Color Doppler in Obstetrics and Gynecology: Text and Atlas Chaitanya Nagori, Sonal Panchal
INDEX
Page numbers followed by b refer to box, f refer to figure, and t refer to table.
A
Abdomen 188
transverse section of 201f
Abortions 110
Adenocarcinoma 56
serous 62
Adenomyoma 41, 44f, 45f
Adenomyosis 31, 40f, 41, 44f, 45f
fan-shaped acoustic shadowing of 42f
heterogeneous myometrial
echogenicity of 41f
rain in forest or vanishing blind
appearance of 42f
salt and pepper appearance of 42f
ultrasound features of 44b
Adenomyotic myometrium,
heterogeneous 42f
Adenomyotic uteri 43
Adenosine triphosphate 168
Adnexa 128
Adnexal lesions 58
differential diagnosis of 66
Adnexal malignancies 58
Adnexal mass, extraovarian 128f
Adnexal soft tissue band 76f
Agenesis, renal 199
Alobar holoprosencephaly 191f
Alpha fetoprotein 60
Amenorrhea 18
Amniotic fluid 182
assessment 166f
index 166
Amniotic sac 126, 126f
Androgen 86
function of 86
Anemia 182
Angiogenesis 51
Angiogenic switch 51
Anti-Müllerian hormone 86, 88, 91, 102, 103
Antiphospholipid antibody syndrome 163
Antral follicle 87, 91f
count 86, 102, 104f
correlation of 91
multiple 87f, 88f
Aorta 159
arch of 148f
coarctation of 148, 148f, 149f, 160
narrowing of 149f
retrograde filling of 148f
right-sided 160
smaller diameter of 148f
Aortic arch 144f
B-mode image of 176f
color Doppler image of 149f
double 161
interrupted 145, 149
persistent right-sided 161
right-sided 203
Aortic isthmic flow, spectral Doppler of 176f
Aortic isthmus 175
flow 175
Aortic stenosis 145, 147f
critical 148, 160
Aorto-left ventricular tunnel 159
Arachnoid cyst 189, 190f
Artery
narrow pulmonary 159
renal 201f
spiral 116
Atresia
pulmonary 160
valve 144, 145
Atrial contraction 173
Atrioventricular concordance 140
Atrioventricular septal defect 152, 154, 155, 156f
Atrioventricular valves 136, 139, 140f
Automated volume calculation 104
Avascular region 51
B
Beta human chorionic gonadotropin 74, 110
Biophysical profile, role of 178
Bird's nest appearance 74, 74f
Birth weight, low 163
Bladder exstrophy 201, 201f
Blood
clots 73
flow, velocity of 1
vessels
diameter of 44f
homogeneous distribution of 39f
Body mass index 102
Brenner's tumors 59, 80, 81f
C
Cancer antigen 73
Carcinoma 62
endometrial 18, 52
Cardiac abnormalities 188, 202
Cardiac disease 163
Cardiac failure, congestive 183
Cardiotocography 178
Cardiovascular system 188
Cavum septum pellucidum 190f
Central pelvic organ 14
Cerebral
artery 184
anterior 191f
circulation 184f
Cervical
canal 95f
cancer 55
carcinoma 55, 56
length 32
malignancies 55
mass
coronal plane image of 57f
heterogeneous well-defined 57f
three-dimensional power Doppler image of 58f
polyps 24f
pregnancy 130, 130f
Cervix
B-mode ultrasound image of 56f, 95f
malignancy of 51
tumor-free wall measurement of 57f
Chorioangiomas 120
Choriocarcinoma 59, 63
Chorionic villi 120, 129
Circle of Willis 120, 170f, 184f
Doppler image of 169f
Clavicle measurement 165f
Clear cell 59
carcinoma 58, 62
Cleft lip, central 191f
Cog wheel appearance 76, 77f
Collagen vascular disease 163
Color comet sign 117
Complete atrioventricular septal defect, B-mode ultrasound image of 157f
Complete mole 131
Coombs test, indirect 182
Cord
complete loops of 198f
Doppler image of 197f
eccentric 198f
knot of 198f
three loops of 198f
Cordocentesis 182
Cornu, vertical orientation of 20f
Corpus callosum 190f
agenesis of 189
partial agenesis of 191
Corpus luteal flow 113, 113t
normal 112f
