Imperial College London

ProfessorAndreaRockall

Faculty of MedicineDepartment of Surgery & Cancer

Clinical Chair in Radiology
 
 
 
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a.rockall

 
 
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ICTEM buildingHammersmith Campus

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Summary

 

Publications

Publication Type
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226 results found

Rockall A, Barwick T, Wilson W, Singh N, Bharwani N, Sohaib A, Nobbenhuis M, Warbey V, Miquel M, Koh D-M, De Paepe KN, Martin-Hirsch P, Ghaem-Maghami S, Fotopoulou C, Stringfellow H, Sundar S, Manchanda R, Sahdev A, Hackshaw A, Cook GJet al., 2021, Diagnostic accuracy of FEC-PET/CT, FDG-PET/CT and diffusion-weighted MRI in detection of nodal metastases in surgically treated endometrial and cervical carcinoma, Clinical Cancer Research, ISSN: 1078-0432

Purpose:Pre-operative nodal staging is important for planning treatment in cervical cancer (CC) and endometrial cancer (EC) but remains challenging. We compare nodal staging accuracy of 18F-ethyl-choline-(FEC)-PET/CT, 18F-Fluoro-deoxy-glucose-(FDG)-PET/CT and diffusion-weighted-MRI (DW-MRI) with conventional morphological MRI.Experimetal Design:A prospective, multicentre observational study of diagnostic accuracy for nodal metastases was undertaken in 5 gyne-oncology centres. FEC-PET/CT, FDG-PET/CT and DW-MRI were compared to nodal size and morphology on MRI. Reference standard was strictly correlated nodal histology. Eligibility included operable CC stage=>1B1 or EC (grade 3 any stage with myometrial invasion or grade 1-2 stage=>II). Results:Among 162 consenting participants, 136 underwent study DW-MRI and FDG-PET/CT, and 60 underwent FEC-PET/CT. 267 nodal regions in 118 women were strictly correlated at histology (nodal positivity rate 25%). Sensitivity per-patient (n=118) for nodal size, morphology, DW-MRI, FDG- and FEC-PET/CT were 40%*, 53%, 53%, 63%* and 67% for all cases (*p=0.016); 10%, 10%, 20%, 30% and 25% in CC (n=40); 65%, 75%, 70%, 80% and 88% in EC (n=78). FDG-PET/CT outperformed nodal size (p=0.006) and size ratio (p=0.04) for per-region sensitivity. False positive rates were all <10%. Conclusions:All imaging techniques had low sensitivity for detection of nodal metastases and cannot replace surgical nodal staging. The performance of FEC-PET/CT was not statistically different to other techniques that are more widely available. FDG-PET/CT had higher sensitivity than size in detecting nodal metastases. False positive rates were low across all methods. The low false positive rate demonstrated by FDG-PET/CT may be helpful in arbitration of challenging surgical planning decisions.

Journal article

Bass E, Pantovic A, Connor M, Gabe R, Padhani A, Rockall A, Sokhi H, Tam H, Winkler M, Ahmed Het al., 2021, A systematic review and meta-analysis of the diagnostic accuracy of biparametric prostate MRI for prostate cancer in men at risk, Prostate Cancer and Prostatic Diseases, Vol: 24, Pages: 596-611, ISSN: 1365-7852

