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September 2019; 6 (5) ArticleOpen Access

Gray matter microglial activation in relapsing vs progressive MS

A [F-18]PBR06-PET study

Tarun Singhal, Kelsey O'Connor, Shipra Dubey, Hong Pan, Renxin Chu, Shelley Hurwitz, Steven Cicero, Shahamat Tauhid, David Silbersweig, Emily Stern, Marie Kijewski, Marcelo DiCarli, Howard L. Weiner, Rohit Bakshi
First published July 1, 2019, DOI: https://doi.org/10.1212/NXI.0000000000000587
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Article Information

vol. 6 no. 5 e587
DOI: 
https://doi.org/10.1212/NXI.0000000000000587
PubMed: 
31454766
Published By: 
Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology
Online ISSN: 
2332-7812
History: 
  • Received November 19, 2018
  • Accepted in final form May 15, 2019
  • First Published July 1, 2019.
Copyright & Usage: 
Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Author Disclosures

    1. Tarun Singhal, MD,
    2. Kelsey O'Connor, BS,
    3. Shipra Dubey, PhD,
    4. Hong Pan, PhD,
    5. Renxin Chu, PhD,
    6. Shelley Hurwitz, PhD,
    7. Steven Cicero, BS,
    8. Shahamat Tauhid, MD,
    9. David Silbersweig, MD,
    10. Emily Stern, MD,
    11. Marie Kijewski, DSc,
    12. Marcelo DiCarli, MD,
    13. Howard L. Weiner, MD and
    14. Rohit Bakshi, MD, MA
  1. Tarun Singhal, MD,
    2. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. National Multiple Sclerosis Society

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  2. Kelsey O'Connor, BS,
    3. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  3. Shipra Dubey, PhD,
    4. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  4. Hong Pan, PhD,
    5. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. (1) Systems and Methods For Generating Biomarkers Based On Multivariate Classification Of Functional Imaging and Associated Data. (2) System and Method For Z-Shim Compensated Echo-Planar Magnetic Resonance Imaging. (3) System and Method for a Multivariate, Automated, Systematic and Hierarchical Searching Algorithm for Biosignature Extraction and Biomarker Discovery via Task- based fMRI Imaging Spacetime Data.

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  5. Renxin Chu, PhD,
    6. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  6. Shelley Hurwitz, PhD,
    7. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. (1) Foundation for Neurologic Diseases

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  7. Steven Cicero, BS,
    8. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  8. Shahamat Tauhid, MD,
    9. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Journal of Neuroimaging, Managing Editor, 2015-present

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  9. David Silbersweig, MD,
    10. Scientific Advisory Boards:

    1. american foundation for suicide prevention (non-profit)

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. speaker at American Neuropsychiatric Association annual meeting 2019

    Editorial Boards:

    1. Consulting editor, Journal of Neuropsychiatry and Clinical Neurosciences Editorial Board, Harvard Review of Psychiatry

    Patents:

    1. (1) System and Method for z-Shim Compensated Echo- Planar Magnetic Resonance Imaging, and Systems (issued) (2) System and Methods for Generating Biomarkers Based on Multivariate Classification of Functional Imaging and Associated Data (issued) (3) System and Method for a Multivariate, Automated, Systematic and/or Hierarchical Searching System for Biosignature Extraction and Biomarker Discovery via task- based fMRI Imaging spacetime data (pending) (4) PhyNFI: System and Method for Physiological-Noise- Free Functional Magnetic Resonance Imaging (planned)

    Publishing Royalties:

    1. Depression in Medical Illness textbook, McGraw-Hill, 2017

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. Biogen Sanofi Philips Goldfinch Tilak

    Speakers' Bureaus:

    1. NONE

    Other activities:

    1. founder of a start-up company, not yet with any assets, not related to paper

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. wife: contract with blackthorn therapeutics, not related to topic

    Research Support, Government Entities:

    1. wife:(1) DHSS Administration for Community Living, formerly the National Institute on Disability and Rehabilitation Research (NIDRR ? 90DP0039-03-01) Co-PI; PI, BWH Site, (10/1/12- 9/30/18) (2) NIH (NIMH ? R01MH090291) Co-investigator, (7/1/17 ? 6/30/22)

    Research Support, Academic Entities:

    1. wife: Baylor college of medicine

    Research Support, Foundations and Societies:

    1. wife: epilepsy foundation

    Stock/Stock Options/Board of Directors Compensation:

    1. founders shares in Compass Neurosciences, no current assets, unrelated founders shares in Buoyant, no current assets, unrelated

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  10. Emily Stern, MD,
    11. Scientific Advisory Boards:

    1. (1) Spaulding Rehabilitation Hospital- TBI Model Systems SAB (non-profit) Husband:(2) American Foundation for suicide prevention (non- profit)

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. (1) National Institute of Heath. Funding for travel for grant review (2) James S. McDonnell Foundation. Funding for travel to speak at conference Husband: (3) Speaker at American Neuropsychiatric Association 2019 Annual Meeting

    Editorial Boards:

    1. (1)The International Journal of Imaging Systems and Technology ? Neuroimaging and Brain Mapping, Co-Editor (2011-2017) (2)Journal of Neuroimaging, Editorial Board. (2015-present) Husband: (3) Consulting editor, Journal of Neuropsychiatry and Clinical Neurosciences Editorial Board, Harvard Review of Psychiatry

