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Yang R, Yuan J, Chen X, Xie X, Ye Z, Qin C. Vessel wall magnetic resonance imaging of symptomatic middle cerebral artery atherosclerosis: A systematic review and meta-analysis. Clin Imaging 2022; 90:90-96. [DOI: 10.1016/j.clinimag.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/18/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
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Sakai Y, Lehman VT, Eisenmenger LB, Obusez EC, Kharal GA, Xiao J, Wang GJ, Fan Z, Cucchiara BL, Song JW. Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review. Front Neurol 2022; 13:968390. [PMID: 35968273 PMCID: PMC9366886 DOI: 10.3389/fneur.2022.968390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Despite advancements in multi-modal imaging techniques, a substantial portion of ischemic stroke patients today remain without a diagnosed etiology after conventional workup. Based on existing diagnostic criteria, these ischemic stroke patients are subcategorized into having cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS). There is growing evidence that in these patients, non-cardiogenic embolic sources, in particular non-stenosing atherosclerotic plaque, may have significant contributory roles in their ischemic strokes. Recent advancements in vessel wall MRI (VW-MRI) have enabled imaging of vessel walls beyond the degree of luminal stenosis, and allows further characterization of atherosclerotic plaque components. Using this imaging technique, we are able to identify potential imaging biomarkers of vulnerable atherosclerotic plaques such as intraplaque hemorrhage, lipid rich necrotic core, and thin or ruptured fibrous caps. This review focuses on the existing evidence on the advantages of utilizing VW-MRI in ischemic stroke patients to identify culprit plaques in key anatomical areas, namely the cervical carotid arteries, intracranial arteries, and the aortic arch. For each anatomical area, the literature on potential imaging biomarkers of vulnerable plaques on VW-MRI as well as the VW-MRI literature in ESUS and CS patients are reviewed. Future directions on further elucidating ESUS and CS by the use of VW-MRI as well as exciting emerging techniques are reviewed.
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Affiliation(s)
- Yu Sakai
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Vance T. Lehman
- Department of Radiology, The Mayo Clinic, Rochester, MN, United States
| | - Laura B. Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | | | - G. Abbas Kharal
- Department of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland, OH, United States
| | - Jiayu Xiao
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Grace J. Wang
- Department of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Zhaoyang Fan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Brett L. Cucchiara
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Jae W. Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Jae W. Song
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Lin X, Guo W, She D, Wang F, Xing Z, Cao D. Follow-up assessment of atherosclerotic plaques in acute ischemic stroke patients using high-resolution vessel wall MR imaging. Neuroradiology 2022; 64:2257-2266. [PMID: 35767010 DOI: 10.1007/s00234-022-03002-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Data on evolution of intracranial plaques in acute ischemic stroke patients after receiving medical therapy is still limited. We aimed to investigate the plaque features associated with culprit lesions and to explore the plaque longitudinal changes during treatment using high-resolution vessel wall MR imaging (VW-MRI). METHODS Twenty-three patients (16 men; mean age, 51.4 years ± 11.1) with acute ischemic stroke underwent 3-T VW-MRI for intracranial atherosclerosis and were taken follow-up assessments. Each identified plaque was retrospectively classified as culprit, probably culprit, or nonculprit. Plaque features were analyzed at both baseline and follow-up and were compared using paired t-test, paired Wilcoxon test, or McNemar's test. RESULTS A total of 87 intracranial plaques were identified (23 [26.4%] culprit, 10 [11.5%] probably culprit, and 54 [62.1%] nonculprit plaques). The median time interval between initial and follow-up MRI scans was 8.0 months. In the multiple ordinal logistic regression analysis, plaque contrast ratio (CR) (OR, 1.037; 95% CI, 1.013-1.062; P = 0.002) and surface irregularity (OR, 4.768; 95% CI, 1.064-21.349; P = 0.041) were independently associated with culprit plaques. During follow-up, plaque length, maximum thickness, normalized wall index (NWI), stenosis degree, and CR significantly decreased (all P-values < 0.05) in the culprit plaque group. The plaque NWI and CR dropped in the probably culprit plaques (P = 0.041, 0.026, respectively). In the nonculprit plaque group, only plaque NWI and stenosis degree showed significant decrement (P = 0.017, 0.037, respectively). CONCLUSION Follow-up VW-MRI may contribute to plaque risk stratification and may provide valuable insights into the evolution of different plaques in vivo.