IntroductionMultiparametric magnetic resonance imaging (mpMRI), the use of three multiple imaging sequences, typically T2-weighted, diffusion weighted (DWI) and dynamic contrast enhanced (DCE) images, has a high sensitivity and specificity for detecting significant cancer. Current guidance now recommends its use prior to biopsy. However, the impact of DCE is currently under debate regarding test accuracy. Biparametric MRI (bpMRI), using only T2 and DWI has been proposed as a viable alternative. We conducted a contemporary systematic review and meta-analysis to further examine the diagnostic performance of bpMRI in the diagnosis of any and clinically significant prostate cancer.MethodsA systematic review of the literature from 01/01/2017 to 06/07/2019 was performed by two independent reviewers using predefined search criteria. The index test was biparametric MRI and the reference standard whole-mount prostatectomy or prostate biopsy. Quality of included studies was assessed by the QUADAS-2 tool. Statistical analysis included pooled diagnostic performance (sensitivity; specificity; AUC), meta-regression of possible covariates and head-to-head comparisons of bpMRI and mpMRI where both were performed in the same study.ResultsForty-four articles were included in the analysis. The pooled sensitivity for any cancer detection was 0.84 (95% CI, 0.80–0.88), specificity 0.75 (95% CI, 0.68–0.81) for bpMRI. The summary ROC curve yielded a high AUC value (AUC = 0.86). The pooled sensitivity for clinically significant prostate cancer was 0.87 (95% CI, 0.78–0.93), specificity 0.72 (95% CI, 0.56–0.84) and the AUC value was 0.87. Meta-regression analysis revealed no difference in the pooled diagnostic estimates between bpMRI and mpMRI.ConclusionsThis meta-analysis on contemporary studies shows that bpMRI offers comparable test accuracies to mpMRI in detecting prostate cancer. These data are broadly supportive of the bpMRI approach but heterogeneity does not al

Journal article

Thomassin-Naggara I, Sadowski E, Rockall A, Reinhold Cet al., 2021, Correspondence on "ESGO/ISUOG/IOTA/ESGE consensus statement on pre-operative diagnosis of ovarian tumors" by Timmerman et al., Int J Gynecol Cancer

Journal article

Brady AP, Visser J, Frija G, Bargallo N, Rockall A, Brkljacic B, Fuchsjaeger M, Birch J, Becker M, Kroencke Tet al., 2021, Value-based radiology: what is the ESR doing, and what should we do in the future?, INSIGHTS INTO IMAGING, Vol: 12, ISSN: 1869-4101

Journal article

Manganaro L, Lakhman Y, Bharwani N, Gui B, Gigli S, Vinci V, Rizzo S, Kido A, Cunha TM, Sala E, Rockall A, Forstner R, Nougaret Set al., 2021, Staging, recurrence and follow-up of uterine cervical cancer using MRI: Updated Guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018 (Apr, 10.1007/s00330-020-07632-9, 2021), EUROPEAN RADIOLOGY, ISSN: 0938-7994

Journal article

Qaiser T, Winzeck S, Barfoot T, Barwick T, Doran SJ, Kaiser MF, Wedlake L, Tunariu N, Koh D-M, Messiou C, Rockall A, Glocker Bet al., 2021, Multiple instance learning with auxiliary task weighting for multiple myeloma classification, International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI)

Whole body magnetic resonance imaging (WB-MRI) is the recommended modalityfor diagnosis of multiple myeloma (MM). WB-MRI is used to detect sites ofdisease across the entire skeletal system, but it requires significantexpertise and is time-consuming to report due to the great number of images. Toaid radiological reading, we propose an auxiliary task-based multiple instancelearning approach (ATMIL) for MM classification with the ability to localizesites of disease. This approach is appealing as it only requires patient-levelannotations where an attention mechanism is used to identify local regions withactive disease. We borrow ideas from multi-task learning and define anauxiliary task with adaptive reweighting to support and improve learningefficiency in the presence of data scarcity. We validate our approach on bothsynthetic and real multi-center clinical data. We show that the MIL attentionmodule provides a mechanism to localize bone regions while the adaptivereweighting of the auxiliary task considerably improves the performance.

Conference paper

Thomassin-Naggara I, Belghitti M, Milon A, Wahab CA, Sadowski E, Rockall AGet al., 2021, O-RADS MRI score: analysis of misclassified cases in a prospective multicentric European cohort, EUROPEAN RADIOLOGY, ISSN: 0938-7994

Journal article

Bernstein D, Taylor A, Nill S, Imseeh G, Kothari G, Llewelyn M, De Paepe KN, Rockall A, Shiarli A-M, Oelfke Uet al., 2021, An Inter-observer Study to Determine Radiotherapy Planning Target Volumes for Recurrent Gynaecological Cancer Comparing Magnetic Resonance Imaging Only With Computed Tomography-Magnetic Resonance Imaging, CLINICAL ONCOLOGY, Vol: 33, Pages: 307-313, ISSN: 0936-6555

