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Webster LA, Villalobos A, Cheng B, Xing M, Majdalany BS, Bercu ZL, Cristescu MM, Brandon D, Schuster D, Baum Y, Loya MF, Kokabi N. Correlation of Non-tumoral Liver Dose with Treatment-Related Adverse Events in Patients with Hepatocellular Carcinoma Treated with Glass-Based Yttrium-90 Radioembolization. Cardiovasc Intervent Radiol 2023; 46:60-68. [PMID: 36450996 DOI: 10.1007/s00270-022-03314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/28/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE To evaluate the relationship between non-tumor liver (NTL) dose and adverse events (AE) in patients with hepatocellular carcinoma (HCC) treated with glass-based Yttrium-90 radioembolization (Y90-RE). MATERIALS AND METHODS A retrospective analysis of patients with HCC treated with Y90-RE between 2013 and 2018 was performed. Baseline characteristics including demographics and Y90-RE treatment approach were captured. Common Terminology Criteria for Adverse Events v5 was assessed at months 3 and 6 post-treatment. Using voxel-based dosimetry with MIM Software V. 6.9, dose-volume histograms of treated area of liver were created. Receiver operator characteristic curve was used to determine NTL dose threshold predicting AEs. Multivariate analysis was used to determine independent clinical factors of predicting severe AEs. Chi-square analysis was used to compare proportions. RESULTS Two hundred and twenty-nine consecutive patients (115(50.2%) lobar and 114(49.8%) segmental) were included. At 3 months, there was a lower rate of any grade AE (55(46%) segmental and 36(31%) lobar, p = 0.009) and increased rate of severe AEs for lobar compared to segmental (2(2%) segmental and 9(8%) lobar, p = 0.029). At 6 months, severe AEs were greater for lobar than segmental (1(1%) segmental vs 10(9%) lobar, p = 0.005). For lobar Y90-RE, mean NTL dose of 112 Gy predicted severe AE (89% sensitivity and 91% specificity (AUC = 0.95, p = < 0.0001) at 3 and 6 months. For the segmental group, no significant association was found between NTL dose and severe treatment-related AE at 3 and 6 months. CONCLUSION In patients with HCC undergoing glass-based lobar Y90-RE, NTL dose of > 112 Gy is associated with severe treatment-related AEs at 3-6 months.
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Affiliation(s)
- Linzi A Webster
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Alex Villalobos
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Bernard Cheng
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Minzhi Xing
- Office of Epidemiology, Dekalb Country Board of Health, Atlanta, GA, USA
| | - Bill S Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Zachary L Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mircea M Cristescu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - David Brandon
- Department of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - David Schuster
- Department of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Yoram Baum
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammed F Loya
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Gholami YH, Willowson KP, Bailey DL. Towards personalised dosimetry in patients with liver malignancy treated with 90Y-SIRT using in vivo-driven radiobiological parameters. EJNMMI Phys 2022; 9:49. [PMID: 35907097 PMCID: PMC9339072 DOI: 10.1186/s40658-022-00479-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/20/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The prediction of response is one of the major challenges in radiation-based therapies. Although the selection of accurate linear-quadratic model parameters is essential for the estimation of radiation response and treatment outcome, there is a limited knowledge about these radiobiological parameters for liver tumours using radionuclide treatments. METHODS The "clinical radiobiological" parameters ([Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text]) for twenty-five patients were derived using the generalised linear-quadratic model, the diagnostic ([18F] FDG PET/CT) and therapeutic ([90Y]-SIR-Spheres PET/CT) images to compute the biological effective dose and tumour control probability (TCP) for each patient. RESULTS It was estimated that the values for [Formula: see text] and [Formula: see text] parameters range in ≈ 0.001-1 Gy-1 and ≈ 1-49 Gy, respectively. We have demonstrated that the time factors, [Formula: see text], [Formula: see text] and [Formula: see text] are the key parameters when evaluating liver malignancy lesional response to [90Y]SIR-Spheres treatment. Patients with cholangiocarcinoma have been shown to have the longest average [Formula: see text] (≈ 236 ± 67 d), highest TCP (≈ 53 ± 17%) and total liver lesion glycolysis response ([Formula: see text] ≈ 64%), while patients with metastatic colorectal cancer tumours have the shortest average [Formula: see text] (≈ 129 ± 19 d), lowest TCP (≈ 28 ± 13%) and [Formula: see text] ≈ 8%, respectively. CONCLUSIONS Tumours with shorter [Formula: see text] have shown a shorter [Formula: see text] and thus poorer TCP and [Formula: see text]. Therefore, these results suggest for such tumours the [90Y]SIR-Spheres will be only effective at higher initial dose rate (e.g. > 50 Gy/day).
