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European Radiology
Published in: European Radiology 11/2015

01-11-2015 | Gastrointestinal

Cost-utility analysis of nonalcoholic steatohepatitis screening

Authors: Eric Zhang, Claire Wartelle-Bladou, Luigi Lepanto, Jean Lachaine, Guy Cloutier, An Tang

Published in: European Radiology | Issue 11/2015

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Abstract

Objectives

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries. No studies have examined the cost-effectiveness of screening its advanced form, nonalcoholic steatohepatitis (NASH).

Methods

We performed a cost-utility analysis of annual noninvasive screening strategies using third-party payer perspective in a general population in comparison to screening a high-risk obese or diabetic population. Screening algorithms involved well-studied techniques, including NAFLD fibrosis score, transient elastography (TE), and acoustic radiation force impulse (ARFI) imaging for detecting advanced fibrosis (≥ F3); and plasma cytokeratin (CK)-18 for NASH detection. Liver biopsy and magnetic resonance elastography (MRE) were compared as confirmation methods. Canadian dollar (CAD or C$) costs were adjusted for inflation and discounted at 5 %. Incremental cost-effectiveness ratio (ICER) of ≤C$ 50,000 was considered cost-effective.

Results

Compared with no screening, screening with NAFLD fibrosis score/TE/CK-18 algorithm with MRE as confirmation for advanced fibrosis had an ICER of C$ 26,143 per quality-adjusted life year (QALY) gained. Screening in high-risk obese or diabetic populations was more cost-effective, with an ICER of C$ 9,051 and C$ 7,991 per quality-adjusted life-year (QALY) gained, respectively. Liver biopsy confirmation was not found to be cost-effective.

Conclusions

Our model suggests that annual NASH screening in high-risk obese or diabetic populations can be cost-effective.

