Publications by authors named "Giovanna Negrão de Figueiredo"

14 Publications

  • Page 1 of 1

Percutaneous CT Fluoroscopy-Guided Core Needle Biopsy of Mediastinal Masses: Technical Outcome and Complications of 155 Procedures during a 10-Year Period.

Diagnostics (Basel) 2021 Apr 26;11(5). Epub 2021 Apr 26.

Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, 81377 Munich, Germany.

Purpose: To evaluate technical outcome, diagnostic yield and safety of computed tomographic fluoroscopy-guided percutaneous core needle biopsies in patients with mediastinal masses.

Methods: Overall, 155 CT fluoroscopy-guided mediastinal core needle biopsies, performed from March 2010 to June 2020 were included. Size of lesion, size of needle, access path, number of success, number of biopsies per session, diagnostic yield, patient's position, effective dose, rate of complications, tumor localization, size of tumor and histopathological diagnosis were considered. Post-interventional CT was performed, and patients observed for any complications. Complications were classified per the Society of Interventional Radiology (SIR).

Results: 148 patients (age, 54.7 ± 18.2) underwent 155 CT-fluoroscopy-guided percutaneous biopsies with tumors in the anterior (114; 73.5%), middle (17; 11%) and posterior (24; 15.5%) mediastinum, of which 152 (98%) were technically successful. For placement of the biopsy needle, in 82 (52.9%) procedures a parasternal trajectory was chosen, in 36 (23.3%) a paravertebral access, in 20 (12.9%) through the lateral intercostal space and in 17 (11%) the thoracic anterior midline, respectively. A total of 136 (89.5%) of the biopsies were considered adequate for a specific histopathologic analysis. Total DLP (dose-length product) was 575.7 ± 488.8 mGy*cm. Mean lesion size was 6.0 ± 3.3 cm. Neoplastic pathology was diagnosed in 115 (75.7%) biopsies and 35 (23%) biopsy samples showed no evidence of malignancy. Minor complications were observed in 18 (11.6%) procedures and major pneumothorax requiring drainage insertion in 3 interventions (1.9%).

Conclusion: CT fluoroscopy-guided percutaneous core needle biopsy of mediastinal masses is an effective and safe procedure for the initial assessment of patients with mediastinal tumors.
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http://dx.doi.org/10.3390/diagnostics11050781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144979PMC
April 2021

Single-center study: dynamic contrast-enhanced ultrasound in the diagnostic assessment of carotid body tumors.

Quant Imaging Med Surg 2020 Sep;10(9):1739-1747

Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany.

Background: Carotid body tumors (CBTs) depict the most common paraganglioma of the head and neck that can metastasize in up to 15% of cases. They develop either sporadically or hereditarily and may produce catecholamines ("functioning CBTs") resulting in associated symptoms like headache, palpitations or flush. Non-functioning CBTs usually present as slowly and often tender growing mass which may affect adjacent cranial nerves. CBTs can be visualized by ultrasound, CT, MRI or angiography. Pre-surgical interventional embolization, surgical resection and radiation therapy are therapeutical options. The aim of this retrospective single-center study is to assess the safe and real-time evaluation of CBTs by contrast-enhanced ultrasound (CEUS).

Methods: Ten patients with CBT were included in this study on whom CEUS was performed between 2007-2018 (mean age: 62 years). In 6/10 patients, results were confirmed by MRI, 4/12 patients underwent subsequent angiography. CEUS was performed and interpreted by a single consultant radiologist with experience since 2000 (EFSUMB level 3). VueBox software was used for standardized perfusion quantification.

Results: CEUS allowed to detect all CBTs and visualize intratumoral microcirculation. Perfusion quantification was performed in 6/10 cases. CBTs showed significantly reduced peak-enhancement (PE), reduced wash-in perfusion index (WiPI) and significantly elevated time to peak (TTP) compared to common carotid arteries (CCA).

Conclusions: CEUS is a useful and safe tool for identifying CBTs and evaluating intratumoral microperfusion at high spatial and temporal resolutions in real-time. In addition to conventional ultrasound, CT, MRI and digital substraction angiography (DSA), CEUS may be implemented in the future diagnostic work-up and follow-up of CBT patients.
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http://dx.doi.org/10.21037/qims-19-920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417754PMC
September 2020

Diagnostic value of contrast-enhanced ultrasound versus computed tomography for hepatocellular carcinoma: a retrospective, single-center evaluation of 234 patients.

J Int Med Res 2020 Jun;48(6):300060520930151

Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany.

