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European Journal of Nuclear Medicine and Molecular Imaging    [8 followers]  Follow    
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1619-7089 - ISSN (Online) 1619-7070
     Published by Springer-Verlag Homepage  [2187 journals]   [SJR: 1.724]   [H-I: 80]
  • Can radioimmunotherapy promote from an orphan drug to daily clinical
    • PubDate: 2014-05-01
  • Pairwise comparison of        class="a-plus-plus">89Zr- and        class="a-plus-plus">124I-labeled cG250 based on
           positron emission tomography imaging and nonlinear immunokinetic modeling:
           in vivo carbonic anhydrase IX receptor binding and internalization in
           mouse xenografts of clear-cell renal cell carcinoma
    • Abstract: Purpose The PET tracer, 124I-cG250, directed against carbonic anhydrase IX (CAIX) shows promise for presurgical diagnosis of clear-cell renal cell carcinoma (ccRCC) (Divgi et al. in Lancet Oncol 8:304–310, 2007; Divgi et al. in J Clin Oncol 31:187–194, 2013). The radiometal 89Zr, however, may offer advantages as a surrogate PET nuclide over 124I in terms of greater tumor uptake and retention (Rice et al. in Semin Nucl Med 41:265–282, 2011). We have developed a nonlinear immunokinetic model to facilitate a quantitative comparison of absolute uptake and antibody turnover between 124I-cG250 and 89Zr-cG250 using a human ccRCC xenograft tumor model in mice. We believe that this unique model better relates quantitative imaging data to the salient biological features of tumor antibody–antigen binding and turnover. Methods We conducted experiments with 89Zr-cG250 and 124I-cG250 using a human ccRCC cell line (SK-RC-38) to characterize the binding affinity and internalization kinetics of the two tracers in vitro. Serial PET imaging was performed in mice bearing subcutaneous ccRCC tumors to simultaneously detect and quantify time-dependent tumor uptake in vivo. Using the known specific activities of the two tracers, the equilibrium rates of antibody internalization and turnover in the tumors were derived from the PET images using nonlinear compartmental modeling. Results The two tracers demonstrated virtually identical tumor cell binding and internalization but showed markedly different retentions in vitro. Superior PET images were obtained using 89Zr-cG250, owing to the more prolonged trapping of the radiolabel in the tumor and simultaneous washout from normal tissues. Estimates of cG250/CAIX complex turnover were 1.35 – 5.51 × 1012 molecules per hour per gram of tumor (20 % of receptors internalized per hour), and the ratio of 124I/89Zr atoms released per unit time by tumor was 17.5. Conclusion Pairwise evaluation of 89Zr-cG250 and 124I-cG250 provided the basis for a nonlinear immunokinetic model which yielded quantitative information about the binding and internalization of radioantibody bound to CAIX on tumor cells in vivo. 89Zr-cG250 is likely to provide high-quality PET images and may be a useful tool to quantify CAIX/cG250 receptor turnover and cG250-accessible antigen density noninvasively in humans.
      PubDate: 2014-05-01
  • Reply to comment by Koranda:        class="a-plus-plus">99mTc-HMPAO-labelled
           leucocytes in musculoskeletal infections—the choice of reference
           tissue for a semiquantitative analysis
    • PubDate: 2014-05-01
  • Role of 68Ga-DOTATOC
           PET/CT in initial evaluation of patients with suspected bronchopulmonary
    • Abstract: Purpose The objective of this study was to evaluate the role of 68Ga-DOTATOC positron emission tomography (PET)/CT scan in patients with suspected pulmonary carcinoid tumour and to compare its results with 18F-fluorodeoxyglucose (FDG) PET/CT scan. Methods In this prospective study, 32 patients (age 34.22 ± 12.03 years; 53.1 % female) with clinical suspicion of bronchopulmonary carcinoid were evaluated with 68Ga-DOTATOC PET/CT and 18F-FDG PET/CT. The two imaging modalities were compared, considering the tissue diagnosis as the reference standard. Results Based on the reference standard 26 cases were carcinoid tumours [21 typical carcinoids (TC) and 5 atypical carcinoids (AC)] and 6 cases were non-carcinoid tumours. The sensitivity, specificity and accuracy of 68Ga-DOTATOC PET/CT in the diagnosis of pulmonary carcinoid tumour were 96.15, 100 and 96.87 % respectively, whereas those of 18F-FDG PET/CT were 78.26, 11.1 and 59.37 % respectively. The maximum standardised uptake value (SUVmax) of TC on 68Ga-DOTATOC PET/CT scan ranged from 3.58 to 55, while that of AC ranged from 1.1 to 32.5. 18F-FDG PET/CT was true-positive in all cases of AC and false-negative in eight cases of TC (sensitivity for TC 61.9 % and for AC 100 %). Conclusion 68Ga-DOTATOC PET/CT is a useful imaging investigation for the evaluation of pulmonary carcinoids. 18F-FDG PET/CT scan suffers from low sensitivity and specificity in differentiating the pulmonary carcinoids from other tumours.
