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1.

Purpose

To estimate the accuracy of 18FDG PET/CT in detection of recurrent cancer ovary and to describe the localization of metastases for restaging.

Materials and methods

44 female patients with suspicion of ovarian cancer recurrence underwent a PET/CT scan from September 2013 to August 2015.

Results

CA-125 levels were elevated in 36 patients, 25 patients presented with alterations on imaging and 18 patients had clinical suspicion of recurrence. Imaging examinations were normal in 10/36 patients with elevated CA-125. 18FDG PET/CT scan was positive in 39/44 patients, and it was negative in 5/44 patients, 4/5 patients continued to be disease free all over the follow-up (true negative), while PET-CT missed recurrence in 1/5 patient (false negative). 1/39 patient was false positive. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of integrated PET/CT were calculated to be 91%, 76%, 96%, 50% and 87%.

Conclusion

18FDG PET/CT is an accurate modality for detection of recurrence of ovarian cancer. The accuracy of PET–CT in precise localization of suspicious FDG uptake can lead to proper assessment of disease recurrence, thus allow for restaging of the disease and subsequently optimizing treatment plan for these patients.  相似文献   

2.

Objectives

Our aim in this study was to evaluate the efficiency of combined positron emission tomography and computed tomography (PET/CT), in the detection of the primary tumor origin in patients with cancer of unknown primary (CUP).

Methods

PET/CT were performed for 52 patients with CUP. These patients presented with metastatic lesions that were proven pathologically, and no primary site was detected by previous investigations.

Results

The number of patients with true positive primary tumor sites was 29 (55.8%), 4 patients with false positive results (7.7%), 9 patients with true negative results (17.3%) and 10 patients with false negative results (19.2%). The sensitivity was 74.4%, specificity was 69.2% and accuracy was 73.1%. Our positive predictive value in this study was 87.9% and our negative predictive value for this study was 47.4%.

Conclusions

This study showed an advantage of PET/CT in the detection of the site of the primary tumor in patients diagnosed with CUP.  相似文献   

3.

Objective

The goal of this study was to highlight the usefulness of fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (18-F-FDG PET/CT) in soft tissue sarcoma (STS) follow-up to distinguish fibrosis from residual/recurring viable tumours and to detect distant metastases.

Methods

Twenty-three patients with confirmed STS underwent PET/CT scans. Bone and visceral sarcomas were excluded. Detailed case-based and statistical analyses were performed. Final diagnosis was confirmed by clinical or radiological examination and/or biopsy.

Results

The most common pathological diagnoses were synovial sarcomas (26.1%). PET/CT detected local disease recurrence in 8 cases. True positives for local disease were detected in 6 cases, and false negatives occurred in 2 cases (well-differentiated liposarcoma and low-grade synovial sarcoma). Distant disease was negative in 14/23 cases, and 2 cases were false negatives. Overall, PET/CT had 80% sensitivity, 87.5% specificity, 92.3% PPV, 70% NPV and 82.6% accuracy in STS treatment response follow-up.

Conclusion

18-F-FDG PET/CT is a useful imaging modality for STS follow-up and is effective in guiding biopsies. Locoregional and distant metastatic spread can be detected using PET/CT, with some limitations.  相似文献   

4.

Aims

The point of this research is to investigate the potential role of (18-F-FDG/PET) in the identification of hepatocellular carcinoma (HCC) and its metastases.

Patients and method

The present study was performed on 22 patients (15 newly diagnosed, 7 previously treated).18F-FDG was injected IV 1?h before the scan. Non-contrast-enhanced CT was performed trailed by PET in the same session. PET/CT scans were performed on (Philips Gemini-NM system). The whole study took around 20–30?min.

Results

PET/CT revealed increased local liver tumor 18-F-FDG uptake in 13/17 of those patients (6 solitary uptakes and 7 multi-nodular uptakes). Primary tumor SUV max. extended from 3 to 11 (mean 6.1) and liver tumor background ratio (TBR) varied from 0.4 to 3 (mean 2.05). 18-F-FDG PET/CT showed extrahepatic metastasis in 6 newly diagnosed patients. It also showed local tumor recurrence in 4 treated patients; 3 of them with no metastasis and 1 previously treated patient had local recurrence and distant metastasis. PET/CT has 76.5% sensitivity, 60% specificity, 86.7% PPV, 42.9% NPV and 59% accuracy in defining HCC and its extrahepatic metastases.