Journal article

Reinhold C, Rockall A, Sadowski EA, Siegelman ES, Maturen KE, Vargas HA, Forstner R, Glanc P, Andreotti RF, Thomassin-Naggara Iet al., 2021, Ovarian-Adnexal Reporting Lexicon for MRI: A White Paper of the ACR Ovarian-Adnexal Reporting and Data Systems MRI Committee, JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY, Vol: 18, Pages: 713-729, ISSN: 1546-1440

Journal article

Manganaro L, Lakhman Y, Bharwani N, Gui B, Gigli S, Vinci V, Rizzo S, Kido A, Cunha TM, Sala E, Rockall A, Forstner R, Nougaret Set al., 2021, Staging, recurrence and follow-up of uterine cervical cancer using MRI: Updated Guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018, EUROPEAN RADIOLOGY, ISSN: 0938-7994

Journal article

Dawood MT, Naik M, Bharwani N, Sudderuddin SA, Rockall AG, Stewart VRet al., 2021, Adnexal Torsion: Review of Radio-logic Appearances, RADIOGRAPHICS, Vol: 41, Pages: 609-624, ISSN: 0271-5333

Journal article

Barwick T, Orton M, Koh DM, Kaiser M, Rockall A, Tunariu N, Blackledge M, Messiou Cet al., 2021, Repeatability and reproducibility of apparent diffusion coefficient and fat fraction measurement of focal myeloma lesions on whole body magnetic resonance imaging, BRITISH JOURNAL OF RADIOLOGY, Vol: 94, ISSN: 0007-1285

Journal article

Sadowski EA, Maturen KE, Rockall A, Reinhold C, Addley H, Jha P, Bharwani N, Thomassin-Naggara Iet al., 2021, Ovary: MRI characterisation and O-RADS MRI, BRITISH JOURNAL OF RADIOLOGY, Vol: 94, ISSN: 0007-1285

Journal article

Arshad MA, Gitau S, Tam H, Park W-HE, Patel NH, Rockall A, Aboagye EO, Bharwani N, Barwick TDet al., 2020, Optimal method for metabolic tumour volume assessment of cervical cancers with inter-observer agreement on [18F]-fluoro-deoxy-glucose positron emission tomography with computed tomography, European Journal of Nuclear Medicine and Molecular Imaging, Pages: 1-15, ISSN: 0340-6997

PurposeCervical cancer metabolic tumour volume (MTV) derived from [18F]-FDG PET/CT has a role in prognostication and therapy planning. There is no standard method of outlining MTV on [18F]-FDG PET/CT. The aim of this study was to assess the optimal method to outline primary cervical tumours on [18F]-FDG PET/CT using MRI-derived tumour volumes as the reference standard.Methods81 consecutive cervical cancer patients with pre-treatment staging MRI and [18F]-FDG PET/CT imaging were included. MRI volumes were compared with different PET segmentation methods. Method 1 measured MTVs at different SUVmax thresholds ranging from 20 to 60% (MTV20-MTV60) with bladder masking and manual adjustment when required. Method 2 created an isocontour around the tumour prior to different SUVmax thresholds being applied. Method 3 used an automated gradient method. Inter-observer agreement of MTV, following manual adjustment when required, was recorded.ResultsFor method 1, the MTV25 and MTV30 were closest to the MRI volumes for both readers (mean percentage change from MRI volume of 2.9% and 13.4% for MTV25 and − 13.1% and − 2.0% for MTV30 for readers 1 and 2). 70% of lesions required manual adjustment at MTV25 compared with 45% at MTV30. There was excellent inter-observer agreement between MTV30 to MTV60 (ICC ranged from 0.898–0.976 with narrow 95% confidence intervals (CIs)) and moderate agreement at lower thresholds (ICC estimates of 0.534 and 0.617, respectively for the MTV20 and MTV25 with wide 95% CIs). Bladder masking was performed in 86% of cases overall. For method 2, excellent correlation was demonstrated at MTV25 and MTV30 (mean % change from MRI volume of −3.9% and − 8.6% for MTV25 and − 16.9% and 19% for MTV30 for readers 1 and 2, respectively). This method also demonstrated excellent ICC across all thresholds with no manual adjustment. Method 3 demonstrated excellent ICC of 0.96 (95% CI 0.94–0.97) but had a