      PubDate: 2014-05-01
  • Retraction Note: EANM Abstracts 2013
    • PubDate: 2014-05-01
  • PET imaging of focal demyelination and remyelination in a rat model of
           multiple sclerosis: comparison of [       class="a-plus-plus">11C]MeDAS, [       class="a-plus-plus">11C]CIC and [       class="a-plus-plus">11C]PIB
    • Abstract: Purpose In this study, we compared the ability of [11C]CIC, [11C]MeDAS and [11C]PIB to reveal temporal changes in myelin content in focal lesions in the lysolecithin rat model of multiple sclerosis. Pharmacokinetic modelling was performed to determine the best method to quantify tracer uptake. Methods Sprague-Dawley rats were stereotactically injected with either 1 % lysolecithin or saline into the corpus callosum and striatum of the right brain hemisphere. Dynamic PET imaging with simultaneous arterial blood sampling was performed 7 days after saline injection (control group), 7 days after lysolecithin injection (demyelination group) and 4 weeks after lysolecithin injection (remyelination group). Results The kinetics of [11C]CIC, [11C]MeDAS and [11C]PIB was best fitted by Logan graphical analysis, suggesting that tracer binding is reversible. Compartment modelling revealed that all tracers were fitted best with the reversible two-tissue compartment model. Tracer uptake and distribution volume in lesions were in agreement with myelin status. However, the slow kinetics and homogeneous brain uptake of [11C]CIC make this tracer less suitable for in vivo PET imaging. [11C]PIB showed good uptake in the white matter in the cerebrum, but [11C]PIB uptake in the cerebellum was low, despite high myelin density in this region. [11C]MeDAS distribution correlated well with myelin density in different brain regions. Conclusion This study showed that PET imaging of demyelination and remyelination processes in focal lesions is feasible. Our comparison of three myelin tracers showed that [11C]MeDAS has more favourable properties for quantitative PET imaging of demyelinated and remyelinated lesions throughout the CNS than [11C]CIC and [11C]PIB.
      PubDate: 2014-05-01
  • Comparison between PET template-based method and MRI-based method for
           cortical quantification of florbetapir (AV-45) uptake in vivo
    • Abstract: Purpose Florbetapir (AV-45) has been shown to be a reliable tool for assessing in vivo amyloid load in patients with Alzheimer’s disease from the early stages. However, nonspecific white matter binding has been reported in healthy subjects as well as in patients with Alzheimer’s disease. To avoid this issue, cortical quantification might increase the reliability of AV-45 PET analyses. In this study, we compared two quantification methods for AV-45 binding, a classical method relying on PET template registration (route 1), and a MRI-based method (route 2) for cortical quantification. Methods We recruited 22 patients at the prodromal stage of Alzheimer’s disease and 17 matched controls. AV-45 binding was assessed using both methods, and target-to-cerebellum mean global standard uptake values (SUVr) were obtained for each of them, together with SUVr in specific regions of interest. Quantification using the two routes was compared between the clinical groups (intragroup comparison), and between groups for each route (intergroup comparison). Discriminant analysis was performed. Results In the intragroup comparison, differences in uptake values were observed between route 1 and route 2 in both groups. In the intergroup comparison, AV-45 uptake was higher in patients than controls in all regions of interest using both methods, but the effect size of this difference was larger using route 2. In the discriminant analysis, route 2 showed a higher specificity (94.1 % versus 70.6 %), despite a lower sensitivity (77.3 % versus 86.4 %), and D-prime values were higher for route 2. Conclusion These findings suggest that, although both quantification methods enabled patients at early stages of Alzheimer’s disease to be well discriminated from controls, PET template-based quantification seems adequate for clinical use, while the MRI-based cortical quantification method led to greater intergroup differences and may be more suitable for use in current clinical research.
