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<meta name="DC.Title" content="Management Outcomes after Image-guided Percutaneous Biopsy for Suspected Vertebral Osteomyelitis-Discitis" />
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<meta name="DC.Date" content="2024-12-23" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Studies show a modest yield for image-guided biopsy of suspected vertebral osteomyelitis-discitis. Many studies evaluate factors to improve diagnostic yield, and few studies assess how biopsy results impact clinical management. We aim to evaluate the impact of biopsy results on clinical management in suspected vertebral osteomyelitis-discitis.

MATERIALS AND METHODS: We performed a retrospective study of patients who underwent image-guided biopsy for suspected vertebral osteomyelitis-discitis. Data collected included risk factors, imaging findings, laboratory values, antibiotics, biopsy procedure details, microbiology and pathology results and clinical course. Factors assessed for management change included whether biopsy results affected antibiotic type or course, decision to start or stop antibiotics, surgical decisions or if an alternate diagnosis was determined.

RESULTS: 310 biopsies were included. Biopsy yield with true positive culture results was 34% (104/310) and similar for patients on antibiotics (36%, 34/94) and off antibiotics (32%, 66/204). Yield was greater when disc was sampled (36%, 82/228) versus bone only (8%, 2/24) and with aspiration of disc and/or bone (42%, 39/92) versus core only (29%, 56/193). With positive blood cultures prior to biopsy, biopsy yield was 50% (22/44) with concordance and discordance rates of 75% (18/24) and 17% (4/24) respectively, and 8% (2/24) of positive biopsy results deemed contaminants. Management was affected in 36% (113/310) of all biopsies and in 78% (81/104) of biopsies with a positive culture result. No management change occurred in 57% (177/310) of biopsies. Management change was unclear in 6% (20/310). Biopsy results changed antibiotics in 27% (85/310). Management change occurred in 23% (10/44) of cases with prior positive blood culture compared to 41% (93/233) without a prior culture source (P = 0.024). Negative culture results influenced management in 16% (32/194).

CONCLUSIONS: Image-guided biopsy for vertebral osteomyelitis-discitis has a meaningful impact on management despite modest yield. Greatest management impact is seen with positive culture results, no prior culture source and patients not on antibiotics at the time of biopsy. Biopsy culture yield is not affected by preceding antibiotics, and yield is greater with disc sampling and aspiration.

ABBREVIATIONS: VO = vertebral osteomyelitis-discitis; WBC = white blood cell count; ESR = erythrocyte sedimentation rate; CRP = C-reactive protein; MC = management change; NMC = no management change; UC = unclear management change; Abx = antibiotics" />
<meta name="DC.Contributor" content="Dania G. Malik" />
<meta name="DC.Contributor" content="Mathew V. Smith" />
<meta name="DC.Contributor" content="Gabriel M. Swenson" />
<meta name="DC.Contributor" content="Robert E. Grady" />
<meta name="DC.Contributor" content="Felix E. Diehn" />
<meta name="DC.Contributor" content="Erik H. Middlebrooks" />
<meta name="DC.Contributor" content="Jeffrey S. Ross" />
<meta name="DC.Contributor" content="TanyaJ. Rath" />
<meta name="article:published_time" content="2024-12-23" />
<meta name="article:section" content="ORIGINAL RESEARCH" />
<meta name="citation_title" content="Management Outcomes after Image-guided Percutaneous Biopsy for Suspected Vertebral Osteomyelitis-Discitis" />
<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;Studies show a modest yield for image-guided biopsy of suspected vertebral osteomyelitis-discitis. Many studies evaluate factors to improve diagnostic yield, and few studies assess how biopsy results impact clinical management. We aim to evaluate the impact of biopsy results on clinical management in suspected vertebral osteomyelitis-discitis.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We performed a retrospective study of patients who underwent image-guided biopsy for suspected vertebral osteomyelitis-discitis. Data collected included risk factors, imaging findings, laboratory values, antibiotics, biopsy procedure details, microbiology and pathology results and clinical course. Factors assessed for management change included whether biopsy results affected antibiotic type or course, decision to start or stop antibiotics, surgical decisions or if an alternate diagnosis was determined.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;310 biopsies were included. Biopsy yield with true positive culture results was 34% (104/310) and similar for patients on antibiotics (36%, 34/94) and off antibiotics (32%, 66/204). Yield was greater when disc was sampled (36%, 82/228) versus bone only (8%, 2/24) and with aspiration of disc and/or bone (42%, 39/92) versus core only (29%, 56/193). With positive blood cultures prior to biopsy, biopsy yield was 50% (22/44) with concordance and discordance rates of 75% (18/24) and 17% (4/24) respectively, and 8% (2/24) of positive biopsy results deemed contaminants. Management was affected in 36% (113/310) of all biopsies and in 78% (81/104) of biopsies with a positive culture result. No management change occurred in 57% (177/310) of biopsies. Management change was unclear in 6% (20/310). Biopsy results changed antibiotics in 27% (85/310). Management change occurred in 23% (10/44) of cases with prior positive blood culture compared to 41% (93/233) without a prior culture source (P = 0.024). Negative culture results influenced management in 16% (32/194).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Image-guided biopsy for vertebral osteomyelitis-discitis has a meaningful impact on management despite modest yield. Greatest management impact is seen with positive culture results, no prior culture source and patients not on antibiotics at the time of biopsy. Biopsy culture yield is not affected by preceding antibiotics, and yield is greater with disc sampling and aspiration.&lt;/p&gt;&lt;p&gt;ABBREVIATIONS: VO = vertebral osteomyelitis-discitis; WBC = white blood cell count; ESR = erythrocyte sedimentation rate; CRP = C-reactive protein; MC = management change; NMC = no management change; UC = unclear management change; Abx = antibiotics&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="2024/12/23" />
<meta name="citation_mjid" content="ajnr;ajnr.A8630v1" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="ORIGINAL RESEARCH" />
<meta name="citation_author" content="Dania G. Malik" />
<meta name="citation_author_institution" content="From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA." />
<meta name="citation_author" content="Mathew V. Smith" />
<meta name="citation_author_institution" content="From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA." />
<meta name="citation_author" content="Gabriel M. Swenson" />
<meta name="citation_author_institution" content="From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA." />
<meta name="citation_author" content="Robert E. Grady" />
<meta name="citation_author_institution" content="From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA." />
<meta name="citation_author" content="Felix E. Diehn" />
<meta name="citation_author_institution" content="From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA." />
<meta name="citation_author" content="Erik H. Middlebrooks" />
<meta name="citation_author_institution" content="From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA." />
<meta name="citation_author" content="Jeffrey S. Ross" />
<meta name="citation_author_institution" content="From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA." />
<meta name="citation_author" content="TanyaJ. Rath" />
<meta name="citation_author_institution" content="From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA." />
<meta name="twitter:title" content="Management Outcomes after Image-guided Percutaneous Biopsy for Suspected Vertebral Osteomyelitis-Discitis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Studies show a modest yield for image-guided biopsy of suspected vertebral osteomyelitis-discitis. Many studies evaluate factors to improve diagnostic yield, and few studies assess how biopsy results impact clinical management. We aim to evaluate the impact of biopsy results on clinical management in suspected vertebral osteomyelitis-discitis.

