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Endovascular Thrombectomy in the Very Elderly (≥85 Years): Outcomes from a High-Volume Stroke Center. 高龄患者(≥85岁)的血管内血栓切除术:来自一个大容量卒中中心的结果
Pub Date : 2026-02-06 DOI: 10.3174/ajnr.A9203
Ludwig Singer, Maximilian Sprügel, Stefan W Hock, David Haupenthal, Bernd Kallmuenzer, Stefan Schwab, Kosmas Macha, Arnd Doerfler, Tobias Engelhorn

Background and purpose: Endovascular therapy (EVT) has become the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, the impact of advanced age on EVT outcomes remains unclear. This study evaluated the safety, efficacy, and outcomes of EVT in elderly patients (≥85 years) compared to younger individuals in a real-world cohort.

Materials and methods: We conducted a retrospective analysis of the Stroke Research Consortium in Northern Bavaria (STAMINA) database, identifying 581 patients with occlusion in the anterior circulation who underwent EVT. Patients were stratified by age (≥85 years: n=95; <85 years: n=486). The primary outcome was functional recovery at 90 days, defined as a modified Rankin Scale (mRS) score ≤ pre-stroke mRS or pre-stroke mRS +1. Secondary outcomes included good functional outcome (mRS ≤2), mortality, successful EVT (TICI ≥ 2b), and symptomatic intracerebral hemorrhage (sICH).

Results: Elderly patients had a significantly higher 90-day mortality rate (53.8% vs 22.3%, p<0.001) and lower rates of good functional outcomes (1.1% vs. 27.0%, p<0.001). Functional recovery occurred in 13.7% of elderly patients compared to 21.0% in younger patients (p=0.14). Rates of sICH were similar (12.6% vs. 8.8%, p=0.34). Pre-stroke mRS was a significant predictor of good outcome in the elderly, with each one-point increase associated with a 56% decrease in the odds of achieving independence (OR 0.43, 95% CI 0.32-0.61; p<0.001).

Conclusion: EVT is technically feasible in elderly patients but associated with worse outcomes and higher mortality. Age alone should not exclude patients from EVT, though careful consideration of pre-stroke status is essential for individualized decision-making.

背景与目的:血管内治疗(EVT)已成为大血管闭塞(LVO)所致急性缺血性卒中(AIS)患者的标准治疗方法。然而,高龄对EVT结果的影响尚不清楚。本研究评估了EVT在老年患者(≥85岁)中的安全性、有效性和结果,并与现实世界队列中的年轻人进行了比较。材料和方法:我们对北巴伐利亚卒中研究联盟(STAMINA)数据库进行了回顾性分析,确定了581例前循环闭塞患者接受EVT。结果:老年患者的90天死亡率明显高于老年患者(53.8% vs 22.3%)。结论:EVT在老年患者中技术上是可行的,但与较差的预后和较高的死亡率相关。年龄本身不应排除EVT患者,尽管仔细考虑卒中前状态对于个体化决策至关重要。
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引用次数: 0
Isolated Congenital Middle Ear Malformations: Comparison of Preoperative 0.1-mm Ultra-High-Resolution CT and Conventional High-Resolution CT. 孤立性先天性中耳畸形:术前0.1 mm超高分辨率CT与常规高分辨率CT的比较。
Pub Date : 2026-02-05 DOI: 10.3174/ajnr.A8999
Jingying Guo, Ning Xu, Ruowei Tang, Heyu Ding, Yuhe Liu, Shusheng Gong, Zhenghan Yang, Zhenchang Wang, Pengfei Zhao

Background and purpose: Isolated congenital middle ear malformation (CMEM) contributes significantly to congenital hearing loss and growth problems. This study aims to compare 0.1-mm isotropic ultra-high-resolution CT (U-HRCT) and conventional high-resolution CT (HRCT) for assessing isolated CMEM, using surgical exploration as the standard.

Materials and methods: This single-center retrospective study included patients with surgically confirmed isolated CMEM who underwent U-HRCT or HRCT from January 2015 to April 2025. Middle ear abnormalities were identified based on operative outcomes and 4 subtypes were classified via the Teunissen standard. Two neuroradiologists blinded to surgical outcomes reviewed CT images for 10 subtle structural abnormalities and specific subtypes. The comparison of U-HRCT and HRCT in terms of interobserver and intraobserver agreement and detection of structural abnormalities and subtypes of CMEM were analyzed.

Results: The U-HRCT and HRCT groups included 61 patients (69 ears) and 37 patients (44 ears), respectively. U-HRCT exhibited significantly higher interobserver and intraobserver agreement and stronger concordance with surgical findings for all 10 abnormalities compared with HRCT. It also showed superior diagnostic sensitivity for CMEM (100.0% versus 90.9%; P = .013) and outperformed HRCT in differentiating clinical subtypes (0.774 versus 0.352; P<.001). U-HRCT achieved accuracies exceeding 0.85 in identifying all abnormalities and outperformed HRCT in detecting specific abnormalities including abnormal long process of the incus, lenticular process, abnormal stapes superstructure, stapes footplate fixation, and oval window atresia (P < .05).

Conclusions: Isotropic 0.1-mm U-HRCT significantly outperforms conventional HRCT in diagnosing CMEM, differencing subtypes, and detecting subtle abnormalities, supporting its clinical superiority for precise preoperative evaluation.