Journal article

Rockall A, Rockall A, Brady AP, Derchi LE, Birch Jet al., 2020, The identity and role of the radiologist in 2020: a survey among ESR full radiologist members, INSIGHTS INTO IMAGING, Vol: 11, ISSN: 1869-4101

Journal article

Salib MY, Russell JHB, Stewart VR, Sudderuddin SA, Barwick TD, Rockall AG, Bharwani Net al., 2020, 2018 FIGO Staging Classification for Cervical Cancer: Added Benefits of Imaging, RADIOGRAPHICS, Vol: 40, Pages: 1807-1822, ISSN: 0271-5333

Journal article

Thomassin-Naggara I, Rockall A, 2020, Editorial for "Validity and Reproducibility of ADNEX MR SCORING System in Diagnosis of Sonographically Indeterminate Adnexal Masses", JOURNAL OF MAGNETIC RESONANCE IMAGING, Vol: 53, Pages: 640-641, ISSN: 1053-1807

Journal article

Kanavati F, Islam S, Arain Z, Aboagye EO, Rockall Aet al., 2020, Fully-automated deep learning slice-based muscle estimation from CT images for sarcopenia assessment, Publisher: arXiv

Objective: To demonstrate the effectiveness of using a deep learning-basedapproach for a fully automated slice-based measurement of muscle mass forassessing sarcopenia on CT scans of the abdomen without any case exclusioncriteria. Materials and Methods: This retrospective study was conducted using acollection of public and privately available CT images (n = 1070). The methodconsisted of two stages: slice detection from a CT volume and single-slice CTsegmentation. Both stages used Fully Convolutional Neural Networks (FCNN) andwere based on a UNet-like architecture. Input data consisted of CT volumes witha variety of fields of view. The output consisted of a segmented muscle mass ona CT slice at the level of L3 vertebra. The muscle mass is segmented intoerector spinae, psoas, and rectus abdominus muscle groups. The output wastested against manual ground-truth segmentation by an expert annotator. Results: 3-fold cross validation was used to evaluate the proposed method.The slice detection cross validation error was 1.41+-5.02 (in slices). Thesegmentation cross validation Dice overlaps were 0.97+-0.02, 0.95+-0.04,0.94+-0.04 for erector spinae, psoas, and rectus abdominus, respectively, and0.96+-0.02 for the combined muscle mass. Conclusion: A deep learning approach to detect CT slices and segment musclemass to perform slice-based analysis of sarcopenia is an effective andpromising approach. The use of FCNN to accurately and efficiently detect aslice in CT volumes with a variety of fields of view, occlusions, and slicethicknesses was demonstrated.

Working paper

Miles A, Evans REC, Halligan S, Beare S, Bridgewater J, Goh V, Janes SM, Navani N, Oliver A, Morton A, Morris S, Rockall A, Taylor SAet al., 2020, Predictors of patient preference for either whole body magnetic resonance imaging (WB-MRI) or CT/ PET-CT for staging colorectal or lung cancer, JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Vol: 64, Pages: 537-545, ISSN: 1754-9477

Journal article

Avesani G, Arshad M, Lu H, Fotopoulou C, Cannone F, Melotti R, Aboagye E, Rockall Aet al., 2020, Radiological assessment of Peritoneal Cancer Index on preoperative CT in ovarian cancer is related to surgical outcome and survival, RADIOLOGIA MEDICA, Vol: 125, Pages: 770-776, ISSN: 0033-8362

Journal article

Evans REC, Taylor SA, Kalasthry J, Sakai NS, Miles A, Streamline investigatorset al., 2020, Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI., Clinical Radiology, Vol: 75, Pages: 308-315, ISSN: 0009-9260

AIM: To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS: A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS: One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS: Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.

Journal article

Rockall A, Howlett D, Brady A, Bonomo L, Frija G, Hierath Met al., 2020, The current status of radiological clinical audit and feedback on the ESR Guide to Clinical Audit in Radiology and the ESR Clinical Audit Tool (Esperanto) – an ESR Survey of European Radiology Departments, Insights into Imaging, Vol: 11, ISSN: 1869-4101

Clinical audit “according to national procedures” is a legal requirement as defined within the recently implemented European Council Basic Safety Standards Directive (BSSD), 2013/59/Euratom. A survey was undertaken in 2019 to assess the current status of clinical audit in European radiology departments and for feedback on the recently published “ESR Guide to Clinical Audit in Radiology” and the “ESR Clinical Audit Tool (Esperanto)”. The survey was distributed within the European Society of Radiology (ESR) EuroSafe Imaging Star network and also to European national radiological societies which are institutional members of the ESR.

