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Manasse S, Koskas P, Savatovsky J, Deschamps R, Vignal-Clermont C, Boudot de la Motte M, Papeix C, Trunet S, Lecler A. Comparison between contrast-enhanced fat-suppressed 3D FLAIR brain MR images and T2-weighted orbital MR images at 3 Tesla for the diagnosis of acute optic neuritis. Diagn Interv Imaging 2024:S2211-5684(24)00170-0. [PMID: 39242307 DOI: 10.1016/j.diii.2024.08.001] [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: 04/27/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE The purpose of this study was to compare the capabilities of contrast-enhanced fat-suppressed (CE FS) three-dimensional fluid-attenuated inversion recovery (3D FLAIR) brain magnetic resonance imaging (MRI) with those of coronal T2-weighted orbital MRI obtained at 3 Tesla for the diagnosis of optic neuritis (ON). MATERIALS AND METHODS Patients who presented to our center with acute visual loss and underwent MRI examination of the orbits and the brain between November 2014 and February 2020 were retrospectively included. Three radiologists independently and blindly analyzed CE FS 3D FLAIR and coronal T2-weighted images. Disagreements in image interpretation were resolved by consensus with an independent neuroradiologist who was not involved in the initial reading sessions. The primary adjudication criterion for the diagnosis of ON was the presence of an optic nerve hypersignal. Sensitivity, specificity, and accuracy of CE 3D FLAIR brain images were compared with those of coronal T2-weighted orbital images using McNemar test. Artifacts were classified into three categories and compared between the two image sets. RESULTS A total of 1023 patients were included. There were 638 women and 385 men with a mean age of 42 ± 18.3 (standard deviation) years (age range: 6-92 years). Optic nerve hyperintensities were identified in 375/400 (94%) patients with ON using both 3D FLAIR and coronal T2-weighted images. Sensitivity, specificity, and accuracy of both sequences were 94% (95% CI: 91.3-96.1), 79% (95% CI: 75.5-82.2), and 89% (95% CI: 86.8-90.7), respectively. Optic disc hypersignal was detected in 120/400 patients (30%) using 3D FLAIR compared to 3/400 (0.75%) using coronal T2-weighted images (P < 0.001). Optic radiation hypersignal was observed in 2/400 (0.5%) patients using 3D FLAIR images. Significantly more artifacts (moderate or severe) were observed on coronal T2-weighted images (801/1023; 78%) by comparison with 3D FLAIR images (448/1023; 44%) (P < 0.001). CONCLUSION The performance of 3D FLAIR brain MRI for the diagnosis of ON is not different from that of coronal T2-weighted orbital MRI and its use for optic nerve analysis may be beneficial.
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Affiliation(s)
- Sharmiladevi Manasse
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France.
| | - Patricia Koskas
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | - Julien Savatovsky
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | - Romain Deschamps
- Department of Neurology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | | | | | - Caroline Papeix
- Department of Neurology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | - Stéphanie Trunet
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
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Geraldes R, Arrambide G, Banwell B, Rovira À, Cortese R, Lassmann H, Messina S, Rocca MA, Waters P, Chard D, Gasperini C, Hacohen Y, Mariano R, Paul F, DeLuca GC, Enzinger C, Kappos L, Leite MI, Sastre-Garriga J, Yousry T, Ciccarelli O, Filippi M, Barkhof F, Palace J. The influence of MOGAD on diagnosis of multiple sclerosis using MRI. Nat Rev Neurol 2024:10.1038/s41582-024-01005-2. [PMID: 39227463 DOI: 10.1038/s41582-024-01005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 09/05/2024]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an immune-mediated demyelinating disease that is challenging to differentiate from multiple sclerosis (MS), as the clinical phenotypes overlap, and people with MOGAD can fulfil the current MRI-based diagnostic criteria for MS. In addition, the MOG antibody assays that are an essential component of MOGAD diagnosis are not standardized. Accurate diagnosis of MOGAD is crucial because the treatments and long-term prognosis differ from those for MS. This Expert Recommendation summarizes the outcomes from a Magnetic Resonance Imaging in MS workshop held in Oxford, UK in May 2022, in which MS and MOGAD experts reflected on the pathology and clinical features of these disorders, the contributions of MRI to their diagnosis and the clinical use of the MOG antibody assay. We also critically reviewed the literature to assess the validity of distinctive imaging features in the current MS and MOGAD criteria. We conclude that dedicated orbital and spinal cord imaging (with axial slices) can inform MOGAD diagnosis and also illuminate differential diagnoses. We provide practical guidance to neurologists and neuroradiologists on how to navigate the current MOGAD and MS criteria. We suggest a strategy that includes useful imaging discriminators on standard clinical MRI and discuss imaging features detected by non-conventional MRI sequences that demonstrate promise in differentiating these two disorders.