Objective: Hepatocellular carcinoma (HCC) is the most common cause of primary liver cancer. A major part of diagnostic HCC work-up is based on imaging findings from sonography, computed tomography (CT), or magnetic resonance imaging (MRI) scans. Contrast-enhanced ultrasound (CEUS) allows for the dynamic assessment of the microperfusion pattern of suspicious liver lesions. This study aimed to evaluate the diagnostic value of CEUS compared with CT scans for assessing HCC.

Methods: We performed a retrospective, single-center study between 2004 and 2018 on 234 patients with suspicious liver lesions who underwent CEUS and CT examinations. All patients underwent native B-mode, color Doppler and CEUS after providing informed consent. Every CEUS examination was performed and interpreted by a single experienced radiologist (European Federation of Societies for Ultrasound in Medicine and Biology level 3).

Results: CEUS was performed on all included patients without occurrence of any adverse effects. CEUS showed a sensitivity of 94%, a specificity of 70%, a positive predictive value of 93% and a negative predictive value of 72% for analyzing HCC compared with CT as the diagnostic gold standard.

Conclusions: CEUS has an excellent safety profile and shows a high diagnostic accuracy in assessing HCC compared with corresponding results from CT scans.
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http://dx.doi.org/10.1177/0300060520930151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294502PMC
June 2020

Multiparametric ultrasonographic analysis of testicular tumors: a single-center experience in a collective of 49 patients.

Scand J Urol 2020 Jun 25;54(3):241-247. Epub 2020 May 25.

Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany.

The aim of the present retrospective single-center study is to evaluate the diagnostic performance of multiparametric ultrasonography for characterizing testicular tumors. Forty-nine patients with testicular tumors, 36 of malignant vs 13 of benign entity, were included in this retrospective single-center study on whom multiparametric sonography, encompassing native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) and elastography, was performed between 2011-2018. In 48 of 49 patients, findings from multiparametric analysis were correlated with histopathological results. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3). Multiparametric ultrasonography was successfully performed in all included patients without any adverse effects. Concomitant testicular microlithiasis, rapid arterial wash-in, elevated values for perfusion quantification - Peak Enhancement (PE), Wash-in Area Under the Curve (WiAUC) and Wash-in Perfusion Index (WiPI) - and higher shear wave velocities were significantly associated with malignancy. Multiparametric ultrasonography depicts a non-ionizing, directly accessible and cost-effective imaging modality that allows for the extensive characterization of testicular tumors, thereby helping to discriminate between malignant and benign entity of testicular tumors.
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http://dx.doi.org/10.1080/21681805.2020.1765863DOI Listing
June 2020

Comparison of computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear renal lesions.

Rofo 2020 Nov 15;192(11):1053-1059. Epub 2020 Apr 15.

Department of Radiology, Ludwig-Maximilians-University Munich, Germany.

Purpose:  To compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of unclear renal lesions to the histopathological outcome.

Materials And Methods:  A total of 255 patients with a single unclear renal mass with initial imaging studies between 2005 and 2015 were included. Patient ages ranged from 18 to 86 with (mean age 62 years; SD ± 13). CEUS (255 patients), CT (88 out of 255 patients; 34.5 %) and MRI (36 out of 255 patients; 14.1 %) were used for determining malignancy or benignancy and initial findings were correlated with the histopathological outcome.

Results:  CEUS showed a sensitivity of 99.1 % (95 % confidence interval (CI): 96.7 %, 99.9 %), a specificity of 80.5 % (95 % CI: 65.1 %, 91.2 %), a positive predictive value (PPV) of 96.4 % (95 % CI: 93.0 %, 98.4 %) and a negative predictive value (NPV) of 94.3 % (95 % CI: 80.8 %, 99.3 %). CT showed a sensitivity of 97.1 % (95 % CI: 89.9 %, 99.6 %), a specificity of 47.4 % (95 % CI: 24.4 %, 71.1 %), a PPV of 87.0 % (95 % CI: 77.4 %, 93.6 %) and a NPV of 81.8 % (95 % CI: 48.2 %, 97.7 %). MRI showed a sensitivity of 96.4 % (95 % CI: 81.7 %, 99.9 %), a specificity of 75.0 % (95 % CI: 34.9 %, 96.8 %), a PPV of 93.1 % (95 % CI: 77.2 %, 99.2 %) and a NPV of 85.7 % (95 % CI: 42.1 %, 99.6 %). Out of the 212 malignant lesions a total of 130 clear cell renal carcinomas, 59 papillary renal cell carcinomas, 7 chromophobe renal cell carcinomas, 4 combined clear cell and papillary renal cell carcinomas and 12 other malignant lesions, e. g. metastases, were diagnosed. Out of the 43 benign lesions a total 10 angiomyolipomas, 3 oncocytomas, 8 benign renal cysts and 22 other benign lesions, e. g. renal adenomas were diagnosed. Using CEUS, 10 lesions were falsely identified as malignant or benign, whereas 8 lesions were false positive and 2 lesions false negative.

