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Gerli MFM, Calà G, Beesley MA, Sina B, Tullie L, Sun KY, Panariello F, Michielin F, Davidson JR, Russo FM, Jones BC, Lee DDH, Savvidis S, Xenakis T, Simcock IC, Straatman-Iwanowska AA, Hirst RA, David AL, O'Callaghan C, Olivo A, Eaton S, Loukogeorgakis SP, Cacchiarelli D, Deprest J, Li VSW, Giobbe GG, De Coppi P. Single-cell guided prenatal derivation of primary fetal epithelial organoids from human amniotic and tracheal fluids. Nat Med 2024; 30:875-887. [PMID: 38438734 PMCID: PMC10957479 DOI: 10.1038/s41591-024-02807-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/05/2024] [Indexed: 03/06/2024]
Abstract
Isolation of tissue-specific fetal stem cells and derivation of primary organoids is limited to samples obtained from termination of pregnancies, hampering prenatal investigation of fetal development and congenital diseases. Therefore, new patient-specific in vitro models are needed. To this aim, isolation and expansion of fetal stem cells during pregnancy, without the need for tissue samples or reprogramming, would be advantageous. Amniotic fluid (AF) is a source of cells from multiple developing organs. Using single-cell analysis, we characterized the cellular identities present in human AF. We identified and isolated viable epithelial stem/progenitor cells of fetal gastrointestinal, renal and pulmonary origin. Upon culture, these cells formed clonal epithelial organoids, manifesting small intestine, kidney tubule and lung identity. AF organoids exhibit transcriptomic, protein expression and functional features of their tissue of origin. With relevance for prenatal disease modeling, we derived lung organoids from AF and tracheal fluid cells of congenital diaphragmatic hernia fetuses, recapitulating some features of the disease. AF organoids are derived in a timeline compatible with prenatal intervention, potentially allowing investigation of therapeutic tools and regenerative medicine strategies personalized to the fetus at clinically relevant developmental stages.
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Affiliation(s)
- Mattia Francesco Maria Gerli
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London, London, UK.
- Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Giuseppe Calà
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Max Arran Beesley
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Beatrice Sina
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Politecnico di Milano, Milan, Italy
| | - Lucinda Tullie
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Stem Cell and Cancer Biology Laboratory, The Francis Crick Institute, London, UK
| | - Kylin Yunyan Sun
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Francesco Panariello
- Armenise/Harvard Laboratory of Integrative Genomics, Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Federica Michielin
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joseph R Davidson
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Francesca Maria Russo
- Department of Development and Regeneration, Woman and Child and UZ Leuven Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium
| | - Brendan C Jones
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Dani Do Hyang Lee
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Savvas Savvidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Theodoros Xenakis
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ian C Simcock
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | | | - Robert A Hirst
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Development and Regeneration, Woman and Child and UZ Leuven Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium
| | | | - Alessandro Olivo
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Simon Eaton
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Stavros P Loukogeorgakis
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Davide Cacchiarelli
- Armenise/Harvard Laboratory of Integrative Genomics, Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
- Department of Translational Medicine, University of Naples Federico II, Naples, Italy
- Genomics and Experimental Medicine Program, Scuola Superiore Meridionale, Naples, Italy
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Development and Regeneration, Woman and Child and UZ Leuven Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium
| | - Vivian S W Li
- Stem Cell and Cancer Biology Laboratory, The Francis Crick Institute, London, UK
| | | | - Paolo De Coppi
- Great Ormond Street Institute of Child Health, University College London, London, UK.
- Department of Development and Regeneration, Woman and Child and UZ Leuven Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium.
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
- Medical and Surgical Department of the Fetus, Newborn and Infant, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
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Simcock IC, Shelmerdine SC, Hutchinson JC, Sebire NJ, Arthurs OJ. Body weight-based iodinated contrast immersion timing for human fetal postmortem microfocus computed tomography. BJR Open 2024; 6:tzad006. [PMID: 38352185 PMCID: PMC10860501 DOI: 10.1093/bjro/tzad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives The aim of this study was to evaluate the length of time required to achieve full iodination using potassium tri-iodide as a contrast agent, prior to human fetal postmortem microfocus computed tomography (micro-CT) imaging. Methods Prospective assessment of optimal contrast iodination was conducted across 157 human fetuses (postmortem weight range 2-298 g; gestational age range 12-37 weeks), following micro-CT imaging. Simple linear regression was conducted to analyse which fetal demographic factors could produce the most accurate estimate for optimal iodination time. Results Postmortem body weight (r2 = 0.6435) was better correlated with iodination time than gestational age (r2 = 0.1384), producing a line of best fit, y = [0.0304 × body weight (g)] - 2.2103. This can be simplified for clinical use whereby immersion time (days) = [0.03 × body weight (g)] - 2.2. Using this formula, for example, a 100-g fetus would take 5.2 days to reach optimal contrast enhancement. Conclusions The simplified equation can now be used to provide estimation times for fetal contrast preparation time prior to micro-CT imaging and can be used to manage service throughput and parental expectation for return of their fetus. Advances in knowledge A simple equation from empirical data can now be used to estimate preparation time for human fetal postmortem micro-CT imaging.
