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Open Access 01-03-2020 | Neuromyelitis Optica Spectrum Disease | Review

Brain miliary enhancement

Authors: Joseph C.J. Bot, Linda Mazzai, Rogier E. Hagenbeek, Silvia Ingala, Bob van Oosten, Esther Sanchez-Aliaga, Frederik Barkhof

Published in: Neuroradiology | Issue 3/2020

Abstract

Purpose

Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted post-contrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes.

Methods

An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1-weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement.

Results

Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses.

Conclusion

A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.

Montagne A, Toga AW, Zlokovic BV (2016) Blood-brain barrier permeability and gadolinium: benefits and potential pitfalls in research. JAMA Neurol 73:13–14. https://doi.org/10.1001/jamaneurol.2015.2960 CrossRefPubMedPubMedCentral

Taieb G, Duran-Peña A, de Chamfleur NM, Moulignier A, Thouvenot E, Allou T, Lacour A, Hoang-Xuan K, Pelletier J, Labauge P (2016) Punctate and curvilinear gadolinium enhancing lesions in the brain: a practical approach. Neuroradiology 58:221–235. https://doi.org/10.1007/s00234-015-1629-y CrossRefPubMed

Rasmussen MK, Mestre H, Nedergaard M (2018) The glymphatic pathway in neurological disorders. Lancet Neurol 17:1016–1024. https://doi.org/10.1016/S1474-4422(18)30318-1 CrossRefPubMedPubMedCentral

Haldorsen IS, Espeland A, Larsson EM (2011) Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. Am J Neuroradiol 32:984–992. https://doi.org/10.3174/ajnr.A2171 CrossRefPubMedPubMedCentral

Malikova H, Burghardtova M, Koubska E, Mandys V, Kozak T, Weichet J (2018) Secondary central nervous system lymphoma: spectrum of morphological MRI appearances. Neuropsychiatr Dis Treat 14:733–740. https://doi.org/10.2147/NDT.S157959 CrossRefPubMedPubMedCentral

Epaliyanage P, King A, Hampton T, Gullan R, Ashkan K (2014) “Brain on fire”: a new imaging sign. J Clin Neurosci 21:2015–2017. https://doi.org/10.1016/j.jocn.2014.04.013 CrossRefPubMed

Faivre G, Lagarde J, Choquet S, Maillart E, Lubetzki C (2014) CNS involvement at diagnosis in mantle cell lymphoma with atypical MRI features. J Neurol 261:1018–1020. https://doi.org/10.1007/s00415-014-7295-x CrossRefPubMed

Ferreri AJM (2011) How I treat primary CNS lymphoma. Blood 118:510–522. https://doi.org/10.1182/blood-2011-03-321349 CrossRefPubMed

Chiavazza C, Pellerino A, Ferrio F et al (2018) Primary CNS lymphomas: challenges in diagnosis and monitoring. Biomed Res Int 2018:1–16. https://doi.org/10.1155/2018/3606970 CrossRef

10.

Koeller KK, Smirniotopoulos JG, Jones RV (2013) Primary central nervous system lymphoma: radiologic-pathologic correlation. RadioGraphics 17:1497–1526. https://doi.org/10.1148/radiographics.17.6.9397461 CrossRef

11.

Mansour A, Qandeel M, Abdel-Razeq H, Abu Ali HA (2014) MR imaging features of intracranial primary CNS lymphoma in immune competent patients. Cancer Imaging 14:1–9. https://doi.org/10.1186/1470-7330-14-22 CrossRef

12.

Lucantoni C, De Bonis P, Doglietto F et al (2009) Primary cerebral lymphomatoid granulomatosis: report of four cases and literature review. J Neuro-Oncol 94:235–242. https://doi.org/10.1007/s11060-009-9834-3 CrossRef

13.

Kim I (2012) Lymphomatoid granulomatosis with spinal involvement after childhood acute lymphoblastic leukemia. Korean J Spine 9:32–36. https://doi.org/10.14245/kjs.2012.9.1.32 CrossRefPubMedPubMedCentral

14.

