Imperial College London

ProfessorTaraBarwick

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Practice (Cancer Imaging)
 
 
 
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t.barwick

 
 
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Commonwealth BuildingHammersmith Campus

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Publications

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109 results found

Grech-Sollars M, Ordidge KL, Vaqas B, Davies C, Vaja V, Honeyfield L, Camp S, Towey D, Mayers H, Peterson D, O'Neill K, Roncaroli F, Barwick TD, Waldman ADet al., 2019, Imaging and tissue biomarkers of choline metabolism in diffuse adult glioma; 18F-fluoromethylcholine PET/CT, magnetic resonance spectroscopy, and choline kinase α, Cancers, Vol: 11, Pages: 1-15, ISSN: 2072-6694

The cellular and molecular basis of choline uptake on PET imaging and MRS-visible choline containing compounds is not well understood. Choline kinase alpha (ChoKa) is an enzyme that phosphorylates choline, an essential step in membrane synthesis. We investigate choline metabolism through 18F-fluoromethylcholine (18F-FMC) PET, MRS and tissue ChoKa in human glioma. 14 patients with suspected diffuse glioma underwent multimodal 3T MRI and dynamic 18FFMC PET/CT prior to surgery. Co-registered PET and MRI data were used to target biopsies to regions of high and low choline signal, and immunohistochemistry for ChoKa expression was performed. 18F-FMC/PET differentiated WHO grade IV from grade II and III tumours, whereas MRS differentiated grade III/IV from grade II tumours. Tumoural 18F-FMC/PET uptake was higher than in normal-appearing white matter across all grades and markedly elevated within regions of contrast enhancement. 18F-FMC/PET correlated weakly with MRS Cho ratios. ChoKa expression on IHC was negative or weak in all but one GBM sample, and did not correlate with tumour grade or imaging choline markers. MRS and 18F-FMC/PET provide complimentary information on glioma choline metabolism. Tracer uptake is, however, potentially confounded by blood-brain barrier permeability. ChoKa overexpression does not appear to be a common feature in diffuse glioma.

Journal article

Inglese M, Katherine L O, Lesley H, Tara D B, Eric O A, Adam D W, Matthew G-Set al., 2019, Reliability of dynamic contrast enhanced magnetic resonance imaging data in primary brain tumours: a comparison of Tofts and shutter speed models, Neuroradiology, Vol: 61, Pages: 1375-1386, ISSN: 0028-3940

PurposeTo investigate the robustness of pharmacokinetic modelling of DCE-MRI brain tumourdata and to ascertain reliable perfusion parameters through a model selection processand a stability test.MethodsDCE-MRI data of 14 patients with primary brain tumours were analysed using the Toftsmodel (TM), the extended Tofts model (ETM), the shutter speed model (SSM) and theextended shutter speed model (ESSM). A no-effect model (NEM) was implemented toassess overfitting of data by the other models.For each lesion, the Akaike Information Criteria (AIC) was used to build a 3D modelselection map. The variability of each pharmacokinetic parameter extracted from thismap was assessed with a noise propagation procedure, resulting in voxel-wisedistributions of the coefficient of variation (CV).ResultsThe model selection map over all patients showed NEM had the best fit in 35.5% ofvoxels, followed by ETM (32%), TM (28.2%), SSM (4.3%) and ESSM (<0.1%). Inanalysing the reliability of Ktrans, when considering regions with a CV<20%, ≈25% ofvoxels were found to be stable across all patients. The remaining 75% of voxels wereconsidered unreliable.ConclusionsThe majority of studies quantifying DCE-MRI data in brain tumours only consider asingle model and whole-tumour statistics for the output parameters. Appropriate modelselection, considering tissue biology and its effects on blood brain barrier permeabilityand exchange conditions, together with an analysis on the reliability and stability of thecalculated parameters, is critical in processing robust brain tumour DCE-MRI data.

