is heterogeneous bone marrow normal

31 As with other infiltrative disorders, the extent of tumor burden correlates with MRI findings. 2022 Jan 29;14(2):105. doi: 10.3390/toxins14020105. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. 17, Issue 3, Pages 391-409. Bone marrow imaging: magnetic resonance studies relating to age and sex. 2 Dooms GC, Fisher MR, Hricak H, Richardson M, Crooks LE, Genant HK. Firstly, MSCs obtained from various parts of the body differ in their biological characteristics. Reconversion can occur depending on the degree to which the therapy has obliterated the marrow. Bone marrow edema is the build-up of fluid in the bone marrow. A lesion is an area of tissue that's not healthy or normal. Yellow marrow is 80% fat1. 8 What does the Central High signal on the T1WI mean? at the participating institution. The relative brilliance of a radiographic image, radioactive tracer, or biological marker. Effect of granulocyte-stimulating factors on marrow of adult patients with musculoskeletal malignancies: incidence and MRI findings. The forms may also be combined. A visually normal vertebral body may harbor up to 20% abnormal cellular infiltration. Nature. An MRI picture is in black and white like an XRay but can provide cross sectional pictures from several different perspectives. 2005;43(4):761-770. history:hla-b27 pos w/inflammatory back pain, xr-degenerative changes. Cellular components of the hematopoietic niche and their regulation of hematopoietic stem cell function. Bone marrow is the sponge-like tissue inside the body's larger bones that produces blood cells. doi: 10.1126/sciadv.abq1551. Gestalt Theory: Implications for Radiology Educa tion. We studied the properties of MSCs from the bone marrow (BM-MSC) before and after implantation under the renal capsule using a mini pig model. Polycythemia Vera. 28.3 ), which has been found to be an indicator of a benign process. Three patterns of proliferation are recognized: a diffuse pattern where the normal bone marrow is completely replaced; a variegated pattern where innumerable tiny clusters of abnormal cells are present; and a focal pattern where larger often spherical lesions predominate. Usually the human eye creates a gestalt of the entirety of the vertebral body signal merging the individual components of red and yellow marrow into a kind of perceptual average19. Beginning approximately 3-6 weeks after initiating radiation therapy, the marrow signal begins to increase on T1w images both qualitatively and quantitatively. As one of the main components of bone tissue engineering . The homogenously and intensely bright signal on T1w images in this 69 year old woman is compatible with a marrow depletion disorder. 18 Griffith JF, Yeung DK, Antonio GE, et al. 8,14 Red marrow has a rich, arborized vascular network. Aplastic anemia is manifested as pancytopenia with numerous causes such as viral infection, drug toxicities and as autoimmune responses to malignancies, although most cases are idiopathic. In a patient such as the test case who demonstrates diffusely low T1w marrow signal on MR, the differential diagnosis is long and includes many benign reconversion conditions, malignant myeloproliferative disorders and abnormalities of the supporting reticulum. Red marrow has intermediate signal on T2 fatsat and STIR. The diffuse pattern mimics other replacement disorders such as leukemia and even marrow reconversion. Importantly, the intensity of marrow in an adult comes with an internal control when viewing T1w sequences. Pancreas is hypoechoic and slightly heterogeneous, What does myometrium is slightly heterogeneous mean, Diffusely heterogeneous bone marrow signal throughout the pelvis. You also have the option to opt-out of these cookies. It is uniformly found throughout the skeleton at birth. Effect of radiation therapy on thoracic and lumbar bone marrow: evaluation with MR imaging. Heterogeneous is a word pathologists use to describe tissue that looks very different from one area of the tissue to the next. What does the Central High signal on the T1WI mean? 6 Sze G, Baierl P, Bravo S. Evolution of the infant spinal column: evaluation with MR imaging. Am. What is heterogeneous bone marrow signal? Definition / general. Schematic representation of erythroblastic island. The bone marrow niche is increasingly recognized as heterogeneous with specific subtypes of mesenchymal niche cells governing the development or homeostasis of selective parenchymal hematopoietic subsets. 