RPS 312 - New insights in paediatric head and neck imaging

RPS 312-1
Neurodevelopmental outcomes of posterior fossa anomalies diagnosed by foetal MRI
Purpose: To retrospectively evaluate neurodevelopmental outcomes (NDO) of prenatally diagnosed isolated posterior fossa abnormalities characterised on foetal MRI.
Methods: Out of 821 foetal MRIs performed on pregnant women referred to a tertiary referral centre from May 2015-July 2018, 66 were done for the further evaluation of isolated posterior fossa abnormalities suspected in ultrasound. Post-delivery follow-up was done by a trained examiner using national registry data and parental phone calls. The abnormal outcome was defined as an ASQ score below the cut-off for age and related skill. Pregnancy termination due to a foetal anomaly or foetal death (TOPFA/FD) was recorded.
Results: The maternal age was 29.3±5.7. Gestational ages at the time of the MRI were 24.7±5.9. Out of 66 cases, 19 cases were diagnosed as normal, 3 were lost to follow-up (LTFU), 1 foetal death, 13 normal, and 2 abnormal NDO (minor communication, fine motor, and problem-solving issues). Out of 36 foetuses referred for possible vermian hypoplasia, 15 foetuses were diagnosed with inferior vermian hypoplasia (4 TOPFA/FD, 6 LTFU, 3 normal, and 2 abnormal NDO), 14 were diagnosed as possible BPC before 19 wks GA (2 LTFU, 2 TOPFA/FD, 8 normal, and 2 abnormal NDO (mean ASQ 217, minor communication issues)), and 5 were diagnosed as mega cisterna magna (1 LTFU and 4 normal NDO). The worse outcome was with cerebellar hypoplasia (5 TOPFA/FD and 1 LTFU) and dandy-walker malformation (6 TOPFA/FD and one abnormal NDO).
Conclusion: MRI is fairly accurate in ruling out clinically significant posterior fossa abnormality even before 19 weeks GA. Prenatally diagnosed cerebellar hypoplasia and DWM are uniformly associated with a poor prognosis. Most cases of BPC have a normal and most cases of IVH have an abnormal NDO.

Limitations: n/a
Ethics: n/a
Funding: No funding was received for this work.
RPS 312-2
Foetal optic structures: a postmortem MRI study
Purpose: To establish normal values of foetal optic structures as a reference for future in vivo imaging studies.
Methods: Postmortem foetal MRI data of 33 foetuses with normal development of optical structures and 25 foetuses with pathologies (GW 16-42) were analysed. The pathology group included complex malformations (15), intrauterine growth restriction (2), premature rupture of membranes (4), twin-associated problems (3), and stillbirth (1). MRI was performed on a 3 Tesla scanner utilising an 8-channel knee coil. Retrobulbar and intracranial optic nerve diameters, optic nerve length, the angle between optic nerves, and minimum transverse diameter of the optic chiasm were obtained. Correlations with gestational age were performed. Measurements were performed using free Image J software on T2-weighted images (TR 300ms, TE 140 ms, and isovoxel 0.4mm ciss 3d sequence).
Results: The optic nerve length increased from 10.5-29.41 mm within 26 GW. The retrobulbar optic nerve diameter increased from 0.83 (right)/0.860 (left) mm to 2.13 (right)/ 2.10 (left) mm. The transverse diameter of the optic chiasm increased from 4.1-6.7 mm within 24 weeks. The angle between the optic nerves decreased by 36.5 degrees within 26 weeks. Optic structure measurements correlated significantly with gestational age. Foetuses in the pathology group had at least one aberration from the normal values.
Conclusion: Postmortem foetal MRI-based optic structure measurements correlated with gestational age and showed a change in orientation of the optic chiasm from a U shape at early gestation towards a V shape at later gestation. Based on the presented normal values, developmental defects can be detected sensitively.
Limitations: More studies are needed to investigate translation to in vivo foetal MRI.
Ethics: This study was approved by the institutional review board.
Funding: No funding was received for this work.
RPS 312-3
Paediatric orbital masses: the value of adding diffusion-weighted imaging to conventional MRI in lesion categorisation
Purpose: To assess the diagnostic contribution of diffusion-weighted (MRI) using apparent diffusion coefficient (ADC) values for the characterisation of orbital masses and differentiation of benign and malignant lesions.
