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Smith ER, Caton MT, Villanueva-Meyer JE, Remer J, Eisenmenger LB, Baker A, Shah VN, Tu-Chan A, Meisel K, Amans MR. Brain herniation (encephalocele) into arachnoid granulations: prevalence and association with pulsatile tinnitus and idiopathic intracranial hypertension. Neuroradiology 2022; 64:1747-1754. [PMID: 35333949 PMCID: PMC9365727 DOI: 10.1007/s00234-022-02934-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/16/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Brain herniation into arachnoid granulations (BHAG) of the dural venous sinuses is a recently described finding of uncertain etiology. The purpose of this study was to investigate the prevalence of BHAG in a cohort of patients with pulsatile tinnitus (PT) and to clarify the physiologic and clinical implications of these lesions. METHODS The imaging and charts of consecutive PT patients were retrospectively reviewed. All patients were examined with MRI including pre- and post-contrast T1- and T2-weighted sequences. Images were reviewed separately by three blinded neuroradiologists to identify the presence of BHAG. Their location, signal intensity, size, presence of arachnoid granulation, and associated dural venous sinus stenosis were documented. Clinical records were further reviewed for idiopathic intracranial hypertension, history of prior lumbar puncture, and opening pressure. RESULTS Two hundred sixty-two consecutive PT patients over a 4-year period met inclusion criteria. PT patients with BHAG were significantly more likely to have idiopathic intracranial hypertension than PT patients without BHAG (OR 4.2, CI 1.5-12, p = 0.006). Sixteen out of 262 (6%) patients were found to have 18 BHAG. Eleven out of 16 (69%) patients had unilateral temporal or occipital lobe herniations located in the transverse sinus or the transverse-sigmoid junction. Three out of 16 (19%) patients had unilateral cerebellar herniations and 2/16 (13%) patients had bilateral BHAG. CONCLUSION In patients with PT, BHAG is a prevalent MRI finding that is strongly associated with the clinical diagnosis of IIH. The pathogenesis of BHAG remains uncertain, but recognition should prompt comprehensive evaluation for IIH.
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Affiliation(s)
- Eric R Smith
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA
| | - M Travis Caton
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA
| | - Javier E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA
| | - Justin Remer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA
| | | | - Amanda Baker
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA
| | - Vinil N Shah
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA
| | - Adelyn Tu-Chan
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Karl Meisel
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA.
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Gozgec E, Ogul H, Izgi E, Kantarci M. Tissue damage in herniated brain parenchyma into giant arachnoid granulations: demonstration with high resolution MRI. Acta Radiol 2021; 62:799-806. [PMID: 32686459 DOI: 10.1177/0284185120941829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Brain herniation (BH) into arachnoid granulation has been remarkable in recent years. PURPOSE To evaluate the damage in herniated parenchyma into the giant arachnoid granulation (GAG) and to investigate the clinical-demographic importance of this damage. MATERIAL AND METHODS Patients with BH into GAG were retrospectively included in the study. Each of the patients had at least one high-resolution 3D magnetic resonance imaging (MRI) sequence. The arachnoid granulation dimensions, locations, and origin of herniated parenchyma were evaluated by two experienced radiologists. The demographic and symptomatic features of the patients were recorded from the hospital database. RESULTS A total of 27 patients (21 females, 6 males; age range 6-71 years; mean age 41.3 years) were found to contain BH into GAG. It was most commonly seen in the transverse sinus (67%); the origin was most common in the cerebellar parenchyma (56%). Abnormal signal and morphology were detected in herniated parenchyma in 11 (47%) patients, atrophy in six, and atrophy and gliosis in five. The most common complaints were headache (47%), while other frequent symptoms were vertigo (15%) and blurred vision (11%). There was a statistically significant positive correlation between frequency of damage in herniated brain parenchyma and the maximal size of GAG (P<0.05). CONCLUSION In patients with BH into GAG, parenchymal damage may be associated with various symptoms, such as headache and vertigo, although they have not been statistically proven. It is important to carefully evaluate hernia tissue, as the risk of tissue damage may increase in larger GAGs.
