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Hafeez R, Punwani S, Boulos P, Bloom S, McCartney S, Halligan S, Taylor SA. Diagnostic and therapeutic impact of MR enterography in Crohn's disease. Clin Radiol 2011; 66:1148-58. [PMID: 21943719 DOI: 10.1016/j.crad.2010.12.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 12/22/2022]
Abstract
AIM To assess the impact of magnetic resonance enterography (MRE) on clinician diagnostic confidence and therapeutic strategy in patients under investigation for small bowel Crohn's disease. MATERIAL AND METHODS Gastroenterologists completed a proforma before and following MRE in 51 patients (mean age 35 years, 26 female) under investigation for small bowel Crohn's disease, indicating percentage confidence for presence/absence of small bowel involvement. In suspected disease, diagnostic confidence (using a scoring system from 1=no to 6=yes) was scored for subcategories: extent >30 cm (DE), terminal ileum (lTI), jejunal (JD), colonic disease (CoD), strictures (ST), activity (AD), extraluminal complications (EL), and surgical need (NS). Therapeutic strategy was recorded. Patients were divided into three groups: 1=suspected disease, MRE normal (n=15); 2=suspected disease, MRE abnormal (n=30); 3=no suspected disease, MRE normal (n=6). Binomial exact and paired t-tests were use to compare confidence pre and post-MRE. RESULTS Mean percentage confidence for the presence/absence of small bowel disease increased from 62 to 84% (p=0.003), 87 to 98% (p=0.0001), and 83 to 98% (p=0.005) after MRE for groups 1, 2, and 3, respectively. In suspected disease, confidence changed significantly for all of the subcategories (p<0.001) except EL in group 1. The percentage of patients with a confidence change ranged from 40% (CoD) to 87% (lTI; group 1) and from 7% (EL) to 93% (DE; group 2). Therapeutic strategy changed in 31/51 (61%, 95% CI 47-74%), 14 with a reduction in planned therapy and 17 with an increase. CONCLUSION MRE had a positive diagnostic impact in patients under investigation for small bowel Crohn's disease and this influenced therapeutic strategy in 61% of the patients.
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Boone D, Halligan S, Frost R, Kay C, Laghi A, Lefere P, Neri E, Stoker J, Taylor S. CT colonography: Who attends training? A survey of participants at educational workshops. Clin Radiol 2011; 66:510-6. [DOI: 10.1016/j.crad.2010.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/22/2010] [Accepted: 12/06/2010] [Indexed: 12/29/2022]
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Murray L, Arteche A, Fearon P, Halligan S, Goodyer I, Cooper P. Maternal postnatal depression and the development of depression in offspring up to 16 years of age. J Am Acad Child Adolesc Psychiatry 2011; 50:460-70. [PMID: 21515195 DOI: 10.1016/j.jaac.2011.02.001] [Citation(s) in RCA: 269] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 02/01/2011] [Accepted: 02/03/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the developmental risk pathway to depression by 16 years in offspring of postnatally depressed mothers. METHOD This was a prospective longitudinal study of offspring of postnatally depressed and nondepressed mothers; child and family assessments were made from infancy to 16 years. A total of 702 mothers were screened, and probable cases interviewed. In all, 58 depressed mothers (95% of identified cases) and 42 nondepressed controls were recruited. A total of 93% were assessed through to 16-year follow-up. The main study outcome was offspring lifetime clinical depression (major depression episode and dysthymia) by 16 years, assessed via interview at 8, 13, and 16 years. It was analysed in relation to postnatal depression, repeated measures of child vulnerability (insecure infant attachment and lower childhood resilience), and family adversity. RESULTS Children of index mothers were more likely than controls to experience depression by 16 years (41.5% versus 12.5%; odds ratio = 4.99; 95% confidence interval = 1.68-14.70). Lower childhood resilience predicted adolescent depression, and insecure infant attachment influenced adolescent depression via lower resilience (model R(2) = 31%). Family adversity added further to offspring risk (expanded model R(2) = 43%). CONCLUSIONS Offspring of postnatally depressed mothers are at increased risk for depression by 16 years of age. This may be partially explained by within child vulnerability established in infancy and the early years, and by exposure to family adversity. Routine screening for postnatal depression, and parenting support for postnatally depressed mothers, might reduce offspring developmental risks for clinical depression in childhood and adolescence.