Methods: 130 patients with recently diagnosed orbital masses who underwent preoperative conventional MRI and DWI were included. The average ADC obtained from each tumour was compared with the histopathological diagnosis determined from the subsequent surgical sample.
Results: 70 girls and 60 boys (age range: 1 month-18 years) with orbital masses were included. The globe was the seat of lesions in 33% of cases, optic nerve in 20.7%, and 7 cases had lesions in the lacrimal gland. 45 cases were diagnosed as benign masses and 85 as malignant lesions.
There was a statistically significant difference between the mean ADC value of the benign lesions (1.39±0.52 x10-3 mm2/s) and those of the malignant lesions (0.69±0.22 x10-3mm2/s).
The optimal ADC cut-off value that was deter
RPS 312-4
Neurosensory hearing loss in children with Zika virus microcephaly and brain MRI evaluation
Purpose: To describe the findings of brain MRI in children affected by congenital Zika virus syndrome (CZS) and sensorineural hearing loss (SHL).
Methods: A retrospective cross-sectional study with two groups was conducted. Group A consisted of 6 children with microcephaly and SHL and group B consisted of 27 children with microcephaly without SHL. All children had a diagnosis of CZS confirmed in a previous study, had a hearing evaluation through BERA, and had brain and/or inner ear MRI. The images were qualitatively evaluated by a radiologist and two otolaryngologists.
Results: In a partial result, we observed a frequency of brainstem hypoplasia in all patients in group A, being 17% moderate, 33% severe, and 50% very serious. In group B, it was 18.5% mild, 25.9% moderate, 44.4% severe, and 11.1% very serious. Regarding hypoplasia of regions of the lower frontal parenchyma, in group A there were 3 (50%) severe cases and 3 (50%) very serious cases. In group B, this division was 3.7% normal, 25.9% mild/moderate, 51.8% severe, and 18.5% very serious. In the evaluation of the temporal parenchyma, in group A we found 7% of severe cases and 83% of very serious cases. In group B, the numbers found were equal to the frontal parenchyma evaluation.
Conclusion: We can observe that the group of patients with hearing loss presents more severity in the classification of their brain alterations, which may reflect in the hearing ability.
Limitations: The small sample of children with CZS with sensorineural hearing loss.
Ethics: Ethics committee approval obtained.
Funding: No funding was received for this work.
RPS 312-5
Chronic rhinosinusitis in patients with primary ciliary dyskinesia: comparison with findings in cystic fibrosis
Purpose: Primary ciliary dyskinesia (PCD) and cystic fibrosis (CF) are characterised by impaired mucociliary clearance. Though pulmonary involvement has been the focus of research in the past, upper airway manifestations with chronic rhinosinusitis (CRS) has been rarely studied. CRS results in an increased disease burden and might be a reservoir for recurrent pulmonary pathogens. Our aim was to evaluate the extent of CRS in patients with PCD and CF using MRI.
Methods: MRI of the paranasal sinuses was performed in 12 PCD patients with 25 MR-examinations (mean age 10.21y, range 0.21-18.22y) and compared to 21 age-matched CF patients with 49 MR examinations (mean 10.78y, range 0.13-18.71y). Abnormalities of the paranasal sinuses (mucosal swelling, mucopyoceles, effusion, polyps, and displacement of the medial maxillary sinus wall) were assessed using a newly developed CRS MRI scoring system.
Results: The overall sum score was significantly lower in PCD compared to CF (p=0.0011). With respect to the individual sinuses, scores of the maxillary sinus, the frontal sinus, the sphenoid sinus, and ethmoid cells were significantly lower in PCD. The involvement of the mastoid cells was significantly higher in PCD (p<0.001). The prevalence of mucopyoceles per individual sinus was significantly higher in CF (p<0.001 per sinus).
Conclusion: MRI is sensitive in detecting CRS across the whole paediatric age range. The novel score is applicable to patients with PCD and revealed a lower extent of CRS in patients with PCD compared to CF, despite similar pathophysiology.
Limitations: Differences in structural abnormalities of CRS in PCD and CF were not yet correlated to clinical outcome parameters.
Ethics: Approved by the institutional ethics committee. Written consent was obtained from parents or legal guardians.
Funding: Supported by the German BMBF, the Mukoviszidose e.V., and the Einstein Foundation.
