Tensor and Coupled Decompositions: Interpretable pattern discovery in multiset and multimodal functional neuroimaging data
Tensor and Coupled Decompositions: Interpretable pattern discovery in multiset and multimodal functional neuroimaging data
- Research Article
1
- 10.3389/conf.fnins.2015.91.00005
- Jan 1, 2015
- Frontiers in Neuroscience
Event Abstract Back to Event Constructing subject-specific virtual brains from multimodal neuroimaging data Michael Schirner1, 2, Simon Rothmeier1, 2 and Petra Ritter1, 2* 1 Charité Berlin, Germany 2 Bernstein Center for Computational Neuroscience, Bernstein Focus State Dependencies of Learning, Germany Large amounts of multimodal neuroimaging data are acquired every year worldwide. In order to extract high dimensional information for computational neuroscience applications standardized data fusion and efficient reduction into integrative data structures are required. Such self-consistent multimodal data sets can be used for computational brain modeling to constrain models with individual measurable features of the brain, such as done with The Virtual Brain (TVB). TVB is a simulation platform that uses empirical structural and functional data to build full brain models of individual humans. For convenient model construction, we developed a shell scripted processing pipeline for structural, functional and diffusion-weighted magnetic resonance imaging (MRI) and optionally electroencephalography (EEG) data. The pipeline combines several state-of-the-art neuroinformatics tools to generate subject-specific cortical and subcortical parcellations, surface-tessellations, structural and functional connectomes, lead field matrices, electrical source activity estimates and region-wise aggregated blood oxygen level dependent (BOLD) functional MRI (fMRI) time-series. The output files of the pipeline can be directly uploaded to TVB to create and simulate individualized large-scale network models. We detail the pitfalls of the individual processing streams and discuss ways of validation. With the pipeline we also introduce novel ways of estimating the transmission strengths of fiber tracts in whole-brain structural connectivity (SC) networks and compare the outcomes of different tractography or parcellation approaches. We tested the functionality of the pipeline on 50 multimodal data sets. In order to quantify the robustness of the connectome extraction part of the pipeline we computed several metrics that quantify its rescan reliability and compared them to other tractography approaches. Together with the pipeline we present several principles to guide future efforts to standardize brain model construction. The code of the pipeline and the fully processed data sets are made available to the public via The Virtual Brain website (thevirtualbrain.org) and via Github (https://github.com/BrainModes/TVB-empirical-data-pipeline). Furthermore, the pipeline can be directly used with High Performance Computing (HPC) resources on the Neuroscience Gateway Portal (http://www.nsgportal.org) through a convenient web-interface. References Michael Schirner, Simon Rothmeier, Viktor K. Jirsa, Anthony Randal McIntosh, Petra Ritter, An automated pipeline for constructing personalized virtual brains from multimodal neuroimaging data, NeuroImage, Available online 31 March 2015, ISSN 1053-8119, http://dx.doi.org/10.1016/j.neuroimage.2015.03.055 Keywords: multi modal data, the virtual brain, connectome, tractography, computational modeling Conference: Neuroinformatics 2015, Cairns, Australia, 20 Aug - 22 Aug, 2015. Presentation Type: Poster, to be considered for oral presentation Topic: Computational neuroscience Citation: Schirner M, Rothmeier S and Ritter P (2015). Constructing subject-specific virtual brains from multimodal neuroimaging data. Front. Neurosci. Conference Abstract: Neuroinformatics 2015. doi: 10.3389/conf.fnins.2015.91.00005 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 29 May 2015; Published Online: 05 Aug 2015. * Correspondence: Dr. Petra Ritter, Charité Berlin, Berlin, Germany, petra.ritter@charite.de Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract Supplemental Data The Authors in Frontiers Michael Schirner Simon Rothmeier Petra Ritter Google Michael Schirner Simon Rothmeier Petra Ritter Google Scholar Michael Schirner Simon Rothmeier Petra Ritter PubMed Michael Schirner Simon Rothmeier Petra Ritter Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.
