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Vyas KS, Suchyta MA, Hunt CH, Gibreel W, Mardini S. Black Bone MRI for Virtual Surgical Planning in Craniomaxillofacial Surgery. Semin Plast Surg 2022; 36:192-198. [PMID: 36506277 PMCID: PMC9729059 DOI: 10.1055/s-0042-1756451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Advances in computer-aided design and computer-aided manufacturing software have improved translational applications of virtual surgical planning (VSP) in craniomaxillofacial surgery, allowing for precise and accurate fabrication of cutting guides, stereolithographic models, and custom implants. High-resolution computed tomography (CT) imaging has traditionally been the gold standard imaging modality for VSP in craniomaxillofacial surgery but delivers ionizing radiation. Black bone magnetic resonance imaging (MRI) reduces the risks related to radiation exposure and has comparable functionality when compared with CT for VSP. Our group has studied the accuracy of utilizing black bone MRI in planning and executing several types of craniofacial surgeries, including cranial vault remodeling, maxillary advancement, and mandibular reconstruction using fibular bone. Here, we review clinical applications of black bone MRI pertaining to VSP and three-dimensional (3D)-printed guide creation for craniomaxillofacial surgery. Herein, we review the existing literature and our institutional experience comparing black bone MRI and CT in VSP-generated 3D model creation in cadaveric craniofacial surgeries including cranial vault reconstruction, maxillary advancement, and mandibular reconstruction with fibular free flap. Cadaver studies have demonstrated the ability to perform VSP and execute the procedure based on black bone MRI data and achieve outcomes similar to CT when performed for cranial vault reshaping, maxillary advancement, and mandibular reconstruction with free fibula. Limitations of the technology include increased time and costs of the MRI compared with CT and the possible need for general anesthesia or sedation in the pediatric population. VSP and 3D surgical guide creation can be performed using black bone MRI with comparable accuracy to high-resolution CT scans in a wide variety of craniofacial reconstructions. Successful segmentation, VSP, and 3D printing of accurate guides from black bone MRI demonstrate potential to change the preoperative planning standard of care. Black bone MRI also reduces exposure to ionizing radiation, which is of particular concern for the pediatric population or patients undergoing multiple scans.
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Affiliation(s)
- Krishna S. Vyas
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Marissa A. Suchyta
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Waleed Gibreel
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Samir Mardini
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota,Department of Radiology, Mayo Clinic, Rochester, Minnesota,Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, Mayo Clinic, Rochester, Minnesota,Address for correspondence Samir Mardini, MD Division of Plastic Surgery, Department of Surgery, Essam and Dalal Obaid Center for Reconstructive Transplant SurgeryMayo Clinic, MA12-44W, 200 First Street SouthwestRochester, MN 55905
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Wiesinger F, Ho ML. Zero-TE MRI: principles and applications in the head and neck. Br J Radiol 2022; 95:20220059. [PMID: 35616709 PMCID: PMC10162052 DOI: 10.1259/bjr.20220059] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Zero echo-time (ZTE) MRI is a novel imaging technique that utilizes ultrafast readouts to capture signal from short-T2 tissues. Additional sequence advantages include rapid imaging times, silent scanning, and artifact resistance. A robust application of this technology is imaging of cortical bone without the use of ionizing radiation, thus representing a viable alternative to CT for both rapid screening and "one-stop-shop" MRI. Although ZTE is increasingly used in musculoskeletal and body imaging, neuroimaging applications have historically been limited by complex anatomy and pathology. In this article, we review the imaging physics of ZTE including pulse sequence options, practical limitations, and image reconstruction. We then discuss optimization of settings for ZTE bone neuroimaging including acquisition, processing, segmentation, synthetic CT generation, and artifacts. Finally, we examine clinical utility of ZTE in the head and neck with imaging examples including malformations, trauma, tumors, and interventional procedures.