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Affiliation(s)
- Xuehua Lin
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
| | - Wei Guo
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
| | - Dejun She
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
| | - Feng Wang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
| | - Zhen Xing
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
| | - Dairong Cao
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China. .,Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian, China. .,Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian, China.
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Jiang H, Ren K, Li T, Qian C, Gong S, Wang T, Zhu L. Correlation of the characteristics of symptomatic intracranial atherosclerotic plaques with stroke types and risk of stroke recurrence: a cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:658. [PMID: 35845483 PMCID: PMC9279796 DOI: 10.21037/atm-22-2586] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
Background Symptomatic intracranial atherosclerotic stenosis (sICAS) patients had a higher risk of stroke recurrence, and the risk of acute ischemic stroke (AIS) was higher than transient ischemic attack (TIA). Therefore, it is important to explore the risk factors associated with sICAS clinical subtypes and the risk of stroke recurrence. The purpose of this study was to investigate the association between intracranial arterial culprit plaque characteristics with sICAS clinical subtypes and the risk of stroke recurrence. Methods A total of 206 patients with sICAS were included. Baseline demographic data and relevant serologic indices were collected from all participants. All participants were assessed by high-resolution vessel wall imaging (HR-VWI) for culprit vessel and culprit plaque characteristics. The follow-up method was outpatient or telephone follow-up. Associated factors for sICAS clinical subtypes were analyzed by binary logistic regression. Cox proportional hazard regression analysis were used to analysis the independent risk factors for recurrent stroke. Results In this group, there were 154 patients with AIS, 52 patients with TIA, 124 patients with anterior circulation ischemic symptom (ACiS), and 82 patients with posterior circulation ischemic symptom (PCiS). Male gender [odds ratio (OR) =5.575, 95% confidence interval (CI): 2.120 to 14.658], history of previous statin use (OR =0.309, 95% CI: 0.113 to 0.843) and serum apolipoprotein A/B values (OR =0.363, 95% CI: 0.139 to 0.948) were associated factors for AIS. A total of 24 patients (11.7%) experienced stroke recurrence during the 1-year follow-up period. Hyperintensity on T1 weighted imaging (T1WI) in the culprit plaque [hazard ratio (HR) =3.798, 95% CI: 1.433 to 10.062] was an independent risk factor for stroke recurrence. The incidence of significant enhancement (62.2% vs. 39.5%, χ2=9.681, P=0.002), positive remodeling (69.5% vs. 52.4%, χ2=5.661, P=0.020), and hyperintensity on T1WI (42.7% vs. 22.6%, χ2=16.472, P=0.003) was higher in the posterior circulation than in the anterior circulation. Conclusions The characteristics of intracranial arterial culprit plaques were independent risk factors for recurrent stroke, and there were differences in the plaque characteristics of anterior and posterior circulation. Early HR-VWI examination for sICAS patients is of great significance for patient risk stratification and personalized management.
