Imperial College London

Professor Anand Devaraj

Faculty of MedicineNational Heart & Lung Institute

Professor of Practice (Thoracic Radiology)
 
 
 
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Contact

 

anand.devaraj Website

 
 
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Location

 

South BlockRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
to

211 results found

Wells AU, Devaraj A, 2021, Residual Lung Disease at Six-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue, RADIOLOGY, Vol: 301, Pages: E406-E408, ISSN: 0033-8419

Journal article

Field JK, Vulkan D, Davies MPA, Baldwin DR, Brain KE, Devaraj A, Eisen T, Gosney J, Green BA, Holemans JA, Kavanagh T, Kerr KM, Ledson M, Lifford KJ, McRonald FE, Nair A, Page RD, Parmar MKB, Rassl DM, Rintoul RC, Screaton NJ, Wald NJ, Weller D, Whynes DK, Williamson PR, Yadegarfar G, Gabe R, Duffy SWet al., 2021, Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis., Lancet Reg Health Eur, Vol: 10

Background: The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial. Methods: From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care). Eligible participants (aged 50-75) had a risk score (LLPv2) ≥ 4.5% of developing lung cancer over five years. Data were collected on lung cancer cases to 31 December 2019 and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. We included our results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence. Findings: 1 987 participants in the intervention and 1 981 in the usual care arms were followed for a median of 7.3 years (IQR 7.1-7.6), 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, 46 in the control arm, (relative rate 0.65 [95% CI 0.41-1.02]; p=0.062). The meta-analysis indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0.84 (95% CI 0.76-0.92) from nine eligible trials. Interpretation: The UKLS trial of single LDCT indicates a reduction of lung cancer death of similar magnitude to the NELSON and NLST trials and was included in a meta-analysis of nine randomised trials which provides unequivocal support for lung cancer screening in identified risk groups. Funding: NIHR Health Technology Assessment programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation.

Journal article

Robbie H, Wells AU, Fang C, Jacob J, Walsh SLF, Nair A, Camoras R, Desai SR, Devaraj Aet al., 2021, Serial decline in lung volume parameters on computed tomography (CT) predicts outcome in idiopathic pulmonary fibrosis (IPF), EUROPEAN RADIOLOGY, ISSN: 0938-7994

Journal article

Vijayakumar B, Tonkin J, Devaraj A, Philip KEJ, Orton CM, Desai SR, Shah PLet al., 2021, CT Lung Abnormalities after COVID-19 at 3 Months and 1 Year after Hospital Discharge., Radiology

Background Data on the long-term pulmonary sequelae in COVID-19 are lacking. Purpose To assess symptoms and functional impairment and residual pulmonary abnormalities on serial chest CT in COVID-19 survivors discharged from hospital at up to 1-year follow-up. Materials and Methods Adult patients with COVID-19 discharged between March 2020 and June 2020 were prospectively evaluated at 3 months and 1 year, through systematic assessment of symptoms, functional impairments, and thoracic CT as part of the PHENOTYPE study, an observational cohort study in COVID-19 survivors. Lung function testing was limited to participants with CT abnormalities and/or persistent breathlessness. All statistical analyses were performed using Graphpad PRISM Version 9.0 (86) for Mac, GraphPad Software, (www.graphpad.com); Bonferroni corrected p values are stated. Results Eighty participants (mean age, 59 ±13 years; 53 men) were assessed. Persistent breathlessness 37 (46%) and cough 17 (21%) were reported at outpatient review (median 97 days [IQR 86-121]). CT scans in 73 participants post-discharge (median 105 days [IQR 95-141]) revealed persistent abnormalities in 41/73 participants (56%), with ground-glass opacification (35/73 [48%]) and bands (27/73 [37%]) predominating. Unequivocal signs indicative of established fibrosis (i.e. volume loss +/- traction bronchiectasis) were present in 9/73 (12%) participants. Higher admission serum C-reactive protein (mg/L), fibrinogen (g/dl), urea (mmol/L) and creatinine (micromol/L), longer hospital stay (days), older age (years) and requirement for invasive ventilation were associated with CT abnormalities at 3-month follow-up. 32/41 (78%) of participants with abnormal 3-month follow-up CT underwent repeat imaging at a median of 364 (360-366) days, with 26/32 (81%) showing further radiological improvement (median 18% [IQR 10-40%]). Conclusion CT abnormalities were common at 3 months after COVID-19 but with signs of fibrosis in a minority. More se