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Hafeez R, Greenhalgh R, Rajan J, Bloom S, McCartney S, Halligan S, Taylor SA. Use of small bowel imaging for the diagnosis and staging of Crohn's disease--a survey of current UK practice. Br J Radiol 2010; 84:508-17. [PMID: 21081570 DOI: 10.1259/bjr/65972479] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study used a postal survey to assess the current use of small bowel imaging investigations for Crohn's disease within National Health Service (NHS) radiological practice and to gauge gastroenterological referral patterns. METHODS Similar questionnaires were posted to departments of radiology (n = 240) and gastroenterology (n = 254) identified, by the databases of the Royal College of Radiologists and British Society of Gastroenterologists. Questionnaires enquired about the use of small bowel imaging in the assessment of Crohn's disease. In particular, questionnaires described clinical scenarios including first diagnosis, disease staging and assessment of suspected extraluminal complications, obstruction and disease flare. The data were stratified according to patient age. RESULTS 63 (27%) departments of radiology (20 in teaching hospitals and 43 in district general hospitals (DGHs)) and 73 (29%) departments of gastroenterology replied. These departments were in 119 institutions. Of the 63 departments of radiology, 55 (90%) routinely performed barium follow-though (BaFT), 50 (80%) CT, 29 (46%) small bowel ultrasound (SbUS) and 24 (38%) small bowel MRI. BaFT was the most commonly used investigation across all age groups and indications. SbUS was used mostly for patients younger than 40 years of age with low index of clinical suspicion for Crohn's disease (in 44% of radiology departments (28/63)). MRI was most frequently used in patients under 20 years of age for staging new disease (in 27% of radiology departments (17/63)) or in whom obstruction was suspected (in 29% of radiology departments (18/63)). CT was preferred for suspected extraluminal complications or obstruction (in 73% (46/63) and 46% (29/63) of radiology departments, respectively). Gastroenterological referrals largely concurred with the imaging modalities chosen by radiologists, although gastroenterologists were less likely to request SbUS and MRI. CONCLUSION BaFT remains the mainstay investigation for luminal small bowel Crohn's disease, with CT dominating for suspected extraluminal complications. There has been only moderate dissemination of the use of MRI and SbUS.
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Robinson C, Halligan S, Iinuma G, Topping W, Punwani S, Honeyfield L, Taylor SA. CT colonography: computer-assisted detection of colorectal cancer. Br J Radiol 2010; 84:435-40. [PMID: 21081583 DOI: 10.1259/bjr/17848340] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Computer-aided detection (CAD) for CT colonography (CTC) has been developed to detect benign polyps in asymptomatic patients. We aimed to determine whether such a CAD system can also detect cancer in symptomatic patients. METHODS CTC data from 137 symptomatic patients subsequently proven to have colorectal cancer were analysed by a CAD system at 4 different sphericity settings: 0, 50, 75 and 100. CAD prompts were classified by an observer as either true-positive if overlapping a cancer or false-positive if elsewhere. Colonoscopic data were used to aid matching. RESULTS Of 137 cancers, CAD identified 124 (90.5%), 122 (89.1%), 119 (86.9%) and 102 (74.5%) at a sphericity of 0, 50, 75 and 100, respectively. A substantial proportion of cancers were detected on either the prone or supine acquisition alone. Of 125 patients with prone and supine acquisitions, 39.3%, 38.3%, 43.2% and 50.5% of cancers were detected on a single acquisition at a sphericity of 0, 50, 75 and 100, respectively. CAD detected three cancers missed by radiologists at the original clinical interpretation. False-positive prompts decreased with increasing sphericity value (median 65, 57, 45, 24 per patient at values of 0, 50, 75, 100, respectively) but many patients were poorly prepared. CONCLUSION CAD can detect symptomatic colorectal cancer but must be applied to both prone and supine acquisitions for best performance.
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Murray L, Arteche A, Fearon P, Halligan S, Croudace T, Cooper P. The effects of maternal postnatal depression and child sex on academic performance at age 16 years: a developmental approach. J Child Psychol Psychiatry 2010; 51:1150-9. [PMID: 20840504 DOI: 10.1111/j.1469-7610.2010.02259.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Postnatal depression (PND) is associated with poor cognitive functioning in infancy and the early school years; long-term effects on academic outcome are not known. METHOD Children of postnatally depressed (N = 50) and non-depressed mothers (N = 39), studied from infancy, were followed up at 16 years. We examined the effects on General Certificate of Secondary Education (GCSE) exam performance of maternal depression (postnatal and subsequent) and IQ, child sex and earlier cognitive development, and mother-child interactions, using structural equation modelling (SEM). RESULTS Boys, but not girls, of PND mothers had poorer GCSE results than control children. This was principally accounted for by effects on early child cognitive functioning, which showed strong continuity from infancy. PND had continuing negative effects on maternal interactions through childhood, and these also contributed to poorer GCSE performance. Neither chronic, nor recent, exposure to maternal depression had significant effects. CONCLUSIONS The adverse effects of PND on male infants' cognitive functioning may persist through development. Continuing difficulties in mother-child interactions are also important, suggesting that both early intervention and continuing monitoring of mothers with PND may be warranted.