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Affiliation(s)
- Huayun Jiang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Kaixuan Ren
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Tiantian Li
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Chengqun Qian
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Shenchu Gong
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Tianle Wang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Li Zhu
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, China
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Li F, Wang Y, Hu T, Wu Y. Application and interpretation of vessel wall magnetic resonance imaging for intracranial atherosclerosis: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:714. [PMID: 35845481 PMCID: PMC9279807 DOI: 10.21037/atm-22-2364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective Atherosclerosis is a systemic disease that occurs in the arteries, and it is the most important causative factor of ischemic stroke. Vessel wall magnetic resonance imaging (VWMRI) is one of the best non-invasive methods for displaying the vascular features of intracranial atherosclerosis. The main clinical applications of this technique include the exploration of the pathogenesis of intracranial atherosclerotic lesions, follow-up monitoring, and treatment prognosis judgment. As the demand for intracranial VWMRI increases in clinical practice, radiologists should be aware of the selection of imaging parameters and how they affect image quality, clinical indications, evaluation methods, and limitations in interpreting these images. Therefore, this review focused on describing how to perform and interpret VWMRI of intracranial atherosclerotic lesions. Methods We searched the studies on the application of VWMRI in the PubMed database from January 1, 2000 to March 31, 2022, and focused on the analysis of related studies on VWMRI in atherosclerotic lesions, including technical application, expert consensus, imaging characteristics, and the clinical significance of intracranial atherosclerotic lesions. Key Content and Findings We reviewed and summarized recent advances in the clinical application of VWMRI in atherosclerotic diseases. Currently accepted principles and expert consensus recommendations for intracranial VWMRI include high spatial resolution, multiplanar two and three-dimensional imaging, multiple tissue-weighted sequences, and blood and cerebrospinal fluid suppression. Understanding the characteristics of VWMRI of normal intracranial arteries is the basis for interpreting VWMRI of atherosclerotic lesions. Evaluating VWMRI imaging features of intracranial atherosclerotic lesions includes plaque morphological and enhancement characteristics. The evaluation of atherosclerotic plaque stability is the highlight of VWMRI. Conclusions VWMRI has a wide range of clinical applications and can address important clinical questions and provide critical information for treatment decisions. VWMRI plays a key role in the comprehensive evaluation and prevention of intracranial atherosclerosis. However, intracranial VWMRI is still unable to obtain in vivo plaque pathological specimens for imaging—pathological comparison is the most significant limitation of this technique. Further technical improvements are expected to reduce acquisition time and may ultimately contribute to a better understanding of the underlying pathology of lesions on VWMRI.
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Affiliation(s)
- Fangbing Li
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Yilin Wang
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Tianxiang Hu
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Yejun Wu
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Symptomatic plaque enhancement is associated with early-onset post-stroke depression. J Affect Disord 2022; 306:281-287. [PMID: 35337924 DOI: 10.1016/j.jad.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The association between imaging features closely associated with symptomatic intracranial atherosclerotic plaques and early-onset post-stroke depression (PSD) is currently unclear. MATERIALS AND METHODS 76 ischemic stroke patients who underwent high-resolution vessel wall magnetic resonance imaging (HR-VWI) were divided into PSD and non-PSD groups according to their DSM-V diagnoses and HAMD-17 scores at 14 days after onset. Clinical data and the imaging features associated with symptomatic plaques (including the enhancement index (EI), remodeling index, and plaque surface irregularity) were compared between groups. Multifactorial logistic regression analysis was used to find independent predictors of early-onset PSD. Spearman rank correlation analysis explores the association between clinical data, symptomatic plaque imaging features, and HAMD-17 in patients. RESULTS The sample comprised 36 patients with early-onset PSD. The symptomatic plaque EI and infarct volume were significantly higher in depressed patients than in patients without depression (P < 0.05). Multivariate logistic regression showed that symptomatic plaque EI could be used as an independent predictor of early-onset PSD after correcting for the confounding factor of infarct volume (OR = 1.034, 95% CI:1.014-1.055, P = 0.001). In the total sample, symptomatic plaque EI, infarct volume, and HAMD-17 had a significant positive correlation with each other (P < 0.05). LIMITATIONS This study focused only on the patients' symptomatic plaques and did not monitor patients' systemic inflammation levels at the time of HR-VWI. CONCLUSIONS The degree of symptomatic plaque enhancement is an independent predictive imaging marker of early-onset PSD and can be used the early diagnosis of early-onset PSD.
