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Erschienen in: Surgical and Radiologic Anatomy 8/2012

01.10.2012 | Original Article

Corticospinal tractography with morphological, functional and diffusion tensor MRI: a comparative study of four deterministic algorithms used in clinical routine

Erschienen in: Surgical and Radiologic Anatomy | Ausgabe 8/2012

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Abstract

Purpose

Diffusion tensor imaging permits study of white matter fibre bundles; however, its main limitation is lack of validation on anatomical data, especially in crossing fibre regions. Our study aimed to compare four deterministic tractography algorithms used in clinical routine. We studied the corticospinal tract, the bundle mediating voluntary movement. Our study seeks to evaluate tractography provided by algorithms through comparative analysis by expert neuroradiologists.

Methods

MRI data from 15 right-handed volunteers (30.8 years) were studied. Regions of interest (ROIs) were segmented on morphological and functional MRI. Diffusion weighted images (15 directions) were performed, then for each voxel the tensor was estimated. Tractography of the corticospinal tract was performed using four fibre-tracking algorithms. Three numerical integration methods Euler, Runge–Kutta second (RK2) and fourth order (RK4), and a tensor deflection method (TEND). Quantitative measurement was performed. Qualitative evaluation was carried out by two expert neuroradiologists using Kappa test concordance.

Results

For the quantitative aspect, only RK2 and TEND presented no significant difference concerning the number of fibres (p = 0.58). There was no difference between right and left side for each algorithm. Regarding the qualitative aspects, there was a lack of fibres from the ventrolateral part of the functional ROIs. Comparison by expert neuroradiologists revealed low rather than high concordance. The algorithm ranked first was RK2 according to expert preferences.