Journal article

Bartlett E, Kemp S, Rawal B, Devaraj Aet al., 2021, Defining growth in small pulmonary nodules using volumetry: results from a "coffee-break" study and implications for current nodule management guidelines, European Radiology, ISSN: 0938-7994

Objectives:An increase in lung nodule volume on serial CT may represent true growth or measurement variation. In nodule guidelines, a 25% increase in nodule volume is frequently used to determine that growth has occurred; this is based on previous same-day, test-retest (coffee-break) studies examining metastatic nodules. Whether results from prior studies apply to small non-metastatic nodules is unknown. This study aimed to establish the interscan variability in the volumetric measurements of small-sized non-metastatic nodules.Methods:Institutional review board approval was obtained for this study. Between March 2019-January 2021, 45 adults (25 males; mean age 65yrs, range 37-84yrs) with previously identified pulmonary nodules (30-150mm3) requiring surveillance, without a known primary tumour, underwent two same-day CT scans. Non-calcified solid nodules were measured using commercial volumetry software, and interscan variability of volume measurements was assessed using a Bland-Altman method and limits of agreement. Results:One hundred nodules (range 28mm3-170mm3; mean 81.1mm3) were analysed. The lower and upper limits of agreement for the absolute volume difference between the two scans were -14.2mm3 and 12.0mm3 respectively (mean difference 1.09mm3, range -33mm3 – 12mm3). The lower and upper limits of agreement for relative volume difference were -16.4% and 14.6% respectively (mean difference 0.90%, range -24.1% - 32.8%). Conclusions:The interscan volume variability in this cohort of small non-metastatic nodules was smaller than in previous studies involving lung metastases of varying sizes. An increase of 15% in nodule volume on sequential CT may represent true growth and closer surveillance of these nodules may be warranted.

Journal article

Flaherty KR, Wells AU, Cottin V, Devaraj A, Inoue Y, Richeldi L, Walsh SLF, Kolb M, Koschel D, Moua T, Stowasser S, Goeldner R-G, Schlenker-Herceg R, Brown KK, INBUILD trial investigatorset al., 2021, Nintedanib in progressive interstitial lung diseases: data from the whole INBUILD trial., Eur Respir J

The primary analysis of the INBUILD trial showed that in subjects with progressive fibrosing interstitial lung diseases (ILDs), nintedanib slowed the decline in forced vital capacity (FVC) over 52 weeks. We report the effects of nintedanib on ILD progression over the whole trial.Subjects with fibrosing ILDs other than idiopathic pulmonary fibrosis, who had ILD progression within the 24 months before screening despite management deemed appropriate in clinical practice, were randomised to receive nintedanib or placebo. Subjects continued on blinded randomised treatment until all subjects had completed the trial. Over the whole trial, mean (sd) exposure to trial medication was 15.6 (7.2) and 16.8 (5.8) months in the nintedanib and placebo groups, respectively.In the nintedanib (n=332) and placebo (n=331) groups, respectively, the proportions of subjects who had ILD progression (absolute decline in FVC ≥10% predicted) or died were 40.4% and 54.7% in the overall population (HR 0.66 [95% CI: 0.53, 0.83]; p=0.0003), and 43.7% and 55.8% among subjects with a usual interstitial pneumonia (UIP)-like fibrotic pattern on high-resolution computed tomography (HRCT) (HR 0.69 [0.53, 0.91]; p=0.009). In the nintedanib and placebo groups, respectively, the proportions who had an acute exacerbation of ILD or died were 13.9% and 19.6% in the overall population (HR 0.67 [95% CI: 0.46, 0.98]; p=0.04), and 15.0% and 22.8% among subjects with a UIP-like fibrotic pattern on HRCT (HR 0.62 [0.39, 0.97]; p=0.03).Based on data from the whole INBUILD trial, nintedanib reduced the risk of events indicating ILD progression.

