1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [cab0b711-096a-433f-b3cf-e1db3781390c] => Array
        (
            [runtime-id] => cab0b711-096a-433f-b3cf-e1db3781390c
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [fd2eb71f-ba25-4b39-977a-94e272df21b9] => Array
                        (
                            [runtime-id] => fd2eb71f-ba25-4b39-977a-94e272df21b9
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [cab0b711-096a-433f-b3cf-e1db3781390c] => Array
        (
            [runtime-id] => cab0b711-096a-433f-b3cf-e1db3781390c
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [fd2eb71f-ba25-4b39-977a-94e272df21b9] => Array
                        (
                            [runtime-id] => fd2eb71f-ba25-4b39-977a-94e272df21b9
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [5559908a-d717-418d-b5d5-99f5cb5f2e3f] => Array
        (
            [runtime-id] => 5559908a-d717-418d-b5d5-99f5cb5f2e3f
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [b4023737-74dc-48ac-9e6e-abfd6a6fb017] => Array
                        (
                            [runtime-id] => b4023737-74dc-48ac-9e6e-abfd6a6fb017
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [7880fa87-ab6a-49a1-bdd9-b5311dd9e851] => Array
        (
            [runtime-id] => 7880fa87-ab6a-49a1-bdd9-b5311dd9e851
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [2de07de0-08a6-4739-89a1-aa92c7b5214d] => Array
                        (
                            [runtime-id] => 2de07de0-08a6-4739-89a1-aa92c7b5214d
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [e9d4c17d-4ba0-4a1f-9427-afee08f27449] => Array
        (
            [runtime-id] => e9d4c17d-4ba0-4a1f-9427-afee08f27449
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [af9b186c-fedc-4807-93c9-1de8a47912cd] => Array
                        (
                            [runtime-id] => af9b186c-fedc-4807-93c9-1de8a47912cd
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [e9d4c17d-4ba0-4a1f-9427-afee08f27449] => Array
        (
            [runtime-id] => e9d4c17d-4ba0-4a1f-9427-afee08f27449
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [af9b186c-fedc-4807-93c9-1de8a47912cd] => Array
                        (
                            [runtime-id] => af9b186c-fedc-4807-93c9-1de8a47912cd
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [cab0b711-096a-433f-b3cf-e1db3781390c] => Array
        (
            [runtime-id] => cab0b711-096a-433f-b3cf-e1db3781390c
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [fd2eb71f-ba25-4b39-977a-94e272df21b9] => Array
                        (
                            [runtime-id] => fd2eb71f-ba25-4b39-977a-94e272df21b9
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [cab0b711-096a-433f-b3cf-e1db3781390c] => Array
        (
            [runtime-id] => cab0b711-096a-433f-b3cf-e1db3781390c
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [fd2eb71f-ba25-4b39-977a-94e272df21b9] => Array
                        (
                            [runtime-id] => fd2eb71f-ba25-4b39-977a-94e272df21b9
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [cab0b711-096a-433f-b3cf-e1db3781390c] => Array
        (
            [runtime-id] => cab0b711-096a-433f-b3cf-e1db3781390c
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [fd2eb71f-ba25-4b39-977a-94e272df21b9] => Array
                        (
                            [runtime-id] => fd2eb71f-ba25-4b39-977a-94e272df21b9
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [cab0b711-096a-433f-b3cf-e1db3781390c] => Array
        (
            [runtime-id] => cab0b711-096a-433f-b3cf-e1db3781390c
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [fd2eb71f-ba25-4b39-977a-94e272df21b9] => Array
                        (
                            [runtime-id] => fd2eb71f-ba25-4b39-977a-94e272df21b9
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
1naresh2naresh<pre>Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [27b48946-aa8d-43f4-bdf6-0e3150a1761b] => Array
        (
            [runtime-id] => 27b48946-aa8d-43f4-bdf6-0e3150a1761b
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => OpenAccess
            [privilege] => Array
                (
                    [6886041f-2cd3-4053-b2a7-4a96505850fc] => Array
                        (
                            [runtime-id] => 6886041f-2cd3-4053-b2a7-4a96505850fc
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;f49c6e8b7ac7c59e15d7f74f1fe2d5fe37097459
                )

        )

)
<!DOCTYPE html>
<html lang="en" dir="ltr" 
  xmlns="http://www.w3.org/1999/xhtml"
  xmlns:mml="http://www.w3.org/1998/Math/MathML">
  <head prefix="og: http://ogp.me/ns# article: http://ogp.me/ns/article# book: http://ogp.me/ns/book#" >
    <!--[if IE]><![endif]-->
<link rel="dns-prefetch" href="//securepubads.g.doubleclick.net" />
<link rel="dns-prefetch" href="//scholar.google.com" />
<link rel="dns-prefetch" href="//cdn.jsdelivr.net" />
<link rel="dns-prefetch" href="//www.google.com" />
<link rel="dns-prefetch" href="//www.googletagmanager.com" />
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<link rel="shortlink" href="/node/12718" />
<meta name="Generator" content="Drupal 7 (http://drupal.org)" />
<link rel="shortcut icon" href="http://ajnr-stage2.stage.highwire.org/sites/default/files/images/favicon.ico" type="image/vnd.microsoft.icon" />
<meta name="article_thumbnail" content="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/embed/icon-1.gif" />
<meta name="issue_cover_image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/34/12.cover-source.jpg" />
<meta name="type" content="article" />
<meta name="category" content="research-article" />
<meta name="HW.identifier" content="/ajnr/34/12/2252.atom" />
<meta name="HW.pisa" content="ajnr;34/12/2252" />
<meta name="DC.Format" content="text/html" />
<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3606" />
<meta name="DC.Date" content="2013-12-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2013 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Contrast enhancement of intracranial atherosclerotic plaques has recently been investigated using high field and high resolution MR imaging as a risk factor in the development of ischemic stroke. We studied the reliability of conventional MR imaging at 1.5T in evaluating intraplaque enhancement and its relationship with acute cerebrovascular ischemic presentations in patients with severe intracranial atherosclerotic disease.

MATERIALS AND METHODS: We retrospectively identified and analyzed 19 patients with 22 high-grade intracranial atherosclerotic disease plaques (&gt;70% stenosis) in vessels cross-sectionally visualized by neuroanatomic MR imaging. Atherosclerotic plaques were classified as asymptomatic or symptomatic. Two blinded neuroradiologists independently ranked each lesion for the presence of intraplaque enhancement by use of a 5-point scale (1–5). Furthermore, plaque enhancement was quantified as the relative change in T1WI spin-echo signal intensity (postcontrast/precontrast) in the vessel wall at the site of each intracranial atherosclerotic disease lesion.

RESULTS: Intraplaque enhancement was observed in 7 of 10 (70%) symptomatic plaques, in contrast to 1 of 12 (8%) asymptomatic plaques. Interobserver reliability correlated well for intraplaque enhancement (κ = 0.82). The degree of relative plaque enhancement in symptomatic versus asymptomatic lesions (63% versus 23%) was statistically significant ( P = .001, t test).

CONCLUSIONS: In this pilot study, we determined that intraplaque enhancement could be reliably evaluated with the use of cross-sectional imaging and analysis of vessels/plaques by use of conventional neuroanatomic MR imaging protocols. In addition, we observed a strong association between intraplaque enhancement in severe intracranial atherosclerotic disease lesions and ischemic events with the use of conventional MR imaging. Our preliminary study suggests that T1 gadolinium-enhancing plaques may be an indicator of progressing or symptomatic intracranial atherosclerotic disease.

ICAD
:   intracranial atherosclerotic disease
IPE
:   intraplaque enhancement
T1w-SE
:   T1-weighted spin-echo
IPH
:   intraplaque hemorrhage
ACA
:   anterior cerebral artery" />
<meta name="DC.Contributor" content="P. Vakil" />
<meta name="DC.Contributor" content="J. Vranic" />
<meta name="DC.Contributor" content="M.C. Hurley" />
<meta name="DC.Contributor" content="R.A. Bernstein" />
<meta name="DC.Contributor" content="A.W. Korutz" />
<meta name="DC.Contributor" content="A. Habib" />
<meta name="DC.Contributor" content="A. Shaibani" />
<meta name="DC.Contributor" content="F.H. Dehkordi" />
<meta name="DC.Contributor" content="T.J. Carroll" />
<meta name="DC.Contributor" content="S.A. Ansari" />
<meta name="article:published_time" content="2013-12-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Contrast enhancement of intracranial atherosclerotic plaques has recently been investigated using high field and high resolution MR imaging as a risk factor in the development of ischemic stroke. We studied the reliability of conventional MR imaging at 1.5T in evaluating intraplaque enhancement and its relationship with acute cerebrovascular ischemic presentations in patients with severe intracranial atherosclerotic disease.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively identified and analyzed 19 patients with 22 high-grade intracranial atherosclerotic disease plaques (&amp;gt;70% stenosis) in vessels cross-sectionally visualized by neuroanatomic MR imaging. Atherosclerotic plaques were classified as asymptomatic or symptomatic. Two blinded neuroradiologists independently ranked each lesion for the presence of intraplaque enhancement by use of a 5-point scale (1–5). Furthermore, plaque enhancement was quantified as the relative change in T1WI spin-echo signal intensity (postcontrast/precontrast) in the vessel wall at the site of each intracranial atherosclerotic disease lesion.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Intraplaque enhancement was observed in 7 of 10 (70%) symptomatic plaques, in contrast to 1 of 12 (8%) asymptomatic plaques. Interobserver reliability correlated well for intraplaque enhancement (κ = 0.82). The degree of relative plaque enhancement in symptomatic versus asymptomatic lesions (63% versus 23%) was statistically significant (&lt;i&gt;P&lt;/i&gt; = .001, &lt;i&gt;t&lt;/i&gt; test).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In this pilot study, we determined that intraplaque enhancement could be reliably evaluated with the use of cross-sectional imaging and analysis of vessels/plaques by use of conventional neuroanatomic MR imaging protocols. In addition, we observed a strong association between intraplaque enhancement in severe intracranial atherosclerotic disease lesions and ischemic events with the use of conventional MR imaging. Our preliminary study suggests that T1 gadolinium-enhancing plaques may be an indicator of progressing or symptomatic intracranial atherosclerotic disease.&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="2013/12/01" />
<meta name="citation_mjid" content="ajnr;34/12/2252" />
<meta name="citation_id" content="34/12/2252" />
<meta name="citation_public_url" content="http://ajnr-stage2.stage.highwire.org/content/34/12/2252" />
<meta name="citation_abstract_html_url" content="http://ajnr-stage2.stage.highwire.org/content/34/12/2252.abstract" />
<meta name="citation_full_html_url" content="http://ajnr-stage2.stage.highwire.org/content/34/12/2252.full" />
<meta name="citation_pdf_url" content="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252.full.pdf" />
<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A3606" />
<meta name="citation_pmid" content="23828109" />
<meta name="citation_volume" content="34" />
<meta name="citation_issue" content="12" />
<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="Brain" />
<meta name="citation_firstpage" content="2252" />
<meta name="citation_lastpage" content="2258" />
<meta name="citation_access" content="all" />
<meta name="citation_author" content="P. Vakil" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)" />
<meta name="citation_author_institution" content="dBiomedical Engineering (P.V., T.J.C.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois" />
<meta name="citation_author" content="J. Vranic" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)" />
<meta name="citation_author" content="M.C. Hurley" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)" />
<meta name="citation_author_institution" content="cNeurosurgery (M.C.H., A.S., S.A.A.)" />
<meta name="citation_author" content="R.A. Bernstein" />
<meta name="citation_author_institution" content="bNeurology (R.A.B., S.A.A.)" />
<meta name="citation_author" content="A.W. Korutz" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)" />
<meta name="citation_author" content="A. Habib" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)" />
<meta name="citation_author" content="A. Shaibani" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)" />
<meta name="citation_author_institution" content="cNeurosurgery (M.C.H., A.S., S.A.A.)" />
<meta name="citation_author" content="F.H. Dehkordi" />
<meta name="citation_author_institution" content="eDepartment of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="T.J. Carroll" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)" />
<meta name="citation_author_institution" content="dBiomedical Engineering (P.V., T.J.C.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois" />
<meta name="citation_author" content="S.A. Ansari" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)" />
<meta name="citation_author_institution" content="bNeurology (R.A.B., S.A.A.)" />
<meta name="citation_author_institution" content="cNeurosurgery (M.C.H., A.S., S.A.A.)" />
<meta name="citation_reference" content="citation_journal_title=New England Journal of Medicine;citation_journal_abbrev=NEJM;citation_author=MI. Chimowitz;citation_author=MJ. Lynn;citation_author=H. Howlett-Smith;citation_title=Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial Stenosis;citation_pages=1305-1316;citation_volume=352;citation_year=2005;citation_issue=13;citation_issn=0028-4793;citation_pmid=15800226;citation_doi=10.1056/NEJMoa043033" />
<meta name="citation_reference" content="citation_journal_title=New England Journal of Medicine;citation_journal_abbrev=NEJM;citation_author=MI. Chimowitz;citation_author=MJ. Lynn;citation_author=CP. Derdeyn;citation_title=Stenting versus aggressive medical therapy for intracranial arterial stenosis.;citation_pages=993-1003;citation_volume=365;citation_year=2011;citation_issue=11;citation_issn=0028-4793;citation_pmid=21899409;citation_doi=10.1056/NEJMoa1105335" />
<meta name="citation_reference" content="citation_journal_title=Radiology;citation_author=C. Yuan;citation_author=LM. Mitsumori;citation_author=KW. Beach;citation_title=Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions;citation_volume=221;citation_year=2001;citation_pmid=11687667;citation_doi=10.1148/radiol.2212001612" />
<meta name="citation_reference" content="citation_journal_title=Stroke;citation_author=BA. Wasserman;citation_author=RJ. Wityk;citation_author=HH. Trout;citation_title=Low-grade carotid stenosis: looking beyond the lumen with MRI;citation_volume=36;citation_year=2005;citation_pmid=16239630;citation_doi=10.1161/01.STR.0000185726.83152.00" />
<meta name="citation_reference" content="citation_journal_title=Radiology;citation_author=WS. Kerwin;citation_author=KD. O'Brien;citation_author=MS. Ferguson;citation_title=Inflammation in carotid atherosclerotic plaque: a dynamic contrast-enhanced MR imaging study;citation_volume=241;citation_year=2006;citation_pmid=16966482;citation_doi=10.1148/radiol.2412051336" />
<meta name="citation_reference" content="citation_journal_title=Radiology;citation_journal_abbrev=Radiology;citation_author=T. Saam;citation_author=TS. Hatsukami;citation_author=N. Takaya;citation_title=The Vulnerable, or High-Risk, Atherosclerotic Plaque: Noninvasive MR Imaging for Characterization and Assessment;citation_pages=64-77;citation_volume=244;citation_year=2007;citation_issue=1;citation_issn=0033-8419;citation_pmid=17581895;citation_doi=10.1148/radiol.2441051769" />
<meta name="citation_reference" content="citation_journal_title=JAMA;citation_journal_abbrev=JAMA;citation_author=LG. Spagnoli;citation_author=A. Mauriello;citation_author=G. Sangiorgi;citation_title=Extracranial Thrombotically Active Carotid Plaque as a Risk Factor for Ischemic Stroke;citation_pages=1845-1852;citation_volume=292;citation_year=2004;citation_issue=15;citation_issn=0002-9955;citation_pmid=15494582;citation_doi=10.1001/jama.292.15.1845" />
<meta name="citation_reference" content="citation_journal_title=Archives of Neurology;citation_journal_abbrev=Arch Neurol;citation_author=MD. Vergouwen;citation_author=FL. Silver;citation_author=DM. Mandell;citation_title=Eccentric Narrowing and Enhancement of Symptomatic Middle Cerebral Artery Stenoses in Patients With Recent Ischemic Stroke;citation_pages=338-342;citation_volume=68;citation_year=2011;citation_issue=3;citation_issn=0003-9942;citation_pmid=21403018;citation_doi=10.1001/archneurol.2011.20" />
<meta name="citation_reference" content="citation_journal_title=Neurology;citation_author=RH. Swartz;citation_author=SS. Bhuta;citation_author=RI. Farb;citation_title=Intracranial arterial wall imaging using high-resolution 3-Tesla contrast-enhanced MRI;citation_pages=627-34;citation_volume=72;citation_year=2009;citation_doi=10.1212/01.wnl.0000342470.69739.b3" />
<meta name="citation_reference" content="citation_journal_title=Neurology;citation_author=IF. Klein;citation_author=PC. Lavallee;citation_author=PJ. Touboul;citation_title=In vivo middle cerebral artery plaque imaging by high-resolution MRI;citation_pages=327-29;citation_volume=67;citation_year=2006;citation_doi=10.1212/01.wnl.0000225074.47396.71" />
<meta name="citation_reference" content="citation_journal_title=Annals of neurology;citation_journal_abbrev=Ann Neurol;citation_author=WH. Xu;citation_author=ML. Li;citation_author=S. Gao;citation_title=Middle cerebral artery intraplaque hemorrhage: prevalence and clinical relevance.;citation_pages=195-198;citation_volume=71;citation_year=2012;citation_issue=2;citation_pmid=22367991;citation_doi=10.1002/ana.22626" />
<meta name="citation_reference" content="citation_title=Handbook of Neurosurgery;citation_author=MS. Greenberg;citation_year=2010" />
<meta name="citation_reference" content="citation_journal_title=Journal of magnetic resonance imaging :  JMRI;citation_journal_abbrev=J Magn Reson Imaging;citation_author=Y. Qiao;citation_author=DA. Steinman;citation_author=Q. Qin;citation_title=Intracranial arterial wall imaging using three-dimensional high isotropic resolution black blood MRI at 3.0 Tesla.;citation_pages=22-30;citation_volume=34;citation_year=2011;citation_issue=1;citation_pmid=21698704;citation_doi=10.1002/jmri.22592" />
<meta name="citation_reference" content="citation_journal_title=AJNR Am J Neuroradiol;citation_author=M. Skarpathiotakis;citation_author=DM. Mandell;citation_author=RH. Swartz;citation_title=Intracranial atherosclerotic plaque enhancement in patients with ischemic stroke;citation_volume=34;citation_year=2013;citation_pmid=22859280;citation_doi=10.3174/ajnr.A3209" />
<meta name="citation_reference" content="citation_journal_title=Atherosclerosis;citation_author=WH. Xu;citation_author=ML. Li;citation_author=S. Gao;citation_title=In vivo high-resolution MR imaging of symptomatic and asymptomatic middle cerebral artery atherosclerotic stenosis;citation_pages=507-11;citation_volume=212;citation_year=2010;citation_pmid=20638663;citation_doi=10.1016/j.atherosclerosis.2010.06.035" />
<meta name="citation_reference" content="citation_journal_title=Circulation;citation_journal_abbrev=Circulation;citation_author=C. Yuan;citation_author=KW. Beach;citation_author=LH. Smith;citation_title=Measurement of Atherosclerotic Carotid Plaque Size In Vivo Using High Resolution Magnetic Resonance Imaging;citation_pages=2666-2671;citation_volume=98;citation_year=1998;citation_issue=24;citation_issn=0009-7322;citation_pmid=9851951;citation_doi=10.1161/01.CIR.98.24.2666" />
<meta name="citation_reference" content="citation_journal_title=Circulation;citation_author=JN. Redgrave;citation_author=JK. Lovett;citation_author=PJ. Gallagher;citation_title=Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: the Oxford plaque study;citation_volume=113;citation_year=2006;citation_pmid=16651471;citation_doi=10.1161/CIRCULATIONAHA.105.589044" />
<meta name="citation_reference" content="citation_journal_title=Journal of vascular surgery :  official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter;citation_journal_abbrev=J Vasc Surg;citation_author=MJ. McCarthy;citation_author=IM. Loftus;citation_author=MM. Thompson;citation_title=Angiogenesis and the atherosclerotic carotid plaque: an association between symptomatology and plaque morphology.;citation_pages=261-268;citation_volume=30;citation_year=1999;citation_issue=2;citation_pmid=10436445;citation_doi=10.1016/S0741-5214(99)70136-9" />
<meta name="citation_reference" content="citation_journal_title=Magnetic resonance in medicine :  official journal of the Society of Magnetic Resonance in Medicine / Society of Magnetic Resonance in Medicine;citation_journal_abbrev=Magn Reson Med;citation_author=WS. Kerwin;citation_author=M. Oikawa;citation_author=C. Yuan;citation_title=MR imaging of adventitial vasa vasorum in carotid atherosclerosis.;citation_pages=507-514;citation_volume=59;citation_year=2008;citation_issue=3;citation_pmid=18306402;citation_doi=10.1002/mrm.21532" />
<meta name="citation_reference" content="citation_journal_title=Circulation;citation_author=W. Kerwin;citation_author=A. Hooker;citation_author=M. Spilker;citation_title=Quantitative magnetic resonance imaging analysis of neovasculature volume in carotid atherosclerotic plaque;citation_volume=107;citation_year=2003;citation_pmid=12591755;citation_doi=10.1161/01.CIR.0000048145.52309.31" />
<meta name="citation_reference" content="citation_journal_title=Circulation;citation_author=J. Cai;citation_author=TS. Hatsukami;citation_author=MS. Ferguson;citation_title=In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque: comparison of high-resolution, contrast-enhanced magnetic resonance imaging and histology;citation_volume=112;citation_year=2005;citation_pmid=16301346;citation_doi=10.1161/CIRCULATIONAHA.104.528174" />
<meta name="citation_reference" content="citation_journal_title=Circulation;citation_journal_abbrev=Circulation;citation_author=PR. Moreno;citation_author=KR. Purushothaman;citation_author=M. Sirol;citation_title=Neovascularization in Human Atherosclerosis;citation_pages=2245-2252;citation_volume=113;citation_year=2006;citation_issue=18;citation_issn=0009-7322;citation_pmid=16684874;citation_doi=10.1161/CIRCULATIONAHA.105.578955" />
<meta name="citation_reference" content="citation_journal_title=Radiology;citation_author=L. Dong;citation_author=WS. Kerwin;citation_author=H. Chen;citation_title=Carotid artery atherosclerosis: effect of intensive lipid therapy on the vasa vasorum–evaluation by using dynamic contrast-enhanced MR imaging;citation_volume=260;citation_year=2011;citation_pmid=21493792;citation_doi=10.1148/radiol.11101264" />
<meta name="citation_reference" content="citation_journal_title=Cerebrovascular diseases (Basel, Switzerland);citation_journal_abbrev=Cerebrovasc Dis;citation_author=CW. Ryu;citation_author=GH. Jahng;citation_author=EJ. Kim;citation_title=High resolution wall and lumen MRI of the middle cerebral arteries at 3 tesla.;citation_pages=433-442;citation_volume=27;citation_year=2009;citation_issue=5;citation_pmid=19295206;citation_doi=10.1159/000209238" />
<meta name="citation_reference" content="citation_journal_title=American Journal of Roentgenology;citation_journal_abbrev=Am. J. Roentgenol.;citation_author=I. Koktzoglou;citation_author=A. Kirpalani;citation_author=TJ. Carroll;citation_title=Dark-Blood MRI of the Thoracic Aorta with 3D Diffusion-Prepared Steady-State Free Precession: Initial Clinical Evaluation;citation_pages=966-972;citation_volume=189;citation_year=2007;citation_issue=4;citation_issn=0361-803X;citation_pmid=17885072;citation_doi=10.2214/AJR.07.2428" />
<meta name="citation_fulltext_world_readable" content="" />
<meta name="twitter:title" content="T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations" />
<meta name="twitter:card" content="summary_large_image" />
<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/34/12.cover-source.jpg" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Contrast enhancement of intracranial atherosclerotic plaques has recently been investigated using high field and high resolution MR imaging as a risk factor in the development of ischemic stroke. We studied the reliability of conventional MR imaging at 1.5T in evaluating intraplaque enhancement and its relationship with acute cerebrovascular ischemic presentations in patients with severe intracranial atherosclerotic disease.

MATERIALS AND METHODS: We retrospectively identified and analyzed 19 patients with 22 high-grade intracranial atherosclerotic disease plaques (&gt;70% stenosis) in vessels cross-sectionally visualized by neuroanatomic MR imaging. Atherosclerotic plaques were classified as asymptomatic or symptomatic. Two blinded neuroradiologists independently ranked each lesion for the presence of intraplaque enhancement by use of a 5-point scale (1–5). Furthermore, plaque enhancement was quantified as the relative change in T1WI spin-echo signal intensity (postcontrast/precontrast) in the vessel wall at the site of each intracranial atherosclerotic disease lesion.

RESULTS: Intraplaque enhancement was observed in 7 of 10 (70%) symptomatic plaques, in contrast to 1 of 12 (8%) asymptomatic plaques. Interobserver reliability correlated well for intraplaque enhancement (κ = 0.82). The degree of relative plaque enhancement in symptomatic versus asymptomatic lesions (63% versus 23%) was statistically significant ( P = .001, t test).

