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Kolade OU, Brink A, Ayeni AO, More S, Holness J. Optimizing PSMA scintigraphy for resource limited settings - a retrospective comparative study. Cancer Imaging 2024; 24:46. [PMID: 38556864 PMCID: PMC10983723 DOI: 10.1186/s40644-024-00693-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND PSMA PET/CT is the most sensitive molecular imaging modality for prostate cancer (PCa), yet much of the developing world has little or no access to PET/CT. [99mTc]Tc-PSMA scintigraphy (PS) is a cheaper and more accessible gamma camera-based alternative. However, many resource-constrained departments have only a single camera without tomographic or hybrid imaging functionality, and camera time is frequently in high demand. Simplifying imaging protocols by limiting the field of view (FOV) and omitting SPECT/CT or even SPECT may provide a partial solution. The aim was thus to determine the adequacy of PS planar-only and/or SPECT-only imaging protocols with a limited FOV. METHODS The scans of 95 patients with histologically proven PCa who underwent PS with full-body planar and multi-FOV SPECT/CT were reviewed. The detection rates for uptake in the prostate gland/bed and in metastases were compared on planar, SPECT, and SPECT/CT. The agreement between modalities was calculated for the detection of metastases and for staging. The impact of imaging a limited FOV was determined. RESULTS Pathological prostatic uptake was seen in all cases on SPECT/CT (excluding two post-prostatectomy patients), 90.3% of cases on SPECT, and 15.1% on planar images (p < 0.001). Eleven (11.7%) patients had seminal vesicle involvement on SPECT/CT, which was undetectable/indistinguishable on planar images and SPECT. The agreement between modalities was moderate to good (κ = 0.41 to 0.61) for the detection of nodal metastases, with detection rates that did not differ significantly (SPECT/CT = 11.6%, SPECT = 8.4%, planar = 5.3%). Detection rates for bone metastases were 14.7% (SPECT/CT) and 11.6% (SPECT and planar). Agreement between modalities for the detection of bone metastases was good (κ = 0.73 to 0.77). Three (3.1%) patients had visceral metastases on SPECT/CT, two of which were detected on SPECT and planar. There was good agreement between modalities for the TNM staging of patients (κ = 0.70 to 0.88). No metastatic lesions were missed on the limited FOV images. CONCLUSION When PS scintigraphy is performed, SPECT/CT is recommended. However, the lack of SPECT/CT capabilities should not preclude the use of PS in the presence of limited resources, as both planar and SPECT imaging are adequate and will correctly stage most PCa patients. Furthermore, time-based optimisations are achievable by limiting the FOV to exclude the distal lower limbs.
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Affiliation(s)
- Olumayowa U Kolade
- Division of Nuclear Medicine, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa.
- Department of Nuclear Medicine, University College Hospital, Ibadan, Oyo State, Nigeria.
| | - Anita Brink
- Division of Nuclear Medicine, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Akinwale O Ayeni
- Division of Nuclear Medicine, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa
- Department of Nuclear Medicine, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa
- Division of Nuclear Medicine, Department of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stuart More
- Division of Nuclear Medicine, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Holness
- Division of Nuclear Medicine, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa
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Al Saffar H, Chen DC, Delgado C, Ingvar J, Hofman MS, Lawrentschuk N, Perera M, Murphy DG, Eapen R. The Current Landscape of Prostate-Specific Membrane Antigen (PSMA) Imaging Biomarkers for Aggressive Prostate Cancer. Cancers (Basel) 2024; 16:939. [PMID: 38473301 DOI: 10.3390/cancers16050939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The review examines the vital role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the diagnosis, staging, and treatment of prostate cancer (PCa). It focuses on the superior diagnostic abilities of PSMA PET/CT for identifying both nodal and distant PCa, and its potential as a prognostic indicator for biochemical recurrence and overall survival. Additionally, we focused on the variability of PSMA's expression and its impact on personalised treatment, particularly the use of [177Lu] Lu-PSMA-617 radioligand therapy. This review emphasises the essential role of PSMA PET/CT in enhancing treatment approaches, improving patient outcomes, and reducing unnecessary interventions, positioning it as a key element in personalised PCa management.
