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1.
Clin Imaging ; 23(3): 184-6, 1999.
Article in English | MEDLINE | ID: mdl-10506914

ABSTRACT

The magnetic resonance imaging (MRI) of a patient with congenital blind megaureter and mullerian anomaly are presented. A retroperitoneal pelvic mass appeared as elongated tubular cystic structure spreading from parametrium to the adnexa and reaching the recto-sigma. On MRI, the mass was hyperintense on T1 and T2-weighted images and disappeared in STIR sequences. The mass with pseudo-intestinal structure, the retroperitoneal site, and the MRI sequences make the differential diagnosis.


Subject(s)
Kidney/abnormalities , Mullerian Ducts/abnormalities , Ureter/abnormalities , Female , Humans , Magnetic Resonance Imaging , Middle Aged
2.
Clin Imaging ; 23(2): 90-3, 1999.
Article in English | MEDLINE | ID: mdl-10416083

ABSTRACT

Intra-abdominal panniculitis is a thickening of the mesentery of the small/large intestine due to infiltration of lipid-laden macrophages associated with a variable amount of fibrosis. This condition is rarely associated with malignant neoplasms. We report the computed tomography (CT) findings of a patient treated for uterine papillary serous adenocarcinoma (UPSC). She had mesenteric panniculitis where metastatic tumor nodules implanted. This was the only intraperitoneal recurrence. To our knowledge, no such finding has been reported in the gynecologic and radiologic literature to date. On CT images, the differential diagnosis is with cystic dilatations of mesenteric lymph vessels.


Subject(s)
Cystadenocarcinoma, Papillary/diagnostic imaging , Panniculitis, Peritoneal/diagnostic imaging , Peritoneal Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Uterine Neoplasms/diagnostic imaging , Aged , Cystadenocarcinoma, Papillary/complications , Cystadenocarcinoma, Papillary/secondary , Diagnosis, Differential , Fatal Outcome , Female , Follow-Up Studies , Humans , Neoplasm Recurrence, Local , Panniculitis, Peritoneal/complications , Peritoneal Neoplasms/complications , Peritoneal Neoplasms/secondary , Uterine Neoplasms/complications , Uterine Neoplasms/pathology
5.
Radiol Med ; 96(3): 178-84, 1998 Sep.
Article in Italian | MEDLINE | ID: mdl-9850708

ABSTRACT

INTRODUCTION: Adequate radiologic assessment of the maxillofacial trauma patient is the basis for planning reparative surgery. We investigated the yield of the integration of axial CT with multiplanar (MP) and three-dimensional (3D) reconstructions with the Spiral technique. MATERIAL AND METHODS: Thirty-five patients (21 men and 14 women, mean age: 31.2 years) with complex maxillofacial traumas were submitted to Spiral CT. Images were acquired with 2-3-mm collimation, 1:1 to 2:1 pitch, 210 mAs, 120 kV, 15-24 s Spiral scan, RI = 1. 3D reconstructions were always obtained and used to guide MPRs targeted on the single injury. The examinations were retrospectively given a score, namely 1 if 3D and MPR yielded no more important diagnostic information than axial CT, 2 if 3D and MPR permitted better detailing of some axial CT findings and thus improved image reading, and 3 if 3D and MPR showed new injuries missed on axial images. Then, a radiologist and a maxillofacial surgeon reviewed the 3D images together only to assess in which cases they were useful to optimize surgical planning. RESULTS: Nine cases (25.7%) scored 1, seventeen (48.6%) scored 2 and nine (25.7%) scored 3. MP and 3D reconstructions were useful or determinant (2 + 3) in over 74% of cases. 3D images made surgical planning easier in 15 of 32 surgical patients (46.8%), allowing the surgeon a better panoramic view of the complex fracture. CONCLUSIONS: The greatest advantage of multiplanar imaging is the improved depiction of skeletal injuries along a horizontal plane, paralleling that of axial scans. The depiction of fractures of cribrum and of orbital roof and floor was particularly useful from a clinical viewpoint. MPRs clearly depicted herniation and incarceration of the lower rectus muscle in blow-out fractures. MP and 3D reconstructions better defined the presence and grade of displaced bone fragments in nearly vertical structures, such as the upward branches and coronoid apophysis of the mandible. 3D images alone never showed any more fractures than those seen on axial and MP images. 3D images are especially useful to the surgeon because they permit the panoramic depiction of the fracture complex, which facilitates treatment planning. The radiologist can use 3D reconstructions to guide the acquisition of targeted MP reconstructions, for better diagnostic yield. The Spiral technique, with its pitch increases up to 2, permits to limit the radiation dose while preserving the quality of postprocessing reconstructions. Finally, decreasing the execution time is important in multiple trauma patients who are often clinically unstable or have damaged vital organs.