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Li L, Tang M, Yan X, Gao J, Ma N, Shi X, Niu Y, Wen Y, Ai K, Lei X, Zhang X. Plaque Characteristics in Young Adults With Symptomatic Intracranial Atherosclerotic Stenosis: A Preliminary Study. Front Neurol 2022; 13:825503. [PMID: 35222253 PMCID: PMC8868124 DOI: 10.3389/fneur.2022.825503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine how intracranial vascular wall and atherosclerosis plaque characteristics differ between young and old adults with sICAS. Methods Eighty-four consecutive patients with sICAS who underwent high-resolution magnetic resonance imaging (HRMRI) from December 2017 to July 2020 were retrospectively collected. These participants were divided into young adult group (18–50 years, n = 28) and old adult group (>50 years, n = 56). Reviewers were blinded to any clinical information and HRMRI scans were analyzed for qualitative and quantitative indicators of vascular walls and plaque at the maximal lumen narrowing site using the independent-sample t-test, Mann–Whitney U-test, chi-square test or Fisher exact test, and logistic regression analysis. Results Young patients with sICAS had significantly smaller maximum wall thickness (1.45 ± 0.38 vs.1.75 ± 0.51 mm2, P = 0.003), higher prevalence of positive remodeling (53.57 vs. 21.43%, P = 0.003), and lower prevalence of diabetes mellitus (14.29 vs. 35.71%, P = 0.04) than old patients. Plaque burden and other plaque features were comparable between young and old patients. Conclusion Young patients with sICAS have smaller maximum wall thickness and greater ability to reconstruct, and are more likely to show positive remodeling, which may lead to some atherosclerotic lesions being missed. Young patients with evidence of vessel narrowing should be carefully examined for presence of high-risk atherosclerotic plaque.
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Affiliation(s)
- Ling Li
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Min Tang
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xuejiao Yan
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Jie Gao
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Niane Ma
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaorui Shi
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yaxin Niu
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yu Wen
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Kai Ai
- Philips Healthcare, Xi'an, China
| | - Xiaoyan Lei
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
- *Correspondence: Xiaoyan Lei
| | - Xiaoling Zhang
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
- Xiaoling Zhang
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Xiao J, Song SS, Schlick KH, Xia S, Jiang T, Han T, Jackson RJ, Diniz MA, Dumitrascu OM, Maya MM, Lyden PD, Li D, Yang Q, Fan Z. Disparate trends of atherosclerotic plaque evolution in stroke patients under 18-month follow-up: a 3D whole-brain magnetic resonance vessel wall imaging study. Neuroradiol J 2022; 35:42-52. [PMID: 34159814 PMCID: PMC8826292 DOI: 10.1177/19714009211026920] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The trend of atherosclerotic plaque feature evolution is unclear in stroke patients with and without recurrence. We aimed to use three-dimensional whole-brain magnetic resonance vessel wall imaging to quantify the morphological changes of causative lesions during medical therapy in patients with symptomatic intracranial atherosclerotic disease. METHODS Patients with acute ischemic stroke attributed to intracranial atherosclerotic disease were retrospectively enrolled if they underwent both baseline and follow-up magnetic resonance vessel wall imaging. The morphological features of the causative plaque, including plaque volume, peak normalized wall index, maximum wall thickness, degree of stenosis, pre-contrast plaque-wall contrast ratio, and post-contrast plaque enhancement ratio, were quantified and compared between the non-recurrent and recurrent groups (defined as the recurrence of a vascular event within 18 months of stroke). RESULTS Twenty-nine patients were included in the final analysis. No significant differences were found in plaque features in the baseline scan between the non-recurrent (n = 22) and recurrent groups (n = 7). The changes in maximum wall thickness (-13.32% vs. 8.93%, P = 0.026), plaque-wall contrast ratio (-0.82% vs. 3.42%, P = 0.005) and plaque enhancement ratio (-11.03% vs. 9.75%, P = 0.019) were significantly different between the non-recurrent and recurrent groups. Univariable logistic regression showed that the increase in plaque-wall contrast ratio (odds ratio 3.22, 95% confidence interval 1.55-9.98, P = 0.003) was related to stroke recurrence. CONCLUSION Morphological changes of plaque features on magnetic resonance vessel wall imaging demonstrated distinct trends in symptomatic intracranial atherosclerotic disease patients with and without stroke recurrence.
