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Timing the Ischemic Stroke by Multiparametric Quantitative Magnetic Resonance Imaging. Stroke 2021. [DOI: 10.36255/exonpublications.stroke.timingischemicstroke.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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McGarry BL, Damion RA, Chew I, Knight MJ, Harston GW, Carone D, Jezzard P, Sitaram A, Muir KW, Clatworthy P, Kauppinen RA. A Comparison of T 2 Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study. J Cent Nerv Syst Dis 2020; 12:1179573520943314. [PMID: 32963473 PMCID: PMC7488882 DOI: 10.1177/1179573520943314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/29/2020] [Indexed: 12/25/2022] Open
Abstract
Background: T2 relaxation-based magnetic resonance imaging (MRI) signals may provide onset time for acute ischemic strokes with an unknown onset. The ability of visual and quantitative MRI-based methods in a cohort of hyperacute ischemic stroke patients was studied. Methods: A total of 35 patients underwent 3T (3 Tesla) MRI (<9-hour symptom onset). Diffusion-weighted (DWI), apparent diffusion coefficient (ADC), T1-weighted (T1w), T2-weighted (T2w), and T2 relaxation time (T2) images were acquired. T2-weighted fluid attenuation inversion recovery (FLAIR) images were acquired for 17 of these patients. Image intensity ratios of the average intensities in ischemic and non-ischemic reference regions were calculated for ADC, DWI, T2w, T2 relaxation, and FLAIR images, and optimal image intensity ratio cut-offs were determined. DWI and FLAIR images were assessed visually for DWI/FLAIR mismatch. Results: The T2 relaxation time image intensity ratio was the only parameter with significant correlation with stroke duration (r = 0.49, P = .003), an area under the receiver operating characteristic curve (AUC = 0.77, P < .0001), and an optimal cut-off (T2 ratio = 1.072) that accurately identified patients within the 4.5-hour thrombolysis treatment window with sensitivity of 0.74 and specificity of 0.74. In the patients with the additional FLAIR, areas under the precision-recall-gain curve (AUPRG) and F1 scores showed that the T2 relaxation time ratio (AUPRG = 0.60, F1 = 0.73) performed considerably better than the FLAIR ratio (AUPRG = 0.39, F1 = 0.57) and the visual DWI/FLAIR mismatch (F1 = 0.25). Conclusions: Quantitative T2 relaxation time is the preferred MRI parameter in the assessment of patients with unknown onset for treatment stratification.
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Affiliation(s)
- Bryony L McGarry
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Robin A Damion
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Isabel Chew
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Michael J Knight
- School of Psychological Science, University of Bristol, Bristol, UK
| | - George Wj Harston
- Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Davide Carone
- Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Peter Jezzard
- Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Amith Sitaram
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Keith W Muir
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Philip Clatworthy
- Stroke Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Karunamuni RA, White NS, Fromm A, Moen G, Renate Grüner E, Dale AM, Oltedal L. Improved characterization of cerebral infarction using combined tissue T2 and high b-value diffusion MRI in post-thrombectomy patients: a feasibility study. Acta Radiol 2019; 60:1294-1300. [PMID: 30626210 DOI: 10.1177/0284185118820063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Roshan A Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Nathan S White
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Moen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Eli Renate Grüner
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Leif Oltedal
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
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Knight MJ, Damion RA, McGarry BL, Bosnell R, Jokivarsi KT, Gröhn OHJ, Jezzard P, Harston GWJ, Carone D, Kennedy J, El-Tawil S, Elliot J, Muir KW, Clatworthy P, Kauppinen RA. Determining T2 relaxation time and stroke onset relationship in ischaemic stroke within apparent diffusion coefficient-defined lesions. A user-independent method for quantifying the impact of stroke in the human brain. BIOMEDICAL SPECTROSCOPY AND IMAGING 2019; 8:11-28. [PMID: 31328097 PMCID: PMC6640032 DOI: 10.3233/bsi-190185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE In hyperacute ischaemic stroke, T2 of cerebral water increases with time. Quantifying this change may be informative of the extent of tissue damage and onset time. Our objective was to develop a user-unbiased method to measure the effect of cerebral ischaemia on T2 to study stroke onset time-dependency in human acute stroke lesions. METHODS Six rats were subjected to permanent middle cerebral occlusion to induce focal ischaemia, and a consecutive cohort of acute stroke patients (n = 38) were recruited within 9 hours from symptom onset. T1-weighted structural, T2 relaxometry, and diffusion MRI for apparent diffusion coefficient (ADC) were acquired. Ischaemic lesions were defined as regions of lowered ADC. The median T2 difference (ΔT2) between lesion and contralateral non-ischaemic control region was determined by the newly-developed spherical reference method, and data compared to that obtained by the mirror reference method. Linear regressions and receiver operating characteristics (ROC) were compared between the two methods. RESULTS ΔT2 increases linearly in rat brain ischaemia by 1.9 ± 0.8 ms/h during the first 6 hours, as determined by the spherical reference method. In patients, ΔT2 linearly increases by 1.6 ± 1.4 and 1.9 ± 0.9 ms/h in the lesion, as determined by the mirror reference and spherical reference method, respectively. ROC analyses produced areas under the curve of 0.83 and 0.71 for the spherical and mirror reference methods, respectively. CONCLUSIONS Data from the spherical reference method showed that the median T2 increase in the ischaemic lesion is correlated with stroke onset time in a rat as well as in a human patient cohort, opening the possibility of using the approach as a timing tool in clinics.
