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Topic:Magnetic Resonance Imaging

Magnetic Resonance Imaging (MRI) is a non-invasive diagnostic tool used in veterinary medicine to obtain detailed images of the internal structures of horses. It utilizes strong magnetic fields and radio waves to create cross-sectional images, allowing for the examination of soft tissues, bones, and joints without the need for radiation. MRI is particularly useful for diagnosing conditions in areas that are challenging to assess with other imaging modalities, such as the hoof, distal limb, and head. This page compiles peer-reviewed research studies and scholarly articles that explore the application, techniques, and advancements in MRI technology for equine diagnostics, as well as its role in improving the understanding of equine anatomy and pathology.
Contrast enhanced magnetic resonance imaging of the foot in horses using intravenous versus regional intraarterial injection of gadolinium.
Open veterinary journal    December 15, 2018   Volume 8, Issue 4 471-478 doi: 10.4314/ovj.v8i4.19
Zani D, Rabbogliatti V, Ravasio G, Pettinato C, Giancamillo MD, Zani DD.The use of contrast enhanced magnetic resonance imaging (MRI) for the detection of orthopedic pathologies in equine patients is poorly described. In few studies, enhanced MRI allowed to differentiate active lesions from chronic ones and to classify ambiguous lesions. The aim of this clinical prospective pilot study is to describe and compare the MRI lesions observed in horses with lameness localized to the foot using a single intravenous bolus dose of gadolinium contrast versus regional intraarterial bolus of contrast agent. Ten horses that underwent contrast enhanced MRI were included in the ...
The Use of Bone Marrow Concentrate in the Treatment of Full-Thickness Chondral Defects.
HSS journal : the musculoskeletal journal of Hospital for Special Surgery    November 26, 2018   Volume 15, Issue 1 96-99 doi: 10.1007/s11420-018-9647-z
Apostolakos JM, Lazaro L, Williams RJ.This article is a critical analysis of a study, "Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects: A One-Year Study in an Equine Model," by Chu et al. (. 100(2):138-146, 2018). The investigation compared two interventions in the management of full-thickness chondral defects in an equine model: autologous bone marrow concentrate without concomitant microfracture treatment versus microfracture treatment alone. This review analyzes the methodology and results of their investigation and examines how their findings may influence ...
Bone marrow lesions of the distal condyles of the third metacarpal bone are common and not always related to lameness in sports and pleasure horses. De Guio C, Ségard-Weisse E, Thomas-Cancian A, Schramme M.The metacarpophalangeal joint is a common site of pain in horses. Little information is available about bone marrow lesions in the distal condyles of the third metacarpal bone in sports and pleasure horses. Aims of this prospective, retrospective, observational study were to evaluate the prevalence of bone marrow lesions in the distal condyles of the third metacarpal bone, to describe their anatomic distribution and to correlate lesions with the presence of lameness and the level and type of activity. All sports and pleasure horses undergoing standing low-field MRI of the front fetlock region ...
Magnetic resonance and radiographic imaging of a case of bilateral bipartite navicular bones in a horse.
Australian veterinary journal    October 30, 2018   Volume 96, Issue 11 464-469 doi: 10.1111/avj.12760
Harcourt M, Smith C, Bell R, Young A.We describe the radiographic and magnetic resonance imaging findings associated with a case of bilateral forelimb bipartite navicular disease in a 7-year-old Warmblood gelding used for eventing. In addition to the radiographically evident partitioned navicular bones, magnetic resonance imaging (MRI) also detected other concurrent abnormalities occurring within the foot that have not been described before in other cases of navicular bone partition. MRI not only revealed soft tissue lesions of the podotrochlear apparatus, but also allowed for more detailed characterisation of the recently diagno...
Comparison of Metzenbaum scissors and Y-shaped fasciotome for deep metatarsal fasciotomy for the treatment of proximal suspensory ligament desmopathy in horses.
