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Koska J, Migrino RQ, Chan KC, Cooper-Cox K, Reaven PD. The Effect of Exenatide Once Weekly on Carotid Atherosclerosis in Individuals With Type 2 Diabetes: An 18-Month Randomized Placebo-Controlled Study. Diabetes Care 2021; 44:1385-1392. [PMID: 33495294 PMCID: PMC8247511 DOI: 10.2337/dc20-2014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Glucagon-like peptide 1 receptor agonists (GLP-1RAs) improved multiple proatherogenic risk factors and reduced cardiovascular events in recent clinical trials, suggesting that they may slow progression of atherosclerosis. We tested whether exenatide once weekly reduces carotid plaque progression in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS In a double-blind, pragmatic trial, 163 participants were randomized (2:1) to exenatide (n = 109) or placebo (n = 54). Changes in carotid plaque volume and composition were measured at 9 and 18 months by multicontrast 3 Tesla MRI. Fasting and post-high-fat meal plasma glucose and lipids, and endothelial function responses, were measured at 3, 9, and 18 months. RESULTS Exenatide reduced hemoglobin A1c (HbA1c) (estimated difference vs. placebo 0.55%, P = 0.0007) and fasting and postmeal plasma glucose (19 mg/dL, P = 0.0002, and 25 mg/dL, P < 0.0001, respectively). Mean (SD) change in plaque volume in the exenatide group (0.3% [2%]) was not different from that in the placebo group (-2.2% [8%]) (P = 0.4). The change in plaque volume in the exenatide group was associated with changes in HbA1c (r = 0.38, P = 0.0004), body weight, and overall plasma glucose (r = 0.29, P = 0.007 both). There were no differences in changes in plaque composition, body weight, blood pressure, fasting and postmeal plasma triglycerides, and endothelial function between the groups. CONCLUSIONS Exenatide once weekly for up to 18 months improved fasting and postprandial glycemic control but did not modify change in carotid plaque volume or composition. This study raises the possibility that short-term antiatherosclerotic effects may not play a central role in the cardiovascular benefits of GLP-1RAs.
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Affiliation(s)
- Juraj Koska
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
| | | | - Keith C Chan
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
| | | | - Peter D Reaven
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
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Detection and Prediction of Peripheral Arterial Plaque Using Vessel Wall MR in Patients with Diabetes. BIOMED RESEARCH INTERNATIONAL 2021. [PMID: 31638151 PMCID: PMC8088372 DOI: 10.1155/2021/5585846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives To evaluate the predictive performance of a newly developed delay alternating with nutation for tailored excitation (DANTE) pulse sequence for detecting lower extremity artery wall morphology and distribution in patients with peripheral artery disease (PAD) with diabetes. Methods Seventy-four PAD patients diagnosed according to 2011 WHO criteria were enrolled, who has diabetic diagnosis by 1999 WHO diabetes criteria. All patients received sequential DANTE, T2WI, DANTE-enhance, and CE-MRA scans. The images consisted of three parts: the iliac artery (segment 1), femoral artery (segment 2), and popliteal artery (segment 3). Regions of interest (ROIs) were drawn on vessels, muscle, and background, and multiple imaging metrics compared between modalities, including image quality score, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). In the images with a score greater than 2, the lumen area (LA), total vessel area (TVA), and vessel thickness (VT) can be identified using semiautomatic image analysis vessel morphology parameters. Results All 222 arterial segments were successfully analyzed from 71 patients, after exclusion of three subjects with poor image quality (IQ < 2) in segment 3. There were 54 diabetic and 17 nondiabetic patients. Quantitative analysis shows that the CNR difference between diabetic patients and nondiabetic patients was statistically significant for the same segment, while there was no significant difference among the three segments of SNR and CNR. There were a total of 54 diabetics with plaque distribution data, which showed that LA of segments 1 and 2 was higher than that of segment 3. The VWI of segments 1 and 2 was lower than segment 3. Diabetic was associated with vascular WT 3 and WA3, which increased by 0.23 and 0.83 units on average compared without diabetic foot, respectively. Diabetic foot was associated with vascular WT 3, which increased by 0.37 units on average compared without diabetic foot. The incidence of segment 3 plaques was higher than that of segment 1. The incidence of the left and right plaques was different. Conclusions MR imaging using the DANTE and multicontrast sequence could evaluate plaque morphology, and distribution of lower extremities and the occurrence of diabetic foot development are closely related; it may predict occurrence of PAD with diabetic foot.