Journal article

Devaraj A, Milanese G, Sverzellati N, 2021, Thoracic computed tomography in the progressive fibrotic phenotype, CURRENT OPINION IN PULMONARY MEDICINE, Vol: 27, Pages: 350-354, ISSN: 1070-5287

Journal article

Bentham R, Litchfield K, Watkins TBK, Lim EL, Rosenthal R, Martínez-Ruiz C, Hiley CT, Bakir MA, Salgado R, Moore DA, Jamal-Hanjani M, TRACERx Consortium, Swanton C, McGranahan Net al., 2021, Using DNA sequencing data to quantify T cell fraction and therapy response., Nature, Vol: 597, Pages: 555-560

The immune microenvironment influences tumour evolution and can be both prognostic and predict response to immunotherapy1,2. However, measurements of tumour infiltrating lymphocytes (TILs) are limited by a shortage of appropriate data. Whole-exome sequencing (WES) of DNA is frequently performed to calculate tumour mutational burden and identify actionable mutations. Here we develop T cell exome TREC tool (T cell ExTRECT), a method for estimation of T cell fraction from WES samples using a signal from T cell receptor excision circle (TREC) loss during V(D)J recombination of the T cell receptor-α gene (TCRA (also known as TRA)). TCRA T cell fraction correlates with orthogonal TIL estimates and is agnostic to sample type. Blood TCRA T cell fraction is higher in females than in males and correlates with both tumour immune infiltrate and presence of bacterial sequencing reads. Tumour TCRA T cell fraction is prognostic in lung adenocarcinoma. Using a meta-analysis of tumours treated with immunotherapy, we show that tumour TCRA T cell fraction predicts immunotherapy response, providing value beyond measuring tumour mutational burden. Applying T cell ExTRECT to a multi-sample pan-cancer cohort reveals a high diversity of the degree of immune infiltration within tumours. Subclonal loss of 12q24.31-32, encompassing SPPL3, is associated with reduced TCRA T cell fraction. T cell ExTRECT provides a cost-effective technique to characterize immune infiltrate alongside somatic changes.

Journal article

Maher TM, Brown KK, Kreuter M, Devaraj A, Walsh SLF, Lancaster LH, Belloli EA, Padilla M, Behr J, Goeldner R-G, Tetzlaff K, Schlenker-Herceg R, Flaherty KR, INBUILD trial investigatorset al., 2021, Effects of nintedanib by inclusion criteria for progression of interstitial lung disease, European Respiratory Journal, ISSN: 0903-1936

The INBUILD trial investigated nintedanib versus placebo in patients with progressive fibrosing interstitial lung diseases (ILDs). We investigated decline in forced vital capacity (FVC) in subgroups based on the inclusion criteria for ILD progression.Subjects had a fibrosing ILD other than idiopathic pulmonary fibrosis and met these criteria for ILD progression within the 24 months before screening despite management deemed appropriate in clinical practice: Group A, relative decline in FVC ≥10% predicted; Group B, relative decline in FVC ≥5-<10% predicted with worsened respiratory symptoms and/or increased extent of fibrosis on HRCT; Group C, worsened respiratory symptoms and increased extent of fibrosis on HRCT only.In the placebo group, the rates of FVC decline over 52 weeks in Groups A, B and C, respectively, were -241.9, -133.1 and -115.3 mL·year-1 in the overall population (p=0.0002 for subgroup-by-time interaction) and -288.9, -156.2 and -100.1 mL·year-1 among subjects with a usual interstitial pneumonia [UIP]-like fibrotic pattern on HRCT (p=0.0005 for subgroup-by-time interaction). Nintedanib had a greater absolute effect on reducing the rate of FVC decline in Group A than Group B or C. However, the relative effect of nintedanib versus placebo was consistent across the subgroups (p>0.05 for heterogeneity).In conclusion, the inclusion criteria used in the INBUILD trial, based on FVC decline or worsening of symptoms and extent of fibrosis on HRCT, were effective at identifying patients with progressive fibrosing ILDs. Nintedanib reduced the rate of decline in FVC across the subgroups based on the inclusion criteria related to ILD progression.

Journal article

Vass L, Fisk M, Cheriyan J, Mohan D, Forman J, Oseni A, Devaraj A, Maki-Petaja KM, McEniery CM, Fuld J, Hopkinson NS, Lomas DA, Cockcroft JR, Tal-Singer R, Polkey M, Wilkinson IBet al., 2021, Quantitative F-18-fluorodeoxyglucose positron emission tomography/computed tomography to assess pulmonary inflammation in COPD, ERJ OPEN RESEARCH, Vol: 7

Journal article

Bartlett E, Belsey J, Derbyshire J, Morris K, Chen M, Addis J, Martins M, Ridge CA, Desai SR, Mirsadraee S, Padley S, Whiteside S, Vaghani P, Morjaria JB, Kemp SV, Devaraj Aet al., 2021, Implications of incidental findings from lung screening for primary care: data from a UK pilot, npj Primary Care Respiratory Medicine, Vol: 31, ISSN: 2055-1010