      PubDate: 2014-05-01
  • Altered serotonin transporter availability in patients with multiple
    • Abstract: Purpose Modulation of the immune system by the CNS may involve serotonergic regulation via the brain serotonin transporters (SERT). This regulation may be disturbed in patients with CNS disorders including multiple sclerosis (MS). Central serotonergic mechanisms have not been investigated in MS by in vivo imaging. The objective of the study was to assess the availability of SERT in antidepressant-naive patients with MS by means of PET. Methods Included in this study were 23 patients with MS and 22 matched healthy volunteers who were investigated with PET and the SERT-selective marker [11C]DASB, and distribution volume ratios were determined. Clinical assessment of the patients included the expanded disability status scale, the MS fatigue scale Würzburger Erschöpfungsinventar bei MS (WEIMuS) and the Beck Depression Inventory (BDI). The PET data were analysed with both volume-of-interest and voxel-based analyses to determine regional SERT availability. Results Patients had lower SERT availability in the cingulate cortex, the thalamus and the insula, and increased availability in the orbitofrontal cortex. Patients with relapsing/remitting MS tended to have lower SERT in the hippocampus, whereas patients with primary progressive disease showed increased SERT availability in prefrontal regions. There was a positive correlation between SERT availability in the insula and both depression and fatigue scores (r = 0.56 vs. BDI, p = 0.02; r = 0.49 vs. WEIMuS, p = 0.05). Conclusion Serotonergic neurotransmission in MS patients is altered in limbic and paralimbic regions as well as in the frontal cortex that this appears to contribute to psychiatric symptoms of MS.
      PubDate: 2014-05-01
  • Evolving role of PET/CT with different tracers in the evaluation of
           pulmonary neuroendocrine tumours
    • PubDate: 2014-05-01
  • Anatomical and functional volume concordance between FDG PET, and T2 and
           diffusion-weighted MRI for cervical cancer: a hybrid PET/MR study
    • Abstract: Purpose To evaluate the concordance among 18F-FDG PET imaging, MR T2-weighted (T2-W) imaging and apparent diffusion coefficient (ADC) maps with diffusion-weighted (DW) imaging in cervical cancer using hybrid whole-body PET/MR. Methods This study prospectively included 35 patients with cervical cancer who underwent pretreatment 18F-FDG PET/MR imaging. 18F-FDG PET and MR images were fused using standard software. The percent of the maximum standardized uptake values (SUVmax) was used to contour tumours on PET images, and volumes were calculated automatically. Tumour volumes measured on T2-W and DW images were calculated with standard techniques of tumour area multiplied by the slice profile. Parametric statistics were used for data analysis. Results FDG PET tumour volumes calculated using SUVmax (14.30 ± 4.70) and T2-W imaging volume (33.81 ± 27.32 cm3) were similar (P > 0.05) at 35 % and 40 % of SUVmax (32.91 ± 18.90 cm3 and 27.56 ± 17.19 cm3 respectively) and significantly correlated (P < 0.001; r = 0.735 and 0.766). The mean DW volume was 30.48 ± 22.41 cm3. DW volumes were not significantly different from FDG PET volumes at either 35 % SUVmax or 40 % SUVmax or from T2-W imaging volumes (P > 0.05). PET subvolumes with increasing SUVmax cut-off percentage showed an inverse change in mean ADC values on DW imaging (P < 0.001, ANOVA). Conclusion Hybrid PET/MR showed strong volume concordance between FDG PET, and T2-W and DW imaging in cervical cancer. Cut-off at 35 % or 40 % of SUVmax is recommended for 18F-FDG PET/MR SUV-based tumour volume estimation. The linear tumour subvolume concordance between FDG PET and DW imaging demonstrates individual regional concordance of metabolic activity and cell density.