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Affiliation(s)
- Michael J Knight
- School of Experimental Psychology, University of Bristol, Bristol, UK; Stroke Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Robin A Damion
- School of Experimental Psychology, University of Bristol, Bristol, UK; Stroke Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Bryony L McGarry
- School of Experimental Psychology, University of Bristol, Bristol, UK; Stroke Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rose Bosnell
- Stroke Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Kimmo T Jokivarsi
- Department of Neurobiology, A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Olli H J Gröhn
- Department of Neurobiology, A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Peter Jezzard
- Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Sciences, University of Oxford, Oxford UK
| | - George W J Harston
- Acute Stroke programme, Radcliff Department of Medicine, University of Oxford, UK
| | - Davide Carone
- Acute Stroke programme, Radcliff Department of Medicine, University of Oxford, UK
| | - James Kennedy
- Acute Stroke programme, Radcliff Department of Medicine, University of Oxford, UK
| | - Salwa El-Tawil
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital, University of Glasgow, Scotland
| | - Jennifer Elliot
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital, University of Glasgow, Scotland
| | - Keith W Muir
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital, University of Glasgow, Scotland
| | - Philip Clatworthy
- Stroke Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Risto A Kauppinen
- School of Experimental Psychology, University of Bristol, Bristol, UK; Stroke Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Damion RA, Knight MJ, McGarry BL, Bosnell R, Jezzard P, Harston GW, Carone D, Kennedy J, El-Tawil S, Elliot J, Muir KW, Clatworthy P, Kauppinen RA. Quantifying T 2 relaxation time changes within lesions defined by apparent diffusion coefficient in grey and white matter in acute stroke patients. Phys Med Biol 2019; 64:095016. [PMID: 30921782 DOI: 10.1088/1361-6560/ab1442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The apparent diffusion coefficient (ADC) of cerebral water, as measured by diffusion MRI, rapidly decreases in ischaemia, highlighting a lesion in acute stroke patients. The MRI T 2 relaxation time changes in ischaemic brain such that T 2 in ADC lesions may be informative of the extent of tissue damage, potentially aiding in stratification for treatment. We have developed a novel user-unbiased method of determining the changes in T 2 in ADC lesions as a function of clinical symptom duration based on voxel-wise referencing to a contralateral brain volume. The spherical reference method calculates the most probable pre-ischaemic T 2 on a voxel-wise basis, making use of features of the contralateral hemisphere presumed to be largely unaffected. We studied whether T 2 changes in the two main cerebral tissue types, i.e. in grey matter (GM) and white matter (WM), would differ in stroke. Thirty-eight acute stroke patients were accrued within 9 h of symptom onset and scanned at 3 T for 3D T 1-weighted, multi b-value diffusion and multi-echo spin echo MRI for tissue type segmentation, quantitative ADC and absolute T 2 images, respectively. T 2 changes measured by the spherical reference method were 1.94 ± 0.61, 1.50 ± 0.52 and 1.40 ± 0.54 ms h-1 in the whole, GM, and WM lesions, respectively. Thus, T 2 time courses were comparable between GM and WM independent of brain tissue type involved. We demonstrate that T 2 changes in ADC-delineated lesions can be quantified in the clinical setting in a user unbiased manner and that T 2 change correlated with symptom onset time, opening the possibility of using the approach as a tool to assess severity of tissue damage in the clinical setting.