Subject(s)
Facial Bones/diagnostic imaging , Facial Bones/injuries , Maxillary Fractures/diagnostic imaging , Skull Fractures/diagnostic imaging , Tomography, X-Ray Computed , Adult , Female , Humans , Male , Preoperative Care , Retrospective Studies , Tomography, X-Ray Computed/methods
7.
Tumori ; 84(3): 387-90, 1998.
Article in English | MEDLINE | ID: mdl-9678623

ABSTRACT

Subcutaneous metastases from clear cell endometrial carcinoma are an uncommon event and tumor implantations are rarely found with diagnostic imaging techniques. The nodular form is the most frequent type of subcutaneous metastasis from genital system tumors, even though plaque-like and infiltrative forms have also been reported. We report the first case of subcutaneous metastasis from clear cell endometrial carcinoma whose progression from the early nodular to the lymphangitic infiltrative form was studied with computed tomography (CT). Differential diagnostic problems are discussed.


Subject(s)
Adenocarcinoma, Clear Cell/diagnostic imaging , Adenocarcinoma, Clear Cell/secondary , Endometrial Neoplasms/pathology , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/secondary , Tomography, X-Ray Computed , Aged , Disease Progression , Female , Humans , Lymphatic Metastasis
8.
Eur Radiol ; 8(5): 739-45, 1998.
Article in English | MEDLINE | ID: mdl-9601958

ABSTRACT

We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 +/- 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 +/- 0.12 cm vs 1.09 +/- 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients.


Subject(s)
Angiography, Digital Subtraction , Intracranial Aneurysm/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/surgery , Diagnosis, Differential , Diagnostic Errors , Female , Follow-Up Studies , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Male , Middle Aged , Oculomotor Nerve Diseases/diagnostic imaging , Oculomotor Nerve Diseases/etiology , Reproducibility of Results , Rupture, Spontaneous , Sensitivity and Specificity , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/surgery
9.
Abdom Imaging ; 22(5): 522-3, 1997.
Article in English | MEDLINE | ID: mdl-9233893

ABSTRACT

Implantation subcutaneous metastases from ovarian cancer are an uncommon event in surgery, and diagnostic procedures such as laparoscopy, fine-needle biopsy, and intraperitoneal catheter access are usually used. Findings of tumor implantations are rarely reported with diagnostic imaging techniques. In this case, an infiltrative subcutaneous metastasis appeared on computed tomography 4 months after paracentesis in a patient with untreated ovarian cancer. Differential diagnostic problems are discussed.


Subject(s)
Cystadenocarcinoma, Papillary/diagnostic imaging , Cystadenocarcinoma, Papillary/secondary , Neoplasm Seeding , Ovarian Neoplasms/pathology , Paracentesis , Soft Tissue Neoplasms/diagnostic imaging , Soft Tissue Neoplasms/secondary , Tomography, X-Ray Computed , Female , Humans , Middle Aged
10.
Recenti Prog Med ; 88(7-8): 325-7, 1997.
Article in English | MEDLINE | ID: mdl-9270293

ABSTRACT

A rare case of abdominal plasmacytoma is described. A computed guided biopsy of abdominal mass permitted an accurate diagnosis. Blood findings revealed an increased gamma-globulin level and serum immunoelectrophoresis revealed high IgG-kappa spike. Bone marrow biopsy resulted negative for neoplastic infiltration. Plasmacytoma is a malignant proliferation of differentiated B lymphocytes which produce immunoglobulin. In our case, microscopically, biopsy of abdominal mass revealed the presence of plasmablasts with bizarre multiforme nuclei, spindled contours and positive immunoenzymatic reaction for CD38, suggestive for plasma cell proliferation.