- Research Article
6
- 10.1007/s12021-021-09523-w
- May 12, 2021
- Neuroinformatics
Uncovering the complex network of the brain is of great interest to the field of neuroimaging. Mining from these rich datasets, scientists try to unveil the fundamental biological mechanisms in the human brain. However, neuroimaging data collected for constructing brain networks is generally costly, and thus extracting useful information from a limited sample size of brain networks is demanding. Currently, there are two common trends in neuroimaging data collection that could be exploited to gain more information: 1) multimodal data, and 2) longitudinal data. It has been shown that these two types of data provide complementary information. Nonetheless, it is challenging to learn brain network representations that can simultaneously capture network properties from multimodal as well as longitudinal datasets. Here we propose a general fusion framework for multi-source learning of brain networks - multimodal brain network fusion with longitudinal coupling (MMLC). In our framework, three layers of information are considered, including cross-sectional similarity, multimodal coupling, and longitudinal consistency. Specifically, we jointly factorize multimodal networks and construct a rotation-based constraint to couple network variance across time. We also adopt the consensus factorization as the group consistent pattern. Using two publicly available brain imaging datasets, we demonstrate that MMLC may better predict psychometric scores than some other state-of-the-art brain network representation learning algorithms. Additionally, the discovered significant brain regions are synergistic with previous literature. Our new approach may boost statistical power and sheds new light on neuroimaging network biomarkers for future psychometric prediction research by integrating longitudinal and multimodal neuroimaging data.
- Research Article
- 10.3389/fnetp.2025.1585019
- Jun 18, 2025
- Frontiers in Network Physiology
Understanding the relationship between structure and function in the human brain is essential for revealing how brain organization influences cognition, perception, emotion, and behavior. To this end, we introduce an interactive web tool and underlying database for Yale Brain Atlas, a high-resolution anatomical parcellation designed to facilitate precise localization and generalizable analyses of multimodal neuroimaging data. The tool supports parcel-level exploration of structural and functional data through dedicated interactive pages for each modality. For structural data, it incorporates white matter connectomes of 1,065 subjects and cortical thickness profiles of 200 subjects both from the Human Connectome Project. For functional data, it includes resting-state fMRI connectivity matrices for 34 healthy subjects and task-specific fMRI activation data acquired from two meta-analytic resources–Neurosynth and NeuroQuery–which, once translated into Yale Brain Atlas space and modified to include 334 function-specific terms, form Parcelsynth and ParcelQuery, respectively. Altogether, to support investigation of brain structure-function relationships, this study presents a web tool and database for the Yale Brain Atlas that enable scalable, interactive exploration of multimodal neuroimaging data.
- Research Article
31
- 10.1161/strokeaha.121.036749
- Jan 26, 2022
- Stroke
Background:Poststroke recovery depends on multiple factors and varies greatly across individuals. Using machine learning models, this study investigated the independent and complementary prognostic role of different patient-related factors in predicting response to language rehabilitation after a stroke.Methods:Fifty-five individuals with chronic poststroke aphasia underwent a battery of standardized assessments and structural and functional magnetic resonance imaging scans, and received 12 weeks of language treatment. Support vector machine and random forest models were constructed to predict responsiveness to treatment using pretreatment behavioral, demographic, and structural and functional neuroimaging data.Results:The best prediction performance was achieved by a support vector machine model trained on aphasia severity, demographics, measures of anatomic integrity and resting-state functional connectivity (F1=0.94). This model resulted in a significantly superior prediction performance compared with support vector machine models trained on all feature sets (F1=0.82, P<0.001) or a single feature set (F1 range=0.68–0.84, P<0.001). Across random forest models, training on resting-state functional magnetic resonance imaging connectivity data yielded the best F1 score (F1=0.87).Conclusions:While behavioral, multimodal neuroimaging data and demographic information carry complementary information in predicting response to rehabilitation in chronic poststroke aphasia, functional connectivity of the brain at rest after stroke is a particularly important predictor of responsiveness to treatment, both alone and combined with other patient-related factors.