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Affiliation(s)
- Florian Wiesinger
- Department for Neuroimaging, Institute of Psychiatry & Neuroscience, King's College London, London, UK.,Principal Scientist at GE Healthcare, Munich, Germany
| | - Mai-Lan Ho
- Nationwide Children's Hospital and The Ohio State University, Columbus, USA
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Bartella AK, Hoshal SG, Lethaus B, Strong EB. Computer assisted skull base surgery: a contemporary review. Innov Surg Sci 2022. [DOI: 10.1515/iss-2021-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Skull base surgery has evolved significantly since Harvey Cushing‘s first descriptions in the early 1900s. Computer aided surgery (CAS) applications continue to expand; they include virtual surgical planning, augmented and virtual reality, 3D printing of models/cutting guides/implants, surgical navigation, and intraoperative imaging. The authors will review the current skull base CAS literature and propose a computer aided surgical workflow categorizing these applications into 3 phases: 1) Virtual planning, 2) Surgical execution, 3) Intraoperative verification.
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Affiliation(s)
| | - Steven G. Hoshal
- Department of Otolaryngology – Head and Neck Surgery , University of California, Davis , Sacramento , CA , USA
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery , Leipzig University Leipzig , Germany
| | - E. Bradley Strong
- Department of Otolaryngology – Head and Neck Surgery , University of California, Davis , Sacramento , CA , USA
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Preliminary experience with black bone magnetic resonance imaging for morphometry of the mandible and visualisation of the facial skeleton. Pediatr Radiol 2022; 52:951-958. [PMID: 35076727 DOI: 10.1007/s00247-021-05257-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/21/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Children with orofacial deformity may require repeated imaging of the facial skeleton. OBJECTIVE To test the feasibility and accuracy of "black bone" magnetic resonance imaging (MRI) for assessing facial deformity in children. MATERIALS AND METHODS Three-dimensional (3-D) black bone gradient echo sequences (flip angle 5°, submillimetre spatial resolution) from 10 children (median age: 13 years, range: 2-16 years), who underwent MRI of the temporomandibular joints, were evaluated with multiplanar reconstruction and 3-D rendering tools. Intra- and inter-reader agreement was investigated for measuring the height of the mandibular ramus and condyle, basal length of the mandible, gonion angle and mandibular inclination angle by intraclass correlation coefficient (ICC) and Bland-Altman analysis. Absolute percentage error was calculated with the average of all measurements serving as reference. RESULTS Sixty linear and 40 angle measurements were obtained on reformatted multiplanar black bone images with excellent inter-reader agreement (ICC > 0.99, agreement bias < 1.4 mm/ < 1.5°) and small error (median absolute error < 3%). The black bone images required inversion of the signal intensity and removal of air before they could be processed with standard volume rendering tools. The diagnostic utility of 3-D views for assessing the facial skeleton was sufficient except for assessing dental relationship. CONCLUSION Morphometric measurements of the mandible can be obtained from black bone MRI with comparable inter-rater agreement to that reported for cone beam computed tomography (CT). With improvements of 3-D rendering techniques and software, black bone MRI may become a radiation-free alternative to CT in children with facial deformities.
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Eley KA, Delso G. Imaging of Bone in the Head and Neck Region, is There More Than CT? CURRENT RADIOLOGY REPORTS 2022; 10:69-82. [PMID: 35463479 PMCID: PMC9013214 DOI: 10.1007/s40134-022-00396-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 01/22/2023]
Abstract
Purpose of Review The objective of this review is to document the advances in non-ionising imaging alternatives to CT for the head and neck. Recent Findings The main alternative to CT for imaging bone of the head and neck region is MRI, particularly techniques which incorporate gradient echo imaging (Black Bone technique) and ultra-short or zero-echo time imaging. Since these techniques can provide high resolution isometric voxels, they can be used to provide multi-planar reformats and, following post processing, 3D reconstructed images of the craniofacial skeleton. As expected, the greatest advancements in recent years have been focused on enhanced image processing techniques and attempts to address the difficulties encountered at air-bone interfaces. Summary This article will review the imaging techniques and recent advancements which are bringing non-ionising alternatives to CT imaging of the bone of the head and neck region into the realm of routine clinical application.
