{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T02:25:09Z","timestamp":1794018309887,"version":"4.8.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Hydrocephalus is a common yet serious condition, and ventricular shunts are used for lifesaving CSF diversion. Existing methods for shunt evaluation provide correlative\/qualitative information, leading to commonplace clinical diagnostic challenges. The aim of this study was to determine accurate and noninvasive measures of volumetric CSF flow rates through ventricular shunts using the phase-contrast (PC) sequence in routine MRI for pediatric patients with hydrocephalus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a prospective observational cohort study of patients with ventricular shunts who underwent a clinically indicated brain MRI and the adjunct PC-MRI shunt flow sequence at a single center between January 2023 and January 2024. At the study institution, PC-MRI has been integrated as a supplementary imaging technique to quantify shunt flow alongside fast protocol MRI for shunted patients. Clinical and imaging data were collected. Data distributions and paired changes in flow measurements over time were assessed using appropriate statistical tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Overall, 207 patients (107 male, mean age 11.3 years [range 8 days\u201327 years]) who underwent PC-MRI were included; 98% had a VP shunt. The mean CSF flow rate was 9.9 \u00b1 8 mL\/hour (range 0.5\u201354 mL\/hour). No significant differences were noted by age, sex, etiology of hydrocephalus, valve type, time interval since shunt placement, BMI, fronto-occipital horn ratio, and frontal horn or atrial width. Repeat PC-MRI was performed in 11 patients, and there was no significant difference in flow measurements between initial and follow-up images (p = 0.83) among these patients. PC-MRI identified alterations that accurately demonstrated failure in 3 patients and avoided unnecessary surgery in a fourth patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Addition of PC-MRI to routine imaging examinations in patients with ventricular shunts accurately and noninvasively measured CSF shunt flow. Flow rate data can provide supplementary information regarding shunt function and serve as a baseline for future comparison assessments. These findings suggest a role for routine acquisition of patient-specific baseline shunt flow measurement in shunted pediatric patients with hydrocephalus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.5.jns253071","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:01:01Z","timestamp":1791936061000},"page":"1-8","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative MRI to assess baseline shunt flow in patients with hydrocephalus: a noninvasive tool to aid clinical decision-making"],"prefix":"10.3171","author":[{"given":"Joseph H.","family":"Ha","sequence":"first","affiliation":[{"name":"Stanford University School of Medicine, Palo Alto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison E.","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M.","family":"Toliao","sequence":"additional","affiliation":[{"name":"University of Southern California, Los Angeles;"},{"name":"Rudi Schulte Research Institute, Santa Barbara;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Torres","sequence":"additional","affiliation":[{"name":"Rudi Schulte Research Institute, Santa Barbara;"},{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Borzage","sequence":"additional","affiliation":[{"name":"University of Southern California, Los Angeles;"},{"name":"Department of Neonatology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eamon K.","family":"Doyle","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Drastal","sequence":"additional","affiliation":[{"name":"Department of Nursing Administration, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Friedli","sequence":"additional","affiliation":[{"name":"University of Southern California, Los Angeles;"},{"name":"Rudi Schulte Research Institute, Santa Barbara;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benita","family":"Tamrazi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin D.