[en] Multi-modal MR-PET-EEG data acquisition in simultaneous mode confers a number of advantages at 3 T and 9.4 T. The three modalities complement each other well; structural-functional imaging being the domain of MRI, molecular imaging with specific tracers is the strength of PET, and EEG provides a temporal dimension where the other two modalities are weak. The utility of hybrid MR-PET at 3 T in a clinical setting is presented and critically discussed. The potential problems and the putative gains to be accrued from hybrid imaging at 9.4 T, with examples from the human brain, are outlined. Steps on the road to 9.4 T multi-modal MR-PET-EEG are also illustrated. From an MR perspective, the potential for ultra-high resolution structural imaging is discussed and example images of the cerebellum with an isotropic resolution of 320 mum are presented, setting the stage for hybrid imaging at ultra-high field. Further, metabolic imaging is discussed and high-resolution images of the sodium distribution are presented. Examples of tumour imaging on a 3 T MR-PET system are presented and discussed. Finally, the perspectives for multi-modal imaging are discussed based on two on-going studies, the first comparing MR and PET methods for the measurement of perfusion and the second which looks at tumour delineation based on MRI contrasts but the knowledge of tumour extent is based on simultaneously acquired PET data.
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.
Bibliography
D. Pauleit, G. Stoffels, A. Bachofner, F.W. Floeth, M. Sabel, H. Herzog, L. Tellmann, P. Jansen, G. Reifenberger, K. Hamacher, H.H. Coenen, and K.J. Langen Comparison of (18)F-FET and (18)F-FDG PET in brain tumors Nucl. Med. Biol. 36 2009 779 787
C.A. Olman, N. Harel, D.A. Feinberg, S. He, P. Zhang, K. Ugurbil, and E. Yacoub Layer-specific fMRI reflects different neuronal computations at different depths in human V1 PLoS One 7 2012 e32536
E. Yacoub, P.F. Van De Moortele, A. Shmuel, and K. Uǧurbil Signal and noise characteristics of Hahn SE and GE BOLD fMRI at 7 T in humans NeuroImage 24 2005 738 750
A. Lu, I.C. Atkinson, X.J. Zhou, K.R. Thulborn, PCr/ATP ratio mapping of the human head by simultaneously imaging of multiple spectral peaks with interleaved excitations and flexible twisted projection imaging readout trajectories at 9.4 T, Magn. Reson. Med. (2012).
K.R. Thulborn, A. Lu, I.C. Atkinson, F. Damen, and J.L. Villano Quantitative sodium MR imaging and sodium bioscales for the management of brain tumors Neuroimaging Clin. N. Am. 19 2009 615 624
X.H. Zhu, N. Zhang, Y. Zhang, X. Zhang, K. Ugurbil, and W. Chen In vivo 17O NMR approaches for brain study at high field NMR Biomed. 18 2005 83 103
H.P. Schlemmer, B.J. Pichler, M. Schmand, Z. Burbar, C. Michel, R. Ladebeck, K. Jattke, D. Townsend, C. Nahmias, P.K. Jacob, W.D. Heiss, and C.D. Claussen Simultaneous MR/PET imaging of the human brain: feasibility study Radiology 248 2008 1028 1035
H. Herzog, U. Pietrzyk, N.J. Shah, and K. Ziemons The current state, challenges and perspectives of MR-PET NeuroImage 49 2010 2072 2082
H. Herzog, K.J. Langen, J. Kaffanke, C. Weirich, I. Neuner, G. Stofels, E. Rota Kops, J. Scheins, L. Tellmann, and N.J. Shah MR-PET opens new horizons in neuroimaging Future Neurol. 5 2010 807 815
H. Herzog, K.J. Langen, C. Weirich, E. Rota Kops, J. Kaffanke, L. Tellmann, J. Scheins, I. Neuner, G. Stoffels, K. Fischer, L. Caldeira, H.H. Coenen, and N.J. Shah High resolution BrainPET combined with simultaneous MRI Nuklearmedizin 50 2011 74 82
A. Boss, S. Bisdas, A. Kolb, M. Hofmann, U. Ernemann, C.D. Claussen, C. Pfannenberg, B.J. Pichler, M. Reimold, and L. Stegger Hybrid PET/MRI of intracranial masses: initial experiences and comparison to PET/CT J. Nucl. Med. 51 2010 1198 1205
I. Neuner, J. Kaffanke, H.J. Langen, E. Rota Kops, L. Tellmann, G. Stoffels, C. Weirich, C. Filss, H. Herzog, N.J. Shah, Multimodal imaging utilising integrated MR-PET for human brain tumour assessment, Eur. Radiol., in press. http://dx.doi.org/10.1007/s00330-012-2543-x.