Conclusion

This study affirms the achievability of 18-F-FDG PET/CT for identification of primary HCC and its extrahepatic metastases.  相似文献   

5.

Aim and objectives

To assess the added value of hybrid FDG PET/CT in evaluation of extranodal lymphoma.

Methodology

In this study, PET/CT was done for 50 patients with lymphoma; (36 NHL and 14 HD), to evaluate its value over CT alone in detecting extranodal extension.

Results

The commonest extranodal sites affected by lymphomatous infiltration are in the following order: lung, bone, bone marrow, spleen, liver, GIT, head and neck, pleura, cutaneous tissue, peritoneum, brain, muscle and pancreas. Regarding the final outcome of the reviewed 77 extranodal lesions: depending on the criteria accepted as standard reference including histopathological results, clinical or radiological follow up, CT defined 66 (85.7%) studies as positive and 11 (14.3%) as negative. While PET/CT defined 71 (92.2%) studies as positive and 6 (7.8%) as negative. Most of the disagreement between both modalities (PET/CT and CT) could be detected among splenic, bone and bone marrow lesions. PET/CT was more sensitive and specific than CT alone in detecting extranodal lesions with sensitivity 97.22% and specificity 80%.

Conclusion

PET/CT is superior over CT alone in detecting extranodal extension especially among splenic, bone and bone marrow lesions.  相似文献   

6.

Aim and objectives

The aim of this study was to assess the role of 18-F FDG-PET/CT in evaluating the peripheral malignant neuronal affection as well as perineural tumoral spread that occurs in patients with cancers.

Methodology

50 patients with clinical symptoms of neurological deficits (34 male and 16 female) were included, their ages ranged from 17 to 74 with a mean of 45?years. PET/CT was done for all patients followed by clinical correlation after anti-inflammatory drugs and chemotherapy.

Results

Interpretation of the PET/CT studies and clinical correlation revealed 10 true positive cases with malignant neuronal involvement, 4 false positive cases diagnosed clinically as radiotherapy-induced neuropathy, 34 true negative cases and 2 false negative cases with negative PET/CT study and clinical evidence of nerve affection with sensitivity 83.33%, specificity 89.47%, PPV 71.43%, NPV 94.44% and diagnostic accuracy 88%. P-value?>?0.05 was considered statistically significant.

Conclusion

PET/CT has a significant role in detection of neuronal involvement by malignancy in cancer patients. Correlation between PET/CT and clinical outcome after chemotherapy improves the accuracy of diagnosis.  相似文献   

7.

Objective

The aim of our study was to determine the role of PET-CT in detection of recurrence and metastasis of renal cell carcinoma.

Patients and methods

Our study included twenty patients with renal cell carcinoma. All patients were from those attending to radio-diagnosis department in Sharq El Madina Hospital in Alexandria referred for PET/CT study. The following were done for all patients: Careful history taking, clinical examination, ultrasound, enhanced CT and PET/CT.

Results

One patient (5%) had positive PET/CT findings at different bone sites with high metabolic activity however these lesions were negative at CECT without any anatomical changes neither lytic nor sclerotic changes could be detected at these bone sites, with sensitivity, specificity and accuracy of PET/CT were 100%, 83% and 95% respectively.

Conclusion

PET/CT had advantage to PET and CT alone, making it an appropriate imaging technique in recurrence detection, therapeutic assessment and follow up of patients with renal cell carcinoma.  相似文献   

8.

Purpose

This study aimed at assessment of the role of (PET/CT) in lymphoma after completion of therapy to differentiate post-treatment fibrosis from residual viable tumor and being familiar with the limitations and interpretative pitfalls of PET/CT.

Method and materials

The present study was performed on 50 patients(27 males and 23 females).18F-FDG was injected IV one hour before performing the study. Contrast enhanced CT was performed followed by PET.

