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Liu Y, Lu T, Wang C, Li H, Xu K, Li P. Intravital assessment of angioarchitecture in rat hepatocellular nodules using in vivo fluorescent microscopy. Quant Imaging Med Surg 2019; 9:1047-1055. [PMID: 31367558 DOI: 10.21037/qims.2019.06.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To prospectively evaluate the stepwise changes that occur in intra-nodular microvessels and microcirculation during the carcinogenesis process of hepatocellular nodules by using in vivo fluorescent microscopy, and to compare these with pathological changes. Methods Forty-five 10-week-old male Wistar rats received drinking water containing N-nitrosomorpholine at 10 mg/100 mL for 18weeks to develop multiple hepatocellular carcinomas (HCC) and dysplastic nodules (DN) in the liver; meanwhile, the non-lesion liver tissues become fibrotic. The microvascular morphological change and hemodynamic change of two lesion areas (HCC or DN) and one non-lesion area in each rat were observed with in vivo fluorescent microscope. After in vivo microscopy, 90 nodules and 45 non-lesion liver tissues that were observed were removed for pathological study. The microvessel density (MVD), branch density (BD), and cell density (CD) of these lesions were compared with the Kruskal-Wallis test and Mann-Whitney test, with an overall statistical significance of 0.05. Results The intra-nodular microvessels appeared tortuous, with irregular branching and abrupt diameter changes to form irregular convoluted networks in the HCC. This was distinctly different from the appearance of DN and non-lesion liver parenchyma. The MVD and BD of HCC were less than that of the DN and non-lesion liver parenchyma (P<0.01), and the BD of DN was also less than that of the non-lesion liver parenchyma (P<0.05). However, the MVD of the DN was similar to that of the non-lesion liver parenchyma (P>0.05). The CD of HCC was more than that of the DN and non-lesion liver parenchyma (P<0.05), and the CD of DN was also more than that of the non-lesion liver parenchyma (P<0.05). Conclusions Concurrent with the carcinogenesis process of the hepatocellular nodule, both the intra-nodular microvascular morphology and hemodynamics were stepwise changed, and the number of the intravascular lumen of intranodular microvessels decreased due to the infiltration and compression of intra-nodular parenchymal cells.
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Affiliation(s)
- Yi Liu
- Department of Radiology, The First Clinical Hospital of China Medical University, Shenyang 110001, China
| | - Tao Lu
- Department of Radiology, The First Clinical Hospital of China Medical University, Shenyang 110001, China
| | - Congcong Wang
- Department of Radiology, The First Clinical Hospital of China Medical University, Shenyang 110001, China
| | - Hui Li
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Ke Xu
- Department of Radiology, The First Clinical Hospital of China Medical University, Shenyang 110001, China
| | - Peiling Li
- Department of Radiology, The First Clinical Hospital of China Medical University, Shenyang 110001, China
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Abstract
There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia–Pacific region, where HCC is one of the leading public health problems. Since the “Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines” meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.
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Diagnosing Borderline Hepatic Nodules in Hepatocarcinogenesis: Imaging Performance. AJR Am J Roentgenol 2015; 205:10-21. [PMID: 26102378 DOI: 10.2214/ajr.14.12655] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purposes of this article are to describe the pathologic and radiologic features of small nodular lesions and to offer insight into the multistep process of hepatocarcinogenesis by describing the progression of imaging changes that link dysplastic nodules and early hepatocellular carcinoma, (HCC) to small HCC that has progressed. CONCLUSION Nodules larger than 1 cm found during ultrasound surveillance of a cirrhotic liver should be investigated further with diagnostic imaging. Contrast-enhanced CT and dynamic MRI are the primary diagnostic studies for the diagnosis of HCC; contrast-enhanced ultrasound can be used as an alternative test. If a nodule has the typical hallmark of hypervascularity in the hepatic arterial phase with washout in the portal venous or delayed phase, a definitive diagnosis of HCC can be made. Nodules found during ultrasound surveillance that are smaller than 1 cm can be followed with ultrasound examinations at intervals of 3-6 months.