W.D. Heiss, P. Raab, and H. Lanfermann Multimodality assessment of brain tumors and tumor recurrence J. Nucl. Med. 52 2011 1585 1600
M. Julià-Sapé, I. Coronel, C. Majós, A.P. Candiota, M. Serrallonga, M. Cos, C. Aguilera, J.J. Acebes, J.R. Griffiths, and C. Arús Prospective diagnostic performance evaluation of single-voxel (1) H MRS for typing and grading of brain tumours NMR Biomed. 25 2012 661 673
W.D. Heiss, P. Raab, and H. Lanfermann Multimodality assessment of brain tumors and tumor recurrence J. Nucl. Med. 52 2011 1585 1600
C. Majos, M. Julia-Sape, J. Alonso, M. Serrallonga, C. Aguilera, J.J. Acebes, C. Arús, and J. Gili Brain tumor classification by proton MR spectroscopy: comparison of diagnostic accuracy at short and long TE Am. J. Neuroradiol. 25 2004 1696 1704
G. Widhalm, M. Krssak, G. Minchev, A. Wöhrer, T. Traub-Weidinger, T. Czech, S. Asenbaum, C. Marosi, E. Knosp, J.A. Hainfellner, D. Prayer, and S. Wolfsberger Value of 1H-magnetic resonance spectroscopy chemical shift imaging for detection of anaplastic foci in diffusely infiltrating gliomas with non-significant contrast-enhancement J. Neurol. Neurosurg. Psychiatry 82 2011 512 520
A.S. Bick, A. Mayer, and N. Levin From research to clinical practice: implementation of functional magnetic imaging and white matter tractography in the clinical environment J. Neurol. Sci. 312 2012 158 165
A. Boss, A. Kolb, M. Hofmann, S. Bisdas, T. Nägele, U. Ernemann, L. Stegger, C. Rossi, H.P. Schlemmer, C. Pfannenberg, M. Reimold, C.D. Claussen, B.J. Pichler, and U. Klose Diffusion tensor imaging in a human PET/MR hybrid system Invest. Radiol. 45 2010 270 274
C. Stippich, N. Rapps, J. Dreyhaupt, A. Durst, B. Kress, E. Nennig, V.M. Tronnier, and K. Sartor Localizing and lateralizing language in patients with brain tumors: feasibility of routine preoperative functional MR imaging in 81 consecutive patients Radiology 243 2007 828 836
P.A. Bandettini, E.C. Wong, R.S. Hinks, R.S. Tikofsky, and J.S. Hyde Time course EPI of human brain function during task activation Magn. Reson. Med. 25 1992 390 397
S. Ogawa, D.W. Tank, R. Menon, J.M. Ellermann, S.G. Kim, H. Merkle, and K. Ugurbil Intrinsic signal changes accompanying sensory stimulation: functional brain mapping with magnetic resonance imaging Proc. Natl. Acad. Sci. U. S. A. 89 1992 5951 5955
S. Debener, M. Ullsperger, M. Siegel, and A.K. Engel Single-trial EEG-fMRI reveals the dynamics of cognitive function Trends Cogn. Sci. 10 2006 558 563
R.J. Huster, S. Debener, T. Eichele, and C.S. Herrmann Methods for simultaneous EEG-fMRI: an introductory review J. Neurosci. 32 2012 6053 6060
H. Laufs Endogenous brain oscillations and related networks detected by surface EEG-combined fMRI Hum. Brain Mapp. 29 2008 762 769
B. Biswal, F.Z. Yetkin, V.M. Haughton, and J.S. Hyde Functional connectivity in the motor cortex of resting human brain using echo-planar MRI Magn. Reson. Med. 34 1995 537 541
M.E. Raichle, A.M. MacLeod, A.Z. Snyder, W.J. Powers, D.A. Gusnard, and G.L. Shulman A default mode of brain function Proc. Natl. Acad. Sci. U. S. A. 98 2001 676 682
C.G. Benar, C. Grova, E. Kobayashi, A.P. Bagshaw, Y. Aghakhani, F. Dubeau, and J. Gotman EEG-fMRI of epileptic spikes: concordance with EEG source localization and intracranial EEG NeuroImage 30 2006 1161 1170
A.P. Bagshaw, and T. Warbrick Single trial variability of EEG and fMRI responses to visual stimuli NeuroImage 38 2007 280 292