背景与目的:孤立性先天性中耳畸形是导致先天性听力损失和发育问题的重要因素。本研究旨在比较0.1 mm各向同性超高分辨率计算机断层扫描和传统高分辨率计算机断层扫描评估孤立的先天性中耳畸形,以手术探查为金标准。材料与方法:本研究为单中心回顾性研究,纳入2015年1月至2025年4月行超高分辨率CT或高分辨率CT手术确诊的孤立性先天性中耳畸形患者。根据手术结果确定中耳异常,并根据Teunissen标准分为四种亚型。两名不知道手术结果的神经放射学家回顾了CT图像,发现了10种细微的结构异常和特定亚型。分析超高分辨率CT与高分辨率CT在观察者间、观察者内一致性、先天性中耳畸形结构异常及亚型检测方面的比较。结果:超高分辨率CT组61例(69耳),高分辨率CT组37例(44耳)。与高分辨率CT相比,超高分辨率CT在所有10种异常中显示出更高的观察者间和观察者内一致性,并且与手术结果的一致性更强。对先天性中耳畸形的诊断敏感性(100.0%比90.9%,P=0.013)优于高分辨率CT(0.774比0.352,P< 0.001)。超高分辨率CT对所有异常的识别准确率均超过0.85,对incus长突异常、透镜突异常、镫骨上部结构异常、镫骨足板固定异常、卵圆窗闭锁等特定异常的检测准确率优于高分辨率CT (P< 0.05)。结论:各向同性0.1 mm超高分辨率CT在诊断先天性中耳畸形、区分亚型和发现细微异常方面均明显优于常规高分辨率CT,支持其在术前精准评估方面的临床优势。缩写:CMEM=先天性中耳畸形;HRCT=高分辨率计算机断层扫描;超高分辨率计算机断层扫描;光子计数检测器CT。
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引用次数: 0
Prediction of CSF Intervention in Fetal Ventriculomegaly via Artificial Intelligence-Powered Normative Modeling. 通过人工智能规范模型预测脑脊液干预胎儿脑室肿大。
Pub Date : 2026-02-05 DOI: 10.3174/ajnr.A9000
Minerva Zhou, Siddharthasiva Anbu Rajan, Pierre Nedelec, Juana Barrera Bayona, Orit Glenn, Nalin Gupta, Dawn Gano, Elizabeth George, Andreas M Rauschecker

Background and purpose: Fetal ventriculomegaly (VM) is common and largely benign when isolated. However, it can occasionally progress to hydrocephalus, a more severe condition associated with increased mortality and neurodevelopmental delay that may require surgical postnatal intervention. Accurate differentiation between VM and hydrocephalus is essential but remains challenging, relying on subjective assessment and limited 2D measurements. Deep learning-based segmentation offers a promising solution for objective and reproducible volumetric analysis. This work presents an artificial intelligence-powered method for segmentation, volume quantification, and classification of the ventricles in fetal brain MRI to predict the need for postnatal intervention.

Materials and methods: This retrospective study included 222 patients with singleton pregnancies. An nnUNet was trained to segment the fetal ventricles on 20 manually segmented, institutional fetal brain MRIs combined with 80 studies from a publicly available data set. The validated model was then applied to 138 normal fetal brain MRIs to generate a normative reference range across a range of gestational ages (18-36 weeks). Finally, it was applied to 64 fetal brains with VM (14 of which required postnatal intervention). Receiver operating characteristic curves and area under curve (AUC) to predict VM and a need for postnatal intervention were calculated.

Results: The nnUNet predicted segmentation of the fetal ventricles in the reference data set were of high quality and accurate (median Dice score: 0.96; interquartile range: 0.93-0.99). A normative reference range of ventricular volumes across gestational ages was developed by using automated segmentation volumes. The optimal threshold for identifying VM was 2 SD from normal with a sensitivity of 92% and a specificity of 93% (AUC 0.97; 95% CI: 0.91-0.98). When normalized to intracranial volume, fetal ventricular volume was higher and subarachnoid volume lower among those who required postnatal intervention (P < .001, P = .003). The optimal threshold for identifying the need for postnatal intervention was 11 SD from normal, with a sensitivity of 86% and a specificity of 100% (AUC: 0.97; 95% CI: 0.86-1.00).

Conclusions: This work introduces a deep learning-based method for fast and accurate quantification of ventricular volumes in fetal brain MRI. A normative reference standard derived by using this method can predict VM and a need for postnatal CSF intervention. Increased ventricular volume is a strong predictor of postnatal intervention.

背景和目的:胎儿脑室肿大(VM)是一种常见的疾病,分离后多数为良性。然而,它偶尔会发展为脑积水,这是一种更严重的疾病,与死亡率增加和神经发育迟缓有关,可能需要手术产后干预。准确区分VM和脑积水至关重要,但仍然具有挑战性,依赖于主观评估和有限的二维测量。基于深度学习的分割为客观和可重复的体积分析提供了一个有前途的解决方案。这项工作提出了一种人工智能驱动的方法,用于胎儿脑MRI中心室的分割、体积量化和分类,以预测产后干预的需要。材料与方法:对222例单胎妊娠患者进行回顾性研究。训练nnUNet对20个人工分割的胎儿脑室进行分割,并结合来自公开数据集的80项研究。然后将验证的模型应用于138个正常胎儿的脑mri,以产生一个胎龄(18-36周)范围内的规范参考范围。最后将其应用于64例VM胎儿脑(其中14例需要产后干预)。计算预测VM和产后干预需求的ROC曲线和AUC。结果:nnUNet预测的参考数据集中胎儿脑室分割质量高,准确率高(Dice中位评分0.96,IQR 0.93-0.99)。使用自动分割体积建立了全胎龄心室容积的标准参考范围。诊断VM的最佳阈值为2个标准差,灵敏度为92%,特异性为93% (AUC 0.97, 95% CI 0.91-0.98)。当归一化到颅内容积时,需要产后干预的胎儿心室容积更高,蛛网膜下腔容积更低(结论:本工作引入了一种基于深度学习的方法,可以快速准确地定量胎儿脑MRI中的心室容积。通过该方法得出的规范性参考标准可以预测VM和产后脑脊液干预的需要。心室容积增加是产后干预的一个强有力的预测指标。缩写:VM =脑室肿大,2D =二维,3D =三维,ROC =受者工作特征,AUC =曲线下面积。
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引用次数: 0
Application of High-Resolution Conebeam CT for Evaluation of Endothelialization after Flow Diverter Implantation for Unruptured Intracranial Aneurysms. 高分辨率锥束计算机断层扫描在颅内未破裂动脉瘤分流术后内皮化评价中的应用。
Pub Date : 2026-02-05 DOI: 10.3174/ajnr.A8997
Shuailong Shi, Zhike Zhang, Shuhai Long, Ji Ma, Peijie Lu, Yuncai Ran, Shanshan Xie, Jie Yang, Ye Wang, Tengfei Li

Background and purpose: Although high-resolution conebeam CT (HR-CBCT) is used for immediate evaluation of stent apposition, studies using this technique to evaluate flow diverter (FD) endothelialization during follow-up are limited. The study aims to investigate the potential of HR-CBCT in assessing FD endothelialization and identify factors influencing poor endothelialization.

