Clinical Radiology

Papers
(The TQCC of Clinical Radiology is 2. The table below lists those papers that are above that threshold based on CrossRef citation counts [max. 250 papers]. The publications cover those that have been published in the past four years, i.e., from 2021-04-01 to 2025-04-01.)
ArticleCitations
Re: Financial implications of CT-guided lung biopsy in a tertiary centre: a radiologist's perspective. A reply77
Contents76
Caesarean-section scar endometriosis (CSSE): clinical and imaging fundamentals of an underestimated entity62
Radiomics-based distinction of small (≤2 cm) hepatocellular carcinoma and precancerous lesions based on unenhanced MRI45
Radiological–pathological correlation in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH): imaging and histopathology44
Enabling early detection of knee osteoarthritis using diffusion–relaxation correlation spectrum imaging31
RCR meetings29
Combination CT and MRI shoulder arthrography: a novel technique and improved patient journey26
When to stop? Mammographic surveillance in breast cancer survivors aged 70 years and older26
A national survey investigating the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK25
Quality of reporting of artificial intelligence studies: Lessons learnt from a systematic review of the literature25
Predictive value of epicardial adipose tissue volume for early detection of left ventricular dysfunction in patients suspected of coronary artery disease24
Correlation of semi-quantitative analyses and visual scores in pulmonary perfusion SPECT/CT imaging with pulmonary function test parameters in patients with interstitial lung diseases24
Comparative study of 3D-T2WI vs. 3D-T2-FLAIR MRI in displaying human meningeal lymphatics vessels24
The role of multiparametric MRI in differentiating uterine leiomyosarcoma from benign degenerative leiomyoma and leiomyoma variants: a retrospective analysis23
Magnetic resonance imaging (MRI)-based intratumoral and peritumoral radiomics for prognosis prediction in glioma patients22
MRI parameters for predicting the effect of ultrasound-guided high-intensity focused ultrasound in the ablation of uterine fibroids22
Bolus tracked computed tomographic pulmonary angiography in the acute care setting: Is it still valid?21
Inter-equipment validation of PET-based radiomics for predicting EGFR mutation statuses in patients with non-small cell lung cancer20
Contents19
MRI-based radiomics analysis of bladder cancer: prediction of pathological grade and histological variant18
RCR meetings18
RCR meetings18
Nomogram for evaluating coronary revascularisation necessity based on multi-parameter coronary CT angiography18
Commentary on: a bump in the night: a 15-year retrospective analysis of urgent inpatient and emergency CT reporting out of hours in a tertiary referral centre17
Ultrasound-guided core-needle biopsy for peripheral pulmonary lesions: a systematic review and meta-analysis16
Comparison of a covered metallic ureteral stent and a double-J stent for malignant ureteral obstruction in advanced gastric cancer16
Multimodality imaging review of breast vascular lesions16
Assessing the diagnostic accuracy and interobserver agreement of MRI perfusion in differentiating disease progression and pseudoprogression following treatment for glioblastoma in a tertiary UK centre16
Ultrasound-guided day-case wide-bore percutaneous mucin aspiration in advanced pseudomyxoma peritonei15
Predicting subsolid pulmonary nodules before percutaneous needle biopsy: a comparison of artificial neural network and biopsy results15
Contents15
Factors influencing the detection rate of fumarate peak in 1H MR spectroscopy of fumarate hydratase-deficient renal cell carcinoma at 3 T MRI15
Re: Ultrasound-guided lymph node sampling: accuracy of FNAC, end-cutting (Franseen), and side-cutting (Temno) needle biopsy techniques14
Re: Quantification of peak blood flow velocity at the cardiac valve and great thoracic vessels by four-dimensional flow and two-dimensional phase-contrast MRI compared with echocardiography: a systema14
Imaging features and management of tuberculomas: a review of cases and literature14
The prevalence of neovascularity in rotator cuff tendinopathy: comparing conventional Doppler with superb microvascular imaging14
Chest radiography predictor of COVID-19 adverse outcomes. A lesson learnt from the first wave14
Re: Clinical evaluation of a deep-learning-based computer-aided detection system for the detection of pulmonary nodules in a large teaching hospital14
Measurement of oesophageal hiatus surface area by multiplanar reconstruction of MDCT: relationship with lower oesophageal sphincter pressure and acid reflux14