- Research Article
37
- 10.1007/s11571-023-09993-5
- Aug 18, 2023
- Cognitive Neurodynamics
In recent years, Alzheimer’s disease (AD) has been a serious threat to human health. Researchers and clinicians alike encounter a significant obstacle when trying to accurately identify and classify AD stages. Several studies have shown that multimodal neuroimaging input can assist in providing valuable insights into the structural and functional changes in the brain related to AD. Machine learning (ML) algorithms can accurately categorize AD phases by identifying patterns and linkages in multimodal neuroimaging data using powerful computational methods. This study aims to assess the contribution of ML methods to the accurate classification of the stages of AD using multimodal neuroimaging data. A systematic search is carried out in IEEE Xplore, Science Direct/Elsevier, ACM DigitalLibrary, and PubMed databases with forward snowballing performed on Google Scholar. The quantitative analysis used 47 studies. The explainable analysis was performed on the classification algorithm and fusion methods used in the selected studies. The pooled sensitivity and specificity, including diagnostic efficiency, were evaluated by conducting a meta-analysis based on a bivariate model with the hierarchical summary receiver operating characteristics (ROC) curve of multimodal neuroimaging data and ML methods in the classification of AD stages. Wilcoxon signed-rank test is further used to statistically compare the accuracy scores of the existing models. With a 95% confidence interval of 78.87–87.71%, the combined sensitivity for separating participants with mild cognitive impairment (MCI) from healthy control (NC) participants was 83.77%; for separating participants with AD from NC, it was 94.60% (90.76%, 96.89%); for separating participants with progressive MCI (pMCI) from stable MCI (sMCI), it was 80.41% (74.73%, 85.06%). With a 95% confidence interval (78.87%, 87.71%), the Pooled sensitivity for distinguishing mild cognitive impairment (MCI) from healthy control (NC) participants was 83.77%, with a 95% confidence interval (90.76%, 96.89%), the Pooled sensitivity for distinguishing AD from NC was 94.60%, likewise (MCI) from healthy control (NC) participants was 83.77% progressive MCI (pMCI) from stable MCI (sMCI) was 80.41% (74.73%, 85.06%), and early MCI (EMCI) from NC was 86.63% (82.43%, 89.95%). Pooled specificity for differentiating MCI from NC was 79.16% (70.97%, 87.71%), AD from NC was 93.49% (91.60%, 94.90%), pMCI from sMCI was 81.44% (76.32%, 85.66%), and EMCI from NC was 85.68% (81.62%, 88.96%). The Wilcoxon signed rank test showed a low P-value across all the classification tasks. Multimodal neuroimaging data with ML is a promising future in classifying the stages of AD but more research is required to increase the validity of its application in clinical practice.
- Research Article
15
- 10.1186/1471-2105-8-389
- Oct 15, 2007
- BMC Bioinformatics
BackgroundThree-dimensional (3-D) visualization of multimodality neuroimaging data provides a powerful technique for viewing the relationship between structure and function. A number of applications are available that include some aspect of 3-D visualization, including both free and commercial products. These applications range from highly specific programs for a single modality, to general purpose toolkits that include many image processing functions in addition to visualization. However, few if any of these combine both stand-alone and remote multi-modality visualization in an open source, portable and extensible tool that is easy to install and use, yet can be included as a component of a larger information system.ResultsWe have developed a new open source multimodality 3-D visualization application, called MindSeer, that has these features: integrated and interactive 3-D volume and surface visualization, Java and Java3D for true cross-platform portability, one-click installation and startup, integrated data management to help organize large studies, extensibility through plugins, transparent remote visualization, and the ability to be integrated into larger information management systems. We describe the design and implementation of the system, as well as several case studies that demonstrate its utility. These case studies are available as tutorials or demos on the associated website: .ConclusionMindSeer provides a powerful visualization tool for multimodality neuroimaging data. Its architecture and unique features also allow it to be extended into other visualization domains within biomedicine.