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Wang L, Deng W, Liang J, Zhuang W, Feng H, Zhuang G, Liu D, Chen H. Loan sharking: changing patterns in, and challenging perceptions of, an abuse of deprivation. JOURNAL OF PUBLIC HEALTH (OXFORD, ENGLAND) 2021; 43:e62-e68. [PMID: 31638151 PMCID: PMC8088372 DOI: 10.1093/pubmed/fdz090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Illegal high interest lending or 'loan sharking' exploits the vulnerable and has profound negative impacts on individuals and communities. The 2008 UK financial crash and subsequent austerity programme coupled with changes in the consumer credit market have fuelled an increase in predatory lending. METHODS The study is a descriptive analysis of demographic, financial, health and behavioural data on 753 victims (2011-2017). A review of the causative factors and potential political, economic and public health responses is analysed. RESULTS Most victims were female but males were considerably more indebted. Illegal loans are largely taken out for routine living expenses and over 70% of victims reported other serious debts. Victims are disproportionately poor, unemployed and on benefits but fewer than half have had financial or benefits advice. Despite 90% reporting they would not borrow illegally again, 30% had previously done so from the same shark and over half considered them a friend. CONCLUSIONS The increase in loan sharking has coincided with the withdrawal of traditional sub-prime lenders and local welfare assistance schemes, and the low penetration of Credit Unions in many areas. Conventional perceptions of loan sharks and their relationships with victims are largely incorrect. A range of coordinated financial, political and social interventions is required.
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Affiliation(s)
- Li Wang
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Wei Deng
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- Medical Imaging Institute of Panyu, Guangzhou, China
| | - Jianke Liang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Weizhao Zhuang
- Invasive Technology Department, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Huigang Feng
- Invasive Technology Department, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Gaoming Zhuang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- Medical Imaging Institute of Panyu, Guangzhou, China
| | - Dexiang Liu
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Hanwei Chen
- Invasive Technology Department, Guangzhou Panyu Central Hospital, Guangzhou, China
- Invasive Technology Department, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Chen L, Zhan Q, Peng W, Song T, Liu Q, Lu J. Comparison of two different measurement methods in evaluating basilar atherosclerotic plaque using high-resolution MRI at 3 tesla. BMC Med Imaging 2018; 18:49. [PMID: 30509197 PMCID: PMC6276224 DOI: 10.1186/s12880-018-0293-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background To compare the Self-referenced and Referenced measurement methods in assessing basilar artery (BA) atherosclerotic plaque employing dark blood high-resolution MRI at 3 Tesla. Methods Forty patients with > 20% stenosis as identified by conventional MRA were recruited and evaluated on a 3 Tesla MRI system. The outer wall, inner wall and lumen areas of maximal lumen narrowing site and the outer wall and lumen areas of sites that were proximal and distal to the maximal lumen narrowing site were manually traced. Plaque area (PA), stenosis rate (SR) and percent plaque burden (PPB) were calculated using the Self-referenced and Referenced measurement methods, respectively. To assess intra-observer reproducibility, BA plaque was measured twice with a 2-week interval in between measurements. Results Thirty-seven patients were included in the final analysis. There were no significant differences in PA, SR and PPB measurements between the two methods. The intra-class coefficients and coefficient of variations (CV) ranged from 0.976 to 0.990 and from 3.73 to 5.61% for the Self-referenced method and ranged from 0.928 to 0.971 and from 4.64 to 9.95% for the Referenced method, respectively. Both methods are effective in the evaluation of BA plaque. However, the CVs of the Self-referenced method is lower than the Referenced measurement method. Moreover, Bland-Altman plots showed that the Self-referenced method has a narrower interval than the Referenced measurement method. Conclusions The Self-referenced method is better and more convenient for evaluating BA plaque, and it may serve as a promising method for evaluation of basilar atherosclerotic plaque.
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Affiliation(s)
- Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Qian Zhan
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Wenjia Peng
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Tao Song
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China.