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Affiliation(s)
- Ruth Geraldes
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK.
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK
| | - Mara Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Declan Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (CLH) Biomedical Research Centre, London, UK
| | - Claudio Gasperini
- Multiple Sclerosis Centre, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience, University Hospital and University, Basel, Switzerland
| | - M Isabel Leite
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Tarek Yousry
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, UK
- University College London Hospitals (UCLH) National Institute for Health and Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Jacqueline Palace
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
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Labella Álvarez F, Mosleh R, Bouthour W, Saindane AM, Bruce BB, Dattilo M, Newman NJ, Biousse V. Optic Nerve MRI T2-Hyperintensity: A Nonspecific Marker of Optic Nerve Damage. J Neuroophthalmol 2024; 44:22-29. [PMID: 38251954 DOI: 10.1097/wno.0000000000002017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND MRI abnormalities are common in optic neuropathies, especially on dedicated orbital imaging. In acute optic neuritis, optic nerve T2-hyperintensity associated with optic nerve contrast enhancement is the typical imaging finding. In chronic optic neuropathies, optic nerve T2-hyperintensity and atrophy are regularly seen. Isolated optic nerve T2-hyperintensity is often erroneously presumed to reflect optic neuritis, frequently prompting unnecessary investigations and neuro-ophthalmology consultations. Our goal was to determine the significance of optic nerve/chiasm T2-hyperintensity and/or atrophy on MRI. METHODS Retrospective study of consecutive patients who underwent brain/orbital MRI with/without contrast at our institution between July 1, 2019, and June 6, 2022. Patients with optic nerve/chiasm T2-hyperintensity and/or atrophy were included. Medical records were reviewed to determine the etiology of the T2-hyperintensity and/or atrophy. RESULTS Four hundred seventy-seven patients (698 eyes) were included [mean age 52 years (SD ±18 years); 57% women]. Of the 364 of 698 eyes with optic nerve/chiasm T2-hyperintensity without atrophy, the causes were compressive (104), inflammatory (103), multifactorial (49), glaucoma (21), normal (19), and other (68); of the 219 of 698 eyes with optic nerve/chiasm T2-hyperintensity and atrophy, the causes were compressive (57), multifactorial (40), inflammatory (38), glaucoma (33), normal (7), and other (44); of the 115 of 698 eyes with optic nerve/chiasm atrophy without T2-hyperintensity, the causes were glaucoma (34), multifactorial (21), inflammatory (13), compressive (11), normal (10), and other (26). Thirty-six eyes with optic nerve/chiasm T2-hyperintensity or atrophy did not have evidence of optic neuropathy or retinopathy on ophthalmologic examination, and 17 eyes had clinical evidence of severe retinopathy without primary optic neuropathy. CONCLUSIONS Optic nerve T2-hyperintensity or atrophy can be found with any cause of optic neuropathy and with severe chronic retinopathy. These MRI findings should not automatically prompt optic neuritis diagnosis, workup, and treatment, and caution is advised regarding their use in the diagnostic criteria for multiple sclerosis. Cases of incidentally found MRI optic nerve T2-hyperintensity and/or atrophy without a known underlying optic neuropathy or severe retinopathy are rare. Such patients should receive an ophthalmologic examination before further investigations.
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Affiliation(s)
- Fernando Labella Álvarez
- Departments of Ophthalmology (FLÁ, RM, WB, BBB, MD, NJN, VB), Radiology and Imaging Sciences (AMS), Neurological Surgery (AMS, NJN), and Neurology (BBB, NJN, VB), Emory University School of Medicine, Atlanta, Georgia; Sheba Medical Center (RM), Goldschleger Eye Institute, Tel Hashomer, Israel; and Department of Epidemiology (BBB), Rollins School of Public Health, Emory University, Atlanta, Georgia
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Song C, Luo Y, Huang W, Duan Y, Deng X, Chen H, Yu G, Huang K, Xu S, Lin X, Wang Y, Shen J. Extraocular muscle volume index at the orbital apex with optic neuritis: a combined parameter for diagnosis of dysthyroid optic neuropathy. Eur Radiol 2023; 33:9203-9212. [PMID: 37405499 DOI: 10.1007/s00330-023-09848-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of the extraocular muscle volume index at the orbital apex (AMI) and the signal intensity ratio (SIR) of the optic nerve in dysthyroid optic neuropathy (DON). METHODS Clinical data and magnetic resonance imaging were collected retrospectively from 63 Graves' ophthalmopathy patients, including 24 patients with DON and 39 without DON. The volume of these structures was obtained by reconstructing their orbital fat and extraocular muscles. The SIR of the optic nerve and axial length of eyeball were also measured. The posterior 3/5 of the retrobulbar space volume was used as the orbital apex to compare parameters in patients with or without DON. Area under the receiver operating characteristic curve (AUC) analysis was used to select the morphological and inflammatory parameters with the highest diagnostic value. A logistic regression was performed to identify the risk factors of DON. RESULTS One hundred twenty-six orbits (35 with DON and 91 without DON) were analyzed. Most of the parameters in DON patients were significantly higher than in non-DON patients. However, the SIR 3 mm behind the eyeball of the optic nerve and AMI had the highest diagnostic value in these parameters and are independent risk factors of DON by stepwise multivariate logistic regression analysis. Combining AMI and SIR had a higher diagnostic value than a single index. CONCLUSIONS Combining AMI with SIR 3 mm behind the eyeball's orbital nerve can be a potential parameter for diagnosing DON. CLINICAL RELEVANCE STATEMENT The present study provided a quantitative index based on morphological and signal changes to assess the DON, allowing clinicians and radiologists to monitor DON patients timely. KEY POINTS The extraocular muscle volume index at the orbital apex (AMI) has excellent diagnostic performance for dysthyroid optic neuropathy. A signal intensity ratio (SIR) of 3 mm behind the eyeball has a higher AUC compared to other slices. Combining AMI and SIR has a higher diagnostic value than a single index.
