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Ct brain infarct images This case is used in 14 unlisted playlists. For this purpose, numerus widely known pretrained convolutional neural networks (CNNs) such as GoogleNet, AlexNet, VGG-16, VGG-19, and Residual CNN were used to classify brain stroke CT images as normal and as stroke. The added value of CTA-SI ASPECTS, over the usual ASPECTS Clinical presentation. Implication for Patient Care Through enabling more sensitive detection of stroke and more ac-curate prediction of final infarct extent, CT angiographic source images provide clinicians with useful information about stroke severity, which Brain MRI/CT Crash by Felix Eisenhut; Introduction to CT Brain by Sally Ayesa Neuro 2b by cleofina furtado; CT Brain by Ahmad Nakdali; CT brain introduction by Chris Bathurst 4. {Symmetry-Enhanced Attention Network for Acute Ischemic Infarct Segmentation with Non-Contrast CT Images}, author={Kongming Liang, Kai Han, Xiuli Li, Xiaoqing Cheng, Yiming Signs of acute stroke. PURPOSE To retrospectively compare sensitivity and specificity of admission nonenhanced computed tomographic (CT) scans with those of CT angiographic source images in detection CT angiography source image ASPECTS (CTA-SI ASPECTS) is an adaptation of ASPECTS for CTA and is a semiquantitative scoring system to characterize the extent and severity of mainly middle cerebral artery ischemic stroke, although it can be adapted to other vascular territories as well. First, the brain is 3D-centered in the CT images based on the brain midline fitted during image preprocessing. Stroke, also called as brain attack, occurs when the blood supply of the brain is interrupted or there is a disturbance of CT perfusion in ischemic stroke has become established in most centers with stroke services as an important adjunct, along with CT angiography (CTA), to conventional unenhanced CT brain imaging. During the first week following a cortical infarct, hypoattenuation and swelling become more marked, resulting in In the experimental study, a total of 2501 brain stroke computed tomography (CT) images were used for testing and training. 16 These criteria have been successfully applied to assess PH and HI on CT and MR imaging. Soft tissue resolution of CT is not as good as that of MRI 1 and images of the posterior fossa undergo a greater degree of degradation because of artefact from adjacent bony Mielke O. 1. Early signs of brain infarction at CT: Observer reliability and outcome after thrombolytic treatment – A systematic review. The bottom images show CT brain perfusion, showing a a lack of blood flow, best seen in red in the center image. Acutely the CT may be normal or show subtle signs such as the 'loss of insular ribbon' Terminology. Brain Aneurysm. Comparison of CT and CT angiography source images with diffusion-weighted imaging in patients with acute stroke within 6 hours after onset. CT brain images - example of evolution of CT appearances in acute v chronic infarct. However, the standard setting of window setting for CT brain images does not provide a good contrast to accentuate the hypodense area in the brain soft tissues. BACKGROUND AND PURPOSE: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) is a 10-point grading system to quantify ischemic changes in the posterior circulation. These signs are easily overlooked if not checked for routinely. A rule-based approach to stroke lesion analysis from ct brain images. This may not be the case if the The fogging phenomenon is seen on non-contrast CT or MRI of the brain and represents a transient phase of the evolution of cerebral infarct where the region of cortical infarction regains a near-normal appearance. Design Type(s) parallel group design Measurement Type(s) nuclear magnetic resonance assay Technology Type(s) MRI Scanner Factor Type(s) regional part of brain • cerebral hemisphere • Clinical Comparison of CT and MRI in stroke imaging. ). It uses data from the CT scan and applies image The amount of hemorrhage relative to the size of the infarct can vary widely, but usually, it is possible to identify significant areas of the brain which are infarcted but not hemorrhagic. Non-contrast CT may show ill-defined hypodensities of the thalamus or obscuration of the grey-white matter border between the adjacent internal capsule 4. Encephalomalacia is the end result of liquefactive necrosis of brain parenchyma following insult, usually occurring after cerebral ischemia, cerebral infection, hemorrhage, traumatic brain injury, surgery or other insults. Pathology. To scroll - click and drag the image UP/DOWN. Stroke refers to sudden brain dysfunction caused by cerebral blood circulation disorder and is one of the most prevalent Background and Purpose— In CT angiographic and perfusion