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradip P.","family":"Chaudhari","sequence":"additional","affiliation":[{"name":"Department of Emergency and Transport Medicine, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Wood","sequence":"additional","affiliation":[{"name":"University of Southern California, Los Angeles;"},{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"},{"name":"Keck School of Medicine of USC, Los Angeles;"},{"name":"Department of Cardiology, Children\u2019s Hospital Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clio","family":"Gonz\u00e1lez-Zacar\u00edas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Los Angeles;"},{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shana","family":"Adise","sequence":"additional","affiliation":[{"name":"College of Family and Consumer Sciences, University of Georgia, Athens, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason K.","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Krieger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Los Angeles;"},{"name":"Keck School of Medicine of USC, Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason S.","family":"Hauptman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Phoenix Children\u2019s Hospital, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Gordon","family":"McComb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Los Angeles;"},{"name":"Keck School of Medicine of USC, Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Bl\u00fcml","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Chiarelli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Phoenix Children\u2019s Hospital, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"Eur J Med Genet","first-page":"359","article-title":"Infantile hydrocephalus: a review of epidemiology, classification and causes","volume":"57","author":"Tully HM","year":"2014","unstructured":"Tully HM, Dobyns WB. Infantile hydrocephalus: a review of epidemiology, classification and causes. Eur J Med Genet. 2014;57(8):359\u2013368. doi:10.1016\/j.ejmg.2014.06.002"},{"issue":"1","key":"b2","series-title":"J Am Coll Surg","first-page":"79","article-title":"John Holter\u2019s shunt","volume":"192","author":"Baru JS","year":"2001","unstructured":"Baru JS, Bloom DA, Muraszko K, Koop CE. John Holter\u2019s shunt. J Am Coll Surg. 2001;192(1):79\u201385. doi:10.1016\/s1072-7515(00)00743-2"},{"issue":"2","key":"b3","series-title":"Neurosurgery","first-page":"294","article-title":"Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus","volume":"43","author":"Drake JM","year":"1998","unstructured":"Drake JM, Kestle JR, Milner R,  Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery. 1998;43(2):294\u2013303. doi:10.1097\/00006123-199808000-00068"},{"issue":"2","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"131","article-title":"Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths","volume":"1","author":"Simon TD","year":"2008","unstructured":"Simon TD, Riva-Cambrin J, Srivastava R, Bratton SL, Dean JM, Kestle JRW. Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatr. 2008;1(2):131\u2013137. doi:10.3171\/PED\/2008\/1\/2\/131"},{"issue":"4","key":"b5","series-title":"JAMA","first-page":"372","article-title":"Pediatric readmission prevalence and variability across hospitals","volume":"309","author":"Berry JG","year":"2013","unstructured":"Berry JG, Toomey SL, Zaslavsky AM,  Pediatric readmission prevalence and variability across hospitals. JAMA. 2013;309(4):372\u2013380. doi:10.1001\/jama.2012.188351"},{"issue":"4","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"346","article-title":"Reinfection after treatment of first cerebrospinal fluid shunt infection: a prospective observational cohort study","volume":"21","author":"Simon TD","year":"2018","unstructured":"Simon TD, Kronman MP, Whitlock KB,  Reinfection after treatment of first cerebrospinal fluid shunt infection: a prospective observational cohort study. J Neurosurg Pediatr. 