Scholars@Duke
Peter George Kranz

Peter George Kranz

Professor of Radiology
Radiology, Neuroradiology
peter.kranz@duke.edu
Box 3808 Med Ctr, Durham, NC 27710
Dept of Radiology, Duke Univ Med Ctr, DUMC Box 3808, Durham, NC 27710

Scholarly Works - Journal articles

Diagnostic Yield of CT Myelography for the Identification of CSF Leaks in Patients with Post Dural Puncture Headache.

Journal article AJNR Am J Neuroradiol · June 3, 2026 BACKGROUND AND PURPOSE: Post dural puncture headache (PDPH) refractory to conservative measures can be clinically debilitating, and diagnostic evaluation with spinal imaging including CT myelography (CTM) may be performed to localize a CSF leak and guide t ... Full text Link to item Cite

Photon-Counting Detector CTA for Localization of the Artery of Adamkiewicz.

Journal article AJNR Am J Neuroradiol · June 3, 2026 Photo-counting detector CT is a relatively new technology that is becoming increasingly prevalent. In recent years, photon-counting CT has been shown to have benefits in numerous neuroradiologic clinical applications, including temporal bone imaging, detec ... Full text Link to item Cite

Incidence and Predictors of Rebound Intracranial Hypertension after Transvenous Embolization of CSF-Venous Fistulas.

Journal article AJNR Am J Neuroradiol · May 4, 2026 BACKGROUND AND PURPOSE: CSF-venous fistula (CVF) is a common cause of spontaneous intracranial hypotension (SIH) and can be treated with transvenous embolization (TVE). Rebound intracranial hypertension (RIH) is an important periprocedural consideration af ... Full text Link to item Cite

Circumferential Epidural Patch for Postdural Puncture Headache: A Technical Report.

Journal article AJNR Am J Neuroradiol · April 2, 2026 A subset of postdural puncture headaches (PDPH) persist despite conventional epidural blood patches (EPDs), leading to chronic symptoms and substantial disability. Dural punctures may involve not only the dorsal dural surface, which is covered by a standar ... Full text Link to item Cite

Likelihood and Predictors of Acute Findings on CTA Head and Neck for Neurologic Presentations to the Emergency Department.

Journal article Neurol Clin Pract · April 2026 BACKGROUND AND OBJECTIVES: CT angiography of the head and neck (CTAHN) is commonly obtained in the emergency department (ED) for patients with acute neurologic symptoms to guide interventions. There are limited data on which clinical characteristics predic ... Full text Link to item Cite

Rates of Retreatment after Transvenous Embolization of CSF-Venous Fistulas in Spontaneous Intracranial Hypotension.

Journal article AJNR Am J Neuroradiol · March 31, 2026 BACKGROUND AND PURPOSE: Cerebrospinal fluid-venous fistulas (CVF) cause spontaneous intracranial hypotension (SIH) and can be treated with transvenous embolization (TVE). Although TVE has been shown to result in substantial symptomatic improvement, some pa ... Full text Link to item Cite

Evaluation of the C1-C2 False Localizing Sign in Spontaneous Intracranial Hypotension: Prevalence and Clinical Insights.

Journal article AJNR Am J Neuroradiol · March 25, 2026 BACKGROUND AND PURPOSE: Dural tears are a major cause of spontaneous intracranial hypotension. The existence of a dural tear can be inferred by the presence of extradural CSF on spine MRI. However, extradural CSF usually spans multiple spinal levels, precl ... Full text Link to item Cite

Photon-Counting Detector vs. Energy-Integrating Detector CT Myelography for Detecting CSF-Venous Fistulas in Spontaneous Intracranial Hypotension: Substantially Lower Radiation Dose.

Journal article AJNR Am J Neuroradiol · March 25, 2026 BACKGROUND AND PURPOSE: Photon-counting detector CT (PCD-CT) offers improved spatial resolution compared with conventional energy-integrating detector CT (EID-CT), but session-level dose comparisons in multi-acquisition CT myelography (CTM) are limited. We ... Full text Link to item Cite

Sacral Dural Tears in Spontaneous Intracranial Hypotension: Imaging Phenotype and Treatment Outcomes in a Multicenter Cohort.

Journal article AJNR Am J Neuroradiol · March 16, 2026 BACKGROUND AND PURPOSE: Sacral dural tears are an underrecognized cause of spontaneous intracranial hypotension, and their clinical behavior and response to treatment remain incompletely defined. We hypothesized that outcomes following epidural patching in ... Full text Link to item Cite

Abd-El-Barr's Mountain-A Radiographic Landmark for Consistent and Successful Docking in Minimally Invasive Lumbar Surgery: A Cadaveric Study.

Journal article Int J Spine Surg · February 26, 2026 BACKGROUND: Minimally invasive surgical techniques have the potential to decrease the morbidity associated with traditional open surgery. However, surgeons may hesitate to implement minimally invasive techniques in their practice due to limited direct visu ... Full text Link to item Cite

Enhancing the Characterization of Dural Tears on Photon-Counting CT Myelography: An Analysis of Reconstruction Techniques.

Journal article AJNR Am J Neuroradiol · February 3, 2026 Photon-counting detector CT myelography is an effective technique for the localization of spinal CSF leaks. The initial studies describing this technique used a relatively smooth Br56 kernel. However, subsequent studies have demonstrated that the use of th ... Full text Link to item Cite

Maximizing the Conspicuity of CSF-Venous Fistulas on CT Myelography: Assessment of Contrast Density and Timing Effects.

Journal article AJNR Am J Neuroradiol · February 3, 2026 BACKGROUND AND PURPOSE: Advancements in CT myelography (CTM) have improved visualization of CSF-venous fistulas (CVFs), a frequent cause of spontaneous intracranial hypotension (SIH). However, the relative impact of the timing of image acquisition and the ... Full text Open Access Link to item Cite

The contribution of lumbar puncture opening pressure in the diagnosis of spontaneous intracranial hypotension: A systematic literature review and meta-analysis.