Corpus luteal inadequacy 99
Corpus luteum 69, 70, 71, 71f, 72f, 74, 98, 112, 116, 119
B-mode image of 70f
low resistance blood flow of 113f
normal flow pattern of 99f
residual 93f
spectral Doppler image of 99f
Crown-rump length 121, 164
measurement of 125f, 164f
Cystadenofibroma 80f
serous 80
Cystadenoma
benign
mucinous 80, 81f
serous 69, 69f
malignant serous 81f
Cystic lesion 77f, 80f, 83f, 194f
large 78f
Cysts
follicular 67, 67f
hemorrhagic 72f, 74
myometrial 20, 36f, 38, 42, 42f, 44
peritoneal inclusion 70f
small echo-free 22
Cytomegalovirus 164
D
Dermoid 82, 83f
mesh 84
Diabetes mellitus, severe 163
Diastolic flow 173
Disseminated peritoneal leiomyomatosis 49
Dominant follicle, perifollicular vascularity of 107f
Doppler 1, 25, 49
assessment, technique of 168
frequency 1
role of 159, 181
safety of 12
studies 38
Double bubble sign 126f
Ductal constriction 150
Ductus arteriosus 150
Ductus venosus 143, 170f, 177
absence of 161, 162
flow, abnormal 173, 175
Dysgerminoma 59, 60, 61f, 84f
Dysplasias, skeletal 163
E
Early pregnancy
abnormal 116, 120
B-mode ultrasound image of 118f, 126f
normal 116
power Doppler image of 120f
three-dimensional ultrasound image
of 119f
Ebstein's anomaly 143, 144
Echogenicity, level of 37
Ectopic pregnancy 127, 128f, 129
adnexal mass of 129f
interstitial 130f
ovarian 75f
tubal 128
Edema 18
Elastography 44, 46f
Embryo transfer 97
Endocardial fibroelastosis 147f
Endometrial
carcinoma, vascularization index of 54
cavity 20f, 96f, 122, 127, 127f
length of 32
lesion, edges of 16f
malignancy 27, 27f, 28f, 54f
power Doppler image of 55f
margins 16f
measurement 15f
metaplasia 22
endometrial cyst of 22f
myometrial junction 21, 30, 132
polyp 23f
scarring 20
synechiae 26
thickness 32, 99
tissue, normal 19
vascularity 110, 110t
vessels 116
volume 54f
Endometrioid 59
carcinoma 62
Endometrioma 71, 73, 73f, 74
three-dimensional power Doppler
image of 74f
Endometritis
acute 18, 18f, 93f
chronic 18, 19, 19f, 20f
postpartum 18
tuberculous 19
Endometrium 14f, 15, 15f, 18, 19f, 21f, 22f, 51, 55f, 95, 97, 98f, 111t
asymmetrical thickening of 117f
B-mode
features of 109
ultrasound image of 94f, 97f, 98f, 109f, 110f, 118f, 123f
coronal image of 27f
Doppler features of 109
echogenic 22
nonhomogeneous 22, 22f
ectopic growth of 41
heterogeneously thickened 28f
high-vascular density of 54f
homogeneous isoechoic 97f
hyperechoic 21f, 127f
outer margins of 98f
secretory 26f
thickened 93f
hyperplastic 22
lateral margin of 130f
morphology of 109
multilayered 98f
nonhyperechoic outer margins of 98f
polyp, large 23f
power Doppler ultrasound image of 94f
preovulatory 98f
progesterone-exposed 21
secretory 99f, 113f, 117f
symmetrical 127f
leaves of 75f
thickened 19, 27f
hypervascular 25f
vascularity of 97
Epidermal growth factor homology
domains 125
Epithelioid trophoblastic tumor 63, 64, 131, 132
Estrogen 86, 92
effect 95
F
Fallopian tube 62f, 66, 75, 76f, 116, 127
malignancy of 61
mass lesion of 62f
Fallot's tetralogy 155, 159, 160
Fan-shaped acoustic shadowing 38f, 44
Feeding vessels 24f
Female reproductive
organs, malignancy of 51
system 86
pivotal organ of 30
Femoral length measurement 165f
Fetal
abdomen
abnormalities of 195
transverse section of 197f, 202f
anemia 181, 186
B-mode signs of 182
common causes of 181
incidence of 181
predictor of 186
role of Doppler in 184
signs of 182
symptoms of 182
blood pressure 167
bradycardia 186
cardiac output 167
circulation 143, 145f