RPS 312-6
The paediatric voice after airway reconstruction on MRI
Purpose: Although the focus in patients after laryngotracheal stenosis (LTS) is mainly on airway function, dysphonia is a common sequela that strongly influences the quality of life of patients. Dysphonia is caused by pre-existing stenosis and anatomical distortion due to airway reconstruction. Magnetic resonance imaging (MRI) is ideal to assess the vocal cords in static and dynamic conditions. The aim of this study was to image the vocal cords in children post airway reconstruction for LTS on static and dynamic MRI and to compare these findings to voice outcome.
Methods: Patients filled out a voice-related questionnaire ((paediatric) voice handicap index (p)VHI), the quality of the voice was tested with the dysphonia severity index (DSI), and static and dynamic upper airway MRI during free-breathing, inspiration and phonation (3T GE scanner, 6CH carotid coil, spatial resolution 0.5x0.5 (in plane) x2 mm, temporal resolution: 240 ms) was performed. Post-surgical anatomy, areas, diameters, and movement of the vocal cords were analysed.
Results: 48 patients (age 14.4 (11.7-19.4) years) and 11 healthy volunteers (age 15.9 (8.4-20) years) were included. Patients showed a high score on the (p)VHI (26.2±18.6%) and a decrease in DSI score (-2.6±2.4 vs 0.68±2.9, p<0.001) compared to healthy volunteers, representing dysphonia. MRI showed vocal cord (80.9%) and arytenoid thickening (59.6%). Furthermore, impaired adduction during phonation (61.7%) was seen, highly correlated to both (p)VHI and DSI score (odds 1.05 (1.01-1.09), p=0.02 and 0.65 (0.48-0.88), p=0.006).
Conclusion: Static and dynamic MRI is an excellent, non-invasive method to visualise the causes of dysphonia in combination with anatomy in paediatric patients with a history of LTS.
Limitations: n/a
Ethics: Approval by the local medical ethics committee (MEC-2018-013) and written informed consent was obtained.
Funding: Funded by the Vrienden van het Sophia Foundation.
RPS 312-7
A preliminary study assessing a novel neonatal brain MRI in the neonatal ICU
Purpose: To compare images from an experimental 1T permanent MRI scanner in the NICU to clinical 1.5T images.
Methods: This was a prospective, non-randomised, feasibility study. Stable premature infants born prior to 28th week, or born between the 28th-32nd week of pregnancy with IVH, US abnormalities, severe morbidity, or abnormal neurological exam, underwent scanning at near term equivalent age with both conventional 1.5T and dedicated neonatal 1T MRI. MRI scans included T1, T2, and diffusion-weighted imaging performed on a conventional 1.5T (Aera, Siemens) and on a novel 1T MRI (Embrace, Aspect) located in the NICU. No more than 72 hours elapsed between the two studies. 3 radiologists blindly reviewed the images for the following: 10 predetermined anatomical structures, bilateral measurement of ADC values in the supraventricular white matter and vitreous humour, and notation of pathological findings. Findings and comparisons were subject to statistical analysis.
Results: 55 neonates were included in the study. 17 were scanned only on the 1T NICU scanner due to lack of parental consent for a second scan. Identification of the anatomical structures was similar for all 10 locations (P=0.64). Normalised ADC values of the white matter were similar (P=0.31, 0.44 for left and right, respectively). Bland Altman analysis demonstrated excellent agreement. 131 pathological findings were noted involving the parenchyma and ventricles on both scanners. Conspicuity of haemorrhage was slightly better on the 1.5T scanner (P<0.01).
Conclusion: The 1T neonatal scanner performs as well as a clinical scanner and is a potential clinical tool for use in the NICU.
Limitations: At the time of the study, SWI imaging was not available on the 1T scanner.
Ethics: Approved by IRB. Parental consent required.
Funding: Aspect Imaging.
RPS 312-8
Cerebral white matter alterations in very preterm infants: the contribution of 2D shear-wave elastography
Purpose: To describe the brain elasticity of very preterm infants during development compared to term-born controls and to determine the diagnostic role of cerebral quantitative shear-wave elastography (SWE) in preterm children compared to standard cranial ultrasound (US) examination.
Methods: 34 very preterm from 24 to 27+6 gestational weeks (GW) and 47 preterms (28 to 31+6 GW) underwent sequential brain US with elasticity measurement from birth to term.