Journal article Headache · February 2026 OBJECTIVE: The objective of this study was to summarize the available evidence regarding the clinical value and trend over time of lumbar cerebrospinal fluid (CSF) opening pressure utilization to diagnose spontaneous intracranial hypotension (SIH). BACKGRO ... Full text Link to item Cite

Systematic Review of the Predictive Value of Negative Brain or Low Probability Brain MRIs in Patients with CSF-Venous Fistulas.

Journal article AJNR Am J Neuroradiol · December 4, 2025 BACKGROUND: Since the discovery of the CSF-venous fistula (CVF), its diagnosis has become more frequent, especially in patients with brain MRIs positive for spontaneous intracranial hypotension (SIH). However, there is a need to understand the likelihood o ... Full text Link to item Cite

Consensus Guidelines on Diagnostic Brain and Spine Imaging of Spontaneous Intracranial Hypotension.

Journal article AJNR Am J Neuroradiol · December 4, 2025 Diagnostic imaging of the brain and spine in spontaneous intracranial hypotension (SIH) has evolved rapidly in the past several years, presenting challenges for practitioners seeking to stay current on the optimal methods for investigating and localizing s ... Full text Link to item Cite

Reporting the Degree of Certainty of CSF-Venous Fistulas in Patients with Spontaneous Intracranial Hypotension: The Duke CSF-Venous Fistula Confidence Score.

Journal article AJNR Am J Neuroradiol · November 3, 2025 BACKGROUND AND PURPOSE: CSF-venous fistulas (CVFs) are a common cause of spontaneous intracranial hypotension (SIH). CVF identification and localization are critical for diagnosis and treatment, but inconsistent visualization of CVFs on myelography leads t ... Full text Link to item Cite

Percutaneous Treatment and Post-treatment Management of CSF Leaks and CSF-Venous Fistulas in Spontaneous Intracranial Hypotension.

Journal article Neurosurg Clin N Am · October 2025 Spontaneous intracranial hypotension (SIH) is a treatable cause of orthostatic headaches secondary to pathologic loss of cerebrospinal fluid (CSF) from the subarachnoid space. SIH has several known pathologic causes including dural tears from disc osteophy ... Full text Link to item Cite

Optimization of Photon-Counting CT Myelography for the Detection of CSF-Venous Fistulas Using Convolutional Neural Network Denoising: A Comparative Analysis of Reconstruction Techniques.

Journal article AJNR Am J Neuroradiol · August 1, 2025 BACKGROUND AND PURPOSE: Photon-counting detector CT myelography (PCD-CTM) is a recently described technique used for detecting spinal CSF leaks, including CSF-venous fistulas. Various image reconstruction techniques, including smoother-versus-sharper kerne ... Full text Link to item Cite

Intramedullary Spinal Cord Tumors and Tumor-Like Lesions.

Journal article Magn Reson Imaging Clin N Am · May 2025 Intramedullary spinal cord tumors are rare neoplasms that can result in significant patient morbidity and mortality. Symptom onset is often insidious and not specific; thus, imaging is imperative for accurate diagnosis and localization of these tumors. Rad ... Full text Link to item Cite

Density and Time Characteristics of CSF-Venous Fistulas on CT Myelography in Patients with Spontaneous Intracranial Hypotension.

Journal article AJNR Am J Neuroradiol · April 2, 2025 BACKGROUND AND PURPOSE: The conspicuity of CSF-venous fistulas (CVFs) on specialized myelographic imaging protocols varies, and the factors that determine their visibility have not yet been extensively studied. The purpose of this study was to determine th ... Full text Link to item Cite

Hypersensitivity Reactions to Fibrin Glue during Epidural Blood Patching.

Journal article AJNR Am J Neuroradiol · April 2, 2025 BACKGROUND AND PURPOSE: Fibrin glue is increasingly incorporated as a component in epidural blood patching (EBP) for the treatment of spinal CSF leaks. Hypersensitivity reactions are a potential complication of its use but are not well studied in the setti ... Full text Link to item Cite

Photon-Counting CT Myelography for the Detection of Spinal CSF Leaks.

Journal article AJNR Am J Neuroradiol · April 2, 2025 Photon-counting CT myelography is a relatively recently described technique for the detection of spinal CSF leaks in patients with spontaneous intracranial hypotension.1-3 In this Video, we outline the fundamental procedural techniques used in CT myelograp ... Full text Link to item Cite

Safety and Technical Performance of Bilateral Decubitus CT Myelography Using Standard versus Increased Intrathecal Iodinated Contrast Volume.

Journal article AJNR Am J Neuroradiol · February 3, 2025 BACKGROUND AND PURPOSE: Lateral decubitus CT myelography (LDCTM) is one of the main studies for the detection of CSF-venous fistulas, but detection of CSF-venous fistulas is dependent on intrathecal contrast attenuation. The purpose of this investigation w ... Full text Link to item Cite

Diagnostic Performance of Renal Contrast Excretion on Early-Phase CT Myelography in Spontaneous Intracranial Hypotension.

Journal article AJNR Am J Neuroradiol · January 8, 2025 BACKGROUND AND PURPOSE: Early opacification of the renal collecting system during CT myelography (CTM) performed for the evaluation of spontaneous intracranial hypotension (SIH) has been demonstrated in prior studies. However, these investigations often in ... Full text Link to item Cite

Spontaneous Intracranial Hypotension in Children: A Multi-Institutional Review of Spinal CSF Leaks Localized on Advanced Myelography.

Journal article AJNR Am J Neuroradiol · December 9, 2024 Spontaneous intracranial hypotension is an increasingly recognized syndrome caused by a spinal CSF leak, with most reported cases occurring in adults. The use of specialized or advanced myelography to localize spinal CSF leaks has evolved substantially in ... Full text Link to item Cite

Spinal CSF Leaks: The Neuroradiologist Transforming Care.

Journal article AJNR Am J Neuroradiol · November 7, 2024 Spinal CSF leak care has evolved during the past several years due to pivotal advances in its diagnosis and treatment. To the reader of the American Journal of Neuroradiology (AJNR), it has been impossible to miss the exponential increase in groundbreaking ... Full text Link to item Cite

Diagnostic Yield of Decubitus CT Myelography for Detection of CSF-Venous Fistulas.