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Affiliation(s)
- Yaser H Gholami
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Sydney Vital Translational Cancer Research Centre, University of Sydney, Sydney, Australia. .,Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia.
| | - Kathy P Willowson
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Dale L Bailey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Sydney Vital Translational Cancer Research Centre, University of Sydney, Sydney, Australia. .,Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia.
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Kim SP, Juneau D, Cohalan C, Enger SA. Standardizing SPECT/CT dosimetry following radioembolization with yttrium-90 microspheres. EJNMMI Phys 2021; 8:71. [PMID: 34716850 PMCID: PMC8557238 DOI: 10.1186/s40658-021-00413-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/10/2021] [Indexed: 12/19/2022] Open
Abstract
Background Multiple post-treatment dosimetry methods are currently under investigation for Yttrium-90 (\documentclass[12pt]{minimal}
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\begin{document}$$^{90}\hbox {Y}$$\end{document}90Y) radioembolization. Within each methodology, a variety of dosimetric inputs exists that affect the final dose estimates. Understanding their effects is essential to facilitating proper dose analysis and crucial in the eventual standardization of radioembolization dosimetry. The purpose of this study is to investigate the dose differences due to different self-calibrations and mass density assignments in the non-compartmental and local deposition methods. A practical mean correction method was introduced that permits dosimetry in images where the quality is compromised by patient motion and partial volume effects. Methods Twenty-one patients underwent \documentclass[12pt]{minimal}
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\begin{document}$$^{90}\hbox {Y}$$\end{document}90Y radioembolization and were imaged with SPECT/CT. Five different self-calibrations (FOV, Body, OAR, Liverlung, and Liver) were implemented and dosimetrically compared. The non-compartmental and local deposition method were used to perform dosimetry based on either nominal- or CT calibration-based mass densities. A mean correction method was derived assuming homogeneous densities. Cumulative dose volume histograms, linear regressions, boxplots, and Bland Altman plots were utilized for analysis. Results Up to 270% weighted dose difference was found between self-calibrations with mean dose differences up to 50 Gy in the liver and 23 Gy in the lungs. Between the local deposition and non-compartmental methods, the liver and lung had dose differences within 0.71 Gy and 20 Gy, respectively. The local deposition method’s nominal and CT calibration-based mass density implementations dosimetric metrics were within 1.4% in the liver and 24% in the lungs. The mean lung doses calculated with the CT method were shown to be inflated. The mean correction method demonstrated that the corrected mean doses were greater by up to \documentclass[12pt]{minimal}
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\begin{document}$$\sim 5$$\end{document}∼5 Gy in the liver and lower by up to \documentclass[12pt]{minimal}
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\begin{document}$$\sim 12$$\end{document}∼12 Gy in the lungs. Conclusions The OAR calibration may be utilized as a potentially more accurate and precise self-calibration. The non-compartmental method was found more comparable to the local deposition method in organs that were more homogeneous in mass densities. Due to the potential for inflated lung mean doses, the non-compartmental and local deposition method implemented with nominal mass densities is recommended for more consistent dosimetric results. If patient motion and partial volume effects are present in the liver, our practical correction method will calculate more representative doses in images suboptimal for dosimetry.
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Affiliation(s)
- S Peter Kim
- Medical Physics Unit, McGill University, Montreal, Canada. .,Biological and Biomedical Engineering, McGill University, Montreal, Canada.
