{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T19:48:34Z","timestamp":1793648914847,"version":"4.5.1"},"reference-count":130,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Fontan-associated liver disease (FALD) is a progressive condition resulting from chronic hepatic venous congestion following the Fontan procedure for univentricular heart defects. As survival improves in these patients, recognition and management of FALD have become increasingly important. Objective: To describe the pathophysiological mechanisms, imaging findings, and diagnostic approach to FALD, with a focus on the role of ultrasonography, including contrast-enhanced ultrasound (CEUS). Methods: This narrative review explores the evolution of FALD through a multidisciplinary lens, integrating cardiovascular and hepatic imaging data. Particular attention is paid to Doppler ultrasound and CEUS, both in early parenchymal changes and in the differential diagnosis of potential complications such as hepatic nodules. Results: FALD is characterized by progressive fibrosis due to long-standing passive congestion, resulting in a wide spectrum of imaging findings. B-mode ultrasound reveals hepatomegaly, heterogeneous parenchyma, and gallbladder wall thickening. Doppler studies show altered hepatic venous flow patterns, while CEUS provides dynamic vascular evaluation, highlighting areas of altered perfusion. In advanced stages, hypo-vascular areas in the late phase may simulate malignant lesions, emphasizing the need for careful interpretation. The role of liver biopsy, though limited by invasiveness, remains crucial in selected cases. Surveillance strategies are not standardized but require close multidisciplinary follow-up. Conclusions: FALD presents complex diagnostic challenges requiring integrated imaging and clinical assessment. CEUS emerges as a valuable, non-invasive tool in characterizing hepatic congestion and guiding management. Increased awareness and standardized protocols are essential for early detection and tailored care in this growing patient population.<\/jats:p>","DOI":"10.3390\/diagnostics15243171","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T09:37:48Z","timestamp":1765532268000},"page":"3171","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ultrasound Evaluation of Fontan-Associated Liver Disease: A State-of-the-Art Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4432-4449","authenticated-orcid":false,"given":"Federica","family":"Di Natale","sequence":"first","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, via Massarenti N 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Boccatonda","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, via Massarenti N 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Musmeci","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, via Massarenti N 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2809-1658","authenticated-orcid":false,"given":"Alice","family":"Brighenti","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, via Massarenti N 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Potena","sequence":"additional","affiliation":[{"name":"Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6015-6347","authenticated-orcid":false,"given":"Christoph Frank","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5555-0745","authenticated-orcid":false,"given":"Carla","family":"Serra","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, via Massarenti N 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/S0022-5223(19)40598-9","article-title":"An operation for the correction of tricuspid atresia","volume":"66","author":"Kreutzer","year":"1973","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/S0022-5223(19)40916-1","article-title":"Right atrial-right ventricular anastomosis for correction of tricuspid atresia","volume":"77","author":"Olin","year":"1979","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1097\/RCT.0000000000001751","article-title":"Ultrasound-MRI Agreement in Individuals Undergoing Surveillance of Fontan-associated Liver Disease","volume":"49","author":"Rubadeux","year":"2025","journal-title":"J Comput Assist Tomogr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101694","DOI":"10.1016\/j.jacadv.2025.101694","article-title":"Prevalence, Risk Factors, and Prognosis for Fontan-Associated Liver Disease: A Systematic Review and Exploratory Meta-Analysis","volume":"4","author":"Cao","year":"2025","journal-title":"JACC Adv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jjcc.2019.02.016","article-title":"Fontan-associated liver disease: A review","volume":"74","author":"Bove","year":"2019","journal-title":"J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1097\/SLA.0000000000005581","article-title":"Evaluation