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Matsuda M, Tsuda T, Yoshioka S, Murata S, Tanaka H, Hirooka M, Hiasa Y, Mochizuki T. Incidence for progression of hypervascular HCC in hypovascular hepatic nodules showing hyperintensity on gadoxetic acid-enhanced hepatobiliary phase in patients with chronic liver diseases. Jpn J Radiol 2014; 32:405-13. [DOI: 10.1007/s11604-014-0323-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/19/2014] [Indexed: 01/22/2023]
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Endo T, Kozaka K, Kobayashi S, Sanada J, Koda W, Minami T, Kitao A, Yoneda N, Nakanuma Y, Gabata T, Matsui O. Hemodynamics and progression of a hypervascular focus in a borderline lesion of hepatocellular carcinoma: analysis by angiography-assisted CT and histopathology. Jpn J Radiol 2013; 32:69-79. [DOI: 10.1007/s11604-013-0268-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 11/13/2013] [Indexed: 02/02/2023]
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Inoue T, Hyodo T, Murakami T, Takayama Y, Nishie A, Higaki A, Korenaga K, Sakamoto A, Osaki Y, Aikata H, Chayama K, Suda T, Takano T, Miyoshi K, Koda M, Numata K, Tanaka H, Iijima H, Ochi H, Hirooka M, Imai Y, Kudo M. Hypovascular hepatic nodules showing hypointense on the hepatobiliary-phase image of Gd-EOB-DTPA-enhanced MRI to develop a hypervascular hepatocellular carcinoma: a nationwide retrospective study on their natural course and risk factors. Dig Dis 2013; 31:472-9. [PMID: 24281023 DOI: 10.1159/000355248] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to investigate the natural outcome of nonhypervascular lesions detected in the hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI by performing a longitudinal study retrospectively enrolled in a nationwide manner. METHODS Between February 2008 and March 2011, 224 patients with 504 nodules that were diagnosed as nonhypervascular by imaging were recruited from institutions that participated in the present study. We examined the natural outcome of nonhypervascular lesions and evaluated the risk factors. RESULTS Of the 504 nodules, 173 (34.3%) showed hypervascular transformation. The overall cumulative incidence of hypervascular transformation was 14.9% at 12 months and 45.8% at 24 months. Multivariate analysis using the Cox regression model revealed previous treatment history for hepatocellular carcinoma (HCC; relative risk = 1.498; p = 0.036, 95% CI 1.03-2.19) and hyperintensity on T2-weighted images (relative risk = 1.724; p = 0.015, 95% CI 1.11-2.67) were identified as independent factors for hypervascular transformation. CONCLUSIONS Patients who have a previous treatment history for HCC and with hypointense nodules showing hyperintensity on T2-weighted images need careful follow-up because of the high incidence of hypervascular transformation.
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Affiliation(s)
- Tatsuo Inoue
- Department of Gastroenterology and Hepatology, Kinki University, Osakasayama, Japan
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Takechi M, Tsuda T, Yoshioka S, Murata S, Tanaka H, Hirooka M, Mochizuki T. Risk of hypervascularization in small hypovascular hepatic nodules showing hypointense in the hepatobiliary phase of gadoxetic acid-enhanced MRI in patients with chronic liver disease. Jpn J Radiol 2012; 30:743-51. [PMID: 23001373 DOI: 10.1007/s11604-012-0120-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/09/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to elucidate the incidence and risk factors for the progression of hypointense nodules observed in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) of hypervascular hepatocellular carcinoma (HCC). MATERIALS AND METHODS Hypovascular nodules (112) showing hypointensity in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were examined in 54 patients. All patients underwent computed tomography during hepatic arteriography and computed tomography during arterial portography (CTAP) within a month after Gd-EOB-DTPA-enhanced MRI. According to the tumor size, 112 nodules were divided into two groups: those >10 mm in diameter (group A, n = 39) and those ≤10 mm in diameter (group B, n = 73). The incidence of progression to hypervascular HCC was calculated using the Kaplan-Meier method. RESULTS The incidence of hypervascularization was significantly higher in group A nodules than in group B nodules (p < 0.0001). Tumor size (p < 0.0001) and hypoattenuation in CTAP (p = 0.0004) showed significant correlation with hypervascularization. CONCLUSION Hypointense nodules observed in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI with diameters of >10 mm had a high probability of hypervascularization.
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Affiliation(s)
- Megumi Takechi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon 791-0295, Japan.