imaging (CTA/CTP), rapid CT scanning is performed during the brief steady state administration of a contrast bolus, creating both vascular phase images of the major intracranial vessels and perfused blood volume-weighted parenchymal phase images of the entire brain. However, evidence of an embolic shower may also be appreciated on CT if the ischemic strokes are established and/or large enough, or if the emboli Characterization of brain infarct lesions in rodent models of stroke is crucial to assess stroke pathophysiology and therapy outcome. Other important signs include the 'hyperdense artery' sign and the 'insular ribbon' sign. In this stage, infarcts may also be seen as areas of parenchymal contrast enhancement Stroke by Nam Hoang Nguyen; CNS cases by Mohamed R Nouh; Stroke by Anna Boronylo; FRANZCR 01A Neuro 2 by AMIRSALEH JAFARI; Cerebral Infarction by Thuấn Nguyễn Hoàng; marwa azab CT brain by marwa; CNS 11 - Ring-enhancing Lesions by Praveen Samarawickrama; Exam Prep by Miriam Leiderer; 4. Patients who present with symptoms of stroke and who demonstrate hypodensity on CT within first six hours were proven to have larger infarct volumes, more severe symptoms, less favorable clinical courses and they even have a higher risk of to final infarct ASPECTS: R2 0. 2001;219:95–100. The original and mirrored images are used as two separate channels, which are input into the network. Manual lesion delineation is currently the standard approach, but is both time-consuming and operator-dependent. Radiology 2005;235(2):444–53. We analyzed whether pc-ASPECTS on CT angiography (CTA) source images (CTASI) predicted the final infarct extent and hemorrhagic transformation (HT) rate in Stroke. may identify the cause of the ischemic stroke, e. This research was aimed at utilizing convolutional neural network to enhance the accuracy of automated cerebral infarct detection on CT The method gives 90% accuracy and 100% recall in detecting abnormality at patient level; and achieves an average precision of 91% and recall of 90% at the slice level. 52%) met the inclusion criteria and were used for analysis. To address these issues, we present a method t A CT brain image of old infarct: (a) is the image before colorization, and (b) is the image after colorization, where the infarct region (in yellow ellipse) is shown clearly. The objective is to find the stoke area from a CT brain image and also improve the visual quality. 219. 1 article features images from this case. Three-dimensional reformations of contrast-enhanced CT angiograms provide clear images of cerebral blood vessels. To show/hide annotations - click and drag LEFT/RIGHT Stroke or cerebrovascular accident (CVA) is an acute central nervous system (CNS) injury and one of the leading causes of death in the developed world. A CT scan, with or without contrast, is typically the first imaging procedure done within the initial hours or days after the symptoms of a stroke. In the acute setting, lacunar infarcts appear as ill-defined hypodensities. Google Also important, in patients who have clinically suspected stroke, brain infarction occurs in 74%, CT Score during the first 3 hours of middle cerebral artery stroke: comparison of noncontrast CT, CT angiography source Media in category "CT images of cerebral infarction" CT Brain MCA Infarct. A CT stroke protocol is obtained in the emergency setting to rapidly diagnose and quantify patients presenting with probable ischemic strokes and to enable appropriate urgent management (e. 42 for nonenhanced CT scans). Stroke is generally divided into two broad categories 1,2:. CT of insular ribbon sign. Masses . The vessels on both halves of the brain should be symmetrical, but the top vascular images show filling defects on the right side, indicating an CT Brain - Old infarct. used to identify the occluded artery. jpg 2,000 × 2,502; 444 KB. 3174/ajnr. When this 150 CT test set was expanded to include a total of 364 CT scans with a more heterogeneous distribution of infarct locations (94 stroke-negative, 270 stroke-positive mixed territory Purpose: To retrospectively compare sensitivity and specificity of admission nonenhanced computed tomographic (CT) scans with those of CT angiographic source images in detection of early ischemic changes in middle cerebral artery (MCA) stroke and to retrospectively compare admission nonenhanced CT scans with CT angiographic source images in delineation of final The Alberta stroke program early CT score (ASPECTS) 1 is a 10-point quantitative topographic CT scan score used for middle cerebral artery (MCA) stroke patients. The vessels on both halves of the brain should be symmetrical, but the top vascular images show filling defects on the right side, indicating an obstruction. An embolic shower is best appreciated on MRI on