Pet Imaging in Carotid Stenosis

  • C. P. Derdeyn


Positron Emission Tomography (PET) is a physiological, not anatomical imaging method: it is not used for the measurement or detection of carotid artery disease. It is primarily a research tool that has several important applications for the study of human carotid atherosclerotic disease. Functional imaging methods, including PET, have provided compelling data that embolic and hemodynamic factors have a synergistic effect on stroke risk. The foremost role of PET has been in studies of the assessment of the hemodynamic and metabolic effects of these lesions on the distal cerebral circulation. This information has proven prognostic value. In addition, molecular imaging applications have been described, allowing investigation of physiological aspects of the plaque itself. Finally, some radiotracers may be used to identify recent brain injury. This could help distinguish symptomatic from asymptomatic lesions, a critical distinction in carotid disease.


Cerebral Perfusion Pressure Cerebral Blood Volume Carotid Stenosis Mean Transit Time Cereb Blood Flow 
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  1. [1]
    Abe K, Kashiwagi Y, Tokumura M et al.: Discrepancy between cell injury and benzodiazepine receptor binding after transient middle cerebral artery occlusion in rats. Synapse 53: 234–239 (2004).PubMedCrossRefGoogle Scholar
  2. [2]
    Adams J, Brierley J, Connor R, Treip C: The effects of systemic hypotension upon the human brain. Clinical and neuropathological observations in 11 cases. Brain 89: 235–268 (1966).PubMedCrossRefGoogle Scholar
  3. [3]
    Baron JC, Bousser MG, Rey A et al.: Reversal of focal “misery perfusion syndrome” by extra-intracranial artery bypass in hemodynamic cerebral ischemia. A case study with 0–15 positron emission tomography. Stroke 12: 454–459 (1981).PubMedGoogle Scholar
  4. [4]
    Baron JC, Steinling M, Tanaka T et al.: Quantitative measurement of CBF, oxygen extraction fraction (OEF) and CMRO2 with the O-15 continuous inhalation technique positron emission tomography (PET): experimental evidence and normal values in man. J Cereb Blood Flow and Metab 1: S5–S6 (1981).Google Scholar
  5. [5]
    Baron JC, Rougemont D, Soussaline F et al.: Local interrelationships of cerebral oxygen consumption and glucose utilization in normal subjects and in ischemic stroke patients: a positron tomography study. J Cereb Blood Flow Metab 4: 140–149 (1984).PubMedGoogle Scholar
  6. [6]
    Baron JC, Frackowiak RSJ, Herholz K et al.: Use of PET methods for measurement of cerebral energy metabolism and hemodynamics in cerebrovascular disease. J Cereb Blood Flow Metab 9: 723–742 (1989).PubMedGoogle Scholar
  7. [7]
    Bogousslavsky J, Hachinski VC, Boughner DR et al.: Cardiac and arterial lesions in transient ischemic attacks. Arch Neurol 43: 223–228 (1986).PubMedGoogle Scholar
  8. [8]
    Bozzao L, Fantozzi LM, Bastianello S et al.: Ischaemic supratentorial stroke: angiographic findings in patients examined in the very early phase. J Neurol 236: 340–342 (1989).PubMedCrossRefGoogle Scholar
  9. [9]
    Brierley JB, Excell BJ: The effects of profound systemic hypotension upon the brain of M. Rhesus: Physiological and pathological observations. Brain 89: 269–298 (1986).CrossRefGoogle Scholar
  10. [10]
    Chimowitz MI, Lynn MJ, Howlett-Smith H et al.: Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352: 1305–1316 (2005).PubMedCrossRefGoogle Scholar
  11. [11]