Veterinary surgery : VS    October 15, 2018   Volume 48, Issue 1 57-63 doi: 10.1111/vsu.13111
Sidhu ABS, Rosanowski SM, Davis AM, Griffith JF, Robinson P.To quantitate the iatrogenic injury associated with deep plantar metatarsal fasciotomy performed with Metzenbaum scissors compared with a Y-shaped fasciotome. Methods: Experimental ex vivo surgical study. Methods: Cadaveric hind limbs (n = 20) from 10 sound thoroughbred racehorses. Methods: A plantar metatarsal fasciotomy was performed, extending from the proximal extent of the deep metatarsal fascia, distally. Hind limbs were randomly assigned to 2 groups, undergoing fasciotomy with straight Metzenbaum scissors (n = 10) or a Y-shaped fasciotome (n = 10). Magnetic resonance imaging...
18 F-sodium fluoride positron emission tomography of the racing Thoroughbred fetlock: Validation and comparison with other imaging modalities in nine horses.
Equine veterinary journal    September 28, 2018   Volume 51, Issue 3 375-383 doi: 10.1111/evj.13019
Spriet M, Espinosa-Mur P, Cissell DD, Phillips KL, Arino-Estrada G, Beylin D, Stepanov P, Katzman SA, Galuppo LD, Garcia-Nolen T, Murphy B, Stover SM.Early and accurate detection of stress remodelling in racehorses is of utmost importance to prevent catastrophic injuries. Current imaging techniques have limitations in assessing early changes predisposing to catastrophic breakdowns. Positron emission tomography (PET) using F-sodium fluoride ( F-NaF) is a sensitive method for the detection of early bone turnover and may improve early recognition of subtle injuries. Objective: To validate the clinical use of F-NaF PET in Thoroughbred racehorses, to assess the value of PET in the detection of bone lesions and to compare PET results with findi...
Magnetic motor evoked potentials of cervical muscles in horses.
BMC veterinary research    September 24, 2018   Volume 14, Issue 1 290 doi: 10.1186/s12917-018-1620-z
Rijckaert J, Pardon B, Van Ham L, Joosten P, van Loon G, Deprez P.When surgical treatment of cervical vertebral malformation is considered, precise localization of compression sites is essential, but remains challenging. Magnetic motor evoked potentials (mMEP) from paravertebral muscles are useful in localizing spinal cord lesions, but no information about cervical muscle mMEP in horses is available yet. Therefore, the aim of this study was to determine the possibility, normal values, inter- and intra-observer agreement and factors that have an effect on cervical mMEP in healthy horses. Methods: Transcranial magnetic stimulation was performed on 50 normal ho...
Conservative versus surgical treatment of 21 sports horses with osseous trauma in the proximal phalangeal sagittal groove diagnosed by low-field MRI.
Veterinary surgery : VS    September 14, 2018   Volume 47, Issue 7 908-915 doi: 10.1111/vsu.12936
Lipreri G, Bladon BM, Giorio ME, Singer ER.To compare the outcome following conservative vs surgical management of sports horses with a diagnosis of subchondral bone trauma of the proximal aspect of the proximal phalanx (PP) by low-field MRI. Methods: Retrospective case series. Methods: Twenty-one mature sports horses with evidence of high water signal within the proximal sagittal groove of the PP according to low-field MRI of the fetlock, with no definitive radiographic evidence of fracture. Methods: Medical records (2010-2017) of horses admitted to 2 referral hospitals were reviewed. Historical, clinical, radiographic, and MRI findin...
Horses with solar foot penetration, deep digital flexor tendon injury, and absence of concurrent synovial sepsis can have a positive outcome. Schiavo S, Cillán-García E, Elce Y, Liuti T, Taylor SE.Solar foot penetration is one of the causes of deep digital flexor tendon injuries in horses, however, limited information is available on the prognosis for return to soundness in the absence of synovial sepsis. Objectives of this retrospective observational study were to describe low-field magnetic resonance imaging (MRI) findings and long-term outcome for a group of horses with this combination of clinical problems. Horses were included if low-field standing MRI of the foot was performed following puncture wounds, injury of the deep digital flexor tendon was diagnosed, and sepsis was confirm...
High field magnetic resonance imaging is comparable with gross anatomy for description of the normal appearance of soft tissues in the equine stifle. Daglish J, Frisbie DD, Selberg KT, Barrett MF.High field magnetic resonance imaging (MRI) is increasingly used for horses with suspected stifle disease, however there is limited available information on normal imaging anatomy and potential incidental findings. The aim of this prospective, anatomic study was to develop an optimized high field MRI protocol for evaluation of the equine stifle and provide detailed descriptions of the normal MRI appearance of the stifle soft tissues, using ultrasound and gross pathological examination as comparison tests. Nine cadaver limbs were acquired from clinically normal horses. Stifles were evaluated ul...
