Publications
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Jeyin N, Desai SR, Padley SPG, et al., 2023, Dual-energy computed tomographic pulmonary angiography accurately estimates lobar perfusion before lung volume reduction for severe emphysema, Journal of Thoracic Imaging, Vol: 38, Pages: 104-112, ISSN: 0883-5993
PURPOSE: To assess if dual-energy computed tomographic pulmonary angiography (DECTPA) derived lobar iodine quantification can provide an accurate estimate of lobar perfusion in patients with severe emphysema, and offer an adjunct to single-photon emission CT perfusion scintigraphy (SPECT-PS) in assessing suitability for lung volume reduction (LVR). MATERIALS AND METHODS: Patients with severe emphysema (forced expiratory volume in 1 s <49% predicted) undergoing evaluation for LVR between May 2018 and April 2020 imaged with both SPECT-PS and DECTPA were included in this retrospective study. DECTPA perfused blood volume maps were automatically segmented and lobar iodine mass was estimated and compared with lobar technetium (Tc99m) distribution acquired with SPECT-PS. Pearson correlation and Bland-Altman analysis were used for intermodality comparison between DECTPA and SPECT-PS. Univariate and adjusted multivariate linear regression were modelled to ascertain the effect sizes of possible confounders of disease severity, sex, age, and body mass index on the relationship between lobar iodine and Tc99m values. Effective radiation dose and adverse reactions were recorded. RESULTS: In all, 123 patients (64.5±8.8 y, 71 men; mean predicted forced expiratory volume in 1 s 32.1 ±12.7%,) were eligible for inclusion. There was a linear relationship between lobar perfusion values acquired using DECTPA and SPECT-PS with statistical significance (P<0.001). Lobar relative perfusion values acquired using DECTPA and SPECT-PS had a consistent relationship both by linear regression and Bland-Altman analysis (mean bias, -0.01, mean r2 0.64; P<0.0001). Individual lobar comparisons demonstrated moderate correlation (r=0.79, 0.78, 0.84, 0.78, 0.8 for the right upper, middle, lower, left upper, and lower lobes, respectively, P<0.0001). The relationship between lobar iodine and Tc99m values was not significantly altered after controlling for conf
Dintakurti SH, Kamath S, Mahon C, et al., 2023, Pulmonary hypertension: the hallmark of acute COVID-19 microvascular angiopathy?, ERJ Open Research, Vol: 9, Pages: 1-4, ISSN: 2312-0541
Sheeka A, Singaravelou A, Bartlett E, et al., 2023, COVID-protected pathways for image-guided lung cancer intervention during the COVID-19 pandemic: A cohort study., Br J Radiol, Vol: 96
OBJECTIVES: To compare the experience of COVID-protected and mixed cohort pathways in COVID-19 transmission at a tertiary referral hospital for elective CT-guided lung biopsy and ablation during the COVID-19 pandemic. METHODS: From September 2020 to August 2021, patients admitted for elective thoracic intervention were treated at a tertiary hospital (Site 1). Site 1 received patients for extracorporeal membrane oxygenation (ECMO) and invasive ventilation in the treatment of COVID-19. Shared imaging, theater, and hallway facilities were used.From April 2020 to August 2020, patients admitted for elective thoracic intervention were treated at a COVID-protected hospital (Site 2). No patients with suspected or confirmed COVID-19 were treated at Site 2.Patients were surveyed for clinical and laboratory signs of COVID-19 infection up to 30 days post-procedure. RESULTS: At Sites 1 and 2, patients (2.4%) were tested positive for COVID-19 at 10 and 14 days post-procedure.At Site 2, there were no COVID-19 positive cases within 30 days of undergoing elective thoracic intervention. CONCLUSION: A mixed-site method for infection control could represent a pragmatic approach to the management of elective procedures during the COVID-19 pandemic or for similar illnesses. ADVANCES IN KNOWLEDGE: Mixed-cohort infection control is possible in the prevention of nosocomial COVID-19 infection.