of Fontan-associated Liver Disease and Ethnic Disparities in Long-term Survivors of the Fontan Procedure: A Population-based Study","volume":"276","author":"Emamaullee","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1055\/a-2556-4897","article-title":"Fontan-Associated Liver Disease","volume":"45","author":"Hilscher","year":"2025","journal-title":"Semin. Liver Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"D\u2019Ardes, D., Pontolillo, M., Esposito, L., Masciarelli, M., Boccatonda, A., Rossi, I., Bucci, M., Guagnano, M.T., Ucciferri, C., and Santilli, F. (2020). Duration of COVID-19: Data from an Italian Cohort and Potential Role for Steroids. Microorganisms, 8.","DOI":"10.3390\/microorganisms8091327"},{"key":"ref_9","first-page":"100439","article-title":"The impact of the COVID-19 pandemic on individuals with Fontan circulation: Focus on gaps in care","volume":"11","author":"Mahendran","year":"2023","journal-title":"Int. J. Cardiol. Congenit. Heart Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s40477-021-00575-x","article-title":"One year of SARS-CoV-2 and lung ultrasound: What has been learned and future perspectives","volume":"24","author":"Boccatonda","year":"2021","journal-title":"J. Ultrasound"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/j.dld.2023.12.017","article-title":"Biomarkers of fibrosis and portal hypertension in Fontan-associated liver disease in children and adults","volume":"56","author":"Jarasvaraparn","year":"2024","journal-title":"Dig. Liver Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Jarasvaraparn, C., Rodenbarger, A., Thoe, J., Vuppalanchi, R., Payne, R.M., Markham, L.W., and Molleston, J.P. (2025). Platelet slope and long-term clinical outcomes in children and adults with Fontan-associated liver disease. Hepatol. Int.","DOI":"10.1007\/s12072-025-10819-1"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Boccatonda, A., Del Cane, L., Marola, L., D\u2019Ardes, D., Lessiani, G., di Gregorio, N., Ferri, C., Cipollone, F., Serra, C., and Santilli, F. (2024). Platelet, Antiplatelet Therapy and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Narrative Review. Life, 14.","DOI":"10.3390\/life14040473"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1055\/s-2002-19633","article-title":"Doppler imaging of hepatic vessels\u2014Review","volume":"40","author":"Ignee","year":"2002","journal-title":"Z. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"437","DOI":"10.2214\/ajr.171.2.9694471","article-title":"Hepatic and portal vein flow pattern in correlation with intrahepatic fat deposition and liver histology in patients with chronic hepatitis C","volume":"171","author":"Dietrich","year":"1998","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1002\/hep.27387","article-title":"Chronic passive venous congestion drives hepatic fibrogenesis via sinusoidal thrombosis and mechanical forces","volume":"61","author":"Simonetto","year":"2015","journal-title":"Hepatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1053\/j.gastro.2019.03.013","article-title":"Mechanical Stretch Increases Expression of CXCL1 in Liver Sinusoidal Endothelial Cells to Recruit Neutrophils, Generate Sinusoidal Microthombi, and Promote Portal Hypertension","volume":"157","author":"Hilscher","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1038\/s41575-019-0146-6","article-title":"LSEC stretch promotes fibrosis during hepatic vascular congestion","volume":"16","author":"Thomas","year":"2019","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1016\/j.ultrasmedbio.2018.06.002","article-title":"New Ultrasound Techniques Challenge the Diagnosis of Sinusoidal Obstruction Syndrome","volume":"44","author":"Dietrich","year":"2018","journal-title":"Ultrasound Med. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Dijkstra, H., Wolff, D., van Melle, J.P., Bartelds, B., Willems, T.P., Oudkerk, M., Hillege, H., van den Berg, A.P., Ebels, T., and Berger, R.M. (2017). Diminished liver microperfusion in Fontan patients: A biexponential DWI study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0173149"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/S0735-1097(96)00568-2","article-title":"Cardiorespiratory response to exercise after modified Fontan operation: Determinants of performance","volume":"29","author":"Durongpisitkul","year":"1997","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ohuchi, H., Mori, A., Nakai, M., Fujimoto, K., Iwasa, T., Sakaguchi, H., Kurosaki, K., and Shiraishi, I. (2022). Pulmonary Arteriovenous Fistulae After Fontan Operation: Incidence, Clinical Characteristics, and Impact on All-Cause Mortality. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.713219"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e001460","DOI":"10.1136\/openhrt-2020-001460","article-title":"Cross-sectional assessment of haemostatic profile and hepatic dysfunction in Fontan patients","volume":"8","author":"Daems","year":"2021","journal-title":"Open Heart"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Skubera, M., Go\u0142\u0105b, A., Plicner, D., Natorska, J., Z\u0105bczyk, M., Trojnarska, O., Mazurek-Kula, A., Sma\u015b-Suska, M., Bartczak-Rutkowska, A., and Podolec, P. (2021). Properties of Plasma Clots in Adult Patients Following Fontan Procedure: Relation to Clot Permeability and Lysis Time-Multicenter Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10245976"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e021765","DOI":"10.1161\/JAHA.120.021765","article-title":"Thromboprophylaxis for Children Post-Fontan Procedure: Insights From the UNIVERSE Study","volume":"10","author":"McCrindle","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.jhep.2022.01.025","article-title":"Hepatic lymphatic vascular system in health and disease","volume":"77","author":"Jeong","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.coi.2018.04.028","article-title":"Lymphatics in the liver","volume":"53","author":"Tanaka","year":"2018","journal-title":"Curr. Opin. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1177\/2150135114547587","article-title":"Outcomes of a hepatitis C screening protocol in at-risk adults with prior cardiac surgery","volume":"5","author":"Cox","year":"2014","journal-title":"World J. Pediatr. Congenit. Heart Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"de Lange, C., M\u00f6ller, T., and Hebelka, H. (2023). Fontan-associated liver disease: Diagnosis, surveillance, and management. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1100514"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1136\/hrt.2006.094516","article-title":"Hepatic changes in the failing Fontan circulation","volume":"93","author":"Kiesewetter","year":"2007","journal-title":"Heart"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ijcard.2016.02.041","article-title":"Fontan circulation causes early, severe liver damage. Should we offer patients a tailored strategy?","volume":"209","author":"Agnoletti","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1053\/jhep.2003.50385","article-title":"Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators","volume":"38","year":"2003","journal-title":"Hepatology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ijcard.2018.09.071","article-title":"What are the mechanisms for FALD and how can we prevent the progression?","volume":"273","author":"Ohuchi","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1053\/j.semtcvs.2021.04.005","article-title":"Surveillance of Fontan Associated Liver Disease in Childhood and Adolescence","volume":"34","author":"Hansen","year":"2022","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1007\/s00247-020-04776-0","article-title":"Imaging of Fontan-associated liver disease","volume":"50","author":"Dillman","year":"2020","journal-title":"Pediatr. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/j.ejrad.2016.02.002","article-title":"Fontan-associated liver disease: Spectrum of US findings","volume":"85","author":"Bae","year":"2016","journal-title":"Eur. J. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s10396-020-01078-8","article-title":"Noninvasive ultrasound technique for assessment of liver fibrosis and cardiac function in Fontan-associated liver disease: Diagnosis based on elastography and hepatic vein waveform type","volume":"48","author":"Koizumi","year":"2021","journal-title":"J. Med. Ultrason. (2001)"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/RCT.0000000000001533","article-title":"Imaging of Fontan-Associated Liver Disease","volume":"48","author":"Brown","year":"2024","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e14435","DOI":"10.1111\/petr.14435","article-title":"Fontan-associated liver disease after heart transplant","volume":"27","author":"Griffiths","year":"2023","journal-title":"Pediatr. Transpl. Transplant."