decompensation 174
echocardiography 136, 137
edema 184f
face, three-dimensional ultrasound of
growth 163
restriction 163
head
axial section of 184f, 191f
cerebellar diameter, transcerebellar axial section of 165f
midsagittal section of 190f, 191f
heart
B-mode image of 160f
rate 173
hypoxia 175f
movements 186
red blood corpuscles 182
tachycardia 186
trunk
HD flow Doppler of 202f
transverse section of 184f
urinary bladder 197f
vasculature, Doppler of 200f
vessels, evaluate 168
well-being, assessment of 176
Fetus
longitudinal section of 183f
sagittal
plane of 144f
section of 161f
transverse section of 183f
Fibroids 31, 41, 45, 47, 48f
edge shadow of 47f
endometrial 25
intramural 45
mapping 48b
pedunculated 23
polyp 25, 26f
reporting of 48b
subendometrial 26f
submucous 18, 45, 46f
subserosal 45
types of 47f, 47t
Fibroma 84
Fibrosis 19
Fibrothecoma 84
Fishnet appearance 72f
Flow index 103, 129
Flow velocities, calculation of 4f
Fluorescence in situ hybridization 155
Follicle 67
early recruitment of 99
granulosa cell of 92, 95
mature 106, 111t
mimicking multilocular cyst, multiple
number per ovary 103
rupture of 98
spectral Doppler image of 93f
stimulating hormone 67, 86, 89
recombinant 103
three-dimensional ultrasound
acquired vocal calculated volume
of 108f
Foramen ovale
aneurysm of 156f
obstructed 155
Four-chamber heart 138, 203f
Fundal
fibroid, subendometrial 26f
length 32
G
Gastroschisis 196
Doppler image of 196f
three-dimensional image of 196f
Germ cell tumors 59, 60, 80, 82
malignant 60, 84
Gestation, multiple 163
Gestational sac 110, 118f, 121, 123f, 124f, 130f
B-mode image of 122f
calculate volume of 121f
central anechoic 128f, 129f
eccentric location of 118f
ectopic 129f
large 122f
small 132f
three-dimensional ultrasound volume
of 121f
Gestational trophoblastic
diseases 131
neoplasia 63
Gonadotropin-releasing hormone 89
antagonist 80, 103
Granulosa cell tumor 59, 61, 84
Great arteries, transposition of 155
Great vessels
complete transposition of 159
corrected transposition of 159
Ground-glass
appearance 72f
echogenicity 73f
Growth restriction intervention trial 176
Gynecological malignancies 51
Gynecological tumors, assessment of 64
Gyri, appearance of 190f
H
Heart
B-mode ultrasound image of 158f
M-mode of 137f
rate 125
Hematoma, subchorionic 122
Hemoglobin values 181t
Hepatic vein 170f
Hernia
congenital diaphragmatic 193, 194
diaphragmatic 193
physiological umbilical 120
umbilical 120f
High-pulse repetition frequency 6f, 9f
High-velocity flow 6f
Holoprosencephaly 191, 191f
Human chorionic gonadotropin 60, 103, 118
Human papilloma virus 55
Human placental lactogen 64, 132
Hybrid leiomyomas 47
Hydatidiform mole
complete 131
invasive 132
partial 132
Hydrosalpinx 18, 67, 76, 77f, 78f
acute 77f
B-mode ultrasound image of 77f
transverse section of 77f
Hypercoiled cord 197f
Hyperechoic endometrium, three-dimensional ultrasound image of 131f
Hyperechoic stroma 91f
Hyperemia 18
Hyperinsulinemia 91
Hyperplasia 23f, 24f
cystic
endometrial 21f
glandular 22f
endometrial 21, 21f, 22
glandular 21
stromal 21
Hypertension, chronic 163
Hypoxemia, stage of 170
Hypoxia 168
inducible transcription factors 51
I
Iceberg sign, tip of 84
Iliac artery 169f
Iliac vessel, transverse section of 78f
In vitro fertilization 92
cycles 102
Inferior vena cava 143, 144f, 173, 184
anterior deviation of 161f
dilated 162
Inner lesion-free margin 37
Intact ventricular septum 144, 145