Journal article

Thomassin-Naggara I, Poncelet E, Jalaguier-Coudray A, Guerra A, Fournier LS, Stojanovic S, Millet I, Bharwani N, Juhan V, Cunha TM, Masselli G, Balleyguier C, Malhaire C, Perrot NF, Sadowski EA, Bazot M, Taourel P, Porcher R, Darai E, Reinhold C, Rockall AGet al., 2020, Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of sonographically indeterminate adnexal masses., JAMA Network Open, Vol: 3, Pages: 1-14, ISSN: 2574-3805

Importance: Approximately one-quarter of adnexal masses detected at ultrasonography are indeterminate for benignity or malignancy, posing a substantial clinical dilemma. Objective: To validate the accuracy of a 5-point Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of adnexal masses. Design, Setting, and Participants: This multicenter cohort study was conducted between March 1, 2013, and March 31, 2016. Among patients undergoing expectant management, 2-year follow-up data were completed by March 31, 2018. A routine pelvic MRI was performed among consecutive patients referred to characterize a sonographically indeterminate adnexal mass according to routine diagnostic practice at 15 referral centers. The MRI score was prospectively applied by 2 onsite readers and by 1 reader masked to clinical and ultrasonographic data. Data analysis was conducted between April and November 2018. Main Outcomes and Measures: The primary end point was the joint analysis of true-negative and false-negative rates according to the MRI score compared with the reference standard (ie, histology or 2-year follow-up). Results: A total of 1340 women (mean [range] age, 49 [18-96] years) were enrolled. Of 1194 evaluable women, 1130 (94.6%) had a pelvic mass on MRI with a reference standard (surgery, 768 [67.9%]; 2-year follow-up, 362 [32.1%]). A total of 203 patients (18.0%) had at least 1 malignant adnexal or nonadnexal pelvic mass. No invasive cancer was assigned a score of 2. Positive likelihood ratios were 0.01 for score 2, 0.27 for score 3, 4.42 for score 4, and 38.81 for score 5. Area under the receiver operating characteristic curve was 0.961 (95% CI, 0.948-0.971) among experienced readers, with a sensitivity of 0.93 (95% CI, 0.89-0.96; 189 of 203 patients) and a specificity of 0.91 (95% CI, 0.89-0.93; 848 of 927 patients). There was good interrater agreement among both experienced and junior readers (κ = 0.784

Journal article

Hameed M, Sandhu A, Soneji N, Amiras D, Rockall A, Messiou C, Wallitt K, Barwick TDet al., 2020, Pictorial review of whole body MRI in myeloma: emphasis on diffusion-weighted imaging, BRITISH JOURNAL OF RADIOLOGY, Vol: 93, ISSN: 0007-1285

Journal article

Rockall A, Schmid MP, Adam JA, 2020, Response assessment and follow-up by imaging in gyn tumours, Medical Radiology, Pages: 517-530

Imaging plays an important role in the staging and management of all main gynaecological tumours. Gynaecological tumours treated primarily with radiotherapy such as cervical, vaginal or vulvar cancer typically show considerable tumour shrinkage during treatment. Following the successful completion of initial treatment, there is no strong evidence to support posttreatment imaging surveillance of asymptomatic women. In general, gynaeco-oncological practice, the initial suspicion of disease relapse relies largely on clinical symptoms rather than radiological evidence. However, once clinical relapse is suspected, imaging plays a crucial role in planning salvage therapy. Typical treatment concepts in locally advanced (non-tubo-ovarian) gynaecological cancers consist of external beam radiotherapy (EBRT) and concomitant chemotherapy followed by brachytherapy. Due to the substantial tumour shrinkage during external beam radiotherapy, the GYN GEC-ESTRO group defined an adaptive target volume concept for MRI-based brachytherapy. So far, target concepts for cervical and vaginal cancer were elaborated. The integration of functional imaging into the delineation process could help to reduce interobserver variations and further differentiate subvolumes with increased risk for recurrence. In cervical cancer, MRI performed at 6 months post end of RT, the cervix should be normal or small in size and of low T2 signal intensity, with no evidence of restricted diffusion, to suggest a complete response. [18F]FDG PET/CT has been shown to be a strong predictor of patient outcome, with better survival outcomes in patients with a complete metabolic response. Imaging plays an essential role when recurrence is suspected. The initial steps will involve confirmation of the relapse, defining the extent of disease and determining the available treatment options. If there is no substrate for rising markers on CT or MRI, an [18F]FDG PET/CT should be performed due to its high sensitivity and spe