Ganeshan D, Menias CO, Lubner MG et al (2018) Sarcoidosis from head to toe: what the radiologist needs to know. RadioGraphics 38:1180–1200. https://doi.org/10.1148/rg.2018170157 CrossRefPubMed

15.

Bathla G, Singh AK, Policeni B, Agarwal A, Case B (2016) Imaging of neurosarcoidosis: common, uncommon, and rare. Clin Radiol 71:96–106. https://doi.org/10.1016/J.CRAD.2015.09.007 CrossRefPubMed

16.

Ginat DT, Dhillon G, Almast J (2011) Magnetic resonance imaging of neurosarcoidosis. J Clin Imaging Sc 1:1–9CrossRef

17.

Bathla G, Watal P, Gupta S et al (2018) Cerebrovascular manifestations in neurosarcoidosis: how common are they and does perivascular enhancement matter? Clin0 Radiol 73:907.e15–907.e23. https://doi.org/10.1016/j.crad.2018.05.018 CrossRef

18.

Kumar P, Singh A, Gamanagatti S, Kumar S, Chandrashekhara SH (2018) Imaging findings in Erdheim-Chester disease: what every radiologist needs to know. Pol J Radiol 83:54–62. https://doi.org/10.5114/pjr.2018.73290 CrossRef

19.

Pan Z, Kleinschmidt-DeMasters BK (2017) CNS Erdheim-Chester disease: a challenge to diagnose. J Neuropathol Exp Neurol 76:986–996. https://doi.org/10.1093/jnen/nlx095 CrossRefPubMed

20.

Mazor RD, Manevich-Mazor M, Shoenfeld Y (2013) Erdheim-Chester disease: a comprehensive review of the literature. Orphanet J Rare Dis 8:1. https://doi.org/10.1186/1750-1172-8-137 CrossRef

21.

Langan RC, Goodbred AJ (2017) Vitamin B₁₂ deficiency: recognition and case management. Am Fam Physician 96:384–389PubMed

22.

Stabler SP (2013) Vitamin B₁₂ deficiency. N Engl J Med 368:149–160. https://doi.org/10.1056/NEJMcp1113996 CrossRefPubMed

23.

Stockton L, Simonsen C, Seago S (2017) Nitrous oxide-induced vitamin B₁₂ deficiency. Proceedings (Baylor University Medical Center) 30:171–172. https://doi.org/10.1080/08998280.2017.11929571 CrossRef

24.

Jain KK, Malhotra HS, Garg RK, Gupta PK, Roy B, Gupta RK (2014) Prevalence of MR imaging abnormalities in vitamin B₁₂ deficiency patients presenting with clinical features of subacute combined degeneration of the spinal cord. J Neurol Sci 342:162–166. https://doi.org/10.1016/J.JNS.2014.05.020 CrossRefPubMed

25.

Briani C, Torre CD, Citton V et al (2013) Cobalamin deficiency: clinical picture and radiological findings. Nutrients 5:4521–4539CrossRefPubMedPubMedCentral

26.

Abdel Razek AAK, Alvarez H, Bagg S, Refaat S, Castillo M (2014) Imaging spectrum of CNS vasculitis. RadioGraphics 34:873–894. https://doi.org/10.1148/rg.344135028 CrossRefPubMed

27.

Terada M, Nakamagoe K, Obara N et al (2017) Chronic graft-versus-host disease presenting with multiple punctate intracranial lesions on contrast-enhanced magnetic resonance imaging. Intern Med (Tokyo, Japan) 56:363–368. https://doi.org/10.2169/internalmedicine.56.7329 CrossRef

28.

Boulouis G, de Boysson H, Zuber M, Guillevin L, Meary E, Costalat V, Pagnoux C, Naggara O, French Vasculitis Group (2017) Primary angiitis of the central nervous system. Stroke 48:1248–1255. https://doi.org/10.1161/STROKEAHA.116.016194 CrossRefPubMed

29.