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Affiliation(s)
- Karen A. Eley
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ UK
| | - Gaspar Delso
- MR Applications & Workflow, GE Healthcare, Barcelona, Spain
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Magdum S, Ganau M, Syrmos N. Imaging in craniofacial disorders with special emphasis on gradient echo Black-Bone and Zero Time Echo MRI sequences. J Pediatr Neurosci 2022; 17:S14-S20. [PMID: 36388002 PMCID: PMC9648653 DOI: 10.4103/jpn.jpn_46_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
Context: The well-known effects of ionizing radiation on brain cells have been a major driving force toward the use of non-ionizing methods of imaging in both elective and emergency settings. Pediatric neurosurgery has certainly leveraged on this shift in clinical practice, however patients with craniofacial disorders could not fully benefit from the adoption of magnetic resonance imaging (MRI) because computed tomography (CT) scans still retain superior imaging power on bone tissue. Aims: To explore the knowledge available on the use of MRI as surrogate for CT scan in the assessment of craniosynostosis. Settings and Design: A scoping review was designed to identify landmark studies and ongoing clinical trials exploring the accuracy of MRI-based bone imaging in the preoperative planning of pediatric patients with craniosynostosis. Materials and Methods: A total of 492 records were screened from Pubmed, Ovid Medline, Scopus, and Cochrane Library databases; while 55 records were retrieved from ClinicalTrials.gov register. Only clinical studies revolving around the use of Gradient Echo Black-Bone (BB) and Zero Time Echo (ZTE) MRI sequences for the preoperative planning of pediatric craniosynostosis were retained for inclusion. Results and Conclusions: This review identified only five clinical studies reporting a high accuracy of MRI-based 3D bone reconstruction in 47 pediatric candidates to surgical correction of craniosynostosis. Although promising, limited evidence (Level IV) exist that BB and ZTE MRI could help in the surgical planning for craniosynostosis management. The results of two ongoing randomized clinical trials, which are actively enrolling patients, will hopefully help answering this research question.
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Cacciaguerra G, Palermo M, Marino L, Rapisarda FAS, Pavone P, Falsaperla R, Ruggieri M, Marino S. The Evolution of the Role of Imaging in the Diagnosis of Craniosynostosis: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8090727. [PMID: 34572159 PMCID: PMC8467503 DOI: 10.3390/children8090727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/15/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022]
Abstract
Craniosynostosis, the premature closure of cranial sutures, is one of the principal causes of pediatric skull deformities. It can cause aesthetic, neurological, acoustic, ophthalmological complications up to real emergencies. Craniosynostosis are primarily diagnosed with accurate physical examination, skull measurement and observation of the deformity, but the radiological support currently plays an increasingly important role in confirming a more precise diagnosis and better planning for therapeutic interventions. The clinician must know how to diagnose in the earliest and least invasive way for the child. In the past, technological limitations reduced the choices; today, however, there are plenty of choices and it is necessary to use the various types of available imaging correctly. In the future, imaging techniques will probably rewrite the common classifications we use today. We provide an updated review of the role of imaging in this condition, through the ages, to outline the correct choice for the clinician for an early and non-invasive diagnosis.
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Affiliation(s)
- Giovanni Cacciaguerra
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, University of Catania, 95125 Catania, Italy; (G.C.); (P.P.); (M.R.)
| | - Monica Palermo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95125 Catania, Italy;
| | - Lidia Marino
- Neonatal Intensive Care Unit, AOU “Policlinico”, PO “San Marco”, University of Catania, 95121 Catania, Italy; (L.M.); (R.F.)
| | | | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, University of Catania, 95125 Catania, Italy; (G.C.); (P.P.); (M.R.)
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit, AOU “Policlinico”, PO “San Marco”, University of Catania, 95121 Catania, Italy; (L.M.); (R.F.)
- Unit of Pediatrics and Pediatric Emergency, AOU “Policlinico”, PO “San Marco”, University of Catania, 95121 Catania, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, University of Catania, 95125 Catania, Italy; (G.C.); (P.P.); (M.R.)
| | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, AOU “Policlinico”, PO “San Marco”, University of Catania, 95121 Catania, Italy
- Correspondence: ; Tel.: +39-0954794046
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Probst FA, Burian E, Malenova Y, Lyutskanova P, Stumbaum MJ, Ritschl LM, Kronthaler S, Karampinos D, Probst M. Geometric accuracy of magnetic resonance imaging-derived virtual 3-dimensional bone surface models of the mandible in comparison to computed tomography and cone beam computed tomography: A porcine cadaver study. Clin Implant Dent Relat Res 2021; 23:779-788. [PMID: 34318580 DOI: 10.1111/cid.13033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Providing accurate 3-dimensional virtual bone surface models is a prerequisite for virtual surgical planning and additive manufacturing in craniomaxillofacial surgery. For this purpose, magnetic resonance imaging (MRI) may be a radiation-free alternative to computed tomography (CT) and cone beam computed tomography (CBCT). PURPOSE The aim of this study was to assess the geometric accuracy of 3-dimensional T1-weighted MRI-derived virtual bone surface models of the mandible in comparison to CT and CBCT. MATERIALS AND METHODS Specimens of the mandible from porcine cadavers were scanned with (1) a 3-dimensional T1-weighted MRI sequence (0.6 mm isotropic voxel) optimized for bone imaging, (2) CT, and (3) CBCT. Cortical mandibular structures (n = 10) were segmented using semiautomated and manual techniques. Imaging-based virtual 3-dimensional models were aligned with a high-resolution optical 3-dimensional surface scan of the dissected bone (=ground truth) and global geometric deviations were calculated (mean surface distance [MSD]/root-mean-square distance [RMSD]). Agreement between the imaging modalities was assessed by equivalence testing and Bland-Altman analysis. RESULTS Intra- and inter-rater agreement was on a high level for all modalities. Global geometric deviations (MSD/RMSD) between optical scans and imaging modalities were 0.225 ± 0.020 mm/0.345 ± 0.074 mm for CT, 0.280 ± 0.067 mm/0.371 ± 0.074 mm for MRI, and 0.352 ± 0.076 mm/0.454 ± 0.071 mm for CBCT. All imaging modalities were statistically equivalent within an equivalence margin of ±0.3 mm, and Bland-Altman analysis indicated high agreement as well. CONCLUSIONS The results of this study indicate that the accuracy and reliability of MRI-derived virtual 3-dimensional bone surface models is equal to CT and CBCT. MRI may be considered as a reliable alternative to CT and CBCT in computer-assisted craniomaxillofacial surgery.
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Affiliation(s)
- Florian Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU München, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU München, Munich, Germany
| | - Plamena Lyutskanova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU München, Munich, Germany
| | | | - Lucas Maximilian Ritschl
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sophia Kronthaler
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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García-Mato D, García-Sevilla M, Porras AR, Ochandiano S, Darriba-Allés JV, García-Leal R, Salmerón JI, Linguraru MG, Pascau J. Three-dimensional photography for intraoperative morphometric analysis in metopic craniosynostosis surgery. Int J Comput Assist Radiol Surg 2021; 16:277-287. [PMID: 33417161 DOI: 10.1007/s11548-020-02301-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgical correction of metopic craniosynostosis typically involves open cranial vault remodeling. Accurate translation of the virtual surgical plan into the operating room is challenging due to the lack of tools for intraoperative analysis of the surgical outcome. This study aimed to evaluate the feasibility of using a hand-held 3D photography device for intraoperative evaluation and guidance during cranial vault surgical reconstruction. METHODS A hand-held structured light scanner was used for intraoperative 3D photography during five craniosynostosis surgeries, obtaining 3D models of skin and bone surfaces before and after the remodeling. The accuracy of this device for 3D modeling and morphology quantification was evaluated using preoperative computed tomography imaging as gold-standard. In addition, the time required for intraoperative 3D photograph acquisition was measured. RESULTS The average error of intraoperative 3D photography was 0.30 mm. Moreover, the interfrontal angle and the transverse forehead width were accurately measured in the 3D photographs with an average error of 0.72 degrees and 0.62 mm. Surgeon's feedback indicates that this technology can be integrated into the surgical workflow without substantially increasing surgical time. CONCLUSION Hand-held 3D photography is an accurate technique for objective quantification of intraoperative cranial vault morphology and guidance during metopic craniosynostosis surgical reconstruction. This noninvasive technique does not substantially increase surgical time and does not require exposure to ionizing radiation, presenting a valuable alternative to computed tomography imaging. The proposed methodology can be integrated into the surgical workflow to assist during cranial vault remodeling and ensure optimal surgical outcomes.
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Affiliation(s)
- David García-Mato
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avenida de la Universidad 30, 28911, Leganés, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mónica García-Sevilla
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avenida de la Universidad 30, 28911, Leganés, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Antonio R Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Santiago Ochandiano
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan V Darriba-Allés
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Roberto García-Leal
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José I Salmerón
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Javier Pascau
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avenida de la Universidad 30, 28911, Leganés, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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