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Affiliation(s)
- Robin A Damion
- School of Psychological Science, University of Bristol, 12a Priory Rd, Bristol BS8 1TU, United Kingdom
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Huang WY, Wu G, Guo SX, Geng DY, Li JJ, Yang K. Multi-parameters of Magnetic Resonance Imaging to Estimate Ischemia-Reperfusion Injury after Stroke in Hyperglycemic Rats. Sci Rep 2019; 9:2852. [PMID: 30814576 PMCID: PMC6393533 DOI: 10.1038/s41598-019-39263-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/17/2019] [Indexed: 01/12/2023] Open
Abstract
The aim of the study is to verify the effect of hyperglycemia on ischemia-reperfusion injury and to explore the feasibility of noninvasive observation of ischemic-reperfusion injury in hyperglycemic ischemic stroke by MRI technique. According to the duration of ischemia and blood glucose levels, 40 rats were divided into hyperglycemic ischemic 2-hr (H-I2h), hyperglycemic ischemic 6-hr (H-I6h), non- hyperglycemic ischemic 2-hr (NH-I2h), and non- hyperglycemic ischemic 6-hr (NH-I6h) groups. T2W imaging, DW imaging, T2 mapping, T2* mapping, DCE, and T1 mapping after enhancement sequences were acquired before reperfusion and approximately 3-hr after reperfusion. ADC, T1, T2, T2*, and Ktrans values of ischemic lesion were obtained in different groups. After reperfusion, the variation of ADC values showed no significant difference between groups with diabetes and groups without diabetes and between different recanalization time-points (2-hr vs 6-hr). After reperfusion, T2, T2*, and Ktrans values increased in different degrees in all four groups. Only the T1 value decreased in all groups. The change of all parameters in groups with hyperglycemia was more obvious than that in groups without hyperglycemia and was more obvious in groups with H-I6h versus those with H-I2h. This study confirms that hyperglycemia aggravates ischemia-reperfusion injury and may be an important risk factor for the prognosis of ischemic stroke. The Ktrans values should be noninvasive imaging indicators to monitor blood brain barrier permeability and ischemic-reperfusion injury in ischemic stroke.
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Affiliation(s)
- Wei-Yuan Huang
- Department of Radiology, Hainan General Hospital, Haikou, 570311, China
| | - Gang Wu
- Department of Radiotherapy, Hainan General Hospital, Haikou, 570311, China
| | - Shan-Xi Guo
- Department of Radiology, Hainan General Hospital, Haikou, 570311, China
| | - Dao-Ying Geng
- Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jian-Jun Li
- Department of Radiology, Hainan General Hospital, Haikou, 570311, China.
| | - Kai Yang
- Department of Radiology, Hainan General Hospital, Haikou, 570311, China.
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Jonkman LE, Kenkhuis B, Geurts JJG, van de Berg WDJ. Post-Mortem MRI and Histopathology in Neurologic Disease: A Translational Approach. Neurosci Bull 2019; 35:229-243. [PMID: 30790214 DOI: 10.1007/s12264-019-00342-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/29/2018] [Indexed: 01/28/2023] Open
Abstract
In this review, combined post-mortem brain magnetic resonance imaging (MRI) and histology studies are highlighted, illustrating the relevance of translational approaches to define novel MRI signatures of neuropathological lesions in neuroinflammatory and neurodegenerative disorders. Initial studies combining post-mortem MRI and histology have validated various MRI sequences, assessing their sensitivity and specificity as diagnostic biomarkers in neurologic disease. More recent studies have focused on defining new radiological (bio)markers and implementing them in the clinical (research) setting. By combining neurological and neuroanatomical expertise with radiological development and pathological validation, a cycle emerges that allows for the discovery of novel MRI biomarkers to be implemented in vivo. Examples of this cycle are presented for multiple sclerosis, Alzheimer's disease, Parkinson's disease, and traumatic brain injury. Some applications have been shown to be successful, while others require further validation. In conclusion, there is much to explore with post-mortem MRI and histology studies, which can eventually be of high relevance for clinical practice.
