{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:57:43Z","timestamp":1789743463676,"version":"4.0.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T00:00:00Z","timestamp":1595289600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T00:00:00Z","timestamp":1595289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Helsinki including Helsinki University Central Hospital"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Neuroradiol"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Current imaging standard for acute mastoiditis (AM) is contrast-enhanced computed tomography (CT), revealing inflammation-induced bone destruction, whereas magnetic resonance imaging (MRI) outperforms CT in detecting intracranial infection. Our aim was to compare the diagnostic performance of MRI with CT in detecting coalescent AM and see to which extent MRI alone would suffice to diagnose or rule out this condition.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The MR images of 32\u00a0patients with AM were retrospectively analyzed. Bone destruction was evaluated from T2 turbo spin echo (TSE) and T1 Gd magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images. Intramastoid enhancement and diffusion restriction were evaluated subjectively and intramastoid apparent diffusion coefficient (ADC) values were measured. The MRI findings were compared with contrast-enhanced CT findings of the same patients within 48\u202fh of the MR scan.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Depending on the anatomical subsite, MRI detected definite bone defects with a\u00a0sensitivity of 100% and a\u00a0specificity of 54\u201382%. Exception was the inner cortical table where sensitivity was only 14% and specificity was 76%. Sensitivity for general coalescent mastoiditis remained 100% due to multiple coexisting lesions. The absence of intense enhancement and non-restricted diffusion had a\u00a0high negative predictive value for coalescent mastoiditis: an intramastoid ADC above 1.2\u202f\u00d7\u200910<jats:sup>\u22123<\/jats:sup>\u202fmm<jats:sup>2<\/jats:sup>\/s excluded coalescent mastoiditis with a\u00a0negative predictive value of 92%.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The MRI did not miss coalescent mastoiditis but was inferior to CT in direct estimation of bone defects. When enhancement and diffusion characteristics are also considered, MRI enables dividing patients into low, intermediate and high-risk categories with respect to coalescent mastoiditis, where only the intermediate risk group is likely to benefit from additional CT.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00062-020-00931-0","type":"journal-article","created":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T11:02:45Z","timestamp":1595329365000},"page":"589-597","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT"],"prefix":"10.1007","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2622-585X","authenticated-orcid":false,"given":"R.","family":"Saat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1086-8810","authenticated-orcid":false,"given":"G.","family":"Kurdo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5109-6944","authenticated-orcid":false,"given":"A.","family":"Laulajainen-Hongisto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9779-1093","authenticated-orcid":false,"given":"A.","family":"Markkola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1945-4008","authenticated-orcid":false,"given":"J.","family":"Jero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,21]]},"reference":[{"key":"931_CR1","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1017\/S0022215100055742","volume":"73","author":"T Palva","year":"1959","unstructured":"Palva\u00a0T, Pulkkinen\u00a0K. Mastoiditis. J\u00a0Laryngol Otol. 1959;73:573\u201388.","journal-title":"J Laryngol Otol"},{"key":"931_CR2","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1017\/S0022215100096407","volume":"99","author":"T Palva","year":"1985","unstructured":"Palva\u00a0T, Virtanen\u00a0H, M\u00e4kinen\u00a0J. Acute and latent mastoiditis in children. J\u00a0Laryngol Otol. 1985;99:127\u201336.","journal-title":"J Laryngol Otol"},{"key":"931_CR3","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.ijporl.2012.02.042","volume":"76","author":"IM Psarommatis","year":"2012","unstructured":"Psarommatis IM, Voudouris C, Douros K, Giannakopoulos P, Bairamis T, Carabinos C. Algorithmic management of pediatric acute mastoiditis. Int J Pediatr Otorhinolaryngol. 2012;76:791\u20136.