Materials and methods: The clinical and imaging data of patients with unruptured intracranial aneurysms (UIAs) treated by FDs from March 2019 to October 2023 were retrospectively analyzed. HR-CBCT was used for immediate evaluation of stent apposition, and FD endothelialization at 3, 6, and 12 months postimplantation was evaluated by using HR-CBCT and digital subtraction angiography. Multivariate logistic regression analysis was used to identify factors associated with poor endothelialization.

Results: Among 402 FDs implanted for 446 aneurysms in 378 patients, 41 showed incomplete stent apposition (ISA) in postimplantation HR-CBCT scans. The aneurysm-occlusion rate at 12 months postimplantation was 84.8% (378/446), with 8.7% (35/402) of the FDs exhibiting in-stent stenosis (ISS). At 12 months postimplantation, 343 (85.1%) FDs showed good endothelialization, while 59 (14.9%) exhibited poor endothelialization. Multivariate logistic regression analysis identified age ≥60 years (OR = 2.209; 95% CI, 1.053-4.635; P = .04), a large aneurysm lumen inflow angle (OR = 1.102; 95% CI, 1.071-1.135; P < .001), parent artery excessive tortuosity (OR = 9.402; 95% CI, 1.141-77.479; P = .04), and ISA (OR = 10.967; 95% CI, 4.290-28.035; P < .001) as independent risk factors for poor endothelialization.

Conclusions: HR-CBCT can accurately evaluate FD endothelialization and ISS of UIAs after FD implantation. Age ≥60 years, a large aneurysm lumen inflow angle, parent artery excessive tortuosity, and ISA are independent risk factors for poor endothelialization.

背景和目的:尽管高分辨率锥束计算机断层扫描(HR-CBCT)用于支架放置的即时评估,但在随访期间使用该技术评估血流分流器(FD)内皮化的研究有限。本研究旨在探讨HR-CBCT在评估FD内皮化方面的潜力,并确定影响内皮化不良的因素。材料与方法:回顾性分析2019年3月至2023年10月fd治疗未破裂颅内动脉瘤(UIAs)患者的临床及影像学资料。使用HR-CBCT立即评估支架放置情况,并在植入后3、6和12个月使用HR-CBCT和数字减影血管造影评估FD内皮化情况。采用多变量logistic回归分析确定与内皮化不良相关的因素。结果:378例患者446例动脉瘤植入402个fd,其中41例在植入后的HR-CBCT扫描中显示支架不完全贴位(ISA)。植入后12个月动脉瘤闭塞率为84.8%(378/446),其中8.7%(35/402)的fd出现支架内狭窄(ISS)。植入后12个月,343例(85.1%)fd内皮化良好,59例(14.9%)fd内皮化不良。多因素logistic回归分析发现年龄≥60岁(OR=2.209;95% CI:1.053 ~ 4.635;P=0.04),动脉瘤腔内流入角较大(OR=1.102;95% CI:1.071 ~ 1.135;P)。结论:HR-CBCT可准确评价FD植入后UIAs的FD内皮化和ISS。年龄≥60岁、动脉瘤腔流入角大、载动脉过度扭曲、ISA是内皮化不良的独立危险因素。HR-CBCT =高分辨率锥束计算机断层扫描;FD =分流器;未破裂颅内动脉瘤;ISA =支架放置不完全;ISS =支架内狭窄。
{"title":"Application of High-Resolution Conebeam CT for Evaluation of Endothelialization after Flow Diverter Implantation for Unruptured Intracranial Aneurysms.","authors":"Shuailong Shi, Zhike Zhang, Shuhai Long, Ji Ma, Peijie Lu, Yuncai Ran, Shanshan Xie, Jie Yang, Ye Wang, Tengfei Li","doi":"10.3174/ajnr.A8997","DOIUrl":"10.3174/ajnr.A8997","url":null,"abstract":"<p><strong>Background and purpose: </strong>Although high-resolution conebeam CT (HR-CBCT) is used for immediate evaluation of stent apposition, studies using this technique to evaluate flow diverter (FD) endothelialization during follow-up are limited. The study aims to investigate the potential of HR-CBCT in assessing FD endothelialization and identify factors influencing poor endothelialization.</p><p><strong>Materials and methods: </strong>The clinical and imaging data of patients with unruptured intracranial aneurysms (UIAs) treated by FDs from March 2019 to October 2023 were retrospectively analyzed. HR-CBCT was used for immediate evaluation of stent apposition, and FD endothelialization at 3, 6, and 12 months postimplantation was evaluated by using HR-CBCT and digital subtraction angiography. Multivariate logistic regression analysis was used to identify factors associated with poor endothelialization.</p><p><strong>Results: </strong>Among 402 FDs implanted for 446 aneurysms in 378 patients, 41 showed incomplete stent apposition (ISA) in postimplantation HR-CBCT scans. The aneurysm-occlusion rate at 12 months postimplantation was 84.8% (378/446), with 8.7% (35/402) of the FDs exhibiting in-stent stenosis (ISS). At 12 months postimplantation, 343 (85.1%) FDs showed good endothelialization, while 59 (14.9%) exhibited poor endothelialization. Multivariate logistic regression analysis identified age ≥60 years (OR = 2.209; 95% CI, 1.053-4.635; <i>P</i> = .04), a large aneurysm lumen inflow angle (OR = 1.102; 95% CI, 1.071-1.135; <i>P</i> < .001), parent artery excessive tortuosity (OR = 9.402; 95% CI, 1.141-77.479; <i>P</i> = .04), and ISA (OR = 10.967; 95% CI, 4.290-28.035; <i>P</i> < .001) as independent risk factors for poor endothelialization.</p><p><strong>Conclusions: </strong>HR-CBCT can accurately evaluate FD endothelialization and ISS of UIAs after FD implantation. Age ≥60 years, a large aneurysm lumen inflow angle, parent artery excessive tortuosity, and ISA are independent risk factors for poor endothelialization.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Brain CT for Diagnosis of Intracranial Disease in Ambulatory Patients with Cancer: Assessment of the Diagnostic Value of Scanning without Contrast Prior to with Contrast. 脑CT在门诊肿瘤患者颅内疾病诊断中的应用:不加对比扫描对加对比扫描诊断价值的评价。
Pub Date : 2026-02-05 DOI: 10.3174/ajnr.A8995
Ethan Wang, Azad Darbandi, Long Tu, Leomar Y Ballester, Charles de Jesus Morales, Melissa Chen, Maria K Gule-Monroe, Jason M Johnson

