1
|
Bhatnagar G, Mallett S, Beable R, Greenhalgh R, Ilangovan R, Lambie H, Mainta E, Patel U, Porté F, Sidhu H, Gupta A, Higginson A, Slater A, Tolan D, Zealley I, Halligan S, Taylor SA. Influence of diffusion weighted imaging and contrast enhanced T1 sequences on the diagnostic accuracy of magnetic resonance enterography for Crohn's disease. Eur J Radiol 2024; 175:111454. [PMID: 38598964 DOI: 10.1016/j.ejrad.2024.111454] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To evaluate the additional diagnostic benefit of diffusion weighted imaging (DWI) and contrast enhanced (CE) images during MR enterography (MRE) of Crohn's disease. METHODS Datasets from 73 patients (mean age 32; 40 male) (28 new-diagnosis, 45 relapsed) were read independently by two radiologists selected from a pool of 13. Radiologists interpreted datasets using three sequential sequence blocks: (1) T2 weighted and steady state free precession gradient echo (SSFP) images alone (T2^); (2) T2 weighted and SSFP images with DWI (T2 + DWI^) and; (3) T2 weighted images, SSFP, DWI and post-contrast enhanced (CE) T1 images (T2 + DWI + CE^), documenting presence, location, and activity of small bowel disease. For each sequence block, sensitivity and specificity (readers combined) was calculated against an outcome-based construct reference standard. RESULTS 59/73 patients had small bowel disease. Per-patient sensitivity for disease detection was essentially identical (80 % [95 % CI 72, 86], 81 % [73,87], and 79 % [71,86] for T2^, T2 + DWI^and T2 + DWI + CE^respectively). Specificity was identical (82 % [64 to 92]). Per patient sensitivity for disease extent was 56 % (47,65), 56 % (47,65) and 52 % (43 to 61) respectively, and specificity was 82 % (64 to 92) for all blocks. Sensitivity for active disease was 97 % (90,99), 97 % (90,99) and 98 % (92,99), and specificity was also comparable between all sequence combination reads. Results were consistent across segments and newly diagnosed/relapse patients. CONCLUSION There is no additional diagnostic benefit of adding either DWI or CE to T2 FSE and SSFP sequences for evaluating small bowel Crohn's disease, suggesting MRE protocols can be simplified safely.
Collapse
Affiliation(s)
- Gauraang Bhatnagar
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK
| | - Richard Beable
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rebecca Greenhalgh
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | | | - Hannah Lambie
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Evgenia Mainta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Uday Patel
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - François Porté
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Harbir Sidhu
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK; Department of Surgery and Cancer, Imperial College London, Exhibition Rd, South Kensington, London SW7 2BX, UK
| | - Anthony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK.
| |
Collapse
|
2
|
Kumar S, Parry T, Mallett S, Plumb A, Bhatnagar G, Beable R, Betts M, Duncan G, Gupta A, Higginson A, Hyland R, Lapham R, Patel U, Pilcher J, Slater A, Tolan D, Zealley I, Halligan S, Taylor SA. Diagnostic performance of sonographic activity scores for adult terminal ileal Crohn's disease compared to magnetic resonance and histological reference standards: experience from the METRIC trial. Eur Radiol 2024; 34:455-464. [PMID: 37526665 PMCID: PMC10791915 DOI: 10.1007/s00330-023-09958-6] [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] [Indexed: 08/02/2023]
Abstract
OBJECTIVES The simple ultrasound activity score for Crohn's disease (SUS-CD) and bowel ultrasound score (BUSS) are promising intestinal ultrasound (IUS) indices of CD, but studied mainly in small settings with few sonographers. We compared SUS-CD and BUSS against histological and magnetic resonance enterography (MRE) reference standards in a post hoc analysis of a prospective multicentre, multireader trial. METHODS Participants recruited to the METRIC trial (ISRCTN03982913) were studied, including those with available terminal ileal (TI) biopsies. Sensitivity and specificity of SUS-CD and BUSS for TI CD activity were calculated with 95% confidence intervals (CI), from the prospective observations of the original METRIC trial sonographers against the histological activity index (HAI) and the simplified magnetic resonance index of activity (sMARIA). RESULTS We included 284 patients (median 31.5 years, IQR 23-46) from 8 centres, who underwent IUS and MRE. Of these, 111 patients had available terminal ileal biopsies with HAI scoring. Against histology, sensitivity and specificity for active disease were 79% (95% CI 69-86%) and 50% (31-69%) for SUS-CD, and 66% (56-75%) and 68% (47-84%) for BUSS, respectively. Compared to sMARIA, the sensitivity and specificity for active CD were 81% (74-86%) and 75% (66-83%) for SUS-CD, and 68% (61-74%) and 85% (76-91%) for BUSS, respectively. The sensitivity of SUS-CD was significantly greater than that of BUSS against HAI and sMARIA (p < 0.001), but its specificity was significantly lower than of BUSS against the MRE reference standard (p = 0.003). CONCLUSIONS Particularly when compared to MRE activity scoring, SUS-CD and BUSS are promising tools in a real-world clinical setting. CLINICAL RELEVANCE STATEMENT When tested using data from a multicentre, multireader diagnostic accuracy trial, the simple ultrasound activity score for Crohn's disease (SUS-CD) and bowel ultrasound score (BUSS) were clinically viable intestinal ultrasound indices that were reasonably sensitive and specific for terminal ileal Crohn's disease, especially when compared to a magnetic resonance reference standard. KEY POINTS The simple ultrasound activity score for Crohn's disease and bowel ultrasound score are promising intestinal ultrasound indices of Crohn's disease but to date studied mainly in small settings with few sonographers. Compared to histology and the magnetic resonance reference standard in a multicentre, multireader setting, the sensitivity of simple ultrasound activity score for Crohn's disease is significantly greater than that of bowel ultrasound score. The specificity of simple ultrasound activity score for Crohn's disease was significantly lower than that of bowel ultrasound score compared to the magnetic resonance enterography reference standard. The specificity of both indices was numerically higher when the magnetic resonance enterography reference standard was adopted.