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Affiliation(s)
- Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
| | - John Ciaran Hutchinson
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
- Department of Histopathology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
- Department of Histopathology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
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del Valle I, Young MD, Kildisiute G, Ogunbiyi OK, Buonocore F, Simcock IC, Khabirova E, Crespo B, Moreno N, Brooks T, Niola P, Swarbrick K, Suntharalingham JP, McGlacken-Byrne SM, Arthurs OJ, Behjati S, Achermann JC. An integrated single-cell analysis of human adrenal cortex development. JCI Insight 2023; 8:e168177. [PMID: 37440461 PMCID: PMC10443814 DOI: 10.1172/jci.insight.168177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/31/2023] [Indexed: 07/15/2023] Open
Abstract
The adrenal glands synthesize and release essential steroid hormones such as cortisol and aldosterone, but many aspects of human adrenal gland development are not well understood. Here, we combined single-cell and bulk RNA sequencing, spatial transcriptomics, IHC, and micro-focus computed tomography to investigate key aspects of adrenal development in the first 20 weeks of gestation. We demonstrate rapid adrenal growth and vascularization, with more cell division in the outer definitive zone (DZ). Steroidogenic pathways favored androgen synthesis in the central fetal zone, but DZ capacity to synthesize cortisol and aldosterone developed with time. Core transcriptional regulators were identified, with localized expression of HOPX (also known as Hop homeobox/homeobox-only protein) in the DZ. Potential ligand-receptor interactions between mesenchyme and adrenal cortex were seen (e.g., RSPO3/LGR4). Growth-promoting imprinted genes were enriched in the developing cortex (e.g., IGF2, PEG3). These findings reveal aspects of human adrenal development and have clinical implications for understanding primary adrenal insufficiency and related postnatal adrenal disorders, such as adrenal tumor development, steroid disorders, and neonatal stress.
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Affiliation(s)
- Ignacio del Valle
- Genetics and Genomic Medicine Research and Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Matthew D. Young
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Gerda Kildisiute
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Olumide K. Ogunbiyi
- Department of Histopathology, Great Ormond Street Hospital for Children National Health Service (NHS) Foundation Trust, London, United Kingdom
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Federica Buonocore
- Genetics and Genomic Medicine Research and Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Ian C. Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- National Institute of Health Research (NIHR) Great Ormond Street Biomedical Research Centre, London, United Kingdom
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Eleonora Khabirova
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Berta Crespo
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Nadjeda Moreno
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Tony Brooks
- UCL Genomics, Zayed Centre for Research, UCL Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Paola Niola
- UCL Genomics, Zayed Centre for Research, UCL Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Katherine Swarbrick
- Department of Histopathology, Great Ormond Street Hospital for Children National Health Service (NHS) Foundation Trust, London, United Kingdom
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Jenifer P. Suntharalingham
- Genetics and Genomic Medicine Research and Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Sinead M. McGlacken-Byrne
- Genetics and Genomic Medicine Research and Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Owen J. Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- National Institute of Health Research (NIHR) Great Ormond Street Biomedical Research Centre, London, United Kingdom
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Sam Behjati
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - John C. Achermann
- Genetics and Genomic Medicine Research and Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
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Simcock IC, Lamouroux A, Sebire NJ, Shelmerdine SC, Arthurs OJ. Less-invasive autopsy for early pregnancy loss. Prenat Diagn 2023; 43:937-949. [PMID: 37127547 DOI: 10.1002/pd.6361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
Autopsy investigations provide valuable information regarding fetal death that can assist in the parental bereavement process, and influence future pregnancies, but conventional autopsy is often declined by parents because of its invasive approach. This has led to the development of less-invasive autopsy investigations based on imaging technology to provide a more accessible and acceptable choice for parents when investigating their loss. Whilst the development and use of more conventional clinical imaging techniques (radiographs, CT, MRI, US) are well described in the literature for fetuses over 20 weeks of gestational age, these investigations have limited diagnostic accuracy in imaging smaller fetuses. Techniques such as ultra-high-field MRI (>3T) and micro-focus computed tomography have been shown to have higher diagnostic accuracy whilst still being acceptable to parents. By further developing and increasing the availability of these more innovative imaging techniques, parents will be provided with a greater choice of acceptable options to investigate their loss, which may in turn increase their uptake. We provide a narrative review focussing on the development of high-resolution, non-invasive imaging techniques to evaluate early gestational pregnancy loss.
