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Lee DH. Current Status and Recent Update of Imaging Evaluation for Peri-Hilar Cholangiocarcinoma. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:298-314. [PMID: 36238748 PMCID: PMC9431946 DOI: 10.3348/jksr.2021.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
간문주변부의 해부학적 복잡성으로 인해 간문주변부 담관암은 그 진단과 치료가 어려운 질환으로 알려져 있다. 간문주변부 담관암이 의심되는 환자에 있어서, 영상 검사는 이상 소견의 발견 및 감별 진단, 종양의 종축 침범 부위의 파악, 인접 혈관 침범과 원격 전이 유무의 파악, 그리고 최종적으로 수술적 절제 가능 유무의 평가에 있어 핵심적인 역할을 하고 있다. 이 종설에서는 간문주변부 담관암의 분류 및 종양의 평가를 위해 권고되는 표준 영상 검사의 기법과 간문주변부 담관암의 전형적인 영상 소견에 대해 기술할 예정이다. 종축 방향의 종양 침범 파악, 인접 혈관 침범 및 원격 전이 유무의 평가에 있어서 각 영상 검사 소견과 그 진단능에 대해 논의할 예정이다. 이후 전통적인 절제 가능성 평가의 개념에 대해 고찰하고, 최근의 경향을 소개한다.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Lee DH, Kim B, Lee ES, Kim HJ, Min JH, Lee JM, Choi MH, Seo N, Choi SH, Kim SH, Lee SS, Park YS, Chung YE. Radiologic Evaluation and Structured Reporting Form for Extrahepatic Bile Duct Cancer: 2019 Consensus Recommendations from the Korean Society of Abdominal Radiology. Korean J Radiol 2020; 22:41-62. [PMID: 32901457 PMCID: PMC7772383 DOI: 10.3348/kjr.2019.0803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Radiologic imaging is important for evaluating extrahepatic bile duct (EHD) cancers; it is used for staging tumors and evaluating the suitability of surgical resection, as surgery may be contraindicated in some cases regardless of tumor stage. However, the published general recommendations for EHD cancer and recommendations guided by the perspectives of radiologists are limited. The Korean Society of Abdominal Radiology (KSAR) study group for EHD cancer developed key questions and corresponding recommendations for the radiologic evaluation of EHD cancer and organized them into 4 sections: nomenclature and definition, imaging technique, cancer evaluation, and tumor response. A structured reporting form was also developed to allow the progressive accumulation of standardized data, which will facilitate multicenter studies and contribute more evidence for the development of recommendations.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
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Balanced MR cholangiopancreatography with motion-sensitised driven-equilibrium (MSDE) preparation: feasibility of Gd-EOB-DTPA-enhanced biliary examination. Clin Radiol 2016; 71:1284-1288. [PMID: 27146898 DOI: 10.1016/j.crad.2016.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/24/2016] [Accepted: 03/24/2016] [Indexed: 12/28/2022]
Abstract
AIM To evaluate the effectiveness of motion-sensitised driven-equilibrium (MSDE)-prepared balanced magnetic resonance cholangiopancreatography (MRCP) in a gadolinium ethoxybenzyl diethylene triamine pentaacetic acid (Gd-EOB-DTPA)-enhanced study compared to conventional T2-weighted MRCP. MATERIALS AND METHODS Fifteen patients (seven male and eight female patients) prospectively underwent conventional three-dimensional turbo spin-echo T2-weighted MRCP and MSDE-balanced MRCP using a 1.5 T MRI system after hepatobiliary phase image acquisition. For quantitative evaluation, the contrast-to-noise ratio (CNR) of the common hepatic duct to liver tissue was calculated. For qualitative analysis, two radiologists evaluated the depiction of the biliary system and main pancreatic duct (MPD) using a scoring system. Signal suppression of the portal vein (PV) and hepatic vein (HV) on MSDE-balanced MRCP was also scored. RESULTS MSDE-balanced MRCP showed significantly higher CNR than T2-weighted MRCP. For all biliary structures, the mean depiction scores of MSDE-balanced MRCP were significantly higher than those of T2-weighted MRCP, whereas the mean depiction score of MPD with MSDE-balanced MRCP was significantly lower than that of T2-weighted MRCP. Signal suppression of the PV and HV was thought to be clinically sufficient. CONCLUSIONS MSDE-balanced MRCP more clearly depicted biliary structures compared with T2-weighted MRCP in a Gd-EOB-DTPA-enhanced study. This sequence may be utilised for routine MRCP on Gd-EOB-DTPA-enhanced MRI.