Subject(s)
Abdominal Neoplasms , Plasmacytoma , Abdominal Neoplasms/diagnosis , Abdominal Neoplasms/pathology , Aged , Aged, 80 and over , Biopsy , Female , Humans , Plasmacytoma/diagnosis , Plasmacytoma/pathology , Tomography, X-Ray Computed
11.
Dentomaxillofac Radiol ; 26(4): 236-41, 1997 Jul.
Article in English | MEDLINE | ID: mdl-9442615

ABSTRACT

PURPOSE: To compare spiral CT with conventional radiography in planning the orthodontic treatment of impacted permanent maxillary canines. METHODS: Nineteen patients with 29 malpositioned permanent maxillary canines (15 palatal and 12 buccal impactions, one ectopic and one transposition) were examined with conventional panoramic and lateral cephalometric radiography and with spiral CT (at 1 mm slice thickness, and 1:1 or 2:1 pitch) using multiplanar (MPR) and 3D reconstruction. RESULTS: Conventional radiography failed to depict root resorption especially on the buccal surfaces of the incisor teeth. CT located impacted teeth better. Contact between impacted maxillary canines and incisor roots was demonstrated in 26 cases and root resorption in eight. MPR proved to be superior for the orientation of impacted teeth, and, in two cases, confirmed the presence of minimal root lesions for which axial images had proved inconclusive. The 3D reconstructions were useful in targeting the MPR. CONCLUSIONS: CT facilitates the treatment of impacted canine especially when the teeth are very oblique to the arch. Root resorption is better demonstrated especially on the palatal and buccal surfaces of the adjacent incisors. Spiral CT reduces examination time and risk of accidental movement, thus optimizing MPR quality. Examination at 2:1 pitch enables a significant reduction in radiation exposure without loss of image quality.


Subject(s)
Tomography, X-Ray Computed/methods , Tooth, Impacted/diagnostic imaging , Adolescent , Adult , Child , Cuspid , Female , Humans , Male , Maxilla , Radiographic Image Enhancement , Radiography, Panoramic , Root Resorption/diagnostic imaging , Root Resorption/etiology , Tooth, Impacted/complications
12.
Radiol Med ; 94(1-2): 52-7, 1997.
Article in Italian | MEDLINE | ID: mdl-9424652

ABSTRACT

Spontaneous esophageal perforation, or Boerhaave syndrome, is an uncommon finding requiring prompt diagnosis and immediate surgery because of its high mortality rate. The clinical diagnosis in typical cases is based on the symptom triad of Macler: vomiting, strong sudden chest pain and subcutaneous emphysema. We report 4 cases of Boerhaave syndrome with atypical presentation studied with Computed Tomography (CT) to make the correct diagnosis with atypical clinical findings. In each patient, we assessed the clinical symptoms, classifying them as typical and atypical, the diagnostic course leading to diagnosis and CT patterns. The classic symptoms were absent in one patient, while one patient had vomiting only, one had vomiting and chest pain and one had chest pain and cough. Chest radiography was performed in three patients and permitted the diagnosis in one of them only. CT permitted the definitive diagnosis in all cases. When spontaneous esophageal rupture presents with aspecific clinical findings. CT permits its accurate and specific diagnosis. We found atypical CT signs of esophageal rupture, namely pneumopericardium, uncommunicating mediastinal and pleural effusions, and focal pleural effusion in a contralateral cavity. Finally, our finding of a periesophageal mediastinal collection moving to the parietal subpleural space is not reported in the radiological literature. The severity of these findings varies and it is probably related to the increase in intraesophageal pressure affecting the progression of abscessual and hydroaerial collections in different anatomical structures; the time when CT is performed is also important. To conclude, the CT diagnosis of spontaneous esophageal rupture is specific and CT shows lesion site correctly.


Subject(s)
Esophageal Diseases/diagnostic imaging , Aged , Female , Humans , Male , Middle Aged , Rupture, Spontaneous , Syndrome , Tomography, X-Ray Computed
13.
Leukemia ; 11(5): 729-31, 1997 May.
Article in English | MEDLINE | ID: mdl-9180299

ABSTRACT

We describe the case of a child affected by acute lymphoblastic leukaemia who received adoptive immunotherapy after cord blood transplantation (CBT). The patient, transplanted in second relapse resistant to chemotherapy, still showed lung and costal leukaemic nodular lesions 2 months after CBT. For this reason, three infusions of donor peripheral blood leukocytes 1 x 10(7)/kg each were administered on days +60, +80 and +100. The procedure was well tolerated by both patient and donor, and a complete disappearance of the lung lesions was documented 2 months after the last infusion. The patient remains in continuous complete haematological remission 13 months after CBT. This experience suggests that adoptive immunotherapy may be safely employed after CBT in order to increase the contribution of immune-mediated anti-leukaemia effect.