Key Points

• This cost-utility analysis suggests that screening for nonalcoholic steatohepatitis may be cost-effective.
• In particular, screening of high-risk obese or diabetic populations is more cost-effective.
• Magnetic resonance elastography was more cost-effective to confirm disease compared to biopsy.
• More studies are needed to determine quality of life in nonalcoholic steatohepatitis.
• More management strategies for nonalcoholic steatohepatitis are also needed.
Appendix
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Literature
1.
Neuschwander-Tetri BA, Caldwell SH (2003) Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 37:1202–1219CrossRefPubMed
2.
Bellentani S, Scaglioni F, Marino M, Bedogni G (2010) Epidemiology of non-alcoholic fatty liver disease. Dig Dis 28:155–161CrossRefPubMed
3.
Adams LA, Sanderson S, Lindor KD, Angulo P (2005) The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J Hepatol 42:132–138CrossRefPubMed
4.
Browning JD, Szczepaniak LS, Dobbins R et al (2004) Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387–1395CrossRefPubMed
5.
Farrell GC, Larter CZ (2006) Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology 43:S99–S112CrossRefPubMed
6.
Ekstedt M, Franzen LE, Mathiesen UL et al (2006) Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology 44:865–873CrossRefPubMed
7.
Ascha MS, Hanouneh IA, Lopez R, Tamimi TA, Feldstein AF, Zein NN (2010) The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology 51:1972–1978CrossRefPubMed
8.
Ratziu V, Bonyhay L, Di Martino V et al (2002) Survival, liver failure, and hepatocellular carcinoma in obesity-related cryptogenic cirrhosis. Hepatology 35:1485–1493CrossRefPubMed
9.
Starley BQ, Calcagno CJ, Harrison SA (2010) Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology 51:1820–1832CrossRefPubMed
10.
Charlton MR, Burns JM, Pedersen RA, Watt KD, Heimbach JK, Dierkhising RA (2011) Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology 141:1249–1253CrossRefPubMed
11.
Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G (2010) A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol 53:372–384CrossRefPubMed
12.
Chalasani N, Younossi Z, Lavine JE et al (2012) The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 55:2005–2023CrossRefPubMed
13.
Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver Diseases (2009) Liver biopsy. Hepatology 49:1017–1044CrossRefPubMed
14.
Musso G, Gambino R, Cassader M, Pagano G (2011) Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 43:617–649CrossRefPubMed
15.
Talwalkar JA, Kurtz DM, Schoenleber SJ, West CP, Montori VM (2007) Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis. Clin Gastroenterol Hepatol 5:1214–1220CrossRefPubMed
16.
Machado MV, Cortez-Pinto H (2013) Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal. J Hepatol 58:1007–1019CrossRefPubMed
17.
Castera L, Pinzani M (2010) Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango? Gut 59:861–866CrossRefPubMed
18.
Promrat K, Kleiner DE, Niemeier HM et al (2010) Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology 51:121–129PubMedCentralCrossRefPubMed
19.
20.
Mahady SE, Webster AC, Walker S, Sanyal A, George J (2011) The role of thiazolidinediones in non-alcoholic steatohepatitis—a systematic review and meta analysis. J Hepatol 55:1383–1390CrossRefPubMed
21.
Mahady SE, Wong G, Craig JC, George J (2012) Pioglitazone and vitamin E for nonalcoholic steatohepatitis: a cost utility analysis. Hepatology 56:2172–2179CrossRefPubMed
22.
Petrou S, Gray A (2011) Economic evaluation using decision analytical modelling: design, conduct, analysis, and reporting. BMJ 342:d1766CrossRefPubMed
23.
Hashimoto E, Yatsuji S, Tobari M et al (2009) Hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. J Gastroenterol 44(Suppl 19):89–95CrossRefPubMed
24.
Vernon G, Baranova A, Younossi ZM (2011) Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 34:274–285CrossRefPubMed
25.
Canadian Agency for Drugs and Technologies in Health (2006) Guidelines for the economic evaluation of health technologies: Canada (3rd edn). Ottawa 75
26.
Wang QB, Zhu H, Liu HL, Zhang B (2012) Performance of magnetic resonance elastography and diffusion-weighted imaging for the staging of hepatic fibrosis: a meta-analysis. Hepatology 56:239–247CrossRefPubMed
27.
28.