Birnbaum J, Hellmann DB (2009) Primary angiitis of the central nervous system. Arch Neurol 66:704–709. https://doi.org/10.1007/978-3-319-14871-7_17 CrossRefPubMed

30.

Abdelrasoul AA, Elsebaie NA, Gamaleldin OA, Khalifa MH, Razek AAKA (2019) Imaging of brain infarctions: beyond the usual territories. J Comput Assist Tomogr 43:443–451. https://doi.org/10.1097/RCT.0000000000000865 CrossRefPubMed

31.

Salvarani C, Brown RD, Calamia KT et al (2007) Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol 62:442–451. https://doi.org/10.1002/ana.21226 CrossRefPubMed

32.

Sostak P, Padovan CS, Eigenbrod S, Roeber S, Segerer S, Schankin C, Siegert S, Saam T, Theil D, Kolb HJ, Kretzschmar H, Straube A (2010) Cerebral angiitis in four patients with chronic GVHD. Bone Marrow Transplant 45:1181–1188. https://doi.org/10.1038/bmt.2009.323 CrossRefPubMed

33.

Pittock SJ, Debruyne J, Krecke KN, Giannini C, van den Ameele J, de Herdt V, McKeon A, Fealey RD, Weinshenker BG, Aksamit AJ, Krueger BR, Shuster EA, Keegan BM (2010) Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). Brain 133:2626–2634. https://doi.org/10.1093/brain/awq164 CrossRefPubMed

34.

Dudesek A, Rimmele F, Tesar S et al (2014) CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Review of an increasingly recognized entity within the spectrum of inflammatory central nervous system disorders. Clin Exp Immunol 175:385–396. https://doi.org/10.1111/cei.12204 CrossRefPubMedPubMedCentral

35.

Tobin WO, Guo Y, Krecke KN, Parisi JE, Lucchinetti CF, Pittock SJ, Mandrekar J, Dubey D, Debruyne J, Keegan BM (2017) Diagnostic criteria for chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). Brain 140:2415–2425. https://doi.org/10.1093/brain/awx200 CrossRefPubMed

36.

Taieb G, Mulero P, Psimaras D et al (2019) CLIPPERS and its mimics: evaluation of new criteria for the diagnosis of CLIPPERS. J Neurol Neurosurg Psychiatry 0:1–12. https://doi.org/10.1136/jnnp-2018-318957 CrossRef

37.

Dutra Garbugio B, da Rocha AJ, Júnior RH, Júnior ACMM (2018) Neuromyelitis optica spectrum disorders: spectrum of MR imaging findings and their differential diagnosis. RadioGraphics 38:169–193CrossRef

38.

Pekcevik Y, Orman G, Lee IH, Mealy MA, Levy M, Izbudak I (2016) What do we know about brain contrast enhancement patterns in neuromyelitis optica? Clin Imaging 40:573–580. https://doi.org/10.1016/j.clinimag.2015.07.027 CrossRefPubMed

39.

Pekcevik Y, Izbudak I (2015) Perivascular enhancement in a patient with neuromyelitis optica spectrum disease during an optic neuritis attack. J Neuroimaging 25:686–687. https://doi.org/10.1111/jon.12198 CrossRefPubMed

40.

Flanagan EP, Hinson SR, Lennon VA, Fang B, Aksamit AJ, Morris PP, Basal E, Honorat JA, Alfugham NB, Linnoila JJ, Weinshenker BG, Pittock SJ, McKeon A (2017) Glial fibrillary acidic protein immunoglobulin G as biomarker of autoimmune astrocytopathy: analysis of 102 patients. Ann Neurol 81:298–309. https://doi.org/10.1002/ana.24881 CrossRefPubMed

41.