CONCLUSIONS: In this pilot study, we determined that intraplaque enhancement could be reliably evaluated with the use of cross-sectional imaging and analysis of vessels/plaques by use of conventional neuroanatomic MR imaging protocols. In addition, we observed a strong association between intraplaque enhancement in severe intracranial atherosclerotic disease lesions and ischemic events with the use of conventional MR imaging. Our preliminary study suggests that T1 gadolinium-enhancing plaques may be an indicator of progressing or symptomatic intracranial atherosclerotic disease.

ICAD
:   intracranial atherosclerotic disease
IPE
:   intraplaque enhancement
T1w-SE
:   T1-weighted spin-echo
IPH
:   intraplaque hemorrhage
ACA
:   anterior cerebral artery" />
<meta name="og-title" property="og:title" content="T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/34/12/2252" />
<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 enhancement of intracranial atherosclerotic plaques has recently been investigated using high field and high resolution MR imaging as a risk factor in the development of ischemic stroke. We studied the reliability of conventional MR imaging at 1.5T in evaluating intraplaque enhancement and its relationship with acute cerebrovascular ischemic presentations in patients with severe intracranial atherosclerotic disease.

MATERIALS AND METHODS: We retrospectively identified and analyzed 19 patients with 22 high-grade intracranial atherosclerotic disease plaques (&gt;70% stenosis) in vessels cross-sectionally visualized by neuroanatomic MR imaging. Atherosclerotic plaques were classified as asymptomatic or symptomatic. Two blinded neuroradiologists independently ranked each lesion for the presence of intraplaque enhancement by use of a 5-point scale (1–5). Furthermore, plaque enhancement was quantified as the relative change in T1WI spin-echo signal intensity (postcontrast/precontrast) in the vessel wall at the site of each intracranial atherosclerotic disease lesion.

RESULTS: Intraplaque enhancement was observed in 7 of 10 (70%) symptomatic plaques, in contrast to 1 of 12 (8%) asymptomatic plaques. Interobserver reliability correlated well for intraplaque enhancement (κ = 0.82). The degree of relative plaque enhancement in symptomatic versus asymptomatic lesions (63% versus 23%) was statistically significant ( P = .001, t test).

CONCLUSIONS: In this pilot study, we determined that intraplaque enhancement could be reliably evaluated with the use of cross-sectional imaging and analysis of vessels/plaques by use of conventional neuroanatomic MR imaging protocols. In addition, we observed a strong association between intraplaque enhancement in severe intracranial atherosclerotic disease lesions and ischemic events with the use of conventional MR imaging. Our preliminary study suggests that T1 gadolinium-enhancing plaques may be an indicator of progressing or symptomatic intracranial atherosclerotic disease.

ICAD
:   intracranial atherosclerotic disease
IPE
:   intraplaque enhancement
T1w-SE
:   T1-weighted spin-echo
IPH
:   intraplaque hemorrhage
ACA
:   anterior cerebral artery" />
<meta name="og-type" property="og:type" content="article" />
<meta name="og-image" property="og:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/34/12.cover-source.jpg" />
<meta name="viewport" content="width=device-width, initial-scale=1" />
<link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/34/12/2252.ppt" />
<link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/34/12/2252.full.txt" />
<link rel="alternate" type="application/pdf" title="Full Text (PDF)" href="/content/34/12/2252.full.pdf" />
<link rel="canonical" href="http://ajnr-stage2.stage.highwire.org/content/34/12/2252" />
<script>window.dataLayer = window.dataLayer || [];window.dataLayer.push({"page":{"hwTitle":"T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations","hwUrl":"http://ajnr-stage2.stage.highwire.org/content/34/12/2252","hwPath":"/node/12718","hwType":"journal page"},"user":{"hwMemberID":"","hwLoggedIntoInstitutionID":"","hwLoggedIntoInstitution":"","hwAccessUsageTerms":"guest","hwRegisteredUser":"no","hwHasFullTextAccess":"yes","hwEntitled":"no"},"content":{"hwIssueDate":"2013-12-01","hwIssueDateTime":"2013-12-01 00:00:00","hwPublicationDate":"2013-12-13","hwPublicationDateTime":"2013-12-13 08:01:11","hwNlmArticleType":"research-article","hwDOI":"10.3174/ajnr.A3606","hwAuthors":"P. Vakil,J. Vranic,M.C. Hurley,R.A. Bernstein,A.W. Korutz,A. Habib,A. Shaibani,F.H. Dehkordi,T.J. Carroll,S.A. Ansari","hwContributors":"","hwIsEarlyRelease":"no","hwEissn":"1936-959X","hwPissn":"0195-6108","hwVolume":"34","hwIssue":"12","hwArticleType":"Brain","hwTabView":"main_tab","hwViewType":"full","hwAccessType":"OpenAccess","hwOpenAccess":"yes","hwFreeAccess":"yes","hwTaxonomy":"","hwCorpusCode":"ajnr","hwType":"article","hwSubtitle":null,"hwOverline":null,"hwPisaId":"ajnr;34/12/2252","hwFirstPage":"2252","hwLastPage":"2258","hwIsLatestVersion":"yes","hwIsCurrentIssue":"no","hwIsOpenIssue":"no","hwHasFullText":"yes","hwHasPDF":"yes","hwParentTitle":"American Journal of Neuroradiology: 34 (12)","hwElectronicPubDate":"2013-12-13","hwElectronicPubDateTime":"2013-12-13 08:01:11"}});
//--><!]]></script>
    <title>T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations | American Journal of Neuroradiology</title>  
    <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__BJ6Ou6QsBRtnFTmxaakamOIS8n4QswDP2XnnZ1sxtaM__NBuvkP6eInGIkb1aJvUHx5PX79XApuxBDkk_77W5tYk__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__azeXjFYQUa4gTbdEg4sgM2osudOlAYwVv6vNmRXI3ac__zr83wx5lNxUVx-jSIFm8RDKOeMAB7RbaBxriFHS3dt4__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__Ep75tNOnm8H2Mejav16FnGCfM1sLwyporbQrCIgwg3g__vXGjszfa0bvxzymQ8Cfns-o2huFvm80jp3igN8XcYeI__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__TKi6DXKzgLPdEthh1Tnc63zY1QF4rLZHoM06Xy7VN6g__zaEHphFiBcrl8WVy_4n080y02dQ7HKxd_aqZbYgQ5Z0__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<link type="text/css" rel="stylesheet" href="/sites/all/modules/highwire/highwire/highwire.style.highwire.css?sycxuq" media="all" />
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__BX3nCkChknRoE-aDbdxprlFaypp4fXWeczbX7JvfqrM__NtFlOF_CU23QNMU5lA_arwbEf0O6qOCUd0hDjDpj968__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<link type="text/css" rel="stylesheet" href="//cdn.jsdelivr.net/qtip2/2.2.1/jquery.qtip.min.css" media="all" />
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__JnM-0sgpwKaRZfZwuqss_otkHPbNak1GxbxWZGNp2wo__ZeyEyuNcSNDfCqRmRUW_NahTWs9Wd-k1qLvZUB0phNg__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<style type="text/css" media="all">
/* <![CDATA[ */
#sliding-popup.sliding-popup-bottom,#sliding-popup.sliding-popup-bottom .eu-cookie-withdraw-banner,.eu-cookie-withdraw-tab{background:#000000;}#sliding-popup.sliding-popup-bottom.eu-cookie-withdraw-wrapper{background:transparent}#sliding-popup .popup-content #popup-text h1,#sliding-popup .popup-content #popup-text h2,#sliding-popup .popup-content #popup-text h3,#sliding-popup .popup-content #popup-text p,.eu-cookie-compliance-secondary-button,.eu-cookie-withdraw-tab{color:#ffffff !important;}.eu-cookie-withdraw-tab{border-color:#ffffff;}.eu-cookie-compliance-more-button{color:#ffffff !important;}

/* ]]> */
</style>

<!--[if lte IE 7]>
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__ElJr3PIJEvw3qLXc1cnYiLj2G4KgDPSXFOfm6Phf8hw__JdWGm15cDWjsK6KrFlQVXQix9YgNeYysf22XZHj-Y-c__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<![endif]-->
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__Wnlyen9qEpwh_Qaf9okEu4QdVGM0BDothxeqA6Nbvo8__EJmw6SZD9bYoS8jocCpPYS3JFRURpdzmuvJoAUNiI-g__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__nv7Hafs9UucfV8bmT4epWF4zWAFU2G9JLHVgOOHDqbA__k9QUw6MohZGXV0YlzqvUpPTbyzhbizsKOi4x3aA7Tx0__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />

<!--[if (lt IE 9)&(!IEMobile)]>
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__XH6bpcI0f2dImc-p674DLCZtWBGb-QwxJK1YexVGtno__vUceGprdo5nIhV6DH93X7fI3r8RcTJbChbas9TQXeW4__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<![endif]-->

<!--[if gte IE 9]><!-->
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__2WBMox6sOrN42ss5lCnH7WWVRdFdJCxtTKnQJYRwTE4__yqNvNYLvMpjy3ffuJrjjm9uW2i-Me1c23KLYuWHaqio__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
<!--<![endif]-->
<link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__wxg7u6KrkAKrph8zjmzjNAiqxtVP2vhMWX2NZ6DPPZE__ECvRNuvDf2Tm_Pc-j1mEkt48QjmIz2s2CyWDspWAhhI__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.css" media="all" />
    <script type="text/javascript">
<!--//--><![CDATA[//><!--
/*!
 * yepnope1.5.4
 * (c) WTFPL, GPLv2
 */
(function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i<a.length;i++)j=a[i],e(j)?g(j,0,l,0):w(j)?B(j):Object(j)===j&&h(j,l);else Object(a)===a&&h(a,l)},B.addPrefix=function(a,b){z[a]=b},B.addFilter=function(a){x.push(a)},B.errorTimeout=1e4,null==b.readyState&&b.addEventListener&&(b.readyState="loading",b.addEventListener("DOMContentLoaded",A=function(){b.removeEventListener("DOMContentLoaded",A,0),b.readyState="complete"},0)),a.yepnope=k(),a.yepnope.executeStack=h,a.yepnope.injectJs=function(a,c,d,e,i,j){var k=b.createElement("script"),l,o,e=e||B.errorTimeout;k.src=a;for(o in d)k.setAttribute(o,d[o]);c=j?h:c||f,k.onreadystatechange=k.onload=function(){!l&&g(k.readyState)&&(l=1,c(),k.onload=k.onreadystatechange=null)},m(function(){l||(l=1,c(1))},e),i?k.onload():n.parentNode.insertBefore(k,n)},a.yepnope.injectCss=function(a,c,d,e,g,i){var e=b.createElement("link"),j,c=i?h:c||f;e.href=a,e.rel="stylesheet",e.type="text/css";for(j in d)e.setAttribute(j,d[j]);g||(n.parentNode.insertBefore(e,n),m(c,0))}})(this,document);

//--><!]]>
</script>
<script type="text/javascript" src="/sites/all/libraries/modernizr/modernizr.min.js?sycxuq"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
yepnope({
  test: Modernizr.matchmedia,
  nope: '/sites/all/libraries/media-match/media.match.min.js'
});
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__wH8myWXKi4A-QKdUKDXzJAnGs-FRS1A2ZzTTNzjRAdI__4MCtOZK_Ov0QKyRlXNLGQ2LRlYRGWj9ArT-NpFox3QA__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
var googletag = googletag || {};
googletag.cmd = googletag.cmd || [];
googletag.slots = googletag.slots || {};
//--><!]]>
</script>
<script type="text/javascript" src="//securepubads.g.doubleclick.net/tag/js/gpt.js"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__9ici6QMeDS-cROq8R0RhuICsMGMP2wcJZNQQFsqQi44__kScSwG4RXGl1LXnj4qqt0ZxtNX4Gh2TK5W-o8Uup4SA__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__fwhbnUWIxW-jFl55E2mBYVtZTjGhJ1JWyZYAJ2cEd3A__jCrCuWCJIPYPe1FzZoUvsJWEjkNMmRIQHYek1h7idBE__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
googletag.slots["rhs"] = googletag.defineSlot("/446583111/RHS_300x250", [300, 250], "dfp-ad-rhs")
  .addService(googletag.pubads());
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__UR8BHznwml64Vq0ijSGFwlm-xe9ttj1aripHInFCOLw__irCalsu-H_fRTOPqjyCv1O8Ax7fqY6DDf-uMOV1dvGY__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
var mapping = googletag.sizeMapping()
  .addSize([768, 0], [728, 90])
  .addSize([0, 0], [300, 50])
  .build();
googletag.slots["bottom_leaderboard"] = googletag.defineSlot("/446583111/Bottom_Banner_728x90", [[728, 90], [300, 50]], "dfp-ad-bottom_leaderboard")
  .addService(googletag.pubads())
  .defineSizeMapping(mapping);
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__bQc6kyz_Gw2afC1F6wguCBh8Z8nev-hxX6F2Tw4bq6k__CO2faEsYCquY82rVj6as9HScSnogGHeR-oh5fSQydG0__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
var mapping = googletag.sizeMapping()
  .addSize([768, 0], [728, 90])
  .addSize([0, 0], [300, 50])
  .build();
googletag.slots["top_leaderboard"] = googletag.defineSlot("/446583111/Top_Leaderboard_728x90", [[728, 90], [300, 50]], "dfp-ad-top_leaderboard")
  .addService(googletag.pubads())
  .defineSizeMapping(mapping);
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__wS6WUeF11NLeJgCqxc-dMvjhALAMQG1jlaeWdG8yVZc__CPiombDS21ooaYdmqHXdcMoJwB2FMn18JzO97LewQxc__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
document.createElement( "picture" );
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__UK1ygaa8bCfT-jsjqYRdRLDZ5N17950T7K5WPC9XtpI__NqLYT1T1SMBsKukLWIe82VgCZYYCMHZX_f609-a1rj8__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
googletag.cmd.push(function() {
  googletag.pubads().enableAsyncRendering();
  googletag.pubads().enableSingleRequest();
  googletag.pubads().collapseEmptyDivs();
  googletag.pubads().addEventListener("slotRenderEnded", function (event) {
    if (event.isEmpty) {
      var id = event.slot.getSlotElementId();
      var x = document.getElementById(id);
      if (x.parentElement.classList.contains("dfp-tag-wrapper")) {
        x.parentElement.style.display = "none";
      }
    }
  });
  googletag.pubads().setTargeting("page:hwTitle", "T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations");
  googletag.pubads().setTargeting("page:hwUrl", "http://ajnr-stage2.stage.highwire.org/content/34/12/2252");
  googletag.pubads().setTargeting("page:hwPath", "/node/12718");
  googletag.pubads().setTargeting("page:hwType", "journal page");
  googletag.pubads().setTargeting("user:hwAccessUsageTerms", "guest");
  googletag.pubads().setTargeting("user:hwRegisteredUser", "no");
  googletag.pubads().setTargeting("user:hwHasFullTextAccess", "yes");
  googletag.pubads().setTargeting("user:hwEntitled", "no");
  googletag.pubads().setTargeting("content:hwIssueDate", "2013-12-01");
  googletag.pubads().setTargeting("content:hwIssueDateTime", "2013-12-01 00:00:00");
  googletag.pubads().setTargeting("content:hwPublicationDate", "2013-12-13");
  googletag.pubads().setTargeting("content:hwPublicationDateTime", "2013-12-13 08:01:11");
  googletag.pubads().setTargeting("content:hwNlmArticleType", "research-article");
  googletag.pubads().setTargeting("content:hwDOI", "10.3174/ajnr.A3606");
  googletag.pubads().setTargeting("content:hwAuthors", ["P. Vakil","J. Vranic","M.C. Hurley","R.A. Bernstein","A.W. Korutz","A. Habib","A. Shaibani","F.H. Dehkordi","T.J. Carroll","S.A. Ansari"]);
  googletag.pubads().setTargeting("content:hwIsEarlyRelease", "no");
  googletag.pubads().setTargeting("content:hwEissn", "1936-959X");
  googletag.pubads().setTargeting("content:hwPissn", "0195-6108");
  googletag.pubads().setTargeting("content:hwVolume", "34");
  googletag.pubads().setTargeting("content:hwIssue", "12");
  googletag.pubads().setTargeting("content:hwArticleType", "Brain");
  googletag.pubads().setTargeting("content:hwTabView", "main_tab");
  googletag.pubads().setTargeting("content:hwViewType", "full");
  googletag.pubads().setTargeting("content:hwAccessType", "OpenAccess");
  googletag.pubads().setTargeting("content:hwOpenAccess", "yes");
  googletag.pubads().setTargeting("content:hwFreeAccess", "yes");
  googletag.pubads().setTargeting("content:hwCorpusCode", "ajnr");
  googletag.pubads().setTargeting("content:hwType", "article");
  googletag.pubads().setTargeting("content:hwPisaId", "ajnr;34/12/2252");
  googletag.pubads().setTargeting("content:hwFirstPage", "2252");
  googletag.pubads().setTargeting("content:hwLastPage", "2258");
  googletag.pubads().setTargeting("content:hwIsLatestVersion", "yes");
  googletag.pubads().setTargeting("content:hwIsCurrentIssue", "no");
  googletag.pubads().setTargeting("content:hwIsOpenIssue", "no");
  googletag.pubads().setTargeting("content:hwHasFullText", "yes");
  googletag.pubads().setTargeting("content:hwHasPDF", "yes");
  googletag.pubads().setTargeting("content:hwParentTitle", "American Journal of Neuroradiology: 34 (12)");
  googletag.pubads().setTargeting("content:hwElectronicPubDate", "2013-12-13");
  googletag.pubads().setTargeting("content:hwElectronicPubDateTime", "2013-12-13 08:01:11");
});

googletag.enableServices();
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__3vwOA0BwlnyBkt9H4CLg6FgNyKAh--OmfOxFOIu_5S4__EXTgktcHbQ7BQfelY6CnrqgPRc4i4eD6XcZ4i3xs5RU__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript" async="async" src="https://scholar.google.com/scholar_js/casa.js"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__11OTRBANYp_FPYy8gxuWv8XYK780LivNl9ef5qg3rfw__TEVdNksA7-zrPiZwnenYHdToBjuVChsDlzQL_vP4NkY__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript" src="//cdn.jsdelivr.net/qtip2/2.2.1/jquery.qtip.min.js"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__yiXGyyzC1oV2sZBtAUN2DFoM2mAH5KP0iYCqS1dmafE__UiTPqZo1iNHqhqhx1lKGu2xkUGpxmin5ny6_22C53JA__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
if(typeof window.MathJax === "undefined") window.MathJax = { menuSettings: { zoom: "Click" } };
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__gzglMimeshoybn5FdOUfx5zFIzXjSZCarAdAqdFwzb0__XnS2ZmP_Eu1FvGruois2GWaJM4qn-3H8Rt4VF8dvyrA__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript" src="https://www.google.com/recaptcha/api.js?hl=en&amp;render=explicit&amp;onload=drupalRecaptchaOnload"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__4ykqVVdSaGtVGauctG3E3Uojp_237f35KQ7wMtKX9S4__4JHByHSitU6UdWxmWARTSoZyB2PFgzkw__raxGdvbvk__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--