Conclusions

Different algorithms used in clinical routine failed to show realistic anatomical bundles. The most mathematically robust algorithm was not selected, nor was the algorithm defining more fibres. Validation of anatomical data provided by tractography remains a challenge.
Literatur
1.
Zurück zum Zitat Annett M (1970) A classification of hand preference by association analysis. Br J Psychol 61:303–321PubMedCrossRef Annett M (1970) A classification of hand preference by association analysis. Br J Psychol 61:303–321PubMedCrossRef
2.
Zurück zum Zitat Bammer R, Auer M, Keeling SL, Augustin M, Stables LA, Prokesch RW, Stollberger R, Moseley ME, Fazekas F (2002) Diffusion tensor imaging using single-shot SENSE-EPI. Magn Reson Med 48:128–136PubMedCrossRef Bammer R, Auer M, Keeling SL, Augustin M, Stables LA, Prokesch RW, Stollberger R, Moseley ME, Fazekas F (2002) Diffusion tensor imaging using single-shot SENSE-EPI. Magn Reson Med 48:128–136PubMedCrossRef
3.
Zurück zum Zitat Basser PJ, Pajevic S, Pierpaoli C, Duda J, Aldroubi A (2000) In vivo fiber tractography using DT-MRI data. Magn Reson Med 44:625–632PubMedCrossRef Basser PJ, Pajevic S, Pierpaoli C, Duda J, Aldroubi A (2000) In vivo fiber tractography using DT-MRI data. Magn Reson Med 44:625–632PubMedCrossRef
4.
Zurück zum Zitat Burgel U, Madler B, Honey CR, Thron A, Gilsbach J, Coenen VA (2009) Fiber tracking with distinct software tools results in a clear diversity in anatomical fiber tract portrayal. Cen Eur Neurosurg 70:27–35CrossRef Burgel U, Madler B, Honey CR, Thron A, Gilsbach J, Coenen VA (2009) Fiber tracking with distinct software tools results in a clear diversity in anatomical fiber tract portrayal. Cen Eur Neurosurg 70:27–35CrossRef
5.
Zurück zum Zitat Caulo M, Briganti C, Mattei PA, Perfetti B, Ferretti A, Romani GL, Tartaro A, Colosimo C (2007) New morphologic variants of the hand motor cortex as seen with MR imaging in a large study population. AJNR Am J Neuroradiol 28:1480–1485PubMedCrossRef Caulo M, Briganti C, Mattei PA, Perfetti B, Ferretti A, Romani GL, Tartaro A, Colosimo C (2007) New morphologic variants of the hand motor cortex as seen with MR imaging in a large study population. AJNR Am J Neuroradiol 28:1480–1485PubMedCrossRef
6.
Zurück zum Zitat Cheng P, Magnotta VA, Wu D, Nopoulos P, Moser DJ, Paulsen J, Jorge R, Andreasen NC (2006) Evaluation of the GTRACT diffusion tensor tractography algorithm: a validation and reliability study. Neuroimage 31:1075–1085PubMedCrossRef Cheng P, Magnotta VA, Wu D, Nopoulos P, Moser DJ, Paulsen J, Jorge R, Andreasen NC (2006) Evaluation of the GTRACT diffusion tensor tractography algorithm: a validation and reliability study. Neuroimage 31:1075–1085PubMedCrossRef
7.
Zurück zum Zitat Cherubini A, Luccichenti G, Peran P, Hagberg GE, Barba C, Formisano R, Sabatini U (2007) Multimodal fMRI tractography in normal subjects and in clinically recovered traumatic brain injury patients. Neuroimage 34:1331–1341PubMedCrossRef Cherubini A, Luccichenti G, Peran P, Hagberg GE, Barba C, Formisano R, Sabatini U (2007) Multimodal fMRI tractography in normal subjects and in clinically recovered traumatic brain injury patients. Neuroimage 34:1331–1341PubMedCrossRef
8.
Zurück zum Zitat Chung HW, Chou MC, Chen CY (2011) Principles and limitations of computational algorithms in clinical diffusion tensor MR tractography. AJNR Am J Neuroradiol 32:3–13PubMedCrossRef Chung HW, Chou MC, Chen CY (2011) Principles and limitations of computational algorithms in clinical diffusion tensor MR tractography. AJNR Am J Neuroradiol 32:3–13PubMedCrossRef
9.
Zurück zum Zitat Ciccarelli O, Catani M, Johansen-Berg H, Clark C, Thompson A (2008) Diffusion-based tractography in neurological disorders: concepts, applications, and future developments. Lancet Neurol 7:715–727PubMedCrossRef Ciccarelli O, Catani M, Johansen-Berg H, Clark C, Thompson A (2008) Diffusion-based tractography in neurological disorders: concepts, applications, and future developments. Lancet Neurol 7:715–727PubMedCrossRef