25 Moulopoulos L A, and Meletios A D. Magnetic Resonance Imaging of the Bone Marrow in Hematologic Malignancies. Inflammation is often also heterogeneous on MRI. Unable to load your collection due to an error, Unable to load your delegates due to an error. In the first few days after initiating radiation, the effects are dominated by necrosis, edema and hemorrhage, especially on STIR. 50 Barosi G. Myelofibrosis with myeloid metaplasia. Magnetic resonance imaging for the detection of bone marrow involvement in malignant lymphoma. Objective: To describe the magnetic resonance (MR) appearances of the bone marrow of children's feet and to determine their frequency and significance. The development or progression of fractures does not necessarily point to progression of disease as tumor elimination may be followed by loss of structural support. 10-25% of all leukemic patients will have normal appearing marrow) abnormal distribution of what appears to be normal red marrow abnormal signal from red marrow in a normal distribution abnormal signal and distribution However, there is a variable mixture of red and yellow marrow in the spine beyond infancy with progressive increase in fat content of red marrow and increased proportion of yellow marrow with aging2,3. AJNR Am J Neuroradiol. It usually means that the tissue has either some wear and tear, for example in a hip joint it would most likely imply arthritis. Prior Radiation Treatment Br J Haematol 2008;141(1):60-68. Bone marrow involvement upstages the patient and may have prognostic and therapeutic implications. "Gestalt" of marrow is normal as the vertebral body centrum is of overall higher signal than the adjacent intervertebral discs. T2w sagittal with fatsat. Not normal. However, you may visit "Cookie Settings" to provide a controlled consent. I think this relates not only to the variability of pathology affecting marrow but also that the best discrimination after enhancement is obtained through quantitative measurements in the first minute after a dynamic infusion of contrast, something which is not usually performed in day to day practice. MR is unable to differentiate that transition. MSCs have been well studied in vitro, while their fate after implantation in vivo has been poorly analyzed. It is curious that some areas of degenerative focal fat remain (arrowheads). if this is normal then why list it? This website uses cookies to improve your experience while you navigate through the website. 42 Stevens SK, Moore SG, Kaplan ID: Early and late bone-marrow changes after irradiation: MR evaluation. 2002; 23:248-254. Chronic Renal Failure in a 50 year old woman. Immune dysregulation has been studied in various prognostic subgroups. from increased water content), or lower signal (e.g. Radiology. Illustration of Osx + cell regulation of B cell maturation and Ocn +, Schematic representation of erythroblastic island., Schematic representation of erythroblastic island. No, diffusely low T1 signal in the bone marrow in the brain is not typically correlated to an accident. author = {Pal, C R, Tasker, A D, Ostlere, S J, and Watson, M S} abstractNote = {Objective To describe the magnetic resonance (MR) appearances of the bone marrow of children`s feet and to determine their frequency and significance.Design and patients. Chan WP, et al. 15, Issue 2, Pages 175-198, 9 Mirowitz S, Apicella P, Reinus WR, Hammerman AM: MR imaging of bone marrow lesions: Relative conspicuousness on T1-weighted, fat-suppressed T2-weighted, and STIR images. In this larger-scale study, we found that bone marrow heterogeneity, assessed by the second-order textural features contrast and dissimilarity, is significantly higher in females compared to males, while PDFF itself showed no significant difference between females and males averaged over all age groups. These cookies will be stored in your browser only with your consent. Heterogeneous marrow suggests that there are abnormalities in the bone marrow. Such differentiation is better than x-ray, CT, PET, or even radionuclide bone scan with technetium. A T1w sagittal image demonstrates diffusely low signal in this 56 year-old woman. The emerging concept is that the bone marrow environment is composed of multiple microniches, each consisting of unique pairing of distinct supportive stromal cells with distinct hematopoietic subtypes to regulate a particular branch of hematopoietic cell process. Major organ for hematopoiesis at birth; also primary and secondary lymphoid organ. Benign and Malignant Processes: Normal values and Differentiation with Chemical Shift MR Imaging in Vertebral Marrow. Of those patients who underwent evaluation for the finding, 24% were diagnosed with a malignancy. 