Journal article AJNR Am J Neuroradiol · October 3, 2024 BACKGROUND AND PURPOSE: Various imaging techniques have been described to detect CSF-venous fistulas in the setting of spontaneous intracranial hypotension, including decubitus CT myelography. The expected diagnostic yield of decubitus CT myelography for C ... Full text Link to item Cite

Myelographic Techniques for the Localization of CSF-Venous Fistulas: Updates in 2024.

Journal article AJNR Am J Neuroradiol · October 3, 2024 CSF-venous fistulas (CVFs) are a common cause of spontaneous intracranial hypotension. Despite their relatively frequent occurrence, they can be exceedingly difficult to detect on imaging. Since the initial description of CVFs in 2014, the recognition and ... Full text Link to item Cite

The Global Reading Room: A Patient With Headaches After Spinal Anesthesia.

Journal article AJR. American journal of roentgenology · August 2024 Full text Cite

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group.

Journal article Reg Anesth Pain Med · July 8, 2024 INTRODUCTION: Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the pre ... Full text Link to item Cite

Myelography Using Energy-Integrating Detector CT Versus Photon-Counting Detector CT for Detection of CSF-Venous Fistulas in Patients With Spontaneous Intracranial Hypotension.

Journal article AJR Am J Roentgenol · April 2024 BACKGROUND. CSF-venous fistulas (CVFs), which are an increasingly recognized cause of spontaneous intracranial hypotension (SIH), are often diminutive in size and exceedingly difficult to detect by conventional imaging. OBJECTIVE. This purpose of this stud ... Full text Open Access Link to item Cite

Percutaneous Treatment and Post-treatment Management of CSF Leaks and CSF-Venous Fistulas in Spontaneous Intracranial Hypotension.

Journal article Radiol Clin North Am · March 2024 Spontaneous intracranial hypotension (SIH) is a treatable cause of orthostatic headaches secondary to pathologic loss of cerebrospinal fluid (CSF) from the subarachnoid space. SIH has several known pathologic causes including dural tears from disc osteophy ... Full text Link to item Cite

Erratum for: CT Myelography: How to Do It.

Journal article Radiographics · February 2024 Full text Link to item Cite

CT Myelography: How to Do It.

Journal article Radiographics · January 2024 Full text Link to item Cite

Facets of facet joint interventions.

Journal article Skeletal Radiol · October 2023 Facet joint (FJ) disease is a common cause of axial low back pain with many minimally invasive image-guided treatment options. This article discusses fluoroscopic and CT-guided intraarticular FJ injections, medial branch (MB) radiofrequency ablation (RFA), ... Full text Link to item Cite

Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension.

Journal article J Neurol Neurosurg Psychiatry · October 2023 BACKGROUND: We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and con ... Full text Link to item Cite

Results of an International Survey on Spinal Imaging by the ASNR/ASSR/ESNR/ESSR "Nomenclature 3.0" Working Group.

Journal article Semin Musculoskelet Radiol · October 2023 Our goal was to determine if "Nomenclature 2.0," the classification of lumbar disk pathology consensus, should be updated. We conducted a social media and e-mail-based survey on preferences regarding the use of classification on magnetic resonance spine re ... Full text Link to item Cite

Biallelic variants in ribonuclease inhibitor (RNH1), an inflammasome modulator, are associated with a distinctive subtype of acute, necrotizing encephalopathy.

Journal article Genet Med · September 2023 PURPOSE: Mendelian etiologies for acute encephalopathies in previously healthy children are poorly understood, with the exception of RAN binding protein 2 (RANBP2)-associated acute necrotizing encephalopathy subtype 1 (ANE1). We provide clinical, genetic, ... Full text Link to item Cite

Validity of the Bern Score as a Surrogate Marker of Clinical Severity in Patients with Spontaneous Intracranial Hypotension.

Journal article AJNR Am J Neuroradiol · September 2023 BACKGROUND AND PURPOSE: The Bern score is a quantitative scale characterizing brain MR imaging changes in spontaneous intracranial hypotension. Higher scores are associated with more abnormalities on brain MR imaging, raising the question of whether the sc ... Full text Link to item Cite

Patient experience of spontaneous intracranial hypotension (SIH): qualitative interviews for concept elicitation.

Journal article J Patient Rep Outcomes · August 15, 2023 BACKGROUND & OBJECTIVES: Spontaneous intracranial hypotension (SIH) is an underdiagnosed and debilitating condition caused by a spinal cerebrospinal fluid (CSF) leak. Although SIH can lead to substantial morbidity and disability, little data exists about p ... Full text Link to item Cite

Resisted Inspiration Improves Visualization of CSF-Venous Fistulas in Spontaneous Intracranial Hypotension.

Journal article AJNR Am J Neuroradiol · August 2023 BACKGROUND AND PURPOSE: CSF-venous fistulas are an important cause of spontaneous intracranial hypotension but are challenging to detect. A newly described technique known as resisted inspiration has been found to augment the CSF-venous pressure gradient a ... Full text Link to item Cite

Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group: A Summary Report.

Journal article JAMA Netw Open · August 1, 2023 IMPORTANCE: Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures, such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prev ... Full text Link to item Cite

Enterothecal fistula as a rare cause of adult pneumocephalus and meningitis: a case report.

Journal article J Spine Surg · June 30, 2023 BACKGROUND: Enterothecal fistulas are pathological connections between the gastrointestinal system and subarachnoid space. These rare fistulas occur mostly in pediatric patients with sacral developmental anomalies. They have yet to be characterized in an a ... Full text Link to item Cite

Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map.

Journal article AJNR Am J Neuroradiol · June 2023 BACKGROUND: Spontaneous intracranial hypotension is an important cause of treatable secondary headaches. Evidence on the efficacy of epidural blood patching and surgery for spontaneous intracranial hypotension has not been synthesized. PURPOSE: Our aim was ... Full text Link to item Cite

Image-Guided Spine Interventions for Pain: Ongoing Controversies.

Journal article AJR Am J Roentgenol · May 2023 An expanding array of image-guided spine interventions have the potential to provide immediate and effective pain relief. Innovations in spine intervention have proceeded rapidly, with clinical adoption of new techniques at times occurring before the devel ... Full text Link to item Cite

Leukocoria in Children: Findings on CT and MRI of the Principal Causes

Journal article Neurographics · October 1, 2022 Leukocoria is the result of an alteration in the normal red reflex of the ocular fundus, secondary to an obstruction of the normal passage of light to the fundus of the eye that produces a white light reflex. There are many ocular pathologies that can pres ... Full text Cite

The microRNA processor DROSHA is a candidate gene for a severe progressive neurological disorder.

