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Erschienen in: Neuroradiology 8/2018

02.07.2018 | Head-Neck-ENT Radiology

Pseudo-continuous arterial spin labeling MR images in Warthin tumors and pleomorphic adenomas of the parotid gland: qualitative and quantitative analyses and their correlation with histopathologic and DWI and dynamic contrast enhanced MRI findings

verfasst von: Tatsuya Yamamoto, Hirohiko Kimura, Kuniyoshi Hayashi, Yoshiaki Imamura, Masaki Mori

Erschienen in: Neuroradiology | Ausgabe 8/2018

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Abstract

Purpose

We investigated the correlation between tumor blood flow (TBF) and histopathologic features of Warthin tumors (WTs) and pleomorphic adenomas (PAs) to determine the TBF in the differential diagnosis of these tumors and evaluated how well pCASL-MRI can differentiate PAs from WTs compared to conventional MRI.

Methods

The ADC, time intensity curve (TIC) pattern of dynamic contrast enhancement, and pCASL (visual assessment and TBF of the MR images of 10 WTs and 13 PAs) were reviewed. We compared the pCASL and ADC or TIC patterns in WT and PA images. Tissue sections were stained with CD34 to evaluate microvessel density (MVD). The TBF and MVD results were compared. The Mann-Whitney U test was used to compare the TBFs, ADCs, and MVDs of these tumors. The diagnostic accuracy was determined by analyzing the receiver operating characteristic curve.

Results

On visual assessment, the signal intensity was higher in all but three cases of WT. The TBF and MVD of the WTs were significantly higher (both, p < 0.01) than the PAs, and the ADC was significantly lower (p < 0.01). Many WTs had early enhancement of the TIC pattern and high washout; many PAs had gradual enhancement. The diagnostic accuracies of visual analysis, TBF, and ADC for differentiation between WTs and PAs were 91.3, 95.7, and 87.0%, respectively.