A Radiology (with AI) christmas carol: Past, present and Yet to come14
Interdepartmental communication in emergency radiology: Documentation of referrer opinion on A&E radiographs13
Improving rationale for contrast CT in differentiated thyroid cancer13
Diagnostic accuracy and complications of image-guided core needle biopsy of lung lesions13
Cardiac CT dose reduction13
Use of functional liver imaging score with MultiHance (gadobenate dimeglumine) in chronic liver disease and its correlation with the Child-Pugh score13
The limping child: Is it septic arthritis? A tertiary centre clinical and radiological guideline12
Cherubism with orbital involvement associated with Noonan syndrome12
Abnormal tongue discoloration following radioactive iodine-131 ablation therapy for papillary cancer thyroid12
Elbow tendonitis and its mimics12
The accuracy of silent-scan MRA in the assessment of treated intracranial aneurysms compared with TOF-MRA and DSA12
Adequacy of coronal FIESTA images in gynaecological MR12
One-stop prostate MRI biopsy service improving the turnaround times from MRI referral to biopsy12
Neurological manifestations of HIV12
Re-audit of a bespoke alerting system for significant unexpected cancer on radiological examinations12
CT signs useful for suggesting usual interstitial pneumonia due to connective tissue disease versus idiopathic pulmonary fibrosis12
Comparison of CTPA and V/Q diagnostic outcomes in postpartum women12
Evaluation of pancreatic masses: Multidetector CT and endoscopic ultrasound correlation12
Institution of a two-week wait brain/CNS ‘cancer exclusion’ imaging pathway12
A review of MR rectal tumours: A review of imaging quality11
Extreme stenting of the GI tract11
Introduction of an electronic referral database for the Mersey on-call hub11
CT imaging of benign and malignant gastric disease: A pictorial review11
Imaging characteristics of axial spondyloarthritis11
Imaging features of paediatric intussusception diagnosis and reduction11
Anomalous coronary arteries: A pictorial review11
Pictorial review of the hepatobiliary phase appearances of colorectal liver metastasis with gadobenate dimeglumine-enhanced MRI11
Pneumatosis cystoides intestinalis in the paediatric population: A radiological diagnostic dilemma11
Comparison of COVID-19 disease severity and PE rates between Kent B1.1.7 lineage versus other lineages on CTPA10
Suboptimal CT imaging due to contrast medium allergy: A UK tertiary hospital experience10
Safety and efficacy of percutaneous plugged splenic biopsy as an alternative to splenectomy for diagnosing disorders of the spleen10
Spectral virtual non-contrast reconstruction in the detection of intramural haematoma10
Undergraduate radiology in low- and middle-income countries (LMICs)10
Impact of COVID-19 on CT imaging in a tertiary care hospital10
Coronary artery calcification on CTPA: Should I say or should I no?10
Increased consistent reporting of FDG PET-CT in presurgical assessment of medically refractory temporal lobe epilepsy10
Trauma in a non-trauma centre: Outcomes and incidental findings10
Sport-related head injuries: What is the burden on the radiology service? A single-centre experience10
Deep venous thrombosis: More than meets the eye10
Introduction to radiomics for a clinical audience9
RCR meetings9
Deep-learning reconstruction to improve image quality of myocardial dynamic CT perfusion: comparison with hybrid iterative reconstruction9
Hepatocellular carcinoma surveillance at a quaternary centre: an audit of adherence to EASL guidance9
RCR meetings9
Predictive value of major adverse cardiac events by T2-mapping texture analysis of the myocardial remote zone in patients with acute myocardial infarction9
Safety and technical success of diphenhydramine as an alternative local anaesthetic agent for radiology procedures9
Making an accurate diagnosis of anterior mediastinal lesions: a proposal for a new diagnostic algorithm from the BTOG Thymic Malignancies Special Interest Group9
Virtual special edition on interventional radiology9
Weight-based paediatric CT abdomen/pelvis dose audit9
Acute embolic stroke with large-vessel occlusion: does contact aspiration thrombectomy show superiority?9
A simple and convenient model combining multiparametric MRI and clinical features to predict tumour-infiltrating lymphocytes in breast cancer9
Ambulatory care in interventional radiology: a framework for radiology day-case9
Association of CT findings with invasive subtypes and the new grading system of lung adenocarcinoma9
Imaging spectrum of extracranial arterial vascular pathology: pearls for the radiologist9