- Research Article
24
- 10.1007/978-3-319-67389-9_16
- Jan 1, 2017
- Machine learning in medical imaging. MLMI (Workshop)
In this paper, we aim to maximally utilize multimodality neuroimaging and genetic data to predict Alzheimer's disease (AD) and its prodromal status, i.e., a multi-status dementia diagnosis problem. Multimodality neuroimaging data such as MRI and PET provide valuable insights to abnormalities, and genetic data such as Single Nucleotide Polymorphism (SNP) provide information about a patient's AD risk factors. When used in conjunction, AD diagnosis may be improved. However, these data are heterogeneous (e.g., having different data distributions), and have different number of samples (e.g., PET data is having far less number of samples than the numbers of MRI or SNPs). Thus, learning an effective model using these data is challenging. To this end, we present a novel three-stage deep feature learning and fusion framework , where the deep neural network is trained stage-wise. Each stage of the network learns feature representations for different combination of modalities, via effective training using maximum number of available samples . Specifically, in the first stage, we learn latent representations (i.e., high-level features) for each modality independently, so that the heterogeneity between modalities can be better addressed and then combined in the next stage. In the second stage, we learn the joint latent features for each pair of modality combination by using the high-level features learned from the first stage. In the third stage, we learn the diagnostic labels by fusing the learned joint latent features from the second stage. We have tested our framework on Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset for multi-status AD diagnosis, and the experimental results show that the proposed framework outperforms other methods.
- Research Article
- 10.1002/alz.052718
- Dec 1, 2021
- Alzheimer's & Dementia
BackgroundMultimodal neuroimaging data can provide complementary information that a single modality cannot about neurodegenerative diseases such as Alzheimer's disease (AD). Deep Generalized Canonical Correlation Analysis (DGCCA) is able to learn a shared feature representation from different views of data by applying non‐linear transformation using neural network. We utilize DGCCA to extract maximally correlated components from multi‐modal neuroimaging data to identify potential imaging‐driven MCI subtypes.MethodWe study 308 Mild Cognitive Impairment (MCI) participants (195 early MCI and 113 late MCI) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), each with voxel level features from FDG PET, amyloid PET (AV45) and structural MRI processed using voxel‐based morphometry (VBM). Six experimental settings are designed to compare single modality with multiview methods ‐ GCCA and DGCCA, see Figure 1. Agglomerative clustering was used to generated 2 clusters with features from each experiment. To investigate differences between the clusters, Wilcoxon rank‐sum tests are conducted on 11 baseline AD biomarkers including 5 cognitive assessments and 6 brain volume measures, from the ADNI QT‐PAD dataset http://www.pi4cs.org/qt‐pad‐challenge.ResultAmong the two multiview methods, DGCCA is able to explain 68.57% variance with 20 features, while GCCA explains 68.66% variance with 94 features. To evaluate the potential subtypes from clustering, the Calinski‐Harabasz (CH) score, Silhouette score and adjusted mutual information (AMI) score are computed, see Table 1. AV45 generates the best defined clusters, where DGCCA generates clusters with quality comparable to single modality features. In our QT analysis, clusters from FDG and DGCCA features show differential measure in all biomarkers where DGCCA learns from multimodal data, see Figure 2.ConclusionDGCCA is able to learn maximally correlated features from multimodal neuroimaging data with reduced dimensionality, and explain more variance than its linear counterpart GCCA. Cluster analysis shows these imaging‐driven MCI subtypes are different from the currently diagnosis with differential QT measures, by incorporating complementary information from 3 imaging modalities. DGCCA shows to be an effective feature learning method, and this multiview learning framework can identify potentially novel MCI subtypes to facilitate early detection of AD.
