Publications
259 results found
Xu Y, Padley SPG, Devaraj A, et al., 2024, Discrepancy Between Achieved and Vendor-Predicted Ablation Zones in the Lung: Contributing Factors., Cardiovasc Intervent Radiol
PURPOSE: Several factors are known to affect lung ablation zones. Questions remain as to why there are discrepancies between achieved and vendor-predicted ablation zones and what contributing factors can be modified to balance therapeutic effects with avoidance of complications. This retrospective study of lung tumour microwave ablation analyses day 1 post-treatment CT to assess the effects of lesion-specific and operator-dependent factors on ablation zones. METHODS AND MATERIALS: Consecutive patients treated at a tertiary centre from 2018 to 2021 were included. All ablations were performed using a single microwave ablation device under lung isolation. The lung tumours were categorised as primary or secondary, and their "resistance" to ablation was graded according to their locations. Intraprocedural pulmonary inflation was assessed as equal to or less than the contralateral non-isolated lung. Ablation energy was categorised as high, medium, or low. Ablation zone dimensions were measured on day 1 CT and compared to vendor reference charts. Ablations with multiple needle positions or indeterminate boundaries were excluded. RESULTS: A total of 47 lesions in 31 patients were analysed. Achieved long axes are longer than predicted by 5 mm or 14% (p < 0.01) without overall short axis discrepancy. Secondary tumours (p = 0.020), low-resistance location (p < 0.01), good lung inflation (p < 0.01), low (p = 0.003) and medium (p = 0.038) total energy produce lengthened long axes by 4-6 mm or 10-19%. High total energy results in shorter than predicated short axes by 6 mm or 18% (p = 0.010). CONCLUSION: We identified several factors affecting ablation zone dimensions which may have implications for ablation planning and the avoidance of complications.
Mumtaz Z-U-A, Desai SR, Padley SPG, 2024, Frequency of extracardiac findings on "negative" CT coronary angiography studies., Clin Radiol, Vol: 79, Pages: e334-e343
AIM: To evaluate the prevalence and nature of extracardiac findings identified on computed tomography (CT) coronary angiography (CTCA) in patients with chest pain but without evidence of coronary artery disease (CAD). MATERIALS AND METHODS: CTCA studies in patients referred to the hospital between January 2017 to February 2021 with chest pain and a suspected diagnosis of CAD were reviewed retrospectively for the presence of extracardiac findings. Consensus review of CTCA studies was performed by two experienced thoracic radiologists. The presence and severity of extracardiac findings, together with the likelihood that chest pain might be attributed to these, was recorded. Patient records were reviewed to ascertain the recording of extracardiac findings on initial CTCA reports and, where applicable, the nature of the follow-up. RESULTS: Extracardiac findings (n=210) were present in 110/180 patients (61%) with a mean of 1.9 findings per patient. Extracardiac findings were more prevalent in patients aged ≥65 years compared to those <65 years (p<0.001). At least one extracardiac finding with the potential to cause chest pain was present in 40 patients (22%): degenerative disc disease (n=23 [13%]) and hiatus hernia (n=6 [3.3%]) were the most common extracardiac findings. Only 37.6% (79) of all retrospectively identified findings had been initially reported and, of these, 12.7% (10) required further follow-up. CONCLUSION: Extracardiac findings are common in patients with no evidence of CAD on CTCA. The entire dataset should be evaluated for the presence of extracardiac findings that could explain chest pain symptoms on wide field of view reconstructions.
Hunter B, Argyros C, Inglese M, et al., 2023, Radiomics-based decision support tool assists radiologists in small lung nodule classification and improves lung cancer early diagnosis, BRITISH JOURNAL OF CANCER, ISSN: 0007-0920
Han J, Takova A, Lowcock D, et al., 2023, Improving hyperacute stroke pathways at two specialist cardiothoracic centres (Royal Brompton Hospital and Harefield Hospital)., Clin Med (Lond), Vol: 23, Pages: 107-108
Gupta A, Thulasidasan N, Mak SM, et al., 2023, Contemporary interventional management of pulmonary embolism., Clin Radiol, Vol: 78, Pages: 315-322
Minimally invasive interventional techniques are being utilised more frequently in the management of acute and chronic pulmonary emboli; however, robust clinical evidence is only emerging for the utilisation of these techniques. Hence, there is a need for a robust mechanism of patient selection and careful consideration of the benefits and risks of the interventions. In this review, we discuss the risk stratification mechanisms; the role of the multidisciplinary pulmonary embolism response team to support decision-making; and describe the various commonly used interventional techniques and how these can be integrated into treatment strategies for the benefit of our patients.
Zhang YZ, Sherlock S, MacMahon S, et al., 2023, Prediction of next generation sequencing test failure in lung adenocarcinoma in a genomic laboratory hub setting, Publisher: ELSEVIER IRELAND LTD, Pages: S1-S2, ISSN: 0169-5002
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
Karunanithy N, Padley S, Ridge C, 2023, Catheter-directed thrombolysis versus mechanical thrombolysis: Who to consider and what to expect, Emergent Pulmonary Embolism Management In Hospital Practice: From Hyperacute To Follow-up Care, Pages: 71-83, ISBN: 9781800612761
Treatment strategies in acute pulmonary embolism have expanded to include catheter-directed thrombolysis and percutaneous mechanical thromboaspiration. The choice of treatment modality is strongly influenced by, among other factors, the availability of appropriate expertise and a pulmonary embolism response team. A team-based approach ensures uniform care to all patients using multidisciplinary risk stratification and treatment selection. This expert review summarises the key roles of the pulmonary embolism response team, indications for catheter directed treatment, the published literature supporting its use, technical considerations including concomitant extracorporeal membrane oxygenation, and potential complications of such treatments.
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
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
Heriot DA, Stock CJW, Mumtaz Z, et al., 2022, IMPACT OF HIATUS HERNIA IN HYPERSENSITIVITY PNEUMONITIS - EXPERIENCE AT A TERTIARY CENTRE, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A94-A94, ISSN: 0040-6376
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, Pages: 1-5, ISSN: 2312-0541
Leahy TA, Chauhan A, Nicholas V, et al., 2022, Responder status and long term outcomes of critically ill patients with ARDS receiving high dose steroids as rescue therapy in a specialist acute respiratory failure centre, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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.
Sheeka A, Singaravelou A, Bartlett E, et al., 2022, COVID- protected pathways for image- guided lung cancer intervention during the COVID-19 pandemic: A cohort study, BRITISH JOURNAL OF RADIOLOGY, Vol: 96, ISSN: 0007-1285
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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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
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: 26
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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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
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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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: 25
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