Assessment of effectiveness and safety of repeat administration of proinflammatory primed allogeneic mesenchymal stem cells in an equine model of chemically induced osteoarthritis.
BMC veterinary research    August 17, 2018   Volume 14, Issue 1 241 doi: 10.1186/s12917-018-1556-3
Barrachina L, Remacha AR, Romero A, Vitoria A, Albareda J, Prades M, Roca M, Zaragoza P, Vázquez FJ, Rodellar C.This study aimed at assessing the effectiveness and safety of repeated administrations of allogeneic bone marrow-derived mesenchymal stem cells (BM-MSCs) primed with tumor necrosis factor (TNF)-α and interferon-γ in an equine model of chemically-induced osteoarthritis. Arthritis was induced in both radio-carpal (RC)-joints by amphotericin-B in 18 ponies, divided into three groups depending on the treatment injected: MSC-naïve (n = 7), MSC-primed (n = 7) and control (n = 4). The study consisted of two phases and used one RC-joint of each animal in each phase, with four months tim...
High field magnetic resonance imaging contributes to diagnosis of equine distal tarsus and proximal metatarsus lesions: 103 horses. Barrett MF, Selberg KT, Johnson SA, Hersman J, Frisbie DD.Injury of the distal tarsus and proximal metatarsus commonly causes lameness. Magnetic resonance imaging (MRI) allows concurrent assessment of both the distal tarsal joints and suspensory ligament origin, and aids identification of lesions that may otherwise go undetected by other modalities. In this retrospective observational study, the medical records of a veterinary imaging center were searched for MRI exams of the distal tarsus and proximal metatarsus for the years 2012 through 2014. Studies for 125 limbs of 103 horses were identified and retrospectively evaluated by two board-certified v...
Effects of mesenchymal stromal cells versus serum on tendon healing in a controlled experimental trial in an equine model.
BMC musculoskeletal disorders    July 18, 2018   Volume 19, Issue 1 230 doi: 10.1186/s12891-018-2163-y
Ahrberg AB, Horstmeier C, Berner D, Brehm W, Gittel C, Hillmann A, Josten C, Rossi G, Schubert S, Winter K, Burk J.Mesenchymal stromal cells (MSC) have shown promising results in the treatment of tendinopathy in equine medicine, making this therapeutic approach seem favorable for translation to human medicine. Having demonstrated that MSC engraft within the tendon lesions after local injection in an equine model, we hypothesized that they would improve tendon healing superior to serum injection alone. Methods: Quadrilateral tendon lesions were induced in six horses by mechanical tissue disruption combined with collagenase application 3 weeks before treatment. Adipose-derived MSC suspended in serum or seru...
Diagnosis of Skeletal Injury in the Sport Horse.
The Veterinary clinics of North America. Equine practice    July 17, 2018   Volume 34, Issue 2 193-213 doi: 10.1016/j.cveq.2018.04.014
Wulster KB.This article discusses the basis of image formation of radiography, scintigraphy, PET, computed tomography (fan beam and cone beam), and magnetic resonance as it relates to imaging of musculoskeletal injury in the sport horse. The benefits and drawbacks of each modality are discussed with particular emphasis on sensitivity, specificity, and accuracy of identification of subchondral bone injury. Examples of straightforward as well as confounding lesions are provided, emphasizing the need for appropriate clinical workup and diagnostic analgesia, where appropriate.
Self-Complementary Adeno-Associated Virus-Mediated Interleukin-1 Receptor Antagonist Gene Delivery for the Treatment of Osteoarthritis: Test of Efficacy in an Equine Model.
