1
|
Darsaut TE, Rheaume AR, Chagnon M, Raymond J. The use and abuse of survival analysis and Kaplan-Meier curves in surgical trials. Neurochirurgie 2024; 70:101567. [PMID: 38761639 DOI: 10.1016/j.neuchi.2024.101567] [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: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Survival analysis based on Cox regression and Kaplan-Meier curves, initially devised for oncology trials, have frequently been used in other contexts where fundamental statistical assumptions (such as a constant hazard ratio) are not satisfied. This is almost always the case in trials that compare surgery with medical management. METHODS We review a trial that compared extracranial-intracranial bypass surgery (EC-IC bypass) with medical management (MM) of patients with symptomatic occlusion of the carotid or middle cerebral artery, where it was claimed that surgery was of no benefit. We discuss a hypothetical study and review other neurovascular trials which have also used survival analysis to compare results. RESULTS The trial comparing EC-IC bypass and MM did not satisfy the fundamental proportional hazard assumption necessary for valid analyses. This was also the case for two prior EC-IC bypass trials, as well as for other landmark neurovascular studies, such as the trials comparing endarterectomy with MM for carotid stenoses, or for the trial that compared intervention and MM for unruptured brain arteriovenous malformations. While minor deviations may have little effect on large trials, it may be impossible to show the benefits of surgery when trial size is small and deviations large. CONCLUSION Survival analyses are inappropriate in RCTs comparing surgery with conservative management, unless survival is calculated after the postoperative period. Alternative ways to compare final clinical outcomes, using for example a fixed follow-up period, should be planned for preventive surgical trials that compare intervention with conservative management.
Collapse
Affiliation(s)
- Tim E Darsaut
- University of Alberta Hospital, Division of Neurosurgery, Department of Surgery, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Alan R Rheaume
- University of Alberta Hospital, Division of Neurosurgery, Department of Surgery, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Miguel Chagnon
- Department of Mathematics and Statistics, University of Montreal, Montreal, Quebec, Canada
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
| |
Collapse
|
2
|
Lu G, Wang J, Wang T, Xu X, Li X, Sun X, Wang Z, Luo J, Ma Y, Yang B, Gao P, Wang Y, Chen Y, Liu S, Jiao L. Incidence and predictors of restenosis following successful recanalization of non-acute internal carotid artery occlusion in 252 cases. J Neurointerv Surg 2024:jnis-2024-021553. [PMID: 38503511 DOI: 10.1136/jnis-2024-021553] [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: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Data concerning restenosis following successful recanalization of non-acute internal carotid artery occlusion (ICAO) are scarce. This study was conducted to identify the incidence and predictors of restenosis following successful recanalization of non-acute ICAO. METHODS We reviewed the incidence of restenosis (defined as >70% restenosis or reocclusion) among 252 consecutive patients with successful recanalization of non-acute ICAO. Baseline, imaging, and surgery-related characteristics were analyzed to assess their association with restenosis. A scoring system was developed to identify high-risk patients for restenosis. RESULTS During a median follow-up of 12.6 months, restenosis occurred in 56 patients (22.2%), including 39 with reocclusion and 17 with >70% restenosis. The cumulative restenosis rate was 18.0% at 12 months and 24.1% at 24 months. The incidence of stroke was higher in patients with restenosis (25.0% vs 1.5%, P<0.01). Multivariate analysis showed occlusion length (5-10 cm vs <5 cm (hazard ratio (HR) 3.15, 95% confidence interval (95% CI) 1.07 to 9.29); ≥ 10 cm vs <5 cm (HR 5.01, 95% CI 1.73 to 14.49)), residual stenosis ≥30% (HR 3.08, 95% CI 1.79 to 5.30), and internal carotid artery (ICA) wall collapse (HR 1.96, 95% CI 1.12 to 3.44) as independent predictors of restenosis. Point scores proportional to model coefficients were assigned, with scores ranging from 0 to 6. Patients scoring 3-6 had a 4.00 times higher chance of developing restenosis (95% CI 2.35 to 6.79) compared with those scoring 0-2. CONCLUSIONS Nearly one in five patients experienced restenosis following successful recanalization of non-acute ICAO. Occlusion length, residual stenosis ≥30%, and ICA wall collapse were independently associated with restenosis.