Juarez-Molina C, Meng C, Morgan C, et al., 2022, Non-viral Gene Therapy for Autoimmune Pulmonary Alveolar Proteinosis, 29th Annual Congress of the European-Society-of-Gene-and-Cell-Therapy (ESCGT), Publisher: MARY ANN LIEBERT, INC, Pages: A189-A189, ISSN: 1043-0342
Price LC, Garfield B, Bloom C, et al., 2022, Persistent isolated impairment of gas transfer following COVID-19 pneumonitis relates to perfusion defects on dual-energy computed tomography, ERJ OPEN RESEARCH, Vol: 8
Zhang YZ, Nicholson AG, Ly F, et al., 2022, Prediction of Clinically Significant Pathological Upstaging in Resected Lung Cancer: Insight from COVID-19 Pandemic (1st wave), Publisher: ELSEVIER SCIENCE INC, Pages: S112-S114, ISSN: 1556-0864
Sheeka A, Singaravelou A, Bartlett E, et al., 2022, COVID-Protected Pathways for Image Guided Lunc Cancer Intervention During the COVID-19 Pandemic: A Cohort Study, Publisher: ELSEVIER SCIENCE INC, Pages: S305-S305, ISSN: 1556-0864
Alton E, Lund-Palau H, Juarez-Molina C, et al., 2022, Correction of a chronic pulmonary disease through lentiviral vector-mediated protein expression, Molecular Therapy - Methods and Clinical Development, Vol: 25, Pages: 382-391, ISSN: 2329-0501
We have developed a novel lentiviral vector, pseudotyped with the F and HN proteins from Sendai virus (rSIV.F/HN), which produces long-lasting, high efficiency transduction of the respiratory epithelium. Here, we addressed whether this platform technology can secrete sufficient levels of a therapeutic protein into the lung to ameliorate a fatal pulmonary disease, as an exemplar of its translational capability. Pulmonary Alveolar Proteinosis (PAP) results from alveolar GM-CSF insufficiency, resulting in abnormal surfactant homeostasis and consequent ventilatory problems. Lungs of GM-CSF knockout mice were transduced with a single dose of rSIV.F/HN expressing murine (m)GM-CSF (1e5-92e7 TU/mouse); mGM-CSF expression was dose-related and persisted for at least 11 months. PAP disease biomarkers were rapidly and persistently corrected, but we noted a narrow toxicity/efficacy window. rSIV.F/HN may be a useful platform technology to deliver therapeutic proteins for lung diseases requiring long-lasting and stable expression of secreted proteins.
Singh S, Gorog DA, Mahon CF, et al., 2021, Optimal Management of Thrombotic Complications in Patients With Coronavirus Disease 2019 Reply, CRITICAL CARE MEDICINE, Vol: 49, Pages: E1190-E1191, ISSN: 0090-3493
Desai S, Devaraj A, Dintakurti S, et al., 2021, INFLUENZA AND COVID-19 PNEUMONIA: THE DIFFERENCE IS PULMONARY HYPERTENSION, Publisher: BMJ PUBLISHING GROUP, Pages: A117-A118, ISSN: 0040-6376
Douraghi-Zadeh D, Logaraj A, Lazoura O, et al., 2021, Extracorporeal membrane oxygenation (ECMO): Radiographic appearances, complications and imaging artefacts for radiologists, JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Vol: 65, Pages: 888-895, ISSN: 1754-9477
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Bartlett E, Belsey J, Derbyshire J, et 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.