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Frudinger A, Kölle D, Schwaiger W, Pfeifer J, Paede J, Halligan S. Muscle-derived cell injection to treat anal incontinence due to obstetric trauma: pilot study with 1 year follow-up. Gut 2010; 59:55-61. [PMID: 19875391 DOI: 10.1136/gut.2009.181347] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To treat anal incontinence due to obstetric external anal sphincter disruption via injection of autologous myoblast cells. DESIGN Observational pilot study. SETTING University hospital and district hospital PATIENTS 10 women suffering from anal incontinence due to obstetric anal sphincter injury, refractory to conventional non-surgical therapy. INTERVENTIONS Autologous myoblasts were cultured from a pectoralis muscle biopsy, harvested, and injected into the external anal sphincter defect using direct ultrasound guidance. MAIN OUTCOME MEASURES Wexner incontinence score, anal squeeze pressures, and quality of life 12 months after injection. Safety and technical feasibility. RESULTS The procedure was well tolerated and no adverse events were observed. At 12 months the Wexner incontince score had decreased by a mean of 13.7 units (95% CI, -16.3 to -11.2), anal squeeze pressures were unchanged, and overall quality of life scores improved by a median of 30 points (95% CI, 25 to 42). Anal squeeze pressures did rise significantly at 1 month and 6 months post-injection (p = 0.03). CONCLUSIONS Injection of autologous myoblasts is safe, well tolerated, and significantly improves symptoms of anal incontinence due to obstetric anal sphincter trauma.
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Von Wagner C, Knight K, Halligan S, Atkin W, Lilford R, Morton D, Wardle J. Patient experiences of colonoscopy, barium enema and CT colonography: a qualitative study. Br J Radiol 2008; 82:13-9. [PMID: 18824501 DOI: 10.1259/bjr/61732956] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Previous studies of patient experience with bowel screening tests, in particular CT colonography (CTC), have superimposed global rating scales and not explored individual experience in detail. To redress this, we performed qualitative interviews in order to characterize patient expectations and experiences in depth. Following ethical permission, 16 patients undergoing CTC, 18 undergoing colonoscopy and 15 undergoing barium enema agreed to a semi-structured interview by a health psychologist. Interviews were recorded, responses transcribed and themes extracted with the aim of assimilating individual experiences to facilitate subsequent development and interpretation of quantitative surveys of overall satisfaction with each diagnostic test. Transcript analysis identified three principal themes: physical sensations, social interactions and information provision. Physical sensations differed for each test but were surprisingly well tolerated overall. Social interactions with staff were perceived as very important in colouring the whole experience, particularly in controlling the feelings of embarrassment, which was critical for all procedures. Information provision was also an important determinant of experience. Verbal feedback was most common during colonoscopy and invariably reassuring. However, patients undergoing CTC received little visual or verbal feedback and were often confused regarding the test outcome. Barium enema had no specific advantage over other tests. Qualitative interviews provided important perspectives on patient experience. Our data demonstrated that models describing the quality of medical encounters are applicable to single diagnostic episodes. Staff interactions and information provision were particularly important. We found advantages specific to both CTC and colonoscopy but none for barium enema. CTC could benefit greatly from improved information provision following examination.