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Affiliation(s)
- Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Audrey Lamouroux
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- Obstetrical Gynaecology Department, Nîmes University Hospital, Nîmes, France
- Clinical Genetics Department, Montpellier University Hospital, Montpellier, France
- ICAR Research Team, LIRMM, CNRS and Charles Coulomb Laboratory, UMR 5221 CNRS-UM, BNIF User Facility Imaging, University of Montpellier, Nîmes and Montpellier, Montpellier, France
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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5
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Novo Matos J, Sargent J, Silva J, Payne JR, Seo J, Spalla I, Borgeat K, Loureiro J, Pereira N, Simcock IC, Hutchinson JC, Arthurs OJ, Luis Fuentes V. Thin and hypokinetic myocardial segments in cats with cardiomyopathy. J Vet Cardiol 2023; 46:5-17. [PMID: 36893525 DOI: 10.1016/j.jvc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION/OBJECTIVES Thin and hypokinetic myocardial segments (THyMS) represent adverse ventricular (LV) remodeling in human hypertrophic cardiomyopathy. We describe the echocardiographic features and outcome in cats with THyMS, and in a subpopulation, the echocardiographic phenotype before LV wall thinning was detected (pre-THyMS). ANIMALS Eighty client-owned cats. MATERIALS AND METHODS Retrospective multicenter study. Clinical records were searched for cats with THyMS, defined as LV segment(s) with end-diastolic wall thickness (LVWT) <3 mm and hypokinesis in the presence of ≥one LV segment(s) with LVWT >4 mm and normal wall motion. When available, echocardiograms pre-THyMS were assessed. Survival time was defined as time from first presentation with THyMS to death. RESULTS Mean thickest LV wall segment (MaxLVWT) was 6.1 mm (95% CI 5.8-6.4 mm) and thinnest (MinLVWT) was 1.7 mm (95% CI 1.6-1.9 mm). The LV free wall was affected in 74%, apex in 13% and septum in 5%. Most cats (85%) presented with heart failure and/or arterial thromboembolism. Median circulating troponin I concentration was 1.4 ng/mL ([range 0.07-180 ng/mL]). Prior echocardiography results were available for 13/80 cats, a mean of 2.5 years pre-THyMS. In segments subsequently undergoing thinning, initial MaxLVWT measured 6.7 mm (95% CI 5.8-7.7 mm) vs. 1.9 mm (95% CI 1.5-2.4 mm) at last echocardiogram (P<0.0001). Survival data were available for 56/80 cats, median survival time after diagnosing THyMS was 153 days (95% CI 83-223 days). Cardiac histopathology in one cat revealed that THyMS was associated with severe transmural scarring. CONCLUSIONS Cats with THyMS had advanced cardiomyopathy and a poor prognosis.
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Affiliation(s)
- J Novo Matos
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, CB3 0ES, Cambridge, UK; Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, London, UK.
| | - J Sargent
- Southern Counties Veterinary Specialists, Unit 6, Forest Corner Farm, Hangersley, BH24 3JW, Ringwood, Hampshire, UK
| | - J Silva
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, CB3 0ES, Cambridge, UK; North Downs Specialist Referrals, The Friesian Buildings 3 & 4, Brewer Street, RH1 4QP, Bletchingley, Surrey, UK
| | - J R Payne
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, BS40 5DU, Langford, UK
| | - J Seo
- Animal Referral Centre, 224 Albany Highway, Schnapper Rock, 0632, Auckland, New Zealand
| | - I Spalla
- Ospedale Veterinario San Francesco, Via Feltrina, 29, 31038, Castagnole, Milan, Italy
| | - K Borgeat
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, BS40 5DU, Langford, UK
| | - J Loureiro
- North Downs Specialist Referrals, The Friesian Buildings 3 & 4, Brewer Street, RH1 4QP, Bletchingley, Surrey, UK
| | - N Pereira
- Freelance Cardiology, Salstrasse 92, 8400, Winterthur, Switzerland
| | - I C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - J C Hutchinson
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - O J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - V Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, London, UK
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Shelmerdine SC, Hutchinson JC, Lewis C, Simcock IC, Sekar T, Sebire NJ, Arthurs OJ. A pragmatic evidence-based approach to post-mortem perinatal imaging. Insights Imaging 2021; 12:101. [PMID: 34264420 PMCID: PMC8282801 DOI: 10.1186/s13244-021-01042-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Post-mortem imaging has a high acceptance rate amongst parents and healthcare professionals as a non-invasive method for investigating perinatal deaths. Previously viewed as a 'niche' subspecialty, it is becoming increasingly requested, with general radiologists now more frequently asked to oversee and advise on appropriate imaging protocols. Much of the current literature to date has focussed on diagnostic accuracy and clinical experiences of individual centres and their imaging techniques (e.g. post-mortem CT, MRI, ultrasound and micro-CT), and pragmatic, evidence-based guidance for how to approach such referrals in real-world practice is lacking. In this review, we summarise the latest research and provide an approach and flowchart to aid decision-making for perinatal post-mortem imaging. We highlight key aspects of the maternal and antenatal history that radiologists should consider when protocolling studies (e.g. antenatal imaging findings and history), and emphasise important factors that could impact the diagnostic quality of post-mortem imaging examinations (e.g. post-mortem weight and time interval). Considerations regarding when ancillary post-mortem image-guided biopsy tests are beneficial are also addressed, and we provide key references for imaging protocols for a variety of cross-sectional imaging modalities.
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Affiliation(s)
- Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute of Child Health, London, UK. .,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK.
| | - J Ciaran Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Celine Lewis
- Population, Policy and Practice Department, UCL GOS Institute of Child Health, London, UK.,North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK
| | - Ian C Simcock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Thivya Sekar
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
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7
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Simcock IC, Reeve R, Burnett C, Costigan C, McNair H, Robinson C, Arthurs OJ. Clinical academic radiographers - A challenging but rewarding career. Radiography (Lond) 2021; 27 Suppl 1:S14-S19. [PMID: 34274226 DOI: 10.1016/j.radi.2021.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/11/2021] [Accepted: 06/20/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To explain what a clinical academic career can be, what it can lead to for the individual, profession and most importantly the patient, and why these roles are so important to radiography. KEY FINDINGS Multiple challenges to the adoption of clinical academic careers exist, including achievable measurable outcomes, visibility & senior support, and balancing different time demands. Equally the rewards are wide ranging and can advance both the individual and profession through role extension opportunities, increased career progression, patient benefits, and academic and research skills. CONCLUSION Clinical academic careers can provide advantages for the individual, department, profession and most importantly the patient with advanced clinical practice through evidenced based research. IMPLICATIONS FOR PRACTICE Improving clinical academic careers within Radiography will promote research participation and increase radiographic roles in patient-centred research delivery and development. Combining evidenced based research with academic skills will lead to improved patient care and better clinical outcomes.