      $(document).ready(function() {
          $.getJSON("//www.deepdyve.com/rental-link?docId=10.3174/ajnr.A3606&journal=1936-959X&fieldName=journal_doi&affiliateId=asnr&format=jsonp&callback=?", function(data) {
            if (data.status === "ok") {
              // Update the href url so it goes straight to the article page
              $(".js-deepdyve-link a").attr("href", data.url);
              $(".js-deepdyve-link").show();
            } else if (data.status === "not_found") {
              $(".js-deepdyve-link").hide();
            }
          });
        });
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__4lG8Nd_Z78ebRQwNtbOlh_jt-whQYFW5Try6DwQUwAM__8EEmyuTE_JxYCL1fbIkxkI5UUKYRtta33k484QkazhA__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript" async="async" src="https://www.googletagmanager.com/gtag/js?id=G-4CRTLTY8KW"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
window.dataLayer = window.dataLayer || [];function gtag(){dataLayer.push(arguments)};gtag("js", new Date());gtag("set", "developer_id.dMDhkMT", true);gtag("config", "G-4CRTLTY8KW", {"groups":"default","anonymize_ip":true});
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__xwmR_XUqgIHdKocIkn2GiqYMVWJ0gY7OwpoARPRxEYM__CdSkXbn46iKUJfVct1nUx50N8MQ35eZOCMya9EuGbeU__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__156__G_TX0wWbp2x4EuISKOgbs4NaeHZ2KmXq85T6UI__w2izI_4UeJKq2XZJo79kNkQyxp_-2ptYjzA3YJcr-tg__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__az53Pz-SG0wejB-7UDzC-AbKqNFb4dAiZbq9Ymbj0sY__8FyXs8A34T1jX6OUXsgX27-4ASoy8QDncslXiOc2PK4__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
jQuery.extend(Drupal.settings, {"basePath":"\/","pathPrefix":"","ajaxPageState":{"theme":"jcore_1","theme_token":"D-COm64hICHrPbq_NR-o8XAiylbGQ0qyiB3ioyXkxIs","js":{"sites\/all\/libraries\/modernizr\/modernizr.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/jquery\/1.8\/jquery.min.js":1,"misc\/jquery-extend-3.4.0.js":1,"misc\/jquery.once.js":1,"misc\/drupal.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.core.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.widget.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.button.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.mouse.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.draggable.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.position.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.resizable.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.dialog.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.tooltip.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.accordion.min.js":1,"sites\/all\/libraries\/jquery.bgiframe\/jquery.bgiframe.js":1,"sites\/all\/libraries\/jquery.hoverIntent\/jquery.hoverIntent.js":1,"sites\/all\/libraries\/superfish\/superfish.js":1,"sites\/all\/modules\/contrib\/nice_menus\/js\/nice_menus.js":1,"sites\/all\/modules\/contrib\/eu_cookie_compliance\/js\/jquery.cookie-1.4.1.min.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.equal-heights.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.panels-ajax-tab.js":1,"sites\/all\/libraries\/colorbox\/jquery.colorbox-min.js":1,"sites\/all\/modules\/contrib\/colorbox\/js\/colorbox.js":1,"sites\/all\/modules\/contrib\/colorbox\/styles\/default\/colorbox_style.js":1,"https:\/\/scholar.google.com\/scholar_js\/casa.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_log\/highwire_log.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_user\/js\/highwire_user_meta.js":1,"sites\/all\/modules\/contrib\/panels_ajax_tab\/js\/panels_ajax_tab.js":1,"\/\/cdn.jsdelivr.net\/qtip2\/2.2.1\/jquery.qtip.min.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js":1,"sites\/all\/modules\/contrib\/captcha\/captcha.js":1,"misc\/textarea.js":1,"sites\/all\/modules\/contrib\/recaptcha\/js\/recaptcha.js":1,"https:\/\/www.google.com\/recaptcha\/api.js?hl=en\u0026render=explicit\u0026onload=drupalRecaptchaOnload":1,"sites\/all\/modules\/highwire\/highwire\/highwire_citation\/plugins\/content_types\/js\/highwire_citation_export.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/minipanel_dialog_link.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_share_dialog.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/clipboard.min.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_clipboard.js":1,"sites\/all\/modules\/contrib\/service_links\/js\/twitter_button.js":1,"sites\/all\/modules\/contrib\/service_links\/js\/facebook_like.js":1,"sites\/all\/modules\/contrib\/service_links\/js\/google_plus_one.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_article_nav.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_nav_float.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_citing_links.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_search\/plugins\/content_types\/js\/highwire_search_similar_articles.js":1,"sites\/all\/modules\/contrib\/panels_accordion\/js\/panels_accordion.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.article-citation-access.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.article-citation-author-tooltip.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_responsive\/plugins\/styles\/highwire_responsive_toggle\/highwire_responsive_toggle.js":1,"sites\/all\/modules\/contrib\/google_analytics\/googleanalytics.js":1,"https:\/\/www.googletagmanager.com\/gtag\/js?id=G-4CRTLTY8KW":1,"sites\/all\/themes\/highwire\/jcore_1\/js\/theme-scripts.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_responsive\/js\/highwire-mediaqueries.js":1,"sites\/all\/libraries\/enquire.js\/enquire.min.js":1,"sites\/all\/modules\/contrib\/picture\/picturefill2\/picturefill.min.js":1,"sites\/all\/modules\/contrib\/picture\/picture.min.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_panels_ajax_tab.js":1,"sites\/all\/libraries\/lazysizes\/lazysizes.min.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_google_scholar_sprinkle.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_article_trendmd.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_user\/plugins\/content_types\/js\/highwire_user_salutation.js":1,"sites\/all\/modules\/contrib\/eu_cookie_compliance\/js\/eu_cookie_compliance.js":1,"http:\/\/securepubads.g.doubleclick.net\/tag\/js\/gpt.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.gtranslate.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_datalayer\/js\/highwire_datalayer.js":1,"sites\/all\/themes\/contrib\/omega\/omega\/js\/jquery.formalize.js":1,"sites\/all\/themes\/contrib\/omega\/omega\/js\/omega-mediaqueries.js":1,"sites\/all\/themes\/contrib\/omega\/omega\/js\/omega-equalheights.js":1},"css":{"modules\/system\/system.base.css":1,"modules\/system\/system.menus.css":1,"modules\/system\/system.messages.css":1,"modules\/system\/system.theme.css":1,"misc\/ui\/jquery.ui.core.css":1,"misc\/ui\/jquery.ui.theme.css":1,"misc\/ui\/jquery.ui.button.css":1,"misc\/ui\/jquery.ui.resizable.css":1,"misc\/ui\/jquery.ui.dialog.css":1,"misc\/ui\/jquery.ui.tooltip.css":1,"misc\/ui\/jquery.ui.accordion.css":1,"sites\/all\/modules\/contrib\/date\/date_api\/date.css":1,"sites\/all\/modules\/contrib\/date\/date_popup\/themes\/datepicker.1.7.css":1,"modules\/field\/theme\/field.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_draw\/css\/highwire-draw.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_folders\/highwire_folders.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_responsive\/css\/highwire-responsive.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_saved_searches\/highwire_saved_searches.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_user\/highwire_user.css":1,"modules\/node\/node.css":1,"sites\/all\/modules\/contrib\/picture\/picture_wysiwyg.css":1,"modules\/search\/search.css":1,"modules\/user\/user.css":1,"sites\/all\/modules\/contrib\/views\/css\/views.css":1,"sites\/all\/modules\/contrib\/ckeditor\/css\/ckeditor.css":1,"sites\/all\/modules\/contrib\/colorbox\/styles\/default\/colorbox_style.css":1,"sites\/all\/modules\/contrib\/ctools\/css\/ctools.css":1,"sites\/all\/modules\/contrib\/google_admanager\/google_admanager.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire.style.highwire.css":1,"sites\/all\/modules\/highwire\/highwire\/css\/nlm-elements.css":1,"sites\/all\/modules\/contrib\/panels\/css\/panels.css":1,"public:\/\/ctools\/css\/263bfdb18936424f0ade19d6bd885f37.css":1,"sites\/all\/modules\/contrib\/panels_ajax_tab\/css\/panels_ajax_tab.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_corrections.css":1,"\/\/cdn.jsdelivr.net\/qtip2\/2.2.1\/jquery.qtip.min.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/layouts\/highwire_2col_stacked\/highwire-2col-stacked.css":1,"sites\/all\/modules\/contrib\/forward\/forward.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_share_link.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_copy_permalink.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire.style.markup.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_citing_links.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_reports_feed.css":1,"sites\/all\/modules\/highwire\/highwire\/css\/highwire-article-citation-list.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_responsive\/plugins\/styles\/highwire_responsive_toggle\/highwire_responsive_toggle.css.less":1,"sites\/all\/modules\/contrib\/nice_menus\/css\/nice_menus.css":1,"sites\/all\/modules\/contrib\/nice_menus\/css\/nice_menus_default.css":1,"sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css":1,"sites\/all\/modules\/contrib\/eu_cookie_compliance\/css\/eu_cookie_compliance.css":1,"sites\/all\/modules\/highwire\/highwire\/css\/highwire.gtranslate.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_theme_tools\/css\/font-hwicons.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_theme_tools\/css\/font-hwicons-glyphs.css":1,"sites\/all\/themes\/highwire\/jcore_1\/eu_cookie_compliance.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/font-awesome-ie7.css":1,"sites\/all\/themes\/contrib\/omega\/alpha\/css\/alpha-reset.css":1,"sites\/all\/themes\/contrib\/omega\/alpha\/css\/alpha-mobile.css":1,"sites\/all\/themes\/contrib\/omega\/alpha\/css\/alpha-alpha.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/formalize.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/omega-text.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/omega-branding.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/omega-menu.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/omega-forms.css":1,"sites\/all\/modules\/highwire\/highwire\/css\/highwire-forms.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/mobile-reset.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/font-awesome.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/forms.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/global.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/jquery-ui-elements.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/text.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/eletters.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/colors.css.less":1,"ie::normal::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default.css":1,"ie::normal::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default-normal.css":1,"ie::normal::sites\/all\/themes\/highwire\/jcore_1\/css\/grid\/jcore_default\/normal\/jcore-default-normal-30.css":1,"narrow::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default.css":1,"narrow::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default-narrow.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/grid\/jcore_default\/narrow\/jcore-default-narrow-30.css":1,"normal::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default.css":1,"normal::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default-normal.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/grid\/jcore_default\/normal\/jcore-default-normal-30.css":1,"wide::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default.css":1,"wide::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default-wide.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/grid\/jcore_default\/wide\/jcore-default-wide-30.css":1,"sites\/all\/modules\/shared\/jnl_ajnr_styles\/css\/jnl-ajnr-styles.css.less":1,"sites\/all\/modules\/shared\/jnl_ajnr_styles\/css\/jnl-ajnr-breakpoints.css.less":1}},"colorbox":{"opacity":"0.85","current":"{current} of {total}","previous":"\u00ab Prev","next":"Next \u00bb","close":"Close","maxWidth":"98%","maxHeight":"98%","fixed":true,"mobiledetect":true,"mobiledevicewidth":"480px"},"highwire":{"markup":[{"requested":"short-text","variant":"abstract","view":"abstract","pisa":"ajnr;34\/12\/2252"},{"requested":"short-text","variant":"abstract","view":"abstract","pisa":"ajnr;34\/12\/2252"},{"requested":"index","variant":"index","view":"full","pisa":"ajnr;ajnr.A3606\/DC1"},{"requested":"long","variant":"full-text","view":"full","pisa":"ajnr;34\/12\/2252"},{"requested":"full-text","variant":"full-text","view":"full","pisa":"ajnr;34\/12\/2252"},{"requested":"index","variant":"index","view":"full","pisa":"ajnr;ajnr.A3606\/DC1"}],"nid":"12718","apath":"\/ajnr\/34\/12\/2252.atom","pisa":"ajnr;34\/12\/2252","ac":{"\/ajnr\/34\/12\/2252.atom":{"access":{"full":true,"reprint":true},"pisa_id":"","apath":"\/ajnr\/34\/12\/2252.atom","jcode":"ajnr"},"ajnr;34\/12\/2252":{"access":{"full":true},"pisa_id":"ajnr;34\/12\/2252","apath":"","jcode":"ajnr"}},"processed":["highwire_math"],"trendmd":{"trendmd-suggestions":"{\u0022element\u0022:\u0022#trendmd-suggestions\u0022,\u0022track_id\u0022:\u0022null\u0022}"},"modal_window_width":"560","share_modal_width":"560","share_modal_title":"Share this Article","dataLayer":"{\u0022page\u0022:{\u0022hwTitle\u0022:\u0022T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations\u0022,\u0022hwUrl\u0022:\u0022http:\\\/\\\/ajnr-stage2.stage.highwire.org\\\/content\\\/34\\\/12\\\/2252\u0022,\u0022hwPath\u0022:\u0022\\\/node\\\/12718\u0022,\u0022hwType\u0022:\u0022journal page\u0022},\u0022user\u0022:{\u0022hwMemberID\u0022:\u0022\u0022,\u0022hwLoggedIntoInstitutionID\u0022:\u0022\u0022,\u0022hwLoggedIntoInstitution\u0022:\u0022\u0022,\u0022hwAccessUsageTerms\u0022:\u0022guest\u0022,\u0022hwRegisteredUser\u0022:\u0022no\u0022,\u0022hwHasFullTextAccess\u0022:\u0022yes\u0022,\u0022hwEntitled\u0022:\u0022no\u0022},\u0022content\u0022:{\u0022hwIssueDate\u0022:\u00222013-12-01\u0022,\u0022hwIssueDateTime\u0022:\u00222013-12-01 00:00:00\u0022,\u0022hwPublicationDate\u0022:\u00222013-12-13\u0022,\u0022hwPublicationDateTime\u0022:\u00222013-12-13 08:01:11\u0022,\u0022hwNlmArticleType\u0022:\u0022research-article\u0022,\u0022hwDOI\u0022:\u002210.3174\\\/ajnr.A3606\u0022,\u0022hwAuthors\u0022:\u0022P. Vakil,J. Vranic,M.C. Hurley,R.A. Bernstein,A.W. Korutz,A. Habib,A. Shaibani,F.H. Dehkordi,T.J. Carroll,S.A. Ansari\u0022,\u0022hwContributors\u0022:\u0022\u0022,\u0022hwIsEarlyRelease\u0022:\u0022no\u0022,\u0022hwEissn\u0022:\u00221936-959X\u0022,\u0022hwPissn\u0022:\u00220195-6108\u0022,\u0022hwVolume\u0022:\u002234\u0022,\u0022hwIssue\u0022:\u002212\u0022,\u0022hwArticleType\u0022:\u0022Brain\u0022,\u0022hwTabView\u0022:\u0022main_tab\u0022,\u0022hwViewType\u0022:\u0022full\u0022,\u0022hwAccessType\u0022:\u0022OpenAccess\u0022,\u0022hwOpenAccess\u0022:\u0022yes\u0022,\u0022hwFreeAccess\u0022:\u0022yes\u0022,\u0022hwTaxonomy\u0022:\u0022\u0022,\u0022hwCorpusCode\u0022:\u0022ajnr\u0022,\u0022hwType\u0022:\u0022article\u0022,\u0022hwSubtitle\u0022:null,\u0022hwOverline\u0022:null,\u0022hwPisaId\u0022:\u0022ajnr;34\\\/12\\\/2252\u0022,\u0022hwFirstPage\u0022:\u00222252\u0022,\u0022hwLastPage\u0022:\u00222258\u0022,\u0022hwIsLatestVersion\u0022:\u0022yes\u0022,\u0022hwIsCurrentIssue\u0022:\u0022no\u0022,\u0022hwIsOpenIssue\u0022:\u0022no\u0022,\u0022hwHasFullText\u0022:\u0022yes\u0022,\u0022hwHasPDF\u0022:\u0022yes\u0022,\u0022hwParentTitle\u0022:\u0022American Journal of Neuroradiology: 34 (12)\u0022,\u0022hwElectronicPubDate\u0022:\u00222013-12-13\u0022,\u0022hwElectronicPubDateTime\u0022:\u00222013-12-13 08:01:11\u0022}}"},"highwire_panel_tabs":[{"panel_name":"jnl_ajnr_tab_pdf","panel_ajax_tab":"jnl_ajnr_tab_pdf"}],"panel_ajax_tab":{"path":"sites\/all\/modules\/contrib\/panels_ajax_tab"},"instances":"{\u0022highwire_abstract_tooltip\u0022:{\u0022content\u0022:{\u0022text\u0022:\u0022\u0022},\u0022style\u0022:{\u0022tip\u0022:{\u0022width\u0022:20,\u0022height\u0022:20,\u0022border\u0022:1,\u0022offset\u0022:0,\u0022corner\u0022:true},\u0022classes\u0022:\u0022qtip-custom hw-tooltip hw-abstract-tooltip qtip-shadow qtip-rounded\u0022,\u0022classes_custom\u0022:\u0022hw-tooltip hw-abstract-tooltip\u0022},\u0022position\u0022:{\u0022at\u0022:\u0022right center\u0022,\u0022my\u0022:\u0022left center\u0022,\u0022viewport\u0022:true,\u0022adjust\u0022:{\u0022method\u0022:\u0022shift\u0022}},\u0022show\u0022:{\u0022event\u0022:\u0022mouseenter click \u0022,\u0022solo\u0022:true},\u0022hide\u0022:{\u0022event\u0022:\u0022mouseleave \u0022,\u0022fixed\u0022:1,\u0022delay\u0022:\u0022100\u0022}},\u0022highwire_author_tooltip\u0022:{\u0022content\u0022:{\u0022text\u0022:\u0022\u0022},\u0022style\u0022:{\u0022tip\u0022:{\u0022width\u0022:15,\u0022height\u0022:15,\u0022border\u0022:1,\u0022offset\u0022:0,\u0022corner\u0022:true},\u0022classes\u0022:\u0022qtip-custom hw-tooltip hw-author-tooltip qtip-shadow qtip-rounded\u0022,\u0022classes_custom\u0022:\u0022hw-tooltip hw-author-tooltip\u0022},\u0022position\u0022:{\u0022at\u0022:\u0022top center\u0022,\u0022my\u0022:\u0022bottom center\u0022,\u0022viewport\u0022:true,\u0022adjust\u0022:{\u0022method\u0022:\u0022\u0022}},\u0022show\u0022:{\u0022event\u0022:\u0022mouseenter \u0022,\u0022solo\u0022:true},\u0022hide\u0022:{\u0022event\u0022:\u0022mouseleave \u0022,\u0022fixed\u0022:1,\u0022delay\u0022:\u0022100\u0022}},\u0022highwire_reflinks_tooltip\u0022:{\u0022content\u0022:{\u0022text\u0022:\u0022\u0022},\u0022style\u0022:{\u0022tip\u0022:{\u0022width\u0022:15,\u0022height\u0022:15,\u0022border\u0022:1,\u0022mimic\u0022:\u0022top center\u0022,\u0022offset\u0022:0,\u0022corner\u0022:true},\u0022classes\u0022:\u0022qtip-custom hw-tooltip hw-ref-link-tooltip qtip-shadow qtip-rounded\u0022,\u0022classes_custom\u0022:\u0022hw-tooltip hw-ref-link-tooltip\u0022},\u0022position\u0022:{\u0022at\u0022:\u0022bottom left\u0022,\u0022my\u0022:\u0022top left\u0022,\u0022viewport\u0022:true,\u0022adjust\u0022:{\u0022method\u0022:\u0022flip\u0022}},\u0022show\u0022:{\u0022event\u0022:\u0022mouseenter \u0022,\u0022solo\u0022:true},\u0022hide\u0022:{\u0022event\u0022:\u0022mouseleave \u0022,\u0022fixed\u0022:1,\u0022delay\u0022:\u0022100\u0022}}}","qtipDebug":"{\u0022leaveElement\u0022:0}","urlIsAjaxTrusted":{"\/node\/12718":true},"ws_fl":{"width":100,"height":21},"ws_gpo":{"size":"","annotation":"","lang":"","callback":"","width":300},"highwire_search_similar_articles":{"highwire-search-similar-articles-list-1":{"conf":{"context":"requiredcontext_entity:node_1","override_title":1,"override_title_text":"\u003Ci class=\u0022icon-caret-right\u0022\u003E\u003C\/i\u003E Similar Articles","number_per_page":"5","show_pager":0,"more_link_path":"similar\/articles","more_link":1,"empty_message":"No similar articles are available.","citation_style":"jcore_standard","title_type":"prefer_short","title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","display_original_link":0,"display_access_indicator":0,"display_cme_link":0,"display_access_indicator_text":0,"display_highlight_image":"0","display_variants":0,"display_supplements":0,"display_abstract_tooltip":0,"display_author_tooltip":0,"override_title_heading":"h2","citation_settings_source":"citation_manager","citation_manager_wrapper":{"citation_manager_citation":"jcore_list_title_only"},"corpus_config_wrapper":{"corpus_config_citation_context":[]},"cache_enabled":1,"cache_time":"600","short_title_options":{"char_count":"50","add_ellipsis":0},"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"highlight_image_style":"","featured_image_variant":"large","featured_image_click_image":"colorbox","display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":1,"display_orcid_tooltip":0,"display_ads_search_tooltip":0,"display_agricola_tooltip":0,"author_site_search_path":"","display_translations":0,"display_translations_text":"","display_translations_text_icon":"","bundle_overrides_checkboxes":{"highwire_book_fragment":{"selector":0},"highwire_news_story":{"selector":0},"highwire_book_edition":{"selector":0},"highwire_article":{"selector":0},"highwire_issue":{"selector":0},"highwire_comment":{"selector":0},"highwire_fragment":{"selector":0},"highwire_book_section":{"selector":0},"highwire_journal":{"selector":0}},"bundle_overrides":{"highwire_book_fragment":{"selector":0,"citation_style":"jcore_title_and_author","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":"0","access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"thumbnail","display_fragment_caption":1,"display_parent_citation":1,"parent_citation_type":"highwire_book_section","parent_citation_settings":{"citation_style":"folio_book_sections_standard","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_abstract_tooltip":0,"display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":0,"author_site_search_path":"search\/"}},"highwire_news_story":{"selector":0,"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":"0","highlight_image_style":"","featured_image_click_image":"nothing","display_author_tooltip":0,"display_google_scholar_tooltip":0,"display_pubmed_tooltip":0,"display_advanced_search_tooltip":0},"highwire_book_edition":{"selector":0,"citation_style":"folio_books_standard","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":1,"display_orcid_tooltip":1,"author_site_search_path":"search\/"},"highwire_article":{"selector":0,"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":0,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":"0","highlight_image_style":"","featured_image_variant":"large","featured_image_click_image":"nothing","display_cme_link":0,"display_abstract_tooltip":0,"display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":1,"display_orcid_tooltip":1,"display_ads_search_tooltip":0,"display_agricola_tooltip":0,"author_site_search_path":"search\/","display_translations":0,"display_translations_text":"Translations Available","display_translations_text_icon":"icon-globe"},"highwire_issue":{"selector":0,"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","featured_image_click_image":"nothing","display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":0,"display_orcid_tooltip":1,"author_site_search_path":"search\/"},"highwire_comment":{"selector":0,"citation_style":"highwire_comment","show_title":0,"title_as_link":0,"title_as_link_type":"tab_view","author_format_type":"fullname","author_format_custom":"","author_list_separator":", ","date_format":"(j F Y)","display_comment_body":1,"display_attachment":1,"display_conflict_of_interest":1},"highwire_fragment":{"selector":0,"citation_style":"jcore_title_and_author","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":"0","access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_fragment_caption":1,"fragment_image_settings":{"fragment_image_variant":"medium","fragment_click_image":"colorbox","show_download_links":1},"display_parent_citation":1,"parent_citation_type":"highwire_article","parent_citation_settings":{"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":0,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":"0","highlight_image_style":"","featured_image_variant":"large","featured_image_click_image":"nothing","display_cme_link":0,"display_abstract_tooltip":0,"display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":1,"display_orcid_tooltip":1,"display_ads_search_tooltip":0,"display_agricola_tooltip":0,"author_site_search_path":"search\/","display_translations":0,"display_translations_text":"Translations Available","display_translations_text_icon":"icon-globe"}},"highwire_book_section":{"selector":0,"citation_style":"folio_book_sections_standard","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_abstract_tooltip":0,"display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":0,"author_site_search_path":"search\/"},"highwire_journal":{"selector":0,"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":0,"display_orcid_tooltip":1,"author_site_search_path":"search\/"}},"cpath_prefix":"\/content","ajax_loading_icon_classes":"icon-spinner icon-spin icon-2x","ajax_loading_text":"","highlight_image_toggle":0,"more_link_label":"See more","url_parameters":{"q":"node\/12718"}},"nid":"12718"}},"panels_accordion":{"highwire_article_accordion_container":{"heightStyle":"content","autoHeight":false,"collapsible":0,"region_accordion_id":"highwire_article_accordion_container","active":0,"animated":"slide"}},"color":{"logo":"http:\/\/ajnr-stage2.stage.highwire.org\/sites\/default\/files\/ajnr-web-logo_0.png"},"nice_menus_options":{"delay":800,"speed":"fast"},"highwireResponsive":{"enquire_enabled":1,"breakpoints_configured":1,"breakpoints":{"zero":"all and (min-width: 0px)","xsmall":"all and (min-width: 380px)","narrow":"all and (min-width: 768px) and (min-device-width: 768px), (max-device-width: 800px) and (min-width: 768px) and (orientation:landscape)","normal":"all and (min-width: 980px) and (min-device-width: 980px), all and (max-device-width: 1024px) and (min-width: 1024px) and (orientation:landscape)","wide":"all and (min-width: 1220px)"}},"eu_cookie_compliance":{"popup_enabled":1,"popup_agreed_enabled":0,"popup_hide_agreed":false,"popup_clicking_confirmation":true,"popup_scrolling_confirmation":false,"popup_html_info":"\u003Cdiv\u003E\n  \u003Cdiv class=\u0022popup-content info\u0022\u003E\n    \u003Cdiv id=\u0022popup-text\u0022\u003E\n      \u003Cp\u003EWe use cookies on this site to enhance your user experience. By clicking any link on this page you are giving your consent for us to set cookies.\u003C\/p\u003E\n    \u003C\/div\u003E\n    \u003Cdiv id=\u0022popup-buttons\u0022\u003E\n      \u003Cbutton type=\u0022button\u0022 role=\u0022dialog\u0022 aria-labelledby=\u0022Continue\u0022\n        class=\u0022agree-button eu-cookie-compliance-default-button\u0022\u003EContinue\u003C\/button\u003E\n                  \u003Cbutton type=\u0022button\u0022 role=\u0022dialog\u0022 aria-labelledby=\u0022Find out more\u0022\n        class=\u0022find-more-button eu-cookie-compliance-more-button\u0022\u003EFind out more\u003C\/button\u003E\n          \u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E","use_mobile_message":false,"mobile_popup_html_info":"\u003Cdiv\u003E\n  \u003Cdiv class=\u0022popup-content info\u0022\u003E\n    \u003Cdiv id=\u0022popup-text\u0022\u003E\n          \u003C\/div\u003E\n    \u003Cdiv id=\u0022popup-buttons\u0022\u003E\n      \u003Cbutton type=\u0022button\u0022 role=\u0022dialog\u0022 aria-labelledby=\u0022Continue\u0022\n        class=\u0022agree-button eu-cookie-compliance-default-button\u0022\u003EContinue\u003C\/button\u003E\n                  \u003Cbutton type=\u0022button\u0022 role=\u0022dialog\u0022 aria-labelledby=\u0022Find out more\u0022\n        class=\u0022find-more-button eu-cookie-compliance-more-button\u0022\u003EFind out more\u003C\/button\u003E\n          \u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E","mobile_breakpoint":"768","popup_html_agreed":"\u003Cdiv\u003E\n  \u003Cdiv class=\u0022popup-content agreed\u0022\u003E\n    \u003Cdiv id=\u0022popup-text\u0022\u003E\n      \u003Cp\u003EThank you for accepting cookies. You can now hide this message or find out more about cookies.\u003C\/p\u003E\n    \u003C\/div\u003E\n    \u003Cdiv id=\u0022popup-buttons\u0022\u003E\n      \u003Cbutton type=\u0022button\u0022 class=\u0022hide-popup-button eu-cookie-compliance-hide-button\u0022\u003EHide\u003C\/button\u003E\n              \u003Cbutton type=\u0022button\u0022 class=\u0022find-more-button eu-cookie-compliance-more-button-thank-you\u0022 \u003EFind out more\u003C\/button\u003E\n          \u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E","popup_use_bare_css":false,"popup_height":"auto","popup_width":"100%","popup_delay":1000,"popup_link":"\/help\/cookie-policy","popup_link_new_window":1,"popup_position":null,"popup_language":"en","store_consent":false,"better_support_for_screen_readers":0,"reload_page":0,"domain":"","popup_eu_only_js":0,"cookie_lifetime":365,"cookie_session":false,"disagree_do_not_show_popup":0,"method":"default","whitelisted_cookies":"","withdraw_markup":"\u003Cbutton type=\u0022button\u0022 class=\u0022eu-cookie-withdraw-tab\u0022\u003EPrivacy settings\u003C\/button\u003E\n\u003Cdiv class=\u0022eu-cookie-withdraw-banner\u0022\u003E\n  \u003Cdiv class=\u0022popup-content info\u0022\u003E\n    \u003Cdiv id=\u0022popup-text\u0022\u003E\n      \u003Cp\u003E\u0026lt;h2\u0026gt;We use cookies on this site to enhance your user experience\u0026lt;\/h2\u0026gt;\u0026lt;p\u0026gt;You have given your consent for us to set cookies.\u0026lt;\/p\u0026gt;\u003C\/p\u003E\n    \u003C\/div\u003E\n    \u003Cdiv id=\u0022popup-buttons\u0022\u003E\n      \u003Cbutton type=\u0022button\u0022 class=\u0022eu-cookie-withdraw-button\u0022\u003EWithdraw consent\u003C\/button\u003E\n    \u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n","withdraw_enabled":false},"googleanalytics":{"account":["G-4CRTLTY8KW"],"trackOutbound":1,"trackMailto":1,"trackDownload":1,"trackDownloadExtensions":"7z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip","trackColorbox":1},"omega":{"layouts":{"primary":"normal","order":["narrow","normal","wide"],"queries":{"narrow":"all and (min-width: 768px) and (min-device-width: 768px), (max-device-width: 800px) and (min-width: 768px) and (orientation:landscape)","normal":"all and (min-width: 980px) and (min-device-width: 980px), all and (max-device-width: 1024px) and (min-width: 1024px) and (orientation:landscape)","wide":"all and (min-width: 1220px)"}}}});
//--><!]]>
</script>
    <!--[if lt IE 9]><script src="http://html5shiv.googlecode.com/svn/trunk/html5.js"></script><![endif]-->
  </head>
  <body class="html not-front not-logged-in page-node page-node- page-node-12718 node-type-highwire-article context-content hw-default-jcode-ajnr hw-article-type-research-article hw-article-category-brain">
<!-- Google Tag Manager -->
<noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-MXP45WNH" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
<script type="text/javascript">(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-MXP45WNH');</script>
<!-- End Google Tag Manager -->
    <div id="skip-link">
      <a href="#main-content" class="element-invisible element-focusable">Skip to main content</a>
    </div>
    <div class="region region-page-top" id="region-page-top">
  <div class="region-inner region-page-top-inner">
      </div>
</div>    <div class="page clearfix footer-borders panels-page panels-layout-jcore_2col" id="page">
      <header id="section-header" class="section section-header">
  <div id="zone-advertising-top-wrapper" class="zone-wrapper zone-advertising-top-wrapper clearfix">  
  <div id="zone-advertising-top" class="zone zone-advertising-top clearfix container-30">
    <div class="grid-28 suffix-1 prefix-1 region region-ad-top" id="region-ad-top">
  <div class="region-inner region-ad-top-inner">
    <div class="block block-panels-mini mobile-hiddens rtecenter block-jnl-ajnr-ad-leaderboard block-panels-mini-jnl-ajnr-ad-leaderboard odd block-without-title" id="block-panels-mini-jnl-ajnr-ad-leaderboard">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_ad_leaderboard">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-dfp-pane text-center" >
  
