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Lakhani DA, Sabsevitz DS, Chaichana KL, Quiñones-Hinojosa A, Middlebrooks EH. Current State of Functional MRI in the Presurgical Planning of Brain Tumors. Radiol Imaging Cancer 2023; 5:e230078. [PMID: 37861422 DOI: 10.1148/rycan.230078] [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: 10/21/2023]
Abstract
Surgical resection of brain tumors is challenging because of the delicate balance between maximizing tumor removal and preserving vital brain functions. Functional MRI (fMRI) offers noninvasive preoperative mapping of widely distributed brain areas and is increasingly used in presurgical functional mapping. However, its impact on survival and functional outcomes is still not well-supported by evidence. Task-based fMRI (tb-fMRI) maps blood oxygen level-dependent (BOLD) signal changes during specific tasks, while resting-state fMRI (rs-fMRI) examines spontaneous brain activity. rs-fMRI may be useful for patients who cannot perform tasks, but its reliability is affected by tumor-induced changes, challenges in data processing, and noise. Validation studies comparing fMRI with direct cortical stimulation (DCS) show variable concordance, particularly for cognitive functions such as language; however, concordance for tb-fMRI is generally greater than that for rs-fMRI. Preoperative fMRI, in combination with MRI tractography and intraoperative DCS, may result in improved survival and extent of resection and reduced functional deficits. fMRI has the potential to guide surgical planning and help identify targets for intraoperative mapping, but there is currently limited prospective evidence of its impact on patient outcomes. This review describes the current state of fMRI for preoperative assessment in patients undergoing brain tumor resection. Keywords: MR-Functional Imaging, CNS, Brain/Brain Stem, Anatomy, Oncology, Functional MRI, Functional Anatomy, Task-based, Resting State, Surgical Planning, Brain Tumor © RSNA, 2023.
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Affiliation(s)
- Dhairya A Lakhani
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - David S Sabsevitz
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Kaisorn L Chaichana
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Alfredo Quiñones-Hinojosa
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Erik H Middlebrooks
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
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Reuter G, Moïse M, Roll W, Martin D, Lombard A, Scholtes F, Stummer W, Suero Molina E. Conventional and advanced imaging throughout the cycle of care of gliomas. Neurosurg Rev 2021; 44:2493-2509. [PMID: 33411093 DOI: 10.1007/s10143-020-01448-3] [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: 08/03/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Although imaging of gliomas has evolved tremendously over the last decades, published techniques and protocols are not always implemented into clinical practice. Furthermore, most of the published literature focuses on specific timepoints in glioma management. This article reviews the current literature on conventional and advanced imaging techniques and chronologically outlines their practical relevance for the clinical management of gliomas throughout the cycle of care. Relevant articles were located through the Pubmed/Medline database and included in this review. Interpretation of conventional and advanced imaging techniques is crucial along the entire process of glioma care, from diagnosis to follow-up. In addition to the described currently existing techniques, we expect deep learning or machine learning approaches to assist each step of glioma management through tumor segmentation, radiogenomics, prognostication, and characterization of pseudoprogression. Thorough knowledge of the specific performance, possibilities, and limitations of each imaging modality is key for their adequate use in glioma management.
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Affiliation(s)
- Gilles Reuter
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium. .,GIGA-CRC In-vivo Imaging Center, ULiege, Liège, Belgium.
