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000845832 1001_ $$0P:(DE-HGF)0$$aRosen, Allyson C.$$b0$$eCorresponding author
000845832 245__ $$aConvergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization
000845832 260__ $$a[Amsterdam u.a.]$$bElsevier$$c2018
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000845832 500__ $$aACR was supported by a K award NIH NIA (K01AG025157) and the Mental Illness Research Education and Clinical Center (MIRECC). JTS was supported by the MIRECC. ARL, SBE, PMF were supported by the NIMH (R01-MH074457). Other grant support includes the American Heart Association (CRP2610312) and NIH NINDS (R01NS070308). JB was supported by NIH NINDS (R21NS081416) and Palo Alto Veterans Institute for Research (PAVIR).
000845832 520__ $$aCarotid revascularization (endarterectomy, stenting) prevents stroke; however, procedure-related embolization is common and results in small brain lesions easily identified by diffusion weighted magnetic resonance imaging (DWI). A crucial barrier to understanding the clinical significance of these lesions has been the lack of a statistical approach to identify vulnerable brain areas. The problem is that the lesions are small, numerous, and non-overlapping. Here we address this problem with a new method, the Convergence Analysis of Micro-Lesions (CAML) technique, an extension of the Anatomic Likelihood Analysis (ALE). The method combines manual lesion tracing, constraints based on known lesion patterns, and convergence analysis to represent regions vulnerable to lesions as probabilistic brain atlases. Two studies were conducted over the course of 12 years in an active, vascular surgery clinic. An analysis in an initial group of 126 patients at 1.5 T MRI was cross-validated in a second group of 80 patients at 3T MRI. In CAML, lesions were manually defined and center points identified. Brains were aligned according to side of surgery since this factor powerfully determines lesion distribution. A convergence based analysis, was performed on each of these groups. Results indicated the most consistent region of vulnerability was in motor and premotor cortex regions. Smaller regions common to both groups included the dorsolateral prefrontal cortex and medial parietal regions. Vulnerability of motor cortex is consistent with previous work showing changes in hand dexterity associated with these procedures. The consistency of CAML also demonstrates the feasibility of this new approach to characterize small, diffuse, non-overlapping lesions in patients with multifocal pathologies.
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000845832 7001_ $$0P:(DE-HGF)0$$aBhat, Jyoti$$b2
000845832 7001_ $$0P:(DE-HGF)0$$aLaird, Angela R.$$b3
000845832 7001_ $$0P:(DE-HGF)0$$aStephens, Jeffrey$$b4
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000845832 7001_ $$0P:(DE-HGF)0$$aLong, Becky$$b7
000845832 7001_ $$0P:(DE-HGF)0$$aDinishak, David$$b8
000845832 7001_ $$0P:(DE-HGF)0$$aOrtega, Mario$$b9
000845832 7001_ $$0P:(DE-HGF)0$$aLane, Barton$$b10
000845832 7001_ $$0P:(DE-HGF)0$$aWintermark, Max$$b11
000845832 7001_ $$0P:(DE-HGF)0$$aHitchner, Elizabeth$$b12
000845832 7001_ $$0P:(DE-HGF)0$$aZhou, Wei$$b13
000845832 773__ $$0PERI:(DE-600)2701571-3$$a10.1016/j.nicl.2018.01.020$$gVol. 18, p. 553 - 559$$p553 - 559$$tNeuroImage: Clinical$$v18$$x2213-1582$$y2018
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