta="3">Min Lang</span>, <span class="highwire-citation-author" data-delta="4">Karen Buch</span> and <span class="highwire-citation-author" data-delta="5">Sandra Rincon</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8439; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8439 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-109702--81057603814" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Kelly Trinh </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.).</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=Kelly%2BTrinh%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=Trinh%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%3AKelly%2BTrinh%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">Michael Tang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.).</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=Michael%2BTang%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=Tang%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%3AMichael%2BTang%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">Claire White-Dzuro </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.).</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=Claire%2BWhite-Dzuro%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=White-Dzuro%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%3AClaire%2BWhite-Dzuro%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">Min Lang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.).</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=Min%2BLang%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=Lang%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%3AMin%2BLang%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">Karen Buch </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.).</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=Karen%2BBuch%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=Buch%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%3AKaren%2BBuch%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">Sandra Rincon </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.).</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=Sandra%2BRincon%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=Rincon%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%3ASandra%2BRincon%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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    <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">Kelly Trinh</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1"></a><a id="xref-fn-1-1" class="xref-fn" href="#fn-1">*</a>, </li><li class="contributor" id="contrib-2"><span class="name">Michael Tang</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1"></a><a id="xref-fn-1-2" class="xref-fn" href="#fn-1">*</a>, </li><li class="contributor" id="contrib-3"><span class="name">Claire White-Dzuro</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-4"><span class="name">Min Lang</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-5"><span class="name">Karen Buch</span><a id="xref-aff-1-5" class="xref-aff" href="#aff-1"></a> and </li><li class="last" id="contrib-6"><span class="name">Sandra Rincon</span><a id="xref-aff-1-6" class="xref-aff" href="#aff-1"></a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address>From the Texas Tech University Health Sciences Center, Lubbock, Texas, USA (K.T.); School of Public Health, Boston University, Boston, Massachusetts, USA (M.T.); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C.W.D.); Harvard Medical School, Boston, Massachusetts, USA (M.L., K.B., S.R.); Massachusetts General Hospital, Boston, Massachusetts, USA (M.L., K.B., S.R.).</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Sandra Rincon, MD Division of Neuroradiology Department of Radiology Massachusetts General Hospital 55 Fruit Street, Boston, MA Phone number: 617-726-8320 Email: <span class="em-link"><span class="em-addr">srincon{at}mgh.harvard.edu</span></span></li></ol></div></div></div>  </div>

  
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