Regional lung cancer screening (LCS) is underway in England, involving a “lung health check” (LHC) and low-dose CT scan for those at high risk of cancer. Incidental findings from LHCs or CTs are usually referred to primary care. We describe the proportion of participants referred from the West London LCS pilot to primary care, the indications for referral, the number of general practitioner (GP) attendances and consequent changes to patient management, and provide an estimated cost-burden analysis for primary care. A small proportion (163/1542, 10.6%) of LHC attendees were referred to primary care, primarily for suspected undiagnosed chronic obstructive pulmonary disease (55/163, 33.7%) or for QRISK® (63/163, 38.7%) assessment. Ninety one of 159 (57.2%) participants consenting to follow-up attended GP appointments; costs incurred by primary care were estimated at £5.69/LHC participant. Patient management changes occurred in only 36/159 (22.6%) referred participants. LHCs result in a small increase to primary care workload provided a strict referral protocol is adhered to. Changes to patient management arising from incidental findings referrals are infrequent.

Journal article

Bartlett EC, Silva M, Callister ME, Devaraj Aet al., 2021, False-Negative Results in Lung Cancer Screening- Evidence and Controversies, JOURNAL OF THORACIC ONCOLOGY, Vol: 16, Pages: 912-921, ISSN: 1556-0864

Journal article

Kishore AK, Devaraj A, Vail A, Ward K, Thomas PG, Sen D, Procter A, Win M, James N, Roffe C, Meisel A, Woodhead M, Smith CJet al., 2021, Use of Pulmonary Computed Tomography for Evaluating Suspected Stroke-Associated Pneumonia., J Stroke Cerebrovasc Dis, Vol: 30

OBJECTIVES: Accurate and timely diagnosis of pneumonia complicating stroke remains challenging and the diagnostic accuracy of chest X-ray (CXR) in the setting of stroke-associated pneumonia (SAP) is uncertain. The overall objective of this study was to evaluate the use of pulmonary computed tomography (CT) in diagnosis of suspected SAP. MATERIALS AND METHODS: Patients with acute ischemic stroke (IS) or intracerebral hemorrhage (ICH) were recruited within 24h of clinically suspected SAP and underwent non-contrast pulmonary CT within 48h of antibiotic initiation. CXR and pulmonary CT were reported by two radiologists. Pulmonary CT was used as the reference standard for final diagnosis of SAP. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and diagnostic odds ratio (OR) for CXR were calculated. RESULTS: 40 patients (36 IS, 4 ICH) with a median age of 78y (range 44y-90y) and a median National Institute of Health Stroke Scale score of 13 (range 3-31) were included. All patients had at least one CXR and 35/40 patients (88%) underwent pulmonary CT. Changes consistent with pneumonia were present in 15/40 CXRs (38%) and 12/35 pulmonary CTs (34%). 9/35 pulmonary CTs (26%) were reported normal. CXR had a sensitivity of 58.3%, specificity of 73.9%, PPV of 53.8 %, NPV of 77.2 %, diagnostic OR of 3.7 (95% CI 0.7 - 22) and an accuracy of 68.5% (95% CI 50.7% -83.1%). DISCUSSION: CXR has limited diagnostic accuracy in SAP. The majority of patients started on antibiotics had no evidence of pneumonia on pulmonary CT with potential implications for antibiotic stewardship. CONCLUSIONS: Pulmonary CT could be applied as a reference standard for evaluation of clinical and biomarker diagnostic SAP algorithms in multi-center studies.

Journal article

Mirsadraee S, Gorog DA, Mahon CF, Rawal B, Semple TR, Nicol ED, Arachchillage DRJ, Devaraj A, Price S, Desai SR, Ridge CA, Singh S, Padley SPGet al., 2021, Prevalence of Thrombotic Complications in ICU-Treated Patients With Coronavirus Disease 2019 Detected With Systematic CT Scanning, CRITICAL CARE MEDICINE, Vol: 49, Pages: 804-815, ISSN: 0090-3493

Journal article

Denton C, Goh N, Humphries SM, Lynch DA, Maher TM, Spiera R, Devaraj A, Ho L, Stock C, Erhardt E, Alves M, Wells AUet al., 2021, Associations Between Extent of Fibrotic Interstitial Lung Disease (ILD) and Forced Vital Capacity (FVC) at Baseline and Change in FVC in Subjects with Systemic Sclerosis-Associated ILD (SSc-ILD) in the SENSCIS Trial, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X