Fang B, McKeon A, Hinson SR, Kryzer TJ, Pittock SJ, Aksamit AJ, Lennon VA (2016) Autoimmune glial fibrillary acidic protein astrocytopathy: a novel meningoencephalomyelitis. JAMA Neurology 73:1297–1307. https://doi.org/10.1001/jamaneurol.2016.2549 CrossRefPubMed

42.

Mehdipoor G, Davatchi F, Ghoreishian H, Arjmand Shabestari A (2018) Imaging manifestations of Behcet’s disease: key considerations and major features. Eur J Radiol 98:214–225. https://doi.org/10.1016/j.ejrad.2017.11.012 CrossRefPubMed

43.

Leonardo NM, McNeil J (2015) Behcet’s disease: is there geographical variation? A review far from the silk road. Int J Rheumatol 2015:1–7. https://doi.org/10.1155/2015/945262 CrossRef

44.

Lee WJ, Choi C, Kim JM, Jung KH, Roh JK (2017) Delayed symptomatic intracerebral hemorrhages in neuro-Behcet’s disease. J Neurol 264:394–396. https://doi.org/10.1007/s00415-016-8363-1 CrossRefPubMed

45.

Matsuo K, Yamada K, Nakajima K, Nakagawa M (2005) Neuro-Behcet disease mimicking brain tumor. AJNR 26:650–653PubMedPubMedCentral

46.

Liu HM, Dong C, Zhang YZ et al (2017) Clinical and imaging features of spinal cord type of neuro Behçet disease: a case report and systematic review. Medicine (United States) 96:1–4. https://doi.org/10.1097/MD.0000000000007958 CrossRef

47.

Kokturk A (2012) Clinical and pathological manifestations with differential diagnosis in Behçet’s disease. Pathol Res Int 2012:1–9. https://doi.org/10.1155/2012/690390 CrossRef

48.

Stanek G, Wormser GP, Gray J, Strle F (2012) Lyme borreliosis. Lancet 379:461–473. https://doi.org/10.1016/B978-0-444-63596-9.00022-0 CrossRefPubMed

49.

Shapiro ED (2014) Clinical practice. Lyme disease. N Engl J Med 370:1724–1731. https://doi.org/10.1056/NEJMcp1314325 CrossRefPubMedPubMedCentral

50.

Agarwal R, Sze G (2009) Neuro-Lyme disease: MR imaging findings. Radiology 253:443–452CrossRef

51.

Lindland ES, Solheim AM, Andreassen S, Quist-Paulsen E, Eikeland R, Ljøstad U, Mygland Å, Elsais A, Nygaard GO, Lorentzen ÅR, Harbo HF, Beyer MK (2018) Imaging in Lyme neuroborreliosis. Insights Imaging 9:833–844CrossRefPubMedPubMedCentral

52.

Hildenbrand P, Craven DE, Jones R, Nemeskal P (2009) Lyme neuroborreliosis: manifestations of a rapidly emerging zoonosis. Am J Neuroradiol 30:1079–1087. https://doi.org/10.3174/ajnr.A1579 CrossRefPubMedPubMedCentral

53.

Shih RY, Koeller KK (2015) Bacterial, fungal, and parasitic infections of the central nervous system: radiologic-pathologic correlation and historical perspectives: from the radiologic pathology archives. RadioGraphics 35:1141–1169. https://doi.org/10.1148/rg.2015140317 CrossRefPubMed

54.

Sharma RR (2010) Fungal infections of the nervous system: current perspective and controversies in management. Int J Surg 8:591–601. https://doi.org/10.1016/j.ijsu.2010.07.293 CrossRef

55.

Liu Y, Mittal R, Solis NV et al (2011) Mechanisms of Candida albicans trafficking to the brain. PLoS Pathog 7:1–13. https://doi.org/10.1371/journal.ppat.1002305 CrossRef

56.

Zarrin M, Mahmoudabadi AZ (2009) Invasive candidiasis; a review article. Jundishapur J Microbiol 2:1–6

57.