Journal article

Isaacs K, Belete S, Miller B, Di Marco A, Kirby S, Barwick T, Tolley N, Anderson J, Palazzo Fet al., 2019, Video‐assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma, BJS Open, Vol: 3, Pages: 743-749, ISSN: 2474-9842

Background: Primary hyperparathyroidism (pHPT) caused by an ectopic mediastinal parathyroid adenoma is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video-assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach for this problem.Methods: Information was obtained related to patients undergoing VATS from a specific database, including clinical presentation, biochemistry, pre-operative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications.Results: Over a 2-year period, 9 patients underwent VATS parathyroidectomy for sporadic pHPT, of whom five had persistent pHPT following previous unsuccessful parathyroidectomy via cervicotomy, while four had had no previous parathyroid surgery. The mean operating time was 101 minutes (range 60 – 160). 8 patients were biochemically cured, with no major complications. 1 patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false positive preoperative imaging.Conclusion: With appropriate pre-operative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well-tolerated approach to an ectopic mediastinal parathyroid adenoma.

Journal article

Park M, Dave D, Russell G, Martin L, Lalvani A, Barwick T, Kon OMet al., 2019, FDG-PET/CT APPEARANCES IN MDR-TB PATIENTS WITH RESIDUAL CT ABNORMALITIES, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A69-A70, ISSN: 0040-6376

Conference paper

Sharma R, Wang WM, Yusuf S, Evans J, Ramaswami R, Wernig F, Frilling A, Mauri F, Al-Nahhas A, Aboagye EO, Barwick TDet al., 2019, 68Ga-DOTATATE PET/CT parameters predict response to peptide receptor radionuclide therapy in neuroendocrine tumours, Radiotherapy and Oncology, Vol: 141, Pages: 108-115, ISSN: 0167-8140

PURPOSE: [177Lu]DOTATATE prolongs progression free survival (PFS) in metastatic neuroendocrine tumours (NETs). However, objective response rate is low. This, coupled with long duration of therapy and expense suggest need for better selection. We aim to assess whether baseline [68Ga]DOTATATE-PET/CT parameters, and whether response assessment by PET accurately predicts clinical outcome to [177Lu]DOTATATE. EXPERIMENTAL DESIGN: Retrospective study of patients receiving [177Lu]DOTATATE was conducted. Patients were followed 3-monthly until disease progression. Four [68Ga]DOTATATE-PET parameters (single lesion SUVmax, tumour to spleen and liver SUV ratios, and SUVmax-av using up to five target lesions in multiple organ sites) were determined at baseline and follow-up. The association between these PET parameters either at baseline, or any changes following treatment, and PET response criteria (PERCIST and modified PERCIST) to predict PFS were determined. Patients were followed 3-monthly until disease progression. Response was determined using RECIST 1.1. Baseline SSTR2 expression was assessed and compared with PET parameters. RESULTS: 55 patients with metastatic NETs were identified predominantly small bowel (N = 18) and pancreatic (N = 8) in origin. 16 were low grade, 15 intermediate and 3 high grade. Response to PRRT (N = 47): partial response (PR) 28%, stable disease (SD) 60% progressive disease (PD) 13%. Response to PRRT predicted PFS: PR 71.8 months (95%CI: not achieved), SD 29.1 months (95%CI: 15.2-43.1), and PD 9.7 months (95%CI: 0-21.02). Baseline, single lesion SUVmax predicted both response and PFS with SUV cut-off of 13.0 giving high sensitivity and specificity. Tumoural SUVmax correlated with SSTR2 expression, Spearman's rho - 0.69, p < 0.01. CONCLUSIONS: Baseline single lesion SUVmax and SUVmax-av predicts response to [177Lu]DOTATATE. Objective response following PRRT defines a subset of patients with markedly improved PFSBaseline SUVmax 13.0 defines a thre

Journal article

Ordidge K, Gandy N, Arshad M, Soneji N, Wallitt K, Khan S, Barwick Tet al., 2019, Inter-observer agreement of the FDG PET CT visual Herder score for the assessment of solitary pulmonary nodules, 32nd Annual Congress of the European-Association-of-Nuclear-Medicine (EANM), Publisher: SPRINGER, Pages: S573-S574, ISSN: 1619-7070