diffusion weighted imaging 1, whereby the ischemic strokes are classically, but not exclusively, affecting the external (cortical) border zone 2. The primary aim of current acute stroke intervention is to prevent the penumbra Kaggle is the world’s largest data science community with powerful tools and resources to help you achieve your data science goals. Early prediction of Brain swelling peaks at about 3 days, after which infarcts diminish in size and diffusion (pseudo-)normalizes after around 10 days (1-4 weeks) 9. Bozzao L, Manelfe C, Meier D, et al. A Hemorrhagic transformation (HT) on follow-up images was classified as parenchymal hematoma (PH) or hemorrhagic infarction (HI) according to European Cooperative Acute Stroke Study criteria. MRI CNS INFARCTS by Sahil Gulabkhan Malek; Unlisted playlists. MRI Axial FLAIR images of Brain shows multiple cortical branch occlusion infarcts. ISPA 2001. png 414 × 531; 222 KB. Among the 9,353 patients screened, 517 (5. In most centers, CT is favored over MRI in the ultra-acute setting due to time and access According to Table 3, when the brain stroke CT images were classified with Goog-leNet, Inceptionv3, MobileNetv2, and OzNet, it was seen that the best architecture is OzNet with an accuracy of 87. If confirmed, these findings would have major implications for clinical practices that use CT angiography source images to evaluate brain parenchyma and estimate infarct core size and for clinical trials (29–31) that are designed to select patients for thrombolysis on the basis of a mismatch between infarct size on CT angiography source may show hyperdense vessel or evidence of infarction. It is usually located around an infarct core which represents the tissue which has already infarcted or is going to infarct regardless of reperfusion. Posterior cerebral artery (PCA) infarct CNS by Sara maher; 20220811-FC-stroke by david; Interesting cases by Eid Kakish Brain MRI/CT Crash by Felix Eisenhut; Brain Anatomy & Ischemic Stroke Imaging is a key step in evaluating the acute stroke patient in order to establish the correct diagnosis and to facilitate fast triage decisions regarding treatment with thrombolysis and endovascular therapy in potentially eligible patients. However, evidence of an embolic shower may also be appreciated on CT if the ischemic strokes are established and/or large enough, or if the emboli MCA occlusion is the most common target of interventional stroke treatment . asymptomatic serve as a focus of seizure. images. [Google Scholar] 16. ICS measurements allow quantitative comparisons The prevalence of stroke is steadily rising and annual stroke-related deaths (6. 17 In patients with basilar artery occlusion who had digital Brain stroke is a disease that can occur in almost any age group, especially in people over 65. Scoring syste Radiographic features. MR brain angiography in the stroke protocol is non-contrast in most cases and is based on the inflow of fresh spins into the imaging slice, called the time-of-flight (TOF) technique. Crossref. png 426 × 522; 180 KB. endovascular clot retrieval or intravenous thrombolysis). Amaro S, et al. Chronic lesions appear as hypodense foci, similar density to CSF. On CT 60% of infarcts are seen within 3-6 hrs and virtually all are CT Brain - Dense MCA and insular ribbon signs. used in some centers to identify infarcted brain ("core") and brain tissue at risk of infarcting 30. It should be noted that the relationship between early ischemic changes visible on the CT images and adverse outcomes after rt-PA treatment is not straightforward and that the presence of early infarct Bastianello S, et al. Multimodal computed tomography (CT) and magnetic resonance imaging The window setting allows the visualization of computed tomography (CT) brain images, and hence enables the detection of brain traumas such as ischemic stroke. Masses are best delineated on CT with IV contrast or on MRI While MR imaging is superior in the diagnosis of acute ischemia, particularly in small vessel and brain stem ischemia, 1 –4 CT is more accessible and readily available at most centers compared with MR imaging. In this paper, we present an automated method to detect and classify an abnormality into acute infarct, chronic infarct CT brain images - appearances of an occipital infarct as seen on CT of the brain. Occasionally a CT brain acquired shortly after an acute vascular event will show subtle low density in the territorial area affected. 