Human gene therapy. Clinical development    June 6, 2018   Volume 29, Issue 2 101-112 doi: 10.1089/humc.2017.143
Watson Levings RS, Smith AD, Broome TA, Rice BL, Gibbs EP, Myara DA, Hyddmark EV, Nasri E, Zarezadeh A, Levings PP, Lu Y, White ME, Dacanay EA....The authors are investigating self-complementary adeno-associated virus (scAAV) as a vector for intra-articular gene-delivery of interleukin-1 receptor antagonist (IL-1Ra), and its therapeutic capacity in the treatment of osteoarthritis (OA). To model gene transfer on a scale proportional to the human knee, a frequent site of OA incidence, studies were focused on the joints of the equine forelimb. Using AAV2.5 capsid and equine IL-1Ra as a homologous transgene, a functional ceiling dose of ∼5 × 10 viral genomes was previously identified, which elevated the steady state levels of eqIL-1R...
Diagnosis of Soft Tissue Injury in the Sport Horse.
The Veterinary clinics of North America. Equine practice    May 28, 2018   Volume 34, Issue 2 215-234 doi: 10.1016/j.cveq.2018.04.009
Bubeck KA, Aarsvold S.For successful diagnosis of soft tissue injuries in the sport horse, localizing the area of injury during clinical and lameness evaluation will be followed in most cases by an ultrasonographic examination. With MRI more available in equine veterinary clinics, this modality can allow for a complete evaluation of soft tissue and osseous structures and is especially useful for evaluation of structures within the hoof capsule. This article discusses special ultrasonographic techniques, an overview of MRI image generation, and the use of contrast computed tomography for diagnosis of soft tissue inj...
Evaluation of the diagnostic accuracy of skeletal scintigraphy for the causes of front foot pain determined by magnetic resonance imaging. Quiney LE, Ireland JL, Dyson SJ.There is good correlation between increased radiopharmaceutical uptake anywhere in the feet of sports or leisure horses and the presence of foot pain. However, low sensitivity of scintigraphy for identifying lesions contributing to foot pain as determined by magnetic resonance imaging (MRI) has been reported. The aim of this retrospective, cross-sectional, analytical study was to assess the accuracy of scintigraphy for identifying the cause(s) of foot pain, using MRI as the reference standard. Sports and leisure horses that underwent both skeletal scintigraphy and MRI of the front feet between...
Effects of Equine-Assisted Activities and Therapies on the Affective Network of Adolescents with Internet Gaming Disorder.
Journal of alternative and complementary medicine (New York, N.Y.)    April 26, 2018   Volume 24, Issue 8 841-849 doi: 10.1089/acm.2017.0416
Kang KD, Jung TW, Park IH, Han DH.Internet gaming disorder (IGD) has been suggested to be a mental health disorder. Attachment and emotional status in IGD patients are important for understanding the etiology and progression of IGD because both parameters are considered to be associated with the affective network. Equine-assisted activities and therapies (EAAT) have been reported to improve emotional status and attachment in subjects. We hypothesized that EAAT would improve attachment in IGD adolescents with insecure attachment issues and increase functional connectivity (FC) within the affective network. Methods: Subjects com...
Critical-sized cartilage defects in the equine carpus.
Connective tissue research    April 12, 2018   Volume 60, Issue 2 95-106 doi: 10.1080/03008207.2018.1455670
Salonius E, Rieppo L, Nissi MJ, Pulkkinen HJ, Brommer H, Brünott A, Silvast TS, Van Weeren PR, Muhonen V, Brama PAJ, Kiviranta I.The horse joint, due to its similarity with the human joint, is the ultimate model for translational articular cartilage repair studies. This study was designed to determine the critical size of cartilage defects in the equine carpus and serve as a benchmark for the evaluation of new cartilage treatment options. Circular full-thickness cartilage defects with a diameter of 2, 4, and 8 mm were created in the left middle carpal joint and similar osteochondral (3.5 mm in depth) defects in the right middle carpal joint of 5 horses. Spontaneously formed repair tissue was examined macroscopically, ...
Axial sesamoiditis in the horse: A review.
Journal of the South African Veterinary Association    March 29, 2018   Volume 89 e1-e8 doi: 10.4102/jsava.v89i0.1544
Le Roux C, Carstens A.Axial sesamoiditis or osteitis of the proximal sesamoid bones (PSBs) in the horse is described as a rare condition. The cause remains unknown and speculative, with vascular, infectious, and traumatic aetiologies implicated. It is specifically associated with injury of the palmar or plantar ligament (PL), also known as the intersesamoidean ligament. Imaging findings are generally rewarding and radiological changes are typical, if not pathognomonic, for the condition. Lesions consist of bone lysis at the apical to mid-body axial margins of the PSBs, with variable degrees of joint effusion. Radio...