2018;21(4):346\u2013358. doi:10.3171\/2017.9.PEDS17112"},{"issue":"1","key":"b7","series-title":"Neurosurgery","first-page":"139","article-title":"Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment","volume":"56","author":"Patwardhan RV","year":"2005","unstructured":"Patwardhan RV, Nanda A. Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery. 2005;56(1):139\u2013144. doi:10.1227\/01.neu.0000146206.40375.41"},{"issue":"5","key":"b8","series-title":"Pediatr Neurosurg","first-page":"254","article-title":"Epidemiology of cerebrospinal fluid shunting","volume":"23","author":"Bondurant CP","year":"1995","unstructured":"Bondurant CP, Jimenez DF. Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg. 1995;23(5):254\u2013258. doi:10.1159\/000120968"},{"issue":"3","key":"b9","series-title":"J Neurosurg Pediatr","first-page":"270","article-title":"Noninvasive measurement of cerebrospinal fluid flow using an ultrasonic transit time flow sensor: a preliminary study","volume":"17","author":"Pennell T","year":"2016","unstructured":"Pennell T, Yi JL, Kaufman BA, Krishnamurthy S. Noninvasive measurement of cerebrospinal fluid flow using an ultrasonic transit time flow sensor: a preliminary study. J Neurosurg Pediatr. 2016;17(3):270\u2013277. doi:10.3171\/2015.7.PEDS1577"},{"issue":"1","key":"b10","series-title":"NPJ Digit Med","first-page":"29","article-title":"Continuous, noninvasive wireless monitoring of flow of cerebrospinal fluid through shunts in patients with hydrocephalus","volume":"3","author":"Krishnan SR","year":"2020","unstructured":"Krishnan SR, Arafa HM, Kwon K,  Continuous, noninvasive wireless monitoring of flow of cerebrospinal fluid through shunts in patients with hydrocephalus. NPJ Digit Med. 2020;3(1):29\u201311. doi:10.1038\/s41746-020-0239-1"},{"issue":"6","key":"b11","series-title":"J Neurosurg","first-page":"1420","article-title":"Quantitative contrast-enhanced ultrasound measurement of cerebrospinal fluid flow for the diagnosis of ventricular shunt malfunction","volume":"123","author":"Hartman R","year":"2015","unstructured":"Hartman R, Aglyamov S, Fox DJ, Emelianov S. Quantitative contrast-enhanced ultrasound measurement of cerebrospinal fluid flow for the diagnosis of ventricular shunt malfunction. J Neurosurg. 2015;123(6):1420\u20131426. doi:10.3171\/2014.12.JNS141014"},{"issue":"7 Suppl 1","key":"b12","series-title":"Jpn J Appl Phys","first-page":"07JF10","article-title":"Fluid flow measurement for diagnosis of ventricular shunt malfunction using nonlinear responses of microbubbles in the contrast-enhanced ultrasound imaging","volume":"56","author":"Park S","year":"2017","unstructured":"Park S, Yoon H, Emelianov S, Aglyamov S. Fluid flow measurement for diagnosis of ventricular shunt malfunction using nonlinear responses of microbubbles in the contrast-enhanced ultrasound imaging. Jpn J Appl Phys. 2017;56(7 Suppl 1):07JF10. doi:10.7567\/JJAP.56.07JF10"},{"issue":"5","key":"b13","series-title":"Am J Crit Care","first-page":"408","article-title":"Measuring stroke volume: impedance cardiography vs phase-contrast magnetic resonance imaging","volume":"26","author":"Borzage M","year":"2017","unstructured":"Borzage M, Heidari K, Chavez T, Seri I, Wood JC, Bl\u00fcml S. Measuring stroke volume: impedance cardiography vs phase-contrast magnetic resonance imaging. Am J Crit Care. 2017;26(5):408\u2013415. doi:10.4037\/ajcc2017488"},{"issue":"1","key":"b14","series-title":"Radiographics","first-page":"122","article-title":"Phase-contrast MRI: physics, techniques, and clinical applications","volume":"40","author":"Wymer DT","year":"2020","unstructured":"Wymer DT, Patel KP, Burke WF, Bhatia VK. Phase-contrast MRI: physics, techniques, and clinical applications. Radiographics. 