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Moradi B, Ardestani RM, Shirazi M, Eslamian L, Kazemi MA. Fetal intracranial hemorrhage and infarct: Main sonographic and MRI characteristics: A review article. Eur J Obstet Gynecol Reprod Biol X 2024; 24:100351. [PMID: 39610469 PMCID: PMC11603015 DOI: 10.1016/j.eurox.2024.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 10/24/2024] [Accepted: 10/31/2024] [Indexed: 11/30/2024] Open
Abstract
Early detection of fetal intracranial hemorrhage and infarct during pregnancy is crucial for preventing lethal and debilitating complications in neonatal life. Every radiologist must be aware of the imaging features of these conditions to refer patients to specialists. Sonographic and MRI features of fetal intracranial hemorrhage and infarct have been discussed in many previous articles. The aim of this article is to organize and categorize these findings into a practical guideline for improved application in diagnosing these diseases. The use of MRI sequences, such as DWI and multiplanar EPI should be developed for suspected prenatal infarct and intracranial hemorrhage and can serve as additional tools for early detection. In this review article, we first explain possible etiologic factors contributing to the development of fetal IVH and infarct. Then we discuss the different imaging features of these disorders on sonography and MRI separately, as well as their differential diagnosis. Finally, the mortality and morbidity associated with these two concerning fetal abnormalities will be addressed.
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Affiliation(s)
- Behnaz Moradi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Mortazavi Ardestani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, Fetal and Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Laleh Eslamian
- Department of Obstetric and Gynecology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Kazemi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Hedayati E, Safari F, Verghese G, Ciancia VR, Sodickson DK, Dehkharghani S, Alon L. An experimental system for detection and localization of hemorrhage using ultra-wideband microwaves with deep learning. COMMUNICATIONS ENGINEERING 2024; 3:126. [PMID: 39242634 PMCID: PMC11379885 DOI: 10.1038/s44172-024-00259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 08/05/2024] [Indexed: 09/09/2024]
Abstract
Stroke is a leading cause of mortality and disability. Emergent diagnosis and intervention are critical, and predicated upon initial brain imaging; however, existing clinical imaging modalities are generally costly, immobile, and demand highly specialized operation and interpretation. Low-energy microwaves have been explored as a low-cost, small form factor, fast, and safe probe for tissue dielectric properties measurements, with both imaging and diagnostic potential. Nevertheless, challenges inherent to microwave reconstruction have impeded progress, hence conduction of microwave imaging remains an elusive scientific aim. Herein, we introduce a dedicated experimental framework comprising a robotic navigation system to translate blood-mimicking phantoms within a human head model. An 8-element ultra-wideband array of modified antipodal Vivaldi antennas was developed and driven by a two-port vector network analyzer spanning 0.6-9.0 GHz at an operating power of 1 mW. Complex scattering parameters were measured, and dielectric signatures of hemorrhage were learned using a dedicated deep neural network for prediction of hemorrhage classes and localization. An overall sensitivity and specificity for detection >0.99 was observed, with Rayleigh mean localization error of 1.65 mm. The study establishes the feasibility of a robust experimental model and deep learning solution for ultra-wideband microwave stroke detection.
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Affiliation(s)
- Eisa Hedayati
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
| | - Fatemeh Safari
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
| | - George Verghese
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
| | - Vito R Ciancia
- LaGuardia Studios, New York University, New York, NY, USA
| | - Daniel K Sodickson
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
| | - Seena Dehkharghani
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA.
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA.
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA.
| | - Leeor Alon
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA.
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA.
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Han W, Song Y, Rocha M, Shi Y. Ischemic brain edema: Emerging cellular mechanisms and therapeutic approaches. Neurobiol Dis 2023; 178:106029. [PMID: 36736599 DOI: 10.1016/j.nbd.2023.106029] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/14/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Brain edema is one of the most devastating consequences of ischemic stroke. Malignant cerebral edema is the main reason accounting for the high mortality rate of large hemispheric strokes. Despite decades of tremendous efforts to elucidate mechanisms underlying the formation of ischemic brain edema and search for therapeutic targets, current treatments for ischemic brain edema remain largely symptom-relieving rather than aiming to stop the formation and progression of edema. Recent preclinical research reveals novel cellular mechanisms underlying edema formation after brain ischemia and reperfusion. Advancement in neuroimaging techniques also offers opportunities for early diagnosis and prediction of malignant brain edema in stroke patients to rapidly adopt life-saving surgical interventions. As reperfusion therapies become increasingly used in clinical practice, understanding how therapeutic reperfusion influences the formation of cerebral edema after ischemic stroke is critical for decision-making and post-reperfusion management. In this review, we summarize these research advances in the past decade on the cellular mechanisms, and evaluation, prediction, and intervention of ischemic brain edema in clinical settings, aiming to provide insight into future preclinical and clinical research on the diagnosis and treatment of brain edema after stroke.
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Affiliation(s)
- Wenxuan Han
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Yang Song
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Marcelo Rocha
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Yejie Shi
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America.
