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A comparison of ventricular volume and linear indices in predicting shunt dependence in aneurysmal subarachnoid hemorrhage. World Neurosurg X 2023; 19:100181. [PMID: 37026086 PMCID: PMC10070174 DOI: 10.1016/j.wnsx.2023.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
Background Guidelines for determining shunt dependence after aneurysmal subarachnoid hemorrhage (aSAH) remain unclear. We previously demonstrated change in ventricular volume (VV) between head CT scans taken pre- and post-EVD clamping was predictive of shunt dependence in aSAH. We sought to compare the predictive value of this measure to more commonly used linear indices. Methods We retrospectively analyzed images of 68 patients treated for aSAH who required EVD placement and underwent one EVD weaning trial, 34 of whom underwent shunt placement. We utilized an in-house MATLAB program to analyze VV and supratentorial VV (sVV) in head CT scans obtained before and after EVD clamping. Evans' index (EI), frontal and occipital horn ratio (FOHR), Huckman's measurement, minimum lateral ventricular width (LV-Min.), and lateral ventricle body span (LV-Body) were measured using digital calipers in PACS. Receiver operating curves (ROC) were generated. Results Area under the ROC curves (AUC) for the change in VV, sVV, EI, FOHR, Huckman's, LV-Min., and LV-Body with clamping were 0.84, 0.84, 0.65, 0.71.0.69, 0.67, and 0.66, respectively. AUC for post-clamp scan measurements were 0.75, 0.75, 0.74, 0.72, 0.72, 0.70, and 0.75, respectively. Conclusion VV change with EVD clamping was more predictive of shunt dependence in aSAH than change in linear measurements with clamping and all post-clamp measurements. Measurement of ventricular size on serial imaging with volumetrics or linear indices utilizing multidimensional data points may therefore be a more robust metric than unidimensional linear indices in predicting shunt dependence in this cohort. Prospective studies are needed for validation.
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Lee SY, Park BY, Ryu T, Lee JH, Kim DH, Roh WS. Linear indices of ventricular volume on brain computed tomography as markers of effectiveness of epidural blood patch for spontaneous intracranial hypotension: A case report. Medicine (Baltimore) 2022; 101:e29279. [PMID: 35960083 PMCID: PMC9371481 DOI: 10.1097/md.0000000000029279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Epidural blood patch (EBP) is an effective treatment for spontaneous intracranial hypotension (SIH). However, its effectiveness can only be judged through subjective symptom improvement; no objective markers have been reported. Linear indices of ventricular volume on brain computed tomography (CT) may aid the objective evaluation of the effectiveness of EBP in patients with SIH. PATIENT CONCERNS A 45-year-old man was hospitalized due to a 3-week history of orthostatic headache, dizziness, and neck pain. He had visited a local emergency department at symptom onset. His neurological examination results were normal and vital signs were stable. DIAGNOSES Brain magnetic resonance imaging (MRI) revealed pachymeningeal enhancement in both convexities with a small subdural hematoma (SDH). Based on the clinical features and MRI findings, he was diagnosed with SIH complicated by SDH. INTERVENTIONS Non-targeted EBP was performed, first at the lumbar level and subsequently at the thoracic level. Linear indices of ventricular volume, including the Evans' index, frontal-occipital horn ratio, and bicaudate index, were measured through brain CT performed before and after EBP. OUTCOMES After lumbar EBP, there was no symptom relief or increase in linear indices of ventricular volume on brain CT. In contrast, the patient's symptoms completely resolved and the linear indices of ventricular volume increased after thoracic EBP. LESSONS The effectiveness of EBP, which is currently evaluated solely based on changes in symptom severity, can be assessed using linear indices of ventricular volume.