Nakayama H, Shibuya K, Kimura M et al (2010) Histopathological study of candidal infection in the central nervous system. Jpn J Med Mycol 51:31–45CrossRef

58.

Starkey J, Moritani T, Kirby J (2014) MRI of CNS fungal infections: review of aspergillosis to histoplasmosis and everything in between. Clin Neuroradiol 24:217–230. https://doi.org/10.1007/s00062-014-0305-7 CrossRefPubMed

59.

Duarte BSL, Oshima MM, Mesquita JVDA et al (2017) Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients. Radiol Bras 50:359–365CrossRefPubMedPubMedCentral

60.

Koshy JM, Mohan S, Deodhar D, John M, Oberoi A, Pannu A (2016) Clinical diversity of CNS cryptococcosis. J Assoc Physicians India 64:15–19PubMed

61.

Bloomgren G, Richman S, Hotermans C, Subramanyam M, Goelz S, Natarajan A, Lee S, Plavina T, Scanlon JV, Sandrock A, Bozic C (2012) Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med 366:1870–1880. https://doi.org/10.1056/NEJMoa1107829 CrossRefPubMed

62.

Takeda S, Yamazaki K, Miyakawa T, Takahashi H, Ikuta F, Arai H (2009) Progressive multifocal leukoencephalopathy showing extensive spinal cord involvement in a patient with lymphocytopenia. Neuropathology 29:485–493. https://doi.org/10.1111/j.1440-1789.2008.00981.x CrossRefPubMed

63.

Wattjes MP, Wijburg MT, Vennegoor A et al (2015) MRI characteristics of early PML-IRIS after natalizumab treatment in patients with MS. J Neurol Neurosurg Psychiatry 87:879–884. https://doi.org/10.1136/jnnp-2015-311411 CrossRefPubMed

64.

Pavlovic D, Patera AC, Nyberg F, Gerber M, Liu M, Progressive Multifocal Leukeoncephalopathy Consortium (2015) Progressive multifocal leukoencephalopathy: current treatment options and future perspectives. Ther Adv Neurol Disord 8:255–273. https://doi.org/10.1177/1756285615602832 CrossRefPubMedPubMedCentral

65.

Wattjes MP, Verhoeff L, Zentjens W et al (2013) Punctate lesion pattern suggestive of perivascular inflammation in acute natalizumab-associated progressive multifocal leukoencephalopathy: productive JC virus infection or preclinical PML-IRIS manifestation? J Neurol Neurosurg Psychiatry 84:1176–1177. https://doi.org/10.1136/jnnp-2013-304986 CrossRefPubMed

66.

Langer-Gould A, Atlas SW, Green AJ, Bollen AW, Pelletier D (2005) Progressive multifocal leukoencephalopathy in a patient treated with natalizumab. N Engl J Med 353:375–381. https://doi.org/10.1056/NEJMoa051847 CrossRefPubMed

67.

Metz I, Radue E-W, Oterino A, Kümpfel T, Wiendl H, Schippling S, Kuhle J, Sahraian MA, Gray F, Jakl V, Häusler D, Brück W (2012) Pathology of immune reconstitution inflammatory syndrome in multiple sclerosis with natalizumab-associated progressive multifocal leukoencephalopathy. Acta Neuropathol 123:235–245. https://doi.org/10.1007/s00401-011-0900-5 CrossRefPubMed

68.

Torok ME (2015) Tuberculous meningitis: advances in diagnosis and treatment. Br Med Bull 113:117–131. https://doi.org/10.1093/bmb/ldv003 CrossRefPubMed

69.

Sanei Taheri M, Karimi MA, Haghighatkhah H et al (2014) Central nervous system tuberculosis: an imaging-focused review of a reemerging disease. Radiol Res Pract 2015:1–8. https://doi.org/10.1155/2015/202806 CrossRef

70.