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Affiliation(s)
- Elif Gozgec
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
- Department of Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Emine Izgi
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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Encephalocele-Associated Drug-Resistant Epilepsy of Adult Onset: Diagnosis, Management, and Outcomes. World Neurosurg 2021; 151:91-101. [PMID: 33964498 DOI: 10.1016/j.wneu.2021.04.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/21/2022]
Abstract
Epileptogenic encephaloceles, most frequently located in the temporal lobe, are a known lesional cause of focal epilepsy. Data are limited regarding diagnosis, management, and outcomes of patients with epilepsy in the setting of an encephalocele, because the literature mostly comprises case reports, case series, and retrospective studies. We conducted a broad literature review for articles related to encephaloceles and epilepsy regardless of level of evidence. Hence, this review provides a summary of all available literature related to the topic. Thirty-six scientific reports that fulfilled our inclusion criteria were reviewed. Most reported patients presented with focal impaired awareness seizures and/or generalized tonic-clonic seizures. Although most of the encephaloceles were located in the temporal lobe, we found 5 cases of extratemporal encephaloceles causing epilepsy. More patients who underwent either lesionectomy or lobectomy were seizure free at time of follow-up. In the temporal lobe, there is no clear consensus on the appropriate management for epileptic encephaloceles and further studies are warranted to understand the associated factors and long-term outcomes associated with epilepsy secondary to encephaloceles. Reported data suggest that these patients could be manageable with surgical procedures including lesionectomy or lobectomy. In addition, because of data suggesting similar results between procedures, a more conservative surgery with lesionectomy and defect repair rather than a lobectomy may have lower surgical risks and similar seizure freedom.
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Waser B, Wood HM, Mews P, Lalloo S. Transverse sinus stenting for treatment of papilloedema secondary to a large brain herniation into a dural venous sinus with associated tectal plate lesion: Case report and literature review. Interv Neuroradiol 2021; 27:756-762. [PMID: 33779375 DOI: 10.1177/15910199211003451] [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: 11/16/2022] Open
Abstract
Brain herniation into a dural venous sinus is a rare entity of unknown clinical significance without a clear relationship to raised intracranial pressure. There are yet to be detailed reports of interventional neuroradiology procedures involving sinus stenting across brain herniations. The authors of this paper present the first case of a stent placed across a large brain herniation into the transverse sinus in a patient with a tectal plate lesion and features of chronically raised intracranial pressure. This case demonstrates objective resolution of papilloedema and venous sinus pressure gradient at six months without complication.
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Affiliation(s)
- Barton Waser
- Department of Neurosurgery, The Canberra Hospital, Australian Capital Territory, Australia
| | - Hannah M Wood
- Department of Neurosurgery, The Canberra Hospital, Australian Capital Territory, Australia
| | - Peter Mews
- Department of Neurosurgery, The Canberra Hospital, Australian Capital Territory, Australia.,Australian National University Medical School, Australian National University, Australian Capital Territory, Australia
| | - Shivendra Lalloo
- Medical Imaging, The Canberra Hospital, Australian Capital Territory, Australia
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Yadav T, Shaikh M, Panda S, Khera P. Temporal encephalocele into transverse sinus in an adult with partial seizures: MRI evaluation of a rare site of brain herniation. Indian J Radiol Imaging 2021; 30:517-520. [PMID: 33737785 PMCID: PMC7954164 DOI: 10.4103/ijri.ijri_503_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/09/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022] Open
Abstract
Herniation of brain parenchyma outside its normal enclosure (also known as encephalocele) has long been known to occur at certain classic sites and is classified accordingly. With widespread use of modern neuroimaging, the previously unknown atypical and rare sites of encephalocele have now been identified. Brain herniation into a dural venous sinus is one such recently described entity with case reports extending only upto the earlier part of this decade. With no definite clinical symptomatology, imaging is crucial to diagnose this lesion accurately and differentiate it from the more familiar entity in this region of the brain, the arachnoid granulations. Also known as occult encephalocele, focal brain herniation into dural venous sinus has few specific imaging features and characteristic sites. We report a case of a 21-year-old man with partial seizures in whom MRI of the brain revealed focal herniation of the normal temporal lobe parenchyma into the left transverse sinus and discuss the key imaging features and pathophysiology of this entity.