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Kobayashi S, Matsui O, Gabata T, Koda W, Minami T, Ryu Y, Kozaka K, Kitao A. Intranodular signal intensity analysis of hypovascular high-risk borderline lesions of HCC that illustrate multi-step hepatocarcinogenesis within the nodule on Gd-EOB-DTPA-enhanced MRI. Eur J Radiol 2012; 81:3839-45. [PMID: 22884705 DOI: 10.1016/j.ejrad.2012.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 06/12/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To analyze intranodular signal intensity pattern of hypovascular high-risk borderline lesions of HCC that illustrate multi-step hepatocarcinogenesis within the nodule on Gd-EOB-DTPA-enhanced MRI. METHODS A total of 73 nodules showing hypervascular foci in hypovascular high-risk borderline lesions identified by angiography-assisted CT were included in this study. The intranodular signal intensities of both the hypervascular foci and the hypovascular high-risk borderline lesions were evaluated on hepatobiliary-phase EOB-enhanced MRI obtained 20 min after intravenous injection of contrast media. RESULTS Among 59 hypervascular foci within hypointense hypovascular high-risk borderline lesions, 6 showed more hypointensity, 32 isointensity, and 21 hyperintensity compared to the surrounding hypointense, hypovascular portion of the nodules. Among 14 hypervascular foci within isointense hypovascular high-risk borderline lesions, 5 showed isointensity, and 9 hypointensity compared to the surrounding isointense hypovascular high-risk borderline lesions. No hypervascular foci showed hyperintensity compared to the surrounding isointense hypovascular high-risk borderline lesions. CONCLUSIONS In most of the hypovascular high-risk borderline lesions containing hypervascular foci within the nodule, the signal intensity was decreased in hypervascular foci as compared with hypovascular high-risk borderline lesions and the surrounding background liver parenchyma. This supports the concept of signal intensity decrease during the dedifferentiation process in multistep hepatocarcinogenesis. However, around 30% of the nodules did not follow this rule, and hypervascular foci showed hyperintensity relative to the hypovascular high-risk borderline lesions.
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Affiliation(s)
- Satoshi Kobayashi
- Dept of Radiology, Kanazawa University School of Medicine, 13-1, Takara Machi, Kanazawa 920-8641, Japan.
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Gadolinium ethoxybenzyl diethylenetriamine pentaacetic Acid-enhanced magnetic resonance imaging findings of borderline lesions at high risk for progression to hypervascular classic hepatocellular carcinoma. J Comput Assist Tomogr 2011; 35:181-6. [PMID: 21412087 DOI: 10.1097/rct.0b013e3182026f3b] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The objectives of the study were to assess the imaging features of hypovascular borderline lesions containing hypervascular foci on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and to evaluate the ability of Gd-EOB-DTPA-enhanced MRI to diagnose high-risk borderline lesions possibly consistent with early hepatocellular carcinoma (HCC). METHODS Institutional review board approval was obtained for this retrospective analysis of imaging findings, and informed consent was obtained from 217 consecutive patients undergoing Gd-EOB-DTPA-enhanced MRI and angiography-assisted computed tomography (CT) for examination of hepatocellular nodular lesions in cirrhotic livers. There were 73 nodules showing hypervascular foci in borderline lesions identified by angiography-assisted CT. Signal intensity patterns of the nodules were evaluated on hepatobiliary-phase Gd-EOB-DTPA-enhanced T1-weighted MRI obtained 20 minutes after intravenous injection of contrast media. RESULTS Among 73 high-risk borderline lesions, 59 were hypointense (81%), and 14 were isointense (19%), compared with background liver parenchyma. There were 27 untreated lesions followed by CT and/or MRI. Almost half of these nodules transformed into hypervascular HCC, regardless of signal intensities seen on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI. CONCLUSIONS Although many high-risk borderline HCC lesions are hypointense on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI, some high-risk borderline lesions are isointense and transform at the same rate into hypervascular HCC.
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Matsui O, Kitao A, Kobayashi S, Sanada J, Ryu Y, Minami T, Kozaka K, Shinnmura R, Nakamura K, Yoneda N, Koda W, Gabata T. Imaging of multi-step hepatocarcinogenesis: imaging, pathophysiologic and molecular correlation. ACTA ACUST UNITED AC 2011. [DOI: 10.2957/kanzo.52.415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Matsushima M, Naganawa S, Ikeda M, Itoh S, Ogawa H, Komada T, Ishigaki S, Kawai H, Suzuki K, Satake H, Iwano S. Diagnostic value of SPIO-mediated breath-hold, black-blood, fluid-attenuated, inversion recovery (BH-BB-FLAIR) imaging in patients with hepatocellular carcinomas. Magn Reson Med Sci 2010; 9:49-58. [PMID: 20585194 DOI: 10.2463/mrms.9.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We assessed the value of adding a breath-hold, black-blood, fluid-attenuated, inversion recovery (BH-BB-FLAIR) sequence with a small motion-probing gradient (b=10 s/mm(2)) using superparamagnetic iron oxide (SPIO) to our present studies that utilize SPIO to detect hepatocellular carcinoma (HCC). We used inversion recovery (IR) in a FLAIR sequence to suppress signals from cysts and a low b-value to suppress vessel signals and provide higher signal to noise than that using high b-value diffusion-weighted imaging. Use of SPIO is expected to reduce the signal in both normal liver parenchyma and in most benign lesions. MATERIALS AND METHODS In 19 patients, we reviewed 38 HCC nodules diagnosed by CT arterioportography (CTAP) and CT during hepatic arteriography (CTHA). We divided SPIO-mediated images into sets, those obtained with and without BH-BB-FLAIR. Six radiologists individually interpreted the 2 image sets and sorted them by their confidence levels for the presence of HCC, and we calculated the area under the receiver operating characteristic (ROC) curve (Az) for each image set. RESULTS On images obtained with BH-BB-FLAIR after SPIO administration, 33 of the 38 HCC nodules appeared as areas of high signal and cyst signal was extinguished. The ROC analysis showed significantly higher Az values in the set with BH-BB-FLAIR (0.89) than in the set without (0.83). CONCLUSIONS Adding BH-BB-FLAIR to existing SPIO-mediated imaging protocols improved detection of HCC nodules and added only 24 s to the scan time.