Conclusion:  CEUS is an useful method which can be additionally used to clinically differentiate between malignant and benign renal lesions. CEUS shows a comparable sensitivity, specificity, PPV and NPV to CT and MRI. In daily clinical routine, patients with contraindications for other imaging modalities can particularly benefit using this method.

Key Points:   · Wide availability. · Safe applicability in patients with known renal insufficiency or allergies to iodine or gadolinium. · Comparable sensitivity, specificity, PPV and NPV to CT and MRT. · May lead to a reduction in interventional radiological or surgical interventions.

Citation Format: · Marschner CA, Ruebenthaler J, Schwarze V et al. Comparison of computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear renal lesions. Fortschr Röntgenstr 2020; 192: 1053 - 1058.
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http://dx.doi.org/10.1055/a-1127-3371DOI Listing
November 2020

Single-center study: the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing renal oncocytoma.

Scand J Urol 2020 Apr 12;54(2):135-140. Epub 2020 Mar 12.

Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany.

The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the evaluation of renal oncocytoma. Thirteen patients with histopathologically confirmed renal oncocytoma and 26 patients with histopathologically confirmed renal cell carcinoma were included in this retrospective single-center study on whom CEUS was performed between 2005 and 2015. The applied contrast agent was a second-generation blood pool agent. CEUS examinations were performed and interpreted by a single radiologist with more than 15 years of experience (EFSUMB Level 3). CEUS examinations were successfully performed in all included patients without any adverse effects. Renal oncocytomas showed varying echogenicity (46% hypoechoic, 23% hyperechoic, 8% iso-/hyperechoic, 8% isoechoic). In two cases renal oncocytoma only demarcated upon i.v. application of contrast medium. In bilateral oncocytosis, lesions presented as hyperechoic. Only 23% of renal oncocytomas showed slight vascularization using Color Doppler. No oncocytoma-specific pattern of microperfusion could be elucidated: 85% of the oncocytomas presented hyperenhancing, of whom 50% also showed delayed venous wash-out; 8% of renal oncocytomas showed venous wash-out without early arterial hyperenhancement. Within the frame of the present study and in line with the recent state of knowledge, no specific sonomorphological feature - including CEUS - could be detected allowing for adequate discrimination between oncocytoma and renal cell carcinoma.
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http://dx.doi.org/10.1080/21681805.2020.1736621DOI Listing
April 2020

Overview of ultrasound applications for assessing scrotal disorders.

J Ultrasound Med 2020 Jun 16;39(6):1047-1056. Epub 2019 Dec 16.

Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany.

The scrotum may be affected by a plethora of different disorders such as infections, vasculopathies, trauma, and manifestations of primary and secondary malignant masses. In addition to the patient's medical history and clinical examination, ultrasound represents the imaging modality of choice to assess scrotal disorders. Time-consuming contrast-enhanced ultrasound and elastography can provide further information to distinguish between benign and malignant testicular mass lesions. The following invited Special Communication gives a comprehensive overview of differential diagnoses of the scrotum and their corresponding sonomorphologic correlates based on representative cases of the Interdisciplinary Ultrasound Center of the University Hospital Munich.
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http://dx.doi.org/10.1002/jum.15197DOI Listing
June 2020

Single-Center Study: Evaluating the Diagnostic Performance and Safety of Contrast-Enhanced Ultrasound (CEUS) in Pregnant Women to Assess Hepatic Lesions.

Ultraschall Med 2020 Feb 30;41(1):29-35. Epub 2019 Jul 30.

Department of Radiology, Ludwig-Maximilians-University of Munich - Großhadern Campus, Munich, Germany.

Background:  Ultrasound is an essential imaging tool for evaluating physiological and pathological fetal or maternal conditions during pregnancy. Published data is limited with respect to the application of CEUS during pregnancy. CEUS has already been safely applied for assessing uteroplacental blood flow, cesarean scar pregnancy and invasive placenta percreta. CT and MRI scans during pregnancy must be thoroughly evaluated due to harmful ionizing radiation and cerebral gadolinium deposition, respectively.