10.
Zurück zum Zitat Ciccarelli O, Parker GJ, Toosy AT, Wheeler-Kingshott CA, Barker GJ, Boulby PA, Miller DH, Thompson AJ (2003) From diffusion tractography to quantitative white matter tract measures: a reproducibility study. Neuroimage 18:348–359PubMedCrossRef Ciccarelli O, Parker GJ, Toosy AT, Wheeler-Kingshott CA, Barker GJ, Boulby PA, Miller DH, Thompson AJ (2003) From diffusion tractography to quantitative white matter tract measures: a reproducibility study. Neuroimage 18:348–359PubMedCrossRef
11.
Zurück zum Zitat Conturo TE, Lori NF, Cull TS, Akbudak E, Snyder AZ, Shimony JS, McKinstry RC, Burton H, Raichle ME (1999) Tracking neuronal fiber pathways in the living human brain. Proc Natl Acad Sci USA 96:10422–10427PubMedCrossRef Conturo TE, Lori NF, Cull TS, Akbudak E, Snyder AZ, Shimony JS, McKinstry RC, Burton H, Raichle ME (1999) Tracking neuronal fiber pathways in the living human brain. Proc Natl Acad Sci USA 96:10422–10427PubMedCrossRef
12.
Zurück zum Zitat Dellatolas G, De Agostini M, Jallon P, Poncet M, Rey M, Lellouch J (1988) Mesure de la préférence manuelle par autoquestionnaire dans la population française adulte. Rev Psychol appl 38:117–136 Dellatolas G, De Agostini M, Jallon P, Poncet M, Rey M, Lellouch J (1988) Mesure de la préférence manuelle par autoquestionnaire dans la population française adulte. Rev Psychol appl 38:117–136
13.
Zurück zum Zitat Descoteaux M, Deriche R, Knosche TR, Anwander A (2009) Deterministic and probabilistic tractography based on complex fibre orientation distributions. IEEE Trans Med Imaging 28:269–286PubMedCrossRef Descoteaux M, Deriche R, Knosche TR, Anwander A (2009) Deterministic and probabilistic tractography based on complex fibre orientation distributions. IEEE Trans Med Imaging 28:269–286PubMedCrossRef
14.
Zurück zum Zitat Fernandez-Miranda JC, Rhoton AL Jr, Alvarez-Linera J, Kakizawa Y, Choi C, de Oliveira EP (2008) Three-dimensional microsurgical and tractographic anatomy of the white matter of the human brain. Neurosurgery 62:989–1026PubMedCrossRef Fernandez-Miranda JC, Rhoton AL Jr, Alvarez-Linera J, Kakizawa Y, Choi C, de Oliveira EP (2008) Three-dimensional microsurgical and tractographic anatomy of the white matter of the human brain. Neurosurgery 62:989–1026PubMedCrossRef
15.
Zurück zum Zitat Fillard P, Arsigny V, Pennec X, Hayashi KM, Thompson PM, Ayache N (2007) Measuring brain variability by extrapolating sparse tensor fields measured on sulcal lines. Neuroimage 34:639–650PubMedCrossRef Fillard P, Arsigny V, Pennec X, Hayashi KM, Thompson PM, Ayache N (2007) Measuring brain variability by extrapolating sparse tensor fields measured on sulcal lines. Neuroimage 34:639–650PubMedCrossRef
16.
Zurück zum Zitat Fillard P, Descoteaux M, Goh A, Gouttard S, Jeurissen B, Malcolm J, Ramirez-Manzanares A, Reisert M, Sakaie K, Tensaouti F, Yo T, Mangin JF, Poupon C (2011) Quantitative evaluation of 10 tractography algorithms on a realistic diffusion MR phantom. Neuroimage 56:220–234PubMedCrossRef Fillard P, Descoteaux M, Goh A, Gouttard S, Jeurissen B, Malcolm J, Ramirez-Manzanares A, Reisert M, Sakaie K, Tensaouti F, Yo T, Mangin JF, Poupon C (2011) Quantitative evaluation of 10 tractography algorithms on a realistic diffusion MR phantom. Neuroimage 56:220–234PubMedCrossRef
17.
Zurück zum Zitat Friston KJ, Holmes AP, Worsley KJ, Poline J-P, frith CD, Frackowiak RS (1995) Statistical parametric maps in functional imaging: a general linear approach. Hum Brain Mapp 2:189–210CrossRef Friston KJ, Holmes AP, Worsley KJ, Poline J-P, frith CD, Frackowiak RS (1995) Statistical parametric maps in functional imaging: a general linear approach. Hum Brain Mapp 2:189–210CrossRef
18.