18 term-born controls had the same protocol at birth.
On conventional US, frontal and parietal white matter (WM) was classified as normal or abnormal according to its echogenicity compared to plexus. Quantitative measurements of brain stiffness were performed with SWE in bilateral frontal and parietal WM and thalami.
Descriptive statistical analysis and multivariate analysis (ANOVA) for comparison between groups were performed.
Results: A progressive increase of brain stiffness was demonstrated with increased gestational age in all brain areas.
Brain stiffness was higher in parietal than in frontal WM at any gestational age.
WM elasticity values measured at term remained significantly lower in both subgroups of preterms compared to controls (p=0.04 and p=0.003 in frontal WM; p=0.003 and p=0.09 in parietal WM).
Brain WM elasticity was similar between preterm infants with or without abnormal WM on standard US examination.
Conclusion: Brain stiffness values change according to the gestational age with an anteroposterior gradient that might reflect normal brain maturation.
WM stiffness of very preterm infants remains lower than control newborns even at term.
Brain stiffness values do not seem to reflect the WM alterations found on conventional US but should be compared to MRI as the gold standard method.
Limitations: The lack of interobserver correlation and the decreasing number of preterms throughout the study.
Ethics: Ethics committee approval obtained.
Funding: No funding was received for this work.
RPS 312-9
The neurodevelopmental effect of intracranial haemorrhage observed in hypoxic-ischaemic brain injury in hypothermia-treated asphyxiated neonates: an MRI study
Purpose: The importance of intracranial haemorrhage (ICH) being present concomitantly to hypoxic-ischaemic encephalopathy (HIE) in hypothermia-treated asphyxiated neonates had not been investigated despite the known influence of hypothermia on haemostasis. We aimed to determine whether the presence of ICH on MRI alongside the signs of HIE have an impact on prognosis.
Methods: A retrospective study of 108 asphyxiated term infants treated with whole-body hypothermia having a brain MRI within one week of life was conducted. The presence or absence of HIE signs on MRI and on MR spectroscopy (MRS) and/or of the 5 major types of ICH were recorded. The neurodevelopmental outcome was measured with the BSID-II test. Death or abnormal neurodevelopment (BSID-II score<85) was considered a poor outcome in a Chi-square test. Multivariate logistic regression analysis was performed on the survivors.
Results: MRI and MRS signs of HIE were present in 72% and ICH in 36% of neonates. The Chi-square test showed a relationship between the neurodevelopmental outcome and initial MRI. Unadjusted logistic regression showed that neonates presenting imaging signs of HIE have 6.23 times higher odds for delayed mental development (OR=6.2292; CI95%=[1.2642; 30.6934], p = 0.0246) than infants without imaging alterations, with no ICH effect on the outcome. Adjustment for clinical and imaging parameters did not change the pattern of results.
Conclusion: HIE related MRI abnormalities proved to be important prognostic factors of poor outcome in cooled asphyxiated infants, suggesting that early MRI with MRS is beneficial for prognostication. Interestingly, ICHs present in 36% of patients had no significant effect on the outcome, despite the known haemostasis altering effects of hypothermia.
Limitations: The retrospective nature of the study.
Ethics: Institutional and Medical Research Council Ethics Committee of Hungary approved this study. Written informed consent was obtained.
Funding: AJ[PPD460004]; LRK[Bolyai Research Fellowship]; GyGy[EFOP-3.6.3-VEKOP-16-2017-00009].
RPS 312-10
Quantitative paediatric MRI going clinical: comprehensive brain assessment from a single sequence based on quantitative brain maturation atlases
Purpose: A quantitative anatomical 3D sequence was optimised for paediatric application and used to build quantitative brain maturation atlases, mapping both the volumetric and T1-relaxometry changes. This allows for a comprehensive assessment of anatomy, morphometry, and a marker for brain microstructure (T1 relaxometry).
Methods: We performed a two-year single-centre prospective study recruiting infants aged 1-16 years from a university hospital to be scanned at 1.5T (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany) using a 20-channel head coil without sedation. A single prototype MP2RAGE scan (TI1/TI2=600/2,000 ms, TR=5,000 ms, voxel size=1.33x1.33x1.25 mm3 isotropic, TA=6:42 min) was performed. The supposed medical condition was an isolated headache with spontaneously favourable evolution. Brain maturation was modelled based on resulting T1 maps and volumetry (using the MorphoBox prototype adapted for paediatrics).