Conclusions

The TBF were significantly higher in WTs than in PAs, and there was a positive correlation between TBF and MVD. Moreover, pCASL-MRI provides more accurate imaging than conventional MRI to differentiate WTs and PAs.
Literatur
1.
Zurück zum Zitat Shimizu M, Ussmuller J, Hartwein J et al (1999) Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:226–233CrossRefPubMed Shimizu M, Ussmuller J, Hartwein J et al (1999) Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:226–233CrossRefPubMed
2.
Zurück zum Zitat Som PM, Brandwein-Gensler MS (2011) Anatomy and pathology of the salivary gland, epithelial tumors. In: Som PM, Curtin HD (eds) Head and neck imaging, 5th edn. Mosby, St Louis, pp 2525–2544 Som PM, Brandwein-Gensler MS (2011) Anatomy and pathology of the salivary gland, epithelial tumors. In: Som PM, Curtin HD (eds) Head and neck imaging, 5th edn. Mosby, St Louis, pp 2525–2544
3.
Zurück zum Zitat Wittich GR, Scheible WF, Hajek PC (1985) Ultrasonography of the salivary glands. Radiol Clin N Am 23:29–37PubMed Wittich GR, Scheible WF, Hajek PC (1985) Ultrasonography of the salivary glands. Radiol Clin N Am 23:29–37PubMed
4.
Zurück zum Zitat Zajkowski P, Jakubowski W, Białek EJ, Wysocki M, Osmólski A, Serafin-Król M (2000) Pleomorphic adenoma and adenolymphoma in ultrasonography. Eur J Ultrasound 12:23–29CrossRefPubMed Zajkowski P, Jakubowski W, Białek EJ, Wysocki M, Osmólski A, Serafin-Król M (2000) Pleomorphic adenoma and adenolymphoma in ultrasonography. Eur J Ultrasound 12:23–29CrossRefPubMed
5.
Zurück zum Zitat Yabuuchi H, Fukuya T, Tajima T, Hachitanda Y, Tomita K, Koga M (2003) Salivary gland tumors: diagnostic value of gadolinium-enhanced dynamic MR imaging with histopathologic correlation. Radiology 226:345–354CrossRefPubMed Yabuuchi H, Fukuya T, Tajima T, Hachitanda Y, Tomita K, Koga M (2003) Salivary gland tumors: diagnostic value of gadolinium-enhanced dynamic MR imaging with histopathologic correlation. Radiology 226:345–354CrossRefPubMed
6.
Zurück zum Zitat Ikeda M, Motoori K, Hanazawa T, Nagai Y, Yamamoto S, Ueda T, Funatsu H, Ito H (2004) Warthin tumor of the parotid gland: diagnostic value of MR imaging with histopathologic correlation. AJNR Am J Neuroradiol 25:1256–1262PubMed Ikeda M, Motoori K, Hanazawa T, Nagai Y, Yamamoto S, Ueda T, Funatsu H, Ito H (2004) Warthin tumor of the parotid gland: diagnostic value of MR imaging with histopathologic correlation. AJNR Am J Neuroradiol 25:1256–1262PubMed
7.
Zurück zum Zitat Yerli H, Aydin E, Coskun M, Geyik E, Ozluoglu LN, Haberal N, Kaskati T (2007) Dynamic multislice computed tomography findings for parotid gland tumors. J Comput Assist Tomogr 31:309–316CrossRefPubMed Yerli H, Aydin E, Coskun M, Geyik E, Ozluoglu LN, Haberal N, Kaskati T (2007) Dynamic multislice computed tomography findings for parotid gland tumors. J Comput Assist Tomogr 31:309–316CrossRefPubMed
8.
Zurück zum Zitat Hisatomi M, Asaumi J, Yanagi Y, Unetsubo T, Maki Y, Murakami J, Matsuzaki H, Honda Y, Konouchi H (2007) Diagnostic value of dynamic contrast-enhanced MRI in the salivary gland tumors. Oral Oncol 43:940–947CrossRefPubMed Hisatomi M, Asaumi J, Yanagi Y, Unetsubo T, Maki Y, Murakami J, Matsuzaki H, Honda Y, Konouchi H (2007) Diagnostic value of dynamic contrast-enhanced MRI in the salivary gland tumors. Oral Oncol 43:940–947CrossRefPubMed
9.
Zurück zum Zitat Christe A, Waldherr C, Hallett R, Zbaeren P, Thoeny H (2011) MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease. AJNR Am J Neuroradiol 32:1202–1207CrossRefPubMed Christe A, Waldherr C, Hallett R, Zbaeren P, Thoeny H (2011) MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease. AJNR Am J Neuroradiol 32:1202–1207CrossRefPubMed
10.