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Lohrke J, Frenzel T, Endrikat J, Alves FC, Grist TM, Law M, Lee JM, Leiner T, Li KC, Nikolaou K, Prince MR, Schild HH, Weinreb JC, Yoshikawa K, Pietsch H. 25 Years of Contrast-Enhanced MRI: Developments, Current Challenges and Future Perspectives. Adv Ther 2016; 33:1-28. [PMID: 26809251 PMCID: PMC4735235 DOI: 10.1007/s12325-015-0275-4] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 12/17/2022]
Abstract
UNLABELLED In 1988, the first contrast agent specifically designed for magnetic resonance imaging (MRI), gadopentetate dimeglumine (Magnevist(®)), became available for clinical use. Since then, a plethora of studies have investigated the potential of MRI contrast agents for diagnostic imaging across the body, including the central nervous system, heart and circulation, breast, lungs, the gastrointestinal, genitourinary, musculoskeletal and lymphatic systems, and even the skin. Today, after 25 years of contrast-enhanced (CE-) MRI in clinical practice, the utility of this diagnostic imaging modality has expanded beyond initial expectations to become an essential tool for disease diagnosis and management worldwide. CE-MRI continues to evolve, with new techniques, advanced technologies, and novel contrast agents bringing exciting opportunities for more sensitive, targeted imaging and improved patient management, along with associated clinical challenges. This review aims to provide an overview on the history of MRI and contrast media development, to highlight certain key advances in the clinical development of CE-MRI, to outline current technical trends and clinical challenges, and to suggest some important future perspectives. FUNDING Bayer HealthCare.
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Affiliation(s)
- Jessica Lohrke
- MR and CT Contrast Media Research, Bayer HealthCare, Berlin, Germany
| | - Thomas Frenzel
- MR and CT Contrast Media Research, Bayer HealthCare, Berlin, Germany
| | - Jan Endrikat
- Global Medical Affairs Radiology, Bayer HealthCare, Berlin, Germany
- Saarland University Hospital, Homburg, Germany
| | | | - Thomas M Grist
- Radiology, Medical Physics and Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Meng Law
- Radiology and Neurological Surgery, University of South California, Keck School of Medicine, USC University Hospital, Los Angeles, CA, USA
| | - Jeong Min Lee
- College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Tim Leiner
- Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Kun-Cheng Li
- Radiology, Xuan Wu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Konstantin Nikolaou
- Radiology, Ludwig-Maximilians University, University Hospitals, Munich, Germany
| | - Martin R Prince
- Radiology, Weill Cornell Medical College, New York, NY, USA
- Columbia College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Kohki Yoshikawa
- Graduate Division of Medical Health Sciences, Graduate School of Komazawa University, Tokyo, Japan
| | - Hubertus Pietsch
- MR and CT Contrast Media Research, Bayer HealthCare, Berlin, Germany.