      
  
  <div class="pane-content">
    <div id="dfp-ad-top_leaderboard-wrapper" class="dfp-tag-wrapper">
<div class="slug">Advertisement</div>
<div  id="dfp-ad-top_leaderboard" class="dfp-tag-wrapper">
  <script type="text/javascript">
    googletag.cmd.push(function() {
      googletag.display("dfp-ad-top_leaderboard");
    });
  </script>
</div>
</div>  </div>

  
  </div>
</div>
  </div>
</div>
    </div>
  </div>
</div>  </div>
</div>  </div>
</div><div id="zone-superheader-wrapper" class="zone-wrapper zone-superheader-wrapper clearfix mobile-only print-hidden">  
  <div id="zone-superheader" class="zone zone-superheader clearfix mobile-only print-hidden container-30">
    <div class="grid-30 region region-superheader" id="region-superheader">
  <div class="region-inner region-superheader-inner">
    <div class="block block-panels-mini block-responsive-menu block-panels-mini-responsive-menu odd block-without-title" id="block-panels-mini-responsive-menu">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panel-1col clearfix" id="mini-panel-responsive_menu">
  <div class="panel-panel panel-col">
    <div><div id="unique-id3" class="highwire-responsive-toggle-group"><div class="panel-pane pane-panels-mini pane-responsive-menu-main-menu" >
  
        <h2 class="pane-title"><span class="icon-reorder"></span><span class="element-invisible">Main menu</span></h2>
    
  
  <div class="pane-content">
    <div class="panel-display panel-1col clearfix" id="mini-panel-responsive_menu_main_menu">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-menu-tree pane-main-menu" >
  
      
  
  <div class="pane-content">
    <div class="menu-block-wrapper menu-block-ctools-main-menu-1 menu-name-main-menu parent-mlid-main-menu:0 menu-level-1">
  <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-772" role="menuitem"><a href="/" class="" data-icon-position="" data-hide-link-title="0">Home</a></li>
<li class="expanded active-trail menu-mlid-773" role="menuitem"><a href="/content/current" data-hide-link-title="0" class="active active-trail" data-icon-position="">Content</a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first expanded menu-mlid-774" role="menuitem"><a href="/content/current" data-hide-link-title="0" class="" data-icon-position="">Current Issue</a></li>
<li class="leaf menu-mlid-1747" role="menuitem"><a href="/content/early/preprint" data-hide-link-title="0" class="" data-icon-position="">Publication Preview--Preprint</a></li>
<li class="leaf menu-mlid-775" role="menuitem"><a href="/content/early/recent" data-hide-link-title="0" class="" data-icon-position="">Publication Preview--Ahead of Print</a></li>
<li class="leaf menu-mlid-776" role="menuitem"><a href="/content/by/year" data-hide-link-title="0" class="" data-icon-position="">Past Issue Archive</a></li>
<li class="leaf menu-mlid-900" role="menuitem"><a href="/cow/by/year" data-hide-link-title="0" class="" data-icon-position="">Case of the Week Archive</a></li>
<li class="leaf menu-mlid-1006" role="menuitem"><a href="/cc/by/year" data-hide-link-title="0" class="" data-icon-position="">Classic Case Archive</a></li>
<li class="leaf menu-mlid-901" role="menuitem"><a href="/com/by/year" data-hide-link-title="0" class="" data-icon-position="">Case of the Month Archive</a></li>
<li class="last leaf menu-mlid-1334" role="menuitem"><a href="http://www.ajnr.org/content/covid-19-content-and-resources" data-hide-link-title="0" class="" data-icon-position="">COVID-19 Content and Resources</a></li>
</ul></nav></li>
<li class="expanded menu-mlid-784" role="menuitem"><a href="/content/about-us" class="" data-icon-position="" data-hide-link-title="0">About Us</a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-785" role="menuitem"><a href="/page/content/About" data-hide-link-title="0" class="" data-icon-position="">About AJNR</a></li>
<li class="leaf menu-mlid-899" role="menuitem"><a href="https://www.ajnr.org/page/content/Ed-Board" data-hide-link-title="0" class="" data-icon-position="">Editorial Board</a></li>
<li class="last leaf menu-mlid-864" role="menuitem"><a href="http://www.asnr.org" data-hide-link-title="0" target="_blank" class="" data-icon-position="">American Society of Neuroradiology</a></li>
</ul></nav></li>
<li class="expanded menu-mlid-1746" role="menuitem"><a href="/" class="" data-icon-position="" data-hide-link-title="0">For Authors</a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-1725" role="menuitem"><a href="https://www.ajnr.org/content/author-policies" data-hide-link-title="0" class="" data-icon-position="">Author Policies</a></li>
<li class="leaf menu-mlid-1856" role="menuitem"><a href="https://www.ajnr.org/preprint_publishing" data-hide-link-title="0" class="" data-icon-position="">Preprint Publishing</a></li>
<li class="last leaf menu-mlid-1726" role="menuitem"><a href="https://www.ajnr.org/content/manuscript-submission-guidelines" data-hide-link-title="0" class="" data-icon-position="">Manuscript Submission Guidelines</a></li>
</ul></nav></li>
<li class="leaf menu-mlid-862" role="menuitem"><a href="https://mc.manuscriptcentral.com/ajnr" data-hide-link-title="0" target="_blank" class="" data-icon-position="">Submit a Manuscript</a></li>
<li class="expanded menu-mlid-1184" role="menuitem"><a href="/content/about-us" data-hide-link-title="0" class="" data-icon-position="">Special Collections</a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-1733" role="menuitem"><a href="http://www.ajnr.org/cc/CSF-Spinal-Leak" data-hide-link-title="0" class="" data-icon-position="">Spinal CSF Leak Articles (Jan 2020-June 2024)</a></li>
<li class="leaf menu-mlid-1185" role="menuitem"><a href="http://www.ajnr.org/cc/most-impactful-ajnr-articles" data-hide-link-title="0" class="" data-icon-position="">Most Impactful AJNR Articles</a></li>
<li class="last leaf menu-mlid-1896" role="menuitem"><a href="http://www.ajnr.org/cc/2024-Awards" data-hide-link-title="0" class="" data-icon-position="">2024 AJNR Journal Awards</a></li>
</ul></nav></li>
<li class="last expanded menu-mlid-788" role="menuitem"><a href="/content/advertising" class="" data-icon-position="" data-hide-link-title="0">More</a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-780" role="menuitem"><a href="/content/subscriber-help-and-services" data-hide-link-title="0" class="" data-icon-position="">Subscribers</a></li>
<li class="leaf menu-mlid-863" role="menuitem"><a href="https://marketplace.copyright.com/rs-ui-web/mp/details/journal/122810747" data-hide-link-title="0" class="" data-icon-position="">Permissions</a></li>
<li class="leaf menu-mlid-782" role="menuitem"><a href="/page/content/Ads" data-hide-link-title="0" class="" data-icon-position="">Advertisers</a></li>
<li class="leaf menu-mlid-790" role="menuitem"><a href="/alerts" data-hide-link-title="0" class="" data-icon-position="">Alerts</a></li>
<li class="last leaf menu-mlid-791" role="menuitem"><a href="/feedback" class="" data-icon-position="" data-hide-link-title="0">Feedback</a></li>
</ul></nav></li>
</ul></nav></div>
  </div>

  
  </div>
</div>
  </div>
</div>
  </div>

  
  </div>
<div class="panel-pane pane-panels-mini pane-responsive-menu-user-menu" >
  
        <h2 class="pane-title"><span class="icon-gear"></span><span class="element-invisible">User menu</span></h2>
    
  
  <div class="pane-content">
    <div class="panel-display panel-1col clearfix" id="mini-panel-responsive_menu_user_menu">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-menu-tree pane-user-menu" >
  
      
  
  <div class="pane-content">
    <div class="menu-block-wrapper menu-block-ctools-user-menu-1 menu-name-user-menu parent-mlid-user-menu:0 menu-level-1">
  <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-801" role="menuitem"><a href="/content/subscriber-help-and-services" data-hide-link-title="0" class="" data-icon-position="">Subscribe</a></li>
<li class="leaf menu-mlid-802" role="menuitem"><a href="/alerts" data-hide-link-title="0" class="" data-icon-position="">Alerts</a></li>
<li class="leaf menu-mlid-803" role="menuitem"><a href="/user/login?destination=/content/34/12/2252" class="" data-icon-position="" data-hide-link-title="0">Log in</a></li>
<li class="last leaf menu-mlid-17" role="menuitem"><a href="/user/logout?current=node/12718" class="" data-icon-position="" data-hide-link-title="0">Log out</a></li>
</ul></nav></div>
  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-highwire-user-identities" >
  
      
  
  <div class="pane-content">
    <div class="highwire-user-message" data-separator="|"><span class="highwire-user-institution" data-id-type="institution" data-identity="a%3A2%3A%7Bs%3A4%3A%22show%22%3Bi%3A1%3Bs%3A7%3A%22message%22%3Bs%3A50%3A%22Institution%3A%20%5Bidentity%3Ainstitutional_display_name%5D%22%3B%7D"></span></div>  </div>

  
  </div>
</div>
  </div>
</div>
  </div>

  
  </div>
<div class="panel-pane pane-panels-mini pane-responsive-menu-search" >
  
        <h2 class="pane-title"><span class="icon-search"></span><span class="element-invisible">Search</span></h2>
    
  
  <div class="pane-content">
    <div class="panel-display panel-1col clearfix" id="mini-panel-responsive_menu_search">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-highwire-seach-qsearch-nocontext" >
  
      
  
  <div class="pane-content">
    <form class="highwire-quicksearch button-style-mini button-style-mini" action="/node/12718" method="post" id="highwire-search-qsearch-nocontext-form" accept-charset="UTF-8"><div><div class="form-item form-item-label-invisible form-type-textfield form-item-keywords">
  <label class="element-invisible" for="quick_search_header_keywords_538242435">Search for this keyword </label>
 <input placeholder="Search..." type="text" id="quick_search_header_keywords_538242435" name="keywords" value="" size="60" maxlength="128" class="form-text" />
</div>
<div class="button-wrapper button-mini"><span class="icon-search"></span><input data-icon-only="1" data-font-icon="icon-search" data-icon-position="after" type="submit" id="quick_search_header_submit_1876737246" name="op" value="Search" class="form-submit" /></div><input type="hidden" name="form_build_id" value="form-cKrXBmQdpMRNYvholCLtRdNnGbbVmaoz40BotNHYOc4" />
<input type="hidden" name="form_id" value="highwire_search_qsearch_nocontext_form" />
</div></form>  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-custom pane-1 highwire-responsive-advanced-search-link pane-menu-tree" >
  
      
  
  <div class="pane-content">
    <ul class="menu">
  <li><a href="/search" title="Advanced search">Advanced search</a></li>
  </ul>  </div>

  
  </div>
</div>
  </div>
</div>
  </div>

  
  </div>
</div></div>
  </div>
</div>
    </div>
  </div>
</div><div class="block block-panels-mini block-hw-small-logo block-panels-mini-hw-small-logo even block-without-title" id="block-panels-mini-hw-small-logo">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panel-1col clearfix" id="mini-panel-hw_small_logo">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-small-logo" >
  
      
  
  <div class="pane-content">
    <a href="/" class="" data-icon-position="" data-hide-link-title="0"><img src="http://ajnr-stage2.stage.highwire.org/sites/default/files/ajnr-logo.png" alt="American Journal of Neuroradiology" title="American Journal of Neuroradiology" /></a>  </div>

  
  </div>
</div>
  </div>
</div>
    </div>
  </div>
</div>  </div>
</div>  </div>
</div><div id="zone-user-wrapper" class="zone-wrapper zone-user-wrapper clearfix mobile-hidden print-hidden">  
  <div id="zone-user" class="zone zone-user clearfix equal-height-container mobile-hidden print-hidden container-30">    
  	    <div class="grid-30 region region-user-second equal-height-element" id="region-user-second">
  <div class="region-inner region-user-second-inner">
    <div class="block block-panels-mini text-right no-margin-bottom block-jnl-ajnr-uid-strng block-panels-mini-jnl-ajnr-uid-strng odd block-without-title" id="block-panels-mini-jnl-ajnr-uid-strng">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_uid_strng">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-highwire-user-identities" >
  
      
  
  <div class="pane-content">
    <div class="highwire-user-message" data-separator=" | "><span class="highwire-user-institution" data-id-type="institution" data-identity="a%3A2%3A%7Bs%3A4%3A%22show%22%3Bi%3A1%3Bs%3A7%3A%22message%22%3Bs%3A85%3A%22%3Cspan%20class%3D%22narrow-hidden%22%3EInstitution%3A%20%3C%2Fspan%3E%5Bidentity%3Ainstitutional_display_name%5D%22%3B%7D"></span></div>  </div>

  
  </div>
</div>
  </div>
</div>
    </div>
  </div>
</div>  </div>
</div>  </div>
</div>  
  <div id="zone-branding" class="zone zone-branding clearfix mobile-hidden print-display-block container-30">
    <div class="grid-19 prefix-1 region region-branding print-display-block" id="region-branding">
  <div class="region-inner region-branding-inner">
        <div class="branding-data clearfix">
            <div class="logo-img">
        <a href="/" rel="home" class="" data-icon-position="" data-hide-link-title="0"><img alt="American Journal of Neuroradiology" src="http://ajnr-stage2.stage.highwire.org/sites/default/files/ajnr-web-logo_0.png" /></a>      </div>
                        <hgroup class="site-name-slogan element-invisible">        
                                <h2 class="site-name element-invisible"><a href="/" title="Home" class="" data-icon-position="" data-hide-link-title="0">American Journal of Neuroradiology</a></h2>
                              </hgroup>
          </div>
          </div>
</div><div class="grid-9 suffix-1 region region-branding-second print-hidden" id="region-branding-second">
  <div class="region-inner region-branding-second-inner">
    <div class="block block-panels-mini text-right no-margin-bottom block-jnl-ajnr-user-menu block-panels-mini-jnl-ajnr-user-menu odd block-without-title" id="block-panels-mini-jnl-ajnr-user-menu">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_user_menu">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-block pane-system-user-menu links inline pane-system" >
  
      
  
  <div class="pane-content">
    <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf" role="menuitem"><a href="/content/subscriber-help-and-services" data-hide-link-title="0" class="" data-icon-position="">Subscribe</a></li>
<li class="leaf" role="menuitem"><a href="/alerts" data-hide-link-title="0" class="" data-icon-position="">Alerts</a></li>
<li class="leaf" role="menuitem"><a href="/user/login?destination=/content/34/12/2252" class="" data-icon-position="" data-hide-link-title="0">Log in</a></li>
<li class="last leaf" role="menuitem"><a href="/user/logout?current=node/12718" class="" data-icon-position="" data-hide-link-title="0">Log out</a></li>
</ul></nav>  </div>

  
  </div>
</div>
  </div>
</div>
    </div>
  </div>
</div><div class="block block-panels-mini block-jnl-ajnr-search-box block-panels-mini-jnl-ajnr-search-box even block-without-title" id="block-panels-mini-jnl-ajnr-search-box">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_search_box">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-highwire-seach-quicksearch no-margin-bottom" >
  
      
  
  <div class="pane-content">
    <form class="highwire-quicksearch button-style-mini button-style-mini" action="/node/12718" method="post" id="highwire-search-quicksearch-form-0" accept-charset="UTF-8"><div><div class="form-item form-item-label-invisible form-type-textfield form-item-keywords">
  <label class="element-invisible" for="search_rightsidebar_keywords_1775080250">Search for this keyword </label>
 <input placeholder="search" type="text" id="search_rightsidebar_keywords_1775080250" name="keywords" value="" size="60" maxlength="128" class="form-text" />
</div>
<div class="button-wrapper button-mini"><span class="icon-search"></span><input data-icon-only="1" data-font-icon="icon-search" data-icon-position="after" type="submit" id="search_rightsidebar_submit_609015243" name="op" value="Search" class="form-submit" /></div><input type="hidden" name="form_build_id" value="form-9RhtWzJf6PKC7BeO5Q8YcYEdP7Ajf-HDQLpy_m4_GGA" />
<input type="hidden" name="form_id" value="highwire_search_quicksearch_form_0" />
</div></form>  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-custom pane-2" >
  
      
  
  <div class="pane-content">
    <p><a href="/search">Advanced Search</a></p>  </div>

  
  </div>
</div>
  </div>
</div>
    </div>
  </div>
</div>  </div>
</div>  </div>
  
  <div id="zone-menu" class="zone zone-menu clearfix mobile-hidden container-30">
    <div class="grid-28 suffix-1 prefix-1 region region-menu region-menu-bg-opaque region-menu-no-border" id="region-menu">
  <div class="region-inner region-menu-inner">
        <div class="block block-nice-menus block-1 block-nice-menus-1 odd block-without-title" id="block-nice-menus-1">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <nav class="menubar-nav"><ul class="nice-menu nice-menu-down nice-menu-main-menu" id="nice-menu-1" role="menu"><li class="menu-772 menu-path-front first odd " role="menuitem"><a href="/" class="" data-icon-position="" data-hide-link-title="0">Home</a></li>
<li class="menu-773 menuparent  menu-path-content-current active-trail  even " role="menuitem"><a href="/content/current" data-hide-link-title="0" class="active" data-icon-position="">Content</a><ul role="menu"><li class="menu-774 menu-path-content-current first odd " role="menuitem"><a href="/content/current" data-hide-link-title="0" class="" data-icon-position="">Current Issue</a></li>
<li class="menu-1747 menu-path-content-early-preprint  even " role="menuitem"><a href="/content/early/preprint" data-hide-link-title="0" class="" data-icon-position="">Publication Preview--Preprint</a></li>
<li class="menu-775 menu-path-content-early-recent  odd " role="menuitem"><a href="/content/early/recent" data-hide-link-title="0" class="" data-icon-position="">Publication Preview--Ahead of Print</a></li>
<li class="menu-776 menu-path-content-by-year  even " role="menuitem"><a href="/content/by/year" data-hide-link-title="0" class="" data-icon-position="">Past Issue Archive</a></li>
<li class="menu-900 menu-path-cow-by-year  odd " role="menuitem"><a href="/cow/by/year" data-hide-link-title="0" class="" data-icon-position="">Case of the Week Archive</a></li>
<li class="menu-1006 menu-path-cc-by-year  even " role="menuitem"><a href="/cc/by/year" data-hide-link-title="0" class="" data-icon-position="">Classic Case Archive</a></li>
<li class="menu-901 menu-path-com-by-year  odd " role="menuitem"><a href="/com/by/year" data-hide-link-title="0" class="" data-icon-position="">Case of the Month Archive</a></li>
<li class="menu-1334 menu-path-ajnrorg-content-covid-19-content-and-resources  even last" role="menuitem"><a href="http://www.ajnr.org/content/covid-19-content-and-resources" data-hide-link-title="0" class="" data-icon-position="">COVID-19 Content and Resources</a></li>
</ul></li>
<li class="menu-784 menuparent  menu-path-node-7  odd " role="menuitem"><a href="/content/about-us" class="" data-icon-position="" data-hide-link-title="0">About Us</a><ul role="menu"><li class="menu-785 menu-path-node-935 first odd " role="menuitem"><a href="/page/content/About" data-hide-link-title="0" class="" data-icon-position="">About AJNR</a></li>
<li class="menu-899 menu-path-sajnrorg-page-content-ed-board  even " role="menuitem"><a href="https://www.ajnr.org/page/content/Ed-Board" data-hide-link-title="0" class="" data-icon-position="">Editorial Board</a></li>
<li class="menu-864 menu-path-asnrorg  odd last" role="menuitem"><a href="http://www.asnr.org" data-hide-link-title="0" target="_blank" class="" data-icon-position="">American Society of Neuroradiology</a></li>
</ul></li>
<li class="menu-1746 menuparent  menu-path-front  even " role="menuitem"><a href="/" class="" data-icon-position="" data-hide-link-title="0">For Authors</a><ul role="menu"><li class="menu-1725 menu-path-sajnrorg-content-author-policies first odd " role="menuitem"><a href="https://www.ajnr.org/content/author-policies" data-hide-link-title="0" class="" data-icon-position="">Author Policies</a></li>
<li class="menu-1856 menu-path-sajnrorg-preprint-publishing  even " role="menuitem"><a href="https://www.ajnr.org/preprint_publishing" data-hide-link-title="0" class="" data-icon-position="">Preprint Publishing</a></li>
<li class="menu-1726 menu-path-sajnrorg-content-manuscript-submission-guidelines  odd last" role="menuitem"><a href="https://www.ajnr.org/content/manuscript-submission-guidelines" data-hide-link-title="0" class="" data-icon-position="">Manuscript Submission Guidelines</a></li>
</ul></li>
<li class="menu-862 menu-path-smcmanuscriptcentralcom-ajnr  odd " role="menuitem"><a href="https://mc.manuscriptcentral.com/ajnr" data-hide-link-title="0" target="_blank" class="" data-icon-position="">Submit a Manuscript</a></li>
<li class="menu-1184 menuparent  menu-path-node-7  even " role="menuitem"><a href="/content/about-us" data-hide-link-title="0" class="" data-icon-position="">Special Collections</a><ul role="menu"><li class="menu-1733 menu-path-ajnrorg-cc-csf-spinal-leak first odd " role="menuitem"><a href="http://www.ajnr.org/cc/CSF-Spinal-Leak" data-hide-link-title="0" class="" data-icon-position="">Spinal CSF Leak Articles (Jan 2020-June 2024)</a></li>
<li class="menu-1185 menu-path-ajnrorg-cc-most-impactful-ajnr-articles  even " role="menuitem"><a href="http://www.ajnr.org/cc/most-impactful-ajnr-articles" data-hide-link-title="0" class="" data-icon-position="">Most Impactful AJNR Articles</a></li>
<li class="menu-1896 menu-path-ajnrorg-cc-2024-awards  odd last" role="menuitem"><a href="http://www.ajnr.org/cc/2024-Awards" data-hide-link-title="0" class="" data-icon-position="">2024 AJNR Journal Awards</a></li>
</ul></li>
<li class="menu-788 menuparent  menu-path-node-9  odd last" role="menuitem"><a href="/content/advertising" class="" data-icon-position="" data-hide-link-title="0">More</a><ul role="menu"><li class="menu-780 menu-path-node-960 first odd " role="menuitem"><a href="/content/subscriber-help-and-services" data-hide-link-title="0" class="" data-icon-position="">Subscribers</a></li>
<li class="menu-863 menu-path-smarketplacecopyrightcom-rs-ui-web-mp-details-journal-122810747  even " role="menuitem"><a href="https://marketplace.copyright.com/rs-ui-web/mp/details/journal/122810747" data-hide-link-title="0" class="" data-icon-position="">Permissions</a></li>
<li class="menu-782 menu-path-node-937  odd " role="menuitem"><a href="/page/content/Ads" data-hide-link-title="0" class="" data-icon-position="">Advertisers</a></li>
<li class="menu-790 menu-path-alerts  even " role="menuitem"><a href="/alerts" data-hide-link-title="0" class="" data-icon-position="">Alerts</a></li>
<li class="menu-791 menu-path-node-10  odd last" role="menuitem"><a href="/feedback" class="" data-icon-position="" data-hide-link-title="0">Feedback</a></li>
</ul></li>
</ul></nav>
    </div>
  </div>
</div><div class="block block-menu text-right block-menu-social-media block-menu-menu-social-media even block-without-title" id="block-menu-menu-social-media">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf" role="menuitem"><a href="http://www.twitter.com/TheAJNR" target="_blank" class="link-icon-only link-icon"><span class="hw-icon-x-twitter"></span> <span class="title element-invisible">Follow AJNR on Twitter</span></a></li>
<li class="leaf" role="menuitem"><a href="http://www.facebook.com/AmJNeuroradiol" target="_blank" class="link-icon-only link-icon"><span class="icon-facebook-sign icon-2x"></span> <span class="title element-invisible">Visit AJNR on Facebook</span></a></li>
<li class="leaf" role="menuitem"><a href="https://www.instagram.com/the_ajnr/?hl=en" class="link-icon-only link-icon"><span class="icon-instagram icon-2x"></span> <span class="title element-invisible">Follow AJNR on Instagram</span></a></li>
<li class="leaf" role="menuitem"><a href="https://www.linkedin.com/company/american-journal-of-neuroradiology" class="link-icon-only link-icon"><span class="icon-linkedin icon-2x"></span> <span class="title element-invisible">Join AJNR on LinkedIn</span></a></li>
<li class="last leaf" role="menuitem"><a href="/rss" class="link-icon-only link-icon"><span class="icon-rss icon-2x"></span> <span class="title element-invisible">RSS Feeds</span></a></li>
</ul></nav>    </div>
  </div>
</div>  </div>
</div>
  </div>
  