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Affiliation(s)
- Cheng Song
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Jiazi Road, Lunjiao Town, Shunde District, Guangdong, 528308, Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yaosheng Luo
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Jiazi Road, Lunjiao Town, Shunde District, Guangdong, 528308, Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Weihong Huang
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Jiazi Road, Lunjiao Town, Shunde District, Guangdong, 528308, Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yongbo Duan
- Department of Ophthalmopathy, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Foshan, China
| | - Xuefeng Deng
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Jiazi Road, Lunjiao Town, Shunde District, Guangdong, 528308, Foshan, China
| | - Haixiong Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Radiology, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Foshan, China
| | - Genfeng Yu
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Jiazi Road, Lunjiao Town, Shunde District, Guangdong, 528308, Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Kai Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Radiology, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Foshan, China
| | - Sirong Xu
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Jiazi Road, Lunjiao Town, Shunde District, Guangdong, 528308, Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaoxin Lin
- Department of Radiology, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Foshan, China
| | - Yi Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Jie Shen
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University, (The First People's Hospital of Shunde), Jiazi Road, Lunjiao Town, Shunde District, Guangdong, 528308, Foshan, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Martí-Juan G, Frías M, Garcia-Vidal A, Vidal-Jordana A, Alberich M, Calderon W, Piella G, Camara O, Montalban X, Sastre-Garriga J, Rovira À, Pareto D. Detection of lesions in the optic nerve with magnetic resonance imaging using a 3D convolutional neural network. Neuroimage Clin 2022; 36:103187. [PMID: 36126515 PMCID: PMC9486565 DOI: 10.1016/j.nicl.2022.103187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/14/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Optic neuritis (ON) is one of the first manifestations of multiple sclerosis, a disabling disease with rising prevalence. Detecting optic nerve lesions could be a relevant diagnostic marker in patients with multiple sclerosis. OBJECTIVES We aim to create an automated, interpretable method for optic nerve lesion detection from MRI scans. MATERIALS AND METHODS We present a 3D convolutional neural network (CNN) model that learns to detect optic nerve lesions based on T2-weighted fat-saturated MRI scans. We validated our system on two different datasets (N = 107 and 62) and interpreted the behaviour of the model using saliency maps. RESULTS The model showed good performance (68.11% balanced accuracy) that generalizes to unseen data (64.11%). The developed network focuses its attention to the areas that correspond to lesions in the optic nerve. CONCLUSIONS The method shows robustness and, when using only a single imaging sequence, its performance is not far from diagnosis by trained radiologists with the same constraint. Given its speed and performance, the developed methodology could serve as a first step to develop methods that could be translated into a clinical setting.
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Affiliation(s)
- Gerard Martí-Juan
- Neuroradiology Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Marcos Frías
- BCN Medtech, Department of Information and Communication Technologies, Barcelona, Spain
| | - Aran Garcia-Vidal
- Neuroradiology Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Angela Vidal-Jordana
- Department of Neurology, Multiple Sclerosis center of Catalonia (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Manel Alberich
- Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Willem Calderon
- Neuroradiology Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Gemma Piella
- BCN Medtech, Department of Information and Communication Technologies, Barcelona, Spain
| | - Oscar Camara
- BCN Medtech, Department of Information and Communication Technologies, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology, Multiple Sclerosis center of Catalonia (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology, Multiple Sclerosis center of Catalonia (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Àlex Rovira
- Neuroradiology Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Deborah Pareto
- Neuroradiology Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain.
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