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Affiliation(s)
- I C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK; National Institute of Health Research, Great Ormond Street Hospital Biomedical Research Centre, London, UK.
| | - R Reeve
- Diagnostic Imaging Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK; University of Southampton, Southampton, UK.
| | - C Burnett
- Leeds Teaching Hospitals NHS Trust, UK; Leeds Institute of Medical Research, University of Leeds, UK; Leeds National Institute of Health Research Biomedical Research Centre, UK.
| | - C Costigan
- Nottingham University Hospitals NHS Trust, Nottingham, UK; National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.
| | - H McNair
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
| | - C Robinson
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK.
| | - O J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK; National Institute of Health Research, Great Ormond Street Hospital Biomedical Research Centre, London, UK.
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8
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Simcock IC, Shelmerdine SC, Hutchinson JC, Sebire NJ, Arthurs OJ. Human fetal whole-body postmortem microfocus computed tomographic imaging. Nat Protoc 2021; 16:2594-2614. [PMID: 33854254 DOI: 10.1038/s41596-021-00512-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/05/2021] [Indexed: 02/02/2023]
Abstract
Perinatal autopsy is the standard method for investigating fetal death; however, it requires dissection of the fetus. Human fetal microfocus computed tomography (micro-CT) provides a generally more acceptable and less invasive imaging alternative for bereaved parents to determine the cause of early pregnancy loss compared with conventional autopsy techniques. In this protocol, we describe the four main stages required to image fetuses using micro-CT. Preparation of the fetus includes staining with the contrast agent potassium triiodide and takes 3-19 d, depending on the size of the fetus and the time taken to obtain consent for the procedure. Setup for imaging requires appropriate positioning of the fetus and takes 1 h. The actual imaging takes, on average, 2 h 40 min and involves initial test scans followed by high-definition diagnostic scans. Postimaging, 3 d are required to postprocess the fetus, including removal of the stain, and also to undertake artifact recognition and data transfer. This procedure produces high-resolution isotropic datasets, allowing for radio-pathological interpretations to be made and long-term digital archiving for re-review and data sharing, where required. The protocol can be undertaken following appropriate training, which includes both the use of micro-CT techniques and handling of postmortem tissue.
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Affiliation(s)
- Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - J Ciaran Hutchinson
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK. .,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK. .,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
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9
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Abstract
PURPOSE OF REVIEW Uptake of perinatal autopsy has declined in the West over the past 30 years, largely because of reduced parental acceptance of a traditional invasive autopsy. Several studies have recently investigated the decline to identify the key factors and how they may be mitigated. RECENT FINDINGS Three main themes were identified that have been found to improve uptake of perinatal autopsy: improved communication, in particular ensuring the consent process was conducted as a conversation with time spent talking through the procedure and allowing time for questions; health professional training to ensure staff discussing autopsy with parents have adequate understanding of the procedure and are able to convey confidence and empathy; and availability of less invasive autopsy, including noninvasive as well as minimally invasive options. These should be offered alongside standard autopsy, which some parents may still prefer. SUMMARY This review highlights that the discussions that take place, and the options that are available to parents, can profoundly impact whether or not they consent to autopsy investigation. Further research should focus on the impact of offering less invasive options as well as evaluating the training and support materials that have recently been developed.
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Affiliation(s)
- Celine Lewis
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health
- North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust
| | - Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children
- UCL Great Ormond Street Institute of Child Health
- National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children
- UCL Great Ormond Street Institute of Child Health
- National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
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10
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Shelmerdine SC, Simcock IC, Hutchinson JC, Guy A, Ashworth MT, Sebire NJ, Arthurs OJ. Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses. Am J Obstet Gynecol 2021; 224:103.e1-103.e15. [PMID: 32682860 PMCID: PMC7805479 DOI: 10.1016/j.ajog.2020.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
Background Noninvasive imaging autopsy alternatives for fetuses weighing <500 grams are limited. Microfocus computed tomography has been reported as a viable option in small case series with the potential to avoid an invasive autopsy. Implementation of postmortem microfocus computed tomography in a large cohort as part of routine clinical service has yet been unreported, and realistic “autopsy prevention rates” are unknown. Objective This study aimed to describe the range of abnormalities detectable on fetal microfocus computed tomography in a clinical setting and additional findings identified on the antenatal ultrasound and to estimate the invasive autopsy avoidance rate (ie, cases in which imaging was sufficient to deem autopsy unnecessary). Study Design A prospective observational case series of all fetuses referred for microfocus computed tomography imaging at a single institution was conducted for 3 years (2016–2019). Imaging was reported by 2 pediatric radiologists before autopsy, with “decision to proceed” based on the specialist perinatal pathologists’ judgment and parental consent. Agreement rates between microfocus computed tomography and antenatal ultrasound were evaluated, and where feasible, diagnostic accuracy for microfocus computed tomography was calculated using autopsy as a reference standard. Results A total of 268 fetuses were included (2–350 grams body weight; 11–24 weeks’ gestation), with cause for demise in 122 of 268 (45.5%). Of the 122 fetuses, 64 (52.5%) exhibited fetal anomalies. Although 221 of 268 (82.5%) fetuses had consent for invasive autopsy, only 29 of the 221 (13.1%) underwent this procedure, which implied an autopsy avoidance rate of 192 of 221 (86.9%). Complete agreement was present for all brain, thoracic, and abdominal pathologies, whereas sensitivity and specificity for cardiac anomalies were 66.7% and 91.7%, respectively. Microfocus computed tomography and antenatal ultrasound agreement was found in 219 of 266 cases (81.9%), with partial agreement in 21 of 266 (7.9%) and disagreement in 26 of 266 (10.5%), mostly because of additional cardiac, soft tissue, or genitourinary findings by microfocus computed tomography, which were not seen on the ultrasound. Conclusion Fetal microfocus computed tomography imaging is a viable and useful tool for imaging early gestational fetuses and can avoid the need for invasive autopsy. Confirmation of antenatal diagnoses is achieved in most cases, and additional anomalies may also be detected.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom.
| | - Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - John Ciaran Hutchinson
- Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Anna Guy
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Michael T Ashworth
- Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
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11
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Frauenfelder C, Shelmerdine SC, Simcock IC, Hall A, Hutchinson JC, Ashworth MT, Arthurs OJ, Butler CR. Micro-CT Imaging of Pediatric Thyroglossal Duct Cysts: A Prospective Case Series. Front Pediatr 2021; 9:746010. [PMID: 34557462 PMCID: PMC8453197 DOI: 10.3389/fped.2021.746010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: To determine the feasibility of micro-CT as a high-resolution 3D imaging tool for thyroglossal duct cysts and to evaluate its role augmenting traditional histopathological examination of resected specimens. Methods: A single centre, prospective case series of consecutive children undergoing excision of a thyroglossal duct cyst was performed at a quaternary paediatric referral hospital in the United Kingdom. Consecutive children listed for excision of a thyroglossal duct cyst whose parents agreed to participate were included and there were no exclusion criteria. Results: Surgically excised thyroglossal duct cyst or remnant specimens from five patients (two males, three females) were examined using micro-CT alongside traditional histopathological examination. In all cases, micro-CT imaging was able to demonstrate 3D imaging datasets of the specimens successfully and direct radio-pathological comparisons were made (Figures 1-5, Supplementary Video 1). Conclusions: The study has shown the feasibility and utility of post-operative micro-CT imaging of thyroglossal duct cysts specimens as a visual aid to traditional histopathological examination. It better informs the pathological specimen sectioning using multi-planar reconstruction and volume rendering tools without tissue destruction. In the complex, often arborised relationship between a thyroglossal duct cyst and the hyoid, micro-CT provides valuable image plane orientation and indicates proximity of the duct to the surgical margins. This is the first case series to explore the use of micro-CT imaging for pediatric thyroglossal duct specimens and it informs future work investigating the generalizability of micro-CT imaging methods for other lesions, particularly those from the head and neck region where precisely defining margins of excision may be challenging.
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Affiliation(s)
- Claire Frauenfelder
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Discipline of Surgery, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Ian C Simcock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Andrew Hall
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John Ciaran Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom.,Department of Histopathology, St Thomas' Hospital, London, United Kingdom
| | - Michael T Ashworth
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Colin R Butler
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom
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12
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Novo Matos J, Garcia-Canadilla P, Simcock IC, Hutchinson JC, Dobromylskyj M, Guy A, Arthurs OJ, Cook AC, Luis Fuentes V. Micro-computed tomography (micro-CT) for the assessment of myocardial disarray, fibrosis and ventricular mass in a feline model of hypertrophic cardiomyopathy. Sci Rep 2020; 10:20169. [PMID: 33214588 PMCID: PMC7678873 DOI: 10.1038/s41598-020-76809-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/02/2020] [Indexed: 01/15/2023] Open
Abstract
Micro-computed tomography (micro-CT) is a high-resolution imaging modality that provides accurate tissue characterization. Hypertrophic cardiomyopathy (HCM) occurs as a spontaneous disease in cats, and is characterized by myocardial hypertrophy, disarray and fibrosis, as in humans. While hypertrophy/mass (LVM) can be objectively measured, fibrosis and myocyte disarray are difficult to assess. We evaluated the accuracy of micro-CT for detection and quantification of myocardial disarray and fibrosis by direct comparison with histopathology. 29 cat hearts (12 normal and 17 HCM hearts) underwent micro-CT and pathologic examination. Myocyte orientation was assessed using structure tensor analysis by determination of helical angle (HA), fractional anisotropy (FA) and myocardial disarray index (MDI). Fibrosis was segmented and quantified based on comparison of gray-scale values in normal and fibrotic myocardium. LVM was obtained by determining myocardial volume. Myocardial segments with low FA, low MDI and disruption of normal HA transmural profile on micro-CT were associated with myocardial disarray on histopathology. FA was consistently lower in HCM than normal hearts. Assessment of fibrosis on micro-CT closely matched the histopathologic evaluation. LVM determined by micro-CT was higher in HCM than normal hearts. Micro-CT can be used to detect and quantify myocardial disarray and fibrosis and determine myocardial mass in HCM.