| | - Martin Moïse
- Department of Radiology, University Hospital of Liège, Liège, Belgium
| | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany
| | - Didier Martin
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Arnaud Lombard
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Félix Scholtes
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium.,Department of Neuroanatomy, University of Liège, Liège, Belgium
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
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Ghinda DC, Yang Y, Wu S, Lu J, Su L, Damiani S, Tumati S, Jansen G, Duffau H, Wu JS, Northoff G. Personalized Multimodal Demarcation of Peritumoral Tissue in Glioma. JCO Precis Oncol 2020; 4:1128-1140. [PMID: 35050774 DOI: 10.1200/po.20.00115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Gliomas are life-threatening brain tumors, and the extent of surgical resection is one of the strongest influences on survival rate. However, the proper distinction of infiltrated tissue remains elusive. The aim of this study was to use multimodal analyses to demarcate peritumoral tissue (PT) from tumoral (TT) and healthy tissue (HT). METHODS A total of 40 patients with histologically confirmed glioma were recruited. We analyzed resting-state functional magnetic resonance imaging (rs-fMRI) using the voxel-based mean blood-oxygen-level-dependent (BOLD) signal and the corresponding structural MRI (s-MRI) alongside RNA sequencing, whole-exome sequencing, and histology results of biopsy samples obtained from PT, HT, and TT. RESULTS We demarcated a functionally defined PT area where the mean BOLD signal gradually decreased near the edge of the tumor and extended beyond the TT borders (as defined by s-MRI), which was confirmed on a case-by-case basis. Correspondingly, genetic analyses showed a gene expression pattern and mutational landscape of the PT that were distinct from that seen in HT and TT. The genetic characterization of PT relative to HT and TT converged with the MRI-defined PT zones. This was confirmed in three individual cases after additional histologic analysis. A wider PT was associated with a longer progression-free survival, which suggests PT might act as an intermediate area between TT and HT. CONCLUSION Combined multimodal imaging and genetic analyses can allow for an objective demarcation of the PT in glioma and a robust classification of the degree of infiltration of the PT. These findings could help improve both neurosurgical resection and radio-oncologic therapy.
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Affiliation(s)
- Diana C Ghinda
- Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Yufei Yang
- Genetron Health (Beijing) Co Ltd, Beijing, China
| | - Shuai Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junfeng Lu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Su
- Genetron Health (Beijing) Co Ltd, Beijing, China
| | - Stefano Damiani
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Shankar Tumati
- Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Gerard Jansen
- Department of Neuropathology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France.,Brain Plasticity, Stem Cells, and Glial Tumors Team, National Institute for Health and Medical Research, Montpellier, France
| | - Jin-Song Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Georg Northoff
- Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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Silva MA, See AP, Essayed WI, Golby AJ, Tie Y. Challenges and techniques for presurgical brain mapping with functional MRI. NEUROIMAGE-CLINICAL 2017; 17:794-803. [PMID: 29270359 PMCID: PMC5735325 DOI: 10.1016/j.nicl.2017.12.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/10/2017] [Accepted: 12/05/2017] [Indexed: 01/22/2023]
Abstract
Functional magnetic resonance imaging (fMRI) is increasingly used for preoperative counseling and planning, and intraoperative guidance for tumor resection in the eloquent cortex. Although there have been improvements in image resolution and artifact correction, there are still limitations of this modality. In this review, we discuss clinical fMRI's applications, limitations and potential solutions. These limitations depend on the following parameters: foundations of fMRI, physiologic effects of the disease, distinctions between clinical and research fMRI, and the design of the fMRI study. We also compare fMRI to other brain mapping modalities which should be considered as alternatives or adjuncts when appropriate, and discuss intraoperative use and validation of fMRI. These concepts direct the clinical application of fMRI in neurosurgical patients. fMRI is increasingly used for presurgical brain mapping for surgical planning. Understanding of the limitations of fMRI is critical for its clinical use. Clinical fMRI's challenges and potential solutions are discussed. Intraoperative use and validation of fMRI are discussed.