Purpose:  The aim of the present retrospective single-center study is to assess the diagnostic performance and safety of CEUS during pregnancy to evaluate hepatic lesions of unknown entity.

Methods:  6 pregnant patients who underwent CEUS between 2005 and 2014 (mean age: 32 years; mean weeks of pregnancy: 28 weeks) were included in this study. The applied contrast agent was a second-generation blood-pool agent (SonoVue, Bracco, Milan, Italy). CEUS examinations were performed and interpreted by a single radiologist with experience since 2000 (EFSUMB Level 3).

Results:  CEUS was safely performed on all included pregnant women without the occurrence of adverse fetal or maternal events. In the context of the present study, CEUS helped to safely differentiate hepatic metastases, focal nodular hyperplasia, atypical hemangioma, hepatic arteriovenous malformation and cystic echinococcosis. In two patients CEUS determined immediate therapy.

Conclusion:  Although not clinically approved in obstetrics so far, CEUS is a safe imaging modality which, in addition to B-mode and color Doppler ultrasonography, may be applied during pregnancy for further medical indications and to provide helpful information.
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http://dx.doi.org/10.1055/a-0973-8517DOI Listing
February 2020

Digital Analysis in Breast Imaging.

Breast Care (Basel) 2019 Jun 4;14(3):142-150. Epub 2019 Jun 4.

Department of Radiology, Ludwig Maximilian University of Munich - Grosshadern Campus, Munich, Germany.

Breast imaging is a multimodal approach that plays an essential role in the diagnosis of breast cancer. Mammography, sonography, magnetic resonance, and image-guided biopsy are imaging techniques used to search for malignant changes in the breast or precursors of malignant changes in, e.g., screening programs or follow-ups after breast cancer treatment. However, these methods still have some disadvantages such as interobserver variability and the mammography sensitivity in women with radiologically dense breasts. In order to overcome these difficulties and decrease the number of false positive findings, improvements in imaging analysis with the help of artificial intelligence are constantly being developed and tested. In addition, the extraction and correlation of imaging features with special tumor characteristics and genetics of the patients in order to get more information about treatment response, prognosis, and also cancer risk are coming more and more in focus. The aim of this review is to address recent developments in digital analysis of images and demonstrate their potential value in multimodal breast imaging.
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http://dx.doi.org/10.1159/000501099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600033PMC
June 2019

SonoVue® Does Not Appear to Cross the Placenta as Observed During an Examination Aimed at Confirming a Diagnosis of Liver Echinococcosis in a Pregnant Woman.

Ultraschall Med 2020 04 7;41(2):146-147. Epub 2019 Feb 7.

Department of Radiology, Interdisciplinary Ultrasound Center, Hospital of the Ludwig-Maximilians-University Munich (LMU), Munich, Germany.

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http://dx.doi.org/10.1055/a-0837-0791DOI Listing
April 2020

Detection and monitoring of postinterventional success and complications of the liver using contrast-enhanced ultrasound (CEUS) - a case report after interventional treatment of a giant hemangioma.

Med Ultrason 2018 Dec;20(4):536-538

Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany.

This case report relates the use of contrast-enhanced ultrasound (CEUS) for the assessment and treatment of a postinterventional cholecystitis, a rare but important complication after transcatheter arterial embolization of a giant hemangioma. Regarding the imaging diagnosis, hemangiomas have specific features allowing a fast recognition by all radiological modalities,and in recent years, especially by CEUS.
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http://dx.doi.org/10.11152/mu-1553DOI Listing
December 2018

Ultrasound and contrast enhanced ultrasound imaging in the diagnosis of acute aortic pathologies.

Vasa 2019 Jan 7;48(1):17-22. Epub 2018 Nov 7.

1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany.

Conventional ultrasound is worldwide the first-line imaging modality for the prompt diagnosis in the daily practice because it is a cost-effective and easy to perform technique. The additional application of contrast media has been used to enhance the intravascular contrast and to improve the imaging diagnostic accuracy in the detection, classification and follow-up of vascular pathologies. Contrast-enhanced ultrasound has the advantage of being a safe, fast and dynamic non-invasive imaging tool with excellent results in the diagnosis of acute aortic pathologies, especially the detection of endoleaks after endovascular aneurysm repair. This review describes the diagnostic and therapeutic roles of ultrasound and contrast-enhanced ultrasound imaging in the most common vascular pathologies such as aortic dissections, aneurysms and endoleaks. Keywords: Endoleak, contrast media, ultrasonography, aorta.
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http://dx.doi.org/10.1024/0301-1526/a000758DOI Listing
January 2019

T1-MPRAGE and T2-FLAIR segmentation of cortical and subcortical brain regions-an MRI evaluation study.