Results: 63 normal brain MRIs (33 female) were obtained. Automated segmentation and T1-mapping was successful in all scans. The evolution of volumes and T1 values were modelled over age to obtain reference ranges (without gender difference). The absolute volume of white matter increased continuously during childhood, with stable cortical grey matter volumes. Reference regional T1 values decreased rapidly during the first two years of age (supposedly showing myelinisation) and then more smoothly.
Conclusion: In addition to anatomical T1 images, the 3D MP2RAGE sequence allows for automated morphometric and relaxometry assessment. Based on this data, we created reference brain maturation atlases covering the entire childhood which have the potential to quantitatively support clinical decision making in paediatrics.
Limitations: A single-centre study with a limited sample of patients.
Ethics: Approved by the local ethics committee for human research (RNI-2017-093).
Funding: GF Piredda, T Hilbert, B Maréchal, and T Kober are Siemens Healthineers employees.
RPS 312-11
Frequency-dependent changes of interhemispheric functional connectivity and aberrant cerebral synchronisation in idiopathic generalised epilepsy
Purpose: To characterise the functional connectivities (FC) frequency-dependency between hemispheres and the alteration within the cerebral in patients with idiopathic generalised epilepsy (IGE).
Methods: Resting-state functional imaging was performed in 21 patients with IGE and 22 healthy controls. The FC for different frequency bands between the bilateral hemispheres and within the cerebral were calculated and within-group differences were analysed. Altered interhemispheric FC regions shown in patients were selected as seed regions for cerebral FC analysis. Two-way ANOVA and threshold-free cluster enhancement were performed.
Results: Compared with the controls, patients with IGE showed decreased interhemispheric FC between the bilateral orbitofrontal cortex in the full frequency band (0.01-0.1 Hz) the putamen and the superior temporal gyrus in the slow-4 band (0.027-0.073 Hz), and the orbitofrontal cortex and lingual gyrus in the slow-5 band (0.01-0.027 Hz). Moreover, the cortical-subcortical FC was decreased, the connection within the default mode network (DMN) was segregated into the front and back parts, and the DMN and auditory perceptual processing network was enhanced.
Conclusion: Our findings suggested that the FC in patients with IGE is frequency-dependent and the interaction alteration of cortical-subcortical and the coupling change of brain functional networks may play a crucial role in the pathophysiology of IGE.
Limitations: We acquired the r-fMRI data without recording the patient's simultaneous EEG data. Some patients in this study are taking antiepileptic drugs, which may have effects on cognitive ability and inhibiting the functional synchronisation of brain networks. The sample size of our study is relatively small.
Ethics: The retrospective study was approved by the local medical ethics committee and written informed consent was obtained.
Funding: Zunyi Science and Technology Cooperation Program (Number: (2017) 46).
RPS 312-12
Fibre tractography and diffusion tensor imaging in children with corpus callosum anomalies: a clinico-radiologic correlation
Purpose: To evaluate the role of fibre tractography (FT) and diffusion tensor imaging (DTI) of the brain in paediatric patients with corpus callosum anomalies and correlate the findings with the clinical presentation.
Methods: A prospective study included 115 children with CT findings suggested corpus callosum anomalies. Their ages ranged from 4 months-8 years old. All patients were referred from a paediatric neurology unit to the radiology department from April 2018-December 2018. All patients underwent MRI tractography and diffusion tensor imaging.
Results: Our study included 42 males and 73 females. They were reviewed for the presence and type of corpus callosum anomalies according to the Hanna classification. The most common type was hypoplasia without dysplasia 37/115 (32 %). An isolated anomaly was seen in 90/115 (78.3%). Using DTI and fibre tractography, corpus callosum fibre defects were classified into fronto-rostral, caudal, and whole body. A significant statistical correlation was found between ADHD as well as autism and loss of fronto-rostral fibres. Epilepsy and developmental delay were correlated to a whole-body defect and caudal fibre tract defects.
Conclusion: Fibre tractography and diffusion tensor imaging are promising techniques in the assessment of patients with corpus callosum anomalies. They provide accurate localisation of the affected segment of callosal fibres and help to predict the clinical prognosis of patients that could not be explained by the morphological changes seen in conventional MRI alone.