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Affiliation(s)
- Masaya Matsushima
- Department of Radiology, Nagoya University Graduate School of Medicine, Shouwa-ku, Nagoya, Japan.
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Thomas MB, Jaffe D, Choti MM, Belghiti J, Curley S, Fong Y, Gores G, Kerlan R, Merle P, O'Neil B, Poon R, Schwartz L, Tepper J, Yao F, Haller D, Mooney M, Venook A. Hepatocellular carcinoma: consensus recommendations of the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol 2010; 28:3994-4005. [PMID: 20679622 DOI: 10.1200/jco.2010.28.7805] [Citation(s) in RCA: 306] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hepatocelluar carcinoma (HCC) is the most common primary malignancy of the liver in adults and the third most common cause of cancer death worldwide. The incidence of HCC in the United States is rising steadily because of the prevalence of hepatitis C viral infection and other causes of hepatic cirrhosis. The majority of patients have underlying hepatic dysfunction, which complicates patient management and the search for safe and effective therapies. The Clinical Trials Planning Meeting (CTPM) in HCC was convened by the National Cancer Institute's Gastrointestinal Cancer Steering Committee to identify the key knowledge gaps in HCC and define clinical research priorities. The CTPM structured its review according to current evidence-based treatment modalities in HCC and prioritized the recommendations on the basis of the patient populations representing the greatest unmet medical need.
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Affiliation(s)
- Melanie B Thomas
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA.
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NAKAMURA KENSUKE, TAKAGI SATOSHI, SASAKI NOBORU, BANDULA KUMARA WICKRAMASEKARARAJAPAKSHAGE, MURAKAMI MASAHIRO, OHTA HIROSHI, YAMASAKI MASAHIRO, TAKIGUCHI MITSUYOSHI. CONTRAST-ENHANCED ULTRASONOGRAPHY FOR CHARACTERIZATION OF CANINE FOCAL LIVER LESIONS. Vet Radiol Ultrasound 2010; 51:79-85. [DOI: 10.1111/j.1740-8261.2009.01627.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Shimofusa R, Ueda T, Kishimoto T, Nakajima M, Yoshikawa M, Kondo F, Ito H. Magnetic resonance imaging of hepatocellular carcinoma: a pictorial review of novel insights into pathophysiological features revealed by magnetic resonance imaging. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2009; 17:583-9. [DOI: 10.1007/s00534-009-0198-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 09/01/2009] [Indexed: 12/16/2022]
Affiliation(s)
- Ryota Shimofusa
- Department of Radiology; Chiba University Hospital; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
| | - Takuya Ueda
- Department of Radiology; Chiba University Hospital; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
- Department of Radiology; Stanford University School of Medicine; 300 Pasteur Drive, Room S-072 Stanford CA 94305 USA
| | - Takashi Kishimoto
- Department of Molecular Pathology, Graduate School of Medicine; Chiba University; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
| | - Masayuki Nakajima
- Department of General Surgery, Graduate School of Medicine; Chiba University; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
| | - Masaharu Yoshikawa
- Department of Medicine and Clinical Oncology, Graduate School of Medicine; Chiba University; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
| | - Fukuo Kondo
- Department of Pathology; Teikyo University Faculty of Medicine; 2-11-1 Kaga, Itabashi-ku Tokyo 173-8605 Japan
| | - Hisao Ito
- Department of Radiology; Chiba University Hospital; 1-8-1 Inohana, Chuoh-ku Chiba 260-8670 Japan
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