Conference paper

Sharma R, Valls PO, Inglese M, Dubash S, Chen M, Gabra H, Montes A, Challapalli A, Arshad M, Thakaran G, Chambers E, Cole T, Lozano-Kuehne J, Barwick TD, Aboagye EOet al., 2019, [<SUP>18</SUP>F]fluciclatide Pet As A Biomarker Of Response To Combination Therapy Of Pazopanib And Paclitaxel In Platinum-resistant/refractory Ovarian Cancer, 32nd Annual Congress of the European-Association-of-Nuclear-Medicine (EANM), Publisher: SPRINGER, Pages: S223-S223, ISSN: 1619-7070

Conference paper

Sharma R, Wang W, Yusuf S, Evans J, Ramaswami R, Wernig F, Frilling A, Mauri F, Al-Nahaas A, Aboagye EO, Barwick TDet al., 2019, [<SUP>68</SUP>Ga]-DOTATATE PET/CT parameters predict response to peptide receptor radionuclide therapy in neuroendocrine tumours, 32nd Annual Congress of the European-Association-of-Nuclear-Medicine (EANM), Publisher: SPRINGER, Pages: S640-S640, ISSN: 1619-7070

Conference paper

Gandy N, Arshad MA, Park W-HE, Rockall AG, Barwick TDet al., 2019, FDG-PET Imaging in Cervical Cancer, Seminars in Nuclear Medicine, ISSN: 0001-2998

Journal article

Sharma R, Valls PO, Inglese M, Dubash SR, Chen M, Gabra H, Montes A, Challapalli A, Tharakan G, Chambers E, Cole T, Lozano-kuehne J, Barwick T, Aboagye Eet al., 2019, [18F] Fluciclatide PET as a biomarker of clinical response to combination therapy of pazopanib and paclitaxel in patients with platinum-resistant or platinum-refractory advanced ovarian cancer: Results of a phase Ib study., Journal of Clinical Oncology, Vol: 37, Pages: 3070-3070, ISSN: 0732-183X

Journal article

Dumba M, Khan S, Patel N, Perry L, Malhotra P, Perry R, Nijran K, Barwick T, Wallitt K, Win Zet al., 2019, Clinical 18F-FDG and amyloid brain positron emission tomography/CT in the investigation of cognitive impairment: where are we now?, British Journal of Radiology, Vol: 92, ISSN: 0007-1285

The number of people living with dementia is increasing, but as yet there remains no cure or disease-modifying treatment. This review aims to help readers understand the role of 18F-FDG PET/CT imaging in the investigation of cognitive impairment and how the advent of amyloid PET/CT imaging may hold the key to radically changing management of the most common form of dementia - Alzheimer's disease. The indications for 18F-FDG PET/CT and amyloid PET/CT imaging in cognitive impairment are outlined. Additionally, the mechanisms of action, technique, patient preparation and acquisition parameters for both are detailed. We conclude by providing a framework for interpreting 18F-FDG PET/CT and amyloid PET/CT imaging in the more common conditions that lead to cognitive impairment conditions with tips on avoiding pitfalls in interpretation.

Journal article

Fakhry-Darian D, Patel NH, Khan S, Barwick T, Svensson W, Khan S, Perry RJ, Malhotra P, Carswell CJ, Nijran KS, Win Zet al., 2019, Optimisation and usefulness of quantitative analysis of 18F-florbetapir PET, British Journal of Radiology, Vol: 92, ISSN: 0007-1285

OBJECTIVES: This study investigates the usefulness of quantitative SUVR thresholds on sub types of typical (type A) and atypical (non-type A) positive (Aβ+) and negative (Aβ-) 18F-florbetapir scans and aims to optimise the thresholds. METHODS: Clinical 18F-florbetapir scans (n = 100) were categorised by sub type and visual reads were performed independently by three trained readers. Inter-reader agreement and reader-to-reference agreement were measured. Optimal SUVR thresholds were derived by ROC analysis and were compared with thresholds derived from a healthy control group and values from published literature. RESULTS: Sub type division of 18F-florbetapir PET scans improves accuracy and agreement of visual reads for type A: accuracy 90%, 96% and 70% and agreement κ > 0.7, κ ≥ 0.85 and -0.1 < κ < 0.9 for all data, type A and non-type A respectively. Sub type division also improves quantitative classification accuracy of type A: optimum mcSUVR thresholds were found to be 1.32, 1.18 and 1.48 with accuracy 86%, 92% and 76% for all data, type A and non-type A respectively. CONCLUSIONS: Aβ+/Aβ- mcSUVR threshold of 1.18 is suitable for classification of type A studies (sensitivity = 97%, specificity = 88%). Region-wise SUVR thresholds may improve classification accuracy in non-type A studies. Amyloid PET scans should be divided by sub type before quantification. ADVANCES IN KNOWLEDGE: We have derived and validated mcSUVR thresholds for Aβ+/Aβ- 18F-florbetapir studies. This work demonstrates that division into sub types improves reader accuracy and agreement and quantification accuracy in scans with typical presentation and highlights the atypical presentations not suited to global SUVR quantification.