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Affiliation(s)
- So Young Lee
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, Nam-gu, Daegu, Republic of Korea
| | - Bum Young Park
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, Nam-gu, Daegu, Republic of Korea
| | - Taeha Ryu
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, Nam-gu, Daegu, Republic of Korea
| | - Ji Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, Nam-gu, Daegu, Republic of Korea
| | - Dong Hyuck Kim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, Nam-gu, Daegu, Republic of Korea
| | - Woon Seok Roh
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, Nam-gu, Daegu, Republic of Korea
- *Correspondence: Woon Seok Roh, Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Republic of Korea (e-mail: )
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Trovatelli M, Spediacci C, Castellano A, Bernardini A, Dini D, Malfassi L, Pieri V, Falini A, Ravasio G, Riva M, Bello L, Brizzola S, Zani DD. Morphometric study of the ventricular indexes in healthy ovine BRAIN using MRI. BMC Vet Res 2022; 18:97. [PMID: 35277171 PMCID: PMC8915498 DOI: 10.1186/s12917-022-03180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/21/2022] [Indexed: 11/19/2022] Open
Abstract
Background Sheep (Ovis aries) have been largely used as animal models in a multitude of specialties in biomedical research. The similarity to human brain anatomy in terms of brain size, skull features, and gyrification index, gives to ovine as a large animal model a better translational value than small animal models in neuroscience. Despite this evidence and the availability of advanced imaging techniques, morphometric brain studies are lacking. We herein present the morphometric ovine brain indexes and anatomical measures developed by two observers in a double-blinded study and validated via an intra- and inter-observer analysis. Results For this retrospective study, T1-weighted Magnetic Resonance Imaging (MRI) scans were performed at 1.5 T on 15 sheep, under general anaesthesia. The animals were female Ovis aries, in the age of 18-24 months. Two observers assessed the scans, twice time each. The statistical analysis of intra-observer and inter-observer agreement was obtained via the Bland-Altman plot and Spearman rank correlation test. The results are as follows (mean ± Standard deviation): Indexes: Bifrontal 0,338 ± 0,032 cm; Bicaudate 0,080 ± 0,012 cm; Evans’ 0,218 ± 0,035 cm; Ventricular 0,241 ± 0,039 cm; Huckman 1693 ± 0,174 cm; Cella Media 0,096 ± 0,037 cm; Third ventricle ratio 0,040 ± 0,007 cm. Anatomical measures: Fourth ventricle length 0,295 ± 0,073 cm; Fourth ventricle width 0,344 ± 0,074 cm; Left lateral ventricle 4175 ± 0,275 cm; Right lateral ventricle 4182 ± 0,269 cm; Frontal horn length 1795 ± 0,303 cm; Interventricular foramen left 1794 ± 0,301 cm; Interventricular foramen right 1,78 ± 0,317 cm. Conclusions The present study provides baseline values of linear indexes of the ventricles in the ovine models. The acquisition of these data contributes to filling the knowledge void on important anatomical and morphological features of the sheep brain.
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Dias SF, Jehli E, Haas-Lude K, Bevot A, Okechi H, Zipfel J, Schuhmann MU. Ventriculomegaly in children: nocturnal ICP dynamics identify pressure-compensated but active paediatric hydrocephalus. Childs Nerv Syst 2021; 37:1883-1893. [PMID: 33884480 DOI: 10.1007/s00381-021-05164-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Paediatric ventriculomegaly without obvious signs or symptoms of raised intracranial pressure (ICP) is often interpreted as resulting from either relative brain atrophy, arrested "benign" hydrocephalus, or "successful" endoscopic third ventriculostomy (ETV). We hypothesise that the typical ICP "signature" found in symptomatic hydrocephalus can be present in asymptomatic or oligosymptomatic children, indicating pressure-compensated, but active hydrocephalus. METHODS A total of 37 children fulfilling the mentioned criteria underwent computerised ICP overnight monitoring (ONM). Fifteen children had previous hydrocephalus treatment. ICP was analysed for nocturnal dynamics of ICP, ICP amplitudes (AMP), magnitude of slow waves (SLOW), and ICP/AMP correlation index RAP. Depending on the ONM results, children were either treated or observed. The ventricular width was determined at the time of ONM and at 1-year follow-up. RESULTS The recordings of 14 children (group A) were considered normal. In the 23 children with pathologic recordings (group B), all ICP values and dependent variables (AMP, SLOW) were significantly higher, except for RAP. In group B, 12 of 15 children had received a pre-treatment and 11 of 22 without previous treatment. All group B children received treatment for hydrocephalus and showed a significant reduction of frontal-occipital horn ratio at 1 year. During follow-up, a positive neurological development was seen in 74% of children of group A and 100% of group B. CONCLUSION Ventriculomegaly in the absence of signs and symptoms of raised ICP was associated in 62% of cases to pathological ICP dynamics. In 80% of pre-treated cases, ETV or shunt failure was found. Treating children with abnormal ICP dynamics resulted in an outcome at least as favourable as in the group with normal ICP dynamics. Thus, asymptomatic ventriculomegaly in children deserves further investigation and, if associated with abnormal ICP dynamics, should be treated in order to provide a normalised intracranial physiology as basis for best possible long-term outcome.