Background and purpose: Brain imaging with MRI or CT is standard in screening for intracranial disease among ambulatory patients with cancer. Though MRI offers greater sensitivity, CT is frequently employed because of its accessibility, affordability, and faster acquisition time. However, the necessity of routinely performing a noncontrast CT with the contrast-enhanced study is unknown. This study evaluates the clinical and economic utility of the noncontrast portion of the brain CT examination.

Materials and methods: A board-certified neuroradiologist reviewed 737 brain CT reports from outpatients at The University of Texas MD Anderson Cancer Center who underwent contrast and noncontrast CT for cancer staging (October 2014 to March 2016) to assess if clinically meaningful findings were identified only on noncontrast CT. A Generative Pretrained Transformers-3 (GPT-3) model was then fine-tuned to extract reports with a high likelihood of unique and meaningful noncontrast findings from 1980 additional brain CT reports (January 2017 to April 2022). These reports were manually reviewed by 2 neuroradiologists, with adjudication by a third reviewer if needed. The incremental cost-effectiveness ratio of noncontrast CT inclusion was then calculated based on Medicare reimbursement and the 95% CI of the proportion of all reports in which noncontrast CT was necessary for identifying meaningful findings.

Results: Seven of 737 reports in the initial data set revealed meaningful findings unique to the noncontrast CT, all of which were hemorrhage. The GPT-3 model identified 145 additional reports with a high unique noncontrast CT finding likelihood for manual review from the second data set of 1980 reports. Nineteen of these reports were found to have unique and meaningful noncontrast CT findings. In total, 0.96% (95% CI: 0.63-1.40) of reports had meaningful findings identified only on noncontrast CT. The incremental cost-effectiveness ratio for the identification of a single meaningful finding on noncontrast CT missed on the contrast-enhanced study was $1855 to $4122.

Conclusions: In brain CT for ambulatory screening for intracranial disease in patients with cancer, noncontrast CT offers limited additional diagnostic value compared with contrast-enhanced CT alone. Considering the associated financial cost, workload, and patient radiation exposure associated with performing a noncontrast CT, contrast-enhanced brain CT alone is sufficient for cancer staging in patients with asymptomatic cancer.

背景和目的:MRI或CT脑成像是筛查非流动肿瘤患者颅内疾病的标准方法。尽管MRI具有更高的灵敏度,但由于其可及性、可负担性和更快的采集时间,CT经常被采用。然而,常规进行非对比CT增强检查的必要性尚不清楚。本研究评估了脑CT检查的非对比部分的临床和经济效用。材料和方法:一名委员会认证的神经放射学家回顾了MD安德森癌症中心门诊患者的737份脑CT报告,这些患者接受了对比和非对比CT来评估癌症分期(2014年10月至2016年3月),以评估是否仅在非对比CT上发现了重大发现。然后对GPT-3模型进行微调,以从1980份额外的脑CT报告(2017年1月至2022年4月)中提取具有高可能性的独特且重要的非对比结果的报告。这些报告由两名神经放射学家手工审查,如果需要,由第三名审稿人裁决。然后,根据医疗保险报销和所有报告中需要进行非对比CT检查以确定重要发现的比例的95%置信区间,计算非对比CT纳入的增量成本-效果比。结果:初始数据集中的737份报告中有7份显示了非对比CT独有的重要发现,所有这些发现都是出血。GPT-3模型从1,980份报告的第二个数据集中确定了145份具有高独特非对比CT发现可能性的额外报告。这些报告中有19例发现有独特和显著的非对比CT表现。总的来说,0.96% (95% CI: 0.63% -1.40%)的报告仅在非对比CT上发现了显著的发现。在对比增强研究中,在非对比CT上识别单个重要发现的增量成本-效果比为1855美元至4122美元。结论:在用于肿瘤患者颅内疾病动态筛查的脑CT中,与单独增强CT相比,非对比CT提供的额外诊断价值有限。考虑到相关的财务成本、工作量和与进行非对比CT相关的患者辐射暴露,在无症状的癌症患者中,仅进行对比增强脑CT就足以确定癌症分期。缩写:GPT-3=生成预训练变形金刚3。
{"title":"Brain CT for Diagnosis of Intracranial Disease in Ambulatory Patients with Cancer: Assessment of the Diagnostic Value of Scanning without Contrast Prior to with Contrast.","authors":"Ethan Wang, Azad Darbandi, Long Tu, Leomar Y Ballester, Charles de Jesus Morales, Melissa Chen, Maria K Gule-Monroe, Jason M Johnson","doi":"10.3174/ajnr.A8995","DOIUrl":"10.3174/ajnr.A8995","url":null,"abstract":"<p><strong>Background and purpose: </strong>Brain imaging with MRI or CT is standard in screening for intracranial disease among ambulatory patients with cancer. Though MRI offers greater sensitivity, CT is frequently employed because of its accessibility, affordability, and faster acquisition time. However, the necessity of routinely performing a noncontrast CT with the contrast-enhanced study is unknown. This study evaluates the clinical and economic utility of the noncontrast portion of the brain CT examination.</p><p><strong>Materials and methods: </strong>A board-certified neuroradiologist reviewed 737 brain CT reports from outpatients at The University of Texas MD Anderson Cancer Center who underwent contrast and noncontrast CT for cancer staging (October 2014 to March 2016) to assess if clinically meaningful findings were identified only on noncontrast CT. A Generative Pretrained Transformers-3 (GPT-3) model was then fine-tuned to extract reports with a high likelihood of unique and meaningful noncontrast findings from 1980 additional brain CT reports (January 2017 to April 2022). These reports were manually reviewed by 2 neuroradiologists, with adjudication by a third reviewer if needed. The incremental cost-effectiveness ratio of noncontrast CT inclusion was then calculated based on Medicare reimbursement and the 95% CI of the proportion of all reports in which noncontrast CT was necessary for identifying meaningful findings.</p><p><strong>Results: </strong>Seven of 737 reports in the initial data set revealed meaningful findings unique to the noncontrast CT, all of which were hemorrhage. The GPT-3 model identified 145 additional reports with a high unique noncontrast CT finding likelihood for manual review from the second data set of 1980 reports. Nineteen of these reports were found to have unique and meaningful noncontrast CT findings. In total, 0.96% (95% CI: 0.63-1.40) of reports had meaningful findings identified only on noncontrast CT. The incremental cost-effectiveness ratio for the identification of a single meaningful finding on noncontrast CT missed on the contrast-enhanced study was $1855 to $4122.</p><p><strong>Conclusions: </strong>In brain CT for ambulatory screening for intracranial disease in patients with cancer, noncontrast CT offers limited additional diagnostic value compared with contrast-enhanced CT alone. Considering the associated financial cost, workload, and patient radiation exposure associated with performing a noncontrast CT, contrast-enhanced brain CT alone is sufficient for cancer staging in patients with asymptomatic cancer.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Foraminal [18F]FDG Uptake on PET/MRI is Associated with Radiculopathy and Symptom Reduction after Image-Guided Nerve Root Block. PET/MRI上椎间孔[18F]FDG摄取与图像引导下神经根阻滞后神经根病变和症状减轻有关。
Pub Date : 2026-02-05 DOI: 10.3174/ajnr.A8974
Virginie Kreutzinger, Katharina Ziegeler, Cynthia T Chin, Misung Han, Emma Bahroos, Isabelle Remick, Thomas M Link, Sharmila Majumdar, Daehyun Yoon