Journal article

Arshad MA, Thornton A, Lu H, Tam H, Wallitt K, Rodgers N, Scarsbrook A, McDermott G, Cook GJ, Landau D, Chua S, O'Connor R, Dickson J, Power DA, Barwick TD, Rockall A, Aboagye EOet al., 2019, Discovery of pre-therapy 2-deoxy-2-F-18-fluoro-D-glucose positron emission tomography-based radiomics classifiers of survival outcome in non-small-cell lung cancer patients, European Journal of Nuclear Medicine and Molecular Imaging, Vol: 46, Pages: 455-466, ISSN: 0340-6997

PurposeThe aim of this multi-center study was to discover and validate radiomics classifiers as image-derived biomarkers for risk stratification of non-small-cell lung cancer (NSCLC).Patients and methodsPre-therapy PET scans from a total of 358 Stage I–III NSCLC patients scheduled for radiotherapy/chemo-radiotherapy acquired between October 2008 and December 2013 were included in this seven-institution study. A semi-automatic threshold method was used to segment the primary tumors. Radiomics predictive classifiers were derived from a training set of 133 scans using TexLAB v2. Least absolute shrinkage and selection operator (LASSO) regression analysis was used for data dimension reduction and radiomics feature vector (FV) discovery. Multivariable analysis was performed to establish the relationship between FV, stage and overall survival (OS). Performance of the optimal FV was tested in an independent validation set of 204 patients, and a further independent set of 21 (TESTI) patients.ResultsOf 358 patients, 249 died within the follow-up period [median 22 (range 0–85) months]. From each primary tumor, 665 three-dimensional radiomics features from each of seven gray levels were extracted. The most predictive feature vector discovered (FVX) was independent of known prognostic factors, such as stage and tumor volume, and of interest to multi-center studies, invariant to the type of PET/CT manufacturer. Using the median cut-off, FVX predicted a 14-month survival difference in the validation cohort (N = 204, p = 0.00465; HR = 1.61, 95% CI 1.16–2.24). In the TESTI cohort, a smaller cohort that presented with unusually poor survival of stage I cancers, FVX correctly indicated a lack of survival difference (N = 21, p = 0.501). In contrast to the radiomics classifier, clinically routine PET variables including SUVmax, SUVmean and SUVpeak lacked any prognostic information.ConclusionPET-based radiomics classifiers deriv

Journal article

Eskian M, Alavi A, Khorasanizadeh M, Viglianti BL, Jacobsson H, Barwick TD, Meysamie A, Yi SK, Iwano S, Bybel B, Caobelli F, Lococo F, Gea J, Sancho-Munoz A, Schildt J, Tatci E, Lapa C, Keramida G, Peters M, Boktor RR, John J, Pitman AG, Mazurek T, Rezaei Net al., 2019, Effect of blood glucose level on standardized uptake value (SUV) in <SUP>18</SUP>F- FDG PET-scan: a systematic review and meta-analysis of 20,807 individual SUV measurements, EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, Vol: 46, Pages: 224-237, ISSN: 1619-7070

Journal article

Barwick T, Bretsztajn L, Wallitt K, Amiras D, Rockall A, Messiou Cet al., 2019, Imaging in myeloma with focus on advanced imaging techniques., British Journal of Radiology, Vol: 92, Pages: 1-13, ISSN: 0007-1285