36 Hanrahan CJ, Christensen CR, Crim JR. Current Concepts in the Evaluation of Multiple Myeloma with MR Imaging and FDG PET/CT: RadioGraphics. For example, it is sometimes seen in heavy smokers. Marrow signal is similar or even less than adjacent muscle and disc such that pathologic marrow may be very difficult to ascertain6. By using our website, you consent to our use of cookies. MRI in the detection of malignant infiltration of bone marrow-a commentary. Pelvic marrow biopsy revealed metastatic adenocarcinoma. J. Roentgenol. A bone marrow biopsy can help diagnose conditions affecting the blood cells or marrow. AJR Am J Roentgenol. Careers. Arrowheads denotes a lesion which has some bright T1w signal that appears substantially larger on the T2w and STIR images, possibly representing a hemorrhagic metastasis. The more yellow marrow which is present within a vertebral body the more homogeneously suppressed (hypointense) the body will appear with these techniques. Functional contributions of individual cellular components of the bone-marrow microenvironment to myelofibrosis (MF) in patients with myeloproliferative neoplasms (MPNs) are incompletely. Adipose tissue-derived stromal vascular fraction (SVF) comprises a heterogeneous cell population, considered an easily accessible source of MSCs with therapeutic potential in autoimmune diseases. Journal of Magnetic Resonance Imaging. official website and that any information you provide is encrypted On this fast spin echo sequence the marrow appears of normal intensity. 2006; 27: 1183-1188. 37 Bone-marrow oedema syndrome and transient osteoporosis of the hip. The focal pattern is the classical pattern of metastases from solid organ malignancies and will not be discussed in this review. They cause vertebrae fractures and back pain. Why are the red cells larger than normal in megaloblastic anemia? However, many such fractures look benign on MR. And every disease or medicine that affects the human . The Effect of Low Doses of Zearalenone (ZEN) on the Bone Marrow Microenvironment and Haematological Parameters of Blood Plasma in Pre-Pubertal Gilts. Typically this process occurs in a reverse direction from central to peripheral as demands increase. JCAT. The treatments used in oncology modify pathological marrow but also normal marrow and may sometimes lead to complications. The T1-weighted sagittal sequence demonstrates diffusely reduced signal of the bone marrow. I had a bone marrow biopsy looking or myaloma but it was negative. 1993; 186:833-838. AJNR Am J Neuroradiol. MR imaging characteristics of cranial bone marrow in adult patients with underlying systemic disorders compared with healthy control subjects. The signal is similar. An abnormality may not be evident on T2w FSE but often is of greater than normal signal on STIR or T2w fatsat. Heterogeneous bone marrow signal means that on MRI Magnetic Resonance Imaging (MRI) A radiologist interprets the results and classifies it as normal, abnormal, or potentially abnormal. 1996;167(2):355358. Bone marrow involvement by malignant lymphoma is much more common with Non-Hodgkin disease than Hodgkin disease and spreads to the marrow 95% of the time hematogenously. This inborn error of metabolism leads to accumulation of glucocerebrosides within the macrophage-monocyte cell line. MR is a very sensitive technique for evaluating bone marrow. Gauchers disease is the most common lysosomal storage disorder and can be included in disturbances of the marrow reticulum. Bone marrow reconversion and the diffuse pattern of myeloma may be similar especially if bone marrow stimulators have been administered. PMC The normal marrow signal usually is completely replaced by abnormal signal best appreciated as low signal on T1w images. Initially edema and necrosis occur which can be followed by hypocelluarity if a positive tumoral response is elicited. Other diffuse marrow diseases and conditions are possible based on the images and will be discussed. The radiologist can validate this advice for you or for the ordering ph After being discharged from the hospital, a patient continues recovery at home (or at lodging near the transplant center if the patient is from out of What does fatty marrow signal is diffusely heterogeneous without focal suspicious lesion nonspecified mean? Radiology. 1990; 154:745-750. 2005; 53:705-710. This "heterogeneous marrow s reconversion usually indicates a chronic hypoxic or anemic state. Design and patients: A review of MR studies obtained in a retrospective series of 35 children with foot pain and in a prospective series of 19 asymptomatic children was performed. 