    Dahl AL, Russell D, Nyberg-Hansen R et al.: Simultaneous assessment of vasoreactivity using transcranial Doppler ultrasound and cerebral blood flow in healthy subjects. J Cereb Blood Flow Metab 14: 974–981 (1994).PubMedGoogle Scholar
  12. [12]
    Davies MJ: Stability and instability: two faces of coronary atherosclerosis-The Paul Dudley White Lecture 1995. Circulation 94: 2013–2020 (1996).PubMedGoogle Scholar
  13. [13]
    Davies JR, Rudd JH, Weissberg PL: Molecular and metabolic imaging of atherosclerosis. J Nucl Med 45: 1898–1907 (2004).PubMedGoogle Scholar
  14. [14]
    De Reuck J, Vonck K, Santens P et al.: Cobalt-55 positron emission tomography in late-onset epileptic seizures after thrombo-embolic middle cerebral artery infarction. J Neurol Sci 181: 13–18 (2000).PubMedCrossRefGoogle Scholar
  15. [15]
    De Reuck J, Paemeleire K, Santens P et al.: Cobalt-55 positron emission tomography in symptomatic atherosclerotic carotid artery disease: borderzone versus territorial infarcts. Clin Neurol Neurosurg 106: 77–81 (2004).PubMedCrossRefGoogle Scholar
  16. [16]
    Derdeyn CP, Khosla A, Videen TO et al.: Severe hemodynamic impairment and border zone-region infarction. Radiology 220: 195–201 (2001).PubMedGoogle Scholar
  17. [17]
    Derdeyn CP, Simmons NR, Videen TO et al.: Absence of selective deep white matter ischemia in chronic carotid disease: a positron emission tomographic study of regional oxygen extraction. AJNR 21: 631–638 (2000).PubMedGoogle Scholar
  18. [18]
    Derdeyn CP, Videen TO, Fritsch SM et al.: Compensatory mechanisms for chronic cerebral hypoperfusion in patients with carotid occlusion. Stroke 30: 1019–1024 (1999).PubMedGoogle Scholar
  19. [19]
    Derdeyn CP, Videen TO, Simmons NR et al.: Countbased PET method for predicting ischemic stroke in patients with symptomatic carotid arterial occlusion. Radiology 212: 499–506 (1999).PubMedGoogle Scholar
  20. [20]
    Derdeyn CP, Grubb RL Jr., Powers WJ.: Cerebral hemodynamic impairment: methods of measurement and association with stroke risk. Neurology 53: 251–259 (1999).PubMedGoogle Scholar
  21. [21]
    Derdeyn CP, Videen TO, Yundt KD et al.: Variability of cerebral blood volume and oxygen extraction: stages of cerebral haemodynamic impairment revisited. Brain 125: 595–607 (2002).PubMedCrossRefGoogle Scholar
  22. [22]
    Derdeyn CP.: Conventional angiography remains an important tool for measurement of carotid arterial stenosis. Radiology 235: 711–712; author reply 712–713 (2005).PubMedGoogle Scholar
  23. [23]
    De Reuck JL: Pathophysiology of carotid artery disease and related clinical syndromes. Acta Chir Belg 104: 30–34 (2004).PubMedGoogle Scholar
  24. [24]
    European Carotid Surgery Trialists’ Collaborative Group.: MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337: 1235–1243 (1991).CrossRefGoogle Scholar
  25. [25]
    Executive Committee of the Asymptomatic Carotid Atherosclerosis Study.: Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273: 1421–1428 (1995).CrossRefGoogle Scholar
  26. [26]
    Feeney DM, Baron JC: Diaschisis. Stroke 17: 817–830 (1986).PubMedGoogle Scholar
  27. [27]
    Ferrari M, Wilson DA, Hanley DF et al.: Effects of graded hypotension on cerebral blood flow, blood volume, and mean transit time in dogs. Am J Physiol 262: H1908–H1914 (1992).PubMedGoogle Scholar
  28. [28]
    Fog M. Cerebral circulation.: The reaction of the pial arteries to a fall in blood pressure. Arch Neurol and Psychiatry 24: 351–364 (1937).Google Scholar
  29. [29]