Journal article Hum Mol Genet · August 25, 2022 DROSHA encodes a ribonuclease that is a subunit of the Microprocessor complex and is involved in the first step of microRNA (miRNA) biogenesis. To date, DROSHA has not yet been associated with a Mendelian disease. Here, we describe two individuals with pro ... Full text Open Access Link to item Cite

Digital manometry to measure cerebrospinal fluid pressure during lumbar puncture.

Journal article Neuroradiol J · August 2022 RATIONALE AND OBJECTIVES: Accurate cerebrospinal fluid (CSF) pressure measurements are critical for diagnosis and treatment of pathologic processes involving the central nervous system. Measuring opening CSF pressure using an analog device takes several mi ... Full text Link to item Cite

An Exploratory Analysis of Biomarkers of Perihematomal Edema in the CN-105 in Participants with Acute Supratentorial Intracerebral Hemorrhage (CATCH) Trial.

Journal article J Stroke Cerebrovasc Dis · August 2022 OBJECTIVE: To identify biomarkers with potential to indicate severity of perihematomal edema and secondary tissue injury after intracerebral hemorrhage (ICH), and which could be used as surrogate markers in future clinical trials for novel ICH therapeutics ... Full text Link to item Cite

Efficacy of epidural blood patching or surgery in spontaneous intracranial hypotension: an evidence map protocol.

Journal article Syst Rev · June 7, 2022 BACKGROUND: Spontaneous intracranial hypotension (SIH) is a debilitating disorder caused by non-iatrogenic spinal cerebrospinal fluid leaks. SIH is increasingly recognized as an important treatable cause of secondary headaches. Treatment involves either ep ... Full text Link to item Cite

Differentiation of Chiari malformation type 1 and spontaneous intracranial hypotension using objective measurements of midbrain sagging.

Journal article J Neurosurg · June 1, 2022 OBJECTIVE: Chiari malformation type 1 (CM-1) and spontaneous intracranial hypotension (SIH) are causes of headache in which cerebellar tonsillar ectopia (TE) may be present. An accurate method for differentiating these conditions on imaging is needed to av ... Full text Link to item Cite

Dual energy CT for the identification of CSF-Venous Fistulas and CSF leaks in spontaneous intracranial hypotension: Report of four cases.

Journal article Radiol Case Rep · May 2022 Spontaneous intracranial hypotension (SIH) is a debilitating condition caused by spinal CSF leaks or CSF-venous fistulas (CVFs). Localizing the causative CSF leak or CVF is critical for definitive treatment but can be difficult using conventional myelograp ... Full text Link to item Cite

CN-105 in Participants with Acute Supratentorial Intracerebral Hemorrhage (CATCH) Trial.

Journal article Neurocrit Care · February 2022 BACKGROUND: Endogenous apolipoprotein (apo) E mediates neuroinflammatory responses and recovery after brain injury. Exogenously administered apoE-mimetic peptides effectively penetrate the central nervous system compartment and downregulate acute inflammat ... Full text Open Access Link to item Cite

CSF-Venous Fistulas: Anatomy and Diagnostic Imaging.

Journal article AJR Am J Roentgenol · December 2021 CSF-venous fistulas (CVFs), first described in 2014, are an important cause of spontaneous intracranial hypotension. CVFs can be challenging to detect on conventional anatomic imaging because, unlike other types of spinal CSF leak, they do not typically re ... Full text Link to item Cite

Respiratory Phase Affects the Conspicuity of CSF-Venous Fistulas in Spontaneous Intracranial Hypotension.

Journal article AJNR Am J Neuroradiol · September 2020 Spinal CSF-venous fistulas are a cause of spontaneous intracranial hypotension that can be difficult to detect on imaging. We describe how the respiratory phase affects the visibility of CSF-venous fistulas during myelography. ... Full text Link to item Cite

Clinical Outcomes Following Surgical Ligation of Cerebrospinal Fluid-Venous Fistula in Patients With Spontaneous Intracranial Hypotension: A Prospective Case Series.

Journal article Oper Neurosurg · March 1, 2020 BACKGROUND: Cerebrospinal fluid-venous fistula (CVF) is a recently described cause of spontaneous intracranial hypotension (SIH). Surgical ligation of CVF has been reported, but clinical outcomes are not well described. OBJECTIVE: To determine the clinical ... Full text Link to item Cite

Spontaneous Intracranial Hypotension: Pathogenesis, Diagnosis, and Treatment.

Journal article Neuroimaging Clin N Am · November 2019 Spontaneous intracranial hypotension (SIH) is a clinical syndrome that is increasingly recognized as an important and treatable secondary cause of headaches. Insight into the condition has evolved significantly over the past decade, resulting in a greater ... Full text Link to item Cite

CSF volume provocation maneuvers during lumbar puncture as a possible predictive tool for diagnosing spontaneous intracranial hypotension.

Journal article Clin Neurol Neurosurg · November 2019 OBJECTIVES: Spontaneous intracranial hypotension (SIH) is a pathologic state of low CSF volume caused by a CSF to venous fistula or CSF leak. It is diagnosed based on symptoms, imaging, and CSF pressure but is often a diagnostic challenge because no single ... Full text Link to item Cite

Cross-sectional CT Assessment of the Extent of Injectate Spread at CT Fluoroscopy-guided Cervical Epidural Interlaminar Steroid Injections.

Journal article Radiology · September 2019 Background Previous studies analyzed contrast agent spread during cervical interlaminar epidural steroid injections (CILESIs) by using planar fluoroscopy and reported wide variance of the rate of spread to the ventral epidural space (VES). Cross-sectional ... Full text Open Access Link to item Cite

Heterozygous variants in MYBPC1 are associated with an expanded neuromuscular phenotype beyond arthrogryposis.