Zurück zum Zitat Yabuuchi H, Matsuo Y, Kamitani T, Setoguchi T, Okafuji T, Soeda H, Sakai S, Hatakenaka M, Nakashima T, Oda Y, Honda H (2008) Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization? Radiology 249:909–916CrossRefPubMed Yabuuchi H, Matsuo Y, Kamitani T, Setoguchi T, Okafuji T, Soeda H, Sakai S, Hatakenaka M, Nakashima T, Oda Y, Honda H (2008) Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization? Radiology 249:909–916CrossRefPubMed
11.
Zurück zum Zitat Eida S, Sumi M, Nakamura T (2010) Multiparametric magnetic resonance imaging for the differentiation between benign and malignant salivary gland tumors. J Magn Reson Imaging 31:673–679CrossRefPubMed Eida S, Sumi M, Nakamura T (2010) Multiparametric magnetic resonance imaging for the differentiation between benign and malignant salivary gland tumors. J Magn Reson Imaging 31:673–679CrossRefPubMed
12.
Zurück zum Zitat Habermann CR, Arndt C, Graessner J, Diestel L, Petersen KU, Reitmeier F, Ussmueller JO, Adam G, Jaehne M (2009) Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible? AJNR Am J Neuroradiol 30:591–596CrossRefPubMed Habermann CR, Arndt C, Graessner J, Diestel L, Petersen KU, Reitmeier F, Ussmueller JO, Adam G, Jaehne M (2009) Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible? AJNR Am J Neuroradiol 30:591–596CrossRefPubMed
13.
Zurück zum Zitat Eida S, Sumi M, Sakihama N, Takahashi H, Nakamura T (2007) Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy. AJNR Am J Neuroradiol 28:116–121PubMed Eida S, Sumi M, Sakihama N, Takahashi H, Nakamura T (2007) Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy. AJNR Am J Neuroradiol 28:116–121PubMed
14.
Zurück zum Zitat Matsushima N, Maeda M, Takamura M, Takeda K (2007) Apparent diffusion coefficients of benign and malignant salivary gland tumors. Comparison to histopathological findings. J Neuroradiol 34:183–189CrossRefPubMed Matsushima N, Maeda M, Takamura M, Takeda K (2007) Apparent diffusion coefficients of benign and malignant salivary gland tumors. Comparison to histopathological findings. J Neuroradiol 34:183–189CrossRefPubMed
15.
Zurück zum Zitat Kimura H, Takeuchi H, Koshimoto Y, Arishima H, Uematsu H, Kawamura Y, Kubota T, Itoh H (2006) Perfusion imaging of meningioma by using continuous arterial spin-labeling: comparison with dynamic susceptibility-weighted contrast-enhanced MR images and histopathologic features. AJNR Am J Neuroradiol 27:85–93PubMed Kimura H, Takeuchi H, Koshimoto Y, Arishima H, Uematsu H, Kawamura Y, Kubota T, Itoh H (2006) Perfusion imaging of meningioma by using continuous arterial spin-labeling: comparison with dynamic susceptibility-weighted contrast-enhanced MR images and histopathologic features. AJNR Am J Neuroradiol 27:85–93PubMed
16.
Zurück zum Zitat Noguchi T, Yoshiura T, Hiwatashi A, Togao O, Yamashita K, Nagao E, Shono T, Mizoguchi M, Nagata S, Sasaki T, Suzuki SO, Iwaki T, Kobayashi K, Mihara F, Honda H (2008) Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. AJNR Am J Neuroradiol 29:688–693CrossRefPubMed Noguchi T, Yoshiura T, Hiwatashi A, Togao O, Yamashita K, Nagao E, Shono T, Mizoguchi M, Nagata S, Sasaki T, Suzuki SO, Iwaki T, Kobayashi K, Mihara F, Honda H (2008) Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. AJNR Am J Neuroradiol 29:688–693CrossRefPubMed
17.
Zurück zum Zitat Weber MA, Thilmann C, Lichy MP et al (2004) Assessment of irradiated brain metastases by means of arterial spin-labeling and dynamic susceptibility-weighted contrast-enhanced perfusion MRI: initial results. Investig Radiol 39:277–287CrossRef Weber MA, Thilmann C, Lichy MP et al (2004) Assessment of irradiated brain metastases by means of arterial spin-labeling and dynamic susceptibility-weighted contrast-enhanced perfusion MRI: initial results. Investig Radiol 39:277–287CrossRef