    Forbes HS.: The cerebral circulation, I: observation and measurement of pial vessels. Arch Neurol Psych 19: 751–761 (1928).Google Scholar
  30. [30]
    Fox PT, Raichle ME.: Focal physiological uncoupling of cerebral blood flow and oxidative metabolism during somatosensory stimulation in human subjects. Proc Natl Acad Sci USA 83: 1140–1144 (1986).PubMedCrossRefGoogle Scholar
  31. [31]
    Frackowiak RS: The pathophysiology of human cerebral ischaemia: a new perspective obtained with positron tomography. Q J Med 57: 713–727 (1985).PubMedGoogle Scholar
  32. [32]
    Fuster V, Fallon JT, Nemerson Y.: Coronary thrombosis. Lancet 348: S7–S10 (1996).PubMedCrossRefGoogle Scholar
  33. [33]
    Gibbs JM, Wise RJS, Leendeers KL, Jones T.: Evaluation of cerebral perfusion reserve in patients with carotid artery occlusion. Lancet 1: 310–314 (1984).PubMedCrossRefGoogle Scholar
  34. [34]
    Grubb RL Jr, Phelps ME, Raichle ME et al.: The effects of arterial blood pressure on the regional cerebral blood volume by X-ray fluorescence. Stroke 4: 390–399 (1973).PubMedGoogle Scholar
  35. [35]
    Grubb RL, Jr., Raichle ME, Eichling JO et al.: The effects of changes in PaCO2 on cerebral blood volume, blood flow, and vascular mean transit time. Stroke 5: 630–639 (1974).PubMedGoogle Scholar
  36. [36]
    Grubb RL, Jr., Raichle ME, Phelps ME, Ratcheson RA: Effects of increased intracranial pressure on cerebral blood volume, blood flow, and oxygen utilization in monkeys. J Neurosurg 43: 385–398 (1975).PubMedGoogle Scholar
  37. [37]
    Grubb RL, Jr., Derdeyn CP, Fritsch SM et al.: Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA 280: 1055–1060 (1978).CrossRefGoogle Scholar
  38. [38]
    Grubb RL, Jr., Powers WJ, Derdeyn CP et al.: The carotid occlusion surgery study. Neurosurg Focus 14: e9 (2003).PubMedGoogle Scholar
  39. [39]
    Hartmann A, Dettmers C, Schuier FJ et al.: Effect of stable Xenon on regional cerebral blood flow and the electroencephalogram in normal volunteers. Stroke (1991).Google Scholar
  40. [40]
    Hasegawa Y, Minematsu K, Matsuoka H et al.: CBF responses to acetazolamide and CO2 for the prediction of hemodynamic failure: a PET study [abstract]. Stroke 28: 242 (1997).Google Scholar
  41. [41]
    Hauge A, Nicolaysen G, Thoresen M: Acute effects of acetazolamide on cerebral blood flow in man. Acta Physiol Scand 117: 233–239 (1983).PubMedCrossRefGoogle Scholar
  42. [42]
    Hayashida K, Hirose Y, Tanaka Y et al.: Stratification of severity by cerebral blood flow, oxygen metabolism and acetazolamide reactivity in patients with cerebrovascular disease. In: Ishii Y, ed. Recent Advances in Biomedical Imaging: Elsevier Science BV, (1997).Google Scholar
  43. [43]
    Herold S, Brown MM, Frackowiak RSJ, Mansfield AO, Thomas DJ, Marshall J: Assessment of cerebral haemodynamic reserve: correlation between PET and CO2 reactivity measured by the intravenous 133 xenon injection technique. J Neurol Neurosurg Psychiatry 51: 1045–1050 (1988).PubMedGoogle Scholar
  44. [44]
    Hirano T, Minematsu K, Hasegawa Y et al.: Acetazolamide reactivity on I-IMP single photon emission computed tomography in patients with major cerebral artery occlusive disease: correlation with positron emission tomography parameters. J Cereb Blood Flow Metab 14: 763–770 (1994).PubMedGoogle Scholar
  45. [45]
    Inao S, Tadokoro M, Nishino M et al.: Neural activation of the brain with hemodynamic insufficiency. J Cereb Blood Flow and Metab 18: 960–967 (1998).CrossRefGoogle Scholar
  46. [46]