Background and purpose: There is an imperfect correlation between morphologic MRI findings and radiating low back pain (LBP). Nerve irritation, visualized as glucose hypermetabolism on [18F]FDG-PET/MRI, has the potential to identify symptomatic segments. This study aimed to investigate the association of foraminal [18F]FDG uptake on PET/MRI, radiologic abnormalities, and patient outcomes.

Materials and methods: Prospectively recruited patients with radiating LBP underwent [18F]FDG-PET/MRI of the lumbar spine in this observational study. Back pain and leg/buttock pain were assessed by using the visual analog scale (0-10). Foraminal stenosis, facet joint arthropathy, and annular fissures of the disc were graded by radiologists. As part of the standard clinical care, a subset of patients received image-guided nerve root blocks, by using a steroid/anesthetic mixture, and pain on visual analog scale was noted before and after injection. Standardized tracer uptake was quantitatively assessed in all neural foramina, facet joints, and discs. Generalized estimating equations were used to investigate associations between the maximum standardized uptake value of [18F]FDG in the neural foramina, degree of stenosis (none, mild, moderate, severe), and pain, additionally adjusted for tracer uptake in the adjacent tissues, age, sex, and body mass index.

Results: A total of 110 lumbar neural foramina in 11 patients were included in the analysis. Generalized estimating equations revealed significant associations between foraminal [18F]FDG uptake and degree of foraminal stenosis (β = 0.18; 95% CI, 0.03-0.33; P = .02). In patients with unilateral radicular symptoms but bilateral stenoses on MRI, [18F]FDG uptake was significantly higher on the symptomatic side (1.64 versus 1.88; P = .002). In segments treated with image-guided nerve root block, change in pain was positively associated with foraminal [18F]FDG uptake before injection (β = 2.24; 95% CI, 0.03-4.45; P = .05) but negatively associated with degree of stenosis (β = -1.27; 95%CI -2.24 to -0.31; P = .01).

Conclusions: Foraminal [18F]FDG uptake on PET/MRI as a surrogate marker of nerve irritation may improve differentiation between painful versus nonpainful foraminal stenosis.

背景与目的:MRI形态学表现与放射性腰痛之间的相关性不完全。神经刺激,在[18F]FDG-PET/MRI上显示为葡萄糖高代谢,具有识别症状节段的潜力。本研究旨在探讨椎间孔[18F]FDG摄取与PET/MRI、影像学异常和患者预后的关系。材料和方法:前瞻性招募放射性腰痛患者,在本观察性研究中对腰椎进行[18F]FDG PET/MRI检查。背部疼痛和腿/臀部疼痛采用视觉模拟量表(0-10)进行评估。放射科医生对椎间孔狭窄、关节突关节病变和椎间盘环裂进行分级。作为标准临床护理的一部分,一部分患者接受图像引导的神经根阻滞,使用类固醇/麻醉剂混合物,并在注射前后以视觉模拟量表记录疼痛。在所有神经孔、小关节和椎间盘中定量评估标准化示踪剂摄取。使用广义估计方程来研究神经孔中[18F]FDG的最大标准化摄取值、狭窄程度(无、轻度、中度、重度)和疼痛之间的关系,并根据邻近组织的示踪剂摄取、年龄、性别和体重指数进行调整。结果:11例患者共110个腰椎神经孔纳入分析。广义估计方程显示椎间孔[18F]FDG摄入与椎间孔狭窄程度之间存在显著相关性(β 0.18, 95%CI 0.03, 0.33, p=0.02)。在MRI显示单侧神经根症状但双侧狭窄的患者中,[18F]症状侧FDG摄取明显更高(1.64 vs. 1.88, p=0.002)。在图像引导神经根阻滞治疗的节段中,疼痛变化与注射前椎间孔[18F]FDG摄入呈正相关(β 2.24, 95%CI 0.03, 4.45, p=0.05),但与狭窄程度负相关(β -1.27, 95%CI -2.24, -0.31, p=0.01)。结论:椎间孔[18F]FDG在PET/MRI上摄取作为神经刺激的替代标记物,可以改善疼痛性和非疼痛性椎间孔狭窄的区分。缩写:LBP =腰痛,SUVmax =最大标准化摄取值。
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引用次数: 0
Head-to-Head Comparison of 2 Artificial Intelligence Computer-Aided Triage Solutions for Detecting Intracranial Hemorrhage on Noncontrast Head CT. 两种AI计算机辅助分诊方案在非对比头部CT上检测颅内出血的头对头比较
Pub Date : 2026-02-03 DOI: 10.3174/ajnr.A8986
Glenn M Garcia, Peter Young, Lydia Dawood, Mohammed Elshikh