I. Neuner, T. Stocker, T. Kellermann, V. Ermer, H.P. Wegener, S.B. Eickhoff, F. Schneider, and N.J. Shah Electrophysiology meets fMRI: neural correlates of the startle reflex assessed by simultaneous EMG-fMRI data acquisition Hum. Brain. Mapp. 31 2010 1675 1685
T. Warbrick, A. Mobascher, J. Brinkmeyer, F. Musso, N. Richter, T. Stoecker, G.R. Fink, N.J. Shah, and G. Winterer Single-trial P3 amplitude and latency informed event-related fMRI models yield different BOLD response patterns to a target detection task NeuroImage 47 2009 1532 1544
S. Sadaghiani, G. Hesselmann, K.J. Friston, and A. Kleinschmidt The relation of ongoing brain activity, evoked neural responses, and cognition Front. Syst. Neurosci. 4 2010 20
K. Mullinger, and R. Bowtell Combining EEG and fMRI Methods Mol. Biol. 711 2011 303 326
P.J. Allen, O. Josephs, and R. Turner A method for removing imaging artifact from continuous EEG recorded during functional MRI NeuroImage 12 2000 230 239
R.K. Niazy, C.F. Beckmann, G.D. Iannetti, J.M. Brady, and S.M. Smith Removal of FMRI environment artifacts from EEG data using optimal basis sets NeuroImage 28 2005 720 737
S. Debener, K.J. Mullinger, R.K. Niazy, and R.W. Bowtell Properties of the ballistocariogram artefact as revealed by EEG recordings at 1.5, 3 and 7 T static magnetic field strength Int. J. Psychophysiol. 67 2008 189 199
T. Eichele, V.D. Calhoun, and S. Debener Mining EEG-fMRI using independent component analysis Int. J. Psychophysiol. 73 2009 53 61
I. Neuner, T. Warbrick, A. Celik, J. Felder, M. Reske, F. Boers, N.J. Shah, EEG acquisition in ultra high static magnetic fields up to 9.4 T, NeuroImage, 2012, in press, http://dx.doi.org/10.1016/j.neuroimage.2012.11.064.
J.D. Schmahmann Disorders of the cerebellum: ataxia, dysmetria of thought, and the cerebellar cognitive affective syndrome J. Neuropsychiatry Clin. Neurosci. 16 2004 367 378
M. Steinlin Cerebellar disorders in childhood: cognitive problems Cerebellum 7 2008 607 610
M. Grisoli, A. Piperno, L. Chiapparini, R. Mariani, and M. Savoiardo MR imaging of cerebral cortical involvement in aceruloplasminemia Am. J. Neuroradiol. 26 2005 657 661
B.N. Patel, R.J. Dunn, S.Y. Jeong, Q. Zhu, J.P. Julien, and S. David Ceruloplasmin regulates iron levels in the CNS and prevents free radical injury J. Neurosci. 22 2002 6578 6586
J.P. Marques, W. van der Zwaag, C. Granziera, G. Krueger, and R. Gruetter Cerebellar cortical layers: in vivo visualization with structural high-field-strength MR imaging Radiology 254 2010 942 948
J. Pauly, D. Nishimura, and A. Macovski A k-space analysis of small-tip-angle excitation J. Magn. Reson. 81 1989 43 56
C.Y. Yip, J.A. Fessler, and D.C. Noll A constrained minimization approach to designing multi-dimensional, spatially selective RF pulses Proc. Intl. Soc. Mag. Res. Med. 2004 188
U. Katscher, P. Börnert, C. Leussler, and J.S. van den Brink Transmit SENSE Magn. Reson. Med. 49 2003 144 150
Y. Zhu Parallel excitation with an array of transmit coils Magn. Res. Med. 51 2004 775 784
W. Grissom, C.Y. Yip, Z. Zhang, V.A. Stenger, J.A. Fessler, and D.C. Noll Spatial domain method for the design of RF pulses in multicoil parallel excitation Magn. Reson. Med. 56 2006 620 629
W.A. Grissom, J.A. Fessler, and D.C. Noll Time-segmented spin domain method for fast large-tip-angle RF pulse design in parallel excitation Proc. Intl. Soc. Mag. Res. Med. 2007 676
K. Setsompop, L.L. Wald, V. Alagappan, B. Gagoski, F. Hebrank, U. Fontius, F. Schmitt, and E. Adalsteinsson Parallel RF transmission with eight channels at 3 Tesla Magn. Reson. Med. 56 2006 1163 1171
