The Journal of Nuclear Medicine最新文献

{"title":"Measuring Total Metabolic Tumor Volume from 18F-FDG PET: A Reality Check","authors":"Ronald Boellaard, Gerben J.C. Zwezerijnen, Irène Buvat, Laurence Champion, Narinée Hovhannisyan-Baghdasarian, Fanny Orlhac, Anne I.J. Arens, Daphne Lobeek, Filiz Celik, Cristina Mitea, Julia E. Huijbregts, Nelleke Tolboom, Bart de Keizer, Roelf Valkema, Floris H.P. van Velden, Petra Dibbets-Schneider, Sanne E. Wiegers, Pieternella J. Lugtenburg, Sally F. Barrington, Josée M. Zijlstra","doi":"10.2967/jnumed.124.269271","DOIUrl":"https://doi.org/10.2967/jnumed.124.269271","url":null,"abstract":"<p>Measuring total metabolic tumor volume (TMTV) on ¹⁸F-FDG PET/CT images in clinical practice requires a fast, reliable, and easy-to-perform multilesional segmentation workflow. We conducted a field test to derive total metabolic volumes using 5 representative baseline ¹⁸F-FDG PET/CT scans from patients with diffuse large B-cell lymphoma. The scans were transferred to 10 different sites or readers who used different commercially available software platforms to derive TMTV after a recently proposed benchmark workflow. Observed TMTVs were compared with reference values, and overall analysis times were reported. Our results show that TMTVs can be obtained with reasonable accuracy across readers and platforms (within 10% compared with reference benchmark values for most TMTVs) but that processing times can vary considerably depending on reader experience and the software platform. Our study showed that there is an urgent need to improve TMTV segmentation workflows in clinical practice, requiring closer collaboration between users and software vendors.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Maximum-Intensity Projections and Deep Learning Adds Value to the Fully Automatic Segmentation of Lesions Avid for [18F]FDG and [68Ga]Ga-PSMA in PET/CT","authors":"Cláudia S. Constantino, Francisco P.M. Oliveira, Marisa Machado, Susana Vinga, Durval C. Costa","doi":"10.2967/jnumed.124.269067","DOIUrl":"https://doi.org/10.2967/jnumed.124.269067","url":null,"abstract":"<p>This study investigated the added value of using maximum-intensity projection (MIP) images for fully automatic segmentation of lesions using deep learning (DL) in [¹⁸F]FDG and [⁶⁸Ga]Ga-prostate-specific membrane antigen (PSMA) PET/CT scans. <strong>Methods:</strong> We used 489 staging [¹⁸F]FDG PET/CT scans from patients diagnosed with melanoma, lymphoma, or lung cancer (391 scans for training and 98 for internal testing). As an external test set, 117 staging [¹⁸F]FDG PET/CT scans from lymphoma patients (another center, 2 scanners) were used. For [⁶⁸Ga]Ga-PSMA, 355 whole-body [⁶⁸Ga]Ga-PSMA PET/CT scans from patients with prostate cancer were used (285 scans for training and 70 scans for testing). All scans had corresponding expert-based segmentation (ground truth). Three approaches per radiopharmaceutical were used for fully automatic segmentation: 3-dimensional U-Net applied directly on PET images (standard-DL–based), 3-dimensional U-Net applied on multiangle MIP images (MIP-DL–based), and a combined approach (standard-DL+MIP-DL–based). The performance was evaluated in comparison with ground truth segmentation through lesion detection scores, voxelwise segmentation overlap metrics, and quantification of clinically relevant imaging features. <strong>Results:</strong> For [¹⁸F]FDG PET scans, the MIP-DL–based method showed a lower lesion false-discovery rate than did the standard-DL–based approach, although not significant in internal and external test sets. Sensitivity in lesion detection did not vary significantly, and a reduction in voxelwise metrics was observed (median Dice coefficient of 0.65 vs. 0.80 in the internal test set). Significantly increased performance was obtained with the combined approach in both test sets. In the internal test set, the median false-discovery rate was 0% (12% using the standard-DL), and a considerable increase in the agreement of lesion features was observed (intraclass correlation coefficient range, 0.42–0.94 for standard-DL–based and 0.80–0.94 for the combined approach). Similar results were observed in the external set. Regarding [⁶⁸Ga]Ga-PSMA scans, there was no significant increase in the performance of MIP-DL–based and combined approaches compared with standard-DL, which was already outstanding in lesion detectability. <strong>Conclusion:</strong> Fully automatic segmentation of lesions in whole-body or total-body [¹⁸F]FDG PET/CT scans may benefit from the addition of the MIP-DL–based segmentation compared with the standard-DL–based method. It reduces the number of false-positive lesions and improves the patients’ tumor burden quantification. In [⁶⁸Ga]Ga-PSMA PET/CT scans, no benefits were observed compared with standard-DL–based segmentation.