Interatrial septum, anatomy of 155f
International Endometrial Tumor Analysis 15, 15f17f
International Federation of Gynecology and Obstetrics 48
classification 46, 47f, 47t
International Ovarian Tumor Analysis 66
Interventricular septal defects 152
Intracytoplasmic sperm injection 103
Intramural fibroid, anterior 37f
Intraovarian
cystic lesion, multilocular 69f
unilocular cyst, large 67f
Intrauterine
contraceptive device 28f
growth restriction 163, 177, 178
early-onset 177t
late-onset 177t
prediction of 178
role of Doppler in 163
severe 186
insemination 97
cycles 102
transfusions, multiple 186
Invasive mole 63, 131
Isoechoic extraovarian adnexal mass, color Doppler ultrasound image of 128f
K
Kidney, ectopic 199
L
Left ventricular outflow tract 138, 138f, 140, 141f, 153
B-mode ultrasound image of 141f
Leiomyoma, benign metastasizing 49
Leiomyomatosis, diffuse 49
Leiomyosarcoma 41, 58
Leydig cell tumor 61
Low pulse repetition frequency 6f
Low resistance
corpus luteal flow 116f
perifollicular flow 93f
pulse Doppler image of 107f
Low-velocity flow
information, nonvisibility of 5f
spectral Doppler image of 9f
Lung
cystadenomatoid malformation of
hyperechoic 194f
microcystic cystadenomatoid
malformation of 194f
sequestration of 194f
triangular hyperechoic area of 194f
Luteal phase
defect 113, 113t
scan 102
Luteinized unruptured follicle 72f, 74, 95
Luteinizing hormone 86, 89, 92, 95, 106, 113
receptors 49
Lymph node 54
Lymphangioleiomyomatosis 50
M
Magnetic resonance imaging 44
Malignancy index, sensitivity of risk of 58
Malignant mass, power Doppler image of 55f
Malignant tumor 62f
diagnosis of 64
Mature follicle, B-mode ultrasound image of 107f
Melanoma 58
Meningomyelocele 202f
Menstrual cycle, mid-luteal phase of 98f
Methotrexate, local injection of 130
Mickey Mouse
appearance 196
sign 197f
Micropolyposis 21f
Middle cerebral artery 168, 169, 169f, 177, 184, 185t
flow 184
spectral Doppler of 185f
Mitral valve 139
cusp 141f
defects 150
disease 145
septal cusp of 139f
M-mode study 137
Molar cysts 132
Morphological uterus sonographic assessment 32, 32f, 33f
Multilocular cystic
lesion 69
structures 69
Multilocular solid
lesion 60f
tumor 61f
Multiloculated solid mass, B-mode ultrasound image of 60f
Multiple anomaly syndromes 163
Multiple cardiac cycles, trace of 11f
Muscular ventricular septal defect 152, 153f
Myocardial performance index 178
Myometrial extension 28f
Myometrial heterogenicities 37
Myometrial lesion 30, 31, 41
malignant 52
reporting details of 41b
Myometrial thickness 45f
Myometrial vessels, abnormal orientation of 44
Myometrial walls
anterior 32
posterior 32
symmetry of 41
Myometrium 20, 26f, 28f, 30, 47f, 51, 54, 55f, 97, 130f
description of 35
generalized heterogenicity of 36f
heterogeneous 36f, 44
normal anterior 35f
thick posterior 35f
thickness of posterior 35f
vanishing blind appearance of 42
N
Nabothian cysts, multiple 69f
Necrosis 24
Negative predictive value 24, 73, 97, 111, 126, 185
Neoplastic lesions 22
Nephroblastoma 202
Nonhierarchical vascular network 51
Nonpolycystic ovary 103
Nonstress test, abnormal 177
Noonan's syndrome 162
Nyquist frequency 4, 5, 11
O
Obesity 87
Oligohydramnios 183
severe 131
Omphalocele, Doppler image of 196f
Oophorectomy 49
Oophoritis 18, 76
Optimum pulse repetition frequency 6f
Outflow tract defects 155
Ovarian
cancers, diagnosis of 58
cystic lesions, nonseptated 67t
fibroma 84f
hyperstimulation 78
syndrome 78, 90
lesion 69, 74t
malignancies 51