2020;40(1):122\u2013140. doi:10.1148\/rg.2020190039"},{"issue":"Suppl 2","key":"b15","series-title":"Arch Dis Child","first-page":"A99","article-title":"Cerebrospinal fluid flow quantification of the cerebral aqueduct in children and adults with two-dimentional cine phase-contrast cine MR imaging","volume":"97","author":"Fan HC","year":"2012","unstructured":"Fan HC, Giiang LH, Huang TY, Juan CJ, Chen CY, Chen SJ. Cerebrospinal fluid flow quantification of the cerebral aqueduct in children and adults with two-dimentional cine phase-contrast cine MR imaging. Arch Dis Child. 2012;97(Suppl 2):A99-A99. doi:10.1136\/archdischild-2012-302724.0337"},{"issue":"4","key":"b16","series-title":"J Neurosurg","first-page":"1117","article-title":"Quantitative noninvasive measurement of cerebrospinal fluid flow in shunted hydrocephalus","volume":"140","author":"Ha JH","year":"2024","unstructured":"Ha JH, Borzage MT, Vanstrum EB,  Quantitative noninvasive measurement of cerebrospinal fluid flow in shunted hydrocephalus. J Neurosurg. 2024;140(4):1117\u20131128. doi:10.3171\/2023.7.JNS231326"},{"issue":"1","key":"b17","series-title":"Pediatr Neurosurg","first-page":"20","article-title":"Evidence for a patent fibrous tract in fractured, outgrown, or disconnected ventriculoperitoneal shunts","volume":"23","author":"Clyde BL","year":"1995","unstructured":"Clyde BL, Albright AL. Evidence for a patent fibrous tract in fractured, outgrown, or disconnected ventriculoperitoneal shunts. Pediatr Neurosurg. 1995;23(1):20\u201325. doi:10.1159\/000120931"},{"issue":"6","key":"b18","series-title":"Childs Nerv Syst","first-page":"351","article-title":"Proof of the patent subcutaneous fibrous tract in children with V-P shunt malfunction","volume":"16","author":"Kazan S","year":"2000","unstructured":"Kazan S, A\u00e7ikba\u015f C, Rahat O, Tuncer R. Proof of the patent subcutaneous fibrous tract in children with V-P shunt malfunction. Childs Nerv Syst. 2000;16(6):351\u2013356. doi:10.1007\/s003810050530"},{"issue":"2","key":"b19","series-title":"J Neurosurg Pediatr","first-page":"160","article-title":"Utility of computed tomography or magnetic resonance imaging evaluation of ventricular morphology in suspected cerebrospinal fluid shunt malfunction","volume":"14","author":"Sellin JN","year":"2014","unstructured":"Sellin JN, Cherian J, Barry JM, Ryan SL, Luerssen TG, Jea A. Utility of computed tomography or magnetic resonance imaging evaluation of ventricular morphology in suspected cerebrospinal fluid shunt malfunction. J Neurosurg Pediatr. 2014;14(2):160\u2013166. doi:10.3171\/2014.4.PEDS13451"},{"issue":"3","key":"b20","series-title":"Pediatr Neurosurg","first-page":"151","article-title":"CSF shunt failure with stable normal ventricular size","volume":"42","author":"Winston KR","year":"2006","unstructured":"Winston KR, Lopez JA, Freeman J. CSF shunt failure with stable normal ventricular size. Pediatr Neurosurg. 2006;42(3):151\u2013155. doi:10.1159\/000091857"},{"issue":"2","key":"b21","series-title":"Pediatr Neurosurg","first-page":"128","article-title":"Pediatric shunt malfunction without ventricular dilatation","volume":"44","author":"McNatt SA","year":"2008","unstructured":"McNatt SA, Kim A, Hohuan D, Krieger M, McComb JG. Pediatric shunt malfunction without ventricular dilatation. Pediatr Neurosurg. 2008;44(2):128\u2013132. doi:10.1159\/000113115"},{"issue":"1","key":"b22","series-title":"Pediatr Neurosurg","first-page":"22","article-title":"Measurement of cerebrospinal fluid output through external ventricular drainage in one hundred infants and children: correlation with cerebrospinal fluid production","volume":"36","author":"Yasuda T","year":"2002","unstructured":"Yasuda T, Tomita T, McLone DG, Donovan M. Measurement of cerebrospinal fluid output through external ventricular drainage in one hundred infants and children: correlation with cerebrospinal fluid production. Pediatr Neurosurg. 