  <div id="zone-header" class="zone zone-header clearfix container-30">
  	      <div id="messages" class="grid-28 prefix-1 suffix-1"><div role="alert" class="messages single-msg status highwire">
<div class="msg-col-left"><span class="icon icon-info-sign"></span></div><div class="msg-col-right">Getting new auth cookie, if you see this message a lot, tell someone!</div></div>
</div>
          </div>
</header>    
      <section id="section-content" class="section section-content">
    
  <div id="zone-content" class="zone zone-content clearfix container-30">    
        
    <div class="grid-28 suffix-1 prefix-1 region region-content" id="region-content">
  <div class="region-inner region-content-inner">
    <a id="main-content"></a>
                        <div class="block block-system block-main block-system-main odd block-without-title" id="block-system-main">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panels-960-layout jcore-2col-layout" >
	  <div class="panel-row-wrapper panel-row-first clearfix">
		
		<div class="top-wrapper">
			<div class="panel-panel panel-region-top">
			  <div class="inside"><div class="panel-pane pane-highwire-article-citation" >
  
      
  
  <div class="pane-content">
    <div class="highwire-article-citation highwire-citation-type-highwire-article node12718--5" data-node-nid="12718" id="top-node-12718--6447894462" data-pisa="ajnr;34/12/2252" data-pisa-master="ajnr;ajnr.A3606" data-apath="/ajnr/34/12/2252.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">Brain</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">P. Vakil</span>, <span class="highwire-citation-author" data-delta="1">J. Vranic</span>, <span class="highwire-citation-author" data-delta="2">M.C. Hurley</span>, <span class="highwire-citation-author" data-delta="3">R.A. Bernstein</span>, <span class="highwire-citation-author" data-delta="4">A.W. Korutz</span>, <span class="highwire-citation-author" data-delta="5">A. Habib</span>, <span class="highwire-citation-author" data-delta="6">A. Shaibani</span>, <span class="highwire-citation-author" data-delta="7">F.H. Dehkordi</span>, <span class="highwire-citation-author" data-delta="8">T.J. Carroll</span> and <span class="highwire-citation-author" data-delta="9">S.A. Ansari</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 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2252-2258; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3606 </span></div>
  
  
  
</div>
<div id="hw-article-author-popups-top-node-12718--6447894462" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">P. Vakil </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Biomedical Engineering (P.V., T.J.C.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BVakil%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=Vakil%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.%2BVakil%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">J. Vranic </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)</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=J.%2BVranic%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=Vranic%20J&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%3AJ.%2BVranic%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">M.C. Hurley </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurosurgery (M.C.H., A.S., S.A.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.C.%2BHurley%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=Hurley%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%3AM.C.%2BHurley%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">R.A. Bernstein </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (R.A.B., S.A.A.)</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=R.A.%2BBernstein%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=Bernstein%20R&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%3AR.A.%2BBernstein%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">A.W. Korutz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.W.%2BKorutz%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=Korutz%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.W.%2BKorutz%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">A. Habib </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BHabib%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=Habib%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.%2BHabib%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">A. Shaibani </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurosurgery (M.C.H., A.S., S.A.A.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BShaibani%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=Shaibani%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.%2BShaibani%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">F.H. Dehkordi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois.</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=F.H.%2BDehkordi%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=Dehkordi%20F&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%3AF.H.%2BDehkordi%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-8"><div class="author-tooltip-name">T.J. Carroll </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Biomedical Engineering (P.V., T.J.C.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois</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=T.J.%2BCarroll%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=Carroll%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%3AT.J.%2BCarroll%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">S.A. Ansari </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (P.V., J.V., M.C.H., A.W.K., A.H., A.S., T.J.C., S.A.A.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (R.A.B., S.A.A.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurosurgery (M.C.H., A.S., S.A.A.)</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=S.A.%2BAnsari%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=Ansari%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%3AS.A.%2BAnsari%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>

  
  </div>
</div>
			</div>
		</div>
	
	</div> <!-- /.panel-row-wrapper -->	
	  
  <div class="panel-row-wrapper clearfix">
		
		<div class="main-content-wrapper grid-17 suffix-1 alpha">
			<div class="panel-panel panel-region-content">
			  <div class="inside"><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs" >
  
      
  
  <div class="pane-content">
    <div class="item-list"><ul class="tabs inline panels-ajax-tab"><li class="first"><a href="/content/34/12/2252" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_art" data-target-id="highwire_article_tabs" data-entity-context="node:12718" data-trigger="" data-url-enabled="1">Article</a><a href="/panels_ajax_tab/jnl_ajnr_tab_art/node:12718/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/34/12/2252/tab-figures-data" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_data" data-target-id="highwire_article_tabs" data-entity-context="node:12718" data-trigger="tab-figures-data" data-url-enabled="1">Figures &amp; Data</a><a href="/panels_ajax_tab/jnl_ajnr_tab_data/node:12718/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/34/12/2252/tab-supplemental" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_supp" data-target-id="highwire_article_tabs" data-entity-context="node:12718" data-trigger="tab-supplemental" data-url-enabled="1">Supplemental</a><a href="/panels_ajax_tab/jnl_ajnr_tab_supp/node:12718/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/34/12/2252/tab-references" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_refs" data-target-id="highwire_article_tabs" data-entity-context="node:12718" data-trigger="tab-references" data-url-enabled="1">References</a><a href="/panels_ajax_tab/jnl_ajnr_tab_refs/node:12718/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/34/12/2252/tab-article-info" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_info" data-target-id="highwire_article_tabs" data-entity-context="node:12718" data-trigger="tab-article-info" data-url-enabled="1">Info &amp; Metrics</a><a href="/panels_ajax_tab/jnl_ajnr_tab_info/node:12718/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li class="last"><a href="/content/ajnr/34/12/2252.full.pdf" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_pdf" data-target-id="highwire_article_tabs" data-entity-context="node:12718" data-trigger="tab-pdf" data-url-enabled="1"><i class="icon-file-alt"></i> PDF</a><a href="/panels_ajax_tab/jnl_ajnr_tab_pdf/node:12718/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li></ul></div>  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container" >
  
      
  
  <div class="pane-content">
    <div data-panels-ajax-tab-preloaded="jnl_ajnr_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="http://ajnr-stage2.stage.highwire.org/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_ajnr_tab_art"><div class="panel-display panel-1col clearfix" >
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-highwire-markup" >
  
      
  