Collapse
Affiliation(s)
- Guangdong Lu
- Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junqing Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Neurosurgery, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xinjuan Xu
- Department of Neurosurgery, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Xin Li
- Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Xinyi Sun
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zhengyu Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Bin Yang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Peng Gao
- Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liqun Jiao
- Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Baron JC. Predicting Stroke Recurrence in Occlusive Disease Using Noninvasive Quantitative Mapping of Cerebrovascular Reserve. Stroke 2024; 55:622-624. [PMID: 38328925 DOI: 10.1161/strokeaha.124.046235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, FHU NeuroVasc, France. Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, France
| |
Collapse
|
4
|
Elder TA, White TG, Woo HH, Siddiqui AH, Nunna R, Siddiq F, Esposito G, Chang D, Gonzalez NR, Amin-Hanjani S. Future of Endovascular and Surgical Treatments of Atherosclerotic Intracranial Stenosis. Stroke 2024; 55:344-354. [PMID: 38252761 DOI: 10.1161/strokeaha.123.043634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Intracranial atherosclerotic disease and resultant intracranial stenosis is a global leading cause of stroke, and poses an ongoing treatment challenge. Among patients with intracranial stenosis, those with hemodynamic compromise are at high risk for recurrent stroke despite medical therapy and risk factor modification. Revascularization of the hypoperfused territory is the most plausible treatment strategy for these high-risk patients, yet surgical and endovascular therapies have not yet shown to be sufficiently safe and effective in randomized controlled trials. Advances in diagnostic and therapeutic technologies have led to a resurgence of interest in surgical and endovascular treatment strategies, with a growing body of evidence to support their further evaluation in the treatment of select patient populations. This review outlines the current and emerging endovascular and surgical treatments and highlights promising future management strategies.
Collapse
Affiliation(s)
- Theresa A Elder
- University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, OH (T.A.E., S.A.-H.)
| | - Timothy G White
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY (T.G.W., H.H.W.)
| | - Henry H Woo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY (T.G.W., H.H.W.)
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, NY (A.H.S.)
| | - Ravi Nunna
- Department of Neurological Surgery, University of Missouri School of Medicine, Columbia (R.N., F.S.)
| | - Farhan Siddiq
- Department of Neurological Surgery, University of Missouri School of Medicine, Columbia (R.N., F.S.)
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland (G.E.)
| | - Daniel Chang
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA (D.C., N.R.G.)
| | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA (D.C., N.R.G.)
| | - Sepideh Amin-Hanjani
- University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, OH (T.A.E., S.A.-H.)
| |
Collapse
|
5
|
Khan NR, Labib M, Xu B, Lawton MT, Baskaya MK, Morcos JJ. Commentary: In Response to Extracranial-Intracranial Bypass in Symptomatic Arterial Occlusion Trial (CMOSS). Neurosurgery 2024; 94:e30-e32. [PMID: 38038433 DOI: 10.1227/neu.0000000000002784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, Semmes Murphey Clinic, Memphis , Tennessee , USA
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis , Tennessee , USA
| | - Mohamed Labib
- Department of Neurosurgery, University of Maryland, Baltimore , Maryland , USA
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai , China
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix , Arizona , USA
| | - Mustafa K Baskaya
- Department of Neurosurgery, University of Wisconsin, Madison , Wisconsin , USA
| | - Jacques J Morcos
- Department of Neurosurgery, University of Miami, Miami , Florida , USA
| |
Collapse
|
6
|
Oliveira LDB, Cieslak PH, Marques GN, Batista S, Andreão FF, Palavani LB, Bocanegra-Becerra JE, Bertani R, Rabelo NN, Welling LC, Figueiredo EG. Maxillary artery utilization in subcranial-intracranial bypass procedures: a comprehensive systematic review and pooled analysis. Neurosurg Rev 2024; 47:41. [PMID: 38206429 DOI: 10.1007/s10143-023-02265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
The utilization of the internal maxillary artery (IMAX) in subcranial-intracranial bypass for revascularization in complex aneurysms, tumors, or refractory ischemia shows promise. However, robust evidence concerning its outcomes is lacking. Hence, the authors embarked on a systematic review with pooled analysis to elucidate the efficacy of this approach. We systematically searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Included articles used the IMAX as a donor vessel for revascularizing an intracranial area and reported at least one of the following outcomes: patency, complications, or clinical data. Favorable outcomes were defined as the absence of neurologic deficits or improvement in the baseline condition. Complications were considered any adverse event directly related to the procedure. Out of 418 retrieved articles, 26 were included, involving 183 patients. Among them, 119 had aneurysms, 41 experienced ischemic strokes (transient or not), 2 had arterial occlusions, and 3 had neoplasia. Furthermore, 91.8% of bypasses used radial artery grafts, and 87.9% revascularized the middle cerebral artery territory. The median average follow-up period was 12 months (0.3-53.1). The post-operation patency rate was 99% (95% CI: 97-100%; I2=0%), while the patency rate at follow-up was 82% (95% CI: 68-96%; I2=77%). Complications occurred in 21% of cases (95% CI: 9-32%; I2=58%), with no significant procedure-related mortality in 0% (95% CI: 0-2%; I2=0%). Favorable outcomes were observed in 88% of patients (95% CI: 81-96%; I2=0%), and only 3% experienced ischemia (95% CI: 0-6%; I2=0%). The subcranial-intracranial bypass with the IMAX shows excellent postoperative patency and considerable favorable clinical outcomes. While complications exist, the procedure carries a minimal risk of mortality. However, long-term patency presents heterogeneous findings, warranting additional research.