Conference paper

Wells AU, Devaraj A, Desai SR, 2021, Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties COMMENT, RADIOLOGY, Vol: 299, Pages: E216-E218, ISSN: 0033-8419

Journal article

Koschel D, Flaherty KR, Wells AU, Cottin V, Devaraj A, Inoue Y, Richeldi L, Walsh SLF, Kolb M, Moua T, Stowasser S, Goeldner RG, Schlenker-Herceg R, Brown KKet al., 2021, Effects of nintedanib on progression of ILD in patients with fibrosing ILDs and a progressive phenotype: further analyses of the INBUILD trial, Publisher: GEORG THIEME VERLAG KG, Pages: S30-S31, ISSN: 0934-8387

Conference paper

Behr J, Brown KK, Walsh SLF, Devaraj A, Song JW, Wuyts WA, Valenzuela C, Goeldner RG, Stowasser S, Schlenker-Herceg R, Wells AUet al., 2021, Does HRCT pattern influence the effect of nintedanib in patients with progressive fibrosing interstitial lung diseases?, Publisher: GEORG THIEME VERLAG KG, Pages: S31-S32, ISSN: 0934-8387

Conference paper

Horst C, Dickson J, Tisi S, Hall H, Verghese P, Mullin A, Farrelly L, Levermore C, Gyertson K, Clarke C, Allen B, Hamilton S, Hartman A, Nair A, Devaraj A, Hackshaw A, Janes Set al., 2021, The SUMMIT Study: Pulmonary Nodule and Incidental Findings in the First 10,000 Participants of a Population-Based Low-Dose CT Screening Study, Publisher: ELSEVIER SCIENCE INC, Pages: S473-S474, ISSN: 1556-0864

Conference paper

Invernizzi R, Wu BG, Barnett J, Ghai P, Kingston S, Hewitt RJ, Feary J, Li Y, Chua F, Wu Z, Wells AU, Renzoni EA, Nicholson AG, Rice A, Devaraj A, Segal LN, Byrne AJ, Maher TM, Lloyd CM, Molyneaux PLet al., 2021, The respiratory microbiome in chronic hypersensitivity pneumonitis is distinct from that of idiopathic pulmonary fibrosis, American Journal of Respiratory and Critical Care Medicine, Vol: 203, Pages: 339-347, ISSN: 1073-449X

RATIONALE: Chronic hypersensitivity pneumonitis (CHP) is a condition that arises following repeated exposure and sensitisation to inhaled antigens. The lung microbiome is increasingly implicated in respiratory disease but to date, no study has investigated the composition of microbial communities in the lower airways in CHP. OBJECTIVE: To characterise and compare the airway microbiome in subjects with CHP, idiopathic pulmonary fibrosis (IPF) and controls. METHODS: We prospectively recruited individuals diagnosed with CHP (n=110), IPF (n=45) and controls (n=28). Subjects underwent bronchoalveolar lavage and bacterial DNA was isolated, quantified by qPCR and the 16S rRNA gene was sequenced to characterise the bacterial communities in the lower airways. MAIN MEASUREMENTS AND RESULTS: Distinct differences in the microbial profiles were evident in the lower airways of subjects with CHP and IPF. At the phylum level, the prevailing microbiota of both IPF and CHP subjects included Firmicutes, Bacteroidetes, Proteobacteria and Actinobacteria. However, in IPF, Firmicutes dominated while the percentage of reads assigned to Proteobacteria in the same group was significantly lower compared to CHP subjects. At the genus level, Staphylococcus was increased in CHP and Actinomyces and Veillonella in IPF. The lower airway bacterial burden in CHP subjects was higher than controls but lower than those with IPF. In contrast to IPF, there was no association between bacterial burden and survival in CHP. CONCLUSIONS: The microbial profile of the lower airways in subjects with CHP is distinct from that of IPF and, notably, bacterial burden in individuals with CHP fails to predict survival.

