Coronary sinus anatomy by computerized tomography, overlaid on live fluoroscopy can be successfully used to guide left ventricular lead implantation: a feasibility study
Objective This study aims to optimize coronary sinus (CS) computerized tomography (CT) imaging and evaluate its utility for preprocedural planning and intraoperative guidance by overlay of 3D reconstructed CS images on live fluoroscopy. Background Optimal CS lead placement for cardiac resynchronizat...
Gespeichert in:
| Veröffentlicht in: | Journal of interventional cardiac electrophysiology 2013-04, Vol.36 (3), p.217-222 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 222 |
|---|---|
| container_issue | 3 |
| container_start_page | 217 |
| container_title | Journal of interventional cardiac electrophysiology |
| container_volume | 36 |
| creator | Alikhani, Zoubin Li, Jonathan Merchan, Juan A. Nijhof, Niels Mendel, Jeffrey Orlov, Michael V. |
| description | Objective
This study aims to optimize coronary sinus (CS) computerized tomography (CT) imaging and evaluate its utility for preprocedural planning and intraoperative guidance by overlay of 3D reconstructed CS images on live fluoroscopy.
Background
Optimal CS lead placement for cardiac resynchronization therapy (CRT) remains challenging. Preprocedural knowledge of CS anatomy can significantly affect procedural outcome. Optimal CS imaging protocols by CT have not been well defined.
Methods
Seventeen consecutive CRT recipients underwent contrast-enhanced functional cardiac CT on a 64-slice scanner. The CS target branch closest to the most dyssynchronous LV segment was identified. 3D volume rendered CS images were superimposed onto live fluoroscopy via EP Navigator (Philips Healthcare, Best, The Netherlands) to guide CS cannulation and lead placement. The imaging protocol was optimized.
Results
CT images were successfully reconstructed and overlaid on live fluoroscopy in 16/17 patients. The overlay facilitated CS cannulation and lead placement into a predefined target branch. Excellent correlation between CT and angiographic CS anatomy was noted. By using the overlaid 3D CS as a road map, average total fluoroscopy time (14.56 ± 4.22 min) was significantly shorter when compared to historical controls. Total radiation exposure was significantly higher in the CT-guided group. Images obtained using double bolus injection and gated acquisition at 40 % of the cardiac cycle contained the most anatomical detail of the CS.
Conclusion
Overlay of 3D CS anatomy defined by preprocedural cardiac CT is feasible. It allows planning of CRT implantation and live guidance of CS lead placement into a predefined target branch. Limiting the CT imaging to 40 % of the cardiac cycle phase provides optimal CS images and reduces radiation exposure. This approach may result in shorter procedural time and more optimal CS lead positioning. However, the concept remains to be confirmed by future studies. |
| doi_str_mv | 10.1007/s10840-012-9736-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1326316795</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2942920441</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-db7931d95a14359f54813b3e7e810e0788ab700398f4c1cce0fd311093d414763</originalsourceid><addsrcrecordid>eNp1kc2OFSEQhTtG44yjD-DGkLi1FZqmAXfmxr9kEjeauCN0U1yZ0NDyc5P2jXxLGe9o3LiCVJ1zquDruqcEvyQY81eZYDHiHpOhl5xOvbjXXRLGh14wye63OxW0F5x9vege5XyDMZZ4mB52FwMlchKMXXY_DzHFoNOOsgs1Ix10ieuO5h0tcd1qgeR-gEGtGI9Jb9_2FyieIHntDIoBeXcCZH1tKXmJW3PpgGZAuS4L5Gyr9zuq-XcCOlZnAHmwBZ0glOSW6nVqBW2QWzevQ9HFxfAaaWRBZzc770pbrVSzP-4eWO0zPLk7r7ov795-Pnzorz-9_3h4c90vlA-lNzOXlBjJNBkpk5aNgtCZAgdBMGAuhJ45xlQKOy6kLYmtoYRgSc1IRj7Rq-75OXdL8XuFXNRNrCm0kYrQYaJk4pI1FTmrlvbwnMCqLbm1_aMiWN3CUWc4qsFRt3CUaJ5nd8l1XsH8dfyh0QTDWZBbKxwh_TP6v6m_AH_jngk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1326316795</pqid></control><display><type>article</type><title>Coronary sinus anatomy by computerized tomography, overlaid on live fluoroscopy can be successfully used to guide left ventricular lead implantation: a feasibility study</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Alikhani, Zoubin ; Li, Jonathan ; Merchan, Juan A. ; Nijhof, Niels ; Mendel, Jeffrey ; Orlov, Michael V.</creator><creatorcontrib>Alikhani, Zoubin ; Li, Jonathan ; Merchan, Juan A. ; Nijhof, Niels ; Mendel, Jeffrey ; Orlov, Michael V.</creatorcontrib><description>Objective
This study aims to optimize coronary sinus (CS) computerized tomography (CT) imaging and evaluate its utility for preprocedural planning and intraoperative guidance by overlay of 3D reconstructed CS images on live fluoroscopy.