  <div class="pane-content">
    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-2"><h2>Abstract</h2>
<div id="sec-1" class="subsection">
<p id="p-3"><strong>BACKGROUND AND PURPOSE:</strong> Contrast enhancement of intracranial atherosclerotic plaques has recently been investigated using high field and high resolution MR imaging as a risk factor in the development of ischemic stroke. We studied the reliability of conventional MR imaging at 1.5T in evaluating intraplaque enhancement and its relationship with acute cerebrovascular ischemic presentations in patients with severe intracranial atherosclerotic disease.</p>
</div>
<div id="sec-2" class="subsection">
<p id="p-4"><strong>MATERIALS AND METHODS:</strong> We retrospectively identified and analyzed 19 patients with 22 high-grade intracranial atherosclerotic disease plaques (&gt;70% stenosis) in vessels cross-sectionally visualized by neuroanatomic MR imaging. Atherosclerotic plaques were classified as asymptomatic or symptomatic. Two blinded neuroradiologists independently ranked each lesion for the presence of intraplaque enhancement by use of a 5-point scale (1–5). Furthermore, plaque enhancement was quantified as the relative change in T1WI spin-echo signal intensity (postcontrast/precontrast) in the vessel wall at the site of each intracranial atherosclerotic disease lesion.</p>
</div>
<div id="sec-3" class="subsection">
<p id="p-5"><strong>RESULTS:</strong> Intraplaque enhancement was observed in 7 of 10 (70%) symptomatic plaques, in contrast to 1 of 12 (8%) asymptomatic plaques. Interobserver reliability correlated well for intraplaque enhancement (κ = 0.82). The degree of relative plaque enhancement in symptomatic versus asymptomatic lesions (63% versus 23%) was statistically significant (<em>P</em> = .001, <em>t</em> test).</p>
</div>
<div id="sec-4" class="subsection">
<p id="p-6"><strong>CONCLUSIONS:</strong> In this pilot study, we determined that intraplaque enhancement could be reliably evaluated with the use of cross-sectional imaging and analysis of vessels/plaques by use of conventional neuroanatomic MR imaging protocols. In addition, we observed a strong association between intraplaque enhancement in severe intracranial atherosclerotic disease lesions and ischemic events with the use of conventional MR imaging. Our preliminary study suggests that T1 gadolinium-enhancing plaques may be an indicator of progressing or symptomatic intracranial atherosclerotic disease.</p>
</div>
</div><div class="section glossary" id="glossary-1"><h2>ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">ICAD<span class="def-item-dt-sep"></span></dt><dd>intracranial atherosclerotic disease<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">IPE<span class="def-item-dt-sep"></span></dt><dd>intraplaque enhancement<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">T1w-SE<span class="def-item-dt-sep"></span></dt><dd>T1-weighted spin-echo<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">IPH<span class="def-item-dt-sep"></span></dt><dd>intraplaque hemorrhage<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">ACA<span class="def-item-dt-sep"></span></dt><dd>anterior cerebral artery</dd></dl>
</div><p id="p-7">Intracranial atherosclerotic disease (ICAD) is a significant cause of stroke worldwide, accounting for 7–10% of acute ischemic stroke cases.<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> In symptomatic ICAD with high-grade stenoses (&gt;70%), the risk of stroke or death at 1 year is 12–22% with medical therapy based on the WASID<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a></sup> (Warfarin-Aspirin Symptomatic Intracranial Disease) and SAMMPRIS<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> (Stent placement versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) trial.</p><p id="p-8">The SAMMPRIS trial was designed to determine whether intracranial angioplasty/stent placement as a primary treatment option could benefit patients with severe ICAD in reducing the risk of stroke/death over aggressive medical management alone. However, patient recruitment in the SAMMPRIS trial was prematurely terminated as mandated by the National Institutes of Health/National Institute of Neurological Disorders and Stroke because of unexpectedly high stroke/death rates with endovascular intervention (14.7% at 30 days and 20% at 1 year) and better-than-expected outcomes with modern medical management (5.8% at 30 days and 12.2% at 1 year).<sup><a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a></sup> Hence, the role of intracranial angioplasty/stent placement was again relegated to a subpopulation of patients with severe ICAD who would fail optimum medical therapy. Although these patients remain at risk for recurrent TIAs or strokes, we have yet to develop a stratification scheme to identify this refractory subpopulation and perhaps alter their management (medical and/or surgical) before an ischemic presentation.</p><p id="p-9">Increasing evidence indicates the role of neovascularization and intraplaque hemorrhage (IPH) in the progression and rupture of carotid atherosclerotic plaques analogous to the coronary literature.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a>,<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> Inflammation, which is associated with neovascularization and IPH, locally alters vascular endothelium permeability, potentially allowing gadolinium contrast uptake and visualization on T1WI. In fact, evidence of neovascularization and/or focal inflammation in the arterial wall of the cervical carotid arteries through atherosclerotic plaque enhancement has been correlated with a higher incidence of ipsilateral stroke secondary to extracranial atherosclerotic lesions.<sup><a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a>,<a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a>,<a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6</a></sup> Spagnoli et al<sup><a id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7</a></sup> recently reported on the high-resolution MR imaging findings of both IPH and adventitial enhancement (neovascularization and/or inflammation) as being independently associated with symptomatic carotid stenoses and recent cerebrovascular ischemic events.</p><p id="p-10">Inflammation may be an attractive imaging marker in the setting of ICAD for risk stratification, though the diminutive nature of intracranial vessels makes plaque evaluation challenging because of spatial resolution and signal-to-noise ratio concerns. Several groups have attempted high-field, high–spatial resolution, contrast-enhanced MR imaging of the intracranial vessel wall and atherosclerotic plaques with the use of dark-blood sequences.<sup><a id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8</a><a id="xref-ref-9-1" class="xref-down-link" href="#ref-9"><span>⇓</span></a><a id="xref-ref-10-1" class="xref-down-link" href="#ref-10"><span>⇓</span></a><a id="xref-ref-11-1" class="xref-down-link" href="#ref-11"><span>⇓</span></a><a id="xref-ref-12-1" class="xref-down-link" href="#ref-12"><span>⇓</span></a>–<a id="xref-ref-13-1" class="xref-bibr" href="#ref-13">13</a></sup> Swartz et al<sup><a id="xref-ref-9-2" class="xref-bibr" href="#ref-9">9</a></sup> identified the existence of intracranial atherosclerotic plaque enhancement through the use of 3T high-resolution MR imaging. More recently, this type of high-resolution MR imaging assessment found strong enhancement in ICAD plaques in patients with acute ischemic stroke.<sup><a id="xref-ref-14-1" class="xref-bibr" href="#ref-14">14</a></sup> In this pilot study, it was our goal to determine whether postgadolinium T1 intracranial plaque enhancement (IPE) could be reliably delineated through the use of low-resolution, conventional neuroanatomic MR techniques in patients with severe ICAD (&gt;70% stenosis) and whether IPE was associated with the occurrence of recent ischemic cerebrovascular events.</p><div class="section materials-methods" id="sec-5"><h2>Materials and Methods</h2>
<div id="sec-6" class="subsection subjects"><h3>Patients</h3>
<p id="p-11">Institutional review board approval was obtained for a retrospective study to identify patients with severe ICAD causing ≥70% stenosis, diagnosed with our institution's MR imaging/MRA stroke protocol between January 2008 and January 2011. A PACS–based report search was performed on this cohort to identify subjects with severe ICAD. The following key word search terms were used: “severe OR high-grade OR attenuation” AND “plaque OR stenosis.” Patients with plaques that could be visualized on 3D time-of-flight (TOF) MRA and axial pregadolinium and postgadolinium contrast T1–weighted spin-echo (T1w-SE) sequences were selected for the study.</p>
<p id="p-12">Patient exclusion criteria included imaging artifacts secondary to patient motion, metallic susceptibility from medical implants, or complete vessel occlusion. Additionally, intracranial aneurysms, multiple/tandem intracranial stenoses, or presence of moderate to severe atherosclerotic disease in cervical vessels supplying the same vascular distribution were also excluded to allow clear association of symptoms with the corresponding intracranial lesion. The retrospective nature of this study prevented patient-specific optimization of imaging parameters such as orientation, section thickness, and coverage. At our institution, the T1w-SE sequences in the MR imaging/MRA brain stroke protocol are performed with the use of axial-oriented imaging and parameters optimized for maximum coverage of the neuroanatomy, limiting vessel coverage to approximately 24 thick (5-mm) axial sections with 1.5-mm gaps.</p>
<p id="p-13">Although partial volume effects are a concern with 5-mm section imaging, our preliminary studies indicated that cross-sectionally visualized vessels could be successfully evaluated. Because most neuroanatomic MR imaging protocols use axially oriented imaging, vessels parallel to the imaging plane (ie, middle and posterior cerebral arteries), which were more severely affected by partial volume effects, were excluded. Hence, ICAD lesions evaluated in this study were found within the intracranial V4 segment of the vertebral arteries, the basilar artery, supraclinoid ICAs, or the A2 segment of the anterior cerebral artery (ACA). A total of 19 patients age 68.7 ± 9.6 years (13 men, 6 women) fulfilled the stated criteria and were thus evaluated.</p>
</div>
<div id="sec-7" class="subsection"><h3>Imaging Evaluation</h3>
<p id="p-14">Two experienced neuroradiologists (M.C.H. and S.A.A.) performed independent qualitative grading of each ICAD lesion while blinded to the study population: identity, symptoms, DWI abnormalities, and outcomes. Both reviewers confirmed &gt;70% stenosis on 3D TOF and its cross-sectional visualization on precontrast and postcontrast T1w-SE imaging. On the basis of the T1w-SE precontrast and postcontrast imaging, the degree of IPE caused by gadolinium uptake was determined qualitatively and quantitatively by assessment of the degree of enhancement of the plaque/vessel wall. For qualitative assessment, values of 1, 2, 3, 4, or 5 were assigned to each lesion corresponding to “definite nonenhancement,” “suspected nonenhancement,” “uncertain,” “suspected enhancement,” and “definite enhancement,” respectively. Scores rendered by each independent observer were averaged to determine the final degree of plaque enhancement. A plaque with an average score &gt;3 was considered “enhancing” (eg, scores of 5/5, 5/4, 4/4, or 4/3), and a score &lt;3 was considered nonenhancing (eg, scores of 3/2, 2/2, 2/1, or 1/1). In the event of interobserver disagreement, (eg, a score of 4/2), a third independent observer would be used to break the tie.</p>
<p id="p-15">In a separate and independent evaluation conducted by both observers 1 month after qualitative evaluation, the degree of plaque enhancement was quantified as the relative increase in lesion T1-signal postcontrast. Circular ROIs were specifically localized to the lumen of the stenosed vessel and the outer boundary of the vessel wall at the site of the ICAD plaque. The outer wall area was defined and calculated as the difference between the area within the boundary of the vessel wall at the interface with the CSF and the area of the vessel lumen as in Xu et al<sup><a id="xref-ref-15-1" class="xref-bibr" href="#ref-15">15</a></sup> and Yuan et al<sup><a id="xref-ref-16-1" class="xref-bibr" href="#ref-16">16</a></sup> and demonstrated in <a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig 1</a>. The percent wall area was defined as the ratio of the outer wall area to the total wall area multiplied by 100%. Percent wall area was used for more meaningful comparison of plaque/vessel wall areas between subgroups containing vessels of different origin and sizes. Quantitative plaque enhancement was defined as the mean T1 signal intensity in the outer wall area on postcontrast T1w-SE images divided by its precontrast T1 signal. All T1 signal intensity values in precontrast and postcontrast images were normalized with the signal in the ventricle to control for signal intensity differences between the 2 separate sequences. ROI analysis was conducted with the use of in-house software developed in Matlab (MathWorks, Natick, Massachusetts).</p>
<div id="F1" class="fig pos-float  odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F1.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Symptomatic patient with MR DWI (A) demonstrating focal infarcts in the bilateral distributions (white arrows). TOF MR angiography MIP (B) and source images (C) confirm severe stenosis in an A2 azygous ACA segment. Axial T1-weighted-pre (D) and T1-weighted-post contrast (E) images identify enhancing ICAD plaque (inset) involving the azygous A2 ACA segment. Methodology of plaque/wall area measurements are demonstrated (F), with solid black line delineating outer wall boundary and dotted line segmenting the vessel lumen denoted as &#x201C;L.&#x201D;" class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-1125439476" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;Symptomatic patient with MR DWI (&lt;em&gt;A&lt;/em&gt;) demonstrating focal infarcts in the bilateral distributions (&lt;em&gt;white arrows&lt;/em&gt;). TOF MR angiography MIP (&lt;em&gt;B&lt;/em&gt;) and source images (&lt;em&gt;C&lt;/em&gt;) confirm severe stenosis in an A2 azygous ACA segment. Axial T1-weighted-pre (&lt;em&gt;D&lt;/em&gt;) and T1-weighted-post contrast (&lt;em&gt;E&lt;/em&gt;) images identify enhancing ICAD plaque (inset) involving the azygous A2 ACA segment. Methodology of plaque/wall area measurements are demonstrated (&lt;em&gt;F&lt;/em&gt;), with solid black line delineating outer wall boundary and dotted line segmenting the vessel lumen denoted as &#x201C;L.&#x201D;&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 1." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F1.medium.gif" width="440" height="268"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 1." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F1.medium.gif" width="440" height="268"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 1." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/41252" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Fig 1.</span> <p id="p-16" class="first-child">Symptomatic patient with MR DWI (<em>A</em>) demonstrating focal infarcts in the bilateral distributions (<em>white arrows</em>). TOF MR angiography MIP (<em>B</em>) and source images (<em>C</em>) confirm severe stenosis in an A2 azygous ACA segment. Axial T1-weighted-pre (<em>D</em>) and T1-weighted-post contrast (<em>E</em>) images identify enhancing ICAD plaque (inset) involving the azygous A2 ACA segment. Methodology of plaque/wall area measurements are demonstrated (<em>F</em>), with solid black line delineating outer wall boundary and dotted line segmenting the vessel lumen denoted as “L.”</p><div class="sb-div caption-clear"></div></div></div>
</div>
<div id="sec-8" class="subsection"><h3>Clinical Evaluation</h3>
<p id="p-17">All patient neurologic histories, physical examinations, and DWI findings, at the time of diagnostic MR imaging/MRA imaging, were recorded by means of medical record and PACS imaging review. Of the 19 patients, 16 received MR imaging within 24 hours of symptomatic presentations with suspected TIAs or strokes. Routine follow-up stroke protocol MR imaging was performed for an additional 3 patients with history of stroke; all 3 patients harbored severe intracranial stenoses but were asymptomatic at the time of imaging. Presentations with acute ischemic symptoms were classified into anterior or posterior circulation pathology.<sup><a id="xref-ref-12-2" class="xref-bibr" href="#ref-12">12</a></sup> A symptomatic ICAD plaque was defined as presenting with acute neurologic (ischemic) symptoms and/or restricted DWI abnormalities (acute watershed, thromboembolic, or perforator infarcts) corresponding to the vascular distribution of the intracranial stenosis. Asymptomatic patients either presented for follow-up imaging because of history of stroke or received first-time imaging in response to symptoms (typically TIAs) that were not associated with the plaque of interest, that is, symptoms that did not correlate to the vascular distribution of the intracranial stenosis.<sup><a id="xref-ref-12-3" class="xref-bibr" href="#ref-12">12</a></sup></p>
</div>
<div id="sec-9" class="subsection"><h3>MR Imaging</h3>
<p id="p-18">Patients referred to our institution who demonstrated symptoms of TIA or stroke, as determined from neurologic examination, received an MR imaging/MRA stroke imaging protocol. This included the following relevant sequences evaluated in this study: precontrast 3D TOF, DWI, axial T1w-SE before and after a single-dose (0.1 mmol/kg) injection of a gadolinium-based T1 shortening contrast agent (Magnevist; Bayer HealthCare Pharmaceuticals, Wayne, New Jersey). All patients received postcontrast T1 imaging within 20 minutes of contrast injection. MR imaging studies were performed on a 1.5T scanner (Avanto/Espree; Siemens, Erlangen, Germany) with the use of a receive-only head coil for signal reception. Typical imaging parameters were as follows:</p>
<div id="sec-10" class="subsection"><h4>3D TOF.</h4>
<p id="p-19">TR/TE 23 ms/5.1 ms, 25° flip angle, 320 × 284 matrix, 220–240 mm FOV, voxel size 0.69 × 0.77 × 0.63 mm.</p>
</div>
<div id="sec-11" class="subsection"><h4>T1w-SE.</h4>
<p id="p-20">TR/TE 663 ms/15 ms, 90° flip angle, 256 × 256 matrix with 220–240 mm FOV, section thickness = 5 mm, section gap = 1.5 mm, voxel size 0.9 × 0.9 × 5 mm.</p>
</div>
<div id="sec-12" class="subsection"><h4>DWI.</h4>
<p id="p-21">TR/TE 4500/185 ms, 90° flip angle, 192 × 192 matrix, 220–240 mm FOV, section gap 1.5 mm, voxel size 1.3 × 1.3 × 5 mm.</p>
</div>
</div>
<div id="sec-13" class="subsection"><h3>Statistical Analysis</h3>
<p id="p-22">The interobserver strength of agreement on qualitative grading of ICAD plaque enhancement was determined by means of quadratically weighted Cohen κ statistic for categoric variables. Reliabilities &lt;0.4 were defined as poor; 0.4–0.75 as fair to good; and &gt;0.75 as excellent.<sup><a id="xref-ref-13-2" class="xref-bibr" href="#ref-13">13</a></sup> Interobserver agreement on measurements of plaque/vessel wall areas and quantitative T1 wall enhancement was assessed by means of the Wilcoxon rank sum test for continuous variables. With the use of a paired Student <em>t</em> test, the quantitative measure of T1 signal enhancement and percentage wall area were compared between symptomatic and asymptomatic lesion cohorts. Logistic regression was used to evaluate IPE as a predictor of ischemic symptoms. A value of <em>P</em> &lt; .05 was defined as statistically significant. All calculations were performed with the use of in-house software written in Matlab.</p>
</div>
</div><div class="section results" id="sec-14"><h2>Results</h2>
<p id="p-23">Initially, 40 patients with severe (&gt;70%) intracranial stenoses (confirmed on TOF MRA by both reviewers) were identified for this study. ICAD plaques in 21 patients were excluded for the following reasons: MR imaging studies in 4 patients were nondiagnostic because of severe motion or susceptibility (metallic implants) artifacts, 3 patients had total vessel occlusion, 1 patient had a partially thrombosed fusiform aneurysm distal to the stenosis, and 5 patients had various confounding stenoses in the same vascular distribution. In addition, 8 patients presented with intracranial stenoses involving the MCA or posterior cerebral artery preventing lesion evaluation with the standard 5-mm-thick axial imaging as stated in the Materials and Methods section. All remaining lesions were in the intracranial ICA, A2 ACA, basilar artery, or V4 vertebral arteries, with the stenosis cross-sectionally visualized in the axial plane.</p>
<p id="p-24">A total of 22 severe ICAD plaques were evaluated independently in 19 patients by 2 neuroradiologists blinded to each subject's clinical data. <a id="xref-table-wrap-1-1" class="xref-table" href="#T1">Table 1</a> and the On-line Table provide pertinent patient demographics, clinical history, ICAD risk factors, and qualitative and quantitative results for each recruited subject and lesion. In our cohort of 22 ICAD plaques, 10 patients presented with 10 symptomatic plaques and 9 patients harbored 12 asymptomatic plaques. Asymptomatic plaques remained stable, with no attributed ischemic symptoms or acute infarcts on DWI for at least 3 months.</p>
<div class="table pos-float" id="T1"><div class="table-inline table-callout-links"><div class="callout"><span>View this table:</span><ul class="callout-links"><li class="view-inline first"><a href="" class="table-expand-inline" data-table-url="/highwire/markup/41283/expansion?postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed&amp;table-expand-inline=1" data-icon-position="" data-hide-link-title="0">View inline</a></li><li class="view-popup last"><a href="/highwire/markup/41283/expansion?width=1000&amp;height=500&amp;iframe=true&amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables" data-icon-position="" data-hide-link-title="0">View popup</a></li></ul></div></div><div class="table-caption"><span class="table-label">Table 1:</span> <p id="p-25" class="first-child">Patient demographics, clinical history, and imaging assessment</p><div class="sb-div caption-clear"></div></div></div>
<p id="p-27">Within our symptomatic cohort, precontrast and postcontrast T1w-SE imaging revealed qualitative contrast enhancement in 7 of 10 (70%) atherosclerotic plaques, correlating with symptomatic presentations and/or acute infarcts on DWI. Conversely, within our asymptomatic cohort, 11 of 12 (92%) atherosclerotic plaques were determined to be nonenhancing according to precontrast and postcontrast T1w-SE imaging.</p>
<p id="p-28">Vessels of symptomatic lesions did not have a higher percentage plaque/vessel wall area compared with asymptomatic lesions at the site of the ICAD plaque (89.7 ± 4.0% versus 86.9 ± 6.1%, respectively, <em>P</em> = .2 in Student <em>t</em> test). Furthermore, the cross-sectional areas of plaques in the symptomatic and asymptomatic cohort were not significantly different (12.8 ± 5.9 mm<sup>2</sup> versus 10.8 ± 4.0 mm<sup>2</sup>, respectively, <em>P</em> = .4, Student <em>t</em> test). The mean increase in quantitative enhancement in the outer wall of symptomatic stenosed vessels at the site of the ICAD plaque was 63% (precontrast to postcontrast relative signal change of 1.63 ± 0.28) compared with 23% in the outer wall of asymptomatic lesions (1.23 ± 0.18 relative signal change). A Student <em>t</em> test found this difference to be significant (<em>P</em> = .001). In addition, a logistic regression model found IPE to be significantly associated with ischemic symptoms or positive DWI findings, that is, IPE-demonstrating plaques were 25 times more likely to be symptomatic (<em>P</em> = .0095).</p>
<p id="p-29">Interobserver agreement was excellent for determining qualitative plaque enhancement on T1w-SE imaging. A quadratic weighted Cohen κ value of 0.82 was found. Quantitative enhancement scores and outer plaque/wall area measurements were also found to be in agreement between both observers because the Wilcoxon signed rank sum test showed insignificant differences between independent measurements (<em>P</em> = .4 between separate quantitative enhancement scores and <em>P</em> = .3 between separate outer plaque/wall area measurements).</p>
<div id="sec-15" class="subsection"><h3>Illustrative Cases</h3>
<p id="p-30">Patient 2 is a 60-year-old man with history of stroke/TIAs, hyperlipidemia, and hypertension, presenting at the time of imaging with acute lower-extremity weakness and acute infarcts on DWI in the bilateral ACA distributions (<a id="xref-fig-1-2" class="xref-fig" href="#F1">Fig 1</a><em>A</em>). Hence, the ICAD plaque was determined to be symptomatic. A severe intracranial stenosis involving the azygous A2 branch of the ACA was confirmed on TOF MRA sagittal MIP (<a id="xref-fig-1-3" class="xref-fig" href="#F1">Fig 1</a><em>B</em>) and source images (<a id="xref-fig-1-4" class="xref-fig" href="#F1">Fig 1</a><em>C</em>). Postcontrast enhanced T1w-SE images (<a id="xref-fig-1-5" class="xref-fig" href="#F1">Fig 1</a><em>E</em>) visualizing the ICAD plaque were graded to be “definitely enhancing” (scored 5), relative to precontrast T1 imaging (<a id="xref-fig-1-6" class="xref-fig" href="#F1">Fig 1</a><em>D</em>), by both observers. ROIs drawn (<a id="xref-fig-1-7" class="xref-fig" href="#F1">Fig 1</a><em>F</em>) around the vessel outer wall boundary, segmenting out the lumen, demonstrated quantitative enhancement of 78% between precontrast and postcontrast images.</p>
<p id="p-31">Patient 14 is a 75-year-old man with a history of hypertension, hyperlipidemia, and prior vertebrobasilar TIAs/strokes in the posterior circulation but with no active symptoms or acute infarcts on DWI, presenting for follow-up imaging evaluation of severe intracranial stenosis of the basilar artery. The patient's ICAD plaque, visualized on TOF MRA MIP (<a id="xref-fig-2-1" class="xref-fig" href="#F2">Fig 2</a><em>A</em>) and source images (<a id="xref-fig-2-2" class="xref-fig" href="#F2">Fig 2</a><em>B</em>), was subsequently determined to be asymptomatic. Precontrast (<a id="xref-fig-2-3" class="xref-fig" href="#F2">Fig 2</a><em>B</em>) and postcontrast (<a id="xref-fig-2-4" class="xref-fig" href="#F2">Fig 2</a><em>B</em>) T1w-SE imaging demonstrated a nonenhancing atherosclerotic plaque, receiving scores of 2 from both reviewers, with quantitative enhancement of 16%.</p>
<div id="F2" class="fig pos-float  odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F2.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Asymptomatic patient with history of stroke receiving follow-up imaging. TOF MRA reveals severe basilar stenosis in MIP (A) and source images (B). Axial T1WI precontrast (C) and postcontrast (D) demonstrates nonenhancing ICAD plaque." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-1125439476" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;Asymptomatic patient with history of stroke receiving follow-up imaging. TOF MRA reveals severe basilar stenosis in MIP (&lt;em&gt;A&lt;/em&gt;) and source images (&lt;em&gt;B&lt;/em&gt;). Axial T1WI precontrast (&lt;em&gt;C&lt;/em&gt;) and postcontrast (&lt;em&gt;D&lt;/em&gt;) demonstrates nonenhancing ICAD plaque.&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 2." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F2.medium.gif" width="390" height="440"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 2." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F2.medium.gif" width="390" height="440"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F2.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 2." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/12/2252/F2.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/41246" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption"><span class="fig-label">Fig 2.</span> <p id="p-32" class="first-child">Asymptomatic patient with history of stroke receiving follow-up imaging. TOF MRA reveals severe basilar stenosis in MIP (<em>A</em>) and source images (<em>B</em>). Axial T1WI precontrast (<em>C</em>) and postcontrast (<em>D</em>) demonstrates nonenhancing ICAD plaque.</p><div class="sb-div caption-clear"></div></div></div>
</div>
</div><div class="section discussion" id="sec-16"><h2>Discussion</h2>
<p id="p-33">In this study of severe ICAD, we found that IPE was strongly associated with symptomatic ischemic presentations. Furthermore, postgadolinium T1w-SE images with the use of conventional, low-resolution MR imaging were capable of reliably detecting IPE (high interobserver agreement; κ = 0.82) when the acquisition sections allowed cross-sectional visualization of the vessels of interest. This may indicate that a more robust implementation of this protocol would require sagittal or oblique acquisitions for assessing atherosclerotic disease in the middle cerebral arteries. Given the association between IPE in carotid atherosclerotic disease, plaque destabilization, and thromboembolic events, our study suggests that an analogous process may occur in the intracranial vasculature in the setting of ICAD.</p>
<p id="p-34">Prior MR imaging and histopathologic studies have shown that vulnerable carotid artery atherosclerotic plaques are characterized by a ruptured fibrous cap, a lipid-rich necrotic core, and IPH.<sup><a id="xref-ref-7-2" class="xref-bibr" href="#ref-7">7</a>,<a id="xref-ref-17-1" class="xref-bibr" href="#ref-17">17</a></sup> Furthermore, postgadolinium T1 enhancement of symptomatic carotid plaques suggests plaque neovascularization and/or inflammation may predispose plaques to IPH or ischemic/thromboembolic complications.<sup><a id="xref-ref-13-3" class="xref-bibr" href="#ref-13">13</a>,<a id="xref-ref-18-1" class="xref-bibr" href="#ref-18">18</a></sup> In fact, Kerwin et al<sup><a id="xref-ref-19-1" class="xref-bibr" href="#ref-19">19</a></sup> introduced several quantitative MR imaging parameters including higher <em>K</em><sup>trans</sup> measurements or adventitial contrast uptake with the use of dynamic contrast-enhanced MR imaging that correlated with macrophage infiltration (inflammation) and neovasculature on subsequent histopathologic analyses.<sup><a id="xref-ref-20-1" class="xref-bibr" href="#ref-20">20</a>,<a id="xref-ref-21-1" class="xref-bibr" href="#ref-21">21</a></sup></p>
<p id="p-35">Our study suggests that similar arterial wall pathology in ICAD may be the inciting factor for plaque progression and destabilization. Although neovascularization may be responsible for IPH as the result of rupture of fragile adventitial neovessels resulting in a thrombogenic lipid core, both neovascularization and IPH are associated with the recruitment of inflammatory cells. Conversely, because intracranial vessels usually lack the presence of vasa vasorum, atherosclerotic inflammation may promote a hypoxic environment and stimulate pathologic angiogenic factors such as vascular endothelial growth factor to promote neovascularization, contributing to plaque instability by means of edema, hemorrhage, and rupture.<sup><a id="xref-ref-22-1" class="xref-bibr" href="#ref-22">22</a></sup> However, we recommend caution in interpreting our findings in the absence of IPE as stable atherosclerotic lesions. Ischemic complications related to ICAD may also be precipitated through independent mechanisms including thin or ruptured fibrous caps, a large lipid-rich necrotic core, and/or IPH.</p>
<p id="p-36">Previous studies have reported differences in plaque/wall thickening between asymptomatic and symptomatic lesions.<sup><a id="xref-ref-15-2" class="xref-bibr" href="#ref-15">15</a>,<a id="xref-ref-16-2" class="xref-bibr" href="#ref-16">16</a></sup> This could bias enhancement scores because larger lesions could show greater enhancement. However, we observed no statistically significant differences in total plaque area or percentage wall area within the capacity of low-resolution 1.5T MR imaging techniques. We therefore do not believe that greater enhancement in the symptomatic group is attributable to differences in plaque/wall area size or percentage alone.</p>
<p id="p-37">A paucity of previous literature has studied ICAD IPE through the use of high-resolution MR imaging techniques but with variable correlations to symptomatic ischemic presentations.<sup><a id="xref-ref-9-3" class="xref-bibr" href="#ref-9">9</a></sup> Klein et al<sup><a id="xref-ref-10-2" class="xref-bibr" href="#ref-10">10</a></sup> studied 6 patients with MCA stenoses, but both asymptomatic and symptomatic patients displayed plaque enhancement. Xu et al<sup><a id="xref-ref-11-2" class="xref-bibr" href="#ref-11">11</a></sup> recently characterized a large series of severe MCA stenoses (&gt;70% occlusion) with high-resolution MR imaging and detected a significantly increased rate of T1 hyperintensity indicative of IPH in symptomatic versus asymptomatic plaques (19.6% versus 3.2%).</p>
<p id="p-38">The progression and instability of ICAD plaques secondary to neovascularization, IPH, and/or inflammation can present with either symptomatic ischemic or thromboembolic complications. In extracranial carotid atherosclerosis, end-stage hypoperfusion with watershed infarcts to the distal intracranial circulation requires an extensive plaque burden to achieve luminal stenosis. Conversely, acute inflammation/edema or IPH of even moderate ICAD stenoses could achieve significant percentage narrowing in small (diameter &lt;3 mm), fragile intracranial vessels that lack an external elastic lamina and adventitial support, predisposing to watershed ischemia. Alternatively, local IPH and thrombogenic plaque rupture may result in adjacent small perforator occlusions or thromboembolic complications to the distal intracranial vasculature. These mechanisms may be an explanation for the propensity of symptomatic intracranial stenoses to present equivalently with ischemic watershed and thromboembolic infarcts.</p>
<p id="p-39">Because inflammation is an integral component of atherosclerosis, it may be a transient or undulating process. Identification of active inflammation and/or neovascularization (IPE) could serve as future diagnostic imaging markers to characterize the susceptibility of an ICAD plaque for symptomatic presentations. Furthermore, there may be ramifications for treatment planning in ICAD whereby angioplasty/stent placement could be advocated, delayed, or contraindicated in favor of antiplatelet, anticholesterolemic (statins), novel anti-inflammatory, or anti-angiogenic medical therapies. In fact, statins have been shown to reduce at intervals the quantitative <em>K</em><sup>trans</sup> measurements of adventitial contrast enhancement after 1 year of therapy in cervical carotid atherosclerotic plaques.<sup><a id="xref-ref-23-1" class="xref-bibr" href="#ref-23">23</a></sup></p>
<p id="p-40">Our data suggest that identification of ICAD plaque neovascularization and/or inflammation with postcontrast T1WI may be used to assess lesion vulnerability for symptomatic ischemic or thromboembolic presentations. Interestingly, the failure of the SAMMPRIS trial has been attributed to high periprocedural risk (14.7% mean adverse events in &lt;30 days).<sup><a id="xref-ref-2-3" class="xref-bibr" href="#ref-2">2</a></sup> The trial was designed to initiate intracranial angioplasty/stent placement early after enrollment of patients presenting with TIAs/strokes (&lt;30 days) to maximize the potential clinical benefit of intervention, but this strategy may be flawed. Early imprudent enrollment with angioplasty/stent placement in the acute setting could disrupt potentially active, inflammatory, and/or thrombogenic atherosclerotic plaques, possibly accounting for the high periprocedural complications (thromboembolism/stroke dissection and vessel wall rupture/intracranial hemorrhage) in the trial.</p>
<p id="p-41">We propose that future high-resolution and functional MR imaging will assist in better interpreting the vulnerability of ICAD plaques and hence risk stratification of severe intracranial stenoses for improved treatment planning. Future diagnostic imaging studies in ICAD may include high-resolution intracranial plaque visualization with symptomatic correlation, quantitative plaque T1/T2 intensity and contrast enhancement, contrast permeability (<em>K</em><sup>trans</sup>) measurements, quantitative perfusion MR imaging, and oxygen extraction fraction (PET/MR imaging) parameters to document stage 2 hemodynamic failure and impaired cerebrovascular reserve.</p>
<p id="p-42">Wall enhancement can be related to vasculitis or inflammation associated with atherosclerotic disease, and we cannot definitively exclude a vasculitic process in our patient cohort. However, because of the advanced age and findings of multiple atherosclerotic risk factors in the studied group as well as no demonstration of clinical or imaging evidence of cerebral vasculitis, the likelihood of a superimposed vasculitic etiology is small.</p>
<p id="p-43">Our study posed several inherent limitations and challenges. The small sample size limits the power of the statistical results, and, as such, they should be interpreted with caution. Although T1w-SE imaging is an inherently dark-blood technique, slow-flow regions within small intracranial vessels adjacent to an atherosclerotic lesion may produce hyperintense signal that could be mistaken for wall enhancement, resulting in false-positive values and reducing the technique's specificity. Delineating boundaries of the vessel lumen by use of an appropriate diffusion-prepared dark-blood imaging technique<sup><a id="xref-ref-24-1" class="xref-bibr" href="#ref-24">24</a>,<a id="xref-ref-25-1" class="xref-bibr" href="#ref-25">25</a></sup> may mitigate this issue. Ultimately, high-resolution dark-blood imaging sequences, at high-field strengths with improved SNR, should be used to direct imaging to specific vessel morphology and pathology.<sup><a id="xref-ref-8-2" class="xref-bibr" href="#ref-8">8</a>,<a id="xref-ref-10-3" class="xref-bibr" href="#ref-10">10</a>,<a id="xref-ref-24-2" class="xref-bibr" href="#ref-24">24</a></sup></p>
<p id="p-44">Because of the retrospective nature of this study, we were limited to standard neurovascular anatomic protocols on a 1.5T scanner. The use of thick sections (5 mm) in the T1w-SE acquisitions improved the SNR limitations of the lower field magnet but could cause errors in plaque enhancement evaluation as a result of partial volume averaging. In addition, this protocol did not allow successful evaluation of vessels that projected parallel to the imaging plane, such as the MCAs, producing a selection bias of intracranial plaques. Therefore, we do not advocate conventional MR imaging protocols as sufficient or robust diagnostic tools for intracranial vessel and plaque interrogation.</p>
</div><div class="section conclusions" id="sec-17"><h2>Conclusions</h2>
<p id="p-45">Standard low-resolution neuroanatomic MR imaging may provide useful information for the evaluation of ICAD by demonstrating IPE on precontrast and postcontrast T1w-SE imaging in severely stenotic vessels visualized cross-sectionally in the imaging plane. In these vessels, we found an association between IPE and ischemic/thromboembolic events through the use of conventional MR imaging. However, assessment of the true sensitivity, specificity, and predictive values of IPE in the setting of severe ICAD will require a large, prospective, longitudinal study with the use of high-resolution plaque MR imaging techniques and pathology correlation.</p>
</div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-financial-disclosure" id="fn-2"><p id="p-51">Disclosures: Parmede Vakil—<em>RELATED: Grant:</em> NIH*; <em>UNRELATED: Grants/Grants Pending:</em> NIH.* Richard Bernstein—<em>UNRELATED: Consultancy:</em> Boehringer Ingelheim, Janssen, Medtronic, Medscap, Comments: None relevant to this work; <em>Payment for Lectures (including service on Speakers Bureaus):</em> Boehringer Ingelheim, Janssen, Medtronic, Comments: None relevant; <em>Payment for Development of Educational Presentations:</em> Janssen Pharmaceuticals, Medscape, Boehringer Ingelheim. Timothy Carroll—<em>RELATED: Grant:</em> NIH, Comments: Two separate NIH grants supported this work; <em>UNRELATED: Grants/Grants Pending:</em> NIH (*<em>money paid to institutions).</em></p></li><li class="fn-supported-by" id="fn-3"><p id="p-52">This study was supported by NIH/NHLBI grants R01 HL088437 and NIH/NIBIB T32 EB005170.</p></li></ul></div><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><div class="section ref-list" id="ref-list-1"><h2>REFERENCES</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.1" data-doi="10.1056/NEJMoa043033"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Chimowitz</span>  <span class="cit-name-given-names">MI</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Lynn</span>  <span class="cit-name-given-names">MJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Howlett-Smith</span>  <span class="cit-name-given-names">H</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis</span>. <abbr class="cit-jnl-abbrev">N Engl J Med</abbr> <span class="cit-pub-date">2005</span>;<span class="cit-vol">352</span>:<span class="cit-fpage">1305</span>–<span class="cit-lpage">16</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1056/NEJMoa043033&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15800226&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.2" data-doi="10.1056/NEJMoa1105335"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Chimowitz</span>  <span class="cit-name-given-names">MI</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Lynn</span>  <span class="cit-name-given-names">MJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Derdeyn</span>  <span class="cit-name-given-names">CP</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Stenting versus aggressive medical therapy for intracranial arterial stenosis</span>. <abbr class="cit-jnl-abbrev">N Engl J Med</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">365</span>:<span class="cit-fpage">993</span>–<span class="cit-lpage">1003</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1056/NEJMoa1105335&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21899409&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.3" data-doi="10.1148/radiol.2212001612"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Yuan</span>  <span class="cit-name-given-names">C</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mitsumori</span>  <span class="cit-name-given-names">LM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Beach</span>  <span class="cit-name-given-names">KW</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions</span>. <abbr class="cit-jnl-abbrev">Radiology</abbr> <span class="cit-pub-date">2001</span>;<span class="cit-vol">221</span>:<span class="cit-fpage">285</span>–<span class="cit-lpage">99</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/radiol.2212001612&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=11687667&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.4" data-doi="10.1161/01.STR.0000185726.83152.00"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Wasserman</span>  <span class="cit-name-given-names">BA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Wityk</span>  <span class="cit-name-given-names">RJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Trout</span>  <span class="cit-name-given-names">HH</span>  <span class="cit-name-suffix">3rd</span>.</span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Low-grade carotid stenosis: looking beyond the lumen with MRI</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2005</span>;<span class="cit-vol">36</span>:<span class="cit-fpage">2504</span>–<span class="cit-lpage">13</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjEwOiIzNi8xMS8yNTA0IjtzOjQ6ImF0b20iO3M6MjE6Ii9ham5yLzM0LzEyLzIyNTIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.5" data-doi="10.1148/radiol.2412051336"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Kerwin</span>  <span class="cit-name-given-names">WS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">O'Brien</span>  <span class="cit-name-given-names">KD</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ferguson</span>  <span class="cit-name-given-names">MS</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Inflammation in carotid atherosclerotic plaque: a dynamic contrast-enhanced MR imaging study</span>. <abbr class="cit-jnl-abbrev">Radiology</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">241</span>:<span class="cit-fpage">459</span>–<span class="cit-lpage">68</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/radiol.2412051336&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=16966482&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">6.</span><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 6. in text" id="ref-6">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.6" data-doi="10.1148/radiol.2441051769"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Saam</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hatsukami</span>  <span class="cit-name-given-names">TS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Takaya</span>  <span class="cit-name-given-names">N</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">The vulnerable, or high-risk, atherosclerotic plaque: noninvasive MR imaging for characterization and assessment</span>. <abbr class="cit-jnl-abbrev">Radiology</abbr> <span class="cit-pub-date">2007</span>;<span class="cit-vol">244</span>:<span class="cit-fpage">64</span>–<span class="cit-lpage">77</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/radiol.2441051769&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=17581895&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">7.</span><a class="rev-xref-ref" href="#xref-ref-7-1" title="View reference 7. in text" id="ref-7">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.7" data-doi="10.1001/jama.292.15.1845"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Spagnoli</span>  <span class="cit-name-given-names">LG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mauriello</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Sangiorgi</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke</span>. <abbr class="cit-jnl-abbrev">JAMA</abbr> <span class="cit-pub-date">2004</span>;<span class="cit-vol">292</span>:<span class="cit-fpage">1845</span>–<span class="cit-lpage">52</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1001/jama.292.15.1845&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15494582&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">8.</span><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8. in text" id="ref-8">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.8" data-doi="10.1001/archneurol.2011.20"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Vergouwen</span>  <span class="cit-name-given-names">MD</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Silver</span>  <span class="cit-name-given-names">FL</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mandell</span>  <span class="cit-name-given-names">DM</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Eccentric narrowing and enhancement of symptomatic middle cerebral artery stenoses in patients with recent ischemic stroke</span>. <abbr class="cit-jnl-abbrev">Arch Neurol</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">68</span>:<span class="cit-fpage">338</span>–<span class="cit-lpage">42</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1001/archneurol.2011.20&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21403018&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">9.</span><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9. in text" id="ref-9">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.9" data-doi="10.1212/01.wnl.0000342470.69739.b3"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Swartz</span>  <span class="cit-name-given-names">RH</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Bhuta</span>  <span class="cit-name-given-names">SS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Farb</span>  <span class="cit-name-given-names">RI</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Intracranial arterial wall imaging using high-resolution 3-Tesla contrast-enhanced MRI</span>. <abbr class="cit-jnl-abbrev">Neurology</abbr> <span class="cit-pub-date">2009</span>;<span class="cit-vol">72</span>:<span class="cit-fpage">627</span>–<span class="cit-lpage">34</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1212/01.wnl.0000342470.69739.b3&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></div></div></li><li><span class="ref-label">10.</span><a class="rev-xref-ref" href="#xref-ref-10-1" title="View reference 10. in text" id="ref-10">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.10" data-doi="10.1212/01.wnl.0000225074.47396.71"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Klein</span>  <span class="cit-name-given-names">IF</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Lavallee</span>  <span class="cit-name-given-names">PC</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Touboul</span>  <span class="cit-name-given-names">PJ</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">In vivo middle cerebral artery plaque imaging by high-resolution MRI</span>. <abbr class="cit-jnl-abbrev">Neurology</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">67</span>:<span class="cit-fpage">327</span>–<span class="cit-lpage">29</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1212/01.wnl.0000225074.47396.71&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></div></div></li><li><span class="ref-label">11.</span><a class="rev-xref-ref" href="#xref-ref-11-1" title="View reference 11. in text" id="ref-11">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.11" data-doi="10.1002/ana.22626"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Xu</span>  <span class="cit-name-given-names">WH</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Li</span>  <span class="cit-name-given-names">ML</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gao</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Middle cerebral artery intraplaque hemorrhage: prevalence and clinical relevance</span>. <abbr class="cit-jnl-abbrev">Ann Neurol</abbr> <span class="cit-pub-date">2012</span>;<span class="cit-vol">71</span>:<span class="cit-fpage">195</span>–<span class="cit-lpage">98</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/ana.22626&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=22367991&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">12.</span><a class="rev-xref-ref" href="#xref-ref-12-1" title="View reference 12. in text" id="ref-12">↵</a>