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s00270-024-03761-6","article-title":"Transfemoral-Transcaval Liver Biopsy (TFTC) and Transjugular Liver Biopsy (TJLB) in Patients with Fontan-Associated Liver Disease (FALD)","volume":"47","author":"Shahid","year":"2024","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ijcard.2020.11.037","article-title":"Transjugular liver biopsy for Fontan associated liver disease surveillance: Technique, outcomes and hemodynamic correlation","volume":"328","author":"Borquez","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Francalanci, P., Giovannoni, I., Tancredi, C., Gagliardi, M.G., Palmieri, R., Brancaccio, G., Spada, M., Maggiore, G., Pietrobattista, A., and Monti, L. (2024). Histopathological Spectrum and Molecular Characterization of Liver Tumors in the Setting of Fontan-Associated Liver Disease. Cancers, 16.","DOI":"10.3390\/cancers16020307"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"100362","DOI":"10.1016\/j.jhepr.2021.100362","article-title":"Non-invasive biomarkers of Fontan-associated liver disease","volume":"3","author":"Emamaullee","year":"2021","journal-title":"JHEP Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1007\/s00246-023-03207-9","article-title":"Challenges in Accurate Diagnosis of HCC in FALD: A Case Series","volume":"44","author":"Feeley","year":"2023","journal-title":"Pediatr. Cardiol."},{"key":"ref_45","first-page":"133","article-title":"Hepatocellular carcinoma in Fontan-associated liver disease","volume":"38","author":"Bianco","year":"2025","journal-title":"Ann. Gastroenterol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1055\/a-1491-1771","article-title":"Conventional ultrasound for diagnosis of hepatic steatosis is better than believed","volume":"60","author":"Dietrich","year":"2022","journal-title":"Z. Gastroenterol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.dld.2011.08.021","article-title":"Relationship between hepatic haemodynamics assessed by Doppler ultrasound and liver stiffness","volume":"44","author":"Salvatore","year":"2012","journal-title":"Dig. Liver Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.3748\/wjg.v9.i11.2484","article-title":"Liver fibrosis in chronic viral hepatitis: An ultrasonographic study","volume":"9","author":"Zheng","year":"2003","journal-title":"World J. Gastroenterol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e0580","DOI":"10.1097\/HC9.0000000000000580","article-title":"Clinical predictors and noninvasive imaging in Fontan-associated liver disease: A systematic review and meta-analysis","volume":"8","author":"Seol","year":"2024","journal-title":"Hepatol. Commun."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"101357","DOI":"10.1016\/j.jacadv.2024.101357","article-title":"Liver Imaging in Fontan Patients: How Does Ultrasound Compare to Cross-Sectional Imaging?","volume":"3","author":"Garagiola","year":"2024","journal-title":"JACC Adv."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3205","DOI":"10.1007\/s00261-021-02994-0","article-title":"Spectrum of Fontan-associated liver disease assessed by MRI and US in young adolescents","volume":"46","author":"Thrane","year":"2021","journal-title":"Abdom. Radiol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Liu, X., Han, L., Zhou, Z., Tu, J., Ma, J., and Chen, J. (2024). Effect of liver abnormalities on mortality in Fontan patients: A systematic review and meta-analysis. BMC Cardiovasc. Disord., 24.","DOI":"10.1186\/s12872-024-04042-3"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Heering, G., Lebovics, N., Agarwal, R., Frishman, W.H., and Lebovics, E. (2024). Fontan-Associated Liver Disease: A Review. Cardiol. Rev.","DOI":"10.1097\/CRD.0000000000000684"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1148\/rg.2016150207","article-title":"Imaging Findings of Congestive Hepatopathy","volume":"36","author":"Wells","year":"2016","journal-title":"Radiographics"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1007\/s40477-025-01068-x","article-title":"B-flow imaging in abdominal ultrasound: A pictorial essay","volume":"28","author":"Becciolini","year":"2025","journal-title":"J. Ultrasound"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1111\/hepr.13248","article-title":"Identification of liver fibrosis using the hepatic vein waveform in patients with Fontan circulation","volume":"49","author":"Nakatsuka","year":"2019","journal-title":"Hepatol. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1136\/gut.52.8.1200","article-title":"Platelet count\/spleen diameter ratio: Proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis","volume":"52","author":"Giannini","year":"2003","journal-title":"Gut"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1067\/mtc.2001.112527","article-title":"Subdiaphragmatic venous hemodynamics in the Fontan circulation","volume":"121","author":"Hsia","year":"2001","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1136\/heart.83.5.582b","article-title":"Instantaneous pressure-flow velocity relations of systemic venous return in patients with univentricular circulation","volume":"83","author":"Hsia","year":"2000","journal-title":"Heart"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/S1010-7940(01)00705-9","article-title":"Effect of fenestration on the sub-diaphragmatic venous hemodynamics in the