Journal article

Barnett J, Pulzato I, Javed M, Lee YJ, Choraria A, Kemp S, Rice A, Jordan S, Shah PL, Nicholson AG, Padley S, Devaraj Aet al., 2021, Radiological-pathological correlation of negative CT biopsy results enables high negative predictive value for thoracic malignancy, CLINICAL RADIOLOGY, Vol: 76, ISSN: 0009-9260

Journal article

Folgoc LL, Baltatzis V, Alansary A, Desai S, Devaraj A, Ellis S, Manzanera OEM, Kanavati F, Nair A, Schnabel J, Glocker Bet al., 2021, Bayesian analysis of the prevalence bias: learning and predicting from imbalanced data

Datasets are rarely a realistic approximation of the target population. Say,prevalence is misrepresented, image quality is above clinical standards, etc.This mismatch is known as sampling bias. Sampling biases are a major hindrancefor machine learning models. They cause significant gaps between modelperformance in the lab and in the real world. Our work is a solution toprevalence bias. Prevalence bias is the discrepancy between the prevalence of apathology and its sampling rate in the training dataset, introduced uponcollecting data or due to the practioner rebalancing the training batches. Thispaper lays the theoretical and computational framework for training models, andfor prediction, in the presence of prevalence bias. Concretely a bias-correctedloss function, as well as bias-corrected predictive rules, are derived underthe principles of Bayesian risk minimization. The loss exhibits a directconnection to the information gain. It offers a principled alternative toheuristic training losses and complements test-time procedures based onselecting an operating point from summary curves. It integrates seamlessly inthe current paradigm of (deep) learning using stochastic backpropagation andnaturally with Bayesian models.

Working paper

Dafydd DAP, O'Mahony M, Jhanji S, Devaraj A, Allum W, Nicol D, Blunt DM, Riddell AMet al., 2021, The role of CT chest in screening for asymptomatic COVID-19 infection in self-isolating patients prior to elective oncological surgery: findings from a UK Cancer Hub, BRITISH JOURNAL OF RADIOLOGY, Vol: 94, ISSN: 0007-1285

Journal article

George PM, Hida T, Putman RK, Hino T, Desai SR, Devaraj A, Kumar S, Mackintosh JA, Gudnason V, Hatabu H, Gudmundsson G, Hunninghake GM, George PM, Hida T, Putman RK, Desai SR, Devaraj A, Kumar S, Mackintosh JA, Gudnason V, Hatabu H, Gudmundsson G, Hunninghake GMet al., 2020, Hiatus hernia and interstitial lung abnormalities, EUROPEAN RESPIRATORY JOURNAL, Vol: 56, ISSN: 0903-1936

Journal article

Arachchillage DJ, Desai SR, Devaraj A, Ridge CA, Padley SPG, Patel BV, all authors of Pulmonary Angiopathy in Severe COVID-19 Physiologic, Imaging and Hematologic Observationset al., 2020, Reply to: Sanfilippo et al Caviedes et al., American Journal of Respiratory and Critical Care Medicine, Vol: 203, Pages: 261-263, ISSN: 1073-449X

Journal article

George PM, Barratt SL, Condliffe R, Desai SR, Devaraj A, Forrest I, Gibbons MA, Hart N, Jenkins RG, McAuley DF, Patel BV, Thwaite E, Spencer LGet al., 2020, Respiratory follow-up of patients with COVID-19 pneumonia, Thorax, Vol: 75, Pages: 1009-1016, ISSN: 0040-6376

The COVID-19 pandemic has led to an unprecedented surge in hospitalised patients with viral pneumonia. The most severely affected patients are older men, individuals of black and Asian minority ethnicity and those with comorbidities. COVID-19 is also associated with an increased risk of hypercoagulability and venous thromboembolism. The overwhelming majority of patients admitted to hospital have respiratory failure and while most are managed on general wards, a sizeable proportion require intensive care support. The long-term complications of COVID-19 pneumonia are starting to emerge but data from previous coronavirus outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggest that some patients will experience long-term respiratory complications of the infection. With the pattern of thoracic imaging abnormalities and growing clinical experience, it is envisaged that interstitial lung disease and pulmonary vascular disease are likely to be the most important respiratory complications. There is a need for a unified pathway for the respiratory follow-up of patients with COVID-19 balancing the delivery of high-quality clinical care with stretched National Health Service (NHS) resources. In this guidance document, we provide a suggested structure for the respiratory follow-up of patients with clinicoradiological confirmation of COVID-19 pneumonia. We define two separate algorithms integrating disease severity, likelihood of long-term respiratory complications and functional capacity on discharge. To mitigate NHS pressures, virtual solutions have been embedded within the pathway as has safety netting of patients whose clinical trajectory deviates from the pathway. For all patients, we suggest a holistic package of care to address breathlessness, anxiety, oxygen requirement, palliative care and rehabilitation.