Background
Optimal CS lead placement for cardiac resynchronization therapy (CRT) remains challenging. Preprocedural knowledge of CS anatomy can significantly affect procedural outcome. Optimal CS imaging protocols by CT have not been well defined.
Methods
Seventeen consecutive CRT recipients underwent contrast-enhanced functional cardiac CT on a 64-slice scanner. The CS target branch closest to the most dyssynchronous LV segment was identified. 3D volume rendered CS images were superimposed onto live fluoroscopy via EP Navigator (Philips Healthcare, Best, The Netherlands) to guide CS cannulation and lead placement. The imaging protocol was optimized.
Results
CT images were successfully reconstructed and overlaid on live fluoroscopy in 16/17 patients. The overlay facilitated CS cannulation and lead placement into a predefined target branch. Excellent correlation between CT and angiographic CS anatomy was noted. By using the overlaid 3D CS as a road map, average total fluoroscopy time (14.56 ± 4.22 min) was significantly shorter when compared to historical controls. Total radiation exposure was significantly higher in the CT-guided group. Images obtained using double bolus injection and gated acquisition at 40 % of the cardiac cycle contained the most anatomical detail of the CS.
Conclusion
Overlay of 3D CS anatomy defined by preprocedural cardiac CT is feasible. It allows planning of CRT implantation and live guidance of CS lead placement into a predefined target branch. Limiting the CT imaging to 40 % of the cardiac cycle phase provides optimal CS images and reduces radiation exposure. This approach may result in shorter procedural time and more optimal CS lead positioning. However, the concept remains to be confirmed by future studies.</description><identifier>ISSN: 1383-875X</identifier><identifier>EISSN: 1572-8595</identifier><identifier>DOI: 10.1007/s10840-012-9736-8</identifier><identifier>PMID: 23196855</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Aged ; Cardiac Resynchronization Therapy Devices ; Cardiology ; Coronary Sinus - diagnostic imaging ; Coronary Sinus - surgery ; Electrodes, Implanted ; Feasibility Studies ; Female ; Heart Failure - prevention & control ; Heart Failure - surgery ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - surgery ; Humans ; Imaging, Three-Dimensional - methods ; Male ; Medicine ; Medicine & Public Health ; Prosthesis Implantation - methods ; Radiography, Interventional - methods ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, X-Ray Computed - methods ; Treatment Outcome</subject><ispartof>Journal of interventional cardiac electrophysiology, 2013-04, Vol.36 (3), p.217-222</ispartof><rights>Springer Science+Business Media New York 2012</rights><rights>Springer Science+Business Media New York 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-db7931d95a14359f54813b3e7e810e0788ab700398f4c1cce0fd311093d414763</citedby><cites>FETCH-LOGICAL-c372t-db7931d95a14359f54813b3e7e810e0788ab700398f4c1cce0fd311093d414763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10840-012-9736-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10840-012-9736-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23196855$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alikhani, Zoubin</creatorcontrib><creatorcontrib>Li, Jonathan</creatorcontrib><creatorcontrib>Merchan, Juan A.</creatorcontrib><creatorcontrib>Nijhof, Niels</creatorcontrib><creatorcontrib>Mendel, Jeffrey</creatorcontrib><creatorcontrib>Orlov, Michael V.</creatorcontrib><title>Coronary sinus anatomy by computerized tomography, overlaid on live fluoroscopy can be successfully used to guide left ventricular lead implantation: a feasibility study</title><title>Journal of interventional cardiac electrophysiology</title><addtitle>J Interv Card Electrophysiol</addtitle><addtitle>J Interv Card Electrophysiol</addtitle><description>Objective
This study aims to optimize coronary sinus (CS) computerized tomography (CT) imaging and evaluate its utility for preprocedural planning and intraoperative guidance by overlay of 3D reconstructed CS images on live fluoroscopy.
Background
Optimal CS lead placement for cardiac resynchronization therapy (CRT) remains challenging. Preprocedural knowledge of CS anatomy can significantly affect procedural outcome. Optimal CS imaging protocols by CT have not been well defined.