Neuroradiology 2019 Feb 6;61(2):129-136. Epub 2018 Nov 6.

Department of Radiology, Ludwig-Maximilians University Munich, Munich, Germany.

Purpose: Development of a warp-based automated brain segmentation approach of 3D fluid-attenuated inversion recovery (FLAIR) images and comparison to 3D T1-based segmentation.

Methods: 3D FLAIR and 3D T1-weighted sequences of 30 healthy subjects (mean age 29.9 ± 8.3 years, 8 female) were acquired on the same 3T MR scanner. Warp-based segmentation was applied for volumetry of total gray matter (GM), white matter (WM), and 116 atlas regions. Segmentation results of both sequences were compared using Pearson correlation (r).

Results: Correlation of GM segmentation results based on FLAIR and T1 was overall good for cortical structures (mean r across all cortical structures = 0.76). Comparatively weaker results were found in the occipital lobe (r = 0.77), central region (mean r = 0.58), basal ganglia (mean r = 0.59), thalamus (r = 0.30), and cerebellum (r = 0.73). FLAIR segmentation underestimated volume of the central region compared to T1, but showed a better anatomic concordance with the occipital lobe on visual review and subcortical structures, when also compared to manual segmentation. Visual analysis of FLAIR-based WM segmentation revealed frequent misclassification of regions of high signal intensity as GM.

Conclusion: Warp-based FLAIR segmentation yields comparable results to T1 segmentation for most cortical GM structures and may provide anatomically more congruent segmentation of subcortical GM structures. Selected cortical regions, especially the central region and total WM, seem to be underestimated on FLAIR segmentation.
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http://dx.doi.org/10.1007/s00234-018-2121-2DOI Listing
February 2019

Radiomic Analysis Reveals Prognostic Information in T1-Weighted Baseline Magnetic Resonance Imaging in Patients With Glioblastoma.

Invest Radiol 2017 06;52(6):360-366

From the *Josef Lissner Laboratory for Biomedical Imaging, and †Institute for Clinical Radiology, Ludwig-Maximilians University Hospital Munich, Munich; ‡Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg; §Department of Neurosurgery, and ∥Center for Neuropathology and Prion Research, Ludwig-Maximilian University Hospital Munich, Munich, Germany; ¶Research Institute Children's Cancer Center, Hamburg; Departments of #Nuclear Medicine, and **Neuroradiology, Ludwig-Maximilian University Hospital, Munich, Germany.

Objectives: The aim of this study was to investigate whether radiomic analysis with random survival forests (RSFs) can predict overall survival from T1-weighted contrast-enhanced baseline magnetic resonance imaging (MRI) scans in a cohort of glioblastoma multiforme (GBM) patients with uniform treatment.

Materials And Methods: This retrospective study was approved by the institutional review board and informed consent was waived. The MRI scans from 66 patients with newly diagnosed GBM from a previous prospective study were analyzed. Tumors were segmented manually on contrast-enhanced 3-dimensional T1-weighted images. Using these segmentations, P = 208 quantitative image features characterizing tumor shape, signal intensity, and texture were calculated in an automated fashion. On this data set, an RSF was trained using 10-fold cross validation to establish a link between image features and overall survival, and the individual risk for each patient was predicted. The mean concordance index was assessed as a measure of prediction accuracy. Association of individual risk with overall survival was assessed using Kaplan-Meier analysis and a univariate proportional hazards model.

Results: Mean overall survival was 14 months (range, 0.8-85 months). Mean concordance index of the 10-fold cross-validated RSF was 0.67. Kaplan-Meier analysis clearly distinguished 2 patient groups with high and low predicted individual risk (P = 5.5 × 10). Low predicted individual mortality was found to be a favorable prognostic factor for overall survival in a univariate Cox proportional hazards model (hazards ratio, 1.038; 95% confidence interval, 1.015-1.062; P = 0.0059).

Conclusions: This study demonstrates that baseline MRI in GBM patients contains prognostic information, which can be accessed by radiomic analysis using RSFs.
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http://dx.doi.org/10.1097/RLI.0000000000000349DOI Listing
June 2017