<div class="cit ref-cit ref-book" id="cit-34.12.2252.12"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Greenberg</span>  <span class="cit-name-given-names">MS</span></span></li></ol><cite>. <span class="cit-source">Handbook of Neurosurgery</span>. <span class="cit-publ-loc">New York</span>: <span class="cit-publ-name">Thieme Medical Publishers</span>; <span class="cit-pub-date">2010</span></cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">13.</span><a class="rev-xref-ref" href="#xref-ref-13-1" title="View reference 13. in text" id="ref-13">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.13" data-doi="10.1002/jmri.22592"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Qiao</span>  <span class="cit-name-given-names">Y</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Steinman</span>  <span class="cit-name-given-names">DA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Qin</span>  <span class="cit-name-given-names">Q</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Intracranial arterial wall imaging using three-dimensional high isotropic resolution black blood MRI at 3.0 Tesla</span>. <abbr class="cit-jnl-abbrev">J Magn Reson Imaging</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">34</span>:<span class="cit-fpage">22</span>–<span class="cit-lpage">30</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/jmri.22592&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21698704&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">14.</span><a class="rev-xref-ref" href="#xref-ref-14-1" title="View reference 14. in text" id="ref-14">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.14" data-doi="10.3174/ajnr.A3209"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Skarpathiotakis</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mandell</span>  <span class="cit-name-given-names">DM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Swartz</span>  <span class="cit-name-given-names">RH</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Intracranial atherosclerotic plaque enhancement in patients with ischemic stroke</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">34</span>:<span class="cit-fpage">299</span>–<span class="cit-lpage">304</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIzNC8yLzI5OSI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8zNC8xMi8yMjUyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">15.</span><a class="rev-xref-ref" href="#xref-ref-15-1" title="View reference 15. in text" id="ref-15">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.15" data-doi="10.1016/j.atherosclerosis.2010.06.035"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Xu</span>  <span class="cit-name-given-names">WH</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Li</span>  <span class="cit-name-given-names">ML</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gao</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">In vivo high-resolution MR imaging of symptomatic and asymptomatic middle cerebral artery atherosclerotic stenosis</span>. <abbr class="cit-jnl-abbrev">Atherosclerosis</abbr> <span class="cit-pub-date">2010</span>;<span class="cit-vol">212</span>:<span class="cit-fpage">507</span>–<span class="cit-lpage">11</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.atherosclerosis.2010.06.035&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=20638663&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">16.</span><a class="rev-xref-ref" href="#xref-ref-16-1" title="View reference 16. in text" id="ref-16">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.16" data-doi="10.1161/01.CIR.98.24.2666"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Yuan</span>  <span class="cit-name-given-names">C</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Beach</span>  <span class="cit-name-given-names">KW</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Smith</span>  <span class="cit-name-given-names">LH</span>  <span class="cit-name-suffix">Jr</span>.</span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Measurement of atherosclerotic carotid plaque size in vivo using high resolution magnetic resonance imaging</span>. <abbr class="cit-jnl-abbrev">Circulation</abbr> <span class="cit-pub-date">1998</span>;<span class="cit-vol">98</span>:<span class="cit-fpage">2666</span>–<span class="cit-lpage">71</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImNpcmN1bGF0aW9uYWhhIjtzOjU6InJlc2lkIjtzOjEwOiI5OC8yNC8yNjY2IjtzOjQ6ImF0b20iO3M6MjE6Ii9ham5yLzM0LzEyLzIyNTIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">17.</span><a class="rev-xref-ref" href="#xref-ref-17-1" title="View reference 17. in text" id="ref-17">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.17" data-doi="10.1161/CIRCULATIONAHA.105.589044"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Redgrave</span>  <span class="cit-name-given-names">JN</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Lovett</span>  <span class="cit-name-given-names">JK</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gallagher</span>  <span class="cit-name-given-names">PJ</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: the Oxford plaque study</span>. <abbr class="cit-jnl-abbrev">Circulation</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">113</span>:<span class="cit-fpage">2320</span>–<span class="cit-lpage">28</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImNpcmN1bGF0aW9uYWhhIjtzOjU6InJlc2lkIjtzOjExOiIxMTMvMTkvMjMyMCI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8zNC8xMi8yMjUyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">18.</span><a class="rev-xref-ref" href="#xref-ref-18-1" title="View reference 18. in text" id="ref-18">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.18" data-doi="10.1016/S0741-5214(99)70136-9"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">McCarthy</span>  <span class="cit-name-given-names">MJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Loftus</span>  <span class="cit-name-given-names">IM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Thompson</span>  <span class="cit-name-given-names">MM</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Angiogenesis and the atherosclerotic carotid plaque: an association between symptomatology and plaque morphology</span>. <abbr class="cit-jnl-abbrev">J Vasc Surg</abbr> <span class="cit-pub-date">1999</span>;<span class="cit-vol">30</span>:<span class="cit-fpage">261</span>–<span class="cit-lpage">68</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/S0741-5214(99)70136-9&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=10436445&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">19.</span><a class="rev-xref-ref" href="#xref-ref-19-1" title="View reference 19. in text" id="ref-19">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.19" data-doi="10.1002/mrm.21532"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Kerwin</span>  <span class="cit-name-given-names">WS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Oikawa</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Yuan</span>  <span class="cit-name-given-names">C</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">MR imaging of adventitial vasa vasorum in carotid atherosclerosis</span>. <abbr class="cit-jnl-abbrev">Magn Reson Med</abbr> <span class="cit-pub-date">2008</span>;<span class="cit-vol">59</span>:<span class="cit-fpage">507</span>–<span class="cit-lpage">14</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/mrm.21532&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=18306402&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">20.</span><a class="rev-xref-ref" href="#xref-ref-20-1" title="View reference 20. in text" id="ref-20">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.20" data-doi="10.1161/01.CIR.0000048145.52309.31"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Kerwin</span>  <span class="cit-name-given-names">W</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hooker</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Spilker</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Quantitative magnetic resonance imaging analysis of neovasculature volume in carotid atherosclerotic plaque</span>. <abbr class="cit-jnl-abbrev">Circulation</abbr> <span class="cit-pub-date">2003</span>;<span class="cit-vol">107</span>:<span class="cit-fpage">851</span>–<span class="cit-lpage">56</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImNpcmN1bGF0aW9uYWhhIjtzOjU6InJlc2lkIjtzOjk6IjEwNy82Lzg1MSI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8zNC8xMi8yMjUyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">21.</span><a class="rev-xref-ref" href="#xref-ref-21-1" title="View reference 21. in text" id="ref-21">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.21" data-doi="10.1161/CIRCULATIONAHA.104.528174"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Cai</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hatsukami</span>  <span class="cit-name-given-names">TS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ferguson</span>  <span class="cit-name-given-names">MS</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque: comparison of high-resolution, contrast-enhanced magnetic resonance imaging and histology</span>. <abbr class="cit-jnl-abbrev">Circulation</abbr> <span class="cit-pub-date">2005</span>;<span class="cit-vol">112</span>:<span class="cit-fpage">3437</span>–<span class="cit-lpage">44</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImNpcmN1bGF0aW9uYWhhIjtzOjU6InJlc2lkIjtzOjExOiIxMTIvMjIvMzQzNyI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8zNC8xMi8yMjUyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">22.</span><a class="rev-xref-ref" href="#xref-ref-22-1" title="View reference 22. in text" id="ref-22">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.22" data-doi="10.1161/CIRCULATIONAHA.105.578955"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Moreno</span>  <span class="cit-name-given-names">PR</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Purushothaman</span>  <span class="cit-name-given-names">KR</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Sirol</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Neovascularization in human atherosclerosis</span>. <abbr class="cit-jnl-abbrev">Circulation</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">113</span>:<span class="cit-fpage">2245</span>–<span class="cit-lpage">52</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImNpcmN1bGF0aW9uYWhhIjtzOjU6InJlc2lkIjtzOjExOiIxMTMvMTgvMjI0NSI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8zNC8xMi8yMjUyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">23.</span><a class="rev-xref-ref" href="#xref-ref-23-1" title="View reference 23. in text" id="ref-23">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.23" data-doi="10.1148/radiol.11101264"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Dong</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kerwin</span>  <span class="cit-name-given-names">WS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Chen</span>  <span class="cit-name-given-names">H</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Carotid artery atherosclerosis: effect of intensive lipid therapy on the vasa vasorum–evaluation by using dynamic contrast-enhanced MR imaging</span>. <abbr class="cit-jnl-abbrev">Radiology</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">260</span>:<span class="cit-fpage">224</span>–<span class="cit-lpage">31</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/radiol.11101264&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21493792&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">24.</span><a class="rev-xref-ref" href="#xref-ref-24-1" title="View reference 24. in text" id="ref-24">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.24" data-doi="10.1159/000209238"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Ryu</span>  <span class="cit-name-given-names">CW</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Jahng</span>  <span class="cit-name-given-names">GH</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kim</span>  <span class="cit-name-given-names">EJ</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">High resolution wall and lumen MRI of the middle cerebral arteries at 3 Tesla</span>. <abbr class="cit-jnl-abbrev">Cerebrovasc Dis</abbr> <span class="cit-pub-date">2009</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">433</span>–<span class="cit-lpage">42</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1159/000209238&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=19295206&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">25.</span><a class="rev-xref-ref" href="#xref-ref-25-1" title="View reference 25. in text" id="ref-25">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.12.2252.25" data-doi="10.2214/AJR.07.2428"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Koktzoglou</span>  <span class="cit-name-given-names">I</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kirpalani</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Carroll</span>  <span class="cit-name-given-names">TJ</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Dark-blood MRI of the thoracic aorta with 3D diffusion-prepared steady-state free precession: initial clinical evaluation</span>. <abbr class="cit-jnl-abbrev">AJR Am J Roentgenol</abbr> <span class="cit-pub-date">2007</span>;<span class="cit-vol">189</span>:<span class="cit-fpage">966</span>–<span class="cit-lpage">72</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.2214/AJR.07.2428&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=17885072&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F12%2F2252.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="history-list"><li xmlns:hwp="http://schema.highwire.org/Journal" class="received" hwp:start="2012-10-01"><span class="received-label">Received </span>October 1, 2012.</li><li xmlns:hwp="http://schema.highwire.org/Journal" class="accepted" hwp:start="2013-03-07"><span class="accepted-label">Accepted after revision </span>March 7, 2013.</li></ul><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2013 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/34/12/2252.abstract" class="hw-link hw-link-article-abstract" data-icon-position="" data-hide-link-title="0">View Abstract</a></div>  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-highwire-article-trendmd" >
  
      
  
  <div class="pane-content">
    <div id="trendmd-suggestions"></div>  </div>

  
  </div>
</div>
  </div>
</div>
</div></div>  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-highwire-node-pager" >
  
      
  
  <div class="pane-content">
    <div class="pager highwire-pager pager-mini clearfix highwire-node-pager highwire-article-pager"><span class="pager-prev"><a href="/content/34/12/2250" title="Neurofibromatosis: Types 1 and 2" rel="prev" class="pager-link-prev link-icon"><span class="icon-circle-arrow-left"></span> <span class="title">Previous</span></a></span><span class="pager-next"><a href="/content/34/12/2259" title="Intracranial-Derived Atherosclerosis Assessment: An In Vitro Comparison between Virtual Histology by Intravascular Ultrasonography, 7T MRI, and Histopathologic Findings" rel="next" class="pager-link-next link-icon-right link-icon"><span class="title">Next</span> <span class="icon-circle-arrow-right"></span></a></span></div>  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-highwire-back-to-top" >
  
      
  
  <div class="pane-content">
    <a href="#page" class="back-to-top" data-icon-position="" data-hide-link-title="0"><span class="icon-chevron-up"></span> Back to top</a>  </div>

  
  </div>
</div>
			</div>
		</div>
		
		<div class="sidebar-right-wrapper grid-10 omega">
			<div class="panel-panel panel-region-sidebar-right">
			  <div class="inside"><div class="panel-pane pane-panels-mini pane-jnl-ajnr-art-issue pane-style-alt-content" >
  
        <h2 class="pane-title">In this issue</h2>
    
  
  <div class="pane-content">
    <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_art_issue">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-highwire-article-citation" >
  
      
  
  <div class="pane-content">
    <div class="highwire-article-citation highwire-citation-type-highwire-issue node1745" data-node-nid="1745" id="node-1745--21965946588" data-pisa="ajnr;34/12" data-pisa-master="ajnr;34/12" data-apath="/ajnr/34/12.atom"><div class="highwire-cite highwire-cite-highwire-issue highwire-citation-jcore-issue-widget clearfix">
    
      <div class="highwire-cite-highlight"><a href="/content/34/12"  class="highlight-image-linked"><img class="highlight-image" src="http://ajnr-stage2.stage.highwire.org/sites/default/files/styles/medium/public/highwire/ajnr/34/12.cover-source.jpg?itok=TREeGBuw" alt="American Journal of Neuroradiology: 34 (12)" /></a></div>
  
  <div class="highwire-cite-col">
      
      
          <a href="/content/34/12" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">American Journal of Neuroradiology</span></a>      
      
        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 34</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 12 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Dec 2013 </div></div>
      
      
        	<div class="highwire-cite-extras"><div class='highwire-article-citation-variant-list'><ul class="links variants-list"><li class="toc first"><a href="/content/34/12.toc" class="highwire-variant-link variant-toc " title="Table of Contents" rel="alternate" type="text/html" data-icon-position="" data-hide-link-title="0">Table of Contents</a></li><li class="index-by-author"><a href="/content/34/12.index-by-author" class="highwire-variant-link variant-index-by-author " title="Index by author" rel="alternate" data-icon-position="" data-hide-link-title="0">Index by author</a></li><li class="enclosure-complete-issue last"><a href="/content/ajnr/34/12/local/complete-issue.pdf" class="highwire-variant-link variant-enclosure" title="Complete Issue (PDF)" rel="alternative" data-icon-position="" data-hide-link-title="0">Complete Issue (PDF)</a></li></ul></div></div>
      </div>

</div></div>  </div>

  
  </div>
</div>
  </div>
</div>
  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-jnl-ajnr-ad-rhs" >
  
      
  
  <div class="pane-content">
    <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_ad_rhs">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-dfp-pane text-center" >
  
      
  
  <div class="pane-content">
    <div id="dfp-ad-rhs-wrapper" class="dfp-tag-wrapper">
<div class="slug">Advertisement</div>
<div  id="dfp-ad-rhs" class="dfp-tag-wrapper">
  <script type="text/javascript">
    googletag.cmd.push(function() {
      googletag.display("dfp-ad-rhs");
    });
  </script>
</div>
</div>  </div>

  
  </div>
</div>
  </div>
</div>
  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-jnl-ajnr-art-tools" >
  
      
  
  <div class="pane-content">
    <div id="mini-panel-jnl_ajnr_art_tools" class="highwire-2col-stacked panel-display">
	  
  <div class="panel-row-wrapper clearfix">
		<div class="content-left-wrapper content-column">
          <div class="panel-panel panel-region-content-left">
            <div class="inside"><div class="panel-pane pane-highwire-variant-link" >
  
      
  
  <div class="pane-content">
    <a href="/content/ajnr/34/12/2252.full-text.print" target="_blank" rel="nofollow" class="link-icon"><span class="icon-print"></span> <span class="title">Print</span></a>  </div>

  
  </div>
<div class="panel-pane pane-highwire-variant-link text-no-wrap" >
  
      
  
  <div class="pane-content">
    <a href="/content/ajnr/34/12/2252.full-text.pdf" target="_blank" class="link-icon"><span class="icon-download-alt"></span> <span class="title">Download PDF</span></a>  </div>

  
  </div>
<div class="panel-pane pane-minipanel-dialog-link pane-jnl-ajnr-art-email" >
  
      
  
  <div class="pane-content">
    <div class='minipanel-dialog-wrapper'><div class='minipanel-dialog-link-link'><a href="/" oncontextmenu="javascript: return false;" class="minipanel-dialog-link-trigger link-icon" title="Email this Article"><span class="icon-envelope"></span> <span class="title">Email Article</span></a></div><div class='minipanel-dialog-link-mini' style='display:none'><div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_art_email">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-block pane-forward-form pane-forward" >
  
      
  
  <div class="pane-content">
    <form action="/node/12718" method="post" id="forward-form" accept-charset="UTF-8"><div><div id="edit-instructions" class="form-item form-item-label-before form-type-item">
 <p>Thank you for your interest in spreading the word on American Journal of Neuroradiology.</p><p>NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.</p>
</div>
<div class="form-item form-item-label-before form-type-textfield form-item-email">
  <label for="edit-email">Your Email <span class="form-required" title="This field is required.">*</span></label>
 <input type="text" id="edit-email" name="email" value="" size="58" maxlength="256" class="form-text required" />
</div>
<div class="form-item form-item-label-before form-type-textfield form-item-name">
  <label for="edit-name">Your Name <span class="form-required" title="This field is required.">*</span></label>
 <input type="text" id="edit-name" name="name" value="" size="58" maxlength="256" class="form-text required" />
</div>
<div class="form-item form-item-label-before form-type-textarea form-item-recipients">
  <label for="edit-recipients">Send To <span class="form-required" title="This field is required.">*</span></label>
 <div class="form-textarea-wrapper resizable"><textarea id="edit-recipients" name="recipients" cols="50" rows="5" class="form-textarea required"></textarea></div>
<div class="description">Enter multiple addresses on separate lines or separate them with commas.</div>
</div>
<div id="edit-page" class="form-item form-item-label-before form-type-item">
  <label for="edit-page">You are going to email the following </label>
 <a href="/content/34/12/2252" class="active" data-icon-position="" data-hide-link-title="0">T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations</a>
</div>
<div id="edit-subject" class="form-item form-item-label-before form-type-item">
  <label for="edit-subject">Message Subject </label>
 (Your Name) has sent you a message from American Journal of Neuroradiology
</div>
<div id="edit-body" class="form-item form-item-label-before form-type-item">
  <label for="edit-body">Message Body </label>
 (Your Name) thought you would like to see the American Journal of Neuroradiology web site.
</div>
<div class="form-item form-item-label-before form-type-textarea form-item-message">
  <label for="edit-message--2">Your Personal Message </label>
 <div class="form-textarea-wrapper resizable"><textarea id="edit-message--2" name="message" cols="50" rows="10" class="form-textarea"></textarea></div>
</div>
<input type="hidden" name="path" value="node/12718" />
<input type="hidden" name="path_cid" value="" />
<input type="hidden" name="forward_footer" value="" />
<input type="hidden" name="form_build_id" value="form-ZPvxmKSTipHb6FKC-3LMBtmXOUaonagfPUxd13hrIqA" />
<input type="hidden" name="form_id" value="forward_form" />
<fieldset class="captcha form-wrapper"><legend><span class="fieldset-legend">CAPTCHA</span></legend><div class="fieldset-wrapper"><div class="fieldset-description">This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.</div><input type="hidden" name="captcha_sid" value="108748662" />
<input type="hidden" name="captcha_token" value="4f7ca5ff3883a4c4b89ff014927b588c" />
<input type="hidden" name="captcha_response" value="Google no captcha" />
<div class="g-recaptcha" data-sitekey="6LfnJVIUAAAAAE-bUOMg0MJGki4lqSvDmhJp19fN" data-theme="light" data-type="image"></div></div></fieldset>
<div class="form-actions form-wrapper" id="edit-actions"><input type="submit" id="edit-submit" name="op" value="Send Message" class="form-submit" /></div></div></form>  </div>

  
  </div>
</div>
  </div>
</div>
</div></div>  </div>

  
  </div>
<div class="panel-pane pane-minipanel-dialog-link pane-jnl-ajnr-cite-tool" >
  
      
  
  <div class="pane-content">
    <div class='minipanel-dialog-wrapper'><div class='minipanel-dialog-link-link'><a href="/highwire/citation/12718/download" oncontextmenu="javascript: return false;" class="minipanel-dialog-link-trigger link-icon" title="Citation Tools"><span class="icon-globe"></span> <span class="title">Citation Tools</span></a></div><div class='minipanel-dialog-link-mini' style='display:none'><div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_cite_tool">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-highwire-citation-export" >
  
      
  
  <div class="pane-content">
    <div class="highwire-citation-export">  
  <div class="highwire-citation-info">
      <div class="highwire-article-citation highwire-citation-type-highwire-article cite-tool-node12718" data-node-nid="12718" id="citation-node-12718--21786963045" data-pisa="ajnr;34/12/2252" data-pisa-master="ajnr;ajnr.A3606" data-apath="/ajnr/34/12/2252.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-standard clearfix">
  
  
  
  
      <div class="highwire-cite-title">T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Vakil</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Vranic</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.C.</span> <span class="nlm-surname">Hurley</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">R.A.</span> <span class="nlm-surname">Bernstein</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.W.</span> <span class="nlm-surname">Korutz</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Habib</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Shaibani</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">F.H.</span> <span class="nlm-surname">Dehkordi</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">T.J.</span> <span class="nlm-surname">Carroll</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">S.A.</span> <span class="nlm-surname">Ansari</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2252-2258; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3606 </span></div>
  
  
  
</div>
</div>  </div>
  <div class="highwire-citation-formats">
  	      <h2>Citation Manager Formats</h2>
        <div class="highwire-citation-formats-links">
      <span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.spage=2252&amp;rft.epage=2258&amp;rft.atitle=T1%20Gadolinium%20Enhancement%20of%20Intracranial%20Atherosclerotic%20Plaques%20Associated%20with%20Symptomatic%20Ischemic%20Presentations&amp;rft.volume=34&amp;rft.issue=12&amp;rft.date=2013-12-01%2000%3A00%3A00&amp;rft.stitle&amp;rft.jtitle=American%20Journal%20of%20Neuroradiology&amp;rft.au=Vakil%2C+P.&amp;rft.au=Vranic%2C+J.&amp;rft.au=Hurley%2C+M.C.&amp;rft.au=Bernstein%2C+R.A.&amp;rft.au=Korutz%2C+A.W.&amp;rft.au=Habib%2C+A.&amp;rft.au=Shaibani%2C+A.&amp;rft.au=Dehkordi%2C+F.H.&amp;rft.au=Carroll%2C+T.J.&amp;rft.au=Ansari%2C+S.A."></span><ul class="hw-citation-links inline button button-alt button-grid clearfix"><li class="bibtext first"><a href="/highwire/citation/12718/bibtext" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">BibTeX</a></li><li class="bookends"><a href="/highwire/citation/12718/bookends" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Bookends</a></li><li class="easybib"><a href="/highwire/citation/12718/easybib" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">EasyBib</a></li><li class="endnote-tagged"><a href="/highwire/citation/12718/endnote-tagged" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">EndNote (tagged)</a></li><li class="endnote-8-xml"><a href="/highwire/citation/12718/endnote-8-xml" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">EndNote 8 (xml)</a></li><li class="medlars"><a href="/highwire/citation/12718/medlars" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Medlars</a></li><li class="mendeley"><a href="/highwire/citation/12718/mendeley" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Mendeley</a></li><li class="papers"><a href="/highwire/citation/12718/papers" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Papers</a></li><li class="refworks-tagged"><a href="/highwire/citation/12718/refworks-tagged" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">RefWorks Tagged</a></li><li class="reference-manager"><a href="/highwire/citation/12718/reference-manager" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Ref Manager</a></li><li class="ris"><a href="/highwire/citation/12718/ris" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">RIS</a></li><li class="zotero last"><a href="/highwire/citation/12718/zotero" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Zotero</a></li></ul>    </div>
  </div>
</div>
  </div>