Magnetic resonance imaging following regional limb perfusion of gadolinium contrast medium in 26 horses.
Equine veterinary journal    February 28, 2018   Volume 50, Issue 5 649-657 doi: 10.1111/evj.12818
Aarsvold S, Solano M, Garcia-Lopez J.Systemic administration of gadolinium contrast medium is common in small animals to increase lesion conspicuity and determine vascularisation of lesions identified with magnetic resonance imaging (MRI); however, the large volume required for systemic administration limits its use in horses. Objective: The purpose of this study was to assess the feasibility of administering a low dose of contrast medium via venous regional limb perfusion. Methods: Prospective clinical study. Methods: Distal limbs of 26 horses (one limb per horse) were imaged with MRI before and after administration of 5 mL of g...
Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging.
Equine veterinary journal    February 27, 2018   Volume 50, Issue 5 564-579 doi: 10.1111/evj.12808
Nelson BB, Kawcak CE, Barrett MF, McIlwraith CW, Grinstaff MW, Goodrich LR.Articular cartilage is a critical joint tissue and its evaluation remains a diagnostic challenge in horses. Coupled with a poor capacity for healing, early degenerative changes in articular cartilage are difficult to characterise using routine diagnostic imaging evaluations. Both computed tomography (CT) and magnetic resonance imaging (MRI) provide volumetric joint assessment and highlight morphological and quantitative properties of articular cartilage, improving assessment of this essential tissue. While the use of CT and MRI for joint evaluation is not new, there still remains a shortage of...
Use of high-field and low-field magnetic resonance imaging to describe the anatomy of the proximal portion of the tarsal region of nonlame horses.
American journal of veterinary research    February 22, 2018   Volume 79, Issue 3 299-310 doi: 10.2460/ajvr.79.3.299
Biggi M, Dyson SJ.OBJECTIVE To use high-field and low-field MRI to describe the anatomy of the proximal portion of the tarsal region (proximal tarsal region) of nonlame horses. SAMPLE 25 cadaveric equine tarsi. PROCEDURES The proximal portion of 1 tarsus from each of 25 nonlame horses with no history of tarsal lameness underwent high-field (1.5-T) and low-field (0.27-T) MRI. Resulting images were used to subjectively describe the anatomy of that region and obtain measurements of the collateral ligaments of the tarsocrural joint. RESULTS Long and short components of the lateral and medial collateral ligaments of...
Use of a 3-Telsa magnet to perform delayed gadolinium-enhanced magnetic resonance imaging of the distal interphalangeal joint of horses with and without naturally occurring osteoarthritis.
American journal of veterinary research    February 22, 2018   Volume 79, Issue 3 287-298 doi: 10.2460/ajvr.79.3.287
Bischofberger AS, Fürst AE, Torgerson PR, Carstens A, Hilbe M, Kircher P.OBJECTIVE To characterize delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) features of healthy hyaline cartilage of the distal interphalangeal joint (DIPJ) of horses, to determine whether dGEMRIC can be used to differentiate various stages of naturally occurring osteoarthritis of the DIPJ, and to correlate relaxation times determined by dGEMRIC with the glycosaminoglycan concentration, water content, and macroscopic and histologic findings of hyaline cartilage of DIPJs with and without osteoarthritis. SAMPLE 1 cadaveric forelimb DIPJ from each of 12 adult warmblood horses. PROCEDURES T1-...
Comparison between magnetic resonance imaging, computed tomography, and arthrography to identify artificially induced cartilage defects of the equine carpal joints. Suarez Sanchez-Andrade J, Richter H, Kuhn K, Bischofberger AS, Kircher PR, Hoey S.While articular cartilage changes are considered to be one of the initial events in the pathological cascade leading to osteoarthritis, these changes remain difficult to detect using conventional diagnostic imaging modalities such as plain radiography. The aim of this prospective, experimental, methods comparison study was to compare the sensitivity of magnetic resonance imaging (MRI), magnetic resonance arthrography, computed tomography (CT), and CT arthrography in the detection of artificially induced articular cartilage defects in the equine carpal joints. Defects were created in the antebr...
Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects: A One-Year Study in an Equine Model.