Methods
Seventeen consecutive CRT recipients underwent contrast-enhanced functional cardiac CT on a 64-slice scanner. The CS target branch closest to the most dyssynchronous LV segment was identified. 3D volume rendered CS images were superimposed onto live fluoroscopy via EP Navigator (Philips Healthcare, Best, The Netherlands) to guide CS cannulation and lead placement. The imaging protocol was optimized.
Results
CT images were successfully reconstructed and overlaid on live fluoroscopy in 16/17 patients. The overlay facilitated CS cannulation and lead placement into a predefined target branch. Excellent correlation between CT and angiographic CS anatomy was noted. By using the overlaid 3D CS as a road map, average total fluoroscopy time (14.56 ± 4.22 min) was significantly shorter when compared to historical controls. Total radiation exposure was significantly higher in the CT-guided group. Images obtained using double bolus injection and gated acquisition at 40 % of the cardiac cycle contained the most anatomical detail of the CS.
Conclusion
Overlay of 3D CS anatomy defined by preprocedural cardiac CT is feasible. It allows planning of CRT implantation and live guidance of CS lead placement into a predefined target branch. Limiting the CT imaging to 40 % of the cardiac cycle phase provides optimal CS images and reduces radiation exposure. This approach may result in shorter procedural time and more optimal CS lead positioning. However, the concept remains to be confirmed by future studies.</description><subject>Aged</subject><subject>Cardiac Resynchronization Therapy Devices</subject><subject>Cardiology</subject><subject>Coronary Sinus - diagnostic imaging</subject><subject>Coronary Sinus - surgery</subject><subject>Electrodes, Implanted</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Heart Failure - prevention & control</subject><subject>Heart Failure - surgery</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - surgery</subject><subject>Humans</subject><subject>Imaging, Three-Dimensional - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Prosthesis Implantation - methods</subject><subject>Radiography, Interventional - methods</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Treatment Outcome</subject><issn>1383-875X</issn><issn>1572-8595</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc2OFSEQhTtG44yjD-DGkLi1FZqmAXfmxr9kEjeauCN0U1yZ0NDyc5P2jXxLGe9o3LiCVJ1zquDruqcEvyQY81eZYDHiHpOhl5xOvbjXXRLGh14wye63OxW0F5x9vege5XyDMZZ4mB52FwMlchKMXXY_DzHFoNOOsgs1Ix10ieuO5h0tcd1qgeR-gEGtGI9Jb9_2FyieIHntDIoBeXcCZH1tKXmJW3PpgGZAuS4L5Gyr9zuq-XcCOlZnAHmwBZ0glOSW6nVqBW2QWzevQ9HFxfAaaWRBZzc770pbrVSzP-4eWO0zPLk7r7ov795-Pnzorz-9_3h4c90vlA-lNzOXlBjJNBkpk5aNgtCZAgdBMGAuhJ45xlQKOy6kLYmtoYRgSc1IRj7Rq-75OXdL8XuFXNRNrCm0kYrQYaJk4pI1FTmrlvbwnMCqLbm1_aMiWN3CUWc4qsFRt3CUaJ5nd8l1XsH8dfyh0QTDWZBbKxwh_TP6v6m_AH_jngk</recordid><startdate>20130401</startdate><enddate>20130401</enddate><creator>Alikhani, Zoubin</creator><creator>Li, Jonathan</creator><creator>Merchan, Juan A.</creator><creator>Nijhof, Niels</creator><creator>Mendel, Jeffrey</creator><creator>Orlov, Michael V.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20130401</creationdate><title>Coronary sinus anatomy by computerized tomography, overlaid on live fluoroscopy can be successfully used to guide left ventricular lead implantation: a feasibility study</title><author>Alikhani, Zoubin ; Li, Jonathan ; Merchan, Juan A. ; Nijhof, Niels ; Mendel, Jeffrey ; Orlov, Michael V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-db7931d95a14359f54813b3e7e810e0788ab700398f4c1cce0fd311093d414763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Cardiac Resynchronization Therapy Devices</topic><topic>Cardiology</topic><topic>Coronary Sinus - diagnostic imaging</topic><topic>Coronary Sinus - surgery</topic><topic>Electrodes, Implanted</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Heart Failure - prevention & control</topic><topic>Heart Failure - surgery</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - surgery</topic><topic>Humans</topic><topic>Imaging, Three-Dimensional - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Prosthesis Implantation - methods</topic><topic>Radiography, Interventional - methods</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alikhani, Zoubin</creatorcontrib><creatorcontrib>Li, Jonathan</creatorcontrib><creatorcontrib>Merchan, Juan A.</creatorcontrib><creatorcontrib>Nijhof, Niels</creatorcontrib><creatorcontrib>Mendel, Jeffrey</creatorcontrib><creatorcontrib>Orlov, Michael V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Journal of interventional cardiac electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alikhani, Zoubin</au><au>Li, Jonathan</au><au>Merchan, Juan A.</au><au>Nijhof, Niels</au><au>Mendel, Jeffrey</au><au>Orlov, Michael V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coronary sinus anatomy by computerized tomography, overlaid on live fluoroscopy can be successfully used to guide left ventricular lead implantation: a feasibility study</atitle><jtitle>Journal of interventional cardiac electrophysiology</jtitle><stitle>J Interv Card Electrophysiol</stitle><addtitle>J Interv Card Electrophysiol</addtitle><date>2013-04-01</date><risdate>2013</risdate><volume>36</volume><issue>3</issue><spage>217</spage><epage>222</epage><pages>217-222</pages><issn>1383-875X</issn><eissn>1572-8595</eissn><abstract>Objective
This study aims to optimize coronary sinus (CS) computerized tomography (CT) imaging and evaluate its utility for preprocedural planning and intraoperative guidance by overlay of 3D reconstructed CS images on live fluoroscopy.