West J, Card TR (2010) Reduced mortality rates following elective percutaneous liver biopsies. Gastroenterology 139:1230–1237CrossRefPubMed
29.
30.
Chalasani NP, Sanyal AJ, Kowdley KV et al (2009) Pioglitazone versus vitamin E versus placebo for the treatment of non-diabetic patients with non-alcoholic steatohepatitis: PIVENS trial design. Contemp Clin Trials 30:88–96CrossRefPubMed
31.
Miller DK, Homan SM (1994) Determining transition probabilities: confusion and suggestions. Med Decis Making 14:52–58CrossRefPubMed
32.
33.
Steadman R, Leggett L, Lorenzetti D, Noseworthy T, Rose R, Sutherland L, Clement F (2012) A health technology assessment of transient elastography in liver disease. In: Unit UoCHTA (ed) Alberta Health Technologies Decision Process, Alberta
34.
Barry MH (2004) Magnetic resonance imaging needs assessment .In: Health NSDo (ed) Nova Scotia pp 38
35.
Canadian Institute for Health Information (2008) Medical imaging in Canada, 2007. CIHI, Ottawa
36.
37.
Canadian Institute for Health Information (2008) The cost of acute care hospital stays by medical condition in Canada, 2004–2005. Ottawa, CIHI
38.
Thein HH, Isaranuwatchai W, Campitelli MA et al (2013) Health care costs associated with hepatocellular carcinoma: a population-based study. Hepatology 58:1375–1384CrossRefPubMed
39.
Taylor MC, Greig PD, Detsky AS, McLeod RS, Abdoh A, Krahn MD (2002) Factors associated with the high cost of liver transplantation in adults. Can J Surg 45:425–434PubMedCentralPubMed
40.
41.
David K, Kowdley KV, Unalp A et al (2009) Quality of life in adults with nonalcoholic fatty liver disease: baseline data from the nonalcoholic steatohepatitis clinical research network. Hepatology 49:1904–1912PubMedCentralCrossRefPubMed
42.
Nichol MB, Sengupta N, Globe DR (2001) Evaluating quality-adjusted life years: estimation of the health utility index (HUI2) from the SF-36. Med Decis Making 21:105–112CrossRefPubMed
43.
Chong CA, Gulamhussein A, Heathcote EJ et al (2003) Health-state utilities and quality of life in hepatitis C patients. Am J Gastroenterol 98:630–638CrossRefPubMed
44.
Younossi ZM, Boparai N, McCormick M, Price LL, Guyatt G (2001) Assessment of utilities and health-related quality of life in patients with chronic liver disease. Am J Gastroenterol 96:579–583CrossRefPubMed
45.
Ratcliffe J, Longworth L, Young T et al (2002) Assessing health-related quality of life pre- and post-liver transplantation: a prospective multicenter study. Liver Transpl 8:263–270CrossRefPubMed
46.
McLernon DJ, Dillon J, Donnan PT (2008) Health-state utilities in liver disease: a systematic review. Med Decis Making 28:582–592CrossRefPubMed
47.
Yoneda M, Suzuki K, Kato S et al (2010) Nonalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography. Radiology 256:640–647CrossRefPubMed
48.
Bota S, Herkner H, Sporea I et al (2013) Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int 33:1138–1147CrossRefPubMed
49.
Sasso M, Beaugrand M, de Ledinghen V et al (2010) Controlled attenuation parameter (CAP): a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol 36:1825–1835CrossRefPubMed
50.
Sasso M, Miette V, Sandrin L, Beaugrand M (2012) The controlled attenuation parameter (CAP): a novel tool for the non-invasive evaluation of steatosis using Fibroscan. Clin Res Hepatol Gastroenterol 36:13–20CrossRefPubMed
51.
Myers RP, Pomier-Layrargues G, Kirsch R et al (2012) Feasibility and diagnostic performance of the FibroScan XL probe for liver stiffness measurement in overweight and obese patients. Hepatology 55:199–208CrossRefPubMed
52.
de Ledinghen V, Vergniol J, Foucher J, El-Hajbi F, Merrouche W, Rigalleau V (2010) Feasibility of liver transient elastography with FibroScan using a new probe for obese patients. Liver Int 30:1043–1048CrossRefPubMed
53.
Friedrich-Rust M, Romen D, Vermehren J et al (2012) Acoustic radiation force impulse-imaging and transient elastography for non-invasive assessment of liver fibrosis and steatosis in NAFLD. Eur J Radiol 81:e325–e331CrossRefPubMed
54.
Palmeri ML, Wang MH, Rouze NC et al (2011) Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease. J Hepatol 55:666–672PubMedCentralCrossRefPubMed
55.
Guzman-Aroca F, Frutos-Bernal MD, Bas A et al (2012) Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging. Eur Radiol 22:2525–2532CrossRefPubMed
56.