Book chapter

Rockall A, 2020, From hype to hope to hard work: developing responsible AI for radiology, CLINICAL RADIOLOGY, Vol: 75, Pages: 1-2, ISSN: 0009-9260

Journal article

Lai AYT, Riddell A, Barwick T, Boyd K, Rockall A, Kaiser M, Koh D-M, Saffar H, Yusuf S, Messiou Cet al., 2020, Interobserver agreement of whole-body magnetic resonance imaging is superior to whole-body computed tomography for assessing disease burden in patients with multiple myeloma, European Radiology, Vol: 30, Pages: 320-327, ISSN: 0938-7994

ObjectivesWhole-body MRI (WB-MRI) is recommended by the International Myeloma Working Group for all patients with asymptomatic myeloma and solitary plasmacytoma and by the UK NICE guidance for all patients with suspected myeloma. Some centres unable to offer WB-MRI offer low-dose whole-body CT (WB-CT). There are no studies comparing interobserver agreement and disease detection of contemporary WB-MRI (anatomical imaging and DWI) versus WB-CT. Our primary aim is to compare the interobserver agreement between WB-CT and WB-MRI in the diagnosis of myeloma.MethodsConsecutive patients with newly diagnosed myeloma imaged with WB-MRI and WB-CT were prospectively reviewed. For each body region and modality, two experienced and two junior radiologists scored disease burden with final scores by consensus. Intraclass correlation coefficients (ICC), median scores, Wilcoxon signed-rank test and Spearman’s correlation coefficients were calculated.ResultsThere was no significant difference in overall observer scores between WB-MRI and WB-CT (p = 0.87). For experienced observers, interobserver agreement for WB-MRI was superior to WB-CT overall and for each region, without overlap in whole-skeleton confidence intervals (ICC 0.98 versus 0.77, 95%CI 0.96–0.99 versus 0.45–0.91). For inexperienced observers, although there is a trend for a better interobserver score for the whole skeleton on WB-MRI (ICC 0.95, 95%CI 0.72–0.98) than on WB-CT (ICC 0.72, 95%CI 0.34–0.88), the confidence intervals overlap.ConclusionsWB-MRI offers excellent interobserver agreement which is superior to WB-CT for experienced observers. Although the overall burden was similar across both modalities, patients with lower disease burdens where MRI could be advantageous are not included in this series.

Journal article

Taylor SA, Mallett S, Miles A, Morris S, Quinn L, Clarke CS, Beare S, Bridgewater J, Goh V, Janes S, Koh D-M, Morton A, Navani N, Oliver A, Padhani A, Punwani S, Rockall A, Halligan Set al., 2019, Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies., Health Technology Assessment, Vol: 23, Pages: 1-270, ISSN: 1366-5278

BACKGROUND: Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. OBJECTIVES: The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). DESIGN: The design was a prospective multicentre cohort study. SETTING: The setting was 16 NHS hospitals. PARTICIPANTS: Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). INTERVENTIONS: Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography-computed tomography). REFERENCE STANDARD: Consensus panel decision using 12-month follow-up data. MAIN OUTCOME MEASURES: The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. RESULTS: Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a differe