Re: Ultrasound simulation training to meet the 2021 Royal College of Radiologists' curriculum for radiology trainees: South East London experience9
Paediatric fluoroscopic intussusception reduction audit9
The impact of endoscopic ultrasound on the management and outcome of patients with oesophageal cancer: an update of a systematic review9
A pilot study on preoperative vascular anatomy and clinical application in rectal cancer resection8
Diffusion-weighted imaging of the orbit8
Three-dimensional pseudo-continuous arterial spin-labelled perfusion imaging for diagnosing upper cervical lymph node metastasis in patients with nasopharyngeal carcinoma: a whole-node histogram analy8
Establishment of a non-invasive prediction model for the risk of oesophageal variceal bleeding using radiomics based on CT8
A national cross-sectional survey investigating the use of endoscopic ultrasound in the diagnosis and treatment of oesophageal cancer in the UK8
The ins and outs of male breast and anterior chest wall lesions from childhood to adulthood8
A clinical–radiological predictive model for solitary pulmonary nodules and the relationship between radiological features and pathological subtype8
Multimodality imaging in primary hyperparathyroidism8
Current and future best practice in imaging, staging, and response assessment for Non-Hodgkin's lymphomas: the Specialist Integrated Haematological Malignancy Imaging Reporting (SIHMIR) paradigm shift8
The role of contrast-enhanced mammography in the preoperative evaluation of invasive lobular carcinoma of the breast8
Low-dose three-dimensional CT angiography for the evaluation of posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: a quantitative anatomical comparison study of th8
COVID-19 CT pulmonary angiogram examinations and reported pulmonary embolism incidence: comparison between peak first wave and early second wave8
Impact of superior hypogastric nerve block during uterine fibroid embolisation on pain scores, opioid requirements, and same-day discharge: a case–control study8
Nomogram predictive model for differentiation between renal oncocytoma and chromophobe renal cell carcinoma at multi-phasic CT: a retrospective study8
Current status of the credential “mechanical thrombectomy for acute ischaemic stroke” sponsored by the Royal College of Radiologists. What factors are preventing approval of training for non-radiologi8
White matter integrity assessment in spinocerebellar ataxia type 2 (SCA2) patients8
Contents8
CT coronary angiography as an alternative imaging method to ascertain cardiac output and its correlation with echocardiography8
The “filling defect”: an appropriate radiological term or a fluoroscopic hangover?8
Optimal size threshold for PIRADSv2 category 5 upgrade and its positive predictive value: is it predictive of “very high” likelihood of clinically-significant cancer?8
Alteration of anterior cruciate ligament orientation in knees with trochlear dysplasia: description of a novel angle on MRI8
Re: peritumoural MRI radiomics signature of brain metastases can predict epidermal growth factor receptor mutation status in lung adenocarcinoma8
Routine whole-body CT identifies clinically significant findings in patients supported with veno-venous extracorporeal membrane oxygenation8
Trans-oral ultrasound-guided biopsy for head and neck lesions: an alternative for lesions not amenable to standard percutaneous image-guided biopsy. Description of the technique and case series8
Multiparametric MRI-based radiomics nomogram for predicting malignant transformation of sinonasal inverted papilloma8
A multi-lesional analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a single-centre analysis8
Feature pyramid network-based computer-aided detection and monitoring treatment response of brain metastases on contrast-enhanced MRI8
Role of diffusion-weighted MRI in differentiating between benign and malignant bone lesions: a prospective study8
MRI-based radiomics models for noninvasive evaluation of lymphovascular space invasion in cervical cancer: a systematic review and meta-analysis7
A bump in the night: a 15-year retrospective analysis of urgent inpatient and emergency CT reporting out of hours in a tertiary referral centre7
RCR meetings7
Imaging features of myxoid soft-tissue tumours7
Multimodality imaging of extra-nodal lymphoma in the head and neck7
Accuracy of transvaginal ultrasound versus MRI in the PreOperative Diagnostics of low-grade Endometrial Cancer (PODEC) study: a prospective multicentre study7
Symptomatic pelvic venous insufficiency: a review of the current controversies in pathophysiology, diagnosis, and management7