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Affiliation(s)
- Jiayu Xiao
- Biomedical Imaging Research
Institute, Cedars-Sinai Medical Center, USA
| | - Shlee S Song
- Department of Neurology,
Cedars-Sinai Medical Center, USA
| | | | - Shuang Xia
- Department of Radiology, Tianjin
First Central Hospital, China
| | - Tao Jiang
- Department of Radiology, Beijing
Chaoyang Hospital, China
| | - Tong Han
- Department of Radiology, Tianjin
Huanhu Hospital, China
| | | | - Marcio A Diniz
- Biostatistics and Bioinformatics
Research Center, Cedars-Sinai Medical Center, USA
| | | | - Marcel M Maya
- Department of Imaging, Cedars-Sinai
Medical Center, USA
| | - Patrick D Lyden
- Department of Physiology and
Neuroscience, Zilkha Neurogenetic Institute, University of Southern California,
USA
| | - Debiao Li
- Biomedical Imaging Research
Institute, Cedars-Sinai Medical Center, USA,Department of Bioengineering,
University of California, Los Angeles, USA
| | - Qi Yang
- Department of Radiology, Beijing
Chaoyang Hospital, China
| | - Zhaoyang Fan
- Biomedical Imaging Research
Institute, Cedars-Sinai Medical Center, USA,Departments of Radiology and
Radiation Oncology, University of Southern California, USA,Zhaoyang Fan, 2250 Alcazar Street, Room
104, Los Angeles, CA, USA.
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Evaluation of intracranial artery stenosis using time-of-flight magnetic resonance angiography: new wine in an old bottle. Eur Radiol 2022; 32:3670-3671. [PMID: 35076760 DOI: 10.1007/s00330-021-08521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Abstract
KEY POINTS • TOF MRA is very important in the evaluation of cerebrovascular stenosis, and a novel evaluation system can further enhance its strengths.• This evaluation system is more accurate based on the fact that cerebral vascular stenosis alters hemodynamics and leads to different imaging presentations.
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Mazzacane F, Mazzoleni V, Scola E, Mancini S, Lombardo I, Busto G, Rognone E, Pichiecchio A, Padovani A, Morotti A, Fainardi E. Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases. Diagnostics (Basel) 2022; 12:diagnostics12020258. [PMID: 35204348 PMCID: PMC8871392 DOI: 10.3390/diagnostics12020258] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict outcome and guide therapeutic decisions. The diagnosis of pathological processes involving intracranial arteries is especially challenging, and the visualization of intracranial arteries’ vessel walls is not possible with routine imaging techniques. Vessel wall magnetic resonance imaging (VW-MRI) uses high-resolution, multiparametric MRI sequences to directly visualize intracranial arteries walls and their pathological alterations, allowing a better characterization of their pathology. VW-MRI demonstrated a wide range of clinical applications in acute cerebrovascular disease. Above all, it can be of great utility in the differential diagnosis of atherosclerotic and non-atherosclerotic intracranial vasculopathies. Additionally, it can be useful in the risk stratification of intracranial atherosclerotic lesions and to assess the risk of rupture of intracranial aneurysms. Recent advances in MRI technology made it more available, but larger studies are still needed to maximize its use in daily clinical practice.
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Affiliation(s)
- Federico Mazzacane
- Department of Emergency Neurology and Stroke Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Valentina Mazzoleni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (V.M.); (A.P.)
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Elisa Scola
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Sara Mancini
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Ivano Lombardo
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Elisa Rognone
- Department of Neuroradiology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
- Department of Neuroradiology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (V.M.); (A.P.)