Results

After the end of therapy; PET/CT revealed (38%) of cases showed a partial regression, (28%) of cases showed a progressive disease, (22%) of cases with complete metabolic disease remission, (8%) of cases showed a stationary disease and the remaining (4%) of cases showed mixed response to therapy. CT only agreed with PET/CT in 76% of the cases. Some physiologic uptake often occurs after treatment in (4%) of patients. PET/CT has 100% sensitivity,68.75 % specificity, 87.17% PPV, 100% NPV and 90% accuracy in treatment response of lymphoma; compared to 94.1% sensitivity and 50% specificity, 80% PPV, 80% NPV and 80% accuracy for CECT.

Conclusion

PET/CT is a multimodality technique that can accurately monitor the treatment response of lymphoma. It can differentiate residual mass containing viable tumor from post treatment fibrosis.  相似文献   

9.

Purpose

to assess the efficacy of FDG PET/CT in detecting unexpected additional primary malignant neoplasms in patients being evaluated by PET/CT for known malignancies compared to conventional staging work-up (CSW).

Patients and methods

Of 1889 patients referred for whole-body FDG PET/CT in the period from February 2015 to May 2016, only 273 were included in this prospective study. Patients included are those with histopathologicaly proven primary malignancy and sent for initial tumor staging before treatment within 1 month of CSW that was performed for the patients according to the site and cell type of the primary tumor. Histopathologic examination was performed for lesions indicating additional primary cancer detected by either PET/CT or CSW.

Results

In 13 out of 273 patients included in the study (4.76%) only were proved to have additional primary cancer, the PPV of PET/CT for detecting an additional primary cancer was 56.5%. Also, it showed high sensitivity of 89.2%, which was significantly higher than 23% from the CSW (P < 0.005).

Conclusion

PET/CT is more accurate than CSW for detecting additional primary cancer with a higher sensitivity and positive predictive value, which consequently affect further management.  相似文献   

10.

Aim of the work

To evaluate the diagnostic reliability of qualitative and quantitative data of 18F-FDG PET/CT scanning in the identification and differentiation of adrenal incidentalomas discovered in cancer patients.

Materials and methods

Forty-five consecutive cancer patients (24 males and 21 females), with 54 discovered adrenal incidentalomas, were subjected to whole-body 18F-FDG PET/CT scanning protocol. For each adrenal nodule, the adrenal SUVmax, SUVavg, T/L SUVratio and activity scores were estimated.

Results

Most of the detected adrenal incidentalomas were benign (61.82%), and unilateral (77.8%). The mean T/L SUVratio was significantly higher in malignant compared to benign incidentalomas (P?<?0.001). Most of benign incidentalomas had activity score 1 (60%), while, most of malignant incidentalomas had activity score 3 (62.5%). The ROC curves analyses of 18F-FDG PET/CT in the studied adrenal incidentalomas revealed that, for identification of malignant lesions, the T/L SUVratio at cut-off value >1.60 showed the highest accuracy (99.09%) sensitivity (97.1%) and specificity (100%).

Conclusion

The quantitative (T/L SUVratio at cut-off value?>?1.60 and SUVmax at cut-off value?>?2.97) and qualitative (activity score of?≥?2) analytic data obtained by 18F-FDG PET/CT can be considered as powerful parameters for identification and differentiation of adrenal incidentalomas in cancer patients.  相似文献   

11.

Purpose

The aim of this study is to clarify the role of 18-F-FDG PET/CT over CT alone in the detection of primary, recurrent and metastatic disease in renal cancers patients.

Patients and methods

In this study; 18-F-PET/CT scans were performed for 25 patients (19 males and 6 females) with renal cancer. A patient-based analysis was performed in a dedicated manner to pick up lesions on CT, PET and PET/CT fused images. Statistical analysis was calculated. A final diagnosis of disease extent was affirmed by clinical, radiologic workup and histopathological correlation.

Results

PET/CT has 100% sensitivity, 93% specificity, 100% PPV, 91% NPV and 96% accuracy; compared to 100% sensitivity and 70% specificity, 83% PPV, 100% NPV and 88% accuracy for CT in diagnosis of primary, recurrent and metastatic disease in renal cancer.

Conclusion

Incorporated 18-F FDG PET/CT is a very versatile and accurate imaging technique for renal cancers. It significantly improves the accuracy and predictive values over CT alone for detection of primary, recurrent and metastatic disease in renal cancer thus change the treatment decision.  相似文献   

12.