MATERIALS AND METHODS: We performed a retrospective study of patients who underwent image-guided biopsy for suspected vertebral osteomyelitis-discitis. Data collected included risk factors, imaging findings, laboratory values, antibiotics, biopsy procedure details, microbiology and pathology results and clinical course. Factors assessed for management change included whether biopsy results affected antibiotic type or course, decision to start or stop antibiotics, surgical decisions or if an alternate diagnosis was determined.

RESULTS: 310 biopsies were included. Biopsy yield with true positive culture results was 34% (104/310) and similar for patients on antibiotics (36%, 34/94) and off antibiotics (32%, 66/204). Yield was greater when disc was sampled (36%, 82/228) versus bone only (8%, 2/24) and with aspiration of disc and/or bone (42%, 39/92) versus core only (29%, 56/193). With positive blood cultures prior to biopsy, biopsy yield was 50% (22/44) with concordance and discordance rates of 75% (18/24) and 17% (4/24) respectively, and 8% (2/24) of positive biopsy results deemed contaminants. Management was affected in 36% (113/310) of all biopsies and in 78% (81/104) of biopsies with a positive culture result. No management change occurred in 57% (177/310) of biopsies. Management change was unclear in 6% (20/310). Biopsy results changed antibiotics in 27% (85/310). Management change occurred in 23% (10/44) of cases with prior positive blood culture compared to 41% (93/233) without a prior culture source (P = 0.024). Negative culture results influenced management in 16% (32/194).

CONCLUSIONS: Image-guided biopsy for vertebral osteomyelitis-discitis has a meaningful impact on management despite modest yield. Greatest management impact is seen with positive culture results, no prior culture source and patients not on antibiotics at the time of biopsy. Biopsy culture yield is not affected by preceding antibiotics, and yield is greater with disc sampling and aspiration.

ABBREVIATIONS: VO = vertebral osteomyelitis-discitis; WBC = white blood cell count; ESR = erythrocyte sedimentation rate; CRP = C-reactive protein; MC = management change; NMC = no management change; UC = unclear management change; Abx = antibiotics" />
<meta name="og-title" property="og:title" content="Management Outcomes after Image-guided Percutaneous Biopsy for Suspected Vertebral Osteomyelitis-Discitis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/12/23/ajnr.A8630" />
<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: Studies show a modest yield for image-guided biopsy of suspected vertebral osteomyelitis-discitis. Many studies evaluate factors to improve diagnostic yield, and few studies assess how biopsy results impact clinical management. We aim to evaluate the impact of biopsy results on clinical management in suspected vertebral osteomyelitis-discitis.