2005;237:590-596. This pattern is typical for the acute leukemias. doi: 10.7554/eLife.81480. The cellular composition of normal marrow changes significantly with age . In normal subjects, the bone marrow is fatty and is depicted with homogeneous high signal intensity on T1-weighted MR images. What does it mean that the Bible was divinely inspired? The MRI is a very sensitive technique that allows better visualization of the bones, cartilage, and joint tissue. Oh, and E.K. 17 Castillo M. Diffusion-weighted imaging of the spine: is it reliable? Accessibility These cookies track visitors across websites and collect information to provide customized ads. This tissue includes fat and immature blood cells and creates mature blood cells, white blood cells, which aid in disease-fighting and immunity, as well as red blood cells and platelets. Diagnosis is made by bone marrow biopsy. 2009; 23: 159-170. 1992; 185:833-840, 39 Moulopoulos LA, Dimopoulos MA, Alexanian R, Leeds NE, Libshitz HI: Multiple myeloma: MR patterns of response to treatment. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Radiology. Radiology. This stimulated growth of hematopoietically active marrow increases the visibility of red marrow in the axial and appendicular skeleton. An impression is provided based on the medical history and test results. The present review outlines recent efforts in dissecting these microniches regulated by unique cell pairings within the bone marrow and provides an overview of how the bone marrow orchestrates multiple facets of hematopoiesis. Epub 2017 May 22. This focus also demonstrates a bull's eye sign where a tiny focus of fat is surrounded by lower signal red marrow. 1988; 169:799-804, 33 Vande Berg BC, Schmitz PJ, Scheiff JM, Filleul BJ, Michaux JL, Ferrant A, Jamart J, Malghem J, Maldague BE: Acute myeloid leukemia: Lack of predictive value of sequential quantitative MR imaging during treatment. I will just focus on a few of these disorders excluding primary metabolic diseases of bone. The corresponding T2w FSE image does not appear particularly abnormal. The authors declare no relevant conflicts of interest. Download figure Open in new tab Download powerpoint Radiology. Epub 2021 Dec 10. GOUT Gout is a heterogeneous group of conditions related to a genetic defect of from NUR 149 at Iloilo Science and Technology University - formerly Western Visayas College of Science and Technolog 1994; 162:215-221. 21 Sze G, Bravo S, Baierl P, Shimkin PM: Developing spinal column: Gadolinium-enhanced MR imaging. See this image and copyright information in PMC. . A heterogeneous signal on MRI essentially means that the part of the body shows different brightnesses on MRI. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Radiology. Most of the vertebral bodies have much less high T1w signal within them than normally seen in an 89 year old person. Int J Mol Sci. The list of entities associated with a high signal intensity on T1-weighted images is extensive and classically includes fat, proteins, hemorrhage, melanin and gadolinium. Radiology. from sclerosis) it may not be very conspicuous on T2w views. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. 2003; 17:1191-1210, 30 Stevens SK, Moore SG, Amylon MD: Repopulation of the marrow after transplantation: MR imaging with pathologic correlation. The cookies is used to store the user consent for the cookies in the category "Necessary". Unless pathologic marrow has a much higher signal (e.g. A T2w sagittal also demonstrates very low marrow signal compatible with hemosiderosis in anemia of chronic disease. This heterogeneous marrow signal most likely represents patchy conversion of red to yellow marrow that is a well-described normal variant seen predominantly in older adults. The Revised International . Using MR to follow treatment is problematic5, 7,8,25,31,32,33,35. A large number of studies have been performed to assess the usefulness of various advanced MR techniques in diagnosing and following patients with leukemia. T1 (longitudinal relaxation time) is the time constant which determines the rate at which excited protons return to equilibrium. The T2-weighted fast spin echo sequence is relatively insensitive to the abnormal marrow, and is largely unremarkable. 35 Vande Berg BC, Michaux L, Scheiff JM, Malghem J, Lecouvet FE, Bourgois MP, Ferrant A, Michaux JL, Maldague BE: Sequential quantitative MR analysis of bone marrow: Differences during treatment of lymphoid versus myeloid leukemia. (1a) T1- and (1b) T2-weighted sagittal and (1c) T1-weighted axial images. 