Journal article Hum Mutat · August 2019 Encoding the slow skeletal muscle isoform of myosin binding protein-C, MYBPC1 is associated with autosomal dominant and recessive forms of arthrogryposis. The authors describe a novel association for MYBPC1 in four patients from three independent families ... Full text Link to item Cite

Cerebral Venous Thrombosis: Reviewing Pathophysiology, Diagnosis, and Treatment Strategies

Journal article Journal of Neuroanaesthesiology and Critical Care · June 2019 AbstractThis review discusses cerebral venous thrombosis (CVT), including diagnosis and treatment strategies, a rare class of stroke that, if unrecognized or untreated, can have devastating effects. Thrombosis of one or man ... Full text Cite

Decubitus CT Myelography for Detecting Subtle CSF Leaks in Spontaneous Intracranial Hypotension.

Journal article AJNR Am J Neuroradiol · April 2019 Spontaneous intracranial hypotension is caused by spinal CSF leaks, but the site of the leak is not always detected on spinal imaging. We report on the additional value of decubitus positioning during CT myelography in enhancing the detection of subtle lea ... Full text Link to item Cite

Imaging Approach to Myelopathy: Acute, Subacute, and Chronic.

Journal article Radiol Clin North Am · March 2019 Myelopathy refers to any pathologic process that involves the spinal cord, and can be caused by a variety of different diseases. MR imaging is the primary modality for evaluating the patient presenting with myelopathy. The first step must be the exclusion ... Full text Link to item Cite

Spontaneous Intracranial Hypotension: Imaging in Diagnosis and Treatment.

Journal article Radiol Clin North Am · March 2019 This article reviews the role of imaging in the diagnosis, management, and treatment of spontaneous intracranial hypotension (SIH). SIH is a debilitating and often misdiagnosed condition caused by either a spinal cerebrospinal fluid (CSF) leak or a CSF to ... Full text Link to item Cite

Loss of tubulin deglutamylase CCP1 causes infantile-onset neurodegeneration.

Journal article EMBO J · December 3, 2018 A set of glutamylases and deglutamylases controls levels of tubulin polyglutamylation, a prominent post-translational modification of neuronal microtubules. Defective tubulin polyglutamylation was first linked to neurodegeneration in the Purkinje cell dege ... Full text Link to item Cite

Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision.

Journal article AJNR Am J Neuroradiol · December 2018 BACKGROUND AND PURPOSE: Patient preparation for myelography and postprocedural monitoring varies widely between practices, despite published guidelines. Our aim was to examine the current practice variations in discontinuing reportedly seizure threshold-lo ... Full text Link to item Cite

Associations between Patient Characteristics and a New, Early Do-Not-Attempt Resuscitation Order after Intracerebral Hemorrhage.

Journal article J Palliat Med · August 2018 BACKGROUND: Decisions to limit care, including use of a do-not-resuscitate (DNR) order, are associated with increased risk of death after intracerebral hemorrhage (ICH). Given the value that patient surrogates place on the physician's perception of prognos ... Full text Link to item Cite

CT Fluoroscopy-Guided Interlaminar Epidural Steroid Injections in the Cervical Spine: Rate of Nontarget Injection Into the Retrodural Space of Okada.

Journal article AJR Am J Roentgenol · August 2018 OBJECTIVE: The purpose of this study was to assess the rate of inadvertent injection into the retrodural space of Okada during CT fluoroscopy-guided interlaminar epidural steroid injection in the cervical spine. MATERIALS AND METHODS: Images from cases of ... Full text Link to item Cite

Approach to Imaging in Patients with Spontaneous Intracranial Hemorrhage.

Journal article Neuroimaging Clin N Am · August 2018 Spontaneous intracranial hemorrhage is a commonly encountered neurologic emergency. Imaging plays important roles in both guiding the emergent stabilization of patients with ICH and in elucidating the etiology of the hemorrhage to prevent rebleeding. A tho ... Full text Link to item Cite

Functional variants in TBX2 are associated with a syndromic cardiovascular and skeletal developmental disorder.

Journal article Hum Mol Genet · July 15, 2018 The 17 genes of the T-box family are transcriptional regulators that are involved in all stages of embryonic development, including craniofacial, brain, heart, skeleton and immune system. Malformation syndromes have been linked to many of the T-box genes. ... Full text Link to item Cite

Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions.

Journal article Headache · July 2018 OBJECTIVE: To discuss common myths and misperceptions about spontaneous intracranial hypotension (SIH), focusing on common issues related to diagnosis and treatment, and to review the evidence that contradicts and clarifies these myths. BACKGROUND: Recogni ... Full text Link to item Cite

Looking beyond the exome: a phenotype-first approach to molecular diagnostic resolution in rare and undiagnosed diseases.

Journal article Genet Med · April 2018 PurposeTo describe examples of missed pathogenic variants on whole-exome sequencing (WES) and the importance of deep phenotyping for further diagnostic testing.MethodsGuided by phenotypic information, three children with negative WES underwent targeted sin ... Full text Open Access Link to item Cite

CSF Venous Fistulas in Spontaneous Intracranial Hypotension: Imaging Characteristics on Dynamic and CT Myelography.

Journal article AJR Am J Roentgenol · December 2017 OBJECTIVE: The objective of this study is to describe the anatomic and imaging features of CSF venous fistulas, which are a recently reported cause of spontaneous intracranial hypotension (SIH). MATERIALS AND METHODS: We retrospectively reviewed the record ... Full text Link to item Cite

Incidence of Inadvertent Dural Puncture During CT Fluoroscopy-Guided Interlaminar Epidural Corticosteroid Injections in the Cervical Spine: An Analysis of 974 Cases.

Journal article AJR Am J Roentgenol · September 2017 OBJECTIVE: The objective of this study is to determine the rate of inadvertent dural puncture during CT fluoroscopy-guided cervical interlaminar epidural corticosteroid injection. In addition, in a subanalysis, we aim to assess the rate of inadvertent dura ... Full text Link to item Cite

Update on the Diagnosis and Treatment of Spontaneous Intracranial Hypotension.

Journal article Curr Pain Headache Rep · August 2017 PURPOSE OF REVIEW: The purpose of this study is to provide an update on recent developments in the understanding, diagnosis, and treatment of spontaneous intracranial hypotension (SIH). RECENT FINDINGS: SIH is an important cause of headaches caused by spin ... Full text Link to item Cite

What's Your Impression? Get to the Point!