Moynihan R, Doust J, Henry D (2012) Preventing overdiagnosis: how to stop harming the healthy. BMJ 344, e3502CrossRefPubMed
57.
Argo CK, Caldwell SH (2009) Epidemiology and natural history of non-alcoholic steatohepatitis. Clin Liver Dis 13:511–531CrossRefPubMed
58.
Pais R, Pascale A, Fedchuck L, Charlotte F, Poynard T, Ratziu V (2010) Progression from isolated steatosis to steatohepatitis and fibrosis in nonalcoholic fatty liver disease. Gastroenterol Clin Biol. doi:10.​1016/​j.​gcb.​2010.​06.​004 PubMed
59.
60.
Boursier J, Chaigneau J, Roullier V et al (2011) Steatosis degree, measured by morphometry, is linked to other liver lesions and metabolic syndrome components in patients with NAFLD. Eur J Gastroenterol Hepatol 23:974–981CrossRefPubMed
61.
Permutt Z, Le T, Peterson MR et al (2012) Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease—MRI accurately quantifies hepatic steatosis in NAFLD. Aliment Pharmacol Ther 36(1):22–29PubMedCentralCrossRefPubMed
62.
Chen J, Zhu Y, Zheng Q, Jiang J (2013) Serum cytokeratin-18 in the diagnosis of non-alcoholic steatohepatitis: a meta-analysis. Hepatol Res. doi:10.​1111/​hepr.​12197
63.
Chen J, Talwalkar JA, Yin M, Glaser KJ, Sanderson SO, Ehman RL (2011) Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology 259:749–756PubMedCentralCrossRefPubMed
64.
65.
Miller ER 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E (2005) Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 142:37–46CrossRefPubMed
66.
Mamtani R, Haynes K, Bilker WB et al (2012) Association between longer therapy with thiazolidinediones and risk of bladder cancer: a cohort study. J Natl Cancer Inst 104:1411–1421PubMedCentralCrossRefPubMed
67.
Vallarino C, Perez A, Fusco G et al (2013) Comparing pioglitazone to insulin with respect to cancer, cardiovascular and bone fracture endpoints, using propensity score weights. Clin Drug Investig 33:621–631PubMedCentralCrossRefPubMed
68.
Monami M, Dicembrini I, Mannucci E (2014) Thiazolidinediones and cancer: results of a meta-analysis of randomized clinical trials. Acta Diabetol 51:91–101CrossRefPubMed
69.
Lazo M, Hernaez R, Eberhardt MS et al (2013) Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Epidemiol 178:38–45PubMedCentralCrossRefPubMed
70.
Targher G, Bertolini L, Padovani R et al (2007) Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care 30:1212–1218CrossRefPubMed
71.
72.
Medina J, Fernandez-Salazar LI, Garcia-Buey L, Moreno-Otero R (2004) Approach to the pathogenesis and treatment of nonalcoholic steatohepatitis. Diabetes Care 27:2057–2066CrossRefPubMed
73.
Preiss D, Sattar N (2008) Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations. Clin Sci (Lond) 115:141–150CrossRef
74.
Williams CD, Stengel J, Asike MI et al (2011) Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology 140:124–131CrossRefPubMed
75.
Wanless IR, Lentz JS (1990) Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology 12:1106–1110CrossRefPubMed
76.
Silverman JF, Pories WJ, Caro JF (1989) Liver pathology in diabetes mellitus and morbid obesity. Clinical, pathological, and biochemical considerations. Pathol Annu 24(Pt 1):275–302PubMed
77.
Pinto HC, Baptista A, Camilo ME, Valente A, Saragoca A, de Moura MC (1996) Nonalcoholic steatohepatitis. Clinicopathological comparison with alcoholic hepatitis in ambulatory and hospitalized patients. Dig Dis Sci 41:172–179CrossRefPubMed
78.
World Gastroenterology Organisation (2012) WGO global guidelines nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. p 29
79.
Zelber-Sagi S, Lotan R, Shlomai A et al (2012) Predictors for incidence and remission of NAFLD in the general population during a seven-year prospective follow-up. J Hepatol 56:1145–1151CrossRefPubMed
80.
Teli MR, James OF, Burt AD, Bennett MK, Day CP (1995) The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology 22:1714–1719CrossRefPubMed
81.
Wong VW, Wong GL, Choi PC et al (2010) Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. Gut 59:969–974CrossRefPubMed
82.
Rafiq N, Bai C, Fang Y et al (2009) Long-term follow-up of patients with nonalcoholic fatty liver. Clin Gastroenterol Hepatol 7:234–238CrossRefPubMed
83.
Fassio E, Alvarez E, Dominguez N, Landeira G, Longo C (2004) Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology 40:820–826PubMed
84.