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50121 Florence, Italy
- Correspondence:
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Zhai SJ, Jia L, Kukun HJ, Wang YL, Wang H, Ding S, Jia WX. Predictive power of high-resolution vessel wall magnetic resonance imaging in ischemic stroke. Am J Transl Res 2022; 14:664-671. [PMID: 35173884 PMCID: PMC8829603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Intracranial atherosclerotic disease (ICAD) is a key contributor to ischemic stroke and has a high recurrence rate. This study aimed to investigate the function of high-resolution vessel wall MRI (HR-VW-MRI) and evaluate plaque characteristics in patients with ICAD. METHODS A consecutive series of patients with ICAD who underwent HR-VW-MRI were enrolled, and imaging measurements were acquired. Baseline clinical characteristics were identified. Telephone follow-up was conducted every three months. The endpoint events were the first onset or recurrence of ischemic stroke and new clinical vascular events. Patients were divided into groups with or without events according to whether the endpoint event occurred. RESULTS A total of 70 patients (mean age = 57.6 years old) were enrolled. The median follow-up duration was 182 days. During the follow-up, 10 patients developed ischemic stroke, experienced endpoint events, and were found with 44 plaques in the artery area. A total of 169 plaques were further found in 70 patients. There were significant differences in EI, HST1, surface features, and WA reference between the two groups (P < 0.05). Logistic analysis showed that grade 2 enhancements, stenosis degree ≥ 50%, HST1, and surface features were independent prognostic factors of the onset of stroke, caused by ICAD. CONCLUSION This prospective study demonstrates that HR-VW-MRI can identify atherosclerotic plaques in the cerebral artery and high-risk plaques, which may contribute to the prevention of ICAD and guide clinical treatment.
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Affiliation(s)
- Shu-Jia Zhai
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Lin Jia
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Han-Jiaerbieke Kukun
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Yun-Ling Wang
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Hong Wang
- Department of Radiology, The Second Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830063, China
| | - Shuang Ding
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Wen-Xiao Jia
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
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62
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Kim SJ, Schneider DJ, Feldmann E, Liebeskind DS. Intracranial atherosclerosis: Review of imaging features and advances in diagnostics. Int J Stroke 2022; 17:599-607. [PMID: 34983259 DOI: 10.1177/17474930211066427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intracranial atherosclerotic disease is one of the leading causes of ischemic strokes and poses a moderate risk of recurrence. Diagnosis is currently limited to stenosis on luminal imaging, which likely underestimates the true prevalence of the disease. Detection of non-stenosing intracranial atherosclerosis is important in order to optimize secondary stroke prevention strategies. This review collates findings from the early seminal trials and the latest studies in advanced radiological techniques that characterize symptomatic intracranial atherosclerotic disease across various imaging modalities. While computed tomography angiography (CTA) and magnetic resonance angiography (MRA) comprise diagnostic mainstays in identifying stenotic changes secondary to atherosclerosis, emerging techniques such as high-resolution MRA, quantitative MRA, and computational fluid dynamics may reveal a myriad of other underlying pathophysiological mechanisms.
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Affiliation(s)
- Song J Kim
- Vascular Neurology and Neurocritical Care, Sutter Health Comprehensive Stroke Care Center, San Francisco, CA, USA
| | - David J Schneider
- Cardiovascular Research Institute of Vermont, The University of Vermont, Colchester, VT, USA
| | - Edward Feldmann
- Neurosciences and Rehabilitation, Baystate Health, Springfield, MA, USA
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, CA, USA
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63
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Xiao J, Padrick MM, Song SS, Fan Z, Schlick KH. Case Report: Serial MR Vessel Wall Imaging Visualizes the Response of Intracranial Plaques and Assists in Decision-Making. Front Neurosci 2021; 15:739178. [PMID: 34744611 PMCID: PMC8564011 DOI: 10.3389/fnins.2021.739178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022] Open
Abstract
Intracranial atherosclerotic disease (ICAD) is a dynamic process that leads to ischemic stroke. Symptomatic ICAD patients still suffer a high recurrent rate even under standard treatment. In this case report, to better understand the response of intracranial atherosclerotic plaques to medication, serial MR imaging was added to standard clinical workup in a 47-year-old male patient with acute occipital lobe infarction at baseline, 3-month, 6-month, and 12-month post index stroke to directly visualize the morphology and signal change of plaques. We noticed that one of the plaques showed dramatic worsening at 3-month imaging follow-up despite a decrease in low-density lipoprotein level. Early identification of patients who do not respond well to medication is critical to prevent the recurrence of cardiovascular events in ICAD patients.