mass 81f
neoplasms 80
pregnancy 130
stroma, hypoechoic 77f
stromal flow 105, 105f
index 79
stromal vessels, vascular parameters
of 90, 90t
tissue 68f
Beak sign of 68f, 83f
tumor
malignant 59
metastatic 61, 62f
multiloculated 81f
solid 81f
typical complex malignant 82f
vascularization index 80
volume 103
Ovary 66
acquired volume of 91f
adnexa comprises of 66
B-mode ultrasound image of 75f, 87f,
hyperstimulated 79f
three-dimensional ultrasound image
of 88f, 104f
vocal calculated volume of 91f
Ovum pick-up 103
Oxygen, low partial pressure of 112
P
Pap smear 55
Paraovarian cyst 68f
Partial mole 131
Peak systolic velocity 79, 90, 92, 103, 111, 116, 169, 184, 185t, 186f
Pelvic
abnormalities 120
infection, acute 18f
inflammatory disease 18, 75
kidney 201f
organs 66
Pelvicalyceal system 201f
renal 202f
Pelvis 30
Pericallosal artery, absent 190f
Perisac hematoma 122, 123f
Persistent left superior vena cava 160
Placenta
accreta 198, 200f
adherent 197, 199
increta 198, 200f
percreta 198, 200f
thickened 183f
Placental
bleeding 163
infarct 163
infections 163
myometrial interface 199f
site trophoblastic tumor 63, 64, 131,
vessels, widening of 167
villi, continuous maturation of 167
Placentation, abnormal 167
Plasma progesterone 116
Polycystic ovarian
morphology 90
syndrome 86, 90, 91, 105
Polycystic ovary
power Doppler ultrasound image of 90f
spectral Doppler image of 91f
Polyhydramnios 183
Polyps 2224, 24f
B-mode image of 24f, 25f
diagnosis of 25
multiple 24f
Positive predictive value 24, 73, 111, 126, 185
Power Doppler 2, 111
Pregnancy
abdominal 130
associated plasma protein-A 178
induced hypertension 163
interstitial 129, 130
tubal 126
Preovulatory period 92
Preovulatory scan 102, 106
Progesterone 86, 92
correlation of 99
Pseudogestational sac 127
Pulmonary artery, large 159
Pulmonary venous drainage 140
abnormal 203f
anomalous 202
Pulsatile umbilical venous flow 173f, 175f
Pulsatility index 90, 94, 111
Pulse repetition frequency 4, 5, 8, 9f, 107, 184
Pulsed Doppler 4
Q
Question mark sign 44
R
Rain in forest or vanishing blind appearance 44
Red blood cells 1
Renal disease 163
Resistance index 43, 52, 90, 93, 111, 113, 116
Retroverted retroflexed uterus 31f, 34f, 35f
Rhesus isoimmunization 181
Rhombencephalon 119
Right ventricular outflow tract 138, 140, 141f, 143f
B-mode ultrasound image of 141f
S
Sacrococcygeal teratoma 192, 192f, 193f
types of 193f
Saline infusion sonohysterography 23f
Salpingitis, acute 75, 76f
Sarcoma 52
botryoides 58
Scanty endometrial vascularity 22f
Scimitar syndrome 193, 194
Seminecrotic region 51
Septal defect 159f
Sertoli cell tumors 61, 84
Sertoli-Leydig cell tumor 59, 61, 84
Sessile polyps 24
Sex cord 59, 61, 80, 84
Single feeding vessel 25f, 62f
Situs inversus 160
Small for gestational age 163
Smith-Lemli-Opitz syndrome 162
Snake under skull sign 191
Soft tissues, thermal index for 12
Sonohysterography 24f, 25, 44, 56f
Sound beam, angle of incidence of 1t, 2t
Spectral Doppler 3
activation of 10f
Spine
sagittal section of 202f
three-dimensional ultrasound of 193f
Spiral artery flow 113, 113t
Squamous cell carcinoma 56
Stenosis
pulmonary 144, 145, 159
subaortic 147, 148f
Stomach, diaphragmatic hernia of 195f
Stroma, isoechoic 84f
Stromal echogenicity 99
Stromal flow 99
Stromal resistance index 103
Subclavian artery, aberrant right 161
Sulci, appearance of 190f
Superior vena cava 144f
Synechiae 20
T
Tamoxifen 22
Teratogens 163
Teratomas, immature 59