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Haggenmüller B, Kreiser K, Sollmann N, Huber M, Vogele D, Schmidt SA, Beer M, Schmitz B, Ozpeynirci Y, Rosskopf J, Kloth C. Pictorial Review on Imaging Findings in Cerebral CTP in Patients with Acute Stroke and Its Mimics: A Primer for General Radiologists. Diagnostics (Basel) 2023; 13:diagnostics13030447. [PMID: 36766552 PMCID: PMC9914845 DOI: 10.3390/diagnostics13030447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
The imaging evaluation of computed tomography (CT), CT angiography (CTA), and CT perfusion (CTP) is of crucial importance in the setting of each emergency department for suspected cerebrovascular impairment. A fast and clear assignment of characteristic imaging findings of acute stroke and its differential diagnoses is essential for every radiologist. Different entities can mimic clinical signs of an acute stroke, thus the knowledge and fast identification of stroke mimics is important. A fast and clear assignment is necessary for a correct diagnosis and a rapid initiation of appropriate therapy. This pictorial review describes the most common imaging findings in CTP with clinical signs for acute stroke or other acute neurological disorders. The knowledge of these pictograms is therefore essential and should also be addressed in training and further education of radiologists.
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Affiliation(s)
- Benedikt Haggenmüller
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
- Correspondence:
| | - Kornelia Kreiser
- Department of Radiology and Neuroradiology, RKU—Universitäts- und Rehabilitationskliniken Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Magdalena Huber
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Stefan A. Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Bernd Schmitz
- Department of Neuroradiology, Bezirkskrankenhaus Günzburg, Lindenallee 2, 89312 Günzburg, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Johannes Rosskopf
- Department of Neuroradiology, Bezirkskrankenhaus Günzburg, Lindenallee 2, 89312 Günzburg, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Obenaus A, Badaut J. Role of the noninvasive imaging techniques in monitoring and understanding the evolution of brain edema. J Neurosci Res 2021; 100:1191-1200. [PMID: 34048088 DOI: 10.1002/jnr.24837] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/13/2021] [Indexed: 12/21/2022]
Abstract
Human brain injury elicits accumulation of water within the brain due to a variety of pathophysiological processes. As our understanding of edema emerged two temporally (and cellular) distinct processes were identified, cytotoxic and vasogenic edema. The emergence of both types of edema is reflected by the temporal evolution and is influenced by the underlying pathology (type and extent). However, this two-edema compartment model does not adequately describe the transition between cytotoxic and vasogenic edema. Hence, a third category has been proposed, termed ionic edema, that is observed in the transition between cytotoxic and vasogenic edema. Magnetic resonance neuroimaging of edema today primarily utilizes T2-weighted (T2WI) and diffusion-weighted imaging (DWI). Clinical diagnostics and translational science studies have clearly demonstrated the temporal ability of both T2WI and DWI to monitor edema content and evolution. DWI measures water mobility within the brain reflecting cytotoxic edema. T2WI at later time points when vasogenic edema develops visualizes increased water content in the brain. Clinically relevant imaging modalities, including ultrasound and positron emission tomography, are not typically used to assess edema. In sum, edema imaging is an important cornerstone of clinical diagnostics and translational studies and can guide effective therapeutics manage edema and improve patient outcomes.
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Affiliation(s)
- Andre Obenaus
- Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA.,Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Jérôme Badaut
- Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA.,CNRS UMR5287, INCIA, University of Bordeaux, Bordeaux, France
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Penailillo E, Bravo-Grau S, Plaza N, Cruz JP. Cerebral Venous Thrombosis: Review of Diagnosis, Follow-Up, Late Complications and Potential Pitfalls. Curr Probl Diagn Radiol 2020; 50:725-733. [PMID: 32950306 DOI: 10.1067/j.cpradiol.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
Cerebral venous thrombosis is a less common but relevant cause of stroke in adults. The clinical manifestations are nonspecific leading frequently diagnostic delays, so imaging findings are is of vital importance. Conventional imaging modalities, namely computed tomography and magnetic resonance imaging (MRI), allow identification of the thrombus and parenchymal involvement due to venous congestion to a variable degree, but this entity may appears as a nonexpected finding in a nonvenographic study. computed tomography and MRI venographies allow noninvasive confirmation of the diagnosis and adequate characterization of the extent of the thrombus and acute complications, both of them being robust diagnostic techniques. MR venography also can be done without the use of contrast media, which is especially important in certain clinical situations. Cerebral venous thrombosis needs follow-up, and imaging plays a key role in detection of late complications of the disease, including dural arteriovenous fistulas and intracranial hypertension due to veno-occlusive disease. Knowledge of other diseases and conditions that may mimic a thrombus is needed to avoid wrong diagnosis. In this article, we conduct a pictorial comprehensive review of cerebral venous thrombosis, including also the technical aspects of different imaging modalities, diagnosis and acute complications, follow-up, late complications and potential imaging mimics.
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Affiliation(s)
- Eduardo Penailillo
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile
| | - Sebastian Bravo-Grau
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile
| | - Nicole Plaza
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile
| | - Juan Pablo Cruz
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile.