Purpose

To assess the value of contrast enhanced CT (ceCT) when added to positron emission tomography combined with the standard low-dose non-contrast CT (PET/CT) protocols for staging patients with malignant pleural mesothelioma (MPM).

Methods

Retrospective analysis of 47 patients with pathologically proved MPM. All patients underwent PET/CT with low dose CT followed by ceCT. PET/CT and ce-CT were evaluated separately then in combination. All the results were validated either by histopathology and/or clinical-radiological follow-up. Staging was performed based on TNM system.

Results

For T-stage, the sensitivities for PET/CT, ceCT and combined PET/CT-ceCT were 89.1%, 86.9%, and 97.5%, respectively, p = 0.04. Regarding nodal stage, the sensitivity, specificity and accuracy for PET/CT were 88.5%, 90.5%, and 89.4%; for ceCT 73.1%, 95.2% and 82.9%; and for PET/CT-ceCT 96.2%, 95.2% and 95.7%, respectively. PET/CT-ceCT significantly associated with the sensitivity, p = 0.05. Considering the metastatic disease, the sensitivity, specificity and accuracy for PET/CT were 81.3%, 96.8%, and 91.5%; for ceCT 56.3%, 90.3% and 78.7%; and for PET/CT-ceCT 93.8%, 96.8% and 95.7%, respectively. PET/CT-ceCT significantly improved the sensitivity (p = 0.03) and accuracy (p = 0.02). Furthermore, combined PET/CT-ceCT significantly identified patients not suitable for surgery.

Conclusion

The addition of ceCT to PET/CT protocol has significantly contributed to the staging of MPM.  相似文献   

13.

Aim of work

To detect the diagnostic value of PET/CT in breast cancer patients. We compared the performance of PET/CT with that of conventional imaging in detection of recurrence and distant metastasis and evaluated the impact PET/CT results have on disease free survival.

Materials and methods

We retrospectively studied 50 patients with breast cancer with clinical suspicion of recurrent or metastatic lesion and who underwent PET/CT and conventional imaging procedures. The imaging results were retrospectively compared with histopathology and clinical follow-up as a reference standard.

Results

PET/CT detected distant metastases with a sensitivity of 97% and a specificity of 93%. In contrast, the sensitivity and specificity of combined conventional imaging procedures were 75% and 73%, respectively, disease-free survival was significantly shorter in the 34 M1-PET/CT patients than in the 14 M0-PET/CT patients (log-rank P = 0.002) also PET/CT detected recurrence in 1 patient with equivocal mammographic findings.

Conclusion

In breast cancer, PET/CT is superior to conventional imaging procedures for detection of recurrence, distant metastases and PET/CT can be used to improve prediction of the clinical outcome of breast cancer patients.  相似文献   

14.

Aim

To evaluate the value of 18F-FDG (positron emission tomography) PET/CT in assessment patients with fever of unknown origin (FUO) and to compare the findings with the results of the other investigations.

Patients and methods

This is perspective study in which 27 patients having FUO underwent 18F-FDG-PET/CT examination, using combined PET/CT with contrast enhanced CT. PET/CT findings were compared with the results of biopsies, immunology, or microbiology around the examination period & for the following 3 month duration, during which patients with negative PET/CT findings were followed also.

Results

The cause of FUO was explained according to the PET/CT findings and the other investigations in 27 patients: 6 patients with infections, 2 patients with autoimmune inflammation, 3 patients with solid malignancies, 2 patients with sarcoidosis, 6 patients with vasculitis, 5 patients with lymphoproliferative disease & 3 patients with negative findings. PET/CT findings matched the clinical diagnosis in 23 patients, 4 patients showed negative PET/CT findings (2 patients as true negative & the other 2 patients as false negative that were fatherly diagnosed as lymphoma). The examination sensitivity 95%, specificity 67%.

Conclusion

18F-FDG PET/CT can be a useful tool for scanning the whole body to suggest the FUO cause.  相似文献   

15.

Purpose

The purpose of this study was to investigate the correlation of primary tumor FDG uptake to clinicopathological prognostic factors in invasive ductal carcinoma of the breast.