Journal article

Ridge CA, Desai SR, Jeyin N, Mahon C, Lother DL, Mirsadraee S, Semple T, Price S, Bleakley C, Arachchillage DJ, Shaw E, Patel BV, Padley SPG, Devaraj Aet al., 2020, Dual-energy CT pulmonary angiography (DECTPA) quantifies vasculopathy in severe COVID-19 pneumonia, Radiology: Cardiothoracic Imaging, Vol: 2, ISSN: 2638-6135

BackgroundThe role of dual energy computed tomographic pulmonary angiography (DECTPA) in revealing vasculopathy in coronavirus disease 2019 (COVID-19) has not been fully explored.PurposeTo evaluate the relationship between DECTPA and disease duration, right ventricular dysfunction (RVD), lung compliance, D-dimer and obstruction index in COVID-19 pneumonia.Materials and MethodsThis institutional review board approved this retrospective study, and waived the informed consent requirement. Between March-May 2020, 27 consecutive ventilated patients with severe COVID-19 pneumonia underwent DECTPA to diagnose pulmonary thrombus (PT); 11 underwent surveillance DECTPA 14 ±11.6 days later. Qualitative and quantitative analysis of perfused blood volume (PBV) maps recorded: i) perfusion defect ‘pattern’ (wedge-shaped, mottled or amorphous), ii) presence of PT and CT obstruction index (CTOI) and iii) PBV relative to pulmonary artery enhancement (PBV/PAenh); PBV/PAenh was also compared with seven healthy volunteers and correlated with D-Dimer and CTOI.ResultsAmorphous (n=21), mottled (n=4), and wedge-shaped (n=2) perfusion defects were observed (M=20; mean age=56 ±8.7 years). Mean extent of perfusion defects=36.1%±17.2. Acute PT was present in 11/27(40.7%) patients. Only wedge-shaped defects corresponded with PT (2/27, 7.4%). Mean CTOI was 2.6±5.4 out of 40. PBV/PAenh (18.2 ±4.2%) was lower than in healthy volunteers (27 ±13.9%, p = 0.002). PBV/PAenh correlated with disease duration (β = 0.13, p = 0.04), and inversely correlated with RVD (β = -7.2, p = 0.001), persisting after controlling for confounders. There were no linkages between PBV/PAenh and D-dimer or CTOI.ConclusionPerfusion defects and decreased PBV/PAenh are prevalent in severe COVID-19 pneumonia. PBV/PAenh correlates with disease duration and inversely correlates with RVD. PBV/PAenh may be an important marker of vasculopathy in severe COVID-19 pneumonia

Journal article

Bartlett EC, Kemp S, Ridge CA, Desai SR, Mirsadraee S, Morjaria JB, Shah PL, Popat S, Nicholson AG, Rice AJ, Jordan S, Begum S, Mani A, Derbyshire J, Morris K, Chen M, Peacock C, Addis J, Martins M, Kaye SB, Padley SPG, Devaraj A, McDonald F, Robertus JL, Lim E, Barnett J, Finch J, Dalal P, Yousaf N, Jamali A, Ivashniova N, Phillips C, Newsom-Davies T, Lee R, Vaghani P, Whiteside S, Vaughan-Smith Set al., 2020, Baseline Results of the West London lung cancer screening pilot study - Impact of mobile scanners and dual risk model utilisation, LUNG CANCER, Vol: 148, Pages: 12-19, ISSN: 0169-5002

Journal article

Horst C, Dickson JL, Tisi S, Ruparel M, Nair A, Devaraj A, Janes SMet al., 2020, Delivering low-dose CT screening for lung cancer: a pragmatic approach, THORAX, Vol: 75, Pages: 831-832, ISSN: 0040-6376

Journal article

Ruparel M, Quaife SL, Dickson JL, Horst C, Tisi S, Hall H, Taylor M, Ahmed A, Shaw P, Burke S, Soo M-J, Nair A, Devaraj A, Sennett K, Duffy SW, Navani N, Bhowmik A, Baldwin DR, Janes SMet al., 2020, Lung Screen Uptake Trial: results from a single lung cancer screening round, THORAX, Vol: 75, Pages: 908-912, ISSN: 0040-6376

Journal article

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