Subject(s)
Hematopoietic Stem Cell Transplantation , Leukocyte Transfusion , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adoptive Transfer , Antigens, CD/analysis , Child , Colony-Forming Units Assay , Cyclosporine/therapeutic use , Fetal Blood , Graft vs Host Reaction , Hematopoiesis , Humans , Immunophenotyping , Immunosuppression Therapy , Immunosuppressive Agents/therapeutic use , Living Donors , Lung/diagnostic imaging , Lung/pathology , Male , Nuclear Family , Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology , Tomography, X-Ray Computed , Whole-Body Irradiation
14.
Radiol Med ; 93(5): 567-71, 1997 May.
Article in English | MEDLINE | ID: mdl-9251740

ABSTRACT

This retrospective study was aimed at assessing Computed Tomography (CT) capabilities in identifying low- and high-risk groups of clinical stage I endometrial carcinoma patients. CT of the pelvis was performed on 125 endometrial carcinoma patients who were divided into two groups based on T (stage and depth of myometrial invasion) and N (lymph node status) parameters. All patients had histologic evidence of well/moderately-differentiated adenocarcinoma (G1-G2). The low-risk group consisted of stage I patients with superficial myometrial involvement and no lymphadenopathy, while the high-risk group consisted of the patients with deep myometrial invasion and/or stage II and/or positive lymph nodes. All patients were operated on-i.e., total abdominal hysterectomy with vaginal cuff, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The patients were followed-up for 36 months at least. On the basis of CT findings, 85 patients were included in the low-risk group, but 11 misstaged cases were found at surgery in which lymphadenectomy never changed the factor risk. Only four relapses (4.7%) were observed in this group. Forty patients were included in the high-risk group: CT misstaged 20 cases and 12 relapses (30%) were observed. This study demonstrates the clinical value of CT in the assessment of radiologic risk factors in stage I endometrial carcinoma; CT findings can be used as guidelines for different treatments.


Subject(s)
Adenocarcinoma/diagnostic imaging , Endometrial Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Adenocarcinoma/pathology , Adult , Aged , Aged, 80 and over , Endometrial Neoplasms/pathology , Female , Humans , Middle Aged , Neoplasm Staging , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity
15.
Minerva Med ; 88(3): 105-7, 1997 Mar.
Article in English | MEDLINE | ID: mdl-9105327

ABSTRACT

Meningeal carcinomatosis (MC) is an uncommon from of metastasis of solid tumors. We reported a clinical case of a woman with esophagus adenocarcinoma that a few months after surgical operation, presented episodes of vomiting, nausea, hypertension, mental change, unconsiousness; A contrast-enhanced CT of the brain revealed an "area of enhancement in the caudate nucleus" and cerebrospinal fluid cytologic studies evidenced the presence of carcinomatous cells. The clinical state of the patient deteriorated and she died a few days later. Autopsy confirmed meningeal carcinomatosis without parenchymal involvement.


Subject(s)
Adenocarcinoma/secondary , Esophageal Neoplasms/pathology , Meningeal Neoplasms/secondary , Female , Humans , Middle Aged
16.
Eur Radiol ; 7(5): 718-20, 1997.
Article in English | MEDLINE | ID: mdl-9166571

ABSTRACT

Pulmonary sequestration has always been diagnosed by direct demonstration of the vessels tributary to the lesion, usually by angiography. Conventional CT can identify the arterial supply in only two thirds of cases. We report a case of pulmonary sequestration diagnosed using Spiral CT, based on the demonstration of both arterial supply and venous drainage. The capabilities of Spiral CT to detect subtle vessel abnormalities and to yield reliable multiplanar imaging enabled us to show the whole course of both the artery and the vein tributary to the lesion. Axial images were the most useful ones to diagnose pulmonary sequestration; 2D and 3D reconstructions were useful for a detailed and immediate spatial depiction of the parenchymal abnormality and of its vascular pedicle.


Subject(s)
Bronchopulmonary Sequestration/diagnostic imaging , Tomography, X-Ray Computed/methods , Humans , Image Processing, Computer-Assisted/methods , Male , Middle Aged
17.
Eur Radiol ; 7(2): 235-7, 1997.
Article in English | MEDLINE | ID: mdl-9038122

ABSTRACT

We report a case of communicating uterus diagnosed with MRI. These uterine malformations are characterized by a communicating tract between two separate uterocervical cavities, which is usually detected with hysterosalpingography performed for a suspected uterine malformation. In our patient MRI was performed after the clinical finding of a double cervix and a vaginal septum and demonstrated two separate uterine cavities, each of them with its own junctional area, and an isthmian transverse communicating tract with endometrial tissue inside, which helped make the diagnosis of a type-4 a communicating uterus according to Toaff.