18.
Zurück zum Zitat Yamamoto T, Kinoshita K, Kosaka N, Sato Y, Shioura H, Takeuchi H, Kimura H (2013) Monitoring of extra-axial brain tumor response to radiotherapy using pseudo-continuous arterial spin labeling images: preliminary results. Magn Reson Imaging 31:1271–1277CrossRefPubMed Yamamoto T, Kinoshita K, Kosaka N, Sato Y, Shioura H, Takeuchi H, Kimura H (2013) Monitoring of extra-axial brain tumor response to radiotherapy using pseudo-continuous arterial spin labeling images: preliminary results. Magn Reson Imaging 31:1271–1277CrossRefPubMed
19.
Zurück zum Zitat Shimizu K, Kosaka N, Fujiwara Y, et al (2016) Arterial transit time-corrected renal blood flow measurement with pulsed continuous arterial spin labeling MR imaging. Magn Reson Med Sci 2016 May 9 Shimizu K, Kosaka N, Fujiwara Y, et al (2016) Arterial transit time-corrected renal blood flow measurement with pulsed continuous arterial spin labeling MR imaging. Magn Reson Med Sci 2016 May 9
20.
Zurück zum Zitat Yamamoto T, Kosaka N, Mori M, Imamura Y, Kimura H (2014) Assessment of tumor blood flow and its correlation with histopathologic features in Warthin tumors and pleomorphic adenomas of the salivary gland by using pulsed-continuous arterial spin labeling images. In: Proceedings of the Joint Annual Meeting ISMRM-ESMRMB, Milan, Italy Yamamoto T, Kosaka N, Mori M, Imamura Y, Kimura H (2014) Assessment of tumor blood flow and its correlation with histopathologic features in Warthin tumors and pleomorphic adenomas of the salivary gland by using pulsed-continuous arterial spin labeling images. In: Proceedings of the Joint Annual Meeting ISMRM-ESMRMB, Milan, Italy
21.
Zurück zum Zitat Kato H, Kanematsu M, Watanabe H, Kajita K, Mizuta K, Aoki M, Okuaki T (2015) Perfusion imaging of parotid gland tumours: usefulness of arterial spin labeling for differentiating Warthin's tumours. Eur Radiol 25:3247–3254CrossRefPubMed Kato H, Kanematsu M, Watanabe H, Kajita K, Mizuta K, Aoki M, Okuaki T (2015) Perfusion imaging of parotid gland tumours: usefulness of arterial spin labeling for differentiating Warthin's tumours. Eur Radiol 25:3247–3254CrossRefPubMed
22.
Zurück zum Zitat Dai W, Garcia D, de Bazelaire C, Alsop DC (2008) Continuous flow-driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields. Magn Reson Med 60:1488–1497CrossRefPubMedPubMedCentral Dai W, Garcia D, de Bazelaire C, Alsop DC (2008) Continuous flow-driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields. Magn Reson Med 60:1488–1497CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Alsop DC, Detre JA (1996) Reduced transit-time sensitivity in noninvasive magnetic resonance imaging of human cerebral blood flow. J Cereb Blood Flow Metab 16:1236–1249CrossRefPubMed Alsop DC, Detre JA (1996) Reduced transit-time sensitivity in noninvasive magnetic resonance imaging of human cerebral blood flow. J Cereb Blood Flow Metab 16:1236–1249CrossRefPubMed
24.
Zurück zum Zitat Wang J, Zhang Y, Wolf RL, Roc AC, Alsop DC, Detre JA (2005) Amplitude-modulated continuous arterial spin-labeling 3.0-T perfusion MR imaging with a single coil: feasibility study. Radiology 235:218–228CrossRefPubMed Wang J, Zhang Y, Wolf RL, Roc AC, Alsop DC, Detre JA (2005) Amplitude-modulated continuous arterial spin-labeling 3.0-T perfusion MR imaging with a single coil: feasibility study. Radiology 235:218–228CrossRefPubMed
25.
Zurück zum Zitat Herscovitch P, Raichle ME (1985) What is the correct value for the brain - blood partition coefficient for water? J Cereb Blood Flow Metab 5:65–69CrossRefPubMed Herscovitch P, Raichle ME (1985) What is the correct value for the brain - blood partition coefficient for water? J Cereb Blood Flow Metab 5:65–69CrossRefPubMed