11 Castillo, M, Malko, JA, Hoffman, JC, Jr: The bright intervertebral disk: an indirect sign of abnormal spinal bone marrow on T1-weighted MR images AJNR Am J Neuroradiol. In adults with normal marrow, the marrow should have higher T1-weighted signal than muscle. The cookie is used to store the user consent for the cookies in the category "Performance". We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Radiology. Although fatty marrow contains more fat cells than hematopoietic marrow, both types of marrow appear hyperintense relative to skeletal muscle on T1-weighted imaging because they contain a higher proportion of fat cells relative to skeletal muscle. Many diffuse pathologic processes in the spinal marrow have a non-specific appearance with reduced signal on T1w images and intermediate T2w signal. This cookie is set by GDPR Cookie Consent plugin. Signal intensity can vary considerably with areas of high and low T2w with low T2 signal thought to be attributable to dense clusters with hypercellularity. As in the leukemias, follow-up of diffuse forms may be problematic in differentiating hypercellular reactive marrow, fibrosis and residual or recurrent active tumor7,25,41. Except for transition from an infantile pattern of homogeneous red marrow to pattern 1, the patterns do not progress or evolve in a predictable or clinically useful manner3. What is a heterogeneous abnormal marrow signal? Vasopressin storage, bone marrow, and adenohypophysial hyperactivity are the three main causes of high T1 signal intensity in normal conditions. 5.11 and 5.12). 2022 Oct 28;11:e81480. 26 Fletcher BD, Wall JE, Hanna SL: Effect of hematopoietic growth factors on MR images of bone marrow in children undergoing chemotherapy. 2005;236(3):945-951. In this patient, alteration of the marrow signal intensity on T1-weighted images was the first indication of metastatic disease. A few weeks after the transplant, a band-like zone becomes visible in the periphery of the vertebral centrum particularly beneath the endplates. FOIA On the T1WI, small islands of central high signal can be seen within the red marrow ( arrows, Fig. The signal and pattern are abnormal for an adult. However, these transplants often cause infections that may increase the risk of morbidity or mortality among patients. Lumbar mri showed extensive heterogeneous bone marrow signal dr shrugged when i mention it know what it is, do i ignore it like dr ?had back pain yrs, Mri/pelvis. This heterogeneous marrow signal most likely represents patchy conversion of red to yellow marrow that is a well-described normal variant seen predominantly in older adults. Transgenic mouse models that enable endogenous cell deletion or lineage tracing, coupled with advanced intravital microscopy has identified several mesenchymal cell types, including the osteolineage cells, megakaryocytes, macrophages, perivascular cells, and Schwann cells, to be indispensible regulators of hematopoiesis. Bone marrow edema An edema is a buildup of fluid. Ask someone who has. Erly, E.S. Thankfully, this perceptual averaging becomes easier as the patient ages and the percentage of fat within the marrow increases. Abstract. Normal 26 month-old boy. Talk to your doctor about what Dr. John Munshower and another doctor agree, Often a normal finding, but in one study 6 percent of people with this finding on. Bulls eyes and halos: useful MR discriminators of osseous metastases. It's a build up old cancer cells.The abnormal cells are plasma cells. Images obtained with these sequences tend to be grainier and less distinct due to suppression of signal from lipid protons decreasing the signal to noise ratio9. Epub 2022 Nov 23. Outwater: The Utility of In-Phase/Opposed-Phase Imaging in Differentiating Malignancy from Acute Benign Compression Fractures of the Spine AJNR Am J Neuroradiol. 47 Geremia GK, McCluney KW, Adler SS, et al. Red and yellow marrow are evenly dispersed. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. This patient exhibits a diffusely abnormal bone marrow pattern due to previously unrecognized leukemia. The bone marrow in patients with TN-PMF showed fewer granulocytic elements and more frequent dyserythropoiesis. Who wrote the music and lyrics for Kinky Boots? In summary, incidentally noted abnormal or heterogeneous bone marrow signal on MRI was not inconsequential. Secondary myelofibrosis is much more common, usually resulting from chemotherapy or radiation therapy. 