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Affiliation(s)
- Jose Novo Matos
- Clinical Sciences and Services, Royal Veterinary College, London, UK.
| | - Patricia Garcia-Canadilla
- Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Institute of Cardiovascular Science, University College London, London, UK
| | - Ian C Simcock
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - J Ciaran Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | - Anna Guy
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, UK
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13
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Novo Matos J, Garcia-Canadilla P, Simcock IC, Hutchinson JC, Dobromylskyj M, Guy A, Arthurs OJ, Cook AC, Luis Fuentes V. Micro-computed tomography (micro-CT) for the assessment of myocardial disarray, fibrosis and ventricular mass in a feline model of hypertrophic cardiomyopathy. Sci Rep 2020. [PMID: 33214588 DOI: 10.1038/s41598-020-76809-5.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Micro-computed tomography (micro-CT) is a high-resolution imaging modality that provides accurate tissue characterization. Hypertrophic cardiomyopathy (HCM) occurs as a spontaneous disease in cats, and is characterized by myocardial hypertrophy, disarray and fibrosis, as in humans. While hypertrophy/mass (LVM) can be objectively measured, fibrosis and myocyte disarray are difficult to assess. We evaluated the accuracy of micro-CT for detection and quantification of myocardial disarray and fibrosis by direct comparison with histopathology. 29 cat hearts (12 normal and 17 HCM hearts) underwent micro-CT and pathologic examination. Myocyte orientation was assessed using structure tensor analysis by determination of helical angle (HA), fractional anisotropy (FA) and myocardial disarray index (MDI). Fibrosis was segmented and quantified based on comparison of gray-scale values in normal and fibrotic myocardium. LVM was obtained by determining myocardial volume. Myocardial segments with low FA, low MDI and disruption of normal HA transmural profile on micro-CT were associated with myocardial disarray on histopathology. FA was consistently lower in HCM than normal hearts. Assessment of fibrosis on micro-CT closely matched the histopathologic evaluation. LVM determined by micro-CT was higher in HCM than normal hearts. Micro-CT can be used to detect and quantify myocardial disarray and fibrosis and determine myocardial mass in HCM.
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Affiliation(s)
- Jose Novo Matos
- Clinical Sciences and Services, Royal Veterinary College, London, UK.
| | - Patricia Garcia-Canadilla
- Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Institute of Cardiovascular Science, University College London, London, UK
| | - Ian C Simcock
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - J Ciaran Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | - Anna Guy
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, UK
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14
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Simcock IC, Hutchinson JC, Shelmerdine SC, Matos JN, Sebire NJ, Fuentes VL, Arthurs OJ. Investigation of optimal sample preparation conditions with potassium triiodide and optimal imaging settings for microfocus computed tomography of excised cat hearts. Am J Vet Res 2020; 81:326-333. [PMID: 32228254 DOI: 10.2460/ajvr.81.4.326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine optimal sample preparation conditions with potassium triiodide (I2KI) and optimal imaging settings for microfocus CT (micro-CT) of excised cat hearts. SAMPLE 7 excised hearts (weight range, 10 to 17.6 g) obtained from healthy adult cats after euthanasia by IV injection of pentobarbital sodium. PROCEDURES Following excision, the hearts were preserved in 10% formaldehyde solution. Six hearts were immersed in 1.25% I2KI solution (n = 3) or 2.5% I2KI solution (3) for a 12-day period. Micro-CT images were acquired at time 0 (prior to iodination) then approximately every 24 and 48 hours thereafter to determine optimal sample preparation conditions (ie, immersion time and concentration of I2KI solution). Identified optimal conditions were then used to prepare the seventh heart for imaging; changes in voltage, current, exposure time, and gain on image quality were evaluated to determine optimal settings (ie, maximal signal-to-noise and contrast-to-noise ratios). Images were obtained at a voxel resolution of 30 μm. A detailed morphological assessment of the main cardiac structures of the seventh heart was then performed. RESULTS Immersion in 2.5% I2KI solution for 48 hours was optimal for sample preparation. The optimal imaging conditions included a tube voltage of 100 kV, current of 150 μA, and exposure time of 354 milliseconds; scan duration was 12 minutes. CONCLUSIONS AND CLINICAL RELEVANCE Results provided an optimal micro-CT imaging protocol for excised cat hearts prepared with I2KI solution that could serve as a basis for future studies of micro-CT for high resolution 3-D imaging of cat hearts.