K. Vahedipour, N.J. Shah, and T. Stöcker Direct method for parallel transmit pulse design by time-reversal of the small-tip angle excitation Proc. Intl. Soc. Mag. Reson. Med 20 2012 637
F.E. Boada, G. LaVerde, C. Jungreis, E. Nemoto, C. Tanase, and I. Hancu Loss of cell ion homeostasis and cell viability in the brain: what sodium MRI can tell us Curr. Top. Dev. Biol. 70 2005 77 101
R. Ouwerkerk, K. Bleich, J. Gillen, and M. Pomper Tissue sodium concentration in human brain tumors as measured with 23Na MR imaging Radiology 227 2003 529 537
M. Horn, C. Weidensteiner, H. Scheffer, M. Meininger, M. de Groot, and H. Remkes Detection of myocardial viability based on measurement of sodium content: a (23)Na-NMR study Magn. Reson. Med. 45 2001 756 764
S. Romanzetti, C.C. Mirkes, D.P. Fiege, A. Celik, J. Felder, and N.J. Shah A comparison of imaging sequences for sodium MR imaging on a 9.4 T whole body machine Proc. Intl. Soc. Mag. Reson. Med. 19 2011 1493
S. Romanzetti, D. Fiege, J. Felder, A. Celik, C. Mirkes, and N.J. Shah Ultra-high field sodium imaging of the human brain at 9.4 Tesla Proc. Intl. Soc. Mag. Reson. Med. 20 2012 4419
P.M. Winter, and N. Bansal Triple-quantum-filtered (23)Na NMR spectroscopy of subcutaneously implanted 9l gliosarcoma in the rat in the presence of TmDOTP(5-1) J. Magn. Reson. 152 2001 70 78
D.P. Fiege, S. Romanzetti, C. Mirkes, D. Brenner, N.J. Shah, Simultaneous single-quantum and triple-quantum-filtered MRI of 23Na (SISTINA), Magn. Reson. Med. (2012).
G. LaVerde, E. Nemoto, C. Jungreis, C. Tanase, and F.E. Boada Serial triple quantum sodium MRI during non-human primate focal brain ischemia Magn. Reson. Med. 57 2007 201 205
M.L. Montandon, and H. Zaidi Atlas-guided non-uniform attenuation correction in cerebral 3D PET imaging NeuroImage 25 2005 278 286
E. Rota Kops, and H. Herzog Template based attenuation correction for PET in MR-PET scanners IEEE NSS Conf. Rec. 2008 3786 3789
J. Ashburner, and K.J. Friston Nonlinear spatial normalization using basis functions Hum. Brain Mapp. 7 1999 254 266
M. Hofmann, F. Steinke, V. Scheel, G. Charpiat, J. Farquhar, P. Aschoff, M. Brady, B. Schölkopf, and B.J. Pichle MRI-based attenuation correction for PET/MRI: a novel approach combining pattern recognition and atlas registration J. Nucl. Med. 49 2008 1875 1883
C. Catana, A. van der Kouwe, T. Benner, C.J. Michel, M. Hamm, M. Fenchel, B. Fischl, B. Rosen, M. Schmand, and A.G. Sorensen Toward implementing an MRI-based PET attenuation-correction method for neurologic studies on the MR-PET brain prototype J. Nucl. Med. 51 2010 1431 1438
V. Keereman, Y. Fierens, T. Broux, Y. De Deene, M. Lonneux, and S. Vandenberghe MRI-based attenuation correction for PET/MRI using ultrashort echo time sequences J. Nucl. Med. 51 2010 812 818
Y. Berker, J. Franke, A. Salomon, M. Palmowski, H.C. Donker, Y. Temur, F.M. Mottaghy, C. Kuhl, D. Izquierdo-Garcia, Z.A. Fayad, F. Kiessling, and V. Schulz MRI-based attenuation correction for hybrid PET/MRI systems: a 4-class tissue segmentation technique using a combined ultrashort-echo-time/Dixon MRI sequence J. Nucl. Med. 53 2012 796 804
C. Catana, T. Benner, A. van der Kouwe, L. Byars, M. Hamm, D.B. Chonde, C.J. Michel, G. El Fakhri, M. Schmand, and A.G. Sorensen MRI-assisted PET motion correction for neurologic studies in an integrated MR-PET scanner J. Nucl. Med. 52 2011 154 161
M. Ullisch, C. Weirich, J. Scheins, E. Rota Kops, A. Celik, T. Stöcker, N.J. Shah, A MR-based PET motion correction procedure for simultaneous MR-PET neuroimaging of human brain, PLoS One, 7 (2012) e48149.