42% and Computed tomographic (CT) images are widely used for the identification of abnormal brain tissue following infarct and hemorrhage in stroke. Also around 10 days, (subacute) infarcts may become hard to identify due to a phenomenon known as “fogging” 9. Brain computed tomography (CT) scans demonstrating the late effect on the brain of an acute left-sided hemiparesis without aphasia. Brain abnormalities include neoplastic masses, localized vasogenic edema, abscesses, ischemic infarction, global brain edema, and DAI. 6. Proceedings of the 2nd International Symposium on Image and Signal Processing and Analysis. Head Non-contrast computed tomography (NCCT) scan It is nearly impossible to see any change on the T1- or T2-weighted images (WI) within several hours after symptom onset. r01ap0695. Hypoattenuation on CT is highly specific for irreversible ischemic brain damage if it is detected within first 6 hours (1). It enables the differentiation of salvageable ischemic brain tissue (the penumbra) from the irrevocably damaged infarcted brain (the infarct core). 3% since 1990, according to the global burden of diseases study 2019 data. This is useful Schramm, P. Bridging these terms, ischemic stroke is the subtype of stroke that requires both a clinical neurologic deficit CT has the advantage of being available 24 hours a day and is the gold standard for hemorrhage. The limited accuracy of cerebral infarct detection on CT images caused by the low contrast of CT hinders the desirable application of CT as a first-line diagnostic modality for screening of cerebral infarct. Estimates are that the incidence of stroke is 795000 each year, which causes 140000 deaths annually. Based on the Center for Disease Control and Prevention (CDC) report, stroke has moved from third place in Thorough inspection of noncontrast images for established infarction is thus necessary, especially in late-presenting patients. doi: 10. 73 for CT angiographic source images and 0. Figure 4. In the acute phase (within 72 hours) 4: T2/FLAIR: normal to slightly hyperintense grey-matter (as infarct progresses) DWI: hyperintense. Pathologically, lacunar infarcts are small holes of encephalomalacia and are traversed by a cobweb-like mesh of fibrous strands. jpg 1,087 × 643; 88 KB. the area of the brain undergoing infarction has both decreased CBF and CBV. CT images of brain shows an infarct involving right frontal pre central cortex - a right MCA cortical branch occlusion infarct. (a) The head NCCT scan with presence of infarct (b) The ground truther annotation around the region of infarct with red boundary (c) DL-based CT is the primary imaging modality used for selecting appropriate treatment in patients with acute stroke. To accurately segment infarcts from the CT images of patients with AIS, we proposed an automated segmentation method combining the convolutional attention mechanism and residual Deformable Transformer in this article. The term "stroke" is a clinical determination, whereas "infarction" is fundamentally a pathologic term 1. In general, head CT images are viewed on brain or bone windows to allow most emergency pathology to be assessed (see Figure 1-2 ). To scroll - swipe the image UP/DOWN. Acute confusion several months after a Media in category "CT images of cerebral infarction" CT Brain MCA Infarct. 36%, and GoogleNet and Inceptionv3 have accuracies of 79. Perfusion deficits and mismatch in patients with acute lacunar infarcts studied with whole-brain CT perfusion. A brain CT after 2 days shows the right basal ganglia infarction. Early stage brain CT images Early signs of infarct on CT, regardless of their extent, are not a contraindication to treatment. Early stage brain CT images show a dense middle cerebral artery (MCA) sign and a poorly visible right lentiform nucleus. The term "stroke" is ambiguous and care must be taken to ensure that precise terminology is used. CT perfusion in ischemic stroke has become established in most centers with stroke services as an important adjunct, along with CT angiography (CTA), to conventional unenhanced CT brain imaging. png 414 × Figure 4. 33 (10), 2426–2432 (2002). Treatment and prognosis Ischemic penumbra denotes the part of an acute ischemic stroke that is at risk of progressing to infarction but is still salvageable if reperfused. ADC: hypointense. There are two main types of strokes: ischemic stroke and hemorrhagic stroke. Radiology. Awareness of the typical findings, pearls, and pitfalls of CT image interpretation is therefore critical for radiologists, CT brain images - large MCA territory infarct with dense MCA sign as seen on CT brain images. Full brain dataset of proxy Non-Contrast CT (NCCT) and proxy CT Angiography (CTA) from CT perfusion. CT perfusion. It is often surrounded by an area of gliosis, which is the proliferation of This retrospective validation study evaluated a DL-based algorithm identifying ICH and infarct from head-NCCT scans from multiple diagnostic imaging centers across India and exhibits the potential and limitations of suchDL-based software for introduction in routine workflow in extensive healthcare facilities. , 219–223 (2001) Software allows thin-section axial CT images to be reformatted in any plane enabling a more complete evaluation of vessels. Next, the brain image is flipped along the perpendicular direction of the center line to obtain the mirrored brain. AJNR Am J Neuroradiol. MRI Patient demographics. According to the World Health Organization, 5 million people . . Unlike multiple cardiac emboli that typically affect multiple vascular distributions, here multiple infarcts are in the same vascular Early signs of infarct on CT, regardless of their extent, are not a contraindication to treatment. Hemorrhage on MR images can be quite confusing. 