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Affiliation(s)
- Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Minhaj Shaikh
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Drocton GT, Copelan A, Eisenmenger L, Villanueva-Meyer JE, Dillon WP, Shah VN, Meisel K, Amans M. Venous sinus stenting as a treatment approach in patients with idiopathic intracranial hypertension and encephaloceles. Interv Neuroradiol 2020; 27:129-136. [PMID: 32954924 DOI: 10.1177/1591019920956860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stenosis of a dural venous sinus is the most common cause of idiopathic intracranial hypertension (IIH) and can be classified as either intrinsic or extrinsic. Intrinsic stenoses are characterized by a focal filling defect within the sinus secondary to an enlarged arachnoid granulation or fibrous septa while extrinsic stenoses tend to be long and smooth-tapered and are most commonly secondary to external compression from the adjacent brain parenchyma. Brain herniations, or encephaloceles, into arachnoid granulations in dural venous sinuses have rarely been reported in the literature in patients with IIH. We propose that dural venous sinus stenting (VSS) may be a safe and effective treatment approach in patients with an encephalocele and IIH. METHODS We retrospectively analyze three cases of patients with encephalocele who underwent VSS for treatment of medically refractory IIH at our institution. RESULTS One patient underwent stenting ipsilateral and two patients underwent stenting contralateral to the side of their encephaloceles. No technical related issues or complications occurred during either of the three stenting procedures. Two out of the three patients had complete resolution in their IIH-related symptoms and normalization of cerebrospinal (CSF) pressures shortly after stenting. We await clinical follow-up in the third patient. CONCLUSIONS Our results suggest that VSS is a technically feasible and effective approach in treating patients with medically refractory IIH and encephaloceles.
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Affiliation(s)
- Gerald T Drocton
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
| | - Alexander Copelan
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
| | - Laura Eisenmenger
- Radiology and Biomedical Imaging, UW Health University Hospital, Madison, WI, USA
| | | | - William P Dillon
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
| | - Vinil N Shah
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
| | - Karl Meisel
- Department of Neurology, UCSF Medical Center, San Francisco, CA, USA
| | - Matthew Amans
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
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Battal B. Letter to the Editor. Brain herniation with surrounding CSF into the skull. J Neurosurg 2018; 128:949-951. [DOI: 10.3171/2017.6.jns171237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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8
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Brain Herniation into Giant Arachnoid Granulation: An Unusual Case. Case Rep Radiol 2017; 2017:8532074. [PMID: 28392955 PMCID: PMC5368369 DOI: 10.1155/2017/8532074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/21/2017] [Accepted: 03/05/2017] [Indexed: 11/17/2022] Open
Abstract
Arachnoid granulations are structures filled with cerebrospinal fluid (CSF) that extend into the venous sinuses through openings in the dura mater and allow the drainage of CSF from subarachnoid space into venous system. Usually they are asymptomatic but can be symptomatic when large enough to cause sinus occlusion. We report a rare case of a brain herniation into a giant arachnoid granulation in an asymptomatic elderly male patient, which was discovered incidentally.
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Liebo GB, Lane JJI, Van Gompel JJ, Eckel LJ, Schwartz KM, Lehman VT. Brain Herniation into Arachnoid Granulations: Clinical and Neuroimaging Features. J Neuroimaging 2016; 26:592-598. [DOI: 10.1111/jon.12366] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Greta B. Liebo
- Department of Radiology; Mayo Clinic-Rochester; Rochester MN
| | | | - Jamie J. Van Gompel
- Department of Neurologic Surgery and Otolaryngology; Mayo Clinic-Rochester; Rochester MN
| | | | | | - Vance T. Lehman
- Department of Radiology; Mayo Clinic-Rochester; Rochester MN
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10
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Brain herniations into arachnoid granulations: about 68 cases in 38 patients and review of the literature. Neuroradiology 2016; 58:443-57. [DOI: 10.1007/s00234-016-1662-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/04/2016] [Indexed: 11/25/2022]
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Kakisaka Y, Sato S, Takayanagi M, Nakasato N. Epilepsy case with focal cerebral herniation into the sigmoid sinus. Neurol Sci 2015; 37:487-8. [PMID: 26670592 DOI: 10.1007/s10072-015-2430-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/23/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Yosuke Kakisaka
- Department of Epileptology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.