Maximal diameters and mean computed tomography (CT) value of synchronous multiple pure ground-glass opacities in lung adenocarcinoma are smaller7
Contents7
CT and MRI features of extraocular muscle granular cell tumour: preliminary experience in eight cases7
Utility of synthetic MRI in predicting pathological complete response of various breast cancer subtypes prior to neoadjuvant chemotherapy7
Changes in brain susceptibility in Wilson’s disease patients: a quantitative susceptibility mapping study7
Differentiation of malignant from benign orbital tumours using dual-energy CT7
A multicentre review of the direct-access mammography programme in Ireland for women with breast pain7
Monitoring mild cognitive impairment of workers exposed to occupational aluminium based on quantitative susceptibility mapping7
Response to Editorial: addressing inequalities in access to radiology services and the subsequent correspondence7
Re: gender representation within radiology conferences in the UK in 20217
World Federation for Interventional Stroke Treatment (WIST) multispecialty training guidelines for endovascular stroke intervention: Time is brain! – Response to commentary by UKNG7
25 Years of day-case interventional radiology at King’s College Hospital, London: worth the effort7
Diagnostic accuracy of a decision-support software for the detection of intracranial large-vessel occlusion in CT angiography7
Brain structural and functional MRI alterations and their predictive value for the visual outcome at 3 years in clinically isolated optic neuritis7
The design and use of a simple device for the MRI assessment of changes in cardiovascular function by lower-body negative-pressure-simulated reduction of central blood volume7
A retrospective cohort study comparing a novel, spherical, resorbable particle against five established embolic agents for uterine fibroid embolisation7
The imperative of a radiology AI deployment registry and the potential of ChatGPT7
Prognostic value of myocardial tissue characterization by cardiac magnetic resonance imaging using T1 mapping in nonischemic dilated cardiomyopathy: a systematic review and meta-analysis6
Diagnostic performance of diffusion-weighted imaging and intravoxel incoherent motion for renal lesions: a meta-analysis6
Clinical and MRI findings in patients with pediatric optic pathway glioma presenting with initial leptomeningeal dissemination6
Direct puncture versus contralateral femoral artery approach for catheter-directed thrombolysis of occluded infra-inguinal arterial bypass grafts6
CT features of acute COVID-19 and long-term follow-up6
Ultrasound simulation training to meet the 2021 Royal College of Radiologists' curriculum for radiology trainees: South East London experience6
In and around the pineal gland: a neuroimaging review6
Adrenal venous sampling in primary aldosteronism: lessons from over 600 single-operator procedures6
Arterial spin labelling qualitative assessment in paediatric patients with MRI-negative epilepsy6
MRI-based radiomics for the diagnosis of triple-negative breast cancer: a meta-analysis6
Lung parenchyma and structure visualisation in paediatric chest MRI: a comparison of different short and ultra-short echo time protocols6
Imaging features of the evolving patterns of metastatic prostate cancer6
Peritumoral and intratumoral radiomics for predicting visceral pleural invasion in lung adenocarcinoma based on preoperative computed tomography (CT)6
“Triple-low” radiation dose bronchial artery CT angiography before bronchial artery embolisation: a feasibility study6
Predicting neuroendocrine neoplasm grade with dual tracer positron emission tomography/computed tomography (PET/CT) using 18F-fluorodeoxyglucose (18F-FDG) and 18F–AlF-NOTA-octreotide: a lesion-based a6
Pulmonary transit time as a marker of diastolic dysfunction in Takotsubo syndrome6
Clinical application of ultrashort echo-time MRI for lung pathologies in children6
Opportunities in cancer imaging: risk-adapted breast imaging in screening6
Multimodality imaging appearance of intrapericardial paragangliomas6
CT appearances of pleural infection: analysis of the Second Multi-centre Intra-pleural Sepsis Trial (MIST 2) cohort6
Endolymphatic sac tumour: exploring the role of CT and MRI features in the diagnosis of 22 cases6
RESOLVE-based radiomics in cervical cancer: improved image quality means better feature reproducibility?6
Impact of COVID-19 on radiology training: Royal College of Radiologists Junior Radiologists Forum national survey6