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Affiliation(s)
- Michael A Silva
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Alfred P See
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Walid I Essayed
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Alexandra J Golby
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Yanmei Tie
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
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Hall CN, Howarth C, Kurth-Nelson Z, Mishra A. Interpreting BOLD: towards a dialogue between cognitive and cellular neuroscience. Philos Trans R Soc Lond B Biol Sci 2017; 371:rstb.2015.0348. [PMID: 27574302 DOI: 10.1098/rstb.2015.0348] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 12/11/2022] Open
Abstract
Cognitive neuroscience depends on the use of blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to probe brain function. Although commonly used as a surrogate measure of neuronal activity, BOLD signals actually reflect changes in brain blood oxygenation. Understanding the mechanisms linking neuronal activity to vascular perfusion is, therefore, critical in interpreting BOLD. Advances in cellular neuroscience demonstrating differences in this neurovascular relationship in different brain regions, conditions or pathologies are often not accounted for when interpreting BOLD. Meanwhile, within cognitive neuroscience, the increasing use of high magnetic field strengths and the development of model-based tasks and analyses have broadened the capability of BOLD signals to inform us about the underlying neuronal activity, but these methods are less well understood by cellular neuroscientists. In 2016, a Royal Society Theo Murphy Meeting brought scientists from the two communities together to discuss these issues. Here, we consolidate the main conclusions arising from that meeting. We discuss areas of consensus about what BOLD fMRI can tell us about underlying neuronal activity, and how advanced modelling techniques have improved our ability to use and interpret BOLD. We also highlight areas of controversy in understanding BOLD and suggest research directions required to resolve these issues.This article is part of the themed issue 'Interpreting BOLD: a dialogue between cognitive and cellular neuroscience'.
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Affiliation(s)
| | - Clare Howarth
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Zebulun Kurth-Nelson
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
| | - Anusha Mishra
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
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Valsalva-induced elevation of intracranial pressure selectively decouples deoxygenated hemoglobin concentration from neuronal activation and functional brain imaging capability. Neuroimage 2017; 162:151-161. [DOI: 10.1016/j.neuroimage.2017.08.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 08/24/2017] [Accepted: 08/26/2017] [Indexed: 11/19/2022] Open
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Mishra A. Binaural blood flow control by astrocytes: listening to synapses and the vasculature. J Physiol 2016; 595:1885-1902. [PMID: 27619153 DOI: 10.1113/jp270979] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/15/2016] [Indexed: 12/28/2022] Open
Abstract
Astrocytes are the most common glial cells in the brain with fine processes and endfeet that intimately contact both neuronal synapses and the cerebral vasculature. They play an important role in mediating neurovascular coupling (NVC) via several astrocytic Ca2+ -dependent signalling pathways such as K+ release through BK channels, and the production and release of arachidonic acid metabolites. They are also involved in maintaining the resting tone of the cerebral vessels by releasing ATP and COX-1 derivatives. Evidence also supports a role for astrocytes in maintaining blood pressure-dependent change in cerebrovascular tone, and perhaps also in blood vessel-to-neuron signalling as posited by the 'hemo-neural hypothesis'. Thus, astrocytes are emerging as new stars in preserving the intricate balance between the high energy demand of active neurons and the supply of oxygen and nutrients from the blood by maintaining both resting blood flow and activity-evoked changes therein. Following neuropathology, astrocytes become reactive and many of their key signalling mechanisms are altered, including those involved in NVC. Furthermore, as they can respond to changes in vascular pressure, cardiovascular diseases might exert previously unknown effects on the central nervous system by altering astrocyte function. This review discusses the role of astrocytes in neurovascular signalling in both physiology and pathology, and the impact of these findings on understanding BOLD-fMRI signals.
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Affiliation(s)
- Anusha Mishra
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK
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Abstract
Functional magnetic resonance imaging (fMRI) maps the spatiotemporal distribution of neural activity in the brain under varying cognitive conditions. Since its inception in 1991, blood oxygen level-dependent (BOLD) fMRI has rapidly become a vital methodology in basic and applied neuroscience research. In the clinical realm, it has become an established tool for presurgical functional brain mapping. This chapter has three principal aims. First, we review key physiologic, biophysical, and methodologic principles that underlie BOLD fMRI, regardless of its particular area of application. These principles inform a nuanced interpretation of the BOLD fMRI signal, along with its neurophysiologic significance and pitfalls. Second, we illustrate the clinical application of task-based fMRI to presurgical motor, language, and memory mapping in patients with lesions near eloquent brain areas. Integration of BOLD fMRI and diffusion tensor white-matter tractography provides a road map for presurgical planning and intraoperative navigation that helps to maximize the extent of lesion resection while minimizing the risk of postoperative neurologic deficits. Finally, we highlight several basic principles of resting-state fMRI and its emerging translational clinical applications. Resting-state fMRI represents an important paradigm shift, focusing attention on functional connectivity within intrinsic cognitive networks.