Journal article J Am Coll Radiol · April 2017 Full text Link to item Cite

A Recurrent De Novo Variant in NACC1 Causes a Syndrome Characterized by Infantile Epilepsy, Cataracts, and Profound Developmental Delay.

Journal article Am J Hum Genet · February 2, 2017 Whole-exome sequencing (WES) has increasingly enabled new pathogenic gene variant identification for undiagnosed neurodevelopmental disorders and provided insights into both gene function and disease biology. Here, we describe seven children with a neurode ... Full text Link to item Cite

Reformatted images improve the detection rate of acute traumatic subdural hematomas on brain CT compared with axial images alone.

Journal article Emerg Radiol · February 2017 Subdural hematomas (SDHs) comprise a significant percentage of missed intracranial hemorrhage on axial brain CT. SDH detection rates could be improved with the addition of reformatted images. Though performed at some centers, the potential additional diagn ... Full text Link to item Cite

Inadvertent Intrafacet Injection during Lumbar Interlaminar Epidural Steroid Injection: A Comparison of CT Fluoroscopic and Conventional Fluoroscopic Guidance.

Journal article AJNR Am J Neuroradiol · February 2017 BACKGROUND AND PURPOSE: Inadvertent intrafacet injection can occur during interlaminar epidural steroid injection, resulting in a false-positive loss of resistance and nontarget injection of medication. The purpose of this investigation was to compare the ... Full text Link to item Cite

Time-Dependent Changes in Dural Enhancement Associated With Spontaneous Intracranial Hypotension.

Journal article AJR Am J Roentgenol · December 2016 OBJECTIVE: The objective of our study was to determine whether the presence of individual imaging signs of spontaneous intracranial hypotension (SIH) is correlated with increasing duration of headache symptoms. Of particular interest is the relationship of ... Full text Link to item Cite

How common is normal cerebrospinal fluid pressure in spontaneous intracranial hypotension?

Journal article Cephalalgia · November 2016 Objectives To determine the proportion of patients with spontaneous intracranial hypotension (SIH) who had a cerebrospinal fluid (CSF) pressure >6 cm H2O and to investigate the clinical and imaging variables associated with CSF pressure ( PCSF) in this con ... Full text Link to item Cite

De Novo Truncating Variants in ASXL2 Are Associated with a Unique and Recognizable Clinical Phenotype.

Journal article Am J Hum Genet · October 6, 2016 The ASXL genes (ASXL1, ASXL2, and ASXL3) participate in body patterning during embryogenesis and encode proteins involved in epigenetic regulation and assembly of transcription factors to specific genomic loci. Germline de novo truncating variants in ASXL1 ... Full text Link to item Cite

CT Fluoroscopy-Guided Blood Patching of Ventral CSF Leaks by Direct Needle Placement in the Ventral Epidural Space Using a Transforaminal Approach.

Journal article AJNR Am J Neuroradiol · October 2016 BACKGROUND AND PURPOSE: Epidural blood patch treatment of spontaneous intracranial hypotension arising from ventral CSF leaks can be difficult secondary to challenges in achieving ventral spread of patching material. The purpose of this study was to determ ... Full text Link to item Cite

Technique for CT Fluoroscopy-Guided Lumbar Medial Branch Blocks and Radiofrequency Ablation.

Journal article AJR Am J Roentgenol · September 2016 OBJECTIVE: The purpose of this study is to describe the procedure for CT fluoroscopy-guided lumbar medial branch blocks and facet radiofrequency ablation. CONCLUSION: CT fluoroscopic guidance allows more-precise needle tip positioning and is an alternative ... Full text Link to item Cite

The "Hyperdense Paraspinal Vein" Sign: A Marker of CSF-Venous Fistula.

Journal article AJNR Am J Neuroradiol · July 2016 CSF-venous fistula is a recently reported cause of spontaneous intracranial hypotension that may occur in the absence of myelographic evidence of CSF leak. Information about this entity is currently very limited, but it is of potential importance given the ... Full text Link to item Cite

Imaging Signs in Spontaneous Intracranial Hypotension: Prevalence and Relationship to CSF Pressure.

Journal article AJNR Am J Neuroradiol · July 2016 BACKGROUND AND PURPOSE: Patients with spontaneous intracranial hypotension often exhibit low CSF pressure and changes on brain MR imaging and/or evidence of CSF leak on myelography. We investigated whether individual imaging signs of spontaneous intracrani ... Full text Link to item Cite

Reducing Patient Radiation Exposure From CT Fluoroscopy-Guided Lumbar Spine Pain Injections by Targeting the Planning CT.

Journal article AJR Am J Roentgenol · February 2016 OBJECTIVE: CT fluoroscopy-guided lumbar spine pain injections typically include a preprocedural planning CT that contributes considerably to patient dose. The purpose of this study was to quantify the degree of radiation exposure reduction achieved by modi ... Full text Link to item Cite

Myelographic Techniques for the Detection of Spinal CSF Leaks in Spontaneous Intracranial Hypotension.

Journal article AJR Am J Roentgenol · January 2016 OBJECTIVE: Spinal leakage of CSF causes almost all cases of spontaneous intracranial hypotension. Leak detection and localization are important for both diagnosis and treatment. The myelographic appearance of the leaks may vary, however, depending on the c ... Full text Link to item Cite

Comparison of Acoustic Radiation Force Impulse Imaging Derived Carotid Plaque Stiffness With Spatially Registered MRI Determined Composition.

Journal article IEEE Trans Med Imaging · November 2015 Measurements of plaque stiffness may provide important prognostic and diagnostic information to help clinicians distinguish vulnerable plaques containing soft lipid pools from more stable, stiffer plaques. In this preliminary study, we compare in vivo ultr ... Full text Link to item Cite

Incidence of Inadvertent Intravascular Injection during CT Fluoroscopy-Guided Epidural Steroid Injections.

Journal article AJNR Am J Neuroradiol · May 2015 BACKGROUND AND PURPOSE: Inadvertent intravascular injection during epidural steroid injection can result in complications and has been investigated previously with conventional fluoroscopy, but not CT fluoroscopy. The purpose of this study was to determine ... Full text Link to item Cite

Spontaneous brain parenchymal hemorrhage: an approach to imaging for the emergency room radiologist.