| | - Daniel Juneau
- Department of Medical Imaging, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Claire Cohalan
- Department of Physics and Biomedical Engineering, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Shirin A Enger
- Medical Physics Unit, McGill University, Montreal, Canada.,Biological and Biomedical Engineering, McGill University, Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
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Thompson BC, Dezarn WA. Retrospective SPECT/CT dosimetry following transarterial radioembolization. J Appl Clin Med Phys 2021; 22:143-150. [PMID: 33710776 PMCID: PMC8035553 DOI: 10.1002/acm2.13213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/22/2021] [Accepted: 02/10/2021] [Indexed: 01/14/2023] Open
Abstract
Transarterial radioembolization (TARE) effectively treats unresectable primary and metastatic liver tumors through intra‐arterial injection of Yttrium‐90 (90Y) beta particle emitting microspheres which implant around the tumor. Current dosimetry models are highly simplistic and there is a large need for an image‐based dosimetry post‐TARE, which would improve treatment safety and efficacy. Current post‐TARE imaging is 90Y bremsstrahlung SPECT/CT and we study the use of these images for dosimetry. Retrospective image review of ten patients having a Philips HealthcareTM SPECT/CT following TARE SIR‐Spheres® implantation. Emission series with attenuation correction were resampled to 3 mm resolution and used to create image‐based dose distributions. Dose distributions and analysis were performed in MIM Software SurePlanTM utilizing SurePlanTM Local Deposition Method (LDM) and a dose convolution method (WFBH). We sought to implement a patient‐specific background subtraction prior to dose calculation to make these noisy bremsstrahlung SPECT images suitable for post‐TARE dosimetry. On average the percentage of mean background counts to maximum count in the image across all patients was 9.4 ± 4.9% (maximum = 7.6%, minimum = 2.3%). Absolute dose increased and profile line width decreased as background subtraction value increased. The average value of the LDM and WFBH dose methods was statistically the same. As background subtraction value increased, the DVH curves become unrealistic and distorted. Background subtraction on bremsstrahlung SPECT image has a large effect on post‐TARE dosimetry. The background contour defined provides a systematic estimate to the activity background that accounts for the scanner and patient conditions at the time of the image study and is easily implemented using commercially available software. Using the mean count in the background contour as a subtraction across the entire image gave the most realistic dose distributions. This methodology is independent of microsphere and software manufacturer allowing for use with any available products or tools.
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Affiliation(s)
- Briana C Thompson
- Department of Radiation Oncology, Wake Forest Baptist Hospital, Winston-Salem, NC, USA.,Wake Forest School of Medicine, Molecular Medicine and Translational Sciences, Winston Salem, NC, USA
| | - William A Dezarn
- Department of Radiation Oncology, Wake Forest Baptist Hospital, Winston-Salem, NC, USA.,Wake Forest School of Medicine, Molecular Medicine and Translational Sciences, Winston Salem, NC, USA
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Li R, Li D, Jia G, Li X, Sun G, Zuo C. Diagnostic Performance of Theranostic Radionuclides Used in Transarterial Radioembolization for Liver Cancer. Front Oncol 2021; 10:551622. [PMID: 33569342 PMCID: PMC7868560 DOI: 10.3389/fonc.2020.551622] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022] Open
Abstract
Primary liver tumor with hepatocellular carcinoma accounting for 75–80% of all such tumors, is one of the global leading causes of cancer-related death, especially in cirrhotic patients. Liver tumors are highly hypervascularized via the hepatic artery, while normal liver tissues are mainly supplied by the portal vein; consequently, intra-arterially delivered treatment, which includes transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), is deemed as a palliative treatment. With the development of nuclear technology and radiochemistry, TARE has become an alternative for patients with hepatic cancer, especially for patients who failed other therapies, or for patients who need tumor downstaging treatment. In practice, some radionuclides have suitable physicochemical characteristics to act as radioactive embolism agents. Among them, 90Y emits β rays only and is suitable for bremsstrahlung single photon emission computed tomography (BS SPECT) and positron emission tomography (PET); meanwhile, some others, such as 131I, 153Sm, 166Ho, 177Lu, 186Re, and 188Re, emit both β and γ rays, enabling embolism beads to play a role in both therapy and single photon emission computed tomography (SPECT) imaging. During TARE, concomitant imaging provide additive diagnostic information and help to guide the course of liver cancer treatment. Therefore, we review the theranostic radionuclides that have been used or could potentially be used in TARE for liver cancer and focus on the clinical benefits of diagnostic applications, including real-time monitoring of embolism beads, evaluating irradiation dose, predicting therapy effects, and corresponding adjustments to TARE.