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Affiliation(s)
- Sandra F Dias
- Section of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Tübingen, Germany. .,Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
| | - Elisabeth Jehli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Karin Haas-Lude
- Department of Paediatric Neurology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Andrea Bevot
- Department of Paediatric Neurology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Humphrey Okechi
- Section of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Tübingen, Germany
| | - Julian Zipfel
- Section of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Tübingen, Germany
| | - Martin U Schuhmann
- Section of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Tübingen, Germany
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Liu M, Zhang J, Zong L, Fan W, Wang B, Chen Z. The Differential Diagnostic Value of the Callosal Angle and Evans Index in Mild Cognitive Impairment and Alzheimer's Disease. Curr Med Imaging 2020; 17:889-896. [PMID: 33357199 PMCID: PMC8811612 DOI: 10.2174/1573405616666201223150004] [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: 04/17/2020] [Revised: 09/06/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
Background Callosal Angle (CA) and Evans Index (EI) are considered as imaging biomarkers to diagnose normal-pressure hydrocephalus using traditional MR measurement methods. Objective The current study aimed to evaluate the differential diagnostic value of CA and EI in Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD). Methods Five-hundred and two subjects were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database, which included 168 Normal Controls (NC), 233 MCI and 101 AD patients. The structural MR images were interactively applied with multiplanar reconstruction to measure the CA and EI. Results CA presented no significant difference among NC, MCI and AD groups (H value = 3.848, P value = 0.146), and EI demonstrated higher value in MCI and AD groups than that in NC groups (P = 0.000 and 0.001, respectively). MCI group had significant larger EI (0.29±0.04) than (0.27±0.03) NC group in 70-75 years old sub-groups. ROC showed that the area under the curve was 0.704±0.045 for NC-MCI in 70-75 years old groups. The correlation analysis indicated that EI was significantly negatively related to MMSE scores of MCI patients (r = -0.131, P = 0.046). Conclusion EI might serve as a screening imaging biomarker for MCI in 70-75 years old patients, and show limited differential value for the diagnosis of AD. CA could present no diagnostic value for MCI and AD in the current study.
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Affiliation(s)
- Mengqi Liu
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Jing Zhang
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Linxiong Zong
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Wenping Fan
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Botao Wang
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Zhiye Chen
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
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Brix MK, Westman E, Simmons A, Ringstad GA, Eide PK, Wagner-Larsen K, Page CM, Vitelli V, Beyer MK. The Evans' Index revisited: New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly. Eur J Radiol 2017; 95:28-32. [PMID: 28987681 DOI: 10.1016/j.ejrad.2017.07.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Assessment of ventricular enlargement is subjective and based on the radiologist's experience. Linear indices, such as the Evans Index (EI), have been proposed as markers of ventricular volume with an EI≥0.3 indicating pathologic ventricular enlargement in any subject. However, normal range for EI measured on magnetic resonance imaging (MRI) scans are lacking in healthy elderly according to age and sex. We propose new age and sex specific cut-off values for ventricular enlargement in the elderly population. MATERIALS AND METHODS 534 participants (53% women) aged 65-84 years; 226 patients with Alzheimer's disease (AD), and 308 healthy elderly controls (CTR) from the AddNeuroMed and ADNI studies were included. The cut-off for pathological ventricular enlargement was estimated from healthy elderly categorized into age groups of 5 years range and defined as EI 97,5 percentile (mean+2SD). Cut-off values were tested on patients with Alzheimer's disease and a small sample of patients with probable idiopathic normal pressure hydrocephalus (iNPH) to assess the sensitivity. RESULTS The range of the EI in healthy elderly is wide and 29% of the CTR had an EI of 0.3 or greater. The EI increases with age in both CTR and AD, and the overall EI for women were lower than for men (p<0.001). New EI cut off values for male/female: 65-69 years 0.34/0.32, 70-74 years 0.36/0.33, 75-79 years 0.37/0.34 and 80-84 years 0.37/0.36. When applying the proposed cut-offs for EI in men and women aged 65-84, they differentiated between iNPH and CTR with a sensitivity of 80% and for different age and sex categories of AD and CTR with a sensitivity and specificity of 0-27% and 91-98%, respectively. CONCLUSION The range of the EI measurements in healthy elderly is wide, and a cut-off value of 0.3 cannot be used to differentiate between normal and enlarged ventricles in individual cases. The proposed EI thresholds from the present study show good sensitivity for the iNPH diagnosis.