Journal article Emerg Radiol · February 2015 Spontaneous intracranial hemorrhage is a neurological emergency commonly encountered by the emergency radiologist. This article reviews the approach to spontaneous brain parenchymal hemorrhage, including common causes and the role of various neuroimaging m ... Full text Link to item Cite

Computed tomography-guided epidural patching of postoperative cerebrospinal fluid leaks.

Journal article J Neurosurg Spine · November 2014 OBJECT: Cerebrospinal fluid leaks due to unrecognized durotomy during spinal surgery are often managed with a second surgery for dural closure. CT-guided percutaneous patching targeted to the dural defect offers an alternative to surgery since it can be pe ... Full text Link to item Cite

Effect of Body Habitus on Radiation Dose During CT Fluoroscopy-Guided Spine Injections.

Journal article Interv Neuroradiol · October 31, 2014 This study investigated the degree to which body habitus influences radiation dose during CT fluoroscopy (CTF)-guided lumbar epidural steroid injections (ESI). An anthropomorphic phantom containing metal oxide semiconductor field effect transistor (MOSFET) ... Full text Link to item Cite

Effect of the CT table strap on radiation exposure and image quality during cervical spine CT.

Journal article AJNR Am J Neuroradiol · October 2014 BACKGROUND AND PURPOSE: The CT table strap may impair shoulder lowering during cervical spine CT. The purpose of this investigation was to evaluate the effect of the CT table strap on radiation exposure and image quality during CT of the cervical spine. MA ... Full text Link to item Cite

A novel, reproducible, and objective method for volumetric magnetic resonance imaging assessment of enhancing glioblastoma.

Journal article J Neurosurg · September 2014 OBJECT: Robust methodology that allows objective, automated, and observer-independent measurements of brain tumor volume, especially after resection, is lacking. Thus, determination of tumor response and progression in neurooncology is unreliable. The obje ... Full text Link to item Cite

Malignant brainstem gliomas in adults: clinicopathological characteristics and prognostic factors.

Journal article J Neurooncol · August 2014 Adult malignant brainstem gliomas (BSGs) are poorly characterized due to their relative rarity. We have examined histopathologically confirmed cases of adult malignant BSGs to better characterize the patient and tumor features and outcomes, including the n ... Full text Link to item Cite

High variability in radiologists' reporting practices for incidental thyroid nodules detected on CT and MRI.

Journal article AJNR Am J Neuroradiol · June 2014 BACKGROUND AND PURPOSE: There are no guidelines for reporting incidental thyroid nodules seen on CT and MR imaging. We evaluated radiologists' current reporting practices for incidental thyroid nodules detected on these imaging modalities. MATERIALS AND ME ... Full text Link to item Cite

Rebound intracranial hypertension: a complication of epidural blood patching for intracranial hypotension.

Journal article AJNR Am J Neuroradiol · June 2014 Rebound intracranial hypertension is a complication of epidural blood patching for treatment of intracranial hypotension characterized by increased intracranial pressure, resulting in potentially severe headache, nausea, and vomiting. Because the symptoms ... Full text Link to item Cite

Use of apparent diffusion coefficient values for diagnosis of pediatric posterior fossa tumors.

Journal article Neuroradiol J · April 2014 We prospectively compared the ability of neuroradiologists to diagnose medulloblastoma with novice raters using only apparent diffusion coefficient (ADC) values measured on ADC maps. One hundred and three pediatric patients with pre-operative magnetic reso ... Full text Link to item Cite

Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system?

Journal article AJR Am J Roentgenol · January 2014 OBJECTIVE: The purpose of this study was to determine the number of thyroid nodule workups that could be eliminated and the number of malignant tumors that would be missed if the Society of Radiologists in Ultrasound (SRU) recommendations and the three-tie ... Full text Link to item Cite

Cerebral air embolism from angioinvasive cavitary aspergillosis.

Journal article Case Rep Neurol Med · 2014 Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two ... Full text Open Access Link to item Cite

Optimal contrast concentration for CT-guided epidural steroid injections.

Journal article AJNR Am J Neuroradiol · January 2014 BACKGROUND AND PURPOSE: Contrast is used in CT-guided epidural steroid injections to ensure proper needle placement. Once injected, undiluted contrast often obscures the needle, hindering subsequent repositioning. The purpose of this investigation was to e ... Full text Link to item Cite

Predictors of late neurological deterioration after spontaneous intracerebral hemorrhage.

Journal article Neurocrit Care · December 2013 BACKGROUND: Although intracerebral hemorrhage (ICH) is a common form of cerebrovascular disease, little is known about factors leading to neurological deterioration occurring beyond 48 h after hematoma formation. The purpose of this study was to characteri ... Full text Link to item Cite

Gender and age interact to affect early outcome after intracerebral hemorrhage

Journal article Plos One · November 27, 2013 Background: Intracerebral hemorrhage (ICH) is a common and devastating form of cerebrovascular disease. In ICH, gender differences in outcomes remain relatively understudied but have been examined in other neurological emergencies. Further, a potential eff ... Full text Cite

Reorganization and stability for motor and language areas using cortical stimulation: case example and review of the literature.

Journal article Brain Sci · November 26, 2013 The cerebral organization of language in epilepsy patients has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping and more recently with noninvasive neuroimaging techniques, such as functional MRI. In the ... Full text Open Access Link to item Cite

Clinical characteristics and treatment of malignant brainstem gliomas in elderly patients.

Journal article J Clin Neurosci · October 2013 Adult brainstem gliomas (BSG) are uncommon tumors that constitute only 2% of all brain tumors. Due to its rare occurrence in the elderly (60 years and older), there is no literature discussing the natural history, prognosis, and best treatment strategy for ... Full text Link to item Cite

Positive deviance.

Journal article Am J Nurs · October 2013 Full text Link to item Cite

Intraaxial dermoid cyst of the medulla.