Background and purpose: This study aims to provide a comprehensive comparison of the performance and reproducibility of 2 commercially available artificial intelligence (AI) software computer-aided triage and notification solutions, Vendor A (Aidoc) and Vendor B (Viz.ai), for the detection of intracranial hemorrhage (ICH) on noncontrast-enhanced head CT scans performed within a single academic institution.

Materials and methods: The retrospective analysis was conducted on a large patient cohort from multiple health care settings within a single academic institution, utilizing standardized scanning protocols. Sensitivity, specificity, false-positive (FP), and false-negative (FN) rates were evaluated for both vendors. Outputs assessed included AI-generated case-level classification.

Results: Among 4081 scans, 595 were positive for ICH. Vendor A demonstrated a sensitivity of 94.4% and specificity of 97.4%, PPV of 77.7%, and NPV of 99.5%. Vendor B showed a sensitivity of 59.5% and specificity of 99.0%, PPV of 85.5%, and NPV of 96.2%. Vendor A had 20 FNs, which primarily involved subdural and intraparenchymal hemorrhages, and 97 FPs, which appear to be related to motion artifact. Vendor B had 145 FNs, largely comprising of subdural and subarachnoid hemorrhages, and 36 FPs, which appeared to be related to motion artifact and calcified or dense lesions. Concordantly, 18 cases were FNs and 11 cases were FPs for both AI solutions.

Conclusions: The findings of this study provide valuable information for clinicians and health care institutions considering the implementation of AI software for computer-aided triage and notification in the detection of intracranial hemorrhage. The discussion encompasses the implications of the results, the importance of evaluating AI findings in context-especially in the absence of explainability tools, potential areas for improvement, and the relevance of standardized scanning protocols in ensuring the reliability of AI-based diagnostic tools in clinical practice.

背景和目的:本研究旨在全面比较两种商用人工智能(AI)软件计算机辅助分类和通知解决方案的性能和可重复性,供应商a (Aidoc)和供应商B (Viz.ai),用于在单个学术机构内进行的非对比增强头部CT (NCHCT)扫描中检测颅内出血(ICH)。材料和方法:采用标准化扫描协议,对来自单一学术机构的多个医疗保健机构的大型患者队列进行回顾性分析。对两家供应商的敏感性、特异性、假阳性和假阴性率进行了评估。评估的产出包括人工智能生成的病例级分类。结果:4081次扫描中,595次为脑出血阳性。供应商A的敏感性为94.4%,特异性为97.4%,PPV为85.9%,NPV为99.1%。卖方B的敏感性为59.5%,特异性为99.0%,PPV为90.0%,NPV为92.6%。供应商A有20个假阴性,主要涉及硬膜下和实质内出血,97个假阳性,似乎与运动伪影有关。供应商B有145例假阴性,主要包括硬膜下和蛛网膜下腔出血,36例假阳性,似乎与运动伪影和钙化或致密病变有关。两种人工智能解决方案均有18例假阴性,11例假阳性。结论:本研究结果为临床医生和医疗机构考虑在颅内出血检测中实施人工智能软件进行计算机辅助分诊和通知提供了有价值的信息。讨论内容包括研究结果的含义、评估人工智能发现的重要性,特别是在缺乏可解释性工具的情况下,潜在的改进领域,以及标准化扫描协议在确保临床实践中基于人工智能的诊断工具的可靠性方面的相关性。缩写:ICH =颅内出血;非对比增强头部CT;AI =人工智能;SDH =硬膜下出血;蛛网膜下腔出血;IPH =肝实质内出血;脑室内出血;PPV =阳性预测值;NPV =负预测值;计算机辅助分诊;图片存档和通信系统;FN =假阴性;FP =假阳性;CI =置信区间。
{"title":"Head-to-Head Comparison of 2 Artificial Intelligence Computer-Aided Triage Solutions for Detecting Intracranial Hemorrhage on Noncontrast Head CT.","authors":"Glenn M Garcia, Peter Young, Lydia Dawood, Mohammed Elshikh","doi":"10.3174/ajnr.A8986","DOIUrl":"10.3174/ajnr.A8986","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study aims to provide a comprehensive comparison of the performance and reproducibility of 2 commercially available artificial intelligence (AI) software computer-aided triage and notification solutions, Vendor A (Aidoc) and Vendor B (Viz.ai), for the detection of intracranial hemorrhage (ICH) on noncontrast-enhanced head CT scans performed within a single academic institution.</p><p><strong>Materials and methods: </strong>The retrospective analysis was conducted on a large patient cohort from multiple health care settings within a single academic institution, utilizing standardized scanning protocols. Sensitivity, specificity, false-positive (FP), and false-negative (FN) rates were evaluated for both vendors. Outputs assessed included AI-generated case-level classification.</p><p><strong>Results: </strong>Among 4081 scans, 595 were positive for ICH. Vendor A demonstrated a sensitivity of 94.4% and specificity of 97.4%, PPV of 77.7%, and NPV of 99.5%. Vendor B showed a sensitivity of 59.5% and specificity of 99.0%, PPV of 85.5%, and NPV of 96.2%. Vendor A had 20 FNs, which primarily involved subdural and intraparenchymal hemorrhages, and 97 FPs, which appear to be related to motion artifact. Vendor B had 145 FNs, largely comprising of subdural and subarachnoid hemorrhages, and 36 FPs, which appeared to be related to motion artifact and calcified or dense lesions. Concordantly, 18 cases were FNs and 11 cases were FPs for both AI solutions.</p><p><strong>Conclusions: </strong>The findings of this study provide valuable information for clinicians and health care institutions considering the implementation of AI software for computer-aided triage and notification in the detection of intracranial hemorrhage. The discussion encompasses the implications of the results, the importance of evaluating AI findings in context-especially in the absence of explainability tools, potential areas for improvement, and the relevance of standardized scanning protocols in ensuring the reliability of AI-based diagnostic tools in clinical practice.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"376-385"},"PeriodicalIF":0.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
American Society of Neuroradiology Consensus Statement: Integrating Neuro-PET Interpretation into Neuroradiology Training and Practice. ASNR共识声明:将神经pet解读纳入神经放射学培训和实践。
Pub Date : 2026-02-03 DOI: 10.3174/ajnr.A8959
Jana Ivanidze, Ana M Franceschi, Max Wintermark, John E Jordan, Mariam Aboian, Jim C Anderson, Reza Assadsangabi, Marc Daniel Benayoun, Tammie L Benzinger, Gloria Chia-Yi Chiang, Edward J Ebani, Akinrinola Famuyide, Norbert Galldiks, Leland S Hu, Derek R Johnson, Jason M Johnson, Alexander Khalaf, Ashley Knight-Greenfield, Philipp Lohmann, Farshad Moradi, Ali Nabavizadeh, Joshua P Nickerson, Gloria J Guzmán Pérez-Carrillo, Nadya Pyatigorskaya, Michelle Roytman, Timothy Shepherd, Gagandeep Singh, Jay Starkey, Michael C Veronesi, Christopher T Whitlow, Sema Yildiz, Michael Zeineh, Greg Zaharchuk, Prashant Raghavan, Ramon Francisco Barajas