Background
Optimal CS lead placement for cardiac resynchronization therapy (CRT) remains challenging. Preprocedural knowledge of CS anatomy can significantly affect procedural outcome. Optimal CS imaging protocols by CT have not been well defined.
Methods
Seventeen consecutive CRT recipients underwent contrast-enhanced functional cardiac CT on a 64-slice scanner. The CS target branch closest to the most dyssynchronous LV segment was identified. 3D volume rendered CS images were superimposed onto live fluoroscopy via EP Navigator (Philips Healthcare, Best, The Netherlands) to guide CS cannulation and lead placement. The imaging protocol was optimized.
Results
CT images were successfully reconstructed and overlaid on live fluoroscopy in 16/17 patients. The overlay facilitated CS cannulation and lead placement into a predefined target branch. Excellent correlation between CT and angiographic CS anatomy was noted. By using the overlaid 3D CS as a road map, average total fluoroscopy time (14.56 ± 4.22 min) was significantly shorter when compared to historical controls. Total radiation exposure was significantly higher in the CT-guided group. Images obtained using double bolus injection and gated acquisition at 40 % of the cardiac cycle contained the most anatomical detail of the CS.
Conclusion
Overlay of 3D CS anatomy defined by preprocedural cardiac CT is feasible. It allows planning of CRT implantation and live guidance of CS lead placement into a predefined target branch. Limiting the CT imaging to 40 % of the cardiac cycle phase provides optimal CS images and reduces radiation exposure. This approach may result in shorter procedural time and more optimal CS lead positioning. However, the concept remains to be confirmed by future studies.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>23196855</pmid><doi>10.1007/s10840-012-9736-8</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1383-875X |
| ispartof | Journal of interventional cardiac electrophysiology, 2013-04, Vol.36 (3), p.217-222 |
| issn | 1383-875X 1572-8595 |
| language | eng |
| recordid | cdi_proquest_journals_1326316795 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Aged Cardiac Resynchronization Therapy Devices Cardiology Coronary Sinus - diagnostic imaging Coronary Sinus - surgery Electrodes, Implanted Feasibility Studies Female Heart Failure - prevention & control Heart Failure - surgery Heart Ventricles - diagnostic imaging Heart Ventricles - surgery Humans Imaging, Three-Dimensional - methods Male Medicine Medicine & Public Health Prosthesis Implantation - methods Radiography, Interventional - methods Reproducibility of Results Sensitivity and Specificity Tomography, X-Ray Computed - methods Treatment Outcome |
| title | Coronary sinus anatomy by computerized tomography, overlaid on live fluoroscopy can be successfully used to guide left ventricular lead implantation: a feasibility study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T04%3A49%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Coronary%20sinus%20anatomy%20by%20computerized%20tomography,%20overlaid%20on%20live%20fluoroscopy%20can%20be%20successfully%20used%20to%20guide%20left%20ventricular%20lead%20implantation:%20a%20feasibility%20study&rft.jtitle=Journal%20of%20interventional%20cardiac%20electrophysiology&rft.au=Alikhani,%20Zoubin&rft.date=2013-04-01&rft.volume=36&rft.issue=3&rft.spage=217&rft.epage=222&rft.pages=217-222&rft.issn=1383-875X&rft.eissn=1572-8595&rft_id=info:doi/10.1007/s10840-012-9736-8&rft_dat=%3Cproquest_cross%3E2942920441%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1326316795&rft_id=info:pmid/23196855&rfr_iscdi=true |