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Li H, Li B, Huang W, Dong L, Zhang J. Flow artifact removal in carotid wall imaging based on black and gray-blood dual-contrast images subtraction. Magn Reson Med 2016; 77:1612-1618. [PMID: 27018428 DOI: 10.1002/mrm.26218] [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: 10/22/2015] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop and validate a dual-contrast image subtraction (DCIS) strategy for eliminating the flow artifacts in black-blood carotid MRI. METHODS Twelve patients with carotid stenosis and eight healthy volunteers were imaged using the black and gray-blood dual-contrast imaging based on the relaxation-enhanced compressed sensing three-dimensional motion-sensitizing driven equilibrium prepared rapid-gradient-echo (RECS-3D MERGE) sequence. Subtraction of black-blood images (BBIs) and gray-blood images (GBIs), together with a preweighting procedure, was performed to eliminate the residual blood signal in BBIs. A wavelet denoising procedure was applied to offset the noise amplification. In addition to the lumen signal-to-noise ratio (SNR) and wall-lumen contrast-to-noise ratio (CNR), the signal variance ratio (SVR) and contrast variance ratio (CVR) were also used to evaluate the blood suppression efficiency. RESULTS By choosing the weighting factor of one, the lumen SNR of DCIS images was approximately 1% of that of the original BBIs, and the CNR showed a 91.4% improvement as compared with the BBIs. The median of the lumen SVR decreased to zero, and the CVR increased to 123% of that of the BBIs. CONCLUSIONS DCIS is demonstrated to be an effective strategy for sufficiently removing the residual flow signal from black-blood carotid MRI. Magn Reson Med 77:1612-1618, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Hao Li
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Bo Li
- College of Engineering, Peking University, Beijing, China
| | - Wenjian Huang
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Li Dong
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jue Zhang
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing, China.,College of Engineering, Peking University, Beijing, China
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Nieuwstadt HA, Kassar ZAM, van der Lugt A, Breeuwer M, van der Steen AFW, Wentzel JJ, Gijsen FJH. A computer-simulation study on the effects of MRI voxel dimensions on carotid plaque lipid-core and fibrous cap segmentation and stress modeling. PLoS One 2015; 10:e0123031. [PMID: 25856094 PMCID: PMC4391711 DOI: 10.1371/journal.pone.0123031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/16/2015] [Indexed: 11/25/2022] Open
Abstract
Background The benefits of a decreased slice thickness and/or in-plane voxel size in carotid MRI for atherosclerotic plaque component quantification accuracy and biomechanical peak cap stress analysis have not yet been investigated in detail because of practical limitations. Methods In order to provide a methodology that allows such an investigation in detail, numerical simulations of a T1-weighted, contrast-enhanced, 2D MRI sequence were employed. Both the slice thickness (2 mm, 1 mm, and 0.5 mm) and the in plane acquired voxel size (0.62x0.62 mm2 and 0.31x0.31 mm2) were varied. This virtual MRI approach was applied to 8 histology-based 3D patient carotid atherosclerotic plaque models. Results A decreased slice thickness did not result in major improvements in lumen, vessel wall, and lipid-rich necrotic core size measurements. At 0.62x0.62 mm2 in-plane, only a 0.5 mm slice thickness resulted in improved minimum fibrous cap thickness measurements (a 2–3 fold reduction in measurement error) and only marginally improved peak cap stress computations. Acquiring voxels of 0.31x0.31 mm2 in-plane, however, led to either similar or significantly larger improvements in plaque component quantification and computed peak cap stress. Conclusions This study provides evidence that for currently-used 2D carotid MRI protocols, a decreased slice thickness might not be more beneficial for plaque measurement accuracy than a decreased in-plane voxel size. The MRI simulations performed indicate that not a reduced slice thickness (i.e. more isotropic imaging), but the acquisition of anisotropic voxels with a relatively smaller in-plane voxel size could improve carotid plaque quantification and computed peak cap stress accuracy.