Journal article J Neurosurg · August 2013 Intracranial dermoid cysts are rare congenital lesions that typically occur in the cisternal spaces. However, exceptionally rare cases of intraaxial involvement have been reported, with only 8 cases having been described in the literature. The authors repo ... Full text Link to item Cite

CT-guided cervical transforaminal steroid injections: where should the needle tip be located?

Journal article AJNR Am J Neuroradiol · March 2013 BACKGROUND AND PURPOSE: The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study w ... Full text Link to item Cite

Gender and age interact to affect early outcome after intracerebral hemorrhage.

Journal article PLoS One · 2013 BACKGROUND: Intracerebral hemorrhage (ICH) is a common and devastating form of cerebrovascular disease. In ICH, gender differences in outcomes remain relatively understudied but have been examined in other neurological emergencies. Further, a potential eff ... Full text Open Access Link to item Cite

Spinal meningeal diverticula in spontaneous intracranial hypotension: analysis of prevalence and myelographic appearance.

Journal article AJNR Am J Neuroradiol · 2013 BACKGROUND AND PURPOSE: Spinal meningeal diverticula have been implicated in the pathogenesis of spontaneous intracranial hypotension and have been proposed as both diagnostic features of and therapeutic targets for the condition. We compared the prevalenc ... Full text Link to item Cite

Reply

Journal article American Journal of Neuroradiology · December 1, 2012 Full text Cite

CT-guided lumbar nerve root injections: are we using the correct radiation dose settings?

Journal article AJNR Am J Neuroradiol · November 2012 BACKGROUND AND PURPOSE: Selecting a lower tube current for CT fluoroscopic spine injections is a method of radiation dose reduction. Ideally tube current should be tailored to the patient's body habitus, but a greater influence on tube current may be the p ... Full text Link to item Cite

Increased corpus callosum volume in children with chromosome 22q11.2 deletion syndrome is associated with neurocognitive deficits and genetic polymorphisms.

Journal article Eur J Hum Genet · October 2012 Chromosome 22q11.2 deletion syndrome (22q11DS) is associated with neurocognitive impairments. The neural substrates of cognitive impairments in 22q11DS remain poorly understood. Because the corpus callosum (CC) is found to be abnormal in a variety of neuro ... Full text Link to item Cite

CT fluoroscopy-guided cervical interlaminar steroid injections: safety, technique, and radiation dose parameters.

Journal article AJNR Am J Neuroradiol · August 2012 BACKGROUND AND PURPOSE: Cervical epidural steroid injections are approached with trepidation because of concerns over safety, including direct spinal cord injury. CT fluoroscopy is an alternative to conventional fluoroscopy that could potentially help redu ... Full text Link to item Cite

Technique for CT fluoroscopy-guided cervical interlaminar steroid injections.

Journal article AJR Am J Roentgenol · March 2012 OBJECTIVE: We describe the use of CT fluoroscopy as a guidance tool for performing interlaminar epidural steroid injections in the cervical spine. CONCLUSION: CT fluoroscopy is an alternative method to perform cervical interlaminar steroid injections that ... Full text Link to item Cite

Understanding errors in diagnostic radiology: proposal of a classification scheme and application to emergency radiology.

Journal article Emerg Radiol · October 2011 Errors in image interpretation are a common problem in diagnostic radiology. Although many published articles provide trainees with the means to correctly interpret imaging studies, they do not provide a framework for understanding why and how errors occur ... Full text Link to item Cite

Resolution of syringohydromyelia with targeted CT-guided epidural blood patching.

Journal article J Neurosurg · September 2011 In the scientific literature, syringohydromyelia has only rarely been reported in association with spontaneous intracranial hypotension. Management of the syringohydromyelia in these patients has heretofore involved relatively invasive surgical procedures. ... Full text Link to item Cite

Bilateral retropharyngeal parathyroid hyperplasia detected with 4D multidetector row CT.

Journal article AJNR Am J Neuroradiol · May 2011 We present a case of bilateral retropharyngeal parathyroid hyperplasia detected with 4D-CT in a patient with persistent primary hyperparathyroidism and failed neck exploration. We discuss the embryologic basis of ectopic retropharyngeal parathyroid adenoma ... Full text Link to item Cite

CT-guided epidural blood patching of directly observed or potential leak sites for the targeted treatment of spontaneous intracranial hypotension.

Journal article AJNR Am J Neuroradiol · May 2011 BACKGROUND AND PURPOSE: Optimal diagnosis and management of spontaneous intracranial hypotension remains uncertain. CT-guided blood patching has been described but has not been evaluated in larger case series. We sought to evaluate the efficacy of CT-guide ... Full text Link to item Cite

Dural sinus thrombosis: sources of error in image interpretation.

Journal article AJR Am J Roentgenol · January 2011 OBJECTIVE: The purpose of this article is to bring some of the potential causes of false-positive and false-negative interpretations of dural sinus thrombosis (DST) on cross-section imaging studies to the attention of radiologists. CONCLUSION: The prompt d ... Full text Link to item Cite

CT fluoroscopy-assisted cervical transforaminal steroid injection: tips, traps, and use of contrast material.

Journal article AJR Am J Roentgenol · October 2010 OBJECTIVE: CT fluoroscopy-assisted cervical transforaminal steroid injection is an effective therapeutic option for cervical radiculopathy, yet it is approached with trepidation by some interventionalists. CT fluoroscopy is superior to conventional fluoros ... Full text Link to item Cite

Magnetic resonance imaging of guinea pig cochlea after vasopressin-induced or surgically induced endolymphatic hydrops.

Journal article Otolaryngol Head Neck Surg · February 2010 OBJECTIVE: To investigate the ability to detect the in vivo cochlear changes associated with vasopressin-induced and surgically induced endolymphatic hydrops using MRI at 3 tesla (T). STUDY DESIGN: Prospective, animal model. SETTING: Animal laboratory. SUB ... Full text Link to item Cite

Does diffusion-weighted imaging represent the ischemic core? An evidence-based systematic review.

Journal article AJNR Am J Neuroradiol · June 2009 BACKGROUND AND PURPOSE: Diffusion-weighted(DWI) hyperintensity is hypothesized to represent irreversibly infarcted tissue (ischemic core) in the setting of acute stroke [corrected]. Measurement of the ischemic core has implications for both prognosis and t ... Full text Link to item Cite