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"931_CR4","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1097\/INF.0000000000000920","volume":"35","author":"T Marom","year":"2016","unstructured":"Marom T, Roth Y, Boaz M, Shushan S, Oron Y, Goldfarb A, Dalal I, Ovnat Tamir S. Acute Mastoiditis in Children: Necessity and Timing of Imaging. Pediatr Infect Dis J. 2016;35:30-4.","journal-title":"Pediatr Infect Dis J"},{"key":"931_CR5","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/S0165-5876(98)00024-X","volume":"45","author":"JG Bizakis","year":"1998","unstructured":"Bizakis\u00a0JG, Velegrakis\u00a0GA, Papadakis\u00a0CE, Karampekios\u00a0SK, Helidonis\u00a0ES. The silent epidural abscess as a\u00a0complication of acute otitis media in children. Int J Pediatr Otorhinolaryngol. 1998;45:163\u20136.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"931_CR6","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1177\/000348940911800207","volume":"118","author":"PS Mallur","year":"2009","unstructured":"Mallur\u00a0PS, Harirchian\u00a0S, Lalwani\u00a0AK. Preoperative and postoperative intracranial complications of acute mastoiditis. Ann Otol Rhinol Laryngol. 2009;118:118\u201323.","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"931_CR7","doi-asserted-by":"publisher","first-page":"2813","DOI":"10.1002\/lary.22193","volume":"122","author":"M Luntz","year":"2012","unstructured":"Luntz\u00a0M, Bartal\u00a0K, Brodsky\u00a0A, Shihada\u00a0R. Acute mastoiditis: the role of imaging for identifying intracranial complications. Laryngoscope. 2012;122:2813\u20137.","journal-title":"Laryngoscope"},{"key":"931_CR8","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/S0194-5998(99)70274-3","volume":"120","author":"PJ Antonelli","year":"1999","unstructured":"Antonelli\u00a0PJ, Garside\u00a0JA, Mancuso\u00a0AA, Strickler\u00a0ST, Kubilis\u00a0PS. Computed tomography and the diagnosis of coalescent mastoiditis. Otolaryngol Head Neck Surg. 1999;120:350\u20134.","journal-title":"Otolaryngol Head Neck Surg"},{"key":"931_CR9","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1097\/INF.0b013e318165c195","volume":"27","author":"J St\u00e4helin-Massik","year":"2008","unstructured":"St\u00e4helin-Massik J, Podvinec M, Jakscha J, R\u00fcst ON, Greisser J, Moschopulos M, Gnehm HE. Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology. Eur J Pediatr. 2008;167:541\u20138.","journal-title":"Pediatr Infect Dis J"},{"key":"931_CR10","doi-asserted-by":"publisher","first-page":"615","DOI":"10.2214\/ajr.152.3.615","volume":"152","author":"K Weingarten","year":"1989","unstructured":"Weingarten\u00a0K, Zimmerman\u00a0RD, Becker\u00a0RD, Heier\u00a0LA, Haimes\u00a0AB, Deck\u00a0MD. Subdural and epidural empyemas: MR imaging. Ajr Am J Roentgenol. 1989;152:615\u201321.","journal-title":"Ajr Am J Roentgenol"},{"key":"931_CR11","first-page":"1016","volume":"25","author":"AM Wong","year":"2004","unstructured":"Wong\u00a0AM, Zimmerman\u00a0RA, Simon\u00a0EM, Pollock\u00a0AN, Bilaniuk\u00a0LT. Diffusion-weighted MR imaging of subdural empyemas in children. AJNR Am J Neuroradiol. 2004;25:1016\u201321.","journal-title":"AJNR Am J Neuroradiol"},{"key":"931_CR12","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/S0022-3476(87)80067-7","volume":"111","author":"DA Cabral","year":"1987","unstructured":"Cabral\u00a0DA, Flodmark\u00a0O, Farrell\u00a0K, Speert\u00a0DP. Prospective study of computed tomography in acute bacterial meningitis. J\u00a0Pediatr. 1987;111:201\u20135.","journal-title":"J Pediatr"},{"key":"931_CR13","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/578986","author":"AK Vaswani","year":"2014","unstructured":"Vaswani AK, Nizamani WM, Ali M, Aneel G, Shahani BK, Hussain S. Diagnostic accuracy of contrast-enhanced FLAIR magnetic resonance imaging in diagnosis of meningitis correlated with CSF analysis. ISRN Radiology 2014. https:\/\/doi.org\/10.1155\/2014\/578986.","journal-title":"Radiology"},{"key":"931_CR14","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1007\/s00234-005-1383-7","volume":"47","author":"A Splendiani","year":"2005","unstructured":"Splendiani\u00a0A, Puglielli\u00a0E, De Amicis\u00a0R, Necozione\u00a0S, Masciocchi\u00a0C, Gallucci\u00a0M. Contrast-enhanced FLAIR in the early diagnosis of infectious meningitis. Neuroradiology. 2005;47:591\u20138.","journal-title":"Neuroradiology"},{"key":"931_CR15","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.ejrad.2005.11.012","volume":"58","author":"H Parmar","year":"2006","unstructured":"Parmar\u00a0H, Sitoh\u00a0YY, Anand\u00a0P, Chua\u00a0V, Hui\u00a0F. Contrast-enhanced flair imaging in the evaluation of infectious leptomeningeal diseases. Eur J Radiol. 