In recent years, there have been major advances in the imaging of myeloma with whole body MRI incorporating diffusion-weighted imaging, emerging as the most sensitive modality. Imaging is now a key component in the work-up of patients with a suspected diagnosis of myeloma. The International Myeloma Working Group now specifies that more than one focal lesion on MRI or lytic lesion on whole body low-dose CT or fludeoxyglucose (FDG) PET/CT fulfil the criteria for bone damage requiring therapy. The recent National Institute for Health and Care Excellence myeloma guidelines recommend imaging in all patients with suspected myeloma. In addition, there is emerging data supporting the use of functional imaging techniques (WB-DW MRI and FDG PET/CT) to predict outcome and evaluate response to therapy. This review summarises the imaging modalities used in myeloma, the latest guidelines relevant to imaging and future directions.

Journal article

Grech-Sollars M, Inglese M, Ordidge K, Davies C, Vaja V, Vaqas B, Camp S, Peterson D, Honeyfield L, Khan S, O'Neill K, Roncaroli F, Aboagye E, Barwick T, Waldman Aet al., 2018, ASSOCIATION BETWEEN METABOLIC PARAMETERS FROM DYNAMIC 18FMC PET, PHARMACOKINETIC DCE-MRI PARAMETERS, MRS CHOLINE TO CREATINE RATIOS AND TISSUE IMMUNOHISTOCHEMISTRY FOR CHOLINE KINASE ALPHA EXPRESSION IN HUMAN BRAIN GLIOMA, 23rd Annual Scientific Meeting and Education Day of the Society-for-Neuro-Oncology (SNO) / 3rd CNS Anticancer Drug Discovery and Development Conference, Publisher: OXFORD UNIV PRESS INC, Pages: 184-184, ISSN: 1522-8517

Conference paper

Curry S, Patel NH, Fakhry-Darian D, Khan SR, Barwick T, Svensson W, Khan S, Nijran KS, Win Zet al., 2018, Amyloid Image Quantification - To Quant or not to Quant?, 31st Annual Congress of the European-Association-of-Nuclear-Medicine (EANM), Publisher: SPRINGER, Pages: S303-S303, ISSN: 1619-7070

Conference paper

Grech-Sollars M, Inglese M, Ordidge K, Davies C, Vaja V, Vaqas B, Camp S, Peterson D, Honeyfield L, O'Neill K, Roncaroli F, Aboagye E, Barwick T, Waldman Aet al., 2018, ASSOCIATION BETWEEN METABOLIC PARAMETERS FROM DYNAMIC 18F-FLUOROMETHYLCHOLINE PET, PHARMACOKINETIC PARAMETERS FROM DCE-MRI, CHOLINE TO CREATINE RATIOS FROM MRS AND TISSUE IMMUNOHISTOCHEMISTRY FOR CHOLINE KINASE ALPHA EXPRESSION IN HUMAN BRAIN GLIOMA, Meeting of the British-Neuro-Oncology-Society (BNOS), Publisher: OXFORD UNIV PRESS INC, Pages: 346-346, ISSN: 1522-8517

Conference paper

Baheerathan A, McNamara C, Kalam S, Rane N, Barwick TD, Grote H, Nicholas Ret al., 2018, The utility of FDG-PET imaging in distinguishing PML-IRIS from PML in a patient treated with natalizumab, NEUROLOGY, Vol: 91, Pages: 562-563, ISSN: 0028-3878

Journal article

Inglese M, Grech-Sollars M, Ordidge K, Vaja V, Honeyfield L, Khan S, Barwick T, Aboagye E, Waldman ADet al., 2018, Association between pharmacokinetic parameters from DCE-MRI and metabolic parameters from dynamic 18F-fluoromethylcholine PET in human brain glioma, 27th International Society for Magnetic Resonance in Medicine

Conference paper

Dubash SR, Barwick T, Mauri FA, Kozlowski K, Frilling A, Valle JWet al., 2018, [<SUP>18</SUP>F]FET-βAG-TOCA versus [<SUP>68</SUP>Ga]DOTATATE PET/CT in functional imaging of neuroendocrine tumours., Publisher: AMER SOC CLINICAL ONCOLOGY, ISSN: 0732-183X