Limitations: The small number of patients and the need for anesthesia in most of the patient cohort.
Ethics: The study was done after the approval of ethical committee of our institution and after written informed consent of patients' parent before the examination and before anesthesia.
Funding: No funding was received for this work.
RPS 312-13
Posterior reversible encephalopathy syndrome in children: the association of blood pressure with imaging severity
Purpose: To evaluate the association and correlation between blood pressure (BP) and posterior reversible encephalopathy syndrome (PRES) imaging severity in the paediatric population in whom radiological features and pathophysiology remains obscure.
Methods: A retrospective evaluation of paediatric patients diagnosed with PRES over the last 10 years at Aga Khan University was performed. Radiological findings were reviewed by two paediatric radiologists along with the clinical profile and outcome. Imaging severity was categorised into mild, moderate, and severe. The distribution of lesions, enhancement, diffusion restriction, and haemorrhage were assessed. Various conditions that may resemble PRES were excluded.
Results: Out of 43 children, 20 were males and 23 were females with a mean age of 10.7 years. The most common primary disease was malignancy (28%) out of which lymphoma predominated. The mean systolic BP was 131.5 (70-205) mmHg and diastolic was 82.9 (35-170) mmHg. 14 children had hypertension higher than autoregulatory limits. Imaging showed a parieto-occipital lobe involvement pattern in 42% of cases, holohemisphereic pattern in 30.2%, cerebellar involvement in 23.3%, and superior frontal sulcus pattern in 2.3%. 4.7% had a haemorrhage, 25.6% had contrast enhancement, and 27.9% had a positive diffusion restriction (cytotoxic oedema). No statistically significant association of imaging severity with BP (P=0.70), imaging severity with haemorrhage (P=0.30), and diffusion restriction (P=0.64) with imaging severity and with each other (P=1) was seen.
Conclusion: We did not find any statistically significant association of blood pressure with imaging severity, haemorrhage, and diffusion restriction (cytotoxic oedema). Further prospective studies are needed to determine the pathophysiological mechanisms and their correlation with imaging findings in PRES in children.
Limitations: The retrospective study design and single-centre study.
Ethics: Ethics committee approval obtained.
Funding: No funding was received for this work.
RPS 312-14
Cerebral perfusion in children sedated with propofol: an arterial spin labelling (ASL) study
Purpose: Paediatric MRI is highly dependent on anaesthesia, but sedative-hypnotic drugs can modify the cerebral metabolic rate and cerebral perfusion. Arterial spin labelling (ASL) MRI allows the investigation of brain perfusion without administrating contrast material.
We sought to evaluate the effects of propofol on the dynamic of cerebral perfusion in early childhood.
Methods: 21 young children (2-5 years old) had an MRI performed using a 3T scanner. None of the children were premature, nor had a stroke, brain tumour, metabolic diseases, seizure, or brain malformations. Patients were sedated immediately before the MRI with an intravenous bolus of propofol. ASL was performed after the reference scout in 7 children (t1a), 3 minutes later in 7 children (t1b), and 6 minutes later in 7 children (t1c). All children underwent ASL at the end of sedation (t2 a, b, c). Individual brain perfusion maps were extracted to evaluate the average whole-brain perfusion (WBP). Mean values of CBF for each group were determined and the differences between groups using a t-test.
Results: The mean CBF (mL/100 g/min) were (t1) 34.7 ±6.4 and (t2) 32.6 ±6.7 (p= 0.0004).
The subgroup values were (t1a) 34.6 ± 5, (t2a) 31.2 ± 5.1, (t1b) 31.3 ± 6, (t2b) 29.4 ± 5.1, (t1c) 38.2 ± 6.8, and (t2c) 37.3 ± 7.7. The difference between t1a and t2a (p= 0.004) was more significant than between t1b and t2b (P=0.028). The difference between t1c and t2c (P=0.363) was not statistically significant.
Conclusion: During sedation with propofol, cerebral perfusion decreases from oversedation.
Limitations: The small size.
Ethics: The institutional review board approved this prospective study.
Funding: No funding was received for this work.


Irena Štěpán-Buksakowska (Czech Republic)

Elida Vazquez Mendez (Spain)

European Society of Radiology

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