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15
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Hutchinson JC, Shelmerdine SC, Lewis C, Parmenter J, Simcock IC, Ward L, Ashworth MT, Chitty LS, Arthurs OJ, Sebire NJ. Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure. Ultrasound Obstet Gynecol 2019; 54:661-669. [PMID: 30620444 DOI: 10.1002/uog.20211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Less invasive autopsy techniques in cases of fetal or infant death have good acceptability among parents, but the published sampling adequacy in needle biopsy studies is generally poor. Minimally Invasive Autopsy with Laparoscopically assisted sampling (MinImAL) has the potential to increase the diagnostic yield of less invasive autopsy by improving the quality and quantity of tissue samples obtained, whilst permitting visualization, extraction and examination of internal organs through a small incision. The aim of this study was to present the findings of our experience with the MinImAL procedure in cases of fetal, neonatal and pediatric death. METHODS This was a retrospective analysis of 103 prospectively recruited unselected cases of fetal, neonatal or pediatric death that underwent the MinImAL procedure at a tertiary referral center over a 5-year period. Following preprocedure 1.5-T whole-body postmortem magnetic resonance imaging, MinImAL autopsy was performed. Procedure duration, sampling adequacy and cause of death were assessed. Chi-square analysis was used to compare the 'unexplained' rate of intrauterine deaths in the cohort with that in a previously published cohort of > 1000 cases of intrauterine death examined by standard autopsy. RESULTS MinImAL autopsy was performed successfully in 97.8% (91/93) of the cases undergoing a complete procedure. There was a satisfactory rate of adequate histological sampling in most major organs; heart (100%, 91 cases), lung (100%, 91 cases), kidney (100%, 91 cases), liver (96.7%, 88 cases), spleen (94.5%, 86 cases), adrenal glands (89.0%, 81 cases), pancreas (82.4%, 75 cases) and thymus (56.0%, 51 cases). Procedure duration was similar to that of standard autopsy in a previously published cohort of intrauterine deaths. The unexplained rate in stillbirths and intrauterine fetal deaths that underwent MinImAL autopsy was not significantly different from that following standard autopsy. CONCLUSIONS The MinImAL procedure provides good histological yield from major organs with minimal cosmetic damage and can be learned by an autopsy practitioner. The MinImAL procedure is an appropriate minimally invasive alternative for the investigation of perinatal and pediatric deaths in which consent to full autopsy is withheld, and may have applications in both high- and low/middle-income settings. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - S C Shelmerdine
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - C Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Parmenter
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - I C Simcock
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - L Ward
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - M T Ashworth
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - L S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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16
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Woolf DK, Li SP, Detre S, Liu A, Gogbashian A, Simcock IC, Stirling J, Kosmin M, Cook GJ, Siddique M, Dowsett M, Makris A, Goh V. Assessment of the Spatial Heterogeneity of Breast Cancers: Associations Between Computed Tomography and Immunohistochemistry. Biomark Cancer 2019; 11:1179299X19851513. [PMID: 31210736 PMCID: PMC6552350 DOI: 10.1177/1179299x19851513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tumour heterogeneity is considered an important mechanism of treatment failure. Imaging-based assessment of tumour heterogeneity is showing promise but the relationship between these mathematically derived measures and accepted 'gold standards' of tumour biology such as immunohistochemical measures is not established. METHODS A total of 20 women with primary breast cancer underwent a research dynamic contrast-enhanced computed tomography prior to treatment with data being available for 15 of these. Texture analysis was performed of the primary tumours to extract 13 locoregional and global parameters. Immunohistochemical analysis associations were assessed by the Spearman rank correlation. RESULTS Hypoxia-inducible factor-1α was correlated with first-order kurtosis (r = -0.533, P = .041) and higher order neighbourhood grey-tone difference matrix coarseness (r = 0.54, P = .038). Vascular maturity-related smooth muscle actin was correlated with higher order grey-level run-length long-run emphasis (r = -0.52, P = .047), fractal dimension (r = 0.613, P = .015), and lacunarity (r = -0.634, P = .011). Micro-vessel density, reflecting angiogenesis, was also associated with lacunarity (r = 0.547, P = .035). CONCLUSIONS The associations suggest a biological basis for these image-based heterogeneity features and support the use of imaging, already part of standard care, for assessing intratumoural heterogeneity.
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Affiliation(s)
- David K Woolf
- Breast Cancer Research Unit, Mount Vernon Cancer Centre, Northwood, UK
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Sonia P Li
- Breast Cancer Research Unit, Mount Vernon Cancer Centre, Northwood, UK
| | - Simone Detre
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Alison Liu
- Division of Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Andrew Gogbashian
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Ian C Simcock
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - James Stirling
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Michael Kosmin
- Breast Cancer Research Unit, Mount Vernon Cancer Centre, Northwood, UK
| | - Gary J Cook
- Division of Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Muhammad Siddique
- Division of Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Andreas Makris
- Breast Cancer Research Unit, Mount Vernon Cancer Centre, Northwood, UK
| | - Vicky Goh
- Division of Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
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17
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Shelmerdine SC, Singh M, Simcock IC, Calder AD, Ashworth M, Beleza A, Sebire NJ, Arthurs OJ. Characterization of Bardet-Biedl syndrome by postmortem microfocus computed tomography (micro-CT). Ultrasound Obstet Gynecol 2019; 53:132-134. [PMID: 30079607 DOI: 10.1002/uog.19190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - M Singh
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - I C Simcock
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - A D Calder
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - M Ashworth
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - A Beleza
- Centre for Craniofacial & Regenerative Biology, King's College London, London, UK
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - N J Sebire
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - O J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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18
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Shelmerdine SC, Simcock IC, Hutchinson JC, Aughwane R, Melbourne A, Nikitichev DI, Ong JL, Borghi A, Cole G, Kingham E, Calder AD, Capelli C, Akhtar A, Cook AC, Schievano S, David A, Ourselin S, Sebire NJ, Arthurs OJ. 3D printing from microfocus computed tomography (micro-CT) in human specimens: education and future implications. Br J Radiol 2018; 91:20180306. [PMID: 29698059 DOI: 10.1259/bjr.20180306] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Microfocus CT (micro-CT) is an imaging method that provides three-dimensional digital data sets with comparable resolution to light microscopy. Although it has traditionally been used for non-destructive testing in engineering, aerospace industries and in preclinical animal studies, new applications are rapidly becoming available in the clinical setting including post-mortem fetal imaging and pathological specimen analysis. Printing three-dimensional models from imaging data sets for educational purposes is well established in the medical literature, but typically using low resolution (0.7 mm voxel size) data acquired from CT or MR examinations. With higher resolution imaging (voxel sizes below 1 micron, <0.001 mm) at micro-CT, smaller structures can be better characterised, and data sets post-processed to create accurate anatomical models for review and handling. In this review, we provide examples of how three-dimensional printing of micro-CT imaged specimens can provide insight into craniofacial surgical applications, developmental cardiac anatomy, placental imaging, archaeological remains and high-resolution bone imaging. We conclude with other potential future usages of this emerging technique.