    Jones T, Chesler DA, Ter-Pogossian MM: The continuous inhalation of Oxygen-15 for assessing regional oxygen extraction in the brain of man. Brit J Radiol 49: 339–343 (1976).PubMedCrossRefGoogle Scholar
  47. [47]
    Kanno I, Uemura K, Higano S et al.: Oxygen extraction fraction at maximally vasodilated tissue in ischemic brain estimated from regional CO2 responsiveness measured by positron emission tomography. J Cereb Blood Flow Metab 8: 227–235 (1988).PubMedGoogle Scholar
  48. [48]
    Klijn CJM, Kappelle LJ, Tulleken CAF et al.: Symptomatic carotid artery occlusion: a reappraisal of hemodynamic factors. Stroke 28: 2084–2093 (1997).PubMedGoogle Scholar
  49. [49]
    Kubota R, Kubota K, Yamada S et al.: Microautoradiographic study for the differentiation of intratumoral macrophages, granulation tissues and cancer cells by the dynamics of fluorine-18-fluorodeoxyglucose uptake. J Nucl Med 35: 104–112 (1994).PubMedGoogle Scholar
  50. [50]
    Lammertsma AA, Wise RJS, Heather JD et al.: Correction for the presence of intravascular Oxygen-15 in the steady-state technique for measuring regional oxygen extraction ratio in the brain: 2. Results in normal subjects and brain tumour and stroke patients. J Cereb Blood Flow Metab 3: 425–431 (1983).PubMedGoogle Scholar
  51. [51]
    Lassen NA, Palvolgyi R: Cerebral steal during hypercapnia and the inverse reaction during hypocapnia observed with the 133xenon technique in man (abstract). Scand J Clin Lab Invest 22(102): 13D (1968).Google Scholar
  52. [52]
    Libby P: Molecular bases of the acute coronary syndromes. Circulation 91: 2844–2850 (1995).PubMedGoogle Scholar
  53. [53]
    Martin WRW, Powers WJ, ME R: Cerebral blood volume measured with inhaled C15O and positron emission tomography. I Cereb Blood Flow and Metab 7: 421–426 (1987).Google Scholar
  54. [54]
    McHenry LC Jr, Fazekas JF, Sullivan JF.: Cerebral hemodynamics of syncope. Am J Med Sci 80: 173–178 (1961).Google Scholar
  55. [55]
    Mead GE, Murray H, Farrell A et al.: Pilot study of carotid surgery for acute stroke. Br J Surg 84: 990–992 (1997).PubMedCrossRefGoogle Scholar
  56. [56]
    Mintun MA, Raichle ME, Martin WRW et al.: Brain oxygen utilization measured with O-15 radiotracers and positron emission tomography. J Nuc Med 25: 177–187 (1984).Google Scholar
  57. [57]
    Molloy J, Markus HS: Asymptomatic embolization predicts stroke and TIA risk in patients with carotid artery stenosis. Stroke 30: 1440–1443 (1999).PubMedGoogle Scholar
  58. [58]
    Murakami Y, Takamatsu H, Noda A et al.: Pharmacokinetic animal PET study of FK506 as a potent neuroprotective agent. J Nucl Med 45: 1946–1949 (2004).PubMedGoogle Scholar
  59. [59]
    Nariai T, Suzuki R, Hirakawa K et al.: Vascular reserve in chronic cerebral ischemia measured by the acetazolamide challenge test: comparison with psotiron emission tomography. AJNR 16: 563–570 (2005).Google Scholar
  60. [60]
    North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325: 445–453 (1991).CrossRefGoogle Scholar
  61. [61]
    Omae T, Mayzel-Oreg O, Li F et al.: Inapparent hemodynamic insufficiency exacerbates ischemic damage in a rat microembolic stroke model. Stroke 31: 2494–2499 (2000).PubMedGoogle Scholar
  62. [62]
    Pantano P, Baron JC, Samson Y et al.: Crossed cerebrellar diaschisis. Further studies. Brain 109: 677–694 (1986).PubMedCrossRefGoogle Scholar
  63. [63]
    Powers WJ, Martin WR, Herscovitch P et al.: Extracranial-intracranial bypass surgery: hemodynamic and metabolic effects. Neurology 34: 1168–1174 (1984).PubMedGoogle Scholar