5. The bone marrow can be viewed as a carrier with subcompartments tailored to support different hematopoietic activities. Is heterogeneous bone marrow normal? Since red marrow has a mixture of water, fat and protein it exhibits intermediate signal intensity on both T1w and T2w sequences1,7,8,9. Finck AV, Blanchard T, Roselle CP, Golinelli G, June CH. Water has a much longer relaxation time compared to fat and is hypointense on T1w and hyperintense on T2w images. The most common pathologic infiltration of marrow is metastases from solid organ tumors, but since metastatic disease is much more often multifocal than diffuse in its imaging pattern in the spine, it will only be briefly discussed in this article. STIR is widely used for bone marrow imaging because it offers excellent delineation of marrow abnormalities . It is interesting that some authors emphasize the STIR and post-contrast differences in appearance between hyperplastic red marrow and malignant infiltration while others do not. Sci Adv. This woman had undergone chemotherapy, but the pattern can not be differentiated from aplastic anemia by MR imaging. A T1w sagittal image demonstrates generally low marrow signal and relatively poor differentiation of marrow from disc. But today, the condition is often called a bone marrow lesion. Classically, there is a "bone within a bone" appearance, which in the spine has been described as the "sandwich" vertebra sign. Clinical, immunophenotypic and genetic data is limited and it is uncertain if acute undifferentiated leukemia is biologically distinct from acute myeloid leukemia with minimal differentiation, which also shows limited myeloid marker expression and has been reported to . The finding of a diffuse marrow abnormality on MRI, however, is non-specific. 1987; 162:701-707, 32 Rosen BR, Fleming DM, Kushner DC, Zaner KS, Buxton RB, Bennet WP, Wismer GL, Brady TJ: Hematologic bone marrow disorders: Quantitative chemical shift MR imaging. Differences in colour, shape, and size can make a tissue look heterogeneous. At birth the majority of marrow is hematopoietically active red marrow. 2008; 190:1156-1160. Bone marrow: The soft blood-forming tissue that fills the bone cavities is referred to as bone marrow. Complexity of bone marrow hematopoietic stem cell niche. Even at this very young age substantial conversion to yellow marrow is displayed in the iliac bones (arrows). Hemorrhages may occur within a vertebral body raising the T1w signal which might under some circumstances confuse the evaluation of a segment. i am a women age 60? 8600 Rockville Pike 5 Burdiles A, Babyn PS. However, newer fast spin echo acquisitions (FSE) do not take advantage of this fact in a trade off for speed so that fat is not as hypointense on the T2wFSE most commonly performed today. It is concluded that MRI seems to show some particular features in transient osteoporosis of the hip, which normalize after a few months of evolution; this could represent a migration of MRI abnormalities. Before Clinical History: A 43 year old male presents with radicular type pain. The region of concern has characteristics of normal focal red marrow. The variegated pattern occurs in less than 5% of patients and is not only attributable to tiny clusters of plasma cells but to inhibition of hematopoiesis creating tiny foci of fat. Usually it forms in the white blood cells, but it can happen in other types of cells, too. It is composed of a combination of hematopoietic red marrow and fatty yellow marrow, and its composition changes throughout life in response to normal maturation (red to yellow conversion) and stress (yellow to red reconversion). WB Saunders, 1994, pp 127-172. 15 W.K. Myeloid depletion equates to loss of normal red marrow and thus diffusely markedly fatty signal on all pulse sequences. About two weeks later fatty replacement begins and may be visible on MR and classically occurs around the basivertebral veins. The multi-focal pattern is the most common pattern and mimics solid organ metastases to the spine. Radiology.1990; 175:213-218, 31 McKinstry CS, Steiner RE, Young AT, Jones L, Swirsky D, Aber V: Bone marrow in leukemia and aplastic anemia: MR imaging before, during and after treatment. and transmitted securely. On T1-weighted images, there is a diffuse decrease in the signal intensity of the marrow. Other areas appear low signal on T1w, T2w and STIR which is not rare in lymphoma. Summary: Low-signal-intensity focal lesions on a T1-weighted . 32. Human Bone Marrow Stromal Cells: A Reliable, Challenging Tool for In Vitro Osteogenesis and Bone Tissue Engineering Approaches . Knowledge of the signal on the variety of pulse sequences and pattern of marrow in the normal spine is essential knowledge in deciding what is potentially pathologic and what is not. Osteocytes regulate senescence of bone and bone marrow.

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