Mirsadraee S, Gorog DA, Mahon CF, et 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
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- Citations: 21
Neville JJ, Chacon CS, Jordan S, et al., 2021, Use of lymphangiography in neonates prior to thoracic duct ligation, JOURNAL OF PEDIATRIC SURGERY CASE REPORTS, Vol: 64, ISSN: 2213-5766
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- Citations: 1
Barnett J, Pulzato I, Javed M, et 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
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- Citations: 2
Castro-Verdes M, Gkouma A, Wort J, et al., 2020, Corona Virus Disease 2019 in situ arterial and venous thrombosis in critically ill patients: a case series, European Heart Journal: Case Reports, Vol: 4, Pages: 1-7, ISSN: 2514-2119
BackgroundCorona Virus Disease 2019 (COVID-19) pneumonitis associated with severe respiratory failure carries a high mortality. Coagulopathy has emerged as a significant contributor to thrombotic complications.Case summaryWe describe two cases of severe COVID-19 pneumonitis refractory to conventional mechanical ventilation and proning position, transferred to our specialist centre for cardiorespiratory failure. Cross-sectional imaging demonstrated concurrent venous and aortic thrombosis with end-organ ischaemic changes. One patient received thrombolysis with a partial response. This could not be offered to the other patient due to a recent haemorrhagic event. Both patients died of multi-organ failure in the hospital.DiscussionConcurrent aortic and venous thromboses are rare. This finding in COVID-19 cases, who were both critically ill patients, likely reflects the strongly thrombogenic nature of this illness which ultimately contributed to poor outcomes. The absence of deep vein thrombosis or a potential systemic source of embolism suggests in situ thrombosis. Further, the management of anticoagulation and thrombolysis is challenging in patients where an attendant bleeding risk exists.
Woodhull S, Bush A, Tang AL, et al., 2020, Massive paediatric pulmonary haemorrhage in Dieulafoy's disease: Roles of CT angiography, embolisation and bronchoscopy., Paediatr Respir Rev, Vol: 36, Pages: 100-105
Acute, major pulmonary haemorrhage in children, is rare, may be life-threatening and at times presents atypically. Dieulafoy's disease of the bronchus presenting with recurrent or massive hemoptysis was first described in adults. Prior to reviewing the literature, we report an illustrative case of bronchial Dieulafoy's disease (BDD) in a child presenting unusually with massive apparent hematemesis. The source of bleeding is a bronchial artery that fails to taper as it terminates within the bronchial submucosa. A high index of suspicion is required to identify such lesions via radiological imaging and the role of bronchial artery embolisation is highlighted with video images of angiography included.
Arachchillage DJ, Desai SR, Devaraj A, et 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
Ridge CA, Desai SR, Jeyin N, et 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
Bartlett EC, Kemp S, Ridge CA, et 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
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- Citations: 17
Fischer AJ, Nagarajan VD, Padley S, et al., 2020, When a multipolar catheter misses an “arm”: A known complication experienced anew, HeartRhythm Case Reports, Vol: 6, Pages: 745-748
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Sathianandan S, Rawal B, Price L, et al., 2020, Dynamic oxygen-enhanced magnetic resonance imaging-based quantification of pulmonary hypertension, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Patel BV, Arachchillage DJ, Ridge CA, et al., 2020, Pulmonary angiopathy in severe COVID-19: physiologic, imaging and hematologic observations, American Journal of Respiratory and Critical Care Medicine, Vol: 202, Pages: 690-699, ISSN: 1073-449X
Rationale: Clinical and epidemiologic data in coronavirus disease 2019 (Covid-19) have accrued rapidly since the outbreak but few address the underlying pathophysiology. Objectives: To ascertain the physiologic, hematologic and imaging basis of lung injury in severe Covid-19 pneumonia. Methods: Clinical, physiologic and laboratory data were collated. Radiologic (computed tomography pulmonary angiography [CTPA, n=39] and dual-energy CT [DECT, n=20]) studies were evaluated: observers quantified CT patterns (including the extent of abnormal lung and the presence/extent of dilated peripheral vessels) and perfusion defects on DECT. Coagulation status was assessed using thromboelastography (TEG). Measurements and Results: In 39 consecutive patients (M:F 32:7; mean age, 53±10 years [range 29-79 years]; black and ethnic minority, n=25 [64%]), there was a significant vascular perfusion abnormality and increased physiologic dead-space (dynamic compliance, 33.7±14.7 mls/cmH2O; Murray Lung Injury Score, 3.14±0.53; mean ventilatory ratios, 2.6±0.8) with evidence of hypercoagulability and fibrinolytic ‘shutdown’. The mean CT extent (±SD) of normally-aerated lung, ground-glass opacification and dense parenchymal opacification were 23.5±16.7%, 36.3±24.7% and 42.7±27.1%, respectively. Dilated peripheral vessels were present in 21/33 (63.6%) patients with at least two assessable lobes (including 10/21 [47.6%] with no evidence of acute pulmonary emboli). Perfusion defects on DECT (assessable in 18/20 [90%]), were present in all patients (wedge-shaped, n=3; mottled, n= 9; mixed pattern, n=6). Conclusions: Physiologic, hematologic and imaging data show not only the presence of a hypercoagulable phenotype in severe Covid-19 pneumonia but also markedly impaired pulmonary perfusion likely caused by pulmonary angiopathy and thrombosis.