J. Schulz, T. Siegert, E. Reimer, C. Labadie, J. Maclaren, M. Herbst, M. Zaitsev, R. Turner, An embedded optical tracking system for motion-corrected magnetic resonance imaging at 7 T, MAGMA, in press. http://dx.doi.org/10.1007/ s10334-012-0320-0.
J. Maclaren, M. Herbst, O. Speck, M. Zaitsev, Prospective motion correction in brain imaging: a review, Magn. Reson. Med., in press. http://dx.doi.org/10.1002/mrm.24314.
R.P.H. Bokkers, J.P. Bremmer, B.N.M. van Berckel, A.A. Lammertsma, J. Hendrikse, J.P. Pluim, L.J. Kappelle, R. Boellaard, and C.J.M. Klijn Arterial spin labeling perfusion mri at multiple delay times: a correlative study with H(2)(15)O positron emission tomography in patients with symptomatic carotid artery occlusion J. Cereb. Blood Flow Metab. 30 2010 222 229
G. Xu, H.A. Rowley, G. Wu, D.C. Alsop, A. Shankaranarayanan, M. Dowling, B.T. Christian, T.R. Oakes, and S. Johnson Reliability and precision of pseudo-continuous arterial spin labeling perfusion MRI on 3.0 T and comparison with 15O-water PET in elderly subjects at risk for Alzheimer's disease NMR Biomed. 23 2010 286 293
O.M. Henriksen, H.B.W. Larsson, A.E. Hansen, J.M. Grüner, I. Law, and E. Rostrup Estimation of intersubject variability of cerebral blood flow measurements using MRI and positron emission tomography J. Magn. Reson. Imaging 35 2012 1290 1299
T. Okell, M.A. Chappell, M.W. Woolrich, M. Günther, D.A. Feinberg, and P. Jezzard Vessel-encoded dynamic magnetic resonance angiography using arterial spin labelling Magn. Reson. Med. 64 2010 698 706
Z. Wang, G.K. Aguirre, H. Rao, J. Wang, M.A. Fernández-Seara, A.R. Childress, and J.A. Detre Empirical optimization of ASL data analysis using an ASL data processing toolbox: ASLtbx Magn. Reson. Imaging 26 2008 261 269
K. Chen, D. Bandy, E. Reiman, S.C. Huang, M. Lawson, D. Feng, L.S. Yun, and A. Palant Noninvasive quantification of the cerebral metabolic rate for glucose using positron emission tomography, 18F-fluoro-2- deoxyglucose, the Patlak method, and an image-derived input function J. Cereb. Blood Flow Metab. 18 1998 716 723
S.M. Sanabria-Bohorquez, A. Maes, P. Dupont, G. Bormans, T. de Groot, A. Coimbra, W. Eng, T. Laethem, I. De Lepeleire, J. Gambale, J.M. Vega, and H.D. Burns Image-derived input function for [11C]flumazenil kinetic analysis in human brain Mol. Imaging Biol. 5 2003 72 78
B.J. Lopresti, W.E. Klunk, C.A. Mathis, J.A. Hoge, S.K. Ziolko, X. Lu, C.C. Meltzer, K. Schimmel, N.D. Tsopelas, S.T. DeKosky, and J.C. Price Simplified quantification of Pittsburgh compound B amyloid imaging PET studies: a comparative analysis J. Nucl. Med. 46 2005 1959 1972
S. Iguchi, Y. Hori, T. Moriguchi, N. Morita, A. Yamamoto, K. Koshino, H. Kawashima, T. Zeniya, J. Enmi, H. Iida, Verification of a semi-automated MRI-guided technique for non-invasive determination of the arterial input function in 15O-labeled gaseous PET, Nucl. Instrum. Methods Phys. Res., Sect. A, in press.