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Affiliation(s)
- Haidar Al Saffar
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
| | - David C Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Department of Surgery, Austin Health, Heidelberg, VIC 3084, Australia
| | - Carlos Delgado
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey 64849, Mexico
| | - Jacob Ingvar
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Surgery (Urology), Royal Melbourne Hospital, Melbourne, VIC 3052, Australia
- EJ Whitten Prostate Cancer Research Centre, Epworth Hospital, Richmond, VIC 3121, Australia
| | - Marlon Perera
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Department of Surgery, Austin Health, Heidelberg, VIC 3084, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Renu Eapen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Department of Surgery, Austin Health, Heidelberg, VIC 3084, Australia
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Jochumsen MR, Bouchelouche K. PSMA PET/CT for Primary Staging of Prostate Cancer - An Updated Overview. Semin Nucl Med 2024; 54:39-45. [PMID: 37487824 DOI: 10.1053/j.semnuclmed.2023.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
Prostate-specific membrane antigen PET/CT for primary staging of prostate cancer is becoming increasingly popular due to simultaneous assessment of whole-body disease burden, with superior sensitivity and specificity for detecting metastases compared to conventional imaging. PSMA PET in combination with multiparametric MRI (mpMRI) improves the sensitivity of assessment of extra-prostatic extension and seminal vesicle invasion compared to mpMRI alone, and may serve as a second line modality for image-guided biopsy in selected patients with negative mpMRI and/or negative primary biopsies. The superior diagnostic accuracy of PSMA PET/CT affects clinical decision-making with a change of clinical management in one-fourth of patients compared to conventional imaging. However, at present, the effect of implementing PSMA PET/CT for primary staging on patient outcomes is not clear, and prospective studies are warranted. There are several PSMA tracers with similar performance and minor individual pharmacokinetic differences such as higher rate of unspecific bone uptake with 18F-PSMA-1007, but on the other hand, lower urinary excretion, which could give an advantage in the detection of local recurrence. Proper training of the reporting physicians and knowledge of the pitfalls of the specific PSMA tracer used is of utmost importance for high-quality reading. We aim to provide an overview of the current literature and an update on the status of PSMA PET/CT for primary staging of prostate cancer.
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Affiliation(s)
- Mads Ryø Jochumsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Esen B, Seymen H, Tarim K, Koseoglu E, Bolukbasi Y, Falay O, Selçukbiricik F, Molinas Mandel N, Kordan Y, Demirkol MO, Tilki D, Esen T. Diagnostic Performance of 68Ga-PSMA-11 Positron Emission Tomography/Computed Tomography to Monitor Treatment Response in Patients with Metastatic Prostate Cancer: The Concordance Between Biochemical Response and Prostate-specific Membrane Antigen Results. Eur Urol Focus 2023; 9:832-837. [PMID: 37032281 DOI: 10.1016/j.euf.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Treatment response is traditionally monitored using prostate-specific antigen (PSA) and conventional imaging in patients with metastatic prostate cancer (mPCa). OBJECTIVE To assess the diagnostic performance of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) when monitoring mPCa patients receiving systemic treatment and also to investigate the concordance between PSMA PET response according to the PSMA PET progression (PPP) criteria and biochemical response. DESIGN, SETTING, AND PARTICIPANTS A total of 96 patients with 68Ga-PSMA-11 PET/CT-detected mPCa at baseline PSMA PET/CT (bPSMA) who underwent at least one follow-up scan after receiving systemic treatment were included in the study. PSA levels at bPSMA and follow-up PSMA PET (fPSMA) scans were recorded. The PPP criteria were used to define PSMA progression. Biochemical progression was defined as ≥25% increase in PSA. PSMA PET and PSA responses were dichotomized into progressive disease (PD) versus non-PD, and the concordance between PSA and PSMA responses was evaluated. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The concordance between PSA and PSMA PET responses was presented using frequencies, percentages, and Cohen's kappa test. RESULTS AND LIMITATIONS A total of 345 serial PSMA PET/CT (96 bPSMA and 249 fPSMA) scans were evaluated. The positivity rates of PSMA PET scans for PSA levels of <0.01, 0.01-0.2, 0.2-4, and >4 ng/ml were 55.6%, 75.0%, 100%, and 98.8%, respectively. PSA and PSMA responses showed moderate-to-high concordance (Cohen's κ = 0.623, p < 0.001). PSA-PSMA discordance was detected in 39 scans (17%). The most common cause of discordance was the discordant results between different metastatic lesions (16/28, 57.1%) in patients with PPP without PSA progression and local progression in prostate (n = 7/11, 63.6%) in patients with PSA progression without PPP. CONCLUSIONS PSMA PET/CT showed very high detection rates of malignant lesions even at very low PSA values and showed significant concordance with PSA response when monitoring treatment response in patients receiving systemic treatment for mPCa. PATIENT SUMMARY This study describes that prostate-specific membrane antigen positron emission tomography (PSMA PET), a new sensitive imaging tool, can detect malignant lesions even at very low prostate-specific antigen values when monitoring metastatic prostate cancer. The PSMA PET response and biochemical response showed significant concordance, and the reason for discordant results seems to be the different responses of metastatic lesions and prostatic lesions to systemic treatment.
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Affiliation(s)
- Baris Esen
- Department of Urology, Koc University Hospital, Istanbul, Turkey.
| | - Hulya Seymen
- Department of Nuclear Medicine, Koc University Hospital, Istanbul, Turkey
| | - Kayhan Tarim
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Ersin Koseoglu
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Yasemin Bolukbasi
- Department of Radiation Oncology, Koc University Hospital, Istanbul, Turkey
| | - Okan Falay
- Department of Nuclear Medicine, Koc University Hospital, Istanbul, Turkey
| | | | - Nil Molinas Mandel
- Department of Medical Oncology, Koc University Hospital, Istanbul, Turkey
| | - Yakup Kordan
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | | | - Derya Tilki
- Department of Urology, Koc University Hospital, Istanbul, Turkey; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tarık Esen
- Department of Urology, Koc University Hospital, Istanbul, Turkey
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Veerman H, Donswijk M, Bekers E, Bodar YJ, Meijer D, van Moorselaar RA, Oprea‐Lager DE, van der Noort V, van Leeuwen PJ, Vis AN, van der Poel HG. The oncological characteristics of non-prostate-specific membrane antigen (PSMA)-expressing primary prostate cancer on preoperative PSMA positron emission tomography/computed tomography. BJU Int 2022; 130:750-753. [PMID: 36117468 PMCID: PMC9828411 DOI: 10.1111/bju.15896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Hans Veerman
- Department of UrologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands,Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - Maarten Donswijk
- Department of Nuclear MedicineNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands
| | - Elise Bekers
- Department of PathologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands
| | - Yves J.L. Bodar
- Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - Dennie Meijer
- Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - R. Jeroen A. van Moorselaar
- Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - Daniela E. Oprea‐Lager
- Department of Radiology and Nuclear Medicine, Cancer Center AmsterdamAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands
| | - Vincent van der Noort
- Department of BiometricsNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands
| | - Pim J. van Leeuwen
- Department of UrologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - André N. Vis
- Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - Henk G. van der Poel
- Department of UrologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands,Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
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Veerman H, Vis AN, Donswijk M, van der Poel HG. Comment on Rosenzweig et al. Very Low Prostate PET/CT PSMA Uptake May Be Misleading in Staging Radical Prostatectomy Candidates. J. Pers. Med. 2022, 12, 410. J Pers Med 2022; 12:800. [PMID: 35629222 PMCID: PMC9145244 DOI: 10.3390/jpm12050800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 12/21/2022] Open
Abstract
With interest, we read the article by Rosenzweig et al. [...].