  64. [64]
    Powers WJ, Raichle ME, Grubb RL Jr.: Positron Emission Tomography to assess cerebral perfusion [letter]. Lancet 1: 102–103 (1985).PubMedCrossRefGoogle Scholar
  65. [65]
    Powers WJ, Tempel LW, Grubb RL Jr et al.: Clinical correlates of cerebral hemodynamics. Stroke 18: 284 (1987).Google Scholar
  66. [66]
    Powers WJ: Cerebral hemodynamics in ischemic cerebrovascular disease. Ann Neurol 29: 231–240 (1991).PubMedCrossRefGoogle Scholar
  67. [67]
    Powers WJ, Dagogo-Jack S, Markham J et al.: Cerebral transport and metabolism of 1-11C-D-glucose during stepped hypoglycemia. Ann Neurol 38: 599–609 (1995).PubMedCrossRefGoogle Scholar
  68. [68]
    Powers WJ, Derdeyn CP, Fritsch SM et al.: Benign prognosis of never-symptomatic carotid occlusion. Neurology 54: 878–882 (2000).PubMedGoogle Scholar
  69. [69]
    Raichle ME, Martin WR, Herscovitch P et al.: Brain blood flow measured with intravenous H2(15)O. II. Implementation and validation. J Nucl Med (1983).Google Scholar
  70. [70]
    Raichle ME.: Behind the scenes of functional brain imaging: a historical and physiological perspective. PNAS 95: 765–772 (1998).PubMedCrossRefGoogle Scholar
  71. [71]
    Rapela CE, Green HD: Autoregulation of canine cerebral blood flow. Circ Res 15: I205–I211 (1964).Google Scholar
  72. [72]
    Rothwell PM, Warlow CP: Low risk of ischemic stroke in patients with reduced internal carotid artery lumen diameter distal to severe symptomatic carotid stenosis: cerebral protection due to low poststenotic flow? On behalf of the European Carotid Surgery Trialists’ Collaborative Group. Stroke 31: 622–630 (2000).PubMedGoogle Scholar
  73. [73]
    Rothwell PM, Eliasziw M, Gutnikov SA et al.: Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361: 107–116 (2003).PubMedCrossRefGoogle Scholar
  74. [74]
    Rothwell PM, Goldstein LB: Carotid endarterectomy for asymptomatic carotid stenosis: asymptomatic carotid surgery trial. Stroke 35: 2425–2427 (2004).PubMedCrossRefGoogle Scholar
  75. [75]
    Rudd JH, Warburton EA, Fryer TD et al.: Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation 105: 2708–2711 (2002).PubMedCrossRefGoogle Scholar
  76. [76]
    Samson Y, Baron JC, Bousser MG et al.: Effects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans. Stroke 16: 609–615 (1985).PubMedGoogle Scholar
  77. [77]
    Samson Y, Baron JC, Pappata S et al.: Angiotensin II infusion improves perfusion and oxygen consumption in both cerebral hemispheres in patients with bilateral carotid artery obstruction. J Cereb Blood Flow Metab 7: S177 (1987).Google Scholar
  78. [78]
    Sasoh M, Ogasawara K, Kuroda K et al.: Effects of EC-IC bypass surgery on cognitive impairment in patients with hemodynamic cerebral ischemia. Surg Neurol 59: 455–460; discussion 460–453 (2003).PubMedCrossRefGoogle Scholar
  79. [79]
    Schumann P, Touzani O, Young AR et al.: Evaluation of the ratio of cerebral blood flow to cerebral blood volume as an index of local cerebral perfusion pressure. Brain 121: 1369–1379 (1998).PubMedCrossRefGoogle Scholar
  80. [80]
    Sette G, Baron JC, Mazoyer B et al.: Local brain haemodynamics and oxygen metabolism in cerebrovascular disease. Brain 113: 931–951 (1989).CrossRefGoogle Scholar
  81. [81]
    Silvestrini M, Vernieri F, Pasqualetti P et al.: Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis. Jama 283: 2122–2127 (2000).PubMedCrossRefGoogle Scholar
  82. [82]