      PubDate: 2014-05-01
  • Impact of initial PET/CT staging in terms of clinical stage, management
           plan, and prognosis in 592 patients with non-small-cell lung cancer
    • Abstract: Purpose Our objective was to determine the impact of initial 18F-FDG PET/CT (PET/CT) staging on clinical stage and the management plan and the prognostic value of PET/CT in patients with non-small-cell lung cancer (NSCLC). Methods We retrospectively reviewed the records of 592 patients with NSCLC who were referred to The University of Texas MD Anderson Cancer Center during 2002/2011 and had both PET/CT and conventional CT for initial staging. Clinical stages and management plans were compared between PET/CT and CT. The impact of PET/CT on management plans was considered medium/high when PET/CT changed the planned treatment modality or treatment intent. PET/CT and CT stages were compared with all-cause mortality and survival rates. We also assessed potential prognostic factors for progression-free survival (PFS) and overall survival (OS). Results PET/CT changed the stage in 170 patients (28.7 %; 16.4 % upstaged, 12.3 % downstaged). PET/CT had a medium/high impact on the management plan in 220 patients (37.2 %). PFS and OS were significantly worse in patients with upstaged disease than in patients with no change in stage (median PFS 29.0 vs. 53.8 months, P < 0.001; median OS:64.7 vs. 115.9 months, P = 0.006). PFS and OS were significantly worse in patients with medium/high impact of PET/CT than in patients with no/low impact of PET/CT (median PFS 24.7 vs. 60.6 months, P < 0.001; median OS 64.7 vs. 115.9 months, P < 0.001). In multivariate analysis, a medium/high impact of PET/CT was an independent predictor of worse PFS (hazard ratio, HR, 1.73; 95 % CI 1.30 – 2.29; P = 0.0002) and OS (HR 1.84; 95 % CI 1.26 – 2.69; P = 0.002). Conclusion Initial PET/CT staging not only impacts stage and management plan but also has prognostic value.
      PubDate: 2014-05-01
  • Paediatric radiopharmaceutical administration: harmonization of the 2007
           EANM paediatric dosage card (version 1.5.2008) and the 2010 North American
           consensus guidelines
    • Abstract: In 2008 the EANM published their paediatric dosage card. In 2011 the North American consensus guidelines recommended a set of administered activities for paediatric nuclear medicine. During the EANM congress in 2012 a working group of the EANM and the SNMMI met to study the possibility of harmonizing these guidelines. The purpose of this work was to identify differences between these guidelines and suggest changes in both guidelines to achieve a level of harmonization. In addition, the new version of the EANM paediatric dosage card (version 01.02.2014) is provided.