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Affiliation(s)
- Rou Li
- Department of Nuclear Medicine, Shanghai Changhai Hospital, Shanghai, China.,School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Danni Li
- Department of Nuclear Medicine, Shanghai Changhai Hospital, Shanghai, China
| | - Guorong Jia
- Department of Nuclear Medicine, Shanghai Changhai Hospital, Shanghai, China
| | - Xiao Li
- Department of Nuclear Medicine, Shanghai Changhai Hospital, Shanghai, China
| | - Gaofeng Sun
- Department of Nuclear Medicine, Shanghai Changhai Hospital, Shanghai, China
| | - Changjing Zuo
- Department of Nuclear Medicine, Shanghai Changhai Hospital, Shanghai, China.,School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
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Huang M, Zhao Q, Ye Z, Xu D, Tang S, Jiang T. Development of a novel melatonin-modified near-infrared fluorescent probe for in vivo hepatocellular carcinoma imaging. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:4556-4561. [PMID: 33001063 DOI: 10.1039/d0ay01135e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hepatocellular carcinoma (HCC) is a common malignancy worldwide with poor prognosis. The early identification and precise resection of HCC are essential for improving the prognosis and overall survival of patients. In clinical practice, fluorescence imaging is a powerful technology to identify and remove HCC lesions, but accurate and reliable detection of HCC continues to remain a challenge due to non-specificity and false-positive uptake of probes. To circumvent these problems, it is crucial to design a specific probe for the accurate detection of HCC. Herein, we reported the design and synthesis of an NIR fluorescent probe by conjugating IRDye800CW with melatonin, which plays a significant role in the HCC development. The in vivo imaging revealed that IRDye800-MT was uptake specifically by the HCC tumor with a high tumor-to-background ratio. These results demonstrated that IRDye800-MT might hold clinical potentials for future diagnosis of HCC patients.
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Affiliation(s)
- Min Huang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province 310003, China.
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Peters SMB, van der Werf NR, Segbers M, van Velden FHP, Wierts R, Blokland KJAK, Konijnenberg MW, Lazarenko SV, Visser EP, Gotthardt M. Towards standardization of absolute SPECT/CT quantification: a multi-center and multi-vendor phantom study. EJNMMI Phys 2019; 6:29. [PMID: 31879813 PMCID: PMC6933042 DOI: 10.1186/s40658-019-0268-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/05/2019] [Indexed: 11/29/2022] Open
Abstract
Abstract Absolute quantification of radiotracer distribution using SPECT/CT imaging is of great importance for dosimetry aimed at personalized radionuclide precision treatment. However, its accuracy depends on many factors. Using phantom measurements, this multi-vendor and multi-center study evaluates the quantitative accuracy and inter-system variability of various SPECT/CT systems as well as the effect of patient size, processing software and reconstruction algorithms on recovery coefficients (RC). Methods Five SPECT/CT systems were included: Discovery™ NM/CT 670 Pro (GE Healthcare), Precedence™ 6 (Philips Healthcare), Symbia Intevo™, and Symbia™ T16 (twice) (Siemens Healthineers). Three phantoms were used based on the NEMA IEC body phantom without lung insert simulating body mass indexes (BMI) of 25, 28, and 47 kg/m2. Six spheres (0.5–26.5 mL) and background were filled with 0.1 and 0.01 MBq/mL 99mTc-pertechnetate, respectively. Volumes of interest (VOI) of spheres were obtained by a region growing technique using a 50% threshold of the maximum voxel value corrected for background activity. RC, defined as imaged activity concentration divided by actual activity concentration, were determined for maximum (RCmax) and mean voxel value (RCmean) in the VOI for each sphere diameter. Inter-system variability was expressed as median absolute deviation (MAD) of RC. Acquisition settings were standardized. Images were reconstructed using vendor-specific 3D iterative reconstruction algorithms with institute-specific settings used in clinical practice and processed using a standardized, in-house developed processing tool based on the SimpleITK framework. Additionally, all data were reconstructed with a vendor-neutral reconstruction algorithm (Hybrid Recon™; Hermes Medical Solutions). Results RC decreased with decreasing sphere diameter for each system. Inter-system variability (MAD) was 16 and 17% for RCmean and RCmax, respectively. Standardized reconstruction decreased this variability to 4 and 5%. High BMI hampers quantification of small lesions (< 10 ml). Conclusion Absolute SPECT quantification in a multi-center and multi-vendor setting is feasible, especially when reconstruction protocols are standardized, paving the way for a standard for absolute quantitative SPECT.
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Affiliation(s)
- Steffie M B Peters
- Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Niels R van der Werf
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Physics, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Marcel Segbers
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Floris H P van Velden
- Department of Radiology, Section of Medical Physics, Leiden University Medical Center, Leiden, The Netherlands
| | - Roel Wierts
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | - Koos J A K Blokland
- Department of Radiology, Section of Medical Physics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark W Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Sergiy V Lazarenko
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Eric P Visser
- Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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