Theca lutein cyst 131f
Thermal effect 12
Thoracic lesions 193
Thorax 188
sagittal section of 161f
transverse section of 138f, 183f, 194f, 195f
Three vessel trachea section 142
Tortuous vessels, abnormal 41f
Transabdominal scan 73
Transvaginal ultrasound, B-mode 47f, 48f
Transverse cardiac diameter, measurement of 183f
Tricuspid atresia 144, 145, 146f
Tricuspid regurgitation 146f, 150f
Tricuspid valve 144, 145, 146f
dysplastic 143, 144
septal cusp of 139f
Trophoblastic diseases 131
Truncus arteriosus 155, 157, 159f, 160
Tubal malignancies 51, 61
Tuberculosis 20
Tubo-ovarian
abscess 79f
mass, B-mode ultrasound image of 79f
Tumoral vascular pattern 28f
Tumors
benign 59
borderline 59, 60f
epithelial 59, 80
hyperemia 51
malignant 59, 80
metastatic 80
mucinous
borderline 82f
epithelial 60, 80
multilocular 81f
renal 201, 202f
septated solid 61f
serous epithelial 59, 80
stromal 59, 61, 80, 84
tubal 62f
vasculature 51
vessels, Doppler studies of 52
Twins
acardiac 204
pregnancies 188
complications of 204
reversed arterial perfusion syndrome
to-twin transfusion 163
syndrome 204
Two bubble sign 126
U
Ultrasound 41, 47, 52, 53, 56, 58, 60, 62, 63, 102, 183
image, B-mode 182f, 183f
scan 119
transvaginal route of 102
transvaginal 29
Umbilical artery 169f, 176
abnormal 173f
acardiac twin 204f
Doppler 168
flow 175f
abnormal 172f, 175f
spectral Doppler image of 168f
spectrum 171f
velocity waveform, normal 167
single 197f
spectral Doppler of 121f
Umbilical cord
abnormalities 196
position 201f
vessels 169f
spectral Doppler 173f, 175f
Unilocular cyst, B-mode ultrasound image of 66f
Unilocular cystic lesion 67t, 68f
ultrasound image of 68f
Unilocular cystic structure 69
color Doppler image of 67f
Unilocular solid lesion, B-mode image of 71f
Uterine 163
abnormalities 120
artery 117f, 169f
Doppler 168
flow spectrum 167f
flow waveform, high-resistance 111f
flow, low resistance 117f
notch 179
resistance 87, 179
malignancies 52
wall, layers of 14f
Uteroplacental dysfunction 163
Uteroplacental vascular anatomy 166
Uterus 14, 30, 66
anteverted anteflexed 31f, 34f, 36f38f,
assessment of 30
B-mode ultrasound image of 20f, 36f,
body of 52f
coronal
plane of 20f
section of 49f
endometrial thickness of 32f
HD flow Doppler image of 132f
longitudinal measurements of 32f
midsagittal section of 15f, 31f34f, 43f
posterior wall of 36f
power Doppler image of 98f
question mark sign of 43
sagittal section of 52f
three-dimensional
power Doppler acquired volume of 54f
ultrasound of 20f, 28f, 49f
transvaginal B-mode ultrasound of 42f
transverse
diameter of 33f
section of 32f, 33f
V
Vaginal carcinoma, primary 57
Vaginal discharge 55
Vaginal malignancy 51, 57
Valvular tissue 144, 145
Vascular endothelial growth factor 51, 78, 91
Vascular resistance index 19
Vascularization flow index 80, 90, 103, 106f, 129
Veins of Galen, aneurysm of 150, 151f, 188, 188f, 189f
Veins
pulmonary 203f
umbilical 169f, 182f
Ventricular septal defect 139, 146f, 152, 152f, 155f, 158f
membranous 152
Vertebral body ossification centers 193f
Vesicular mole, power Doppler image of 132f
Vessels
penetration of 200f
renal 200f
spilling out of 5f
variable caliber of 51
Virtual organ computed-aided analysis 54f, 91, 91f, 104f, 106f, 108, 121
Vulval malignancies 51
W
Wilm's tumor 202
Y
Yagel's technique 142
Yolk sac 118f, 119f, 122f, 123, 124f
large 124f
solid 124f
thick-walled 124f
tumors 59
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