Collapse
Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Thomas Parry
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Gauraang Bhatnagar
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
- Department of Radiology, Frimley Park Hospital, Surrey, UK
| | - Richard Beable
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Margaret Betts
- Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Gillian Duncan
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Arun Gupta
- Department of Radiology, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Antony Higginson
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rachel Hyland
- Department of Radiology, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Roger Lapham
- Department of Radiology, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Uday Patel
- Department of Radiology, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK
| | - James Pilcher
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK.
| |
Collapse
|
3
|
McNeil K, Banziger C, Zealley I. Reducing interruptions during radiology reporting: Beneficial effect of duty radiologist and office reporting. Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
4
|
Walker H, Guthrie GD, Lambourg E, Traill P, Zealley I, Plumb A, Bell S. Systematic review and meta-analysis of prophylaxis use with intravenous contrast exposure to prevent contrast-induced nephropathy. Eur J Radiol 2022; 153:110368. [DOI: 10.1016/j.ejrad.2022.110368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
|
5
|
Bhatnagar G, Mallett S, Quinn L, Beable R, Bungay H, Betts M, Greenhalgh R, Gupta A, Higginson A, Hyland R, Ilangovan R, Lambie H, Mainta E, Patel U, Pilcher J, Plumb A, Porté F, Sidhu H, Slater A, Tolan D, Zealley I, Halligan S, Taylor S. Interobserver variation in the interpretation of magnetic resonance enterography in Crohn's disease. Br J Radiol 2022; 95:20210995. [PMID: 35195444 DOI: 10.1259/bjr.20210995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate interobserver variability for diagnosis of disease presence and extent of small bowel and colonic Crohn's disease using MR enterography (MRE). METHODS Data from the first 73 consecutive patients (mean age 32, 33F, 28 new diagnosis, 45 suspected relapse) recruited to a multicentre, prospective diagnostic accuracy trial evaluating MRE for small bowel Crohn's disease were each read independently by three (from a pool of 20) radiologists. Radiologists documented presence and segmental location of small bowel Crohn's disease and recorded morphological mural/extramural parameters for involved segments. Per patient percentage agreement for disease presence and extent were calculated against an outcome-based construct reference standard (averaged between pairs of readers). Prevalence-adjusted bias-adjusted κ (PABAK) was calculated. RESULTS Agreement for small bowel disease presence for new diagnosis/relapsed patients was 68%(κ = 0.36)/ 78% (κ = 0.56) and 43%(κ = 0.14)/ 53% for disease extent (κ = 0.07), respectively. For disease presence, all three radiologists agreed correctly with the reference standard in 41/59 (69%) of patients with small bowel involvement, and in 8/14 (57%) cases of without small bowel disease. Agreement was highest for multisegment disease, greater than 5 cm in length, with mural thickness>6 mm, and increased mural T2 signal. Agreement for colonic disease presence was 61% (κ = 0.21 fair agreement) for new diagnosis/ 60% (κ = 0.20, slight agreement) for relapsed patients. CONCLUSION There is a reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed Crohn's disease, and patients with suspected relapse, respectively. Agreement is lower for disease extent. ADVANCES IN KNOWLEDGE There is reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed (68%) Crohn's disease, and patients with suspected relapse (78%). Agreement is lower for disease extent (43% new diagnosis and 53% suspected relapse).
Collapse
Affiliation(s)
- Gauraang Bhatnagar
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard Beable
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Helen Bungay
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Margaret Betts
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Rebecca Greenhalgh
- Department of Radiology, St George's University Hospitals NHS Trust, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Anthony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rachel