Zurück zum Zitat Hasan KM, Walimuni IS, Abid H, Hahn KR (2011) A review of diffusion tensor magnetic resonance imaging computational methods and software tools. Comput Biol Med 41:1062–1072 Hasan KM, Walimuni IS, Abid H, Hahn KR (2011) A review of diffusion tensor magnetic resonance imaging computational methods and software tools. Comput Biol Med 41:1062–1072
19.
Zurück zum Zitat Heiervang E, Behrens TE, Mackay CE, Robson MD, Johansen-Berg H (2006) Between session reproducibility and between subject variability of diffusion MR and tractography measures. Neuroimage 33:867–877PubMedCrossRef Heiervang E, Behrens TE, Mackay CE, Robson MD, Johansen-Berg H (2006) Between session reproducibility and between subject variability of diffusion MR and tractography measures. Neuroimage 33:867–877PubMedCrossRef
20.
Zurück zum Zitat Iwasaki S, Nakagawa H, Fukusumi A, Kichikawa K, Kitamura K, Otsuji H, Uchida H, Ohishi H, Yaguchi K, Sumie H (1991) Identification of pre- and postcentral gyri on CT and MR images on the basis of the medullary pattern of cerebral white matter. Radiology 179:207–213PubMed Iwasaki S, Nakagawa H, Fukusumi A, Kichikawa K, Kitamura K, Otsuji H, Uchida H, Ohishi H, Yaguchi K, Sumie H (1991) Identification of pre- and postcentral gyri on CT and MR images on the basis of the medullary pattern of cerebral white matter. Radiology 179:207–213PubMed
21.
Zurück zum Zitat Johansen-Berg H, Behrens TE (2006) Just pretty pictures? What diffusion tractography can add in clinical neuroscience. Curr Opin Neurol 19:379–385PubMedCrossRef Johansen-Berg H, Behrens TE (2006) Just pretty pictures? What diffusion tractography can add in clinical neuroscience. Curr Opin Neurol 19:379–385PubMedCrossRef
22.
Zurück zum Zitat Jones DK, Horsfield MA, Simmons A (1999) Optimal strategies for measuring diffusion in anisotropic systems by magnetic resonance imaging. Magn Reson Med 42:515–525PubMedCrossRef Jones DK, Horsfield MA, Simmons A (1999) Optimal strategies for measuring diffusion in anisotropic systems by magnetic resonance imaging. Magn Reson Med 42:515–525PubMedCrossRef
23.
Zurück zum Zitat Lawes IN, Barrick TR, Murugam V, Spierings N, Evans DR, Song M, Clark CA (2008) Atlas-based segmentation of white matter tracts of the human brain using diffusion tensor tractography and comparison with classical dissection. Neuroimage 39:62–79PubMedCrossRef Lawes IN, Barrick TR, Murugam V, Spierings N, Evans DR, Song M, Clark CA (2008) Atlas-based segmentation of white matter tracts of the human brain using diffusion tensor tractography and comparison with classical dissection. Neuroimage 39:62–79PubMedCrossRef
24.
Zurück zum Zitat Lazar M, Weinstein DM, Tsuruda JS, Hasan KM, Arfanakis K, Meyerand ME, Badie B, Rowley HA, Haughton V, Field A, Alexander AL (2003) White matter tractography using diffusion tensor deflection. Hum Brain Mapp 18:306–321PubMedCrossRef Lazar M, Weinstein DM, Tsuruda JS, Hasan KM, Arfanakis K, Meyerand ME, Badie B, Rowley HA, Haughton V, Field A, Alexander AL (2003) White matter tractography using diffusion tensor deflection. Hum Brain Mapp 18:306–321PubMedCrossRef
25.
Zurück zum Zitat Lin CP, Tseng WY, Cheng HC, Chen JH (2001) Validation of diffusion tensor magnetic resonance axonal fiber imaging with registered manganese-enhanced optic tracts. Neuroimage 14:1035–1047PubMedCrossRef Lin CP, Tseng WY, Cheng HC, Chen JH (2001) Validation of diffusion tensor magnetic resonance axonal fiber imaging with registered manganese-enhanced optic tracts. Neuroimage 14:1035–1047PubMedCrossRef
26.
Zurück zum Zitat Lotze M, Erb M, Flor H, Huelsmann E, Godde B, Grodd W (2000) fMRI evaluation of somatotopic representation in human primary motor cortex. Neuroimage 11:473–481PubMedCrossRef Lotze M, Erb M, Flor H, Huelsmann E, Godde B, Grodd W (2000) fMRI evaluation of somatotopic representation in human primary motor cortex. Neuroimage 11:473–481PubMedCrossRef
27.
