Publications
259 results found
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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- Citations: 1
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
Garner JL, Donovan J, Meireles I, et al., 2019, A Golden Conundrum, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 200, Pages: 631-632, ISSN: 1073-449X
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: 7
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
Nicol ED, Padley SPG, 2018, Coronary Artery Anomalies, Atlas of Cardiovascular Computed Tomography, Second Edition, Pages: 325-337, ISBN: 9781447173564
Coronary artery anomalies are a common finding on CT coronary angiography. The incidence of congenital coronary artery anomaly traditionally has been quoted as between 0.3% and 1% [1], but the true incidence may well be higher, as conventional angiography identifies only half of the coronary anomalies identified by multidetector CT (MDCT) [2].
Skondras E, Rukshan F, Padley S, 2018, Essentials of clinical pulmonology: Interventional radiology, Essentials of Clinical Pulmonology, Pages: 180-192, ISBN: 9781498715799
Radiology plays an important role in pulmonary disease. Imaging guidance is key to a variety of nonvascular and vascular interventional procedures. This chapter outlines the key imaging guided thoracic interventions in common usage today, divided broadly into non-vascular and vascular categories.
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
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- Citations: 7
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.
Schlosser TPC, Semple T, Carr SB, et al., 2017, Scoliosis convexity and organ anatomy are related, EUROPEAN SPINE JOURNAL, Vol: 26, Pages: 1595-1599, ISSN: 0940-6719
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- Citations: 21
Semple T, Minden T, Gartland N, et al., 2017, PAEDIATRIC CARDIAC CT - CURRENT STATE OF PLAY AND ROOM FOR IMPROVEMENT, Annual Spring Meeting of the British-Society-of-Cardiovascular-Imaging/British-Society-of-Cardiovascular-CT (BSCI/BSCCT), Publisher: BMJ PUBLISHING GROUP, Pages: A5-A5, ISSN: 1355-6037
Semple T, Calder A, Owens CM, et al., 2017, Current and future approaches to large airways imaging in adults and children, CLINICAL RADIOLOGY, Vol: 72, Pages: 356-374, ISSN: 0009-9260
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- Citations: 10
Javed M, Sheard S, Robbie H, et al., 2017, Two year audit of CT-guided biopsy for lung cancer in emphysema and fibrotic interstitial lung disease patients, LUNG CANCER, Vol: 103, Pages: S16-S17, ISSN: 0169-5002
Hadjiphilippou S, Shah PL, Rice A, et al., 2016, Bronchial Dieulafoy lesion. A 20-year history of unexplained hemoptysis, American Journal of Respiratory and Critical Care Medicine, Vol: 195, Pages: 397-397, ISSN: 1073-449X
White SK, Castellano E, Gartland N, et al., 2016, Quality assurance in cardiovascular CT: a practical guide, CLINICAL RADIOLOGY, Vol: 71, Pages: 729-738, ISSN: 0009-9260
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- Citations: 3
Harden SP, Bull RK, Bury RW, et al., 2016, The safe practice of CT coronary angiography in adult patients in UK imaging departments, Clinical Radiology, Vol: 71, Pages: 722-728, ISSN: 1365-229X
Computed tomography coronary angiography is increasingly used in imaging departments in the investigation of patients with chest pain and suspected coronary artery disease. Due to the routine use of heart rate controlling medication and the potential for very high radiation doses during these scans, there is a need for guidance on best practice for departments performing this examination, so the patient can be assured of a good quality scan and outcome in a safe environment. This article is a summary of the document on 'Standards of practice of computed tomography coronary angiography (CTCA) in adult patients' published by the Royal College of Radiologists (RCR) in December 2014.
Sriharan M, Lazoura O, Pavitt CW, et al., 2016, Evaluation of High-Pitch Ungated Pediatric Cardiovascular Computed Tomography for the Assessment of Cardiac Structures in Neonates, JOURNAL OF THORACIC IMAGING, Vol: 31, Pages: 177-182, ISSN: 0883-5993
Pavitt CW, Harron K, Lindsay AC, et al., 2016, Technical feasibility and validation of a coronary artery calcium scoring system using CT coronary angiography images, EUROPEAN RADIOLOGY, Vol: 26, Pages: 1493-1502, ISSN: 0938-7994
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Vardhanabhuti V, Nicol E, Morgan-Hughes G, et al., 2016, Recommendations for accurate CT diagnosis of suspected acute aortic syndrome (AAS)-on behalf of the British Society of Cardiovascular Imaging (BSCI)/British Society of Cardiovascular CT (BSCCT), British Journal of Radiology, Vol: 89, ISSN: 1748-880X
Accurate and timely assessment of suspected acute aortic syndrome is crucial in this life-threatening condition. Imaging with CT plays a central role in the diagnosis to allow expedited management. Diagnosis can be made using locally available expertise with optimized scanning parameters, making full use of recent advances in CT technology. Each imaging centre must optimize their protocols to allow accurate diagnosis, to optimize radiation dose and in particular to reduce the risk of false-positive diagnosis that may simulate disease. This document outlines the principles for the acquisition of motion-free imaging of the aorta in this context.
Mak SM, Bhaludin BN, Naaseri S, et al., 2016, Imaging of congenital chest wall deformities, British Journal of Radiology, Vol: 89, ISSN: 1748-880X
To identify the anatomy and pathology of chest wall malformations presenting for consideration for corrective surgery or as a possible chest wall “mass”, and to review the common corrective surgical procedures. Congenital chest wall deformities are caused by anomalies of chest wall growth, leading to sternal depression or protrusion, or are related to failure of normal spine or rib development. Cross-sectional imaging allows appreciation not only of the involved structures but also assessment of the degree of displacement or deformity of adjacent but otherwise normal structures and differentiation between anatomical deformity and neoplasia. In some cases, CT is also useful for surgical planning. The use of three-dimensional reconstructions, utilizing a low-dose technique, provides important information for the surgeon to discuss the nature of anatomical abnormalities and planned corrections with the patient and often with their parents. In this pictorial essay, we discuss the radiological features of the commonest congenital chest wall deformities and illustrate pre- and post-surgical appearances for those undergoing surgical correction.
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