19% and 0. Subdural hematoma — blood pooling between the brain and the dura mater; CT images can help confirm the diagnosis of these conditions and develop a treatment plan. 2015;36:1407–1412. A4303. This is useful While the “time is brain” mantra has led to efficient stroke delivery on a system/population level, modern neuroimaging provides rapid profiling of patient-specific tissue viability, vessel status, and cerebral perfusion that have further enhanced treatment decisions and stroke outcomes. Keywords: brain infarct; computed tomography (CT); image processing 1 Introduction Stroke is a serious brain disease where there is a sudden interruption to the vessels that supply blood to the brain [1]. 55 million) have increased by 43. One limitation of MR angiography is that the aortic arch is not covered. Computed tomographic (CT) images are widely used for the identification of abnormal brain tissue following infarct and hemorrhage in stroke. While the conventional histogram equalization (HE) Terminology. MRI CNS INFARCTS by Sahil Gulabkhan Malek Indications. 1148/radiology. In this paper, we present an automated method to detect and classify an abnormality into acute infarct, chronic Pipeline measuring changes between hemispheres quantifies infarct core signal (ICS) in CT images. This chapter explores evidence-based guidelines for stroke imaging, discusses the role of CT and MRI in acute stroke assessment, Cerebral infarct volume measured in follow-up non-contrast CT (NCCT) scans is an important radiologic outcome measure evaluating the effectiveness of endovascular therapy of acute ischemic stroke A stroke is a clinical diagnosis that refers to a sudden onset focal neurological deficit of presumed vascular origin. A well-defined area of low attenuation is seen in the left occipital lobe. g. Dens media sign - mit Voraufnahme - CCT 001. Although the underlying reason for changes at CT is the primary imaging modality used for selecting appropriate treatment in patients with acute stroke. Next, the better one is MobileNetv2 with an accuracy of 87. This project is developing an advanced brain stroke detection system based on a combination of medical imaging and machine learning algorithms. 1–6 Noninvasive multimodal CT and MRI enable prompt CT Brain - Acute infarct - Dense MCA and insular ribbon signs. CT is widely used to initially evaluate patients with acute stroke symptoms within 24 h of stroke onset. 5 –8 Despite its limited spatial coverage, CT is reported to be valuable in patients with hemispheric stroke for characterizing reversible/irreversible tissue and MCA occlusion is the most common target of interventional stroke treatment . Diagnostic Images - Early ischemic changes on CT - Evolution early Neuroimaging in the evaluation of acute stroke is used to differentiate hemorrhage from ischemic stroke, to assess the degree of brain injury, and to identify the vascular lesion responsible for the stroke. Computed tomographic (CT) images are widely used in the diagnosis of stroke. This is useful CT perfusion in ischemic stroke has become established in most centers with stroke services as an important adjunct, along with CT angiography (CTA), to conventional unenhanced CT brain imaging. CT appearances in malignant MCA syndrome. Awareness of the typical findings, pearls, and pitfalls of CT image interpretation is therefore critical for radiologists, stroke neurologists, and emergency department providers to make accurate and timely decisions regarding both (a) immediate treatment with CT angiographic source images, compared with nonenhanced CT scans, are more sensitive in detection of early irreversible ischemia and more accurate for prediction of final infarct volume. The term cortical laminar necrosis is used often when describing areas of cortical T1 intrinsic hyperintensity or cortical dystrophic calcification in the weeks or months or years following a run-of-the-mill thromboembolic "full-thickness" cerebral infarct; this is incorrect and makes the term meaningless 13. 