      PubDate: 2014-05-01
  • PET imaging of garbage protein in Alzheimer’s disease: does it
           require reappraisal of brain PET analysis'
    • PubDate: 2014-05-01
  • Outcome of peptide receptor radionuclide therapy with        class="a-plus-plus">177Lu-octreotate in advanced
           grade 1/2 pancreatic neuroendocrine tumours
    • Abstract: Purpose The clinical benefit of peptide receptor radionuclide therapy (PRRT) in patients with pancreatic neuroendocrine tumours (pNET) has not yet been well described and defined in its full extent due to limited data in this tumour subgroup. This study was intended to obtain robust, comparative data on the outcome and toxicity of standardized PRRT with 177Lu-octreotate in a well-characterized population of patients with advanced pNET of grade 1/2 (G1/2). Methods We retrospectively analysed a cohort of 68 pNET patients with inoperable metastatic disease consecutively treated with 177Lu-octreotate (four intended cycles at 3-monthly intervals; mean activity per cycle 8.0 GBq). Of these 68 patients, 46 (67.6 %) had documented morphological tumour progression during the 12 months before initiation of treatment, and PRRT was the first-line systemic therapy in 35 patients (51.5 %). Response was evaluated according to modified Southwest Oncology Group (SWOG) criteria and additionally with Response Criteria in Solid Tumors (RECIST) 1.1. Survival was analysed using Kaplan-Meier curves and Cox proportional hazards model for univariate and multivariate analyses. Toxicity was assessed by standard follow-up laboratory work-up including blood count, and liver and renal function, supplemented with serial 99mTc-DTPA clearance measurements. Results The median follow-up period was 58 months (range 4 – 112). Reversible haematotoxicity (grade 3 or more) occurred in four patients (5.9 %). No significant nephrotoxicity (grade 3 or more) was observed. Treatment responses (SWOG criteria) consisted of a partial response in 41 patients (60.3 %), a minor response in 8 (11.8 %), stable disease in 9 (13.2 %), and progressive disease in 10 (14.7 %). Median progression-free survival (PFS) and overall survival (OS) were 34 (95 % CI 26 – 42) and 53 months (95 % CI 46 – 60), respectively. A G1 proliferation status was associated with longer PFS (p = 0.04) and OS (p = 0.044) in the multivariate analysis. Variables linked to impaired OS, on the other hand, were a reduced performance status (Karnofsky score ≤70 %, p = 0.007), a high hepatic tumour burden (≥25 % liver volume, p = 0.017), and an elevated plasma level of neuron-specific enolase (NSE >15 ng/ml, p = 0.035). Conclusion The outstanding response rates and survival outcomes suggest that PRRT is highly effective in advanced G1/2 pNET when compared to data of other treatment modalities. Independent predictors of survival are the tumour proliferation index, the patient’s performance status, tumour burden and baseline plasma NSE level.
      PubDate: 2014-05-01
  • 11C-Choline PET/CT
           detects the site of relapse in the majority of prostate cancer patients
           showing biochemical recurrence after EBRT
    • Abstract: Purpose The aim of this retrospective study was to evaluate the usefulness and the detection rate of 11C-choline PET/CT in a population of patients with prostate cancer (PC), exclusively treated with external beam radiotherapy (EBRT) as primary treatment, who showed biochemical relapse. Materials and methods We enrolled 140 patients showing a serum PSA level >2 ng/mL (mean 8.6 ng/mL, median 5 ng/mL, range 2 – 60 ng/mL). All patients had been treated with EBRT to the prostate gland and prostatic fossa with doses ranging from 70 to 76 Gy in low-risk patients (T1/T2 and/or serum PSA <10 ng/mL) and escalating to >76 Gy (range 76 – 81 Gy) in high-risk patients (T3/T4 and/or serum PSA >10 ng/mL). Of the 140 patients, 53 were receiving androgen deprivation therapy at the time of the scan. All positive 11C-choline PET/CT findings were validated by transrectal ultrasound-guided biopsy or at least 12 months of follow-up with contrast-enhanced CT, MR, bone scintigraphy or a repeated 11C-choline PET/CT scan. The relationships between the detection rate of 11C-choline PET/CT and the factors PSA level, PSA kinetics, Gleason score, age, time to relapse and SUVmax in patients with positive findings were analysed. Results 11C-Choline PET/CT detected the site of relapse in 123 of the 140 patients with a detection rate of 87.8 % (46 patients showed local relapse, 31 showed local and distant relapse, and 46 showed only distant relapse). In patients with relapse the mean serum PSA level was 9.08 ng/mL (median 5.1 ng/mL, range 2 – 60 ng/mL), the mean PSA doubling time was 5.6 months (median 3.5 months, range 0.4 – 48 months), and the mean PSA velocity was 15 ng/mL/year (median 8.8 ng/mL/year, range 0.4 – 87 ng/mL/year). Of the 123 patients with relapse, 77 (62.6 %) showed distant relapse with/without local relapse, and of these 77, 31 (40.2 %) showed oligometastatic disease (one or two distant lesions: lymph node lesions only in 16, bone lesions only in 14, and lymph node lesions and bone lesions in 1). In univariate and multivariate analyses PSA kinetics was the only variable affecting 11C-choline PET/CT detection rate. A significant correlation between PSA kinetics and site of recurrence (local relapse only vs. distant metastasis) was also observed. Conclusion The detection rate of 11C-choline PET/CT in patients with PC showing biochemical recurrence after EBRT as primary treatment is relatively high (87.8 %). 11C-Choline PET/CT was able to detect extraprostatic disease in the 62.6 % of patients. Considering this high detection rate, 11C-choline PET/CT could have clinical usefulness in the management of these PC patients, but this should be confirmed in future studies.