Background: Molecular imaging, particularly PET, has advanced the diagnosis and management of disease by visualizing biologic processes at a cellular and molecular level. PET imaging of the brain, spine, and head/neck, summarized under the umbrella term neuro-PET, enables noninvasive diagnosis and monitoring of diseases such as dementia, epilepsy, cancer, movement, or autoimmune disorders. The increasing prevalence of these conditions, as well as new treatment options necessitating response assessment, are expected to escalate neuro-PET imaging volumes, with projections for an increase in the need for specialized imaging services. This increasing clinical need highlights existing workforce shortages and underscores the need for neuroradiologists to acquire proficiency in molecular imaging. This expanded role seeks to address the growing demand. To this end, we propose a rigorous, structured, patient-centered, and collaborative framework for expanding neuroradiologists' training and practice to include neuro-PET interpretation.

Methods: This American Society of Neuroradiology consensus statement outlines competency recommendations, training pathways, and implementation strategies to incorporate neuro-PET into neuroradiology practice. This approach is based on existing guidelines and was informed by survey data from neuroradiologists and molecular imaging subspecialists revealing current practice patterns and training needs. For neuroradiology fellows, structured training encompasses hands-on neuro-PET imaging experience, understanding the biologic and molecular basis of radiopharmaceuticals used in neuro-PET, and integrating molecular insights with anatomic data. Neuroradiologists beyond fellowship can undertake practice-based curriculum involving supervised case interpretation, standardized reader training courses, continuing medical education (CME), and peer review.

Key message: Neuroradiologists, with their in-depth expertise of central nervous system structure and function, are well positioned to meld molecular imaging data with traditional anatomic findings. They can achieve competency and should be granted practice privileges in interpreting neuro-PET studies through a comprehensive combination of structured training, hands-on clinical experience, and documented CME hours.

背景:分子成像,特别是正电子发射断层扫描(PET),通过在细胞和分子水平上可视化生物过程,显著地促进了疾病的诊断和管理。脑、脊柱和头颈部的PET成像,概括为神经PET,能够对痴呆、癫痫、癌症、运动或自身免疫性疾病等疾病进行无创诊断和监测。这些疾病的患病率不断上升,以及需要进行反应评估的新治疗方案,预计将增加神经pet成像量,预计对专业成像服务的需求将显著增加。这种不断增长的临床需求突出了现有的劳动力短缺,并强调了神经放射科医生熟练掌握分子成像的必要性。这一扩大的作用旨在解决日益增长的需求。为此,我们提出了一个严格的、结构化的、以患者为中心的协作框架,以扩大神经放射学家的培训和实践,包括神经pet解释。方法:本ASNR共识声明概述了将neuropet纳入神经放射学实践的能力建议、培训途径和实施策略。该方法基于现有的指导方针,并根据神经放射学家和分子成像亚专家的调查数据,揭示了当前的实践模式和培训需求。对于神经放射学研究员,结构化培训包括动手神经pet成像经验,了解用于神经pet的放射性药物的生物学和分子基础,以及将分子见解与解剖数据相结合。非研究员的神经放射科医生可以进行实践基础课程,包括有监督的病例解释、标准化的读者培训课程、继续医学教育(CME)和同行评审。关键信息:神经放射学家在中枢神经系统结构和功能方面拥有深厚的专业知识,能够很好地将分子成像数据与传统的解剖学发现融合在一起。通过全面的结构化培训、临床实践经验和记录在案的CME小时数,他们可以获得解释神经pet研究的能力,并应获得实践特权。缩写:PET =正电子发射断层扫描;继续医学教育;美国放射学会。
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引用次数: 0
The Importance of Small Lateral Dural CSF Collections in Spontaneous Intracranial Hypotension: A Radiologic-Anatomic Study. 自发性颅内低血压时硬脑膜侧小脑脊液收集的重要性:影像学解剖研究。
Pub Date : 2026-02-03 DOI: 10.3174/ajnr.A9061
Wouter I Schievink, Marcel M Maya, Andre E Boyke, Franklin G Moser, Ravi S Prasad, Vikram Wadhwa, Xuemo Fan