J.E. Mourik, M. Lubberink, A. Schuitemaker, N. Tolboom, B.N.M. van Berckel, A.A. Lammertsma, and R. Boellaard Image-derived input functions for PET brain studies Eur. J. Nucl. Med. Mol. Imaging 36 2009 463 471
Y. Kato, S. Higano, H. Tamura, S. Mugikura, A. Umetsu, T. Murata, and S. Takahashi Usefulness of contrast-enhanced T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions in detection of small brain metastasis at 3 T MR imaging: comparison with magnetization-prepared rapid acquisition of gradient echo imaging Am. J. Neuroradiol. 30 2009 923 929
K. Pinker, I.M. Noebauer-Huhmann, I. Stavrou, R. Hoeftberger, P. Szomolanyi, G. Karanikas, M. Weber, A. Stadlbauer, E. Knosp, K. Friedrich, and S. Trattnig High-resolution contrast-enhanced, susceptibility-weighted MR imaging at 3 T in patients with brain tumors: correlation with positron-emission tomography and histopathologic findings Am. J. Neuroradiol. 28 2007 1280 1286
V. Sehgal, Z. Delproposto, E.M. Haacke, K.A. Tong, N. Wycliffe, D.K. Kido, Y. Xu, J. Neelavalli, D. Haddar, and J.R. Reichenbach Clinical applications of neuroimaging with susceptibility-weighted imaging J. Magn. Reson. Imaging 22 2005 439 450
L. de Rochefort, T. Liu, B. Kressler, J. Liu, P. Spincemaille, V. Lebon, J. Wu, and Y. Wang Quantitative susceptibility map reconstruction from MR phase data using bayesian regularization: validation and application to brain imaging Magn. Reson. Med. 63 2010 194 206
A.M. Oros-Peusquens, F. Keil, Z. Abbas, V. Gras, K.H. Möllenhoff, N.J. Shah, A seven-minute protocol for quantitative, whole-brain, accurate water mapping at 3 T for neuroscientific applications, NeuroImage, submitted for publication.
Y. Yovel, and Y. Assaf Virtual definition of neuronal tissue by cluster analysis of multi-parametric imaging (virtual-dot-com imaging) NeuroImage 35 2007 58 69
K. Swanson, R. Rostomily, and E. Alvord A mathematical modelling tool for predicting survival of individual patients following resection of glioblastoma: a proof of principle Br. J. Cancer 98 2008 113 119
K.R. Swanson, H.L. Harpold, D.L. Peacock, R. Rockne, C. Pennington, L. Kilbride, R. Grant, J.M. Wardlaw, and E.C. Alvord Jr. Velocity of radial expansion of contrast-enhancing gliomas and the effectiveness of radiotherapy in individual patients: a proof of principle Clin. Oncol. 20 2008 301 308
D.L. Silbergeld, and M.R. Chicoine Isolation and characterization of human malignant glioma cells from histologically normal brain J. Neurosurg. 86 1997 525 531
Similar publications
Sorry the service is unavailable at the moment. Please try again later.
This website uses cookies to improve user experience. Read more
Save & Close
Accept all
Decline all
Show detailsHide details
Cookie declaration
About cookies
Strictly necessary
Performance
Strictly necessary cookies allow core website functionality such as user login and account management. The website cannot be used properly without strictly necessary cookies.
This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
Performance cookies are used to see how visitors use the website, eg. analytics cookies. Those cookies cannot be used to directly identify a certain visitor.
Used to store the attribution information, the referrer initially used to visit the website
Cookies are small text files that are placed on your computer by websites that you visit. Websites use cookies to help users navigate efficiently and perform certain functions. Cookies that are required for the website to operate properly are allowed to be set without your permission. All other cookies need to be approved before they can be set in the browser.
You can change your consent to cookie usage at any time on our Privacy Policy page.