Conference paper

Sharma R, Aboagye E, Barwick T, 2018, Dynamic [18F] FLT-PET is sensitive in detecting hepatocellular carcinoma, International Liver Congress (ILC), Publisher: ELSEVIER SCIENCE BV, Pages: S443-S444, ISSN: 0168-8278

Conference paper

Wallitt K, Yusuf S, Soneji N, Khan SR, Win Z, Barwick TDet al., 2018, PET/CT in Oncologic Imaging of Nodal Disease: Pearls and Pitfalls, RADIOGRAPHICS, Vol: 38, Pages: 564-565, ISSN: 0271-5333

Journal article

Grech-Sollars M, Ordidge K, Vaqas B, Honeyfield L, Camp S, Khan S, Towey D, Peterson D, Roncaroli F, O'Neill K, Barwick T, Waldman Aet al., 2018, 18F-METHYLCHOLINE PET/CT, IN VIVO MAGNETIC RESONANCE SPECTROSCOPY IMAGING AND TISSUE ENZYME BIOMARKERS OF CHOLINE METABOLISM IN PRIMARY BRAIN GLIOMAS., Meeting of the British-Neuro-Oncology-Society (BNOS), Publisher: OXFORD UNIV PRESS INC, Pages: 18-18, ISSN: 1522-8517

Conference paper

Khan SR, Arshad M, Wallitt K, Stewart V, Bharwani N, Barwick TDet al., 2017, What's New in Imaging for Gynecologic Cancer?, CURRENT ONCOLOGY REPORTS, Vol: 19, ISSN: 1523-3790

Journal article

Palmieri C, Szydlo R, Miller M, Barker L, Patel NH, Sasano H, Barwick T, Tam H, Hadjiminas D, Lee J, Shaaban A, Nicholas H, Coombes RC, Kenny LMet al., 2017, IPET study: an FLT-PET window study to assess the activity of the steroid sulfatase inhibitor irosustat in early breast cancer, Breast Cancer Research and Treatment, Vol: 166, Pages: 527-539, ISSN: 0167-6806

BACKGROUND: Steroid sulfatase (STS) is involved in oestrogen biosynthesis and irosustat is a first generation, irreversible steroid sulfatase inhibitor. A pre-surgical window-of-opportunity study with irosustat was undertaken in estrogen receptor-positive (ER+) breast cancer to assess the effect of irosustat on tumour cell proliferation as measured by 3'-deoxy-3'-[18F] fluorothymidine uptake measured by PET scanning (FLT-PET) and Ki67. METHODS: Postmenopausal women with untreated ER+ early breast cancer were recruited, and imaged with FLT-PET at baseline and after at least 2 weeks treatment with irosustat, 40 mg once daily orally. The primary endpoint was changed in FLT uptake; secondary endpoints included safety and tolerability of irosustat, changes in tumoral Ki67 and steroidogenic enzymes expression and circulating steroid hormone levels. RESULTS: Thirteen women were recruited, and ten started irosustat for 2 weeks, followed by repeat FLT-PET scans in eight. Defining response as decreases of ≥20% in standardized uptake value (SUV) or ≥30% in Ki, 1 (12.5% (95% CI 2-47%, p = 0.001)) and 3 (43% (95% CI 16-75%, p = <0.001) patients, respectively, responded. 6 out of 7 patients had a Ki67 reduction (range = -19.3 to 76.4%), and median percentage difference in Ki67 was 52.3% (p = 0.028). In one patient with a low baseline STS expression, a 19.7% increase in Ki67 was recorded. STS decreases were seen in tumours with high basal STS expression, significant decreases were also noted in aromatase, and 17β-hydroxysteroid dehydrogenase type 1 and 2. Irosustat was generally well tolerated with all adverse event CTCAE Grade ≤2. CONCLUSIONS: Irosustat resulted in a significant reduction in FLT uptake and Ki67, and is well tolerated. These data are the first demonstrating clinical activity of irosustat in early breast cancer. Baseline expression of STS may be a biomarker of sensitivity to irosustat.