total-cavopulmonary connection","volume":"19","author":"Hsia","year":"2001","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1148\/rg.311105093","article-title":"Doppler US of the liver made simple","volume":"31","author":"McNaughton","year":"2011","journal-title":"Radiographics"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/0002-9149(84)90034-1","article-title":"Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function","volume":"53","author":"Moreno","year":"1984","journal-title":"Am. J. Cardiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.athoracsur.2008.03.077","article-title":"Liver and cardiac function in the long term after Fontan operation","volume":"86","author":"Camposilvan","year":"2008","journal-title":"Ann. Thorac. Surg."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1002\/hep.26631","article-title":"Increased hepatic stiffness as consequence of high hepatic afterload in the Fontan circulation: A vascular Doppler and elastography study","volume":"59","author":"Kutty","year":"2014","journal-title":"Hepatology"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1148\/rg.293085056","article-title":"Diagnostic and interventional radiology for Budd-Chiari syndrome","volume":"29","author":"Cura","year":"2009","journal-title":"Radiographics"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.jhep.2019.10.027","article-title":"Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort","volume":"72","author":"Minguez","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1007\/s00247-012-2531-y","article-title":"Hepatic pathology after Fontan palliation: Spectrum of imaging findings","volume":"43","author":"Wallihan","year":"2013","journal-title":"Pediatr. Radiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"423","DOI":"10.11152\/mu-4091","article-title":"Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesion\u2014infectious parasitic, fungus","volume":"25","author":"Zander","year":"2023","journal-title":"Med. Ultrason."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"50","DOI":"10.11152\/mu-4260","article-title":"Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part I","volume":"26","author":"Dong","year":"2024","journal-title":"Med. Ultrason."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"168","DOI":"10.11152\/mu-4261","article-title":"Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part II","volume":"26","author":"Dong","year":"2024","journal-title":"Med. Ultrason."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Loiacono, R., Boccatonda, A., Brighenti, A., Tiraferri, V., Agostinelli, D., Masi, L., Venturoli, N., Bakken, S.M., and Serra, C. (2025). The role of ceus in the characterization of indeterminate focal liver lesions at second-level imaging methods (INFOLIL STUDY). Intern. Emerg. Med.","DOI":"10.1007\/s11739-025-04210-z"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ejim.2025.02.001","article-title":"Bedside CEUS: A feasible option to consider","volume":"136","author":"Boccatonda","year":"2025","journal-title":"Eur. J. Intern. Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jpeds.2012.12.071","article-title":"Magnetic resonance imaging identifies unsuspected liver abnormalities in patients after the Fontan procedure","volume":"163","author":"Bulut","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.jhep.2019.01.009","article-title":"Low specificity of washout to diagnose hepatocellular carcinoma in nodules showing arterial hyperenhancement in patients with Budd-Chiari syndrome","volume":"70","author":"Purcell","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s00261-020-02598-0","article-title":"Imaging of hepatocellular carcinoma: A pilot international survey","volume":"46","author":"Tang","year":"2021","journal-title":"Abdom. Radiol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"221","DOI":"10.14366\/usg.19052","article-title":"LI-RADS ancillary features on contrast-enhanced ultrasonography","volume":"39","author":"Dietrich","year":"2020","journal-title":"Ultrasonography"},{"key":"ref_77","first-page":"42","article-title":"Benign Hepatic Nodules Mimicking Hepatocellular Carcinoma in the Setting of Fontan-associated Liver Disease: A Case Report","volume":"10","author":"Lehnert","year":"2020","journal-title":"Euroasian J. Hepatogastroenterol"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Kogiso, T., and Tokushige, K. (2020). Fontan-associated liver disease and hepatocellular carcinoma in adults. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-78840-y"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1016\/j.crad.2022.10.012","article-title":"Hepatocellular carcinoma and focal nodular hyperplasia in patients with Fontan-associated liver disease: Characterisation using dynamic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI","volume":"78","author":"Shiina","year":"2023","journal-title":"Clin. Radiol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1067\/j.cpradiol.2017.04.002","article-title":"Abdominal Imaging Surveillance in Adult Patients After Fontan Procedure: Risk of Chronic Liver Disease and Hepatocellular Carcinoma","volume":"47","author":"Nandwana","year":"2018","journal-title":"Curr. Probl. Diagn. Radiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ijcard.2015.12.033","article-title":"Three cases of hepatocellular carcinoma in Fontan patients: Review of the literature and suggestions for hepatic screening","volume":"206","author":"Wagenaar","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"E140","DOI":"10.1111\/j.1440-1754.2010.01932.x","article-title":"Cardiac cirrhosis and hepatocellular carcinoma in a 13-year-old treated with doxorubicin microbead transarterial chemoembolization","volume":"48","author":"Rosenbaum","year":"2012","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1007\/s00246-021-02802-y","article-title":"Circulatory Response to Rapid Volume Expansion and Cardiorespiratory Fitness in Fontan Circulation","volume":"43","author":"Klungerbo","year":"2022","journal-title":"Pediatr. Cardiol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1017\/S1047951121003188","article-title":"Quality of life and emotional vulnerability in a national cohort of adolescents living with Fontan circulation","volume":"32","author":"Grosch","year":"2022","journal-title":"Cardiol. Young"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s13244-018-0609-2","article-title":"Abdominal imaging findings in adult patients with Fontan circulation","volume":"9","author":"Kim","year":"2018","journal-title":"Insights Imaging"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2623","DOI":"10.1007\/s00261-017-1181-9","article-title":"Benign nodules in post-Fontan livers can show imaging features considered diagnostic for hepatocellular carcinoma","volume":"42","author":"Wells","year":"2017","journal-title":"Abdom. Radiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1007\/s00246-012-0315-7","article-title":"The precarious state of the liver after a Fontan operation: Summary of a multidisciplinary symposium","volume":"33","author":"Rychik","year":"2012","journal-title":"Pediatr. Cardiol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.jtcvs.2016.10.060","article-title":"Liver health in adults with Fontan circulation: A multicenter cross-sectional study","volume":"153","author":"Wu","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"463.e461","DOI":"10.1016\/j.medcli.2020.09.022","article-title":"Diagnosis and treatment of hepatocellular carcinoma. Update of the consensus document of the AEEH, AEC, SEOM, SERAM, SERVEI, and SETH","volume":"156","author":"Reig","year":"2021","journal-title":"Med. Clin."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/j.ultrasmedbio.2024.03.013","article-title":"WFUMB Guideline\/Guidance on Liver Multiparametric Ultrasound: Part 1. Update to 2018 Guidelines on Liver Ultrasound Elastography","volume":"50","author":"Ferraioli","year":"2024","journal-title":"Ultrasound Med. Biol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"95","DOI":"10.11152\/mu-3217","article-title":"How to perform shear wave elastography. Part I","volume":"24","author":"Ferraioli","year":"2022","journal-title":"Med. Ultrason."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"196","DOI":"10.11152\/mu-3342","article-title":"How to perform shear wave elastography. Part II","volume":"24","author":"Ferraioli","year":"2022","journal-title":"Med. Ultrason."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"129","DOI":"10.23736\/S2724-5985.20.02787-7","article-title":"What does liver elastography measure? Technical aspects and methodology","volume":"67","author":"Dietrich","year":"2021","journal-title":"Minerva Gastroenterol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"315","DOI":"10.11152\/mu-2063","article-title":"General advice in ultrasound based elastography of pediatric patients","volume":"21","author":"Dietrich","year":"2019","journal-title":"Med. Ultrason."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1016\/j.ultrasmedbio.2018.07.008","article-title":"Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations","volume":"44","author":"Ferraioli","year":"2018","journal-title":"Ultrasound Med. Biol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1055\/s-0043-103952","article-title":"EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version)","volume":"38","author":"Dietrich","year":"2017","journal-title":"Ultraschall Med."