Methods

We retrospectively reviewed 136 of 215 female patients with pathologically proven invasive ductal breast cancer from January 2008 to December 2011 who underwent F-18 FDG PET/CT for initial staging and follow-up after curative treatment with analysis of estrogen receptor (ER), progesterone receptor (PR) and human epithelial growth factor receptor 2 (HER2). The maximum standardized uptake value (SUVmax) of the primary breast tumor was measured and compared with hormonal receptor and HER2 overexpression status.

Results

The high SUVmax of primary breast tumors is significantly correlated with the clinicopathological factors: tumor size, histologic grade, TNM stage, negativity of ER, negativity of PR, HER2 overexpression and triple negativity. The recurrent group with non-triple negative cancer had a higher SUVmax compared with the non-recurrent group, though no significant difference in FDG uptake was noted between the recurrence and non-recurrent groups in subjects with triple-negative cancer. Lymph node involvement was the independent risk factor for cancer recurrence in the multivariate analysis.

Conclusions

In conclusion, high FDG uptake in primary breast tumors is significantly correlated with clinicopathological factors, such as tumor size, histologic grade, TNM stage, negativity of the hormonal receptor, HER2 overexpression and triple negativity. Therefore, FDG PET/CT is a helpful prognostic tool to direct the further management of patients with breast cancer.  相似文献   

16.

Background

Metastatic adrenal disease can occur in a wide diversity of malignancies. Distinguishing benign from metastatic adrenal masses in oncologic patients is vital.

Objective

To appraise the 18F-FDG PET/CT performance for distinguishing benign from metastatic adrenal masses.

Material and methods

In the current prospective study, 21 patients with proven extra-adrenal primary malignancy, having adrenal masses?≥10?mm on the axial CT images of their PET/CT examinations, were enrolled. Positive PET findings for malignancy were considered if the mass showed FDG uptake equivalent to or more prominent than the FDG liver uptake. Alternatively, negative PET findings for malignancy were considered if the mass showed FDG uptake not as much of the FDG liver uptake. Afterward, the obtained results were correlated with serial imaging follow-up or histopathological diagnosis by surgery or percutaneous biopsy as the diagnostic standard of reference.

Results

An overall number of 24 adrenal masses was diagnosed. Positive PET/CT results were found in 14 adrenal masses. All were finally considered to be metastases by serial imaging follow-up (n?=?8) and histopathological analysis by surgery (n?=?1) and percutaneous biopsy (n?=?5). Accordingly, no false positive result was obtained. Negative PET/CT results were observed in 10 adrenal masses, 9 of them were finally confirmed to be benign by serial imaging follow-up. The remaining mass was finally confirmed to be metastasis by percutaneous biopsy and hence, it represented the false negative result. 93% sensitivity, 100% specificity and 96% accuracy for identifying adrenal metastases were obtained.

Conclusion

18F-FDG PET/CT is a precise, non invasive modality for distinguishing benign from metastatic adrenal masses in oncologic patients.  相似文献   

17.

Objective

We developed a new computed tomography (CT)-based spatial normalization method and CT template to demonstrate its usefulness in spatial normalization of positron emission tomography (PET) images with [18F] fluorodeoxyglucose (FDG) PET studies in healthy controls.

Materials and Methods

Seventy healthy controls underwent brain CT scan (120 KeV, 180 mAs, and 3 mm of thickness) and [18F] FDG PET scans using a PET/CT scanner. T1-weighted magnetic resonance (MR) images were acquired for all subjects. By averaging skull-stripped and spatially-normalized MR and CT images, we created skull-stripped MR and CT templates for spatial normalization. The skull-stripped MR and CT images were spatially normalized to each structural template. PET images were spatially normalized by applying spatial transformation parameters to normalize skull-stripped MR and CT images. A conventional perfusion PET template was used for PET-based spatial normalization. Regional standardized uptake values (SUV) measured by overlaying the template volume of interest (VOI) were compared to those measured with FreeSurfer-generated VOI (FSVOI).

Results

All three spatial normalization methods underestimated regional SUV values by 0.3-20% compared to those measured with FSVOI. The CT-based method showed slightly greater underestimation bias. Regional SUV values derived from all three spatial normalization methods were correlated significantly (p < 0.0001) with those measured with FSVOI.

Conclusion

CT-based spatial normalization may be an alternative method for structure-based spatial normalization of [18F] FDG PET when MR imaging is unavailable. Therefore, it is useful for PET/CT studies with various radiotracers whose uptake is expected to be limited to specific brain regions or highly variable within study population.  相似文献   

18.