Journal article

Carswell C, Win Z, Muckle K, Kennedy A, Waldman A, Dawe G, Barwick T, Khan S, Malhotra PA, Perry Ret al., 2017, Clinical utility of amyloid PET imaging with (18)F-florbetapir: a retrospective study of 100 patients, Journal of Neurology, Neurosurgery and Psychiatry, Vol: 89, Pages: 294-299, ISSN: 1468-330X

Background and objective Amyloid-positron emission tomography (PET) imaging (API) detects amyloid-beta pathology early in the course of Alzheimer’s disease (AD) with high sensitivity and specificity. (18)F-florbetapir (Amyvid) is an amyloid-binding PET ligand with a half-life suitable for clinical use outside of the research setting. How API affects patient investigation and management in the ‘real-world’ arena is unknown. To address this, we retrospectively documented the effect of API in patients in the memory clinic.Methods We reviewed the presenting clinical features, the pre-API and post-API investigations, diagnosis and outcomes for the first 100 patients who had API as part of their routine work-up at the Imperial Memory Centre, a tertiary referral clinic in the UK National Health Service.Results API was primarily used to investigate patients with atypical clinical features (56 cases) or those that were young at onset (42 cases). MRI features of AD did not always predict positive API (67%), and 6 of 23 patients with MRIs reported as normal were amyloid-PET positive. There were significantly more cases categorised as non-AD dementia post-API (from 11 to 23). Patients investigated when API was initially available had fewer overall investigations and all patients had significantly fewer investigations in total post-API.Conclusions API has a clear impact on the investigation of young-onset or complex dementia while reducing the overall burden of investigations. It was most useful in younger patients, atypical presentations or individuals with multiple possible causes of cognitive impairment.

Journal article

Grech-Sollars M, Vaqas B, Thompson G, Barwick T, Honeyfield L, O'Neill K, Waldman ADet al., 2017, An MRS- and PET-guided biopsy tool for intraoperative neuronavigational systems, Journal of Neurosurgery, Vol: 127, Pages: 812-818, ISSN: 0022-3085

OBJECTIVEGlioma heterogeneity and the limitations of conventional structural MRI for identifying aggressive tumor components can limit the reliability of stereotactic biopsy and, hence, tumor characterization, which is a hurdle for developing and selecting effective treatment strategies. In vivo MR spectroscopy (MRS) and PET enable noninvasive imaging of cellular metabolism relevant to proliferation and can detect regions of more highly active tumor. Here, the authors integrated presurgical PET and MRS with intraoperative neuronavigation to guide surgical biopsy and tumor sampling of brain gliomas with the aim of improving intraoperative tumor-tissue characterization and imaging biomarker validation.METHODSA novel intraoperative neuronavigation tool was developed as part of a study that aimed to sample high-choline tumor components identified by multivoxel MRS and 18F-methylcholine PET-CT. Spatially coregistered PET and MRS data were integrated into structural data sets and loaded onto an intraoperative neuronavigation system. High and low choline uptake/metabolite regions were represented as color-coded hollow spheres for targeted stereotactic biopsy and tumor sampling.RESULTSThe neurosurgeons found the 3D spherical targets readily identifiable on the interactive neuronavigation system. In one case, areas of high mitotic activity were identified on the basis of high 18F-methylcholine uptake and elevated choline ratios found with MRS in an otherwise low-grade tumor, which revealed the possible use of this technique for tumor characterization.CONCLUSIONSThese PET and MRI data can be combined and represented usefully for the surgeon in neuronavigation systems. This method enables neurosurgeons to sample tumor regions based on physiological and molecular imaging markers. The technique was applied for characterizing choline metabolism using MRS and 18F PET; however, this approach provides proof of principle for using different radionuclide tracers and other MRI methods

Journal article

Wallitt KL, Khan SR, Dubash S, Tam HH, Khan S, Barwick TDet al., 2017, Clinical PET Imaging in Prostate Cancer (vol 37, pg 1536, 2017), RADIOGRAPHICS, Vol: 37, Pages: 2208-2208, ISSN: 0271-5333

Journal article

Wallitt KL, Khan SR, Dubash S, Tam HH, Khan S, Barwick TDet al., 2017, Clinical PET Imaging in Prostate Cancer, RADIOGRAPHICS, Vol: 37, Pages: 1512-1536, ISSN: 0271-5333

Journal article

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