Journal article

Miles A, Taylor SA, Evans REC, Halligan S, Beare S, Bridgewater J, Goh V, Janes S, Navani N, Oliver A, Morton A, Rockall A, Clarke CS, Morris S, Aboagye A, Agoramoorthy L, Ahmed S, Amadi A, Anand G, Atkin G, Austria A, Ball S, Bazari F, Beable R, Beedham H, Beeston T, Bharwani N, Bhatnagar G, Bhowmik A, Blakeway L, Blunt D, Boavida P, Boisfer D, Breen D, Burke S, Butawan R, Campbell Y, Chang E, Chao D, Chukundah S, Collins B, Collins C, Conteh V, Couture J, Crosbie J, Curtis H, Daniel A, Davis L, Desai K, Duggan M, Ellis S, Elton C, Engledow A, Everitt C, Ferdous S, Frow A, Furneaux M, Gibbons N, Glynne-Jones R, Gogbashian A, Gourtsoyianni S, Green A, Green L, Green L, Groves A, Guthrie A, Hadley E, Hameeduddin A, Hanid G, Hans S, Hans B, Higginson A, Honeyfield L, Hughes H, Hughes J, Hurl L, Isaac E, Jackson M, Jalloh A, Jannapureddy R, Jayme A, Johnson A, Johnson E, Julka P, Kalasthry J, Karapanagiotou E, Karp S, Kay C, Kellaway J, Khan S, Koh D-M, Light T, Limbu P, Lock S, Locke I, Loke T, Lowe A, Lucas N, Maheswaran S, Mallett S, Marwood E, McGowan J, Mckirdy F, Mills-Baldock T, Moon T, Morgan V, Nasseri S, Nichols P, Norman C, Ntala E, Nunes A, Obichere A, O'Donohue J, Olaleye I, Onajobi A, O'Shaughnessy T, Padhani A, Pardoe H, Partridge W, Patel U, Perry K, Piga W, Prezzi D, Prior K, Punwani S, Pyers J, Rafiee H, Rahman F, Rajanpandian I, Ramesh S, Raouf S, Reczko K, Reinhardt A, Robinson D, Russell P, Sargus K, Scurr E, Shahabuddin K, Sharp A, Shepherd B, Shiu K, Sidhu H, Simcock I, Simeon C, Smith A, Smith D, Snell D, Spence J, Srirajaskanthan R, Stachini V, Stegner S, Stirling J, Strickland N, Tarver K, Teague J, Thaha M, Train M, Tulmuntaha S, Tunariu N, van Ree K, Verjee A, Wanstall C, Weir S, Wijeyekoon S, Wilson J, Wilson S, Win T, Woodrow L, Yu Det al., 2019, Patient preferences for whole-body MRI or conventional staging pathways in lung and colorectal cancer: a discrete choice experiment, European Radiology, Vol: 29, Pages: 3889-3900, ISSN: 0938-7994

ObjectivesTo determine the importance placed by patients on attributes associated with whole-body MRI (WB-MRI) and standard cancer staging pathways and ascertain drivers of preference.MethodsPatients recruited to two multi-centre diagnostic accuracy trials comparing WB-MRI with standard staging pathways in lung and colorectal cancer were invited to complete a discrete choice experiment (DCE), choosing between a series of alternate pathways in which 6 attributes (accuracy, time to diagnosis, scan duration, whole-body enclosure, radiation exposure, total scan number) were varied systematically. Data were analysed using a conditional logit regression model and marginal rates of substitution computed. The relative importance of each attribute and probabilities of choosing WB-MRI-based pathways were estimated.ResultsA total of 138 patients (mean age 65, 61% male, lung n = 72, colorectal n = 66) participated (May 2015 to September 2016). Lung cancer patients valued time to diagnosis most highly, followed by accuracy, radiation exposure, number of scans, and time in the scanner. Colorectal cancer patients valued accuracy most highly, followed by time to diagnosis, radiation exposure, and number of scans. Patients were willing to wait 0.29 (lung) and 0.45 (colorectal) weeks for a 1% increase in pathway accuracy. Patients preferred WB-MRI-based pathways (probability 0.64 [lung], 0.66 [colorectal]) if they were equivalent in accuracy, total scan number, and time to diagnosis compared with a standard staging pathway.ConclusionsStaging pathways based on first-line WB-MRI are preferred by the majority of patients if they at least match standard pathways for diagnostic accuracy, time to diagnosis, and total scan number.

Journal article

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