    Stevens H, Jansen HML, De Reuck J et al.: 55Cobalt (Co) as a PET-tracer in stroke, compared with blood flow, oxygen metabolism, blood volume and gadolinium-MRI. Journal of the Neurological Sciences 171: 11–18 (1999).PubMedCrossRefGoogle Scholar
  83. [83]
    Sugimori H, Ibayashi S, Fujii K et al.: Can transcranial Doppler really detect reduced cerebral perfusion states? Stroke 26: 2053–2060 (1995).PubMedGoogle Scholar
  84. [84]
    The EC/IC Bypass Study Group.: Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: results of an international randomized trial. N Engl J Med 313: 1191–2000 (1985).CrossRefGoogle Scholar
  85. [85]
    The European Carotid Surgery Trialists Collaborative Group. Risk of stroke in the distribution of an asymptomatic artery. Lancet 345: 209–212 (1995).Google Scholar
  86. [86]
    Tomita: Significance of cerebral blood volume. In: Tomita M, Sawada T, Naritomi H, Heiss W-D (eds.) Cerebral hyperemia and ischemia: From the standpoint of cerebral blood volume: Elsevier Science Publishers BV, (1988).Google Scholar
  87. [87]
    Torvik A, Skellerud K: Wastershed infarcts in the brain caused by microemboli. Clin Neuropath 1: 99–105 (1982).Google Scholar
  88. [88]
    Torvik A: The pathogenesis of watershed infarctions in the brain. Stroke 15: 221–223 (1984).PubMedGoogle Scholar
  89. [89]
    Wodarz R: Watershed infarctions and computed tomography.: A topographical study in cases with stenosis or occlusion of the carotid artery. Neuroradiol 19: 245–248 (1980).Google Scholar
  90. [90]
    Yamauchi H, Fukuyama H, Kimura J, Ishikawa M, Kikuchi H: Crossed cerebellar hypoperfusion indicates the degree of uncoupling between blood flow and metabolism in major cerebral arterial occlusion. Stroke 25: 1945–1951 (1994).PubMedGoogle Scholar
  91. [91]
    Yamauchi H, Fukuyama H, Nagahama Y et al.: Significance of increased oxygen extraction fraction in fiveyear prognosis of major cerebral arterial occlusive disease. J Nucl Med 40: 1992–1998 (1999).PubMedGoogle Scholar
  92. [92]
    Yamauchi H, Okazawa H, Kishibe Y, Sugimoto K, Takahashi M: Oxygen extraction fraction and acetazolamide reactivity in symptomatic carotid artery disease. J Neurol Neurosurg Psychiatry 75: 33–37 (2004).PubMedCrossRefGoogle Scholar
  93. [93]
    Yokota C, Hasegawa Y, Minematsu K et al.: Effect of Acetazolamide Reactivity and Long-term Outcome in Patients With Major Cerebral Artery Occlusive Diseases. Stroke 29: 640–644 (1998).PubMedGoogle Scholar
  94. [94]
    Yun M, Jang S, Cucchiara A et al.: 18F FDG uptake in the large arteries: a correlation study with the atherogenic risk factors. Semin Nucl Med 32: 70–76 (2002).PubMedCrossRefGoogle Scholar
  95. [95]
    Yun M, Yeh D, Araujo LI et al.: F-18 FDG uptake in the large arteries: a new observation. Clin Nucl Med 26: 314–319 (2001).PubMedCrossRefGoogle Scholar
  96. [96]
    Zaharchuk G, Mandeville JB, Bogdanov AA et al.: Cerebrovascular dynamics of autoregulation and hypoperfusion: An MRI study of CBF and changes in total and microvascular cerebral blood volume during hemorrhagic hypotension. Stroke 30: 2197–2205 (1999).PubMedGoogle Scholar
  97. [97]
    Zulch KJ: Über die Entstehung und Lokalisation der Hirn-Infarkte. Zentralbl Neurochir 21: 158–178 (1961).Google Scholar

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Authors and Affiliations

  • C. P. Derdeyn
    • 1
  1. 1.Mallinckrodt Institute of Radiology and The Departments of Neurology and Neurological SurgeryWashington University School of MedicineSt. LovisUSA

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