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Affiliation(s)
- Laura E Jonkman
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Boyd Kenkhuis
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Wilma D J van de Berg
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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McGarry BL, Jokivarsi KT, Knight MJ, Grohn OHJ, Kauppinen RA. Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia. J Vis Exp 2017; 2017. [PMID: 28979652 PMCID: PMC5624498 DOI: 10.3791/55277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
MRI provides a sensitive and specific imaging tool to detect acute ischemic stroke by means of a reduced diffusion coefficient of brain water. In a rat model of ischemic stroke, differences in quantitative T1 and T2 MRI relaxation times (qT1 and qT2) between the ischemic lesion (delineated by low diffusion) and the contralateral non-ischemic hemisphere increase with time from stroke onset. The time dependency of MRI relaxation time differences is heuristically described by a linear function and thus provides a simple estimate of stroke onset time. Additionally, the volumes of abnormal qT1 and qT2 within the ischemic lesion increase linearly with time providing a complementary method for stroke timing. A (semi)automated computer routine based on the quantified diffusion coefficient is presented to delineate acute ischemic stroke tissue in rat ischemia. This routine also determines hemispheric differences in qT1 and qT2 relaxation times and the location and volume of abnormal qT1 and qT2 voxels within the lesion. Uncertainties associated with onset time estimates of qT1 and qT2 MRI data vary from ± 25 min to ± 47 min for the first 5 hours of stroke. The most accurate onset time estimates can be obtained by quantifying the volume of overlapping abnormal qT1 and qT2 lesion volumes, termed 'Voverlap' (± 25 min) or by quantifying hemispheric differences in qT2 relaxation times only (± 28 min). Overall, qT2 derived parameters outperform those from qT1. The current MRI protocol is tested in the hyperacute phase of a permanent focal ischemia model, which may not be applicable to transient focal brain ischemia.
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Affiliation(s)
- Bryony L McGarry
- School of Experimental Psychology and Clinical Research and Imaging Center Bristol, University of Bristol, Bristol, UK
| | - Kimmo T Jokivarsi
- Department of Neurobiology, A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Michael J Knight
- School of Experimental Psychology and Clinical Research and Imaging Center Bristol, University of Bristol, Bristol, UK
| | - Olli H J Grohn
- Department of Neurobiology, A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Risto A Kauppinen
- School of Experimental Psychology and Clinical Research and Imaging Center Bristol, University of Bristol, Bristol, UK
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Norton TJT, Pereyra M, Knight MJ, McGarry BM, Jokivarsi KT, Gröhn OH, Kauppinen RA. Stroke Onset Time Determination Using MRI Relaxation Times without Non-Ischaemic Reference in A Rat Stroke Model. BIOMEDICAL SPECTROSCOPY AND IMAGING 2017; 6:25-35. [PMID: 28685128 PMCID: PMC5495158 DOI: 10.3233/bsi-160155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Objective timing of stroke in emergency departments is expected to improve patient stratification. Magnetic resonance imaging (MRI) relaxations times, T2 and T1ρ , in abnormal diffusion delineated ischaemic tissue were used as proxies of stroke time in a rat model. METHODS Both 'non-ischaemic reference'-dependent and -independent estimators were generated. Apparent diffusion coefficient (ADC), T2 and T1ρ , were sequentially quantified for up to 6 hours of stroke in rats (n = 8) at 4.7T. The ischaemic lesion was identified as a contiguous collection of voxels with low ADC. T2 and T1ρ in the ischaemic lesion and in the contralateral non-ischaemic brain tissue were determined. Differences in mean MRI relaxation times between ischaemic and non-ischaemic volumes were used to create reference-dependent estimator. For the reference-independent procedure, only the parameters associated with log-logistic fits to the T2 and T1ρ distributions within the ADC-delineated lesions were used for the onset time estimation. RESULT The reference-independent estimators from T2 and T1ρ data provided stroke onset time with precisions of ±32 and ±27 minutes, respectively. The reference-dependent estimators yielded respective precisions of ±47 and ±54 minutes. CONCLUSIONS A 'non-ischaemic anatomical reference'-independent estimator for stroke onset time from relaxometric MRI data is shown to yield greater timing precision than previously obtained through reference-dependent procedures.
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Affiliation(s)
| | | | | | | | - Kimmo T. Jokivarsi
- Department of Neurobiology, A.I.Virtanen Institute, University of Eastern Finland
| | - Olli H.J. Gröhn
- Department of Neurobiology, A.I.Virtanen Institute, University of Eastern Finland
| | - Risto A. Kauppinen
- School of Experimental Psychology, University of Bristol
- Clinical Research and Imaging Centre, University of Bristol, Bristol, UK
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