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Bakken, S.M., Serenari, M., Fiorini, G., Ruiz-Rodr\u00edguez, J., Boccatonda, A., and Serra, C. (2025). Discovering the Current Landscape of Liver Assessment through Viscosity and Shear Wave Elastography: State-of-the-Art Review. Ultraschall Med.","DOI":"10.1055\/a-2708-9064"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1093\/icvts\/ivw186","article-title":"Liver stiffness modifications shortly after total cavopulmonary connection","volume":"23","author":"Deorsola","year":"2016","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.ijcard.2018.01.108","article-title":"Temporal changes in liver stiffness after Fontan operation: Results of serial magnetic resonance elastography","volume":"258","author":"Egbe","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1093\/eurheartj\/ehy620","article-title":"The clinical spectrum of Fontan-associated liver disease: Results from a prospective multimodality screening cohort","volume":"40","author":"Munsterman","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1007\/s00246-020-02291-5","article-title":"Severity of Fontan-Associated Liver Disease Correlates with Fontan Hemodynamics","volume":"41","author":"Schleiger","year":"2020","journal-title":"Pediatr. Cardiol."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Chemello, L., Padalino, M., Zanon, C., Benvegnu, L., Biffanti, R., Mancuso, D., and Cavalletto, L. (2021). Role of Transient Elastography to Stage Fontan-Associated Liver Disease (FALD) in Adults with Single Ventricle Congenital Heart Disease Correction. J. Cardiovasc. Dev. Dis., 8.","DOI":"10.3390\/jcdd8100117"},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Nagasawa, T., Kuroda, H., Abe, T., Saiki, H., and Takikawa, Y. (2022). Shear wave dispersion to assess liver disease progression in Fontan-associated liver disease. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0271223"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1002\/jgh3.12967","article-title":"Poor correlation of 2D shear wave elastography and transient elastography in Fontan-associated liver disease: A head-to-head comparison","volume":"7","author":"Gill","year":"2023","journal-title":"JGH Open"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1002\/jpn3.12182","article-title":"Shear-wave elastography for monitoring Fontan-associated liver disease: A prospective cohort study","volume":"79","author":"Bolia","year":"2024","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.jhep.2024.09.005","article-title":"Non-invasive assessment of severe liver fibrosis in patients with Fontan-associated liver disease: The VALDIG-EASL FONLIVER cohort","volume":"82","author":"Jaillais","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"103178","DOI":"10.3748\/wjg.v31.i11.103178","article-title":"Role of transient elastography in the diagnosis and prognosis of Fontan-associated liver disease","volume":"31","author":"Cuadros","year":"2025","journal-title":"World J. Gastroenterol."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Imoto, K., Goya, T., Azuma, Y., Hioki, T., Aoyagi, T., Nagata, H., Nishizaki, A., Kakino, T., Ishikita, A., and Yamamura, K. (2025). Strain elastography for detecting advanced Fontan-associated liver disease: A retrospective study. BMC Gastroenterol., 25.","DOI":"10.1186\/s12876-025-03965-1"},{"key":"ref_109","first-page":"e85336","article-title":"Fontan-Associated Liver Disease: Predictors of Elevated Liver Stiffness and the Role of Transient Elastography in Long-Term Follow-Up","volume":"17","author":"Sakae","year":"2025","journal-title":"Cureus"},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Abadeer, M., Greer, J., Reddy, S., Divekar, A., Schooler, G.R., Fares, M., Dillenbeck, J., Philip, S., Zabala, L., and Sharma, B. (2025). The Importance of Hepatic Surveillance After Single-Ventricle Palliation: An Interventional Study Validating Liver Elastography. Pediatr. Cardiol.","DOI":"10.1007\/s00246-025-03854-0"},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Lo Yau, Y., Coppola, J.A., Lopez-Colon, D., Purlee, M., Vyas, H., Saulino, D.M., and Gupta, D. (2025). Correlation of Liver Fibrosis on Ultrasound Elastography and Liver Biopsy After Fontan Operation: Is Non-invasive Always Better?. Pediatr. Cardiol.","DOI":"10.1007\/s00246-025-03820-w"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"265","DOI":"10.32604\/chd.2025.065661","article-title":"A Tense Race: Correlation of Liver Stiffness with Ultrasound Elastography and Hemodynamics in Fontan Patients","volume":"20","author":"Yau","year":"2025","journal-title":"Congenit. Heart Dis."