Subject(s)
Magnetic Resonance Imaging , Uterus/abnormalities , Vagina/abnormalities , Adult , Cervix Uteri/abnormalities , Cervix Uteri/pathology , Congenital Abnormalities/diagnosis , Female , Humans , Uterus/pathology , Vagina/pathology
18.
Radiol Med ; 93(1-2): 51-5, 1997.
Article in Italian | MEDLINE | ID: mdl-9380868

ABSTRACT

Vertebral collapse is a frequent complication of osteoporosis with usually severe sequels. We examined a group of female patient with known senile osteoporosis to try to define a subgroup with atraumatic vertebral collapse on the basis of broadband ultrasound attenuation (BUA) values in the heel. 186 patients were submitted to calcaneal ultrasound densitometry and to radiography of the dorsolumbar spine; we also investigated the body mass index and postmenopausal and menopausal ages to identify the variable with the highest correlation with fracture, with the multiple regression statistical analysis. The regression model analysis showed a statistically significant correlation of BUA values (inverse relation) and weight (direct relation) with the risk of collapse (0.967 and 1.075 odds ratio, respectively). We subdivided the patients according to their body mass index and made the receiver operating characteristics (ROC) curves, thus increasing test accuracy, with 45 MHz BUA threshold, 66.67% sensitivity and 71.43% specificity. Calcaneal BUA is a good indicator of atraumatic vertebral collapse in senile osteoporosis patients; when the weight variable is associated, sensitivity, specificity and positive and negative predictive values (66.67%, 71.43% and 66.6% and 71%, respectively) increase, thus helping define this subgroup of patients.


Subject(s)
Calcaneus/diagnostic imaging , Osteoporosis, Postmenopausal/complications , Spinal Fractures/diagnosis , Aged , Aged, 80 and over , Female , Humans , Middle Aged , ROC Curve , Sensitivity and Specificity , Ultrasonography
19.
Radiol Med ; 93(1-2): 95-9, 1997.
Article in Italian | MEDLINE | ID: mdl-9380877

ABSTRACT

Insulinomas are usually benign tumors originating in the pancreatic islets: since they are biologically active tumors, insulinomas present at clinics with hypoglycemia caused by increased insulin production. We examined 7 patients with clinically suspected insulinomas with spiral CT to investigate its capabilities in identifying and characterizing this type of lesion. Four patients had abnormal spiral CT findings (true positives); the diagnosis was confirmed at surgery in 3 patients and at instrumental follow-up in the other. The tumors were 12.2 mm in average diameter. CT showed no tumor mass in 3 cases, which was confirmed at angiography and MRI (true negatives). We observed a typical contrast pattern in 50% of cases, namely a ring-like enhancement changing into homogeneous enhancement. Multiplanar and 3D reconstructions were not necessary for lesion identification, but we used them for regional vascular mapping. In our experience, which is limited to few cases and dose not allow any statistically significant conclusion, spiral CT exhibited high sensitivity in the detection and characterization of pancreatic insulinomas which permits to reduce the resort to more invasive angiographic techniques.


Subject(s)
Insulinoma/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Tomography, X-Ray Computed
20.
Dentomaxillofac Radiol ; 26(6): 327-31, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9482007

ABSTRACT

OBJECTIVE: To compare spiral with conventional CT for multiplanar reconstruction (MPR) prior to dental implant placement. METHODS: Ten patients underwent conventional and then Spiral CT at 1 mm slice thickness. In six patients (Group A) the pitch was 1:1; the other four (Group B) it was 2:1. Image quality and clinical features were evaluated separately on axial and reconstructed images by two experienced radiologists who scored each parameter from 1 (poor, non-diagnostic) to 3 (good, diagnostic). RESULTS: Loss of spatial resolution with spiral CT was not significant and the diagnostic yield poorer only for trabecular bone structure. The MPRs were better and depiction of the mandibular canal more reliable. CONCLUSIONS: We recommend the use of spiral CT instead of conventional CT for dental MPR because examination time is shorter and patient comfort is improved. Use of a pitch of 2:1 permits a marked reduction in X-ray dose with no loss of image quality.


Subject(s)
Dental Implantation , Radiography, Dental/methods , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Female , Humans , Male , Mandible/diagnostic imaging , Maxilla/diagnostic imaging , Middle Aged , Radiographic Image Interpretation, Computer-Assisted , Radiography, Dental/instrumentation , Radiography, Dental/statistics & numerical data , Software , Statistics, Nonparametric , Tomography, X-Ray Computed/instrumentation , Tomography, X-Ray Computed/statistics & numerical data
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