Background and purpose: Spinal CSF leaks cause spontaneous intracranial hypotension (SIH), characterized by orthostatic headaches, but the detection of these leaks may require specialized and invasive spinal imaging. We have noted the presence of small lateral dural CSF collections of unclear significance on digital subtraction myelography (DSM) in some of these patients suspected of having SIH. The purpose of the present study was to compare radiographic and anatomic intraoperative findings in patients with such small lateral dural CSF collections who underwent surgical exploration.

Materials and methods: This retrospective cohort study included a consecutive group of patients suspected of having SIH who 1) did not have a spinal longitudinal extradural collection or CSF-venous fistula on spinal imaging; 2) underwent DSM under general anesthesia in the lateral decubitus position; and 3) underwent surgery for the finding of small lateral dural CSF collections of uncertain significance.

Results: The study group consisted of 27 patients (22 women and 5 men; mean age, 44.6 years; range, 16-72 years). DSM demonstrated a total of 31 small lateral dural CSF collections measuring 0.6-2.4 mm in diameter (mean, 1.3 mm) and 1.3-12.3 mm (mean, 3.5 mm) caudal to the origin of the neve root sleeve. Intraoperative exploration found evidence of a CSF leak in all 27 patients. One or more CSF-venous fistulas were found in 23 patients, and a pedicular type lateral CSF leak, in 4 patients. Radiographic differentiation between these 2 types of spinal CSF leaks could not be made with confidence.

Conclusions: Some patients suspected of having SIH have small lateral dural CSF collections on DSM caudal to the origin of the nerve root sleeve. We have found evidence of a CSF leak in all these patients on surgical exploration. This observation expands their treatment options.

背景和目的:脊髓脊液泄漏引起自发性颅内低血压(SIH),以直立性头痛为特征,但检测这些泄漏可能需要专门的侵入性脊柱成像。我们注意到,在一些怀疑患有SIH的患者中,数字减影脊髓造影(DSM)显示小的外侧硬脑脊液收集,但意义不明确。本研究的目的是比较手术探查有少量侧硬脑脊液收集的患者术中影像学和解剖学表现。材料和方法:本回顾性队列研究纳入了一组连续的疑似SIH患者,他们1)在脊柱成像上没有脊髓纵向硬膜外收集或csf -静脉瘘;2)在全身麻醉下侧卧位行DSM;3)发现有意义不确定的小脑脊膜外侧脑脊液收集而行手术。结果:研究组共有27例患者,其中女性22例,男性5例,平均年龄44.6岁,范围16-72岁。DSM显示共有31个小的外侧硬脑脊液收集,直径0.6-2.4 mm(平均1.3 mm)和1.3-12.3 mm(平均3.5 mm),位于神经根套管起源的尾端。术中探查发现27例患者均有脑脊液泄漏。23例患者发现一个或多个脑脊液静脉瘘,4例患者发现椎弓根型脑脊液外侧漏。这两种类型的脊髓脊液渗漏的影像学鉴别不能确定。结论:一些怀疑患有SIH的患者在神经根套起源的DSM侧侧有少量硬脑脊液收集。我们在手术探查中发现了所有患者脑脊液泄漏的证据。这一观察结果扩大了他们的治疗选择。
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引用次数: 0
Epidural Onyx Treatment for Spontaneous Intracranial Hypotension Caused by a Ventral Dural Tear. 硬膜外缟玛石治疗腹侧硬膜撕裂所致自发性颅内低血压。
Pub Date : 2026-02-03 DOI: 10.3174/ajnr.A8993
Yingchao He, Chao Chen, Yiya Xu, Yongkun Li, Yusheng Yao, Yinzhou Wang

Definitive treatment of spontaneous intracranial hypotension caused by a spinal CSF leak may be challenging with conservative management or an epidural blood patch. This study describes 2 cases of spontaneous intracranial hypotension treated with fluoroscopically-guided, catheter-delivered Onyx to seal a spinal CSF leak, with significant improvement observed during a 2-year follow-up. Digital subtraction myelography was used to localize the site of the CSF leak. Onyx was precisely delivered to the site of the CSF leak via a catheter under fluoroscopic guidance. Postprocedural spinal CT confirmed the presence of Onyx at the injected site. Both patients exhibited resolution of symptoms and CSF leaks during the 2-year follow-up. Repeat spinal MRI demonstrated a gradual and marked reduction in the spinal longitudinal epidural collection during the follow-up period. No noticeable complications were reported. These findings indicate that epidural Onyx treatment may represent a novel and promising strategy for managing spontaneous intracranial hypotension caused by a dural tear.

脊液泄漏引起的自发性颅内低血压的最终治疗可能是保守管理或硬膜外血液贴片的挑战。本研究描述了2例自发性颅内低血压患者,在透视引导下,导管输送Onyx治疗脊髓CSF泄漏,在2年随访期间观察到显著改善。采用数字减影脊髓造影定位脑脊液渗漏部位。在透视引导下,通过导管将玛瑙精确地送到脑脊液泄漏部位。术后脊柱CT证实在注射部位有缟玛瑙。在2年的随访中,两例患者均表现出症状缓解和脑脊液泄漏。在随访期间,重复脊柱MRI显示脊髓纵向硬膜外收集逐渐显著减少。无明显并发症。这些发现表明硬膜外治疗可能是一种新的和有前途的策略来治疗由硬膜撕裂引起的自发性颅内低血压。
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引用次数: 0
期刊
AJNR. American journal of neuroradiology
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