2002;36(1):22\u201328. doi:10.1159\/000048344"},{"issue":"3 Pt 1","key":"b23","series-title":"Neurology","first-page":"500","article-title":"Cerebrospinal fluid production is reduced in healthy aging","volume":"40","author":"May C","year":"1990","unstructured":"May C, Kaye JA, Atack JR, Schapiro MB, Friedland RP, Rapoport SI. Cerebrospinal fluid production is reduced in healthy aging. Neurology. 1990;40(3 Pt 1):500\u2013503. doi:10.1212\/wnl.40.3_part_1.500"},{"issue":"1","key":"b24","series-title":"Nat Commun","first-page":"6778","article-title":"Choroid plexus-mediated CSF secretion remains stable in aging rats via high and age-resistant metabolic activity","volume":"16","author":"Lolansen SD","year":"2025","unstructured":"Lolansen SD, R\u00e9v\u00e9sz EO, Andreassen SN,  Choroid plexus-mediated CSF secretion remains stable in aging rats via high and age-resistant metabolic activity. Nat Commun. 2025;16(1):6778. doi:10.1038\/s41467-025-61889-6"},{"issue":"5","key":"b25","series-title":"Childs Nerv Syst","first-page":"1377","article-title":"CSF and venous blood flow from childhood to adulthood studied by real-time phase-contrast MRI","volume":"40","author":"Sahoo P","year":"2024","unstructured":"Sahoo P, Kollmeier JM, Wenkel N,  CSF and venous blood flow from childhood to adulthood studied by real-time phase-contrast MRI. Childs Nerv Syst. 2024;40(5):1377\u20131388. doi:10.1007\/s00381-024-06275-1"},{"issue":"6","key":"b26","series-title":"J Neurosurg","first-page":"1781","article-title":"Effect of position on intracranial pressure and compliance: a cross-sectional study including 101 patients","volume":"136","author":"D\u2019Antona L","year":"2022","unstructured":"D\u2019Antona L, Craven CL, Bremner F,  Effect of position on intracranial pressure and compliance: a cross-sectional study including 101 patients. J Neurosurg. 2022;136(6):1781\u20131789. doi:10.3171\/2021.6.JNS203573"},{"issue":"1","key":"b27","series-title":"J Physiol Anthropol","first-page":"5","article-title":"Postural influence on intracranial fluid dynamics: an overview","volume":"42","author":"Sagirov AF","year":"2023","unstructured":"Sagirov AF, Sergeev TV, Shabrov AV, Yurov AY, Guseva NL, Agapova EA. Postural influence on intracranial fluid dynamics: an overview. J Physiol Anthropol. 2023;42(1):5. doi:10.1186\/s40101-023-00323-6"},{"key":"b28","series-title":"JMIR Res Protoc","first-page":"e85918","article-title":"Noninvasive measurement of cerebrospinal fluid flow in shunted hydrocephalus: protocol for scanner calibration and multisite data collection","volume":"15","author":"Toliao JM","year":"2026","unstructured":"Toliao JM, Borzage MT, Chaudhari PP,  Noninvasive measurement of cerebrospinal fluid flow in shunted hydrocephalus: protocol for scanner calibration and multisite data collection. JMIR Res Protoc. 2026;15:e85918. doi:10.2196\/85918"},{"issue":"5","key":"b29","series-title":"Pediatrics","first-page":"1431","article-title":"Who will care for me next? Transitioning to adulthood with hydrocephalus","volume":"124","author":"Simon TD","year":"2009","unstructured":"Simon TD, Lamb S, Murphy NA, Hom B, Walker ML, Clark EB. Who will care for me next? Transitioning to adulthood with hydrocephalus. Pediatrics. 2009;124(5):1431\u20131437. doi:10.1542\/peds.2008-3834"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2026.5.JNS253071\/article-10.3171-2026.5.JNS253071.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/aop\/article-10.3171-2026.5.JNS253071\/article-10.3171-2026.5.JNS253071.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T01:44:55Z","timestamp":1794015895000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2026.5.JNS253071\/article-10.3171-2026.5.JNS253071.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":29,"URL":"https:\/\/doi.org\/10.3171\/2026.5.jns253071","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]}}}