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor Dose–Response Relationship of [131I]MIBG Therapy in Patients with Neural Crest Tumors by Means of [124I]MIBG PET","authors":"Alexandros Moraitis, Andre Prochnow, Thorsten Dirk Poeppel, Jochen Schmitz, Christina Laschinsky, Ken Herrmann, Andreas Bockisch, Pedro Fragoso Costa, David Kersting, Walter Jentzen","doi":"10.2967/jnumed.124.269377","DOIUrl":"https://doi.org/10.2967/jnumed.124.269377","url":null,"abstract":"<p>[¹³¹I]Metaiodobenzylguanidine (MIBG) therapy in patients with neural crest tumors has demonstrated sustained control of catecholamine-associated hypertension and corresponding partial response. Details on how neural crest tumors respond to an absorbed dose delivered by [¹³¹I]MIBG-targeted therapies is insufficiently known. The primary aim of this retrospective study was to assess the tumor dose–response relationship by means of quantitative analysis of [¹²⁴I]MIBG PET data. <strong>Methods:</strong> The tumor dose–response relationship was studied in patients with advanced malignant pheochromocytoma, neuroblastoma, or paraganglioma receiving [¹³¹I]MIBG treatment, as well as pretherapeutic and follow-up [¹²⁴I]MIBG-based dosimetry. [¹²⁴I]MIBG PET imaging was performed around 4, 24, 48, and 120 h after injection. Lesion uptake was projected to [¹³¹I]MIBG for every time point, and respective time-integrated activity coefficients (TIACs) for [¹³¹I]MIBG were calculated and used for tumor-absorbed dose estimation. Functional response was denoted for decrease of maximal lesion uptake or TIAC by at least 30% in the follow-up examination. In a consecutive analysis, the predictive value of a single tumor-uptake assessment from PET imaging at 24 h after administration was investigated with respect to receiving the derived target dose. <strong>Results:</strong> In total, 46 lesions from 9 patients were available for dose–response analysis. The mean ± SD tumor-absorbed dose coefficient was 13.4 ± 15.4 Gy/GBq (median, 7.2 Gy/GBq; range, 1.1–64.7 Gy/GBq). A high correlation (−0.60, <em>P</em> &lt; 0.001) was found between uptake decrease and tumor dose. In addition, a very high correlation (0.91, <em>P</em> &lt; 0.001) was found between uptake and TIAC decrease. The estimated targeted tumor dose was 200 Gy, that is, the dose at which the response rate exceeded the 90% threshold. A single 24-h uptake assessment showed predictive value with respect to receiving the target dose. <strong>Conclusion:</strong> This study demonstrated a clear correlation between tumor-absorbed dose and functional response in [¹³¹I]MIBG therapy and proposes a target dose for response at the tumor level.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-in-Human Phase 0 Study of AB001, a Prostate-Specific Membrane Antigen–Targeted 212Pb Radioligand, in Patients with Metastatic Castration-Resistant Prostate Cancer","authors":"Kjetil Berner, Eivor Hernes, Monika Kvassheim, Mona-Elisabeth Revheim, Julie Bastiansen, Silje Selboe, Charlotte L. Bakken, Simen R. Grønningsæter, Øyvind S. Bruland, Roy H. Larsen, Lily Bouzelmat, Vicki L. Jardine, Caroline Stokke","doi":"10.2967/jnumed.124.269299","DOIUrl":"https://doi.org/10.2967/jnumed.124.269299","url":null,"abstract":"<sec><st>Visual Abstract</st><p><fig loc=\"float\"><link locator=\"jnumed.124.269299absf1\"></fig></p></sec>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"18F-Fluoroestradiol PET/CT for Predicting Benefit from Endocrine Therapy in Patients with Estrogen Receptor–Positive Breast Cancer: A Systematic Review and Metaanalysis","authors":"Ashwin Singh Parihar, Sofia Vaz, Siobhan Sutcliffe, Niharika Pant, Jan W. Schoones, Gary A. Ulaner","doi":"10.2967/jnumed.124.269163","DOIUrl":"https://doi.org/10.2967/jnumed.124.269163","url":null,"abstract":"<p>¹⁸F-fluoroestradiol (¹⁸F-FES) PET/CT has been investigated as a potential biomarker to predict response to endocrine therapies in patients with estrogen receptor (ER)–positive breast cancer. Although previous findings were promising, most had limited statistical significance because of small individual sample sizes. Therefore, we performed a systematic review and metaanalysis of the ¹⁸F-FES PET/CT literature to increase our power to evaluate the utility of ¹⁸F-FES PET/CT as a biomarker for prediction of clinical benefit from endocrine therapy in patients with ER-positive breast cancer. <strong>Methods:</strong> A comprehensive literature search was conducted across multiple databases, including PubMed, MEDLINE via OVID, Embase, Web of Science, Emcare, and the Cochrane Central Register of Controlled Trials through November 1, 2024, for studies that included patients with ER-positive breast cancer who received an ¹⁸F-FES PET/CT at baseline and received subsequent endocrine therapy. For each eligible study, data were extracted using a predesigned data extraction form. Random effects models were used to estimate the likelihood of clinical benefit from endocrine therapy after a positive ¹⁸F-FES PET scan, the likelihood of clinical benefit from endocrine therapy after a negative ¹⁸F-FES PET scan, and the risk ratio of clinical benefit from endocrine therapy comparing those who were ¹⁸F-FES–positive to those who were ¹⁸F-FES–negative. <strong>Results:</strong> From 1,105 database records retrieved, 12 studies were included in the metaanalysis (<em>n</em> = 308 participants with data on ¹⁸F-FES PET results and response to endocrine therapy). The likelihood of clinical benefit after a positive ¹⁸F-FES PET scan was 66% (95% CI, 51%–79%; <em>I</em>² = 76.6%; <em>n</em> = 227 participants) and the likelihood after a negative ¹⁸F-FES PET scan was 11% (95% CI, 3.5%–22%; <em>I</em>² = 0.0%; <em>n</em> = 81 participants). The risk ratio of response that compared those who were ¹⁸F-FES–positive with those who were ¹⁸F-FES–negative was 3.21 (95% CI, 1.96–5.25; <em>I</em>² = 0.0%; <em>P</em> &lt; 0.0001). <strong>Conclusion:</strong> ¹⁸F-FES PET is a successful biomarker for predicting the likelihood of success of endocrine therapy in patients with ER-positive breast cancer. There is strong evidence that patients with ¹⁸F-FES–negative disease are unlikely to derive clinical benefit from endocrine therapies, despite the presence of ER-positive disease on pathology. This supports a role for ¹⁸F-FES PET in identifying patients for whom endocrine therapy may or may not be an appropriate treatment option.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiances of Cerenkov-Emitting Radionuclides on the In Vivo Imaging System","authors":"Edwin C. Pratt, Travis M. Shaffer, David Bauer, Jason S. Lewis, Jan Grimm","doi":"10.2967/jnumed.124.268806","DOIUrl":"https://doi.org/10.2967/jnumed.124.268806","url":null,"abstract":"<p>Cerenkov (or Cherenkov) luminescence occurs when charged particles exceed the phase velocity of a given medium. Cerenkov as a modality has gained interest for visualization of numerous radionuclides. However, reported Cerenkov intensities are limited or provided as theoretic fluence estimates. Here, we present the largest experimental dataset of Cerenkov-emitting radionuclides using the in vivo imaging system (IVIS Spectrum). We report Cerenkov radiances for 23 Cerenkov-emitting radionuclides, covering electrons, α-particles, and β-particles purified and in equilibrium where appropriate. Radionuclides measured include ¹¹C, ¹⁸F, ³²P, ⁴⁷Sc, ⁵²Mn, ⁶⁴Cu, ⁶⁷Cu, ⁶⁸Ga, ⁷²As, ⁷⁶Br, ⁸⁶Y, ⁸⁹Zr, ⁹⁰Y, ¹²⁴I, ¹³¹I, ¹³⁴Ce, ¹⁶¹Tb, ¹⁷⁷Lu, ²⁰³Pb, ²¹²Pb, ²²³Ra, ²²⁵Ac, and ²²⁷Th. These radiances allow experimental comparisons of radionuclides in Cerenkov luminescence imaging studies in the visible emission window, alongside minimum detectable activity concentrations. Lastly, these values greatly agree with prior theoretic modeling estimates.