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Affiliation(s)
- Jiayu Xiao
- Departments of Radiology, Keck School of Medicine of USC, Los Angeles, CA, United States.,Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Matthew M Padrick
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zhaoyang Fan
- Departments of Radiology, Keck School of Medicine of USC, Los Angeles, CA, United States.,Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Departments of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Konrad H Schlick
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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64
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Mattay RR, Saucedo JF, Lehman VT, Xiao J, Obusez EC, Raymond SB, Fan Z, Song JW. Current Clinical Applications of Intracranial Vessel Wall MR Imaging. Semin Ultrasound CT MR 2021; 42:463-473. [PMID: 34537115 DOI: 10.1053/j.sult.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Intracranial vessel wall MR imaging (VWI) is increasingly being used as a valuable adjunct to conventional angiographic imaging techniques. This article will provide an updated review on intracranial VWI protocols and image interpretation. We review VWI technical considerations, describe common VWI imaging features of different intracranial vasculopathies and show illustrative cases. We review the role of VWI for differentiating among steno-occlusive vasculopathies, such as intracranial atherosclerotic plaque, dissections and Moyamoya disease. We also highlight how VWI may be used for the diagnostic work-up and surveillance of patients with vasculitis of the central nervous system and cerebral aneurysms.
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Affiliation(s)
- Raghav R Mattay
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jose F Saucedo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Jiayu Xiao
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Scott B Raymond
- Department of Radiology, University of Vermont Medical Center, Burlington, VT
| | - Zhaoyang Fan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.
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65
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MURAOKA S, TAOKA T, KAWAI H, OKAMOTO S, UDA K, NAGANAWA S, ARAKI Y. Changes in Vessel Wall Enhancement Related to the Recent Neurological Symptoms in Patients with Moyamoya Disease. Neurol Med Chir (Tokyo) 2021; 61:515-520. [PMID: 34078772 PMCID: PMC8443970 DOI: 10.2176/nmc.oa.2021-0058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/22/2021] [Indexed: 11/20/2022] Open
Abstract
Moyamoya disease (MMD) causes intracranial arterial stenosis progression. The progression of intracranial arterial stenosis will increase the risk of ischemic cerebrovascular events. This study aims to investigate the relationship between intracranial arterial stenosis progression, vessel wall enhancement (VWE), and the recent neurological symptoms. A total of 39 MMD patients (12 male; 37.6 ± 18.0 years old) were registered in this study analysis between April 2016 and July 2018. All patients received MRI at registration and 6, 12, and 24 months post-registration. The incidence of ischemic cerebrovascular events (transit ischemic attacks or cerebral infarction) was checked until December 2018. We evaluated the relationship between the intensity of VWE, intracranial arterial stenosis, and the recent neurological symptoms. During the mean follow-up period of 13.8 ± 5.5 months, the changes in VWE were observed in 33 hemispheres (42.3%), stenosis progression was observed in 21 hemispheres (26.9%), and recent neurological symptoms occurred in 10 hemispheres (12.8%). Stenosis progression was observed in 11 hemispheres (33.3%) in the VWE(+) group and ten hemispheres (22.2%) in the VWE(-) group (p = 0.310). The recent neurological symptoms were observed in eight hemispheres (21.2%) in the VWE(+) group and two hemispheres (4.44%) in the VWE(-) group (odds ratio 6.88, 95% confidence interval 1.35-34.98, p = 0.015). The intensity of VWE sometimes changes. The changes in VWE were significantly associated with the recent neurological symptoms but not with stenosis progression.