Zurück zum Zitat Mangin JF, Poupon C, Clark C, Le BD, Bloch I (2002) Distortion correction and robust tensor estimation for MR diffusion imaging. Med Image Anal 6:191–198PubMedCrossRef Mangin JF, Poupon C, Clark C, Le BD, Bloch I (2002) Distortion correction and robust tensor estimation for MR diffusion imaging. Med Image Anal 6:191–198PubMedCrossRef
28.
Zurück zum Zitat Mori S, Barker PB (1999) Diffusion magnetic resonance imaging: its principle and applications. Anat Rec 257:102–109PubMedCrossRef Mori S, Barker PB (1999) Diffusion magnetic resonance imaging: its principle and applications. Anat Rec 257:102–109PubMedCrossRef
29.
Zurück zum Zitat Mori S, Crain BJ, Chacko VP, van Zijl PC (1999) Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 45:265–269PubMedCrossRef Mori S, Crain BJ, Chacko VP, van Zijl PC (1999) Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 45:265–269PubMedCrossRef
30.
Zurück zum Zitat Mori S, Frederiksen K, van Zijl PC, Stieltjes B, Kraut MA, Solaiyappan M, Pomper MG (2002) Brain white matter anatomy of tumor patients evaluated with diffusion tensor imaging. Ann Neurol 51:377–380PubMedCrossRef Mori S, Frederiksen K, van Zijl PC, Stieltjes B, Kraut MA, Solaiyappan M, Pomper MG (2002) Brain white matter anatomy of tumor patients evaluated with diffusion tensor imaging. Ann Neurol 51:377–380PubMedCrossRef
31.
Zurück zum Zitat Oldfield RC (1971) The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 9:97–113PubMedCrossRef Oldfield RC (1971) The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 9:97–113PubMedCrossRef
32.
Zurück zum Zitat Qazi AA, Radmanesh A, O’Donnell L, Kindlmann G, Peled S, Whalen S, Westin CF, Golby AJ (2009) Resolving crossings in the corticospinal tract by two-tensor streamline tractography: method and clinical assessment using fMRI. Neuroimage 47(Suppl 2):T98–T106PubMedCrossRef Qazi AA, Radmanesh A, O’Donnell L, Kindlmann G, Peled S, Whalen S, Westin CF, Golby AJ (2009) Resolving crossings in the corticospinal tract by two-tensor streamline tractography: method and clinical assessment using fMRI. Neuroimage 47(Suppl 2):T98–T106PubMedCrossRef
33.
Zurück zum Zitat Schimrigk SK, Bellenberg B, Schluter M, Stieltjes B, Drescher R, Rexilius J, Lukas C, Hahn HK, Przuntek H, Koster O (2007) Diffusion tensor imaging-based fractional anisotropy quantification in the corticospinal tract of patients with amyotrophic lateral sclerosis using a probabilistic mixture model. AJNR Am J Neuroradiol 28:724–730PubMed Schimrigk SK, Bellenberg B, Schluter M, Stieltjes B, Drescher R, Rexilius J, Lukas C, Hahn HK, Przuntek H, Koster O (2007) Diffusion tensor imaging-based fractional anisotropy quantification in the corticospinal tract of patients with amyotrophic lateral sclerosis using a probabilistic mixture model. AJNR Am J Neuroradiol 28:724–730PubMed
34.
Zurück zum Zitat Skare S, Hedehus M, Moseley ME, Li TQ (2000) Condition number as a measure of noise performance of diffusion tensor data acquisition schemes with MRI. J Magn Reson 147:340–352PubMedCrossRef Skare S, Hedehus M, Moseley ME, Li TQ (2000) Condition number as a measure of noise performance of diffusion tensor data acquisition schemes with MRI. J Magn Reson 147:340–352PubMedCrossRef
36.
Zurück zum Zitat Talairach J, Tournoux P (1988) Coplanar stereotaxic atlas of the human brain, Thieme, New York Talairach J, Tournoux P (1988) Coplanar stereotaxic atlas of the human brain, Thieme, New York
37.
Zurück zum Zitat Tensaouti F, Lahlou I, Clarisse P, Lotterie JA, Berry I (2011) Quantitative and reproducibility study of four tractography algorithms used in clinical routine. J Magn Reson Imaging 34:165–172PubMedCrossRef Tensaouti F, Lahlou I, Clarisse P, Lotterie JA, Berry I (2011) Quantitative and reproducibility study of four tractography algorithms used in clinical routine. J Magn Reson Imaging 34:165–172PubMedCrossRef
38.