    Patents:

    1. (1)System and Method for z-Shim Compensated Echo-Planar Magnetic Resonance Imaging, and Systems (issued) (2)System and Methods for Generating Biomarkers Based on Multivariate Classification of Functional Imaging and Associated Data (issued) (3)System and Method for a Multivariate, Automated, Systematic and/or Hierarchical Searching System for Biosignature Extraction and Biomarker Discovery via task- based fMRI Imaging spacetime data (pending) (4)PhyNFI: System and Method for Physiological-Noise-Free Functional Magnetic Resonance Imaging (planned) [All of the above (1-4) apply to both Dr. Stern and her husband]

    Publishing Royalties:

    1. Husband only: (1) Depression in Medical Illness textbook, McGraw Hill 2017

    Employment, Commercial Entity:

    1. (1)Brigham and Women?s Hospital, Director Functional Neuroimaging Laboratory, (2008-present) Husband: (2)Brigham and Women?s Hospital, Chairman Department of Psychiatry, (2008-present)

    Consultancies:

    1. Husband only: (1) Philips (2) Sanofi (3) Biogen (4) Tilak (5) Goldfinch

    Speakers' Bureaus:

    1. NONE

    Other activities:

    1. (1) Dr. Stern is the CEO of a startup company, Compass Neurosciences, that will be spinning out of Brigham and Women?s Hospital in the near future. This has not yet occurred, the company presently has no assets, and this activity did not influence what was written in this manuscript; however, it is felt that this is important to disclose. Husband: Co-founder of a company, Compass Neurosciences, the company presently has no assets, and this activity did not influence what was written in this manuscript

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. (1) Blackthorn Therapeutics

    Research Support, Government Entities:

    1. (1) DHSS Administration for Community Living, formerly the National Institute on Disability and Rehabilitation Research (NIDRR ? 90DP0039-03-01) Co-PI; PI, BWH Site, (10/1/12- 9/30/18) (2) NIH (NIMH ? R01MH090291) Co-investigator, (7/1/17 ? 6/30/22)

    Research Support, Academic Entities:

    1. (1) Baylor College of Medicine

    Research Support, Foundations and Societies:

    1. (1)Epilepsy Foundation

    Stock/Stock Options/Board of Directors Compensation:

    1. (1) Compass NeuroSciences, Inc. Husband: (2)Founders shares for Compass NeuroSciences, Inc., no current assets, unrelated Husband: (3)Founders shares in Buoyant Health, no current assets, unrelated

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  11. Marie Kijewski, DSc,
    12. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. 1. NIH, 5R01HL130563, co-investigator, 2017-2019 2. NIH, 5R01HL132021, co-investigator, 2017-2019 3. NIH, 5R01HL131910, co-investigator, 2017-2019

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  12. Marcelo DiCarli, MD,
    13. Scientific Advisory Boards:

    1. (1) Sanofi Aventis, GE Healthcare

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Associate Editor, Journal of Nuclear Cardiology

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. Gilead Sciences Spectrum Dynamics

    Research Support, Government Entities:

    1. NHLBI 5R01HL132021-03, 5T32HL094301-09

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  13. Howard L. Weiner, MD and
    14. Scientific Advisory Boards:

    1. served on the advisory board for The Guthy Jackson Charitable Foundation, Teva Pharmaceutical Industries Ltd., Biogen Idec, Novartis, Sanofi-aventis, Tilos Therapeutics, CBridge Capital, Genentech, Genzyme, vTv Therapeutics, MedDay Pharmaceuticals

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. Biodextris Biogen Novartis Serono Teva Sanofi Genzyme Tilos Therapeutics Tiziana Life Sciences vTv Therapeutics MedDay Pharmaceuticals Genentech CBridge Capital

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. EMD Serono Google Life Sciences Verily Life Sciences

    Research Support, Government Entities:

    1. NIH UH3TR000890 - PI - 08/01/13 ? 07/31/18 R01 NS087226 - PI - 09/30/14 ? 07/31/19 R01 EY027921 - PI - 09/01/17 ? 08/31/20

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. National Multiple Sclerosis Society

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  14. Rohit Bakshi, MD, MA
    15. Scientific Advisory Boards:

    1. Dr. Bakshi has served on advisory boards for (1) Bayer, (2) Biogen, (3) Celgene, (4) EMD Serono, (5) Genentech, (6) Guerbet, (7) Sanofi-Genzyme, and (8) Shire.

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. Dr. Bakshi received a speaking fee from (1) Novartis.

    Editorial Boards:

    1. Dr. Bakshi serves as Editor-in-Chief of (1) the Journal of Neuroimaging

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. Dr. Bakshi has received consulting fees from (1) EMD Serono.

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. Dr. Bakshi has received research support from (1) EMD Serono, (2) Sanofi-Genzyme, and (3) Verily Life Sciences.

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. Dr. Bakshi has received research support from the (1) Department of Defense (MS170140), (2) National Multiple Sclerosis Society (RR 2005-A-13 and RG-1707-28586), (3) Watercove foundation, and (4) Race to Erase MS. Stock/Stock Options, Medical Equipment & Materials: Dr. Bakshi's spouse holds stock in (1) Biogen, Inc. 2012-present.

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  1. From the Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
  1. Correspondence
    Dr. Singhal tsinghal{at}bwh.harvard.edu
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