The Journal of bone and joint surgery. American volume    January 18, 2018   Volume 100, Issue 2 138-146 doi: 10.2106/JBJS.17.00132
Chu CR, Fortier LA, Williams A, Payne KA, McCarrel TM, Bowers ME, Jaramillo D.Microfracture is commonly performed for cartilage repair but usually results in fibrocartilage. Microfracture augmented by autologous bone marrow concentrate (BMC) was previously shown to yield structurally superior cartilage repairs in an equine model compared with microfracture alone. The current study was performed to test the hypothesis that autologous BMC without concomitant microfracture improves cartilage repair compared with microfracture alone. Methods: Autologous sternal bone marrow aspirate (BMA) was concentrated using a commercial system. Cells from BMC were evaluated for chondroge...
Effect of intra-articular administration of superparamagnetic iron oxide nanoparticles (SPIONs) for MRI assessment of the cartilage barrier in a large animal model.
PloS one    December 29, 2017   Volume 12, Issue 12 e0190216 doi: 10.1371/journal.pone.0190216
Labens R, Daniel C, Hall S, Xia XR, Schwarz T.Early diagnosis of cartilage disease at a time when changes are limited to depletion of extracellular matrix components represents an important diagnostic target to reduce patient morbidity. This report is to present proof of concept for nanoparticle dependent cartilage barrier imaging in a large animal model including the use of clinical magnetic resonance imaging (MRI). Conditioned (following matrix depletion) and unconditioned porcine metacarpophalangeal cartilage was evaluated on the basis of fluorophore conjugated 30 nm and 80 nm spherical gold nanoparticle permeation and multiphoton lase...
[A case of leptomeningeal melanomatosis with acute paraplegia and multiple cranial nerve palsies].
Rinsho shinkeigaku = Clinical neurology    November 28, 2017   Volume 57, Issue 12 769-774 doi: 10.5692/clinicalneurol.cn-001092
Hattori K, Matsuda N, Murakami T, Ito E, Ugawa Y.A 62-year-old man with acute paraplegia was transferred to our hospital. He had flaccid paraplegia and multiple cranial nerve palsies, such as mydriasis of the left pupil, abduction palsy of the left eye, hoarseness and dysphagia, but no meningeal irritation signs. MRI of the spinal canal showed swellings of the conus medullaris and the cauda equine, and also contrast enhancement of the spinal meninges. The cerebrospinal fluid (CSF) showed pleocytosis and protein increment. The lymph node was swollen in his right axilla. The biopsy specimen from the right axillary lymph node revealed metastasi...
Effect of track surface firmness on the development of musculoskeletal injuries in French Trotters during four months of harness race training.
American journal of veterinary research    October 28, 2017   Volume 78, Issue 11 1293-1304 doi: 10.2460/ajvr.78.11.1293
Crevier-Denoix N, Audigié F, Emond AL, Dupays AG, Pourcelot P, Desquilbet L, Chateau H, Denoix JM.OBJECTIVE To evaluate the effect of track surface firmness on the development of musculoskeletal injuries in French Trotters during 4 months of race training. ANIMALS 12 healthy 3-year-old French Trotters. PROCEDURES Horses were paired on the basis of sex and body mass. Horses within each pair were randomly assigned to either a hard-track or soft-track group. The counterclockwise training protocol was the same for both groups. Surface firmness of each track was monitored throughout the training period. Radiography, ultrasonography, MRI, and scintigraphy were performed on all 4 limbs of each ho...
A Rare Case of Deep Digital Flexor Tendinopathy following Centesis of the Navicular Bursa.
Frontiers in veterinary science    October 16, 2017   Volume 4 169 doi: 10.3389/fvets.2017.00169
Froydenlund TJ, Meehan LJ, Morrison LR, Labens R.Navicular bursa (NB) centesis is a common diagnostic and therapeutic procedure in equine practice. This case report documents the clinical, diagnostic imaging and histological findings in a horse with a suspected iatrogenic deep digital flexor tendon (DDFT) injury following centesis of the NB a modified distal plantar approach (placement of two needles in a weight bearing position). Although it cannot be proven with absolute certainty, the authors believe that this is the first reported case where NB centesis is the likely cause of a DDFT lesion, and with magnetic resonance imaging performed ...
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