2006;58:89\u201395.","journal-title":"Eur J Radiol"},{"key":"931_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0165-5876(00)00425-0","volume":"57","author":"M Luntz","year":"2001","unstructured":"Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L, Cohen D, Zohar S, Shapira A, Ophir D, Fishman G, Rosen G, Kisilevsky V, Magamse I, Zaaroura S, Joachims HZ, Goldenberg D. Acute mastoiditis\u2014the antibiotic era: a\u00a0multicenter study. Int J Pediatr Otorhinolaryngol. 2001;57:1\u20139.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"931_CR17","doi-asserted-by":"publisher","first-page":"361","DOI":"10.3174\/ajnr.A4120","volume":"36","author":"R Saat","year":"2015","unstructured":"Saat R, Laulajainen-Hongisto AH, Mahmood G, Lempinen LJ, Aarnialo\u00a0AA, Markkola AT, Jero JP. MR imaging features of acute mastoiditis and their clinical relevance. AJNR Am J Neuroradiol. 2015;36:361\u20137.","journal-title":"AJNR Am J Neuroradiol"},{"key":"931_CR18","doi-asserted-by":"publisher","first-page":"2632","DOI":"10.1007\/s00330-015-4113-5","volume":"26","author":"R Saat","year":"2016","unstructured":"Saat\u00a0R, Mahmood\u00a0G, Laulajainen-Hongisto\u00a0A, Lempinen\u00a0L, Aarnisalo\u00a0AA, Jero\u00a0J, et al. Comparison of MR imaging findings in paediatric and adult patients with acute mastoiditis and incidental intramastoid bright signal on T2-weighted images. Eur Radiol. 2016;26:2632\u20139.","journal-title":"Eur Radiol"},{"key":"931_CR19","doi-asserted-by":"publisher","DOI":"10.1177\/2047981614523415","author":"I Platzek","year":"2014","unstructured":"Platzek I, Kitzler HH, Gudziol V, Laniado M, Hahn G. Magnetic resonance imaging in acute mastoiditis. Acta Radiol Short Rep. 2014;3(2). https:\/\/doi.org\/10.1177\/2047981614523415.","journal-title":"Acta Radiol Short Rep"},{"key":"931_CR20","doi-asserted-by":"publisher","first-page":"2072","DOI":"10.1016\/j.ijporl.2014.09.007","volume":"78","author":"A Laulajainen-Hongisto","year":"2014","unstructured":"Laulajainen-Hongisto\u00a0A, Saat\u00a0R, Lempinen\u00a0L, Markkola\u00a0A, Aarnisalo\u00a0AA, Jero\u00a0J. Bacteriology in relation to clinical findings and treatment of acute mastoiditis in children. Int J Pediatr Otorhinolaryngol. 2014;78:2072\u20138.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"931_CR21","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1016\/j.ijporl.2015.06.019","volume":"79","author":"A Laulajainen-Hongisto","year":"2015","unstructured":"Laulajainen-Hongisto\u00a0A, Saat\u00a0R, Lempinen\u00a0L, Aarnisalo\u00a0AA, Jero\u00a0J. Children hospitalized due to acute otitis media: how does this condition differ from acute mastoiditis? Int J Pediatr Otorhinolaryngol. 2015;79:1429\u201335.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"931_CR22","doi-asserted-by":"publisher","first-page":"224","DOI":"10.5152\/iao.2016.2620","volume":"12","author":"A Laulajainen Hongisto","year":"2016","unstructured":"Laulajainen Hongisto\u00a0A, Jero\u00a0J, Markkola\u00a0A, Saat\u00a0R, Aarnisalo\u00a0AA. Severe Acute Otitis Media and Acute Mastoiditis in Adults. J\u00a0Int Adv Otol. 2016;12:224\u201330.","journal-title":"J Int Adv Otol"},{"issue":"8","key":"931_CR23","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1097\/MAO.0000000000000810","volume":"36","author":"G Horowitz","year":"2015","unstructured":"Horowitz G, Fishman G, Brenner A, Abu-Ghanem S, Derowe A, Cavel O, Fliss DM, Segev Y. A Novel Radiographic Sign and a New Classifying System in Mastoiditis-Related Epidural Abscess. Otol Neurotol. 2015;36:1378\u201382.","journal-title":"Otol Neurotol"},{"issue":"5","key":"931_CR24","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1007\/s13244-016-0516-3","volume":"7","author":"RK Lingam","year":"2016","unstructured":"Lingam RK, Nash R, Majithia A, Kalan A, Singh A. Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl. Insights Imaging. 2016;7:669\u201378.","journal-title":"Insights Imaging"},{"issue":"2","key":"931_CR25","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1148\/radiol.13130065","volume":"269","author":"RK Lingam","year":"2013","unstructured":"Lingam\u00a0RK, Khatri\u00a0P, Hughes\u00a0J, Singh\u00a0A. Apparent diffusion coefficients for detection of postoperative middle ear cholesteatoma on non-echo-planar diffusion-weighted images. Radiology. 