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.clinimag.2022.06.022","article-title":"Liver and spleen volume and stiffness in patients post-Fontan procedure and patients with ARPKD compared to normal controls","volume":"89","author":"Serai","year":"2022","journal-title":"Clin. Imaging"},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Padalino, M.A., Chemello, L., Cavalletto, L., Angelini, A., and Fedrigo, M. (2021). Prognostic Value of Liver and Spleen Stiffness in Patients with Fontan Associated Liver Disease (FALD): A Case Series with Histopathologic Comparison. J. Cardiovasc. Dev. Dis., 8.","DOI":"10.3390\/jcdd8030030"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1007\/s00247-024-06052-x","article-title":"Spleen shear wave elastography measurements do not correlate with histological grading of liver fibrosis in Fontan physiology: A preliminary investigation","volume":"54","author":"Venkatakrishna","year":"2024","journal-title":"Pediatr. Radiol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/RUQ.0000000000000541","article-title":"Quantification of Hepatic and Splenic Stiffness After Fontan Procedure in Children and Clinical Implications","volume":"36","author":"Aliyev","year":"2020","journal-title":"Ultrasound Q."},{"key":"ref_117","first-page":"E33","article-title":"EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV\u2014EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version)","volume":"37","author":"Jenssen","year":"2016","journal-title":"Ultraschall Med."},{"key":"ref_118","first-page":"E1","article-title":"EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III\u2014Abdominal Treatment Procedures (Long Version)","volume":"37","author":"Dietrich","year":"2016","journal-title":"Ultraschall Med."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1136\/jcp.2007.052365","article-title":"Hepatic fibrosis and cirrhosis in the Fontan circulation: A detailed morphological study","volume":"61","author":"Kendall","year":"2008","journal-title":"J. Clin. Pathol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"e004809","DOI":"10.1161\/JAHA.116.004809","article-title":"Hepatic Fibrosis Is Universal Following Fontan Operation, and Severity is Associated With Time From Surgery: A Liver Biopsy and Hemodynamic Study","volume":"6","author":"Goldberg","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1002\/hep.23425","article-title":"Pitfalls of liver stiffness measurement: A 5-year prospective study of 13,369 examinations","volume":"51","author":"Foucher","year":"2010","journal-title":"Hepatology"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"e12892","DOI":"10.1111\/ctr.12892","article-title":"Single-center outcomes of combined heart and liver transplantation in the failing Fontan","volume":"31","author":"Fuller","year":"2017","journal-title":"Clin. Transpl. Transplant."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"e234","DOI":"10.1161\/CIR.0000000000000696","article-title":"Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association","volume":"140","author":"Rychik","year":"2019","journal-title":"Circulation"},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Yoon, J.S., Lee, D.H., Cho, E.J., Song, M.K., Choi, Y.H., Kim, G.B., Lee, Y.B., Lee, J.H., Yu, S.J., and Kim, H. (2020). Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance. Cancers, 12.","DOI":"10.3390\/cancers12071805"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.amjcard.2015.11.014","article-title":"Liver Disease in Patients After the Fontan Operation","volume":"117","author":"Pundi","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"108","DOI":"10.4250\/jcvi.2020.0119","article-title":"Computed Tomography in the Evaluation of Fontan Circulation","volume":"29","author":"Kumar","year":"2021","journal-title":"J. Cardiovasc. Imaging"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.ijcard.2020.08.057","article-title":"Hepatocellular carcinoma and the Fontan circulation: Clinical presentation and outcomes","volume":"322","author":"Possner","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1016\/j.jhep.2023.07.013","article-title":"EASL-ERN position paper on liver involvement in patients with Fontan-type circulation","volume":"79","author":"Tjwa","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_129","doi-asserted-by":"crossref","unstructured":"Kogiso, T., Sagawa, T., Taniai, M., Shimada, E., Inai, K., Shinohara, T., and Tokushige, K. (2022). Risk factors for Fontan-associated hepatocellular carcinoma. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270230"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1111\/hepr.13500","article-title":"Characteristics of hepatocellular carcinoma arising from Fontan-associated liver disease","volume":"50","author":"Sagawa","year":"2020","journal-title":"Hepatol. 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