Khatri GD, Krishnan V, Antil N, Saigal G (2018) Magnetic resonance imaging spectrum of intracranial tubercular lesions: one disease, many faces. Pol J Radiol 83:628–639. https://doi.org/10.5114/pjr.2018.81408 CrossRef

71.

Wheat J, Myint T, Guo Y et al (2018) Central nervous system histoplasmosis. Medicine 97:1–8CrossRef

72.

Kauffman CA (2007) Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev 20:115–132. https://doi.org/10.1128/CMR.00027-06 CrossRefPubMedPubMedCentral

73.

Orlowski HLP, McWilliams S, Mellnick VM, Bhalla S, Lubner MG, Pickhardt PJ, Menias CO (2017) Imaging spectrum of invasive fungal and fungal-like infections. RadioGraphics 37:1119–1134CrossRefPubMed

74.

Kleffner I, Dörr J, Ringelstein M et al (2016) Diagnostic criteria for Susac syndrome. J Neurol Neurosurg Psychiatry 87:1287–1295. https://doi.org/10.1136/JNNP-2016-314295 CrossRefPubMed

75.

Vishnevskia-Dai V, Chapman J, Sheinfeld R, Sharon T, Huna-Baron R, Manor RS, Shoenfeld Y, Zloto O (2016) Susac syndrome: clinical characteristics, clinical classification, and long-term prognosis. Medicine 95:e5223. https://doi.org/10.1097/MD.0000000000005223 CrossRefPubMedPubMedCentral

76.

Susac JO, Murtagh FR, Egan RA et al (2003) MRI findings in Susac’s syndrome. Neurology 61:1783–1788CrossRefPubMed

77.

Hua LH, Donlon SL, Okuda DT (2014) A case of Susac syndrome with cervical spinal cord involvement on MRI. J Neurol Sci 337:228–231. https://doi.org/10.1016/j.jns.2013.11.040 CrossRef

78.

Iguchi Y, Mano K, Goto Y, Nakano T, Nomura F, Shimokata T, Iwamizu-Watanabe S, Hashizume Y (2007) Miliary brain metastases from adenocarcinoma of the lung: MR imaging findings with clinical and post-mortem histopathologic correlation. Neuroradiology 49:35–39. https://doi.org/10.1007/s00234-006-0152-6 CrossRefPubMed

79.

Ogawa M, Kurahashi K, Ebina A, Kaimori M, Wakabayashi K (2007) Miliary brain metastasis presenting with dementia: progression pattern of cancer metastases in the cerebral cortex. Neuropathology 27:390–395. https://doi.org/10.1111/j.1440-1789.2007.00782.x CrossRefPubMed

80.

Bekiesińska-Figatowska M, Kuczyńska-Zardzewiały A, Klepacka T, Brągoszewska H, Iwanowska B, Mądzik J, Lipska I (2013) Miliary brain metastases from papillary adenocarcinoma of the lung—unusual MRI pattern with histopathologic correlation. Pol J Radiol 78:57–60. https://doi.org/10.12659/pjr.889182 CrossRefPubMedPubMedCentral

81.

Richaud C, De Lastours V, Panhard X et al (2017) Candida vertebral osteomyelitis (CVO) 28 cases from a 10-year retrospective study in France. Medicine 31:1–7

82.

Furutani K, Harada M, Mawlan M, Nishitani H (2008) Difference in enhancement between spin echo and 3-dimensional fast spoiled gradient recalled acquisition in steady state magnetic resonance imaging of brain metastasis at 3-T magnetic resonance imaging time-dependent changes in the image contrast of brain

Title: Brain miliary enhancement
Authors: Joseph C.J. Bot
Linda Mazzai
Rogier E. Hagenbeek
Silvia Ingala
Bob van Oosten
Esther Sanchez-Aliaga
Frederik Barkhof
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keywords: Neuromyelitis Optica Spectrum Disease
Neurotuberculosis
Published in: Neuroradiology / Issue 3/2020
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-019-02335-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Brain miliary enhancement

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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