2013;269:504\u201310.","journal-title":"Radiology"},{"key":"931_CR26","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.ejro.2017.03.001","volume":"4","author":"NM Osman","year":"2017","unstructured":"Osman\u00a0NM, Rahman\u00a0AA, Ali\u00a0MT. The accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with apparent diffusion coefficients in diagnosis of recurrent cholesteatoma. Eur J Radiol. 2017;4:27\u201339.","journal-title":"Eur J Radiol"},{"issue":"1011","key":"931_CR27","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1259\/bjr\/95110289","volume":"85","author":"KA Eley","year":"2012","unstructured":"Golding SJ. \u201cBlack bone\u201d MRI: a partial flip angle technique for radiation reduction in craniofacial imaging. Br J Radiol. 2012;85:272\u20138. Erratum in: Br J Radiol. 2012;85:659.","journal-title":"Br J Radiol"},{"issue":"11","key":"931_CR28","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.3174\/ajnr.A5405","volume":"38","author":"MHG Dremmen","year":"2017","unstructured":"Dremmen MHG, Wagner MW, Bosemani T, Tekes A, Agostino D, Day E, Soares BP, Huisman TAGM. Does the Addition of a \u201cBlack Bone\u201d Sequence to a Fast Multisequence Trauma MR Protocol Allow MRI to Replace CT after Traumatic Brain Injury in Children? AJNR Am J Neuroradiol. 2017;38:2187\u201392.","journal-title":"AJNR Am J Neuroradiol"},{"issue":"1","key":"931_CR29","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3174\/ajnr.A5916","volume":"40","author":"SB Cho","year":"2019","unstructured":"Cho SB, Baek HJ, Ryu KH, Choi BH, Moon JI, Kim TB, Kim SK, Park H, Hwang MJ. Clinical Feasibility of Zero TE Skull MRI in Patients with Head Trauma in Comparison with CT: A Single-Center Study. AJNR Am J Neuroradiol. 2019;40:109-15.","journal-title":"Ajnr Am J Neuroradiol"},{"issue":"9","key":"931_CR30","first-page":"1562","volume":"40","author":"A Lu","year":"2019","unstructured":"Lu\u00a0A, Gorny\u00a0KR, Ho\u00a0ML. Zero TE MRI for craniofacial bone imaging. AJNR Am J Neuroradiol. 2019;40:1562\u20136.","journal-title":"Ajnr Am J Neuroradiol"},{"issue":"5","key":"931_CR31","doi-asserted-by":"publisher","first-page":"3007","DOI":"10.1002\/mrm.27625","volume":"81","author":"H Lee","year":"2019","unstructured":"Lee H, Zhao X, Song HK, Zhang R, Bartlett SP, Wehrli FW. Rapid dual-RF, dual-echo, 3D ultrashort echo time craniofacial imaging: A feasibility study. Magn Reson Med. 2019;81:3007-16.","journal-title":"Magn Reson Med"},{"issue":"4","key":"931_CR32","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1007\/s00062-017-0617-5","volume":"28","author":"R Saat","year":"2018","unstructured":"Saat\u00a0R, Kurdo\u00a0G, Brandstack\u00a0N, Laulajainen-Hongisto\u00a0A, Jero\u00a0J, Markkola\u00a0A. A new classification system is helpful in diagnosing Intracranial complications of acute mastoiditis in CT. Clin Neuroradiol. 2018;28:523\u20138.","journal-title":"Clin Neuroradiol"},{"key":"931_CR33","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/S0022-3476(87)80067-7","volume":"111","author":"DA Cabral","year":"1987","unstructured":"Cabral DA, Flodmark O, Farrell K, Speert DP. Prospective study of computed tomography in acute bacterial meningitis. J Pediatr. 1987;111:201\u20135.","journal-title":"J Pediatr"},{"issue":"7","key":"931_CR34","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1016\/S1474-4422(17)30158-8","volume":"16","author":"V Gulani","year":"2017","unstructured":"Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB; International Society for Magnetic Resonance in Medicine. Gadolinium deposition in the brain: summary of evidence and recommendations. Lancet Neurol. 2017;16:564\u201370.","journal-title":"Lancet Neurol"}],"container-title":["Clinical Neuroradiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00062-020-00931-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00062-020-00931-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00062-020-00931-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T17:24:31Z","timestamp":1632504271000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00062-020-00931-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,21]]},"references-count":34,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["931"],"URL":"https:\/\/doi.org\/10.1007\/s00062-020-00931-0","relation":{},"ISSN":["1869-1439","1869-1447"],"issn-type":[{"value":"1869-1439","type":"print"},{"value":"1869-1447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,21]]},"assertion":[{"value":"28 November 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"R.\u00a0Saat, G.\u00a0Kurdo, A.\u00a0Laulajainen-Hongisto, A.\u00a0Markkola and J.\u00a0Jero declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}