Hui AY, Wong VW, Chan HL et al (2005) Histological progression of non-alcoholic fatty liver disease in Chinese patients. Aliment Pharmacol Ther 21:407–413CrossRefPubMed
85.
Bhala N, Angulo P, van der Poorten D et al (2011) The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: an international collaborative study. Hepatology 54:1208–1216PubMedCentralCrossRefPubMed
86.
Hui JM, Kench JG, Chitturi S et al (2003) Long-term outcomes of cirrhosis in nonalcoholic steatohepatitis compared with hepatitis C. Hepatology 38:420–427CrossRefPubMed
87.
Sanyal AJ, Banas C, Sargeant C et al (2006) Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C. Hepatology 43:682–689CrossRefPubMed
88.
Soderberg C, Stal P, Askling J et al (2010) Decreased survival of subjects with elevated liver function tests during a 28-year follow-up. Hepatology 51:595–602CrossRefPubMed
89.
McCullough AJ (2004) The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis 8:521–533, viii
90.
Marrero JA, Fontana RJ, Barrat A et al (2005) Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 41:707–716CrossRefPubMed
91.
Altekruse SF, McGlynn KA, Reichman ME (2009) Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol 27:1485–1491PubMedCentralCrossRefPubMed
92.
Greten TF, Papendorf F, Bleck JS et al (2005) Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients. Br J Cancer 92:1862–1868PubMedCentralCrossRefPubMed
93.
Lang H, Sotiropoulos GC, Brokalaki EI et al (2007) Survival and recurrence rates after resection for hepatocellular carcinoma in noncirrhotic livers. J Am Coll Surg 205:27–36CrossRefPubMed
94.
Perry JF, Charlton B, Koorey DJ et al (2007) Outcome of patients with hepatocellular carcinoma referred to a tertiary centre with availability of multiple treatment options including cadaveric liver transplantation. Liver Int 27:1240–1248PubMed
95.
Feldstein AE, Wieckowska A, Lopez AR, Liu YC, Zein NN, McCullough AJ (2009) Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis: a multicenter validation study. Hepatology 50:1072–1078PubMedCentralCrossRefPubMed
96.
Angulo P, Hui JM, Marchesini G et al (2007) The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 45:846–854CrossRefPubMed
97.
Friedrich-Rust M, Ong MF, Martens S et al (2008) Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 134:960–974CrossRefPubMed
98.
Kwok R, Tse YK, Wong GL et al (2014) Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease—the role of transient elastography and plasma cytokeratin-18 fragments. Aliment Pharmacol Ther 39:254–269CrossRefPubMed
99.
Friedrich-Rust M, Nierhoff J, Lupsor M et al (2012) Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat 19:e212–e219CrossRefPubMed
100.
Nierhoff J, Chavez Ortiz AA, Herrmann E, Zeuzem S, Friedrich-Rust M (2013) The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis. Eur Radiol 23:3040–3053CrossRefPubMed
101.
Castera L, Foucher J, Bernard PH et al (2010) Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology 51:828–835PubMed
102.
Murtagh J, Foerster V (2006) Transient elastography (FibroScan) for non-invasive assessment of liver fibrosis. Issues Emerg Health Technol 1–4
103.
Carlson JJ, Kowdley KV, Sullivan SD, Ramsey SD, Veenstra DL (2009) An evaluation of the potential cost-effectiveness of non-invasive testing strategies in the diagnosis of significant liver fibrosis. J Gastroenterol Hepatol 24:786–791PubMedCentralCrossRefPubMed
104.
DeKoven M (2010) Cost comparison: liver biopsy versus abdominal MRI. Memo to GE Healthcare from IMS Health Incorporated
105.
Myers RP, Fong A, Shaheen AA (2008) Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies. Liver Int 28:705–712CrossRefPubMed
106.
107.
Thompson Coon J, Rogers G, Hewson P et al (2008) Surveillance of cirrhosis for hepatocellular carcinoma: a cost-utility analysis. Br J Cancer 98:1166–1175PubMedCentralCrossRefPubMed
108.
Aberg F, Maklin S, Rasanen P et al (2011) Cost of a quality-adjusted life year in liver transplantation: the influence of the indication and the model for end-stage liver disease score. Liver Transpl 17:1333–1343CrossRefPubMed
Metadata
Title
Cost-utility analysis of nonalcoholic steatohepatitis screening
Authors
Eric Zhang
Claire Wartelle-Bladou
Luigi Lepanto
Jean Lachaine
Guy Cloutier
An Tang
Publication date
01-11-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3731-2

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