Collapse
Affiliation(s)
- Leonardo de Barros Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil.
| | - Pedro Henrique Cieslak
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil
| | | | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipi Fim Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Leonardo C Welling
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil
| | | |
Collapse
|
7
|
Liu L, Li Z, Zhou H, Duan W, Huo X, Xu W, Li S, Nie X, Liu H, Liu J, Sun D, Wei Y, Zhang G, Yuan W, Zheng L, Liu J, Wang D, Miao Z, Wang Y. Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases: executive summary and 2023 update. Stroke Vasc Neurol 2023; 8:e3. [PMID: 38158224 PMCID: PMC10800268 DOI: 10.1136/svn-2023-002998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND China is one of the countries with the highest burden of stroke. Implementing multidimensional management guidelines will help clinicians practise evidence-based care, improve patient outcomes and alleviate societal burdens. This update of the 2019 edition will provide the latest comprehensive recommendations for the diagnosis and treatment of ischaemic cerebrovascular diseases. METHODS We conducted a comprehensive search on MEDLINE (via PubMed) up to 31 August 2023. The writing team established the recommendations through multiple rounds of online and offline discussions. Each recommendation was graded using the evidence grading algorithm developed by the Chinese Stroke Association (CSA). The draft was reviewed and finalised by the CSA Stroke Guidelines Writing Committee. RESULTS This update included revisions of 15 existing recommendations and 136 new recommendations in the following areas of stroke care: emergency assessment and diagnosis of ischaemic cerebrovascular disease, acute-phase reperfusion therapy, evaluation of underlying mechanisms, antithrombotic therapy, prevention and treatment of complications, and risk factor management. CONCLUSIONS This guideline updated the recommendations for the clinical management of ischaemic cerebrovascular disease from 2019.
Collapse
Affiliation(s)
- Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Hongyu Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wanying Duan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaochuan Huo
- Neurological Disease Center, Cerebral Vascular Disease Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weihai Xu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujuan Li
- Department of Neurology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ximing Nie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huihui Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinjie Liu
- Department of General Medicine, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Dapeng Sun
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yufei Wei
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Guitao Zhang
- Department of Neurology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weizhuang Yuan
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lina Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jingyi Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - David Wang
- Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Zhongrong Miao
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| |
Collapse
|
8
|
Darsaut TE, Raymond J. Extracranial-Intracranial Bypass in Patients With Symptomatic Artery Occlusion. JAMA 2023; 330:2396. [PMID: 38147098 DOI: 10.1001/jama.2023.21999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Affiliation(s)
- Tim E Darsaut
- Division of Neurosurgery, University of Alberta, Edmonton, Canada
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
9
|
Ma Y, Wang T, Jiao L. Extracranial-Intracranial Bypass in Patients With Symptomatic Artery Occlusion-Reply. JAMA 2023; 330:2396-2397. [PMID: 38147095 DOI: 10.1001/jama.2023.22002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Affiliation(s)
- Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Beijing, China
| | - Liqun Jiao
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
10
|
Khaw AV, Thiessen JD, St. Lawrence K, Pandey SK. The Quest of Characterizing Hemodynamic Failure in Patients With Cerebrovascular Disease. J Am Heart Assoc 2023; 12:e032657. [PMID: 38084748 PMCID: PMC10863759 DOI: 10.1161/jaha.123.032657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Alexander V. Khaw
- Department of Clinical Neurosciences, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
- Lawson Health Research InstituteLondonOntarioCanada
- Department of Medical Biophysics, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Jonathan D. Thiessen
- Lawson Health Research InstituteLondonOntarioCanada
- Department of Medical Biophysics, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
- Department of Medical Imaging, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Keith St. Lawrence
- Lawson Health Research InstituteLondonOntarioCanada
- Department of Medical Biophysics, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
- Department of Medical Imaging, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Sachin K. Pandey
- Department of Medical Imaging, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| |
Collapse
|