Zurück zum Zitat Tuch DS, Reese TG, Wiegell MR, Makris N, Belliveau JW, Wedeen VJ (2002) High angular resolution diffusion imaging reveals intravoxel white matter fiber heterogeneity. Magn Reson Med 48:577–582PubMedCrossRef Tuch DS, Reese TG, Wiegell MR, Makris N, Belliveau JW, Wedeen VJ (2002) High angular resolution diffusion imaging reveals intravoxel white matter fiber heterogeneity. Magn Reson Med 48:577–582PubMedCrossRef
39.
Zurück zum Zitat Wakana S, Caprihan A, Panzenboeck MM, Fallon JH, Perry M, Gollub RL, Hua K, Zhang J, Jiang H, Dubey P, Blitz A, van Zijl P, Mori S (2007) Reproducibility of quantitative tractography methods applied to cerebral white matter. Neuroimage 36:630–644PubMedCrossRef Wakana S, Caprihan A, Panzenboeck MM, Fallon JH, Perry M, Gollub RL, Hua K, Zhang J, Jiang H, Dubey P, Blitz A, van Zijl P, Mori S (2007) Reproducibility of quantitative tractography methods applied to cerebral white matter. Neuroimage 36:630–644PubMedCrossRef
40.
Zurück zum Zitat Wedeen VJ, Hagmann P, Tseng WY, Reese TG, Weisskoff RM (2005) Mapping complex tissue architecture with diffusion spectrum magnetic resonance imaging. Magn Reson Med 54:1377–1386PubMedCrossRef Wedeen VJ, Hagmann P, Tseng WY, Reese TG, Weisskoff RM (2005) Mapping complex tissue architecture with diffusion spectrum magnetic resonance imaging. Magn Reson Med 54:1377–1386PubMedCrossRef
41.
Zurück zum Zitat Wiest-Daesslé N, Prima S, Morrisey SP, Barillot C (2007) Validation of a new optimisation algorithm for registration tasks in medical imaging In: 4th IEEE International symposium on biomedical imaging: from Nano to Macro, ISBI 41–44 Wiest-Daesslé N, Prima S, Morrisey SP, Barillot C (2007) Validation of a new optimisation algorithm for registration tasks in medical imaging In: 4th IEEE International symposium on biomedical imaging: from Nano to Macro, ISBI 41–44
42.
Zurück zum Zitat Yamada K, Sakai K, Hoogenraad FG, Holthuizen R, Akazawa K, Ito H, Oouchi H, Matsushima S, Kubota T, Sasajima H, Mineura K, Nishimura T (2007) Multitensor tractography enables better depiction of motor pathways: initial clinical experience using diffusion-weighted MR imaging with standard b-value. AJNR Am J Neuroradiol 28:1668–1673PubMedCrossRef Yamada K, Sakai K, Hoogenraad FG, Holthuizen R, Akazawa K, Ito H, Oouchi H, Matsushima S, Kubota T, Sasajima H, Mineura K, Nishimura T (2007) Multitensor tractography enables better depiction of motor pathways: initial clinical experience using diffusion-weighted MR imaging with standard b-value. AJNR Am J Neuroradiol 28:1668–1673PubMedCrossRef
43.
Zurück zum Zitat Yousry TA, Schmid UD, Alkadhi H, Schmidt D, Peraud A, Buettner A, Winkler P (1997) Localization of the motor hand area to a knob on the precentral gyrus. A new landmark. Brain 120(Pt 1):141–157PubMedCrossRef Yousry TA, Schmid UD, Alkadhi H, Schmidt D, Peraud A, Buettner A, Winkler P (1997) Localization of the motor hand area to a knob on the precentral gyrus. A new landmark. Brain 120(Pt 1):141–157PubMedCrossRef
44.
Zurück zum Zitat Zhang Y, Zhang J, Oishi K, Faria AV, Jiang H, Li X, Akhter K, Rosa-Neto P, Pike GB, Evans A, Toga AW, Woods R, Mazziotta JC, Miller MI, van Zijl PC, Mori S (2010) Atlas-guided tract reconstruction for automated and comprehensive examination of the white matter anatomy. Neuroimage 52:1289–1301PubMedCrossRef Zhang Y, Zhang J, Oishi K, Faria AV, Jiang H, Li X, Akhter K, Rosa-Neto P, Pike GB, Evans A, Toga AW, Woods R, Mazziotta JC, Miller MI, van Zijl PC, Mori S (2010) Atlas-guided tract reconstruction for automated and comprehensive examination of the white matter anatomy. Neuroimage 52:1289–1301PubMedCrossRef
Metadaten
Titel
Corticospinal tractography with morphological, functional and diffusion tensor MRI: a comparative study of four deterministic algorithms used in clinical routine
Publikationsdatum
01.10.2012
Erschienen in
Surgical and Radiologic Anatomy / Ausgabe 8/2012
Print ISSN: 0930-1038
Elektronische ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-012-0951-x

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