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Affiliation(s)
- Harm A. Nieuwstadt
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
| | - Zaid A. M. Kassar
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Marcel Breeuwer
- Philips Healthcare, Best, the Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Anton F. W. van der Steen
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
- Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Jolanda J. Wentzel
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
| | - Frank J. H. Gijsen
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
- * E-mail:
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3D MR sequence capable of simultaneous image acquisitions with and without blood vessel suppression: utility in diagnosing brain metastases. Eur Radiol 2014; 25:901-10. [PMID: 25417126 DOI: 10.1007/s00330-014-3496-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/07/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Volume isotropic simultaneous interleaved bright- and black-blood examination (VISIBLE) is a recently developed 3D MR sequence that provides simultaneous acquisitions of images with blood vessel suppression (Black) and images without it (Bright). Our purpose was to evaluate the usefulness of VISIBLE in detecting brain metastases. METHODS This prospective study included patients with suspected brain metastasis imaged with both VISIBLE and MPRAGE. From a data set, we compared the number of visualized blood vessels and the lesion-to-normal contrast-to-noise ratio (CNR) in 60 patients. We also performed an observer test to compare their diagnostic performance with VISIBLE, MPRAGE and only Black in 34 patients. Diagnostic performance was evaluated using a figure of merit (FOM), sensitivity, false-positive results per case (FPs/case) and reading time. RESULTS The number of vessels was significantly fewer in Black compared to MPRAGE and Bright (P < 0.0001). CNR was significantly higher with both Black and Bright than with MPRAGE (P < 0.005). In the observer test, significantly higher sensitivity (P < 0.0001) and FOM (P < 0.0001), significantly shorter reading time (P = 0.0001) and similar FPs/case were achieved with VISIBLE compared to MPRAGE. Compared to only Black, VISIBLE resulted in comparable sensitivity, but significantly fewer FPs/case (P = 0.0008). CONCLUSION VISIBLE can improve radiologists' diagnostic performance for brain metastasis. KEY POINTS • VISIBLE can achieve higher sensitivity and shorter reading time than MPRAGE. • VISIBLE can achieve lower false-positive rates than blood vessel suppressed images. • Compared to MPRAGE, VISIBLE can improve diagnostic performance for brain metastasis.
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Nieuwstadt HA, van der Lugt A, Kassar ZAM, Breeuwer M, van der Steen AFW, Gijsen FJH. Atherosclerotic plaque fibrous cap assessment under an oblique scan plane orientation in carotid MRI. Quant Imaging Med Surg 2014; 4:216-24. [PMID: 25202656 DOI: 10.3978/j.issn.2223-4292.2014.07.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/04/2014] [Indexed: 11/14/2022]
Abstract
Carotid magnetic resonance imaging (MRI) is used to noninvasively assess atherosclerotic plaque fibrous cap (FC) status, which is closely related to ischemic stroke. Acquiring anisotropic voxels improves in-plane visualization, however, an oblique scan plane orientation could then obscure a FC (i.e., contrast below the noise level) and thus impair a reliable status assessment. To quantify this, we performed single-slice numerical simulations of a clinical 3.0T, 2D T1-weighted, black-blood, contrast-enhanced pulse sequence with various voxel dimensions: in-plane voxel size of 0.62 mm × 0.62 mm and 0.31 mm × 0.31 mm, slice thickness of 1, 2, and 3 mm. Idealized plaque models (FC thickness of 0.5, 1, and 1.5 mm) were imaged at various scan plane angles (0°-40° in steps of 10°), and the FC contrast was quantified. We found that when imaging thin FCs with anisotropic voxels, the FC contrast decreased when the scan plane orientation angle increased. However, a reduced in-plane voxel size at the cost of an increased slice thickness often led to enhanced FC contrast even in the presence of scan plane orientation angles of up to 40°. It can be concluded that while isotropic-voxel imaging eliminates the issue of scan plane obliqueness, it comes at the cost of reduced FC contrast, thus likely decreasing the reliability of FC status assessment in carotid MRI. If scan plane orientation obliquity at the slice of interest is moderate (<40°) or otherwise diminished through careful scan planning, voxel anisotropy could increase FC contrast and, in effect, increase the reliability of FC status assessment.
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Affiliation(s)
- Harm A Nieuwstadt
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Aad van der Lugt
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Zaid A M Kassar
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Marcel Breeuwer
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Anton F W van der Steen
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Frank J H Gijsen
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
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