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Nakayama T, Nishie A, Yoshiura T, Asayama Y, Ishigami K, Kakihara D, Obara M, Honda H. Balanced MR cholangiopancreatography with motion-sensitized driven-equilibrium (MSDE) preparation: Feasibility and optimization of imaging parameters. Magn Reson Imaging 2015; 33:1219-1223. [PMID: 26234501 DOI: 10.1016/j.mri.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Tomohiro Nakayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Takashi Yoshiura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshiki Asayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Kakihara
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Makoto Obara
- Philips Electronics Japan, 2-13-37 Konan, Minato-ku, Tokyo, 108-8507, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
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Boraschi P, Donati F. Biliary-enteric anastomoses: spectrum of findings on Gd-EOB-DTPA-enhanced MR cholangiography. ACTA ACUST UNITED AC 2014; 38:1351-9. [PMID: 23820693 DOI: 10.1007/s00261-013-0007-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Biliary-enteric anastomosis is a common surgical procedure performed for the management of a variety of benign and malignant diseases. This procedure presents a high risk of developing complications such as anastomotic leak, hemorrhage, cholangitis, stones, stricture formation, that have been reported as ranging from 3 % to 43 %. Because the endoscopic approach of the biliary tract is generally precluded in this setting, there is clearly a role for a non-invasive imaging technique to follow up these patients and to detect the possible complications. T2-weighted MR cholangiography has been shown to be effective in the evaluation of patients with biliary-enteric anastomosis. Some of these patients may have mild duct dilatation in spite of a patent anastomosis, and stenosis should be considered only when duct dilatation is associated with narrowing of the anastomotic site. T2-weighted MRC depicts the site of biliary-enteric anastomosis, the cause of obstruction, and the status of the biliary ducts upstream. However, the disadvantages of conventional MRC are that it lacks functional information and so, differentiation between obstructive and non-obstructive dilatation of the bile ducts is often extremely difficult. T1-weighted contrast-enhanced MR cholangiography using Gd-EOB-DTPA is a recently emerging technique that is useful for delineating the anatomy of biliary-enteric anastomoses and detecting complications such as strictures, intraductal stones, and biliary leaks; besides, this technique can provide functional information that are extremely promising in the grading of biliary obstruction. We present the spectrum of findings of biliary-enteric anastomoses on Gd-EOB-DTPA-enhanced MR cholangiography focusing on the main clinical applications.
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Affiliation(s)
- Piero Boraschi
- 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy,
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Lee JH, Lee SS, Kim JY, Kim IS, Byun JH, Park SH, Lee MG. Parallel imaging improves the image quality and duct visibility of breathhold two-dimensional thick-slab MR cholangiopancreatography. J Magn Reson Imaging 2013; 39:269-75. [DOI: 10.1002/jmri.24155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 03/05/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ju Hee Lee
- Department of Radiology and Research Institute of Radiology; University of Ulsan College of Medicine; Asan Medical Center, Songpa-Gu Seoul Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology; University of Ulsan College of Medicine; Asan Medical Center, Songpa-Gu Seoul Korea
| | - Joo Young Kim
- University of Ulsan College of Medicine; Songpa-Gu Seoul Korea
| | - In Seong Kim
- Siemens Healthcare Korea, Asia Tower Building; Yeoksam-dong, Kangnam-gu; Seoul Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology; University of Ulsan College of Medicine; Asan Medical Center, Songpa-Gu Seoul Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology; University of Ulsan College of Medicine; Asan Medical Center, Songpa-Gu Seoul Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology; University of Ulsan College of Medicine; Asan Medical Center, Songpa-Gu Seoul Korea
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de Souza DAT, Parente DB, de Araújo ALE, Mortelé KJ. Modern imaging evaluation of the liver: emerging MR imaging techniques and indications. Magn Reson Imaging Clin N Am 2013; 21:337-63. [PMID: 23642557 DOI: 10.1016/j.mric.2013.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Modern MR imaging evaluation of the liver allows for a comprehensive morphologic and functional assessment of the liver parenchyma, hepatic vessels, and biliary tree, thus aiding in the diagnosis of both focal and diffuse liver diseases.