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Affiliation(s)
- Maiken K Brix
- Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Institute of Psychiatry, King's College London, UK
| | - Andrew Simmons
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Institute of Psychiatry, King's College London, UK; NIHR Biomedical Research Centre for Mental Health, London, UK; NIHR Biomedical Research Unit for Dementia, London, UK
| | - Geir Andre Ringstad
- Department of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Per Kristian Eide
- Department of Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | - Christian M Page
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Division of Surgery and Clinical Neuroscience, Oslo University hospital, Oslo, Norway
| | - Valeria Vitelli
- Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Ragan DK, Cerqua J, Nash T, McKinstry RC, Shimony JS, Jones BV, Mangano FT, Holland SK, Yuan W, Limbrick DD. The accuracy of linear indices of ventricular volume in pediatric hydrocephalus: technical note. J Neurosurg Pediatr 2015; 15:547-51. [PMID: 25745953 PMCID: PMC4558898 DOI: 10.3171/2014.10.peds14209] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Assessment of ventricular size is essential in clinical management of hydrocephalus and other neurological disorders. At present, ventricular size is assessed using indices derived from the dimensions of the ventricles rather than the actual volumes. In a population of 22 children with congenital hydrocephalus and 22 controls, the authors evaluated the relationship between ventricular volume and linear indices in common use, such as the frontooccipital horn ratio, Evans' index, and the bicaudate index. Ventricular volume was measured on high-resolution anatomical MR images. The frontooccipital horn ratio was found to have a stronger correlation with both absolute and relative ventricular volume than other indices. Further analysis of the brain volumes found that congenital hydrocephalus produced a negligible decrease in the volume of the brain parenchyma.
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Affiliation(s)
- Dustin K. Ragan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Tiffany Nash
- Department of Radiology, University of Cincinnati, Ohio
| | - Robert C. McKinstry
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S. Shimony
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | - Weihong Yuan
- Department of Radiology, University of Cincinnati, Ohio
| | - David D. Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
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Kim E, Lim YJ, Park HS, Kim SK, Jeon YT, Hwang JW, Lee YS, Park HP. The lack of relationship between intracranial pressure and cerebral ventricle indices based on brain computed tomography in patients undergoing ventriculoperitoneal shunt. Acta Neurochir (Wien) 2015; 157:257-63. [PMID: 25503296 DOI: 10.1007/s00701-014-2295-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND In this study we investigated whether cerebral ventricle indices based on brain computed tomography (CT) scans are reliable for predicting intracranial pressure (ICP) in hydrocephalic patients. METHODS Electronic medical records of 221 patients undergoing ventriculoperitoneal shunt due to hydrocephalus were retrospectively reviewed. Cerebral ventricle indices including Evans' index, third ventricle index, cella media index, and ventricular score were calculated from transverse diameters measured at various levels on preoperative brain CT scans. ICP was considered as CSF opening pressure. Patients were categorized into three groups: communicating hydrocephalus, non-communicating hydrocephalus, and normal pressure hydrocephalus (NPH). The non-communicating hydrocephalus group was further divided according to the obstruction site; aqueduct, fourth ventricle outlet, third ventricle, and the foramen of Monro. The primary endpoint was the extent of the correlation between cerebral ventricle indices and ICP in each hydrocephalus group. RESULTS No cerebral ventricle index correlated with ICP in patients with communicating hydrocephalus (n = 113) and NPH (n = 62). In the non-communicating hydrocephalus group (n = 46), only the third ventricle index revealed moderate negative correlation with ICP (r = -0.395, p < 0.01). In subgroup analyses, the third ventricle index showed a strong negative relationship with ICP only in patients with the third ventricle obstruction (r = -0.779, p < 0.05). CONCLUSIONS In this study we showed that although an inverse correlation existed between ICP and the third ventricle index only in patients with non-communicating hydrocephalus due to obstruction of the third ventricle, cerebral ventricle indices based on brain CT scan were non-reliable predictors of ICP in hydrocephalic patients.
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