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Padmanabhan D, Kella D, Isath A, Tandon N, Mulpuru S, Deshmukh A, Kapa S, Mehta R, Dalzell C, Olson N, Felmlee J, Jondal ML, Asirvatham SJ, Watson RE, Cha YM, Friedman P. Prospective evaluation of the utility of magnetic resonance imaging in patients with non-MRI-conditional pacemakers and defibrillators. J Cardiovasc Electrophysiol 2020; 31:2931-2939. [PMID: 32757438 DOI: 10.1111/jce.14705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/11/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) in patients with legacy cardiovascular implantable electronic devices (CIEDs) in situ is likely underutilized. We hypothesized the clinical benefit of MRI would outweigh the risks in legacy CIED patients. METHODS This is a single-center retrospective study that evaluated and classified the utility of MRI using a prospectively maintained database. The outcomes were classified as aiding in diagnosis, treatment, or both for the patients attributable to the MRI. We then assessed the incidence of adverse effects (AE) when the MRI was performed. RESULTS In 668, MRIs performed on 479 patients, only 13 (1.9%) MRIs did not aid in the diagnosis or treatment of the patient. Power-on reset events without clinical sequelae in three scans (0.45%) were the only AE. The probability of an adverse event happening without any benefit from the MRI scan was 1.1 × 10-4 . A maximum benefit in diagnosis using MRI was obtained in ruling out space-occupying lesions (121/185 scans, 65.4%). Scans performed in patients for elucidating answers to queries in treatment were most frequently done for disease staging at long term follow-up (167/470 scans, 35.5%). Conservative treatment (184/470 scans, 39%) followed by medication changes (153/470 scans, 28.7%) were the most common treatment decisions made. CONCLUSIONS The utility of MRI in patients with non-MRI-conditional CIEDs far outweighs the risk of adverse events when imaging is done in the context of a multidisciplinary program that oversees patient safety.
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Affiliation(s)
- Deepak Padmanabhan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Danesh Kella
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ameesh Isath
- Department of Medicine, Mount Sinai Morningside, New York City, New York, USA
| | - Nidhi Tandon
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva Mulpuru
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ramila Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Connie Dalzell
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Nora Olson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel Felmlee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary L Jondal
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Robert E Watson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong M Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Advanced Neuroimaging Techniques for Difficult Diagnoses. J Craniofac Surg 2018; 29:e757-e759. [DOI: 10.1097/scs.0000000000004711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ozturk K, Soylu E, Parlak M. Dural venous sinus thrombosis: The combination of noncontrast CT, MRI and PC-MR venography to enhance accuracy. Neuroradiol J 2018; 31:473-481. [PMID: 29869561 DOI: 10.1177/1971400918781969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim The aim of this article is to determine whether a combination of noncontrast CT (NCCT), three-dimensional-phase contrast magnetic resonance venography (3D PC-MRV), T1- and T2-weighted MRI sequences can help to identify acute and subacute dural venous sinus thrombosis (DVST) with greater accuracy. Methods A total of 147 patients with DVST ( n = 30) and a control group ( n = 117) underwent NCCT, T1- and T2-weighted MRI sequences, and 3D PC-MRV from 2012 to 2016. Two experienced observers interpreted the images retrospectively for the presence of DVST. Nonvisualization of the dural venous sinuses on 3D PC-MRV and signal changes supporting acute or subacute thrombus on T2- and T1-weighted images were considered a direct sign of DVST. Also, using circle region of interest (ROI) techniques, attenuation measurement from each sinus was obtained on NCCT. Sensitivity and specificity were computed for these modalities separately and in combination for diagnosis of DVST using digital subtraction angiography as the reference standard. Results Nonvisualization of venous sinuses on 3D PC-MRV (sensitivity 100%, specificity 71%) in combination with both applying Hounsfield unit (HU) threshold values of greater than 60 on NCCT (sensitivity 70%, specificity 94%) and acquiring signal changes supporting DVST on T2- and T1-weighted images (sensitivity 83%, specificity 96%), were found to have 100% sensitivity and 100% specificity in the identification of acute or subacute DVST. Conclusion The combination of NCCT, T1- and T2-weighted MRI and 3D PC-MRV may allow the diagnosis of acute or subacute DVST and may obviate the need for contrast usage in patients with renal impairment or contrast allergies.
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Affiliation(s)
- Kerem Ozturk
- 1 Department of Radiology, Uludag University Faculty of Medicine, Gorukle Street, 16059, Bursa, Turkey.,2 Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, 55455, USA
| | - Esra Soylu
- 3 Radiology Clinic, Cekirge State Hospital, Bursa, Turkey
| | - Mufit Parlak
- 1 Department of Radiology, Uludag University Faculty of Medicine, Gorukle Street, 16059, Bursa, Turkey
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Dehkharghani S, Andre J. Imaging Approaches to Stroke and Neurovascular Disease. Neurosurgery 2017; 80:681-700. [DOI: 10.1093/neuros/nyw108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 12/02/2016] [Indexed: 11/14/2022] Open
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