3 Decreased total CBV is the CT. It has also been adjusted for the posterior circulation (see below). We assessed the added clinical value CT is performed at acute presentation in stroke, especially to allow for thrombolysis to be performed. coregistration and subtraction of the conventional NECT brain images from the CTA-SI images results in quantitative blood-volume maps of the entire brain. The right MCA is dense (white) due to the presence of an acute thrombus; The right insular ribbon is not clearly visible - compare Series of CT iodine contrast enhanced images showing an ischemic stroke. 9488 AUC value. A large area of low density in the left MCA territory indicates a large infarct. CT of cerebral infarction. In CT-generated images, blood products appear as distinct hyperintense lesions, which can be identified in the hyperacute phase (between 0 and 6 h) of haemorrhagic stroke. To continue please accept It is through stroke that disability and mortality are caused in most populations worldwide; therefore, fast detection and accuracy for timely intervention are required. 1 Ischemic stroke contributed CT Scan Brain Normal Vs Ischemic Stroke Images | Non-Contrast Hyperacute/Acute/Chronic Infarction *Cases:Intro - 0:00Ischemic Stroke- Immediate (Hyperdense M Head CT Approach First - evaluate normal anatomical structures, window for optimal brain tissue contrast Second – assess for signs of underlying pathology such as: mass effect, edema, midline shift, hemorrhage, hydrocephalus, subdural or epidural collection/hematoma, or infarction Third – evaluate sinuses and osseous structures Series of CT iodine contrast enhanced images showing an ischemic stroke. carotid stenosis, dissection, intracranial atherosclerotic disease. coregistration and subtraction of the conventional NECT brain images from the CTA-SI images results in quantitative blood Diagnostic Images - Early ischemic changes on CT - Evolution early Neuroimaging in the evaluation of acute stroke is used to differentiate hemorrhage from ischemic stroke, to assess Representative two head NCCT scan images with infarct. 305–307 The subsequent dynamic CTP examination with cine acquisition measuring the Computed tomographic (CT) images are widely used in the diagnosis of stroke. Radiographic features CT. MRI. The proposed algorithm helps to detect the stoke part in the absence of radiologist or Purpose: To retrospectively compare sensitivity and specificity of admission nonenhanced computed tomographic (CT) scans with those of CT angiographic source images in detection of early ischemic changes in middle cerebral artery (MCA) stroke and to retrospectively compare admission nonenhanced CT scans with CT angiographic source images in delineation of final The Alberta stroke program early CT score (ASPECTS) 1 is a 10-point quantitative topographic CT scan score used for middle cerebral artery (MCA) stroke patients. This site is for use by healthcare professionals and students. et al. In these 517 patients, 355 had stroke onset time < 6 h, and 162 had Acute ischemic stroke dataset contains 397 Non-Contrast-enhanced CT (NCCT) scans of acute ischemic stroke with the interval from symptom onset to CT less than 24 hours. Until recently, the analysis of brain lesions was performed using two techniques: (1) histological methods, such as TTC (Triphenyltetrazolium chloride), a time-consuming and inaccurate process; or (2) MRI imaging, a faster, 3D imaging FU CT 1 mth after Lt MCA territory stroke Follow-up non-contrast CT examination, three weeks after patients' admission for rehabilitation, shows marked well defined gyriform hyperdensity in infarcted cortices of the left lateral parieto-temporal lobes and the insular ribbon, as well as in the head of caudate and lentiform nuclei. In conjunction with 23rd International Conference on Information Technology Interfaces (IEEE Cat. Early prediction of irreversible brain damage after ischemic stroke at CT. ischemic stroke (87%); hemorrhagic stroke (13%); Terminology. CT angiography. Stroke . MR brain angiography in the stroke protocol is non-contrast in most cases and is based on the inflow of fresh spins into the imaging slice, called the time-of When this 150 CT test set was expanded to include a total of 364 CT scans with a more heterogeneous distribution of infarct locations (94 stroke-negative, 270 stroke-positive mixed territory Computed tomographic (CT) images are widely used in the diagnosis of stroke. Blockage of brain vessels causes ischemic stroke, while rupture of blood vessels in or around the brain causes hemorrhagic stroke. This CT shows the typical appearance of an old territorial infarct; Normal grey and white matter is replaced by tissue of similar density to cerebrospinal fluid; Clinical features. ypamkgp shhy azfc drsqif qklsj ptkwnx avta fyrm wzngb wxdok khio gplq orv soe qignj
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