MATERIALS AND METHODS: We performed a retrospective study of patients who underwent image-guided biopsy for suspected vertebral osteomyelitis-discitis. Data collected included risk factors, imaging findings, laboratory values, antibiotics, biopsy procedure details, microbiology and pathology results and clinical course. Factors assessed for management change included whether biopsy results affected antibiotic type or course, decision to start or stop antibiotics, surgical decisions or if an alternate diagnosis was determined.

RESULTS: 310 biopsies were included. Biopsy yield with true positive culture results was 34% (104/310) and similar for patients on antibiotics (36%, 34/94) and off antibiotics (32%, 66/204). Yield was greater when disc was sampled (36%, 82/228) versus bone only (8%, 2/24) and with aspiration of disc and/or bone (42%, 39/92) versus core only (29%, 56/193). With positive blood cultures prior to biopsy, biopsy yield was 50% (22/44) with concordance and discordance rates of 75% (18/24) and 17% (4/24) respectively, and 8% (2/24) of positive biopsy results deemed contaminants. Management was affected in 36% (113/310) of all biopsies and in 78% (81/104) of biopsies with a positive culture result. No management change occurred in 57% (177/310) of biopsies. Management change was unclear in 6% (20/310). Biopsy results changed antibiotics in 27% (85/310). Management change occurred in 23% (10/44) of cases with prior positive blood culture compared to 41% (93/233) without a prior culture source (P = 0.024). Negative culture results influenced management in 16% (32/194).

CONCLUSIONS: Image-guided biopsy for vertebral osteomyelitis-discitis has a meaningful impact on management despite modest yield. Greatest management impact is seen with positive culture results, no prior culture source and patients not on antibiotics at the time of biopsy. Biopsy culture yield is not affected by preceding antibiotics, and yield is greater with disc sampling and aspiration.

ABBREVIATIONS: VO = vertebral osteomyelitis-discitis; WBC = white blood cell count; ESR = erythrocyte sedimentation rate; CRP = C-reactive protein; MC = management change; NMC = no management change; UC = unclear management change; Abx = antibiotics" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node112489--7" data-node-nid="112489" id="top-node-112489--81805769502" data-pisa="ajnr;ajnr.A8630v1" data-pisa-master="ajnr;ajnr.A8630" data-apath="/ajnr/early/2024/12/23/ajnr.A8630.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">ORIGINAL RESEARCH</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Management Outcomes after Image-guided Percutaneous Biopsy for Suspected Vertebral Osteomyelitis-Discitis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Dania G. Malik</span>, <span class="highwire-citation-author" data-delta="1">Mathew V. Smith</span>, <span class="highwire-citation-author" data-delta="2">Gabriel M. Swenson</span>, <span class="highwire-citation-author" data-delta="3">Robert E. Grady</span>, <span class="highwire-citation-author" data-delta="4">Felix E. Diehn</span>, <span class="highwire-citation-author" data-delta="5">Erik H. Middlebrooks</span>, <span class="highwire-citation-author" data-delta="6">Jeffrey S. Ross</span> and <span class="highwire-citation-author" data-delta="7">TanyaJ. Rath</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">December 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8630; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8630 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-112489--81805769502" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Dania G. Malik </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA.</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=Dania%2BG.%2BMalik%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=Malik%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 last"><a href="/search/author1%3ADania%2BG.%2BMalik%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">Mathew V. Smith </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA.</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=Mathew%2BV.%2BSmith%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=Smith%20MV&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%3AMathew%2BV.%2BSmith%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">Gabriel M. Swenson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA.</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=Gabriel%2BM.%2BSwenson%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=Swenson%20GM&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%3AGabriel%2BM.%2BSwenson%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">Robert E. Grady </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA.</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=Robert%2BE.%2BGrady%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=Grady%20RE&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%3ARobert%2BE.%2BGrady%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">Felix E. Diehn </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA.</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=Felix%2BE.%2BDiehn%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=Diehn%20FE&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%3AFelix%2BE.%2BDiehn%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">Erik H. Middlebrooks </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA.</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=Erik%2BH.%2BMiddlebrooks%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=Middlebrooks%20EH&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%3AErik%2BH.%2BMiddlebrooks%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">Jeffrey S. Ross </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA.</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=Jeffrey%2BS.%2BRoss%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=Ross%20JS&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%3AJeffrey%2BS.%2BRoss%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">TanyaJ. Rath </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (DGM., MVS., GMS., REG., JSR., TJR.) Mayo Clinic, Phoenix, AZ, USA; Department of Radiology (FED.), Mayo Clinic, Rochester, MN, USA. Department of Radiology (EHM.), Mayo Clinic, Jacksonville, FL, USA.</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=TanyaJ.%2BRath%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=Rath%20T&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%3ATanyaJ.%2BRath%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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