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MOTOSUGI U, ICHIKAWA T, ARAKI T. Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges. Magn Reson Med Sci 2013; 12:161-75. [DOI: 10.2463/mrms.2012-0085] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Effect of Flip Angle for Optimization of Image Quality of Gadoxetate Disodium–Enhanced Biliary Imaging at 1.5 T. AJR Am J Roentgenol 2013; 200:90-6. [DOI: 10.2214/ajr.12.8722] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Frydrychowicz A, Lubner MG, Brown JJ, Merkle EM, Nagle SK, Rofsky NM, Reeder SB. Hepatobiliary MR imaging with gadolinium-based contrast agents. J Magn Reson Imaging 2012; 35:492-511. [PMID: 22334493 DOI: 10.1002/jmri.22833] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The advent of gadolinium-based "hepatobiliary" contrast agents offers new opportunities for diagnostic magnetic resonance imaging (MRI) and has triggered great interest for innovative imaging approaches to the liver and bile ducts. In this review article we discuss the imaging properties of the two gadolinium-based hepatobiliary contrast agents currently available in the U.S., gadobenate dimeglumine and gadoxetic acid, as well as important pharmacokinetic differences that affect their diagnostic performance. We review potential applications, protocol optimization strategies, as well as diagnostic pitfalls. A variety of illustrative case examples will be used to demonstrate the role of these agents in detection and characterization of liver lesions as well as for imaging the biliary system. Changes in MR protocols geared toward optimizing workflow and imaging quality are also discussed. It is our aim that the information provided in this article will facilitate the optimal utilization of these agents and will stimulate the reader's pursuit of new applications for future benefit.
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Affiliation(s)
- Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, University of Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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MR liver imaging with Gd-EOB-DTPA: a delay time of 10 minutes is sufficient for lesion characterisation. Eur Radiol 2012; 22:2153-60. [PMID: 22645040 PMCID: PMC3431472 DOI: 10.1007/s00330-012-2486-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/14/2012] [Accepted: 04/01/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess whether, in patients with normal liver function, a hepatobiliary delay time of 10 min after Gd-EOB-DTPA injection is sufficient for lesion characterisation. METHODS In 42 consecutive patients with suspected focal liver lesions, dynamic MRI was performed after intravenous Gd-EOB-DTPA, followed by hepatobiliary phases at 5, 10 and 20 min. The following items were assessed at each hepatobiliary phase: parenchymal enhancement, contrast agent excretion in bile ducts, lesion enhancement characteristics (hypo-, iso-, or hyperintensity, rim enhancement, central non-enhancement), and contrast- and signal-to-noise ratios, separately for hypo- and hyperintense lesions. RESULTS Following enhancement, parenchymal signal intensity increased significantly up to 10 min (86.3%, P < 0.001), and subsequently stabilised (86.5% after 20 min, P = 0.223). Biliary contrast agent excretion was first observed in 2, 32 and 5 patients after 5, 10 and 20 min respectively. Hepatobiliary lesion enhancement characteristics observed after 5 min persisted during later hepatobiliary phases. CNR and SNR ratios increased significantly (P < 0.05) up to 10 min after enhancement without further increase at 20 min, in hypo- and hyperintense lesions. CONCLUSIONS If lesion characterisation is the primary reason for performing MRI, a hepatobiliary delay time of 10 min after Gd-EOB-DTPA injection is sufficient in patients with normal liver function. KEY POINTS • Magnetic resonance imaging is now a first line of investigation of the liver. • Optimal CNR and SNR are achieved 10 min after Gd-EOB-DTPA injection. • Typical enhancement characteristics are observed early and do not change. • Ten-minute hepatobiliary delay is sufficient for characterisation of focal liver lesions.
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Goodwin MD, Dobson JE, Sirlin CB, Lim BG, Stella DL. Diagnostic Challenges and Pitfalls in MR Imaging with Hepatocyte-specific Contrast Agents. Radiographics 2011; 31:1547-68. [DOI: 10.1148/rg.316115528] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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