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a 18F-Flortaucipir PET Visual Stratification Method","authors":"Ilke Tunali, Jian Wang, Anupa K. Arora, Min Jung Kim, Sergey Shcherbinin, Michael Pontecorvo, Leonardo Iaccarino","doi":"10.2967/jnumed.124.268700","DOIUrl":"https://doi.org/10.2967/jnumed.124.268700","url":null,"abstract":"<sec><st>Visual Abstract</st><p><fig loc=\"float\"><link locator=\"jnumed.124.268700absf1\"></fig></p></sec>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor Asphericity in FDG PET Is an Independent Prognostic Parameter Improving Risk Stratification in Patients with Head and Neck Squamous Cell Carcinoma","authors":"Patrick Hausmann, Sebastian Zschaeck, Christian Furth, Pavel Nikulin, Paulina Cegla, Siyer Roohani, Elia Lombardo, Joanna Kazmierska, Nathalie L. Albert, Adrien Holzgreve, Iosif Strouthos, Claus Belka, Guillaume Landry, Witold Cholewinski, Jorg Kotzerke, Michael Baumann, Mechthild Krause, Daniel Zips, Jörg van den Hoff, Frank Hofheinz","doi":"10.2967/jnumed.124.268972","DOIUrl":"https://doi.org/10.2967/jnumed.124.268972","url":null,"abstract":"<p>Tumor asphericity in ¹⁸F-FDG PET is a prognostic marker that has been investigated in small pilot studies of patients with head and neck squamous cell carcinoma (HNSCC). Here, we investigated the prognostic role of asphericity in a large multicenter database of patients with HNSCC treated with primary radiotherapy or chemoradiation and assessed its independent prognostic value. <strong>Methods:</strong> In total, 1,104 patients were included in this analysis. All received pretreatment ¹⁸F-FDG PET scans. Clinical risk factors were evaluated, and quantitative PET parameters SUV_max, metabolic tumor volume (MTV), total lesion glycolysis, and asphericity were calculated. Primary study endpoints were overall survival (OS) and locoregional control (LRC). Uni- and multivariate Cox regression analyses were performed. Additionally, asphericity was combined with the best-established quantitative PET parameter of MTV, and the combinatory approach of using asphericity and MTV was compared with the use of only asphericity or MTV by bootstrap analyses. <strong>Results:</strong> Asphericity showed only a modest correlation with the established PET parameters of MTV, SUV_max, and total lesion glycolysis. On univariate testing asphericity was strongly associated with the outcome of patients (LRC and OS with <em>P</em> &lt; 0.001). In multivariate testing of all imaging parameters that were not highly correlated, both MTV and asphericity showed a significant association with LRC (<em>P</em> &lt; 0.001 for MTV and <em>P</em> = 0.021 for asphericity) and OS (<em>P</em> &lt; 0.001 for MTV and asphericity). Asphericity and MTV were binarized and combined for risk stratification, and the prognostic value of the combination was compared with the prognostic value of individual parameters. Bootstrapping revealed significantly better performance by the combinatory approach when compared with MTV (<em>P</em> = 0.012 for LRC and <em>P</em> &lt; 0.001 for OS) and asphericity with regard to OS (<em>P</em> &lt; 0.001) but not for LRC (<em>P</em> = 0.53). <strong>Conclusion:</strong> We were able to show that asphericity bears independent prognostic value and significantly improves risk stratification when combined with MTV in a comprehensive retrospective cohort of HNSCC patients.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Radioactive Iodine Treatment on Long-Term Relative Survival in Patients with Papillary and Follicular Thyroid Cancer: A SEER-Based Study Covering Histologic Subtypes and Recurrence Risk Categories","authors":"Henning Weis, Jasmin Weindler, Katharina Schmidt, Martin Hellmich, Alexander Drzezga, Matthias Schmidt","doi":"10.2967/jnumed.124.269091","DOIUrl":"https://doi.org/10.2967/jnumed.124.269091","url":null,"abstract":"<sec><st>Visual Abstract</st><p><fig loc=\"float\"><link locator=\"jnumed.124.269091absf1\"></fig></p></sec>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preclinical Evaluation of 177Lu-rhPSMA-10.1, a Radiopharmaceutical for Prostate Cancer: Biodistribution and Therapeutic Efficacy","authors":"Caroline Foxton, Bradley Waldron, Rikke Veggerby Grønlund, Jaime (Jim) Simón, Bart Cornelissen, Edward O’Neill, Daniel Stevens","doi":"10.2967/jnumed.124.268508","DOIUrl":"https://doi.org/10.2967/jnumed.124.268508","url":null,"abstract":"<sec><st>Visual Abstract</st><p><fig loc=\"float\"><link locator=\"jnumed.124.268508absf1\"></fig></p></sec>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143570363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}