238 results found
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
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
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
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
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
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.
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
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
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
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, European-Respiratory-Society (ERS) International Congress, 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
Barnett J, Pulzato I, Padley S, et al., 2019, Radiological-pathological correlation of negative CT biopsy results enables high negative predictive value for thoracic malignancy, Publisher: ELSEVIER IRELAND LTD, Pages: S16-S16, ISSN: 0169-5002
Wong PM, Padley SP, 2018, Cardiac computed tomography, Medicine (United Kingdom), Vol: 46, Pages: 474-479, ISSN: 1357-3039
Advances in computed tomography (CT) technology now allow definitive imaging of the coronary arteries. Non-enhanced CT is used to perform coronary artery calcium scoring, which is useful to stratify the risk of future coronary events but does not allow assessment of stenosis. Contrast-enhanced CT coronary angiography (CTCA) enables angiographic evaluation of both the coronary artery lumen and wall. The high negative predictive accuracy of CTCA makes it a useful test to rule out the presence of significant coronary stenoses, especially in patients with an intermediate pre-test likelihood of coronary artery disease. CTCA also has potential to aid the triage of patients with acute chest pain in the emergency department. CTCA can determine the approximate degree of stenosis as well as detect high-risk plaque characteristics. Coronary artery bypass grafts can be assessed reliably using CT. Intracoronary stent evaluation is possible because of advances in temporal resolution. Myocardial perfusion imaging using cardiac CT is the subject of current investigation.
Dreisbach JG, Nicol ED, Roobottom CA, et al., 2018, Challenges in delivering computed tomography coronary angiography as the first-line test for stable chest pain, Heart, Vol: 104, Pages: 921-927, ISSN: 1355-6037
Objective The National Institute for Health and Care Excellence (NICE) clinical guidelines ‘chest pain of recent onset: assessment and diagnosis’ (update 2016) state CT coronary angiography (CTCA) should be offered as the first-line investigation for patients with stable chest pain. However, the current provision in the UK is unknown. We aimed to evaluate this and estimate the requirements for full implementation of the guidelines including geographical variation. Ancillary aims included surveying the number of CTCA-capable scanners and accredited practitioners in the UK.Methods The number of CTCA scans performed annually was surveyed across the National Health Service (NHS). The number of percutaneous coronary interventions performed for stable angina in the NHS in 2015 was applied to a model based on SCOT-HEART (CTCA in patients with suspected angina due to coronary heart disease: an open-label, parallel-group, multicentre trial) data to estimate the requirement for CTCA, for full guideline implementation. Details of CTCA-capable scanners were obtained from manufacturers and formally accredited practitioner details from professional societies.Results An estimated 42 340 CTCAs are currently performed annually in the UK. We estimate that 350 000 would be required to fully implement the guidelines. 304 CTCA-capable scanners and 198 accredited practitioners were identified. A marked geographical variation between health regions was observed.Conclusions This study provides insight into the scale of increase in the provision of CTCA required to fully implement the updated NICE guidelines. A small specialist workforce and limited number of CTCA-capable scanners may present challenges to service expansion.
Allen CJ, Freeman T, Perera W, et al., 2018, Thoracic Park: cardiac MRI reveals massive thoracic varices as consequence of inferior vena cava ligation, EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging, Vol: 19, Pages: 359-360, ISSN: 2047-2412
Padley SPG, Roditi G, Nicol ED, 2017, Chest pain of recent onset: assessment and diagnosis (CG95). A step change in the requirement for cardiovascular CT, CLINICAL RADIOLOGY, Vol: 72, Pages: 751-753, ISSN: 0009-9260
Ismail TF, Cheasty E, King L, et al., 2017, High-pitch versus conventional cardiovascular CT in patients being assessed for transcatheter aortic valve implantation: A real-world appraisal, Open Heart, Vol: 4, ISSN: 2053-3624
Objective High-pitch protocols are increasingly used in cardiovascular CT assessment for transcatheter aortic valve implantation (TAVI), but the impact on diagnostic image quality is not known. Methods We reviewed 95 consecutive TAVI studies: 44 (46%) high-pitch and 51 (54%) standard-pitch. Single high-pitch scans were performed regardless of heart rate. For standard-pitch acquisitions, a separate CT-aortogram and CT-coronary angiogram were performed with prospective gating, unless heart rate was ≥70 beats/min, when retrospective gating was used. The aortic root and coronary arteries were assessed for artefact (significant artefact=1; artefact not limiting diagnosis=2; no artefact=3). Aortic scans were considered diagnostic if the score was > 1; the coronaries, if all three epicardial arteries scored > 1. Results There was no significant difference in diagnostic image quality for either the aorta (artefact-free high-pitch: 31 (73%) scans vs standard-pitch: 40 (79%), p=0.340) or the coronary tree as a whole (10 (23%) vs 15 (29%), p=0.493). However, proximal coronary arteries were less well visualised using high-pitch acquisitions (16 (36%) vs 30 (59%), p=0.04). The median (IQR) radiation dose was significantly lower in the high-pitch cohort (dose-length product: 347 (318-476) vs 1227 (1150-1474) mGy cm, respectively, p < 0.001), and the protocol required almost half the amount of contrast. Conclusions The high-pitch protocol significantly reduces radiation and contrast doses and is non-inferior to standard-pitch acquisitions for aortic assessment. For aortic root assessment, the high-pitch protocol is recommended. However, if coronary assessment is critical, this should be followed by a conventional standard-pitch, low-dose, prospectively gated CT-coronary angiogram if the high-pitch scan is non-diagnostic.
Moser JB, Mak SM, McNulty WH, et al., 2017, The influence of inspiratory effort and emphysema on pulmonary nodule volumetry reproducibility, Clinical Radiology, Vol: 72, Pages: 925-929, ISSN: 0009-9260
AimTo evaluate the impact of inspiratory effort and emphysema on reproducibility of pulmonary nodule volumetry.Materials and methodsEighty-eight nodules in 24 patients with emphysema were studied retrospectively. All patients had undergone volumetric inspiratory and end-expiratory thoracic computed tomography (CT) for consideration of bronchoscopic lung volume reduction. Inspiratory and expiratory nodule volumes were measured using commercially available software. Local emphysema extent was established by analysing a segmentation area extended circumferentially around each nodule (quantified as percent of lung with density of –950 HU or less). Lung volumes were established using the same software. Differences in inspiratory and expiratory nodule volumes were illustrated using the Bland–Altman test. The influences of percentage reduction in lung volume at expiration, local emphysema extent, and nodule size on nodule volume variability were tested with multiple linear regression.ResultsThe majority of nodules (59/88 [67%]) showed an increased volume at expiration. Mean difference in nodule volume between expiration and inspiration was +7.5% (95% confidence interval: –24.1, 39.1%). No relationships were demonstrated between nodule volume variability and emphysema extent, degree of expiration, or nodule size.ConclusionExpiration causes a modest increase in volumetry-derived nodule volumes; however, the effect is unpredictable. Local emphysema extent had no significant effect on volume variability in the present cohort.
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