26.
Zurück zum Zitat Garcia DM, Duhamel G, Alsop DC (2005) Efficiency of inversion pulses for background suppressed arterial spin labeling. Magn Reson Med 54:366–372CrossRefPubMed Garcia DM, Duhamel G, Alsop DC (2005) Efficiency of inversion pulses for background suppressed arterial spin labeling. Magn Reson Med 54:366–372CrossRefPubMed
27.
Zurück zum Zitat Bosari S, Lee AK, DeLellis RA et al (1992) Microvessel quantitation and prognosis in invasive breast carcinoma. Hum Pathol 23:755–761CrossRefPubMed Bosari S, Lee AK, DeLellis RA et al (1992) Microvessel quantitation and prognosis in invasive breast carcinoma. Hum Pathol 23:755–761CrossRefPubMed
28.
Zurück zum Zitat Pepe MS, Fan J, Feng Z, Gerds T, Hilden J (2015) The net reclassification index (NRI): a misleading measure of prediction improvement even with independent test data sets. Stat Biosci 7:282–295CrossRefPubMed Pepe MS, Fan J, Feng Z, Gerds T, Hilden J (2015) The net reclassification index (NRI): a misleading measure of prediction improvement even with independent test data sets. Stat Biosci 7:282–295CrossRefPubMed
29.
Zurück zum Zitat Liu W, Lou X, Ma L (2016) Use of 3D pseudo-continuous arterial spin labeling to characterize sex and age differences in cerebral blood flow. Neuroradiology 58:943–948CrossRefPubMed Liu W, Lou X, Ma L (2016) Use of 3D pseudo-continuous arterial spin labeling to characterize sex and age differences in cerebral blood flow. Neuroradiology 58:943–948CrossRefPubMed
30.
Zurück zum Zitat Woo SH, Choi DS, Kim JP, Park JJ, Joo YH, Chung PS, Kim BY, Ko YH, Jeong HS, Kim HJ (2013) Two-phase computed tomography study of Warthin tumor of parotid gland: differentiation from other parotid gland tumors and its pathologic explanation. J Comput Assist Tomogr 37:518–524CrossRefPubMed Woo SH, Choi DS, Kim JP, Park JJ, Joo YH, Chung PS, Kim BY, Ko YH, Jeong HS, Kim HJ (2013) Two-phase computed tomography study of Warthin tumor of parotid gland: differentiation from other parotid gland tumors and its pathologic explanation. J Comput Assist Tomogr 37:518–524CrossRefPubMed
31.
Zurück zum Zitat Yamamoto T, Takeuchi H, Kinoshita K, Kosaka N, Kimura H (2014) Assessment of tumor blood flow and its correlation with histopathologic features in skull base meningiomas and schwannomas by using pseudo-continuous arterial spin labeling images. Eur J Radiol 83:817–823CrossRefPubMed Yamamoto T, Takeuchi H, Kinoshita K, Kosaka N, Kimura H (2014) Assessment of tumor blood flow and its correlation with histopathologic features in skull base meningiomas and schwannomas by using pseudo-continuous arterial spin labeling images. Eur J Radiol 83:817–823CrossRefPubMed
32.
Zurück zum Zitat Motoori K, Ueda T, Uchida Y, Chazono H, Suzuki H, Ito H (2005) Identification of Warthin tumor: magnetic resonance imaging versus salivary scintigraphy with technetium-99m pertechnetate. J Comput Assist Tomogr 29:506–512CrossRefPubMed Motoori K, Ueda T, Uchida Y, Chazono H, Suzuki H, Ito H (2005) Identification of Warthin tumor: magnetic resonance imaging versus salivary scintigraphy with technetium-99m pertechnetate. J Comput Assist Tomogr 29:506–512CrossRefPubMed
33.
Zurück zum Zitat Takumi K, Fukukura Y, Hakamada H, Ideue J, Kumagae Y, Yoshiura T (2017) Value of diffusion tensor imaging in differentiating malignant from benign parotid gland tumors. Eur J Radiol 95:249–256CrossRefPubMed Takumi K, Fukukura Y, Hakamada H, Ideue J, Kumagae Y, Yoshiura T (2017) Value of diffusion tensor imaging in differentiating malignant from benign parotid gland tumors. Eur J Radiol 95:249–256CrossRefPubMed
34.