Purpose

Histopathologic features could affect the FDG uptake of primary gastric cancer and detection rate on FDG PET/CT. The aim of this study was to evaluate the FDG uptake of primary gastric cancer by correlating it with the histopathologic features of the tumors.

Methods

Fifty patients with locally advanced gastric adenocarcinoma who were referred for preoperative FDG-PET/CT scans were enrolled in this study. The detection rate of PET/CT and maximum standardized uptake values (SUVmax) of the primary tumor were compared using the WHO, Lauren, Ming and Borrmann classifications and tumor size and location.

Results

In 45 of the 50 patients (90 %), the primary gastric tumors were detected by FDG PET/CT. On comparison using the WHO classification, the detection rate and SUVmax of the tubular type were significantly higher than those of the poorly cohesive type. On comparison using the Lauren and Ming classifications, the SUVmaxs of the intestinal type and expanding type were significantly higher than those of the diffuse and infiltrative type, respectively. On comparison using the Borrmann classification and tumor size and location, there was no significant difference in the detection rate and SUVmax of primary gastric tumors.

Conclusion

This study demonstrates that the poorly cohesive type according to the WHO classification, diffuse type according to the Lauren classification and infiltrative type according to the Ming classification have low FDG uptake in patients with locally advanced gastric carcinoma. Understanding the relationship between primary tumor FDG uptake and histopathologic features would be helpful in detecting the primary tumor by FDG PET/CT in patients with gastric cancer.  相似文献   

19.

Purpose

The purpose of this retrospective, blinded study was to evaluate the additional value of [18F]FDG PET/CT in comparison with PET alone and with side-by-side PET and CT in patients with malignant melanoma (MM).

Methods

A total of 127 consecutive studies of patients with known MM referred for a whole-body PET/CT examination were included in this study. PET alone, side-by-side PET and CT and integrated PET/CT study were independently and separately interpreted without awareness of the clinical information. One score each was applied for certainty of lesion localisation and for certainty of lesion characterisation. Verification of the findings was subsequently performed using all available clinical, pathological (n?=?30) and follow-up information.

Results

The number of lesions with an uncertain localisation was significantly (p?p?p?=?0.057) compared versus PET alone. Respectively, PET, side-by-side PET and CT and PET/CT showed a sensitivity of 86%, 89% and 91%, a specificity of 94%, 94% and 94%, a positive predictive value of 96%, 96% and 96% and a negative predictive value of 80%, 83% and 87%.

Conclusion

Integrated PET/CT offers a significant benefit in lesion localisation and an improvement in lesion characterisation compared with PET alone or with side-by-side PET and CT. The benefit is not as great as that reported for other tumour entities, which may be due to the high avidity of MM for [18F]FDG.  相似文献   

20.

Objective

Our aim was evaluate the role the PET/CT in the assessment of response to therapy in patients with Non-Hodgkin extra-nodal lymphoma: in particular, a five-point scale (Deauville criteria), which can be employed for early- and late-therapeutic response assessment.

Methods

Sixty patients with pathologically confirmed Non-Hodgkin lymphoma (NHL) were enrolled in this prospective study. All patients underwent the following PET/CT examinations: initial PET/CT for staging, interim PET/CT and end of treatment PET/CT. Response assessment was done using new Cheson’s guidelines and five-point scale (Deauville criteria).

Results

All patients were evaluated for response to therapy in the early interim, followed by late interim, as well as end treatment assessment for the overall response. We found good concordance of response assessment according to the Deauville criteria classification with International Harmonization Project (IHP) classification. After early interim 48/60 patients had concordant designations (91.7%, 83.3%, 70%, and 33.3%) and 12 patients had discordant designations. After late interim, 56/60 patients had concordant designations (100%, 100%, 80%, and 50%) and four patients had discordant designations. After end of treatment, 54/60 patients had concordant designations (100%, 100% and 71.4%) and six patients has discordant designations.

Conclusion

Response assessment according to the Deauville criteria classification showed good concordance with IHP classification. According to our findings, we recommend the use of Deauville criteria in reporting of PET/CT for staging and assessment of response to treatment.  相似文献   

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