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Affiliation(s)
- Hans Veerman
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
- Department of Urology, Amsterdam University Medical Centres, Location VU Medical Centre, 1081 HV Amsterdam, The Netherlands;
- Prostate Cancer Network Netherlands, 1066 CX Amsterdam, The Netherlands
| | - André N. Vis
- Department of Urology, Amsterdam University Medical Centres, Location VU Medical Centre, 1081 HV Amsterdam, The Netherlands;
- Prostate Cancer Network Netherlands, 1066 CX Amsterdam, The Netherlands
| | - Maarten Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Henk G. van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
- Department of Urology, Amsterdam University Medical Centres, Location VU Medical Centre, 1081 HV Amsterdam, The Netherlands;
- Prostate Cancer Network Netherlands, 1066 CX Amsterdam, The Netherlands
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Head-to-Head Comparison of 68Ga-PSMA-11 PET/CT and 99mTc-MDP Bone Scintigraphy for the Detection of Bone Metastases in Patients With Prostate Cancer: A Meta-Analysis. AJR Am J Roentgenol 2022; 219:386-395. [PMID: 35441529 DOI: 10.2214/ajr.21.27323] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Bone scintigraphy (BS) using 99mTc-MDP remains the recommended imaging modality for the detection of bone metastases in patients with prostate cancer (PCa). However, PET/CT using prostate-specific membrane antigen (PSMA) ligands is increasingly recognized for evaluating disease extent in patients with PCa, including as a possible standalone test in high-risk patients. Objective: To compare the diagnostic performance of 68Ga-PSMA-PET/CT and 99mTc-MDP BS for the detection of bone metastases in patients with PCa. Evidence Acquisition: PubMed, Embase, and Cochrane Library databases were searched through October 2021 for studies reporting a head-to-head comparison of 68Ga-PSMA-PET/CT and 99mTc-MDP BS for the detection of bone metastases in patients with PCa. Only studies with a well-defined reference standard (including various combinations of imaging and/or clinical follow-up) were included. Pooled diagnostic performance was calculated using bivariate random-effects model, and AUC was derived for each test from hierarchical summary ROC analysis. The two tests' complementary roles in identifying bone metastases in patients in whom the other test was negative were summarized. Evidence Synthesis: Six studies with 546 patients were included. The pooled sensitivity and specificity were 98% (95% CI: 94%-99%) and 97% (95% CI: 91%-99%) for 68Ga-PSMA-11 PET/CT versus 83% (95% CI: 69%-91%) and 68% (95% CI: 41%-87%) for 99mTc-MDP BS. The AUC was 0.99 (95% CI: 0.96-1.00) for 68Ga-PSMA-11 PET/CT and 0.85 (95% CI: 0.81-0.87) for 99mTc-MDP BS. In 408 patients from five included studies, 68Ga-PSMA-11 PET/CT correctly identified bone metastases in 43 (22.3%) of 193 patients with negative 99mTc-MDP BS results, whereas 99mTc-MDP BS correctly identified bone metastases in 4 (1.9%) of 210 patients with negative 68Ga-PSMA-11 PET/CT results. Conclusion: On a per-patient basis, 68Ga-PSMA-11 PET/CT has superior diagnostic performance than 99mTc-MDP BS for the detection of prostate cancer bone metastases. Furthermore, 99mTc-MDP BS offers limited additional information in patients with negative 68Ga-PSMA-11 PET/CT results. Clinical impact: According to current evidence, 99mTc-MDP BS is highly unlikely to be additive to 68Ga-PSMA-11 PET/CT in identifying bone metastases in patients with prostate cancer.
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