Zurück zum Zitat Mikayama R, Yabuuchi H, Sonoda S, Kobayashi K, Nagatomo K, Kimura M, Kawanami S, Kamitani T, Kumazawa S, Honda H (2018) Comparison of intravoxel incoherent motion diffusion-weighted imaging between turbo spin-echo and echo-planar imaging of the head and neck. Eur Radiol 28:316–324CrossRefPubMed Mikayama R, Yabuuchi H, Sonoda S, Kobayashi K, Nagatomo K, Kimura M, Kawanami S, Kamitani T, Kumazawa S, Honda H (2018) Comparison of intravoxel incoherent motion diffusion-weighted imaging between turbo spin-echo and echo-planar imaging of the head and neck. Eur Radiol 28:316–324CrossRefPubMed
35.
Zurück zum Zitat Sigmund EE, Jensen J (2011) Basic physical principles of body diffusion-weighted MRI. In: Taouli B (ed) Extra-cranial applications of diffusion-weighted MRI. Cambridge University Press, Cambridge, pp 1–17 Sigmund EE, Jensen J (2011) Basic physical principles of body diffusion-weighted MRI. In: Taouli B (ed) Extra-cranial applications of diffusion-weighted MRI. Cambridge University Press, Cambridge, pp 1–17
36.
Zurück zum Zitat Verhappen MH, Pouwels PJ, Ljumanovic R et al (2012) Diffusion weighted MR imaging in head and neck cancer: comparison between half-fourier acquisition single-shot turbo spin-echo and EPI techniques. AJNR 33:1239–1246CrossRefPubMed Verhappen MH, Pouwels PJ, Ljumanovic R et al (2012) Diffusion weighted MR imaging in head and neck cancer: comparison between half-fourier acquisition single-shot turbo spin-echo and EPI techniques. AJNR 33:1239–1246CrossRefPubMed
37.
Zurück zum Zitat Alsop DC, Detre JA, Golay X, Günther M, Hendrikse J, Hernandez-Garcia L, Lu H, MacIntosh BJ, Parkes LM, Smits M, van Osch MJP, Wang DJJ, Wong EC, Zaharchuk G (2015) Recommended implementation of arterial spin-labeled perfusion MRI for clinical applications: a consensus of the ISMRM perfusion study group and the European consortium for ASL in dementia. Magn Reson Med 73:102–116CrossRefPubMed Alsop DC, Detre JA, Golay X, Günther M, Hendrikse J, Hernandez-Garcia L, Lu H, MacIntosh BJ, Parkes LM, Smits M, van Osch MJP, Wang DJJ, Wong EC, Zaharchuk G (2015) Recommended implementation of arterial spin-labeled perfusion MRI for clinical applications: a consensus of the ISMRM perfusion study group and the European consortium for ASL in dementia. Magn Reson Med 73:102–116CrossRefPubMed
38.
Zurück zum Zitat Guerra G, Testa D, Montagnani S, Tafuri D, Salzano FA, Rocca A, Amato B, Salzano G, Dell'Aversana Orabona G, Piombino P, Motta G (2014) Surgical management of pleomorphic adenoma of parotid gland in elderly patients: role of morphological features. Int J Surg 12(Suppl 2):S12–S16CrossRefPubMed Guerra G, Testa D, Montagnani S, Tafuri D, Salzano FA, Rocca A, Amato B, Salzano G, Dell'Aversana Orabona G, Piombino P, Motta G (2014) Surgical management of pleomorphic adenoma of parotid gland in elderly patients: role of morphological features. Int J Surg 12(Suppl 2):S12–S16CrossRefPubMed
40.
Zurück zum Zitat McGregor AD, Burgoyne M, Tan KC (1988) Recurrent pleomorphic salivary adenoma-the relevance of age at first presentation. Br J Plast Surg 41:177–181CrossRefPubMed McGregor AD, Burgoyne M, Tan KC (1988) Recurrent pleomorphic salivary adenoma-the relevance of age at first presentation. Br J Plast Surg 41:177–181CrossRefPubMed
Metadaten
Titel
Pseudo-continuous arterial spin labeling MR images in Warthin tumors and pleomorphic adenomas of the parotid gland: qualitative and quantitative analyses and their correlation with histopathologic and DWI and dynamic contrast enhanced MRI findings
verfasst von
Tatsuya Yamamoto
Hirohiko Kimura
Kuniyoshi Hayashi
Yoshiaki Imamura
Masaki Mori
Publikationsdatum
02.07.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Neuroradiology / Ausgabe 8/2018
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-018-2046-9

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