Letter to the editor re: ultrasound as the first line investigation for midgut malrotation: a UK tertiary centre experience6
The ‘Tree trunk and root’ model: key imaging findings may anatomically differentiate axial psoriatic arthritis and DISH from axial spondyloarthropathy6
Weeping sponge kidney: an unusual phenomenon that should be considered in cases of severe renal haemorrhage6
Parenchymal involvement on CT pulmonary angiography in SARS-CoV-2 Alpha variant infection and correlation of COVID-19 CT severity score with clinical disease severity and short-term prognosis in a UK 6
Diagnostic value and limitations of CT in detecting rib fractures and analysis of missed rib fractures: a study based on early CT and follow-up CT as the reference standard6
The top 100 most cited articles on artificial intelligence in radiology: a bibliometric analysis6
Dual-layer spectral detector CT: predicting the invasiveness of pure ground-glass adenocarcinoma6
Differentiating infected focal liver lesions from malignant mimickers: value of ultrasound-based radiomics6
Comparison of contrast-enhanced ultrasonography and MRI results obtained by expert and novice radiologists indicating short-term response after transarterial chemoembolisation for hepatocellular carci6
Usefulness and accuracy of segmental adrenal venous sampling on localisation and functional diagnosis of various adrenal lesions in primary aldosteronism6
A deep-learning model using enhanced chest CT images to predict PD-L1 expression in non-small-cell lung cancer patients5
Imaging of non-specific complaints of the arm, neck, and/or shoulder (CANS): role of the scalene muscles and piercing variants in neurogenic thoracic outlet syndrome5
Automated detection of enteric tubes misplaced in the respiratory tract on chest radiographs using deep learning with two centre validation5
Deep learning for predicting the risk of immune checkpoint inhibitor-related pneumonitis in lung cancer5
Personalising sarcoma care using quantitative multimodality imaging for response assessment5
Improved diagnostic performance of susceptibility-weighted imaging with compressed sensing-sensitivity encoding and neuromelanin-sensitive MRI for Parkinson's disease and atypical Parkinsonism5
Contrast-enhanced ultrasound may be effective for the measurement of the free distal segment length of the internal carotid artery in carotid body tumours5
Determination of the diagnostic accuracy of peritoneal biopsy with an 18G cutting needle under ultrasonography guidance and the contribution of CT findings to diagnosis before biopsy (our 8-year clini5
Medical imaging call centre: a communication success story5
Behaviour of simple thymic cysts over time; is surveillance required?5
CT-based radiomics nomogram for the preoperative prediction of microsatellite instability and clinical outcomes in colorectal cancer: a multicentre study5
Letter to the Editor re: re: ultrasound as the first line investigation for midgut malrotation: a UK tertiary centre experience5
Barriers to research in interventional radiology within the UK5
Discrimination between microcystic meningioma and atypical meningioma using whole-lesion apparent diffusion coefficient histogram analysis5
Muscular MRI and magnetic resonance neurography in spinal muscular atrophy5
Preoperative prediction of microvascular invasion and perineural invasion in pancreatic ductal adenocarcinoma with 18F-FDG PET/CT radiomics analysis5
The value of a dual-energy spectral CT quantitative analysis technique in acute pancreatitis5
Exercise electrocardiogram combined with cadmium zinc tellurium (CZT) cardiac-dedicated single photon emission computed tomography (SPECT) predicts coronary artery disease5
Expanding global health opportunities for UK-based interventional radiology trainees5
The utility of dynamic contrast-enhanced intranodal magnetic resonance lymphangiography (MRL) in the investigation of primary lymphatic anomalies5
Can perihaematomal radiomics features predict haematoma expansion?5
Cerebral CT angiography as an ancillary investigation in the diagnosis of death using neurological criteria: a new UK guideline5
A validation study of combined resection and ablation therapy for multiple hepatocellular carcinoma5
Prognostic value of cardiac magnetic resonance imaging feature tracking technology in patients with light chain amyloidosis5
Post-immunotherapy imaging in lung cancer5
Paediatric radiology training in the UK: a national trainee survey by the British Society of Paediatric Radiologists (BSPR)5
Radiological features of Rosai–Dorfman disease: case series and review of the literature5
Disturbed white matter integrity on diffusion tensor imaging in young children with epilepsy5