  
  </div>
</div>
  </div>
</div>
</div></div>  </div>

  
  </div>
</div>
          </div>
        </div>
        
        <div class="content-right-wrapper content-column">
          <div class="panel-panel panel-region-content-right">
            <div class="inside"><div class="panel-pane pane-highwire-share-link highwire_clipboard_link_ajax"  id="shareit">
  
      
  
  <div class="pane-content">
    <a href="/" class="link-icon"><span class="icon-share-alt"></span> <span class="title">Share</span></a>  </div>

  
  </div>
<div class="panel-pane pane-panels-mini pane-jnl-ajnr-share highwire_clipboard_form_ajax_shareit" >
  
      
  
  <div class="pane-content">
    <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_share">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-highwire-article-citation large-margin-bottom" >
  
      
  
  <div class="pane-content">
    <div class="highwire-article-citation highwire-citation-type-highwire-article node12718--3" data-node-nid="12718" id="share-node-12718--41519141833" data-pisa="ajnr;34/12/2252" data-pisa-master="ajnr;ajnr.A3606" data-apath="/ajnr/34/12/2252.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-standard clearfix">
  
  
  
  
      <div class="highwire-cite-title">T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Vakil</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Vranic</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.C.</span> <span class="nlm-surname">Hurley</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">R.A.</span> <span class="nlm-surname">Bernstein</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.W.</span> <span class="nlm-surname">Korutz</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Habib</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Shaibani</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">F.H.</span> <span class="nlm-surname">Dehkordi</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">T.J.</span> <span class="nlm-surname">Carroll</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">S.A.</span> <span class="nlm-surname">Ansari</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2252-2258; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3606 </span></div>
  
  
  
</div>
</div>  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-highwire-article-clipboard-copy large-margin-bottom" >
  
      
  
  <div class="pane-content">
    <div class = "clipboard-copy">
  <span class="label-url">
    <label for="dynamic">Share This Article:</label>
  </span>
  <span class="input-text-url">
    <input type="text" id="dynamic" value="http://ajnr-stage2.stage.highwire.org/content/34/12/2252" size="50"/>
  </span>
  <span class="copy-button button">
    <button id="copy-dynamic" class="clipboardjs-button" data-clipboard-target="#dynamic" data-clipboard-alert-style="tooltip" data-clipboard-alert-text="Copied!">Copy</button>
  </span>
</div>
  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-service-links" >
  
      
  
  <div class="pane-content">
    <div class="service-links"><a href="http://del.icio.us/post?url=http%3A//ajnr-stage2.stage.highwire.org/content/34/12/2252&amp;title=T1%20Gadolinium%20Enhancement%20of%20Intracranial%20Atherosclerotic%20Plaques%20Associated%20with%20Symptomatic%20Ischemic%20Presentations" id="delicious" title="Bookmark this post on del.icio.us" class="service-links-delicious" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><img src="http://ajnr-stage2.stage.highwire.org/sites/all/modules/highwire/highwire/images/delicious-32.png" alt="del.icio.us logo" /></a> <a href="http://twitter.com/share?url=http%3A//ajnr-stage2.stage.highwire.org/content/34/12/2252&amp;text=T1%20Gadolinium%20Enhancement%20of%20Intracranial%20Atherosclerotic%20Plaques%20Associated%20with%20Symptomatic%20Ischemic%20Presentations" id="twitter" title="Share this on Twitter" class="service-links-twitter" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><img src="http://ajnr-stage2.stage.highwire.org/sites/all/modules/highwire/highwire/images/twitter.png" alt="Twitter logo" /></a> <a href="http://www.facebook.com/sharer.php?u=http%3A//ajnr-stage2.stage.highwire.org/content/34/12/2252&amp;t=T1%20Gadolinium%20Enhancement%20of%20Intracranial%20Atherosclerotic%20Plaques%20Associated%20with%20Symptomatic%20Ischemic%20Presentations" id="facebook" title="Share on Facebook" class="service-links-facebook" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><img src="http://ajnr-stage2.stage.highwire.org/sites/all/modules/highwire/highwire/images/fb-blue.png" alt="Facebook logo" /></a> <a href="http://www.mendeley.com/import/?url=http%3A//ajnr-stage2.stage.highwire.org/content/34/12/2252&amp;title=T1%20Gadolinium%20Enhancement%20of%20Intracranial%20Atherosclerotic%20Plaques%20Associated%20with%20Symptomatic%20Ischemic%20Presentations" id="mendeley" title="Share on Mendeley" class="service-links-mendeley" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><img src="http://ajnr-stage2.stage.highwire.org/sites/all/modules/highwire/highwire/images/mendeley.png" alt="Mendeley logo" /></a></div>  </div>

  
  </div>
</div>
  </div>
</div>
  </div>

  
  </div>
<div class="panel-pane pane-service-links" >
  
      
  
  <div class="pane-content">
    <div class="service-links"><div class="item-list"><ul><li class="first"><a href="http://twitter.com/share?url=http%3A//ajnr-stage2.stage.highwire.org/content/34/12/2252&amp;count=horizontal&amp;via=&amp;text=T1%20Gadolinium%20Enhancement%20of%20Intracranial%20Atherosclerotic%20Plaques%20Associated%20with%20Symptomatic%20Ischemic%20Presentations&amp;counturl=http%3A//ajnr-stage2.stage.highwire.org/content/34/12/2252" class="twitter-share-button service-links-twitter-widget" id="twitter_widget" title="Tweet This" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><span class="element-invisible">Tweet Widget</span></a></li><li><a href="http://www.facebook.com/plugins/like.php?href=http%3A//ajnr-stage2.stage.highwire.org/content/34/12/2252&amp;layout=button_count&amp;show_faces=false&amp;action=like&amp;colorscheme=light&amp;width=100&amp;height=21&amp;font=&amp;locale=" id="facebook_like" title="I Like it" class="service-links-facebook-like" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><span class="element-invisible">Facebook Like</span></a></li><li class="last"><a href="http://ajnr-stage2.stage.highwire.org/content/34/12/2252" id="google_plus_one" title="Plus it" class="service-links-google-plus-one" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><span class="element-invisible">Google Plus One</span></a></li></ul></div></div>  </div>

  
  </div>
</div>
          </div>
        </div>
	</div> <!-- /.panel-row-wrapper -->	
	
	</div>

  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-jnl-ajnr-rental" >
  
      
  
  <div class="pane-content">
    <span class="js-deepdyve-link">
            <a class="button btn btn-primary btn-sm" role="button"  href="https://www.deepdyve.com/doc-view?docId=10.3174/ajnr.A3606&fieldName=journal_doi&affiliateId=asnr"><i class="icon-usd"> </i> Purchase</a>  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-highwire-article-nav mobile-hidden pane-style-alt-content" >
  
        <h2 class="pane-title">Jump to section</h2>
    
  
  <div class="pane-content">
    <div class="highwire-list-wrapper highwire-article-nav highwire-nav-float"><div class="highwire-list"><ul data-highwire-float="1" data-highwire-float-class="grid-10 alpha omega"><li class="parent first odd"><a href="/content/34/12/2252" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_art" data-is-tab-link="true" data-icon-position="" data-hide-link-title="0">Article</a><div class="highwire-list"><ul><li class="first odd"><a href="#abstract-2" class="highwire-article-nav-jumplink first" data-panel-ajax-tab="jnl_ajnr_tab_art" data-icon-position="" data-hide-link-title="0">Abstract</a></li><li class="even"><a href="#glossary-1" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_art" data-icon-position="" data-hide-link-title="0">ABBREVIATIONS:</a></li><li class="odd"><a href="#sec-5" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_art" data-icon-position="" data-hide-link-title="0">Materials and Methods</a></li><li class="even"><a href="#sec-14" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_art" data-icon-position="" data-hide-link-title="0">Results</a></li><li class="odd"><a href="#sec-16" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_art" data-icon-position="" data-hide-link-title="0">Discussion</a></li><li class="even"><a href="#sec-17" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_art" data-icon-position="" data-hide-link-title="0">Conclusions</a></li><li class="odd"><a href="#fn-group-1" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_art" data-icon-position="" data-hide-link-title="0">Footnotes</a></li><li class="last even"><a href="#ref-list-1" class="highwire-article-nav-jumplink last" data-panel-ajax-tab="jnl_ajnr_tab_art" data-icon-position="" data-hide-link-title="0">REFERENCES</a></li></ul></div></li><li class="even"><a href="/content/34/12/2252/tab-figures-data" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_data" data-is-tab-link="true" data-icon-position="" data-hide-link-title="0">Figures &amp; Data</a></li><li class="odd"><a href="/content/34/12/2252/tab-supplemental" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_supp" data-is-tab-link="true" data-icon-position="" data-hide-link-title="0">Supplemental</a></li><li class="even"><a href="/content/34/12/2252/tab-references" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_refs" data-is-tab-link="true" data-icon-position="" data-hide-link-title="0">References</a></li><li class="odd"><a href="/content/34/12/2252/tab-article-info" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_ajnr_tab_info" data-is-tab-link="true" data-icon-position="" data-hide-link-title="0">Info &amp; Metrics</a></li><li class="last even"><a href="/content/34/12/2252.full.pdf" class="highwire-article-nav-jumplink" data-icon-position="" data-hide-link-title="0"><i class="icon-file-alt"></i> PDF</a></li></ul></div></div>  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-jnl-ajnr-accordion" >
  
      
  
  <div class="pane-content">
    <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_accordion">
  <div class="panel-panel panel-col">
    <div><div id="highwire_article_accordion_container"><h3 ><i class="icon-caret-right"></i> Related Articles</h3><div><div class='highwire-list-footer'><div class="highwire-related-articles-footer"><ul class="links inline"><li class="related-pubmed first"><a href="/lookup/external-ref?link_type=MED_NBRS&amp;access_num=23828109" target="_blank" class="" data-icon-position="" data-hide-link-title="0">PubMed</a></li><li class="related-google-scholar last"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=related&amp;author%5B0%5D=P.%2BVakil&amp;author%5B1%5D=J.%2BVranic&amp;author%5B2%5D=M.C.%2BHurley&amp;author%5B3%5D=R.A.%2BBernstein&amp;author%5B4%5D=A.W.%2BKorutz&amp;author%5B5%5D=A.%2BHabib&amp;author%5B6%5D=A.%2BShaibani&amp;author%5B7%5D=F.H.%2BDehkordi&amp;author%5B8%5D=T.J.%2BCarroll&amp;author%5B9%5D=S.A.%2BAnsari&amp;title=T1%2BGadolinium%2BEnhancement%2Bof%2BIntracranial%2BAtherosclerotic%2BPlaques%2BAssociated%2Bwith%2BSymptomatic%2BIschemic%2BPresentations&amp;publication_year=2013&amp;path=content/34/12/2252" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Google Scholar</a></li></ul></div></div></div><h3 ><i class="icon-caret-right"></i> Cited By...</h3><div><div class="highwire-list highwire-cited-by"><ul><li class="first odd"><a href="http://www.ajnr.org/cgi/content/full/45/3/262" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Delayed Enhancement of Intracranial Atherosclerotic Plaque Can Better Differentiate Culprit Lesions: A Multiphase Contrast-Enhanced Vessel Wall MRI Study</div></a><div class="variant-links"></div></li><li class="even"><a href="http://www.ajnr.org/cgi/content/full/40/10/1709" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Effect of Time Elapsed since Gadolinium Administration on Atherosclerotic Plaque Enhancement in Clinical Vessel Wall MR Imaging Studies</div></a><div class="variant-links"></div></li><li class="odd"><a href="http://svn.bmj.com/cgi/content/full/4/3/129" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Perfusion and plaque evaluation to predict recurrent stroke in symptomatic middle cerebral artery stenosis</div></a><div class="variant-links"></div></li><li class="even"><a href="http://www.ajnr.org/cgi/content/full/40/6/954" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Diagnostic Accuracy of High-Resolution Black-Blood MRI in the Evaluation of Intracranial Large-Vessel Arterial Occlusions</div></a><div class="variant-links"></div></li><li class="odd"><a href="http://jnis.bmj.com/cgi/content/full/10/2/143" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Development of a high resolution MRI intracranial atherosclerosis imaging phantom</div></a><div class="variant-links"></div></li><li class="even"><a href="http://www.ajnr.org/cgi/content/full/38/9/1716" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Identification and Quantitative Assessment of Different Components of Intracranial Atherosclerotic Plaque by Ex Vivo 3T High-Resolution Multicontrast MRI</div></a><div class="variant-links"></div></li><li class="odd"><a href="http://jaha.ahajournals.org/cgi/content/full/5/8/e003816" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Gadolinium Enhancement in Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta-Analysis</div></a><div class="variant-links"></div></li><li class="even"><a href="http://www.ajnr.org/cgi/content/full/36/12/2206" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Multimodal Diagnostic Imaging for Hyperacute Stroke</div></a><div class="variant-links"></div></li><li class="odd"><a href="http://circ.ahajournals.org/cgi/content/full/130/2/192" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Imaging Intracranial Vessel Wall Pathology With Magnetic Resonance Imaging: Current Prospects and Future Directions</div></a><div class="variant-links"></div></li><li class="last even"><a href="http://stroke.ahajournals.org/cgi/content/full/45/7/e113" class="" data-icon-position="" data-hide-link-title="0"><div class="highwire-cite-title">Second European Stroke Science Workshop</div></a><div class="variant-links"></div></li></ul></div><div class='highwire-list-footer'><ul class="links inline"><li class="citing-cross-ref first"><a href="/crossref-forward-links/ajnr/34/12/2252#crossref" class="hw-crossref hw-crossref-link-ajax" data-list-wrapper="hw-crossref-list-wrapper" target="_blank" data-icon-position="" data-hide-link-title="0">Crossref</a></li><li class="citing-google-scholar last"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=citedby&amp;path=content/34/12/2252" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Google Scholar</a></li></ul></div><div title="Crossref Cited-by Linking Search Results" style="display:none;" class="hw-crossref-list-wrapper"><p class = "hw-crossref-message">This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.</p></div></div><h3 ><i class="icon-caret-right"></i> More in this TOC Section</h3><div><div class="highwire-list highwire-article-citation-list"><ul><li class="first odd"><div class="highwire-article-citation highwire-citation-type-highwire-article node13922" data-node-nid="13922" id="node-13922--21724537347" data-pisa="ajnr;36/6/1109" data-pisa-master="ajnr;ajnr.A4262" data-apath="/ajnr/36/6/1109.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-standard-title-only clearfix">
  
  
  
  
      <a href="/content/36/6/1109" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">Evaluating the Effects of White Matter Multiple Sclerosis Lesions on the Volume Estimation of 6 Brain Tissue Segmentation Methods</span></a>  
  
  
  
  
</div>
</div></li><li class="even"><div class="highwire-article-citation highwire-citation-type-highwire-article node13927" data-node-nid="13927" id="node-13927--21816929135" data-pisa="ajnr;36/6/1124" data-pisa-master="ajnr;ajnr.A4235" data-apath="/ajnr/36/6/1124.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-standard-title-only clearfix">
  
  
  
  
      <a href="/content/36/6/1124" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">Quiet PROPELLER MRI Techniques Match the Quality of Conventional PROPELLER Brain Imaging Techniques</span></a>  
  
  
  
  
</div>
</div></li><li class="last odd"><div class="highwire-article-citation highwire-citation-type-highwire-article node13929" data-node-nid="13929" id="node-13929--2348512453" data-pisa="ajnr;36/6/1056" data-pisa-master="ajnr;ajnr.A4283" data-apath="/ajnr/36/6/1056.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-standard-title-only clearfix">
  
  
  
  
      <a href="/content/36/6/1056" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">Predictors of Reperfusion in Patients with Acute Ischemic Stroke</span></a>  
  
  
  
  
</div>
</div></li></ul></div><div class='highwire-list-footer'><a href="/content/by/section/Brain" class="" data-icon-position="" data-hide-link-title="0">Show more <span class="wrapper">BRAIN</span></a></div></div><h3 ><i class="icon-caret-right"></i> Similar Articles</h3><div><div class="highwire-search-similar-ajax-wrapper" id="highwire-search-similar-articles-list-1"><div class="highwire-ajax-loading"><span class="icon-spinner icon-spin icon-2x"></span></div></div></div></div></div>
  </div>
</div>
  </div>

  
  </div>
</div>
			</div>
		</div>
	
	</div> <!-- /.panel-row-wrapper -->	
	
	</div>

    </div>
  </div>
</div><div class="block block-panels-mini more-padding-top mobile-hiddens block-jnl-ajnr-ad-bot-leaderboard block-panels-mini-jnl-ajnr-ad-bot-leaderboard even block-without-title" id="block-panels-mini-jnl-ajnr-ad-bot-leaderboard">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_ad_bot_leaderboard">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-dfp-pane text-center" >
  
      
  
  <div class="pane-content">
    <div id="dfp-ad-bottom_leaderboard-wrapper" class="dfp-tag-wrapper">
<div class="slug">Advertisement</div>
<div  id="dfp-ad-bottom_leaderboard" class="dfp-tag-wrapper">
  <script type="text/javascript">
    googletag.cmd.push(function() {
      googletag.display("dfp-ad-bottom_leaderboard");
    });
  </script>
</div>
</div>  </div>

  
  </div>
</div>
  </div>
</div>
    </div>
  </div>
</div>      </div>
</div>  </div>
</section>    
  
      <footer id="section-footer" class="section section-footer">
    
  <div id="zone-postscript" class="zone zone-postscript clearfix container-30">
    <div class="grid-28 suffix-1 prefix-1 region region-postscript-fourth" id="region-postscript-fourth">
  <div class="region-inner region-postscript-fourth-inner">
    <div class="block block-panels-mini block-jnl-ajnr-footer block-panels-mini-jnl-ajnr-footer odd block-without-title" id="block-panels-mini-jnl-ajnr-footer">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panels-960-row jcore-row-4col clearfix" id="mini-panel-jnl_ajnr_footer">
  <div class="panel-panel panel-region-col-1 grid-7 alpha">
    <div class="inside"><div class="panel-pane pane-block pane-menu-navigate pane-menu" >
  
        <h2 class="pane-title">News and Updates</h2>
    
  
  <div class="pane-content">
    <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf" role="menuitem"><a href="https://www.ajnr.org/cc/2024-Awards" data-hide-link-title="0" class="" data-icon-position="">2024 Journal Award Winners</a></li>
<li class="last leaf" role="menuitem"><a href="/page/content/Reviewer-Recognition" data-hide-link-title="0" class="" data-icon-position="">Thanks to our 2023 Distinguished Reviewers</a></li>
</ul></nav>  </div>

  
  </div>
</div>
  </div>
  <div class="panel-panel panel-region-col-2 grid-7">
    <div class="inside"><div class="panel-pane pane-block pane-menu-more-information pane-menu" >
  
        <h2 class="pane-title">Resources</h2>
    
  
  <div class="pane-content">
    <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf" role="menuitem"><a href="/page/content/EBM" data-hide-link-title="0" class="" data-icon-position="">Evidence-Based Medicine Level Guide</a></li>
<li class="leaf" role="menuitem"><a href="/content/browse-podcast-archives" data-hide-link-title="0" class="" data-icon-position="">AJNR Podcast Archive</a></li>
<li class="leaf" role="menuitem"><a href="/content/institutional-subscriptions" data-hide-link-title="0" class="" data-icon-position="">Librarian Resources</a></li>
<li class="last leaf" role="menuitem"><a href="http://www.ajnr.org/page/content/Terms-and-Conditions" data-hide-link-title="0" class="" data-icon-position="">Terms and Conditions</a></li>
</ul></nav>  </div>

  
  </div>
</div>
  </div>
  <div class="panel-panel panel-region-col-3 grid-7">
    <div class="inside"><div class="panel-pane pane-block pane-menu-add-journals pane-menu" >
  
        <h2 class="pane-title">Opportunities</h2>
    
  
  <div class="pane-content">
    <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first last leaf" role="menuitem"><a href="/page/content/Publons" data-hide-link-title="0" class="" data-icon-position="">Get Peer Review Credit from Publons</a></li>
</ul></nav>  </div>

  
  </div>
</div>
  </div>
  <div class="panel-panel panel-region-col-4 grid-7 omega">
    <div class="inside"><div class="panel-pane pane-block pane-menu-other-services pane-menu" >
  
        <h2 class="pane-title">American Society of Neuroradiology</h2>
    
  
  <div class="pane-content">
    <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf" role="menuitem"><a href="http://www.neurographics.org/" data-hide-link-title="0" class="" data-icon-position="">Neurographics</a></li>
<li class="leaf" role="menuitem"><a href="http://www.asnr.org/index.php/education/fellowship-portal/" data-hide-link-title="0" class="" data-icon-position="">Fellowship Portal</a></li>
<li class="last leaf" role="menuitem"><a href="https://www.asnr.org/membership-types/" data-hide-link-title="0" class="" data-icon-position="">Not an ASNR Member? Join Now</a></li>
</ul></nav>  </div>

  
  </div>
</div>
  </div>
</div>    </div>
  </div>
</div>  </div>
</div>  </div>
  
  <div id="zone-footer" class="zone zone-footer clearfix container-30">
    <div class="grid-28 suffix-1 prefix-1 region region-footer-first" id="region-footer-first">
  <div class="region-inner region-footer-first-inner">
    <div class="block block-panels-mini block-jnl-ajnr-foot-info block-panels-mini-jnl-ajnr-foot-info odd block-without-title" id="block-panels-mini-jnl-ajnr-foot-info">
  <div class="block-inner clearfix">
                
    <div class="content clearfix">
      <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_ajnr_foot_info">
  <div class="panel-panel panel-col">
    <div><div class="panel-pane pane-page-logo-footer" >
  
      
  
  <div class="pane-content">
    <img class="footer-logo" src="http://ajnr-stage2.stage.highwire.org/sites/default/files/ajnr-logo.png" alt="" />  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-snippet pane-footer-copyright-text" >
  
      
  
  <div class="pane-content">
    <div class="snippet footer-copyright-text" id="footer-copyright-text">
  
      
  <div class="snippet-content">
    <p>&copy; 2025 by the <a href="http://www.asnr.org">American Society of Neuroradiology</a> All rights, including for text and data mining, AI training, and similar technologies, are reserved.<br />
Print ISSN: 0195-6108 Online ISSN: 1936-959X</p>
  </div>

</div>
  </div>

  
  </div>
<div class="panel-separator"></div><div class="panel-pane pane-highwire-branding" >
  
      
  
  <div class="pane-content">
    <a href="http://home.highwire.org" target="_blank" class="highwire-branding-link" data-icon-position="" data-hide-link-title="0"><img class="logo-highwire" src="http://ajnr-stage2.stage.highwire.org/sites/all/modules/highwire/highwire/plugins/content_types/images/logo_small_hw_white.png" width="190" height="31" alt="Powered by HighWire" /></a>  </div>

  
  </div>
</div>
  </div>
</div>
    </div>
  </div>
</div>  </div>
</div>  </div>
</footer>  </div>    <div class="region region-page-bottom" id="region-page-bottom">
  <div class="region-inner region-page-bottom-inner">
      </div>
</div><script type="text/javascript" src="/sites/default/files/advagg_js/js__bnwyEQSuZLC-kZnFqCi5iE02nOCzM7DjY7zYxcN9nsQ__VBiBT_qq_eHMMO2Q1rXK1u-hHff31XLUkmi9dgjuPeY__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__GM3GJPR36rRIz0TRkjC5OQwrioSyN9aoYRivDhCO_AM__qAl84FcCv2jyN22yFGS5Oc85cjd9zKX6p_cFNLGhe-M__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js" async="async"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__uW7NyUocxI-7E_sL-GP7L5FYvHrfi0D8UkwaFa_jFUQ__ITpTmydBN18ujP4Nq9igNKs2_uPvSa_MMIGZilNH7xo__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__2WRbxlwOW0MEUc_hSWU5MBepQg6Lch6O5SZwefpJ6IE__HCL0YQJqLkOhrLPZZYGqosGvtFsEHMGghHIkSx4y9vA__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js" defer="defer"></script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__K61GuvJPHG_AuI6kUzzWQ_KuPEWSU52DSvFz0wetFTI__h1hom87iW77mbt1VmvMkeHJRLRulNt5eQfx7vfgMDek__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
function euCookieComplianceLoadScripts() {}
//--><!]]>
</script>
<script type="text/javascript">
<!--//--><![CDATA[//><!--
var eu_cookie_compliance_cookie_name = "";
//--><!]]>
</script>
<script type="text/javascript" src="/sites/default/files/advagg_js/js__WcTpt-w0y1FyXrxZNriX8Ts1KjsFTDpdvZaw9yhRn24__aFJpdvsZPb1v9rWrq-WXbz_WQ9IThQN-mFTCdm1cfXc__Op4k-kV4DoWc7bsUP7umKmZ0WXfmoYdRDoZFPNSd-oM.js"></script>
  </body>
</html>