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Affiliation(s)
- Bradley R Buchbinder
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Stippich C, Blatow M, Garcia M. Task-Based Presurgical Functional MRI in Patients with Brain Tumors. CLINICAL FUNCTIONAL MRI 2015. [DOI: 10.1007/978-3-662-45123-6_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Pressman P, Gitelman D. Pearls & oy-sters: functional MRI: a primer for neurology residents. Neurology 2012; 78:e68-71. [PMID: 22391609 DOI: 10.1212/wnl.0b013e318248e57a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Peter Pressman
- Department of Neurology, Northwestern University Medical School, Chicago, IL, USA.
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Wellmer J, Weber B, Urbach H, Reul J, Fernandez G, Elger CE. Cerebral lesions can impair fMRI-based language lateralization. Epilepsia 2009; 50:2213-24. [PMID: 19453706 DOI: 10.1111/j.1528-1167.2009.02102.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Several small patient studies and case reports raise concerns that the reliability of functional magnetic resonance imaging (fMRI) may be impaired in the vicinity of cerebral lesions. This could affect the clinical validity of fMRI for presurgical language lateralization. The current study sets out to identify if a systematic effect of lesion type and localization on fMRI exists. METHODS We classify lesions typically occurring in epilepsy patients according to (1) their potential to disturb blood oxygenation level dependent (BOLD)-effect generation or detection or to disturb spatial brain normalization, and (2) the proximity of lesions to protocol-specific volumes of interest (VOIs). The effect of lesions is evaluated through the examination of 238 epilepsy patients and a subgroup of 37 patients with suspected unilateral left-language dominance according to the Wada test. RESULTS Patients with fMRI-critical lesions such as cavernomas, gliomas, and mass defects close to VOIs, or with severe atrophy, show lower lateralization indices (LIs) and more often discordant language lateralization with the Wada test than do patients without such lesions. DISCUSSION This study points seriously toward fMRI-language lateralization being sensitive to cerebral lesions. Some lesion types and locations are more critical than others. Our results question the noncritical application of fMRI in patients with cerebral lesions.
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Affiliation(s)
- Jörg Wellmer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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Grabowski TJ, Damasio H, Eichhorn GR, Tranel D. Effects of gender on blood flow correlates of naming concrete entities. Neuroimage 2003; 20:940-54. [PMID: 14568464 DOI: 10.1016/s1053-8119(03)00284-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2003] [Revised: 05/02/2003] [Accepted: 05/08/2003] [Indexed: 11/25/2022] Open
Abstract
A cross-cohort PET analysis was performed in 62 normal subjects (31 men and 31 women) to address the issue of whether men and women have different physiologic correlates of naming visually presented concrete entities. The subjects named nonunique concrete entities in one or more conceptual categories and also performed a face orientation decision task. A second analysis was performed in 24 additional subjects to assess whether there were gender effects related to the face orientation decision task and to constrain the interpretation of the first analysis. Male subjects engaged the left inferotemporal region and several other left hemisphere regions more than female subjects did during visual naming. Areas showing more activity in female subjects included the right inferior frontal gyrus and right precentral cortex, regions that were less active in visual naming than in the face orientation decision task. In other words, the male subjects engaged the latter regions less or deactivated them more than female subjects. The results can be interpreted as showing a greater modulation of activity in both hemispheres for men compared to women. Although the gender effects we found are smaller than the task effects, they are not negligible for the purposes of performing and interpreting functional imaging studies.
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Affiliation(s)
- Thomas J Grabowski
- Department of Neurology, The University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
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Current awareness in NMR in biomedicine. NMR IN BIOMEDICINE 2003; 16:56-65. [PMID: 12619641 DOI: 10.1002/nbm.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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