      PubDate: 2014-05-01
  • Myocardial perfusion imaging with a cadmium zinc telluride-based gamma
           camera versus invasive fractional flow reserve
    • Abstract: Purpose Recently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride-based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT-based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease. Methods Both invasive FFR and myocardial perfusion imaging with a CZT-based SPECT camera, using Tc-tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut-off value of <0.75 was used to define abnormal FFR. Results The mean age of the patients was 64 ± 11 years, and 64 % were men. SPECT demonstrated ischaemia in 31 % of the patients, and 20 % had FFR <0.75. The concordance between CZT SPECT and FFR was 73 % on a per-patient basis and 79 % on a per-vessel basis. Discordant findings were more often seen in older patients and were mainly (19 %) the result of ischaemic SPECT findings in patients with FFR ≥0.75, whereas only 8 % had an abnormal FFR without ischaemia as demonstrated by CZT SPECT. Conclusion Only 20 – 30 % of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization.
      PubDate: 2014-05-01
  • 99mTc-HMPAO-labelled
           leucocytes in musculoskeletal infections: the choice of reference tissue
           for semiquantitative analysis
    • PubDate: 2014-05-01
  • 18F-FDG PET/CT
           findings in uterine leiomyomas
    • PubDate: 2014-05-01
  • FDG gated cardiac PET at rest and immediately after dobutamine stress
    • PubDate: 2014-05-01
  • Use of myocardial perfusion imaging and estimation of associated radiation
           doses in Germany from 2005 to 2012
    • Abstract: Purpose For several years the Working Group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine has been performing a regular survey to obtain information on technique, utilization and development of myocardial perfusion scintigraphy (MPS). Currently, data of six surveys from 2005 to 2012 are available. The aim of this paper is to deliver a general and comprehensive overview of all surveys documenting the course of patient doses over time and the development of the method. Methods A one-page questionnaire with number of MPS patients, number of stress and rest MPS, referral structure and several technical issues was sent to all centres performing MPS in Germany and evaluated. With the data on protocol utilization, effective MPS patient doses were estimated. Results MPS per million population (pmp) varied between 2,380 and 2,770. In 2012, MPS pmp showed a slight increase for the first time. From 2005 to 2009 the angiography to MPS ratio increased from 3.4 to 4.4, and the revascularization to MPS ratio decreased from 0.66 to 0.53. In 2012, both indices demonstrated an opposite trend for the first time (4.1 and 0.55). A total of 108 centres participated in all surveys. They showed an increase in MPS patients of 4.0 % over the reporting period. In 2012, more than 50 % of the centres experienced no change or an increase in MPS numbers. The leading single competitor was MRI, followed by angiography and stress echocardiography. 201Tl studies have decreased since 2005 from 20 to 5 %. 99mTc MPS studies showed a mild increase in 2-day protocols. In 2012, the average effective dose per patient was estimated at 7.4 mSv. Due to the decreasing use of 201Tl, a mild decline over the observation period can be documented. Dynamic exercise stress was the most common stress test and adenosine the leading pharmacological stress agent, with a growing percentage. In 2012, the regadenoson percentage was 9 %. Gated single photon emission computed tomography (SPECT) noted an increasing acceptance with >70 % in 2012. The segmental scoring of perfusion studies had a low acceptance. Ambulatory care cardiologists represented the major referral group. Conclusion Germany has a moderate to moderate-high MPS utilization rate. Nevertheless, coronary artery disease (CAD) diagnosis and disease management are dominated by angiography. The survey data reveal a positive trend in MPS and a decrease in average patient dose reflecting good practice with guideline adherence, the implementation of technical improvements and success in training.
      PubDate: 2014-05-01
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