- Abstract
- 10.1016/j.jaac.2022.07.582
- Oct 1, 2022
- Journal of the American Academy of Child & Adolescent Psychiatry
5.1 Deep-Phenotyping of Gene Dosage Disorders and Consequences for Precision Psychiatry
- Research Article
- 10.1109/jbhi.2025.3576436
- Jan 1, 2025
- IEEE journal of biomedical and health informatics
Alzheimer's disease (AD) is an incurable neurodegenerative disorder characterized by progressive cognitive and functional decline. Consequently, early diagnosis and accurate prediction of disease progression are of paramount importance and inherently complex, necessitating the integration of multi-modal data. While existing methods are typically task-specific and lack generalization, we present ADFound, the first multi-modal foundation model for AD capable of simultaneously addressing diagnosis and prognosis tasks through a unified framework. ADFound leverages a substantial amount of unlabeled 3D multi-modal neuroimaging, including paired and unpaired data, to achieve its objectives. Specifically, ADFound is developed upon the Multi-modal Vim encoder by Vision Mamba block to capture long-range dependencies inherent in 3D multi-modal medical images. To efficiently pre-train ADFound on unlabeled paired and upaired multi-modal neuroimaging data, we proposed a novel self-supervised learning framework that integrates multi-modal masked autoencoder (MAE) and contrastive learning. The multi-modal MAE aims to learn local relations among modalities by reconstructing images with unmasked image patches. Additionally, we introduce a Dual Contrastive Learning for Multi-modal Data to enhance the discriminative capabilities of multi-modal representations from intra-modal and inter-modal perspectives. Our experiments demonstrate that ADFound outperforms state-of-the-art methods across a wide range of downstream tasks relevant to the diagnosis and prognosis of AD. Furthermore, the results indicate that our foundation model can be extended to more modalities, such as non-image data, showing its versatility.
- Research Article
28
- 10.1002/hbm.26077
- Sep 15, 2022
- Human Brain Mapping
Characterizing neuropsychiatric disorders is challenging due to heterogeneity in the population. We propose combining structural and functional neuroimaging and genomic data in a multimodal classification framework to leverage their complementary information. Our objectives are two‐fold (i) to improve the classification of disorders and (ii) to introspect the concepts learned to explore underlying neural and biological mechanisms linked to mental disorders. Previous multimodal studies have focused on naïve neural networks, mostly perceptron, to learn modality‐wise features and often assume equal contribution from each modality. Our focus is on the development of neural networks for feature learning and implementing an adaptive control unit for the fusion phase. Our mid fusion with attention model includes a multilayer feed‐forward network, an autoencoder, a bi‐directional long short‐term memory unit with attention as the features extractor, and a linear attention module for controlling modality‐specific influence. The proposed model acquired 92% (p < .0001) accuracy in schizophrenia prediction, outperforming several other state‐of‐the‐art models applied to unimodal or multimodal data. Post hoc feature analyses uncovered critical neural features and genes/biological pathways associated with schizophrenia. The proposed model effectively combines multimodal neuroimaging and genomics data for predicting mental disorders. Interpreting salient features identified by the model may advance our understanding of their underlying etiological mechanisms.
- Research Article
- 10.1109/tmi.2025.3604361
- Aug 29, 2025
- IEEE transactions on medical imaging
Multi-modal neuroimaging data, including magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (PET), have greatly advanced the computer-aided diagnosis of Alzheimer's disease (AD) by providing shared and complementary information. However, the problem of incomplete multi-modal data remains inevitable and challenging. Conventional strategies that exclude subjects with missing data or synthesize missing scans either result in substantial sample reduction or introduce unwanted noise. To address this issue, we propose an Incomplete Multi-modal Disentanglement Learning method (IMDL) for AD diagnosis without missing scan synthesis, a novel model that employs a tiny Transformer to fuse incomplete multi-modal features extracted by modality-wise variational autoencoders adaptively. Specifically, we first design a cross-modality contrastive learning module to encourage modality-wise variational autoencoders to disentangle shared and complementary representations of each modality. Then, to alleviate the potential information gap between the representations obtained from complete and incomplete multi-modal neuroimages, we leverage the technique of adversarial learning to harmonize these representations with two discriminators. Furthermore, we develop a local attention rectification module comprising local attention alignment and multi-instance attention rectification to enhance the localization of atrophic areas associated with AD. This module aligns inter-modality and intra-modality attention within the Transformer, thus making attention weights more explainable. Extensive experiments conducted on ADNI and AIBL datasets demonstrated the superior performance of the proposed IMDL in AD diagnosis, and a further validation on the HABS-HD dataset highlighted its effectiveness for dementia diagnosis using different multi-modal neuroimaging data (i.e., T1-weighted MRI and diffusion tensor imaging).