Mammography-based radiomics analysis and imaging features for predicting the malignant risk of phyllodes tumours of the breast5
Y-shaped airway self-expanding covered metallic stent removal via the interventional technique5
Percutaneous cryoablation for desmoid fibromatosis: initial experience at a UK centre5
Systemic vasculitides and the role of multitechnique imaging in the diagnosis5
Transarterial chemoembolization combined with microwave ablation versus repeated resection for recurrent small hepatocellular carcinoma after resection: What is the better treatment?5
Angiographic features of pulmonary arteriovenous malformations: a new imaging classification system, BRAND, to guide embolisation5
Response evaluation of locoregional therapies in combined hepatocellular–cholangiocarcinoma and intrahepatic cholangiocarcinoma versus hepatocellular carcinoma: a propensity score matched study5
Upper limb computed tomography (CT) angiography in the emergency department5
Evaluation of learning and exposure in the undergraduate interventional radiology curriculum (ELIXIR)5
CT pulmonary angiography: optimising acute thoracic imaging by fixed-timing contrast medium delivery with a modified breathing instruction5
Dynamic thiol–disulphide homeostasis as a biomarker for predicting the development of contrast medium-associated acute kidney injury in the endovascular treatment of peripheral arterial disease: shoul4
Post-mortem radiology in fetal and neonatal death: the diagnostic value of post-mortem MRI versus autopsy regarding non-cardiac thoracic and abdominal abnormalities4
Contents4
Diagnostic performance of transvaginal sonography vs. magnetic resonance imaging for rectovaginal septum deep infiltrating endometriosis: a head-to-head comparative meta-analysis4
Adrenal metastases: early biphasic contrast-enhanced CT findings with emphasis on differentiation from lipid-poor adrenal adenomas4
Primary retrograde urinary drainage using image and endoscopy guidance via urostomies4
Effect of a second-generation motion correction algorithm on image quality and measurement reproducibility of coronary CT angiography in patients with a myocardial bridge and mural coronary artery4
Effectiveness and safety of a ventricular septal occluder device for the treatment of Gastro-tracheal fistula4
Re: UK undergraduate aspirations and attitudes survey: do we have a perception problem in clinical radiology?4
Special issue on imaging the post cancer-treatment chest: heralding a new definition of an “expert thoracic imager”?4
COVID-19: could CT provide the best population level biomarker? Incidental COVID-19 in major trauma patients suggests higher than predicted rates of infection in London4
Impact of the COVID-19 pandemic on a post-mortem CT service for adult non-suspicious death4
Re: Systemic vasculitides and the role of multitechnique imaging in the diagnosis4
Classification of breast edema on T2-weighted imaging for predicting sentinel lymph node metastasis and biological behavior in breast cancer4
Predicting lung adenocarcinoma invasiveness by measurement of pure ground-glass nodule roundness by using multiplanar reformation: a retrospective analysis4
Absence of clinical benefit of FDG PET-CT in staging T1 part-solid lung adenocarcinoma4
Silver trauma: a study of pre- and post-COVID-19 pandemic pan-CT scanning in elderly trauma patients in a large teaching hospital4
Contents4
RCR meetings4
Atrial dimension reference values in healthy participants using the biplane/monoplane method for clinical and research use4
Re: Bench-to-bedside imaging in brain metastases: a road to precision oncology4
RCR meetings4
Cardiac magnetic resonance imaging (MRI) for detecting acute myocardial injury of fulminant myocarditis survivors after extracorporeal membrane oxygenation (ECMO) treatment in adults4
Machine-learning algorithm in acute stroke: real-world experience4
RCR meetings4
Diagnostic accuracy of the jetting sign and a dilatation ratio of left renal vein in CT urography for detecting anterior nutcracker syndrome4
Re: Tumour markers and their utility in imaging of abdominal and pelvic malignancies4
Individualised prediction of progression of solitary sub-solid pulmonary nodules based on CT semantic and clinical features: a 3-year follow-up study4
Predicting the BRAF mutation with pretreatment MRI radiomics features for melanoma brain metastases receiving Gamma Knife radiosurgery4
Improvement of FDG PET/CT and MRI concordance in temporal lobe epilepsy pre-surgical assessment using statistical parametric mapping Z-scores4
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