| | - Shiho Sato
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai, Japan
| | | | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
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Battal B, Hamcan S, Akgun V, Sari S, Oz O, Tasar M, Castillo M. Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance. Eur Radiol 2015; 26:1723-31. [DOI: 10.1007/s00330-015-3959-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 12/01/2022]
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13
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Sari S, Verim S, Hamcan S, Battal B, Akgun V, Akgun H, Celikkanat S, Tasar M. MRI diagnosis of dural sinus—Cortical venous thrombosis: Immediate post-contrast 3D GRE T1-weighted imaging versus unenhanced MR venography and conventional MR sequences. Clin Neurol Neurosurg 2015; 134:44-54. [DOI: 10.1016/j.clineuro.2015.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/03/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
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14
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Kocyigit A, Herek D, Balci YI. Focal herniation of cerebral parenchyma into transverse sinus. J Neuroradiol 2014; 42:126-7. [PMID: 25451667 DOI: 10.1016/j.neurad.2014.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 04/24/2014] [Accepted: 05/22/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Ali Kocyigit
- Department of Radiology, Faculty of Medicine, Kinikli Kampusu, Pamukkale University, 20100 Denizli, Turkey
| | - Duygu Herek
- Department of Radiology, Faculty of Medicine, Kinikli Kampusu, Pamukkale University, 20100 Denizli, Turkey.
| | - Yasemin Isik Balci
- Department of Pediatrics, Faculty of Medicine, Kinikli Kampusu, Pamukkale University, 20100 Denizli, Turkey
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Battal B, Castillo M. Brain herniations into the dural venous sinuses or calvarium: MRI of a recently recognized entity. Neuroradiol J 2014; 27:55-62. [PMID: 24571834 DOI: 10.15274/nrj-2014-10006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 01/09/2014] [Indexed: 11/12/2022] Open
Abstract
Brain herniations into dural venous sinuses (DVS) are rare findings recently described and their etiology and clinical significance are controversial. We describe five patients with brain herniations into the DVS or calvarium identified on MRI, and discuss their imaging findings, possible causes, and relationship to the patient's symptoms. All patients were examined with MRI including high resolution pre- and post-contrast T1- and T2-weighted sequences. With respect to brain herniations we documented their locations, signal intensities in different sequences, and size. We then reviewed clinical records in an attempt to establish if any symptoms were related to the presence of these herniations. Three males and two females were examined (age range, 11-68 years). Three patients had unilateral temporal lobe herniations into transverse sinuses, one had a cerebellar herniation into the skull, and one had bilateral temporal lobe herniations into the transverse sinuses as well as a cerebellar herniation into the sigmoid sinus. In all, the herniated brain and surrounding cerebrospinal fluid (CSF) had normal signal intensity on all MRI sequences. When correlated with clinical symptoms, brain herniations were thought to be incidental and asymptomatic in three patients and two patients had histories of headaches. Brain herniations with surrounding CSF into the DVS/skull should be considered potential sources of filling defects in the DVS. We believe that they are probably incidental findings that may be more common than previously recognized and should be not confused with the more common arachnoid granulations, clots, or tumors. Two patients had headaches, but their relation to the presence of herniated brain was uncertain.
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Affiliation(s)
- Bilal Battal
- Department of Radiology, University of North Carolina at Chapel Hill; Chapel Hill, North Carolina, USA - Department of Radiology, Gulhane Military Medical School; Etlik, Ankara, Turkey -
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina at Chapel Hill; Chapel Hill, North Carolina, USA
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