- Research Article
77
- 10.1038/s41597-019-0020-y
- Apr 3, 2019
- Scientific Data
This dataset, colloquially known as the Mother Of Unification Studies (MOUS) dataset, contains multimodal neuroimaging data that has been acquired from 204 healthy human subjects. The neuroimaging protocol consisted of magnetic resonance imaging (MRI) to derive information at high spatial resolution about brain anatomy and structural connections, and functional data during task, and at rest. In addition, magnetoencephalography (MEG) was used to obtain high temporal resolution electrophysiological measurements during task, and at rest. All subjects performed a language task, during which they processed linguistic utterances that either consisted of normal or scrambled sentences. Half of the subjects were reading the stimuli, the other half listened to the stimuli. The resting state measurements consisted of 5 minutes eyes-open for the MEG and 7 minutes eyes-closed for fMRI. The neuroimaging data, as well as the information about the experimental events are shared according to the Brain Imaging Data Structure (BIDS) format. This unprecedented neuroimaging language data collection allows for the investigation of various aspects of the neurobiological correlates of language.
- Research Article
226
- 10.1002/hbm.24428
- Nov 1, 2018
- Human Brain Mapping
In this article, the authors aim to maximally utilize multimodality neuroimaging and genetic data for identifying Alzheimer's disease (AD) and its prodromal status, Mild Cognitive Impairment (MCI), from normal aging subjects. Multimodality neuroimaging data such as MRI and PET provide valuable insights into brain abnormalities, while genetic data such as single nucleotide polymorphism (SNP) provide information about a patient's AD risk factors. When these data are used together, the accuracy of AD diagnosis may be improved. However, these data are heterogeneous (e.g., with different data distributions), and have different number of samples (e.g., with far less number of PET samples than the number of MRI or SNPs). Thus, learning an effective model using these data is challenging. To this end, we present a novel three-stage deep feature learning and fusion framework, where deep neural network is trained stage-wise. Each stage of the network learns feature representations for different combinations of modalities, via effective training using the maximum number of available samples. Specifically, in the first stage, we learn latent representations (i.e., high-level features) for each modality independently, so that the heterogeneity among modalities can be partially addressed, and high-level features from different modalities can be combined in the next stage. In the second stage, we learn joint latent features for each pair of modality combination by using the high-level features learned from the first stage. In the third stage, we learn the diagnostic labels by fusing the learned joint latent features from the second stage. To further increase the number of samples during training, we also use data at multiple scanning time points for each training subject in the dataset. We evaluate the proposed framework using Alzheimer's disease neuroimaging initiative (ADNI) dataset for AD diagnosis, and the experimental results show that the proposed framework outperforms other state-of-the-art methods.
- Research Article
81
- 10.1371/journal.pcbi.1002987
- Apr 4, 2013
- PLoS Computational Biology
The failure of current strategies to provide an explanation for controversial findings on the pattern of pathophysiological changes in Alzheimer's Disease (AD) motivates the necessity to develop new integrative approaches based on multi-modal neuroimaging data that captures various aspects of disease pathology. Previous studies using [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) and structural magnetic resonance imaging (sMRI) report controversial results about time-line, spatial extent and magnitude of glucose hypometabolism and atrophy in AD that depend on clinical and demographic characteristics of the studied populations. Here, we provide and validate at a group level a generative anatomical model of glucose hypo-metabolism and atrophy progression in AD based on FDG-PET and sMRI data of 80 patients and 79 healthy controls to describe expected age and symptom severity related changes in AD relative to a baseline provided by healthy aging. We demonstrate a high level of anatomical accuracy for both modalities yielding strongly age- and symptom-severity- dependant glucose hypometabolism in temporal, parietal and precuneal regions and a more extensive network of atrophy in hippocampal, temporal, parietal, occipital and posterior caudate regions. The model suggests greater and more consistent changes in FDG-PET compared to sMRI at earlier and the inversion of this pattern at more advanced AD stages. Our model describes, integrates and predicts characteristic patterns of AD related pathology, uncontaminated by normal age effects, derived from multi-modal data. It further provides an integrative explanation for findings suggesting a dissociation between early- and late-onset AD. The generative model offers a basis for further development of individualized biomarkers allowing accurate early diagnosis and treatment evaluation.
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