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Affiliation(s)
- Susan C Shelmerdine
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Ian C Simcock
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - John Ciaran Hutchinson
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,3 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Rosalind Aughwane
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Andrew Melbourne
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Daniil I Nikitichev
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK.,5 Department of Medical Physics and Biomedical Engineering, University College London , London , UK
| | - Ju-Ling Ong
- 6 Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | | | | | - Emilia Kingham
- 8 UCL Culture, Bidborough House, 38-50 Bidborough Street, London UK
| | - Alistair D Calder
- 2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Claudio Capelli
- 9 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,10 Institute of Cardiovascular Science, University College London , London , UK
| | - Aadam Akhtar
- 10 Institute of Cardiovascular Science, University College London , London , UK
| | - Andrew C Cook
- 10 Institute of Cardiovascular Science, University College London , London , UK
| | - Silvia Schievano
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,9 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,10 Institute of Cardiovascular Science, University College London , London , UK
| | - Anna David
- 11 Institute for Women's Health, University College London , London , UK
| | - Sebastian Ourselin
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Neil J Sebire
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,3 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Owen J Arthurs
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
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19
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Hutchinson JC, Shelmerdine SC, Simcock IC, Sebire NJ, Arthurs OJ. Early clinical applications for imaging at microscopic detail: microfocus computed tomography (micro-CT). Br J Radiol 2017; 90:20170113. [PMID: 28368658 DOI: 10.1259/bjr.20170113] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Microfocus CT (micro-CT) has traditionally been used in industry and preclinical studies, although it may find new applicability in the routine clinical setting. It can provide high-resolution three-dimensional digital imaging data sets to the same level of detail as microscopic examination without the need for tissue dissection. Micro-CT is already enabling non-invasive detailed internal assessment of various tissue specimens, particularly in breast imaging and early gestational fetal autopsy, not previously possible from more conventional modalities such as MRI or CT. In this review, we discuss the technical aspects behind micro-CT image acquisition, how early work with small animal studies have informed our knowledge of human disease and the imaging performed so far on human tissue specimens. We conclude with potential future clinical applications of this novel and emerging technique.
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Affiliation(s)
- J Ciaran Hutchinson
- 1 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,2 UCL Great Ormond Street Institute of Child Health, London, UK
| | - Susan C Shelmerdine
- 2 UCL Great Ormond Street Institute of Child Health, London, UK.,3 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ian C Simcock
- 2 UCL Great Ormond Street Institute of Child Health, London, UK.,3 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Neil J Sebire
- 1 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,2 UCL Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- 2 UCL Great Ormond Street Institute of Child Health, London, UK.,3 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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20
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Li SP, Makris A, Gogbashian A, Simcock IC, Stirling JJ, Goh V. Predicting response to neoadjuvant chemotherapy in primary breast cancer using volumetric helical perfusion computed tomography: a preliminary study. Eur Radiol 2012; 22:1871-80. [DOI: 10.1007/s00330-012-2433-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 01/24/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
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21
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Goh V, Tam E, Taylor NJ, Stirling JJ, Simcock IC, Jones RG, Padhani AR. Diffusion tensor imaging of the anal canal at 3 tesla: feasibility and reproducibility of anisotropy measures. J Magn Reson Imaging 2011; 35:820-6. [PMID: 22127778 DOI: 10.1002/jmri.22873] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 10/04/2011] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To assess the feasibility and reproducibility of 3-tesla diffusion tensor imaging (DTI) of the anal canal. MATERIALS AND METHODS DTI was performed in 25 men with no clinical history of anal canal disease undergoing MRI for prostate cancer. Analysis of fractional anisotropy (FA), relative anisotropy (RA), and apparent diffusion coefficient (ADC) were determined for the epithelial/subepithelial layer, internal sphincter, external sphincter, and puborectalis. The directionality of diffusion was recorded from color-coded tractography maps. Obturator internus and gluteus maximus served as reference muscles. Mean (SD) of values for FA, RA, and ADC were compared using analysis of variance. Intra and inter-rater agreement and test reproducibility (n = 5) was assessed by Bland-Altman statistics. RESULTS Mean (SD) for the epithelial/subepithelial layer, internal, external sphincter, and puborectalis were as follows: FA: 0.283 (0.099); 0.337 (0.049); 0.415 (0.072); and 0.407 (0.062), respectively. RA: 0.241 (0.094); 0.292 (0.050); 0.371 (0.083); 0.361 (0.067), respectively; and ADC: 1.49 (0.23); 1.59 (0.19); 1.51 (0.28); and 1.54 (0.29) × 10(-3) mm(2) /s, respectively. Good overall intra and inter-rater agreement and test-retest reproducibility was noted (coefficient of variation of 4.8-19.4% and 5.9-12.9%, respectively). CONCLUSION Anisotropy is evident in the anal canal with good inter-rater agreement and test reproducibility.
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Affiliation(s)
- Vicky Goh
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, United Kingdom.
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