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Affiliation(s)
- Shinsuke MURAOKA
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshiaki TAOKA
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hisashi KAWAI
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sho OKAMOTO
- Department of Neurosurgery, Aichi Rehabilitation Hospital, Nishio, Aichi, Japan
| | - Kenji UDA
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji NAGANAWA
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio ARAKI
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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66
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Zhou H, Xiao J, Fan Z, Ruan D. INTRACRANIAL VESSEL WALL SEGMENTATION FOR ATHEROSCLEROTIC PLAQUE QUANTIFICATION. PROCEEDINGS. IEEE INTERNATIONAL SYMPOSIUM ON BIOMEDICAL IMAGING 2021; 2021:1416-1419. [PMID: 34405036 DOI: 10.1109/isbi48211.2021.9434018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intracranial vessel wall segmentation is critical for the quantitative assessment of intracranial atherosclerosis based on magnetic resonance vessel wall imaging. This work further improves on a previous 2D deep learning segmentation network by the utilization of 1) a 2.5D structure to balance network complexity and regularizing geometry continuity; 2) a UNET++ model to achieve structure adaptation; 3) an additional approximated Hausdorff distance (HD) loss into the objective to enhance geometry conformality; and 4) landing in a commonly used morphological measure of plaque burden - the normalized wall index (NWI) - to match the clinical endpoint. The modified network achieved Dice similarity coefficient of 0.9172 ± 0.0598 and 0.7833 ± 0.0867, HD of 0.3252 ± 0.5071 mm and 0.4914 ± 0.5743 mm, mean surface distance of 0.0940 ± 0.0781 mm and 0.1408 ± 0.0917 mm for the lumen and vessel wall, respectively. These results compare favorably to those obtained by the original 2D UNET on all segmentation metrics. Additionally, the proposed segmentation network reduced the mean absolute error in NWI from 0.0732 ± 0.0294 to 0.0725 ± 0.0333.
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Affiliation(s)
- Hanyue Zhou
- Department of Bioengineering, University of California, Los Angeles, CA 90095, US
| | - Jiayu Xiao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, US
| | - Zhaoyang Fan
- Department of Bioengineering, University of California, Los Angeles, CA 90095, US.,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, US.,Department of Radiology, University of Southern California, Los Angeles, CA 90033, US
| | - Dan Ruan
- Department of Bioengineering, University of California, Los Angeles, CA 90095, US.,Department of Radiation Oncology, University of California, Los Angeles, CA 90095, US
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67
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Arnett N, Pavlou A, Burke MP, Cucchiara BL, Rhee RL, Song JW. Vessel wall MR imaging of central nervous system vasculitis: a systematic review. Neuroradiology 2021; 64:43-58. [PMID: 33938989 DOI: 10.1007/s00234-021-02724-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Beyond vessel wall enhancement, little is understood about vessel wall MR imaging (VW-MRI) features of vasculitis affecting the central nervous system (CNS). We reviewed vessel wall MR imaging patterns of inflammatory versus infectious vasculitis and also compared imaging patterns for intracranial versus extracranial arteries of the head and neck. METHODS Studies reporting vasculitis of the CNS/head and neck and included MR imaging descriptions of vessel wall features were identified by searching PubMed, Scopus, Cochrane, Web of Science, and EMBASE up to June 10, 2020. From 6065 publications, 115 met the inclusion criteria. Data on study characteristics, vasculitis type, MR details, and VW-MRI descriptions were extracted. RESULTS Studies used VW-MRI for inflammatory (64%), infectious (17%), or both inflammatory and infectious vasculitides (19%). Vasculitis affecting intracranial versus extracranial arteries were reported in 58% and 39% of studies, respectively. Commonly reported VW-MRI features were vessel wall enhancement (89%), thickening (72%), edema (10%), and perivascular enhancement (16%). Inflammatory vasculitides affecting the intracranial arteries were less frequently reported to have vessel wall thickening (p = 0.006) and perivascular enhancement (p = 0.001) than extracranial arteries. Varicella zoster/herpes simplex vasculitis (VZV/HSV, 45%) and primary angiitis of the CNS (PACNS, 22%) were the most commonly reported CNS infectious and inflammatory vasculitides, respectively. Patients with VZV/HSV vasculitis more frequently showed decreased or resolution of vessel wall enhancement after therapy compared to PACNS (89% versus 59%). CONCLUSIONS To establish imaging biomarkers of vessel wall inflammation in the CNS, VW-MRI features of vasculitis accounting for disease mechanism and anatomy should be better understood.
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Affiliation(s)
- Nathan Arnett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Athanasios Pavlou
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Morgan P Burke
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Brett L Cucchiara
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rennie L Rhee
- Department of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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