Bartlett EC, Kemp S, Derbyshire J, et al., 2019, IMPLICATIONS AND OUTCOMES OF CLINICAL AND RADIOLOGICAL INCIDENTAL LUNG CANCER SCREENING FINDINGS FOR PRIMARY CARE - RESULTS FROM A PILOT SCREENING STUDY, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A129-A129, ISSN: 0040-6376
Bartlett E, Kemp S, Desai S, et al., 2019, Uptake in Lung Cancer Screening - Does CT Location Matter? A Pilot Study Comparison of a Mobile and Hospital Based CT Scanner, Publisher: ELSEVIER SCIENCE INC, Pages: S289-S289, ISSN: 1556-0864
Devaraj A, Pulzato I, Kemp S, et al., 2019, What Is the Impact of Localised Data When Training Deep Neural Networks for Lung Cancer Prediction?, Publisher: ELSEVIER SCIENCE INC, Pages: S797-S797, ISSN: 1556-0864
Barnett J, Pulzato I, Burn T, et al., 2019, Very Rapid Growth of Small Pulmonary Nodules Predicts Benignity, Publisher: ELSEVIER SCIENCE INC, Pages: S528-S528, ISSN: 1556-0864
Spiro SG, Shah PL, Rintoul RC, et al., 2019, Sequential screening for lung cancer in a high-risk group: randomised controlled trial, European Respiratory Journal, Vol: 54, ISSN: 0903-1936
BACKGROUND: Low-dose computed tomography (LDCT) screening detects early-stage lung cancer and reduces mortality. We proposed a sequential approach targeted to a high-risk group as a potentially efficient screening strategy. METHODS: LungSEARCH was a national multicentre randomised trial. Current/ex-smokers with mild/moderate chronic obstructive pulmonary disease (COPD) were allocated (1:1) to have 5 years surveillance or not. Screened participants provided annual sputum samples for cytology and cytometry, and if abnormal were offered annual LDCT and autofluorescence bronchoscopy (AFB). Those with normal sputum provided annual samples. The primary end-point was the percentage of lung cancers diagnosed at stage I/II (nonsmall cell) or limited disease (small cell). RESULTS: 1568 participants were randomised during 2007-2011 from 10 UK centres. 85.2% of those screened provided an adequate baseline sputum sample. There were 42 lung cancers among 785 screened individuals and 36 lung cancers among 783 controls. 54.8% (23 out of 42) of screened individuals versus 45.2% (14 out of 31) of controls with known staging were diagnosed with early-stage disease (one-sided p=0.24). Relative risk was 1.21 (95% CI 0.75-1.95) or 0.82 (95% CI 0.52-1.31) for early-stage or advanced cancers, respectively. Overall sensitivity for sputum (in those randomised to surveillance) was low (40.5%) with a cumulative false-positive rate (FPR) of 32.8%. 55% of cancers had normal sputum results throughout. Among sputum-positive individuals who had AFB, sensitivity was 45.5% and cumulative FPR was 39.5%; the corresponding measures for those who had LDCT were 100% and 16.1%, respectively. CONCLUSIONS: Our sequential strategy, using sputum cytology/cytometry to select high-risk individuals for AFB and LDCT, did not lead to a clear stage shift and did not improve the efficiency of lung cancer screening.
Sathianandan S, Rawal B, Nashat H, et al., 2019, A retrospective review of computed tomography (CT) findings in Eisenmenger Syndrome and their prognostic implications, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Barnett J, Pulzato I, Wilson R, et al., 2019, Perinodular Vascularity Distinguishes Benign Intrapulmonary Lymph Nodes From Lung Cancer on Computed Tomography, JOURNAL OF THORACIC IMAGING, Vol: 34, Pages: 326-328, ISSN: 0883-5993
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- Citations: 6
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