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Frudinger A, Schwaiger W, Pfeifer J, Paede J, Kölle D, Halligan S. Adulte Stammzellen zur Behandlung von Stuhlinkontinenz nach Dammriss III oder IV–eine Pilot Studie. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Taylor SA, Burling D, Roddie M, Honeyfield L, McQuillan J, Bassett P, Halligan S. Computer-aided detection for CT colonography: incremental benefit of observer training. Br J Radiol 2008; 81:180-6. [PMID: 18180260 DOI: 10.1259/bjr/93375459] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The purpose of this study was to investigate the incremental effect of focused training on observer performance when using computer-assisted detection (CAD) software to interpret CT colonography (CTC). Six radiologists who were relatively inexperienced with CTC interpretation underwent 1 day of focused training before reading 20 patient datasets with the assistance of CAD software (ColonCAR 1.3, Medicsight PLC). Sensitivity, specificity and interpretation times were determined and compared with previous performance when reading the same datasets but without the benefit of focused training, using the binomial exact test and Wilcoxon's signed rank test. Per-polyp sensitivity improved after training by 18% overall (95% confidence interval (CI): 14-24%, p<0.001) and was greatest for polyps of 6-9 mm (26%, 95% CI: 18-34%, p<0.001). Absolute sensitivity was 23% (9-36%), 51% (33-71%) and 74% (44-100%) for polyps of <or=5 mm, 6-9 mm and >or=10 mm, respectively. Specificity fell significantly after focused training (median of 5.5 false positives per 20 datasets (interquartile range (IQR): 4-6) post-training vs median of 2.5 (IQR: 1-5) pre-training, p = 0.03). Interpretation time also increased significantly after training (from a median of 9.3 min (IQR: 9.3-14.5 min) to a median of 17.1 min (IQR: 15.4-19.4 min), p = 0.03). In conclusion, one day of training increases observer polyp sensitivity when using CAD for CTC at the expense of increased reporting time and reduction in specificity.
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Burling D, Halligan S, Atchley J, Dhingsar R, Guest P, Hayward S, Higginson A, Jobling C, Kay C, Lilford R, Maskell G, McCafferty I, McGregor J, Morton D, Kumar Neelala M, Noakes M, Philips A, Riley P, Taylor A, Bassett P, Wardle J, Atkin W, Taylor SA. CT colonography: interpretative performance in a non-academic environment. Clin Radiol 2007; 62:424-9; discussion 430-1. [PMID: 17398266 DOI: 10.1016/j.crad.2006.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 09/15/2006] [Accepted: 11/08/2006] [Indexed: 11/16/2022]
Abstract
AIM To investigate interpretative accuracy and reporting time for radiologists performing computed tomography (CT) colonography in day-to-day non-academic clinical practice. MATERIALS AND METHODS Thirteen radiologists from seven centres, who were reporting CT colonography in non-academic daily clinical practice, interpreted a dataset of 15 colonoscopically validated cases in a controlled environment. Ten cases had either a cancer or polyp >10mm; one case had a medium polyp and four were normal. Correct case categorization and interpretation times were compared using analysis of variance to aggregated results obtained from both experienced observers and observers recently trained using 50 cases, working in an academic environment. The effect of experience was determined using Spearman's rank correlation. RESULTS Individual accuracy was highly variable, range 53% (95% CI 27-79%) to 93% (95% CI 68-100%). Mean accuracy overall was significantly inferior to experienced radiologists (mean 75 versus 88%, p=0.04) but not significantly different from recently trained radiologists (p=0.48). Interpretation time was not significantly different to experienced readers (mean 12.4 min versus 11.7, p=0.74), but shorter than recently trained radiologists (p=0.05). There was a significant, positive, linear correlation between prior experience and accuracy (p<0.001) with no plateau. CONCLUSION Accuracy for sub-specialist radiologists working in a non-academic environment is, on average, equivalent to radiologists trained using 50 cases. However, there is wide variability in individual performance, which generally falls short of the average performance suggested by meta-analysis of published data. Experience improves accuracy, but alone is insufficient to determine competence.
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Burling D, Halligan S, Taylor SA, Honeyfield L, Roddie ME. CT colonography: automatic measurement of polyp diameter compared with manual assessment - an in-vivo study. Clin Radiol 2007; 62:145-51. [PMID: 17207697 DOI: 10.1016/j.crad.2006.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 09/15/2006] [Accepted: 09/29/2006] [Indexed: 11/20/2022]
Abstract
AIM To investigate whether automated diameter assessment was feasible for CT colonography. MATERIALS AND METHODS Two experienced observers independently measured the maximum diameter of 50 polyps (colonoscopic reference size range 5-12 mm) from colonography datasets using conventionally placed software callipers and a variety of two-dimensional (2D) computed tomography (CT) window settings (colon, abdominal, bone, lung), and also three-dimensional (3D) perspective rendering. Polyps were also measured using automated polyp-segmentation software. Agreement between observers and with the colonoscopic reference measurement was determined using Bland-Altman, Wilcoxon, and Mann-Whitney U analyses. RESULTS Inter-observer agreement was similar for all window displays: mean difference in millimetres (SD difference; 95% limits of agreement) ranged from 0 (1.7, -3.3, 3.3) for 2D colon to -1.1mm (1.6, -4.3, 2.0) for 3D, compared with -0.5 (2.09, -4.6, 3.6) for automated measurement. When compared to colonoscopy, the largest discrepancy occurred using the 3D display (mean difference 1.3mm, 2.5mm for each observer). There was also a significant difference between estimates and reference size when using the 2D abdominal and 3D displays (p=0.03, <0.001). CONCLUSION Automated polyp measurement is possible in vivo. Automated and conventional methods have comparable inter-observer agreement. The greatest measurement error is encountered when using a 3D display for estimates of diameter.
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Xiong T, McEvoy K, Morton DG, Halligan S, Lilford RJ. Resources and costs associated with incidental extracolonic findings from CT colonogaphy: a study in a symptomatic population. Br J Radiol 2006; 79:948-61. [PMID: 16822798 DOI: 10.1259/bjr/58438178] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CT colonography (CTC) is increasingly used to detect colonic polyps and cancers, but its impact in practice is also influenced by frequent detection of extracolonic lesions. We have previously documented the frequency and nature of such lesions. The current study was performed to assess the clinical resources and costs associated with the investigation and treatment of extracolonic lesions. We reviewed the reports of 225 consecutive CTC examinations carried out on patients with symptoms of bowel cancer. 116 of the 225 were reported to have one or more extracolonic findings. All 116 patients with an abnormality were followed up for 12-24 months. 24 patients underwent further actions (outpatient attendance, investigations, or surgical procedures) as a result of previously undiagnosed lesions unrelated to bowel cancer. The costs of these further actions were derived from the NHS Reference Costs manual 2004. The total cost for further investigations and interventions was 34,329 pounds sterling and the mean cost over the sample of 225 patients was 153 pounds sterling--more than the cost of the CTC itself. The costs were mainly generated by surgical procedures. Resources consumed as a result of extracolonic findings approximately doubled the costs of diagnostic CTC. These costs, along with inconvenience, anxiety, morbidity and occasionally even mortality suffered by patients, must be offset by the good done to some of those with sub-clinical but potentially lethal diseases.
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Halligan S, Taylor SA, Dehmeshki J, Amin H, Ye X, Tsang J, Roddie ME. Computer-assisted detection for CT colonography: external validation. Clin Radiol 2006; 61:758-63; discussion 764-5. [PMID: 16905382 DOI: 10.1016/j.crad.2006.02.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 02/06/2006] [Accepted: 02/15/2006] [Indexed: 11/29/2022]
Abstract
AIM To externally validate a computer-assisted detection (CAD) system for computed tomography (CT) colonography, using data from a single centre uninvolved with the software development. MATERIALS AND METHODS Twenty-five multi-detector CT colonography examinations of patients with validated polyps accumulated at a single centre were examined by two readers who used endoscopic and histopathological data to identify polyp coordinates. A CAD system that had been developed using data from elsewhere, and had not previously encountered the present data, was then applied to the data at sphericity filter settings of 0.75 and 0.50 and identified potential polyps. True-positive, false-negative, and false-positive counts were determined by comparison with the known polyp coordinates. RESULTS Twenty-five patients had 57 polyps, median size 6mm (range 1-15mm). Per-patient sensitivity for the CAD system was 96% (24 of 25). The CAD system detected 44 (77%) polyps at sphericity setting 0.75 and 49 (86%) polyps at sphericity 0.50: the additional five polyps detected all measured 5mm or less. Sphericity of 0.75 resulted in a median of 10 (one to 34) easily dismissed false-positive prompts per patient and a median of 4 (zero to 15) that needed three-dimensional rendering before dismissal. This rose to 32 (16 to 99) and 11 (three to 35), respectively, at sphericity 0.5. CONCLUSIONS A per-patient sensitivity of 96% was found for the CAD system (in patients with a median polyp diameter of 6mm) using external validation, a more stringent test than either internal cross-validation or temporal validation. Decreasing sphericity increases sensitivity for small polyps at the expense of decreased specificity.
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Goh V, Halligan S, Gartner L, Bassett P, Bartram CI. Quantitative colorectal cancer perfusion measurement by multidetector-row CT: does greater tumour coverage improve measurement reproducibility? Br J Radiol 2006; 79:578-83. [PMID: 16823062 DOI: 10.1259/bjr/18842556] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to determine if greater z-axis tumour coverage improves the reproducibility of quantitative colorectal cancer perfusion measurements using CT. A 65 s perfusion study was acquired following intravenous contrast administration in 10 patients with proven colorectal cancer using a four-detector row scanner. This was repeated within 48 h using identical technical parameters to allow reproducibility assessment. Quantitative tumour blood volume, blood flow, mean transit time and permeability measurements were determined using commercially available software (Perfusion 3.0; GE Healthcare, Waukesha, WI) for data obtained from a 5 mm z-axis tumour coverage, and from a 20 mm z-axis tumour coverage. Measurement reproducibility was assessed using Bland-Altman statistics, for a 5 mm z-axis tumour coverage, and 20 mm z-axis tumour coverage, respectively. The mean difference (95% limits of agreement) for blood volume, blood flow, mean transit time and permeability were 0.04 (-2.50 to +2.43) ml/100 g tissue; +8.80 (-50.5 to +68.0) ml/100 g tissue/min; -0.99 (-8.19 to +6.20) seconds; and +1.20 (-5.42 to +7.83) ml/100 g tissue/min, respectively, for a 5 mm coverage, and -0.04 (-2.61 to +2.53) ml/100 g tissue; +7.40 (-50.3 to +65.0) ml/100 g tissue/min; -2.46 (-12.61 to +7.69) seconds; and -0.23 (-8.31 to +7.85) ml/100 g tissue/min, respectively, for a 20 mm coverage, indicating similar levels of agreement. In conclusion, increasing z-axis coverage does not improve reproducibility of quantitative colorectal cancer perfusion measurements.
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Taylor SA, Halligan S, Slater A, Marshall M, Bartram CI. Comparison of radiologists' confidence in excluding significant colorectal neoplasia with multidetector-row CT colonography compared with double contrast barium enema. Br J Radiol 2006; 79:208-15. [PMID: 16498032 DOI: 10.1259/bjr/99126323] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to compare the confidence of experienced radiologists in excluding colonic neoplasia with CT colonography (CTC) compared with barium enema. 78 patients (median age 70 years, range 61-87 years, 44 women) underwent same day CTC and barium enema. Two radiologists experienced in reporting barium enema assessed whether the examination had excluded a polyp 6 mm or greater as "yes", "probably" or "no" for each of 6 colonic segments. Two different radiologists experienced in CTC independently performed the same assessment on the CT datasets. Responses were compared using a paired exact test. Formal barium enema and CT reports were compared with any endoscopic examination performed within 1 year. Studies reporting polyps 6 mm+ in patients not subsequently undergoing endoscopy were reviewed by two independent observers. Radiologists stated they had confidently excluded a significant lesion in 314 (71%) and 382 (86%) of 444 segments with barium enema and CTC, respectively (p<0.001). Confidence was significantly higher with CTC in the in the descending and ascending colon (p = 0.02 and p<0.001, respectively), and caecum (p<0.001). 22 patients underwent some form of endoscopy. Of five patients with proven colorectal neoplasia (including two with cancer), CTC and barium enema correctly identified five and three, respectively. In 56 patients not undergoing endoscopy, CTC reported 17 polyps 6 mm+, of which 16 were retrospectively classified as definite or probable. 11 could not be identified on the barium enema, even in retrospect. Confidence in excluding polyps 6 mm or larger is significantly greater with CT colonography particularly in the proximal colon.
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Slater A, Halligan S, Taylor SA, Marshall M. Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin. Clin Radiol 2006; 61:65-70. [PMID: 16356818 DOI: 10.1016/j.crad.2005.08.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 07/05/2005] [Accepted: 08/03/2005] [Indexed: 02/07/2023]
Abstract
AIM To determine the effect of rectal distension, used by some workers to facilitate staging, on mesorectal tissues. SUBJECTS AND METHODS Ninety-seven consecutive rectal cancer staging MRI examinations were identified of which 76 were analysable: 48 studies were performed using rectal insufflation of 100 ml room air and 28 were performed without distension. Median age was 69 and 72 years, respectively. In each patient a single experienced observer measured the distance from the outer rectal wall to the inner margin of the mesorectal fascia at four locations (12, 3, 6 and 9 o'clock), excluding sites of tumour involvement, from the T1-weighted axial image at the level of the sacro-coccygeal junction. The two groups of measurements were compared using Mann-Whitney test statistic, and frequencies then categorized into <5 mm or > or =5 mm, and compared using Fisher's exact test. RESULTS The median distance between the rectal wall and mesorectal fascia in the distended group was approximately half that found in the non-distended group, and significantly lower at the 3, 6 and 9 o'clock positions (p<0.001). 68/167 (41%) of measurements were 5mm or less, compared with 19/104 (18%) in the non-distended group (p<0.001). CONCLUSION Rectal distension before MRI significantly reduces the distance between the rectal wall and mesorectal fascia. Although this is advocated to facilitate visualization of the primary tumour, it potentially affects the accuracy with which a clear circumferential resection margin can be predicted.
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Halligan S. Systematic reviews and meta-analysis of diagnostic tests. Clin Radiol 2005; 60:977-9. [PMID: 16124979 DOI: 10.1016/j.crad.2005.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 04/26/2005] [Indexed: 01/18/2023]
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Taylor A, Sheridan M, McGee S, Halligan S. Preoperative staging of rectal cancer by MRI; results of a UK survey. Clin Radiol 2005; 60:579-86. [PMID: 15851046 DOI: 10.1016/j.crad.2004.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 10/24/2004] [Accepted: 11/10/2004] [Indexed: 11/24/2022]
Abstract
AIM To determine current day-to-day practice of and access to preoperative MRI for patients with rectal cancer in the UK, with the aim of identifying constraining factors. MATERIALS AND METHODS A questionnaire asking for details of rectal cancer workload, multidisciplinary team (MDT) practice, preoperative MRI, the use of alternative imaging methods where appropriate, and an assessment of local access to MRI, was mailed to 283 UK departments of radiology. Replies were received from 142 departments (50.2% response rate). These were collated and response frequencies were determined. RESULTS According to their replies, 135 (95%) of respondents always discussed rectal cancer cases within the context of an MDT, usually including a radiologist. Only 49% of respondents attempted to offer preoperative MRI to all rectal cancer patients, and 35% of respondents used MRI in less than 25% of cases. Of the 142 respondents, 73 (51%) felt their practice was currently constrained by lack of MR resources. The most frequently cited constraint was an available but over-subscribed MRI scanner. Limited radiology manpower was the next most frequently cited constraint. A significant minority stated that no MRI scanner was available. CONCLUSIONS The MDT is a well established forum for the discussion of patients with rectal cancer, and a radiologist is usually involved. However, in the face of current guidelines, less than 50% of the units studied were able to offer preoperative MRI to all of their rectal cancer cases. Improved access to MRI and increased radiological manpower are necessary if current management guidelines are to be observed.
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Goh V, Halligan S, Anderson JM, Hugill J, Leonard A. Is direct radiologist supervision of abdominal computed tomography (CT) scans necessary? Clin Radiol 2005; 60:758-61. [PMID: 15978886 DOI: 10.1016/j.crad.2005.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Revised: 11/16/2004] [Accepted: 02/02/2005] [Indexed: 10/25/2022]
Abstract
AIM To determine the effect of direct radiological supervision of patients attending for abdominal CT by assessing the frequency of protocol alteration subsequent to radiologist review of the images obtained. MATERIALS AND METHODS A prospective questionnaire-based observational study was performed of 187 consecutive patients undergoing abdominal CT. The CT protocol was determined by a radiologist in advance, with reference to the request form. Any subsequent change in the prescribed study that was contingent on radiologist review of the images obtained was documented on the questionnaire. Comparison was made with a second (control) group of 100 patients undergoing cranial CT. RESULTS A protocol change was undertaken following radiologist review of the CT images of 17 (9%) of the group undergoing abdominal CT, compared with 14 (14%) of the group undergoing cranial CT. In the abdominal CT group, further scanning was performed for lesion characterization, to guide a subsequent interventional procedure, because of inadequate anatomical coverage or to evaluate an unexpected lung tumour. There was no significant difference in proportions between the two groups (p=0.23). CONCLUSION When abdominal and cranial CT studies were compared, there was no significant difference in the proportion of studies requiring a change in the prescribed protocol following radiologist review of the images obtained. There was no evidence to suggest that abdominal CT was any less suited to protocol.
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Xiong T, Richardson M, Woodroffe R, Halligan S, Morton D, Lilford RJ. Incidental lesions found on CT colonography: their nature and frequency. Br J Radiol 2005; 78:22-9. [PMID: 15673525 DOI: 10.1259/bjr/67998962] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
CT colonography has been used to detect colonic polyps and cancers, but its effect in practice will also be influenced by the frequency with which extracolonic lesions of various types are detected. We performed a systematic review of the types of incidental lesions found on CT colonography. This is necessary to model the benefits and harms of detecting extracolonic lesions. Primary clinical studies of extracolonic findings on CT colonography were identified from electronic databases, scanning reference lists and hand searches of relevant journals and conference proceedings. A data collection proforma was used to collect information on extracolonic findings. 17 discreet studies were identified, involving 3488 patients. In total 40% of patients were recorded to have abnormalities and many had more than one abnormality. Nearly 14% of patients had further investigations and 0.8% were given immediate treatment. Extracolonic cancers were detected in 2.7% (0.9% had N0M0 cancers) and 0.9% had an aortic aneurysm. The number of extracolonic findings was high in all studies. While only a small population were judged "important", the prevalence of serious lesions outside the colon was nevertheless higher than in many other screening programs.
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Taylor SA, Halligan S, Burling D, Bassett P, Bartram CI. Intra-individual comparison of patient acceptability of multidetector-row CT colonography and double-contrast barium enema. Clin Radiol 2005; 60:207-14. [PMID: 15664575 DOI: 10.1016/j.crad.2004.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 06/10/2004] [Accepted: 07/20/2004] [Indexed: 10/25/2022]
Abstract
AIMS To compare the subjective acceptability of CT colonography in comparison with barium enema in older symptomatic patients, and to ascertain preferences for future colonic investigation. MATERIALS AND METHODS The study population comprised 78 persons aged 60 years or over with symptoms suggestive of colorectal neoplasia, who underwent CT colonography followed the same day by barium enema. A 25-point questionnaire was administered after each procedure and an additional follow-up questionnaire a week later. Responses were compared using Wilcoxon matched pairs testing, Mann-Whitney test statistics and binomial exact testing. RESULTS Participants suffered less physical discomfort during CT colonography (p = 0.03) and overall satisfaction was greater compared with barium enema (p = 0.03). On follow-up, respondents reported significantly better tolerance of CT colonography (p = 0.002), and were less prepared to undergo barium enema again (p < 0.001). Of 52 subjects expressing an opinion, all preferred CT to barium enema. CONCLUSION Patient satisfaction was higher with CT colonography than barium enema. CT colonography caused significantly less physical discomfort and was overwhelmingly preferred by patients.
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Halligan S. Reply to: Observer variation in the detection of colorectal neoplasia on double-contrast barium enema: implications for colorectal cancer screening and training. Clin Radiol 2005. [DOI: 10.1016/j.crad.2004.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nicholson FB, Taylor S, Halligan S, Kamm MA. Recent developments in CT colonography. Clin Radiol 2005; 60:1-7. [PMID: 15642287 DOI: 10.1016/j.crad.2004.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 07/29/2004] [Indexed: 01/29/2023]
Abstract
CT colonography allows reliable, non-invasive, rapid, high resolution imaging of the whole large bowel. Recent advances in technology such as computer-aided detection (CAD), scanning with or without bowel preparation, and low radiation are continually developing to improve the efficacy of this technique. This review will update the reader as to ongoing developments while presenting current thinking from the gastroenterological perspective.
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Taylor SA, Halligan S, Moore L, Saunders BP, Gallagher M, Phillips RKS, Bartram CI. Multidetector-row CT duodenography in familial adenomatous polyposis: a pilot study. Clin Radiol 2004; 59:939-45. [PMID: 15451356 DOI: 10.1016/j.crad.2004.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Revised: 05/11/2004] [Accepted: 05/11/2004] [Indexed: 12/01/2022]
Abstract
AIM To investigate the feasibility of using multidetector-row computed tomography (CT) duodenography to stage duodenal polyposis in patients with familial adenomatous polyposis. MATERIALS AND METHODS Six patients underwent multidetector-row CT duodenography before upper gastrointestinal endoscopy. A single-blinded radiologist used a surface shaded three-dimensional endoluminal fly though and two-dimensional axial and multiplanar reformats to assign a score for maximum polyp size and number based on the Spigelman classification. Comparison was made with the corresponding Spigelman scores obtained from subsequent endoscopy. RESULTS CT duodenography was technically successful in five of six patients. The CT derived Spigelman score based on maximum polyp size was accurate in all five patients. The CT derived Spigelman score based on polyp number was accurate in only two cases: Polyp number was overestimated in one patient and underestimated in a further two. In retrospect, fine carpeting of tiny duodenal polyps was poorly visualized with CT. CONCLUSIONS CT duodenography is technically feasible and accurately predicts maximum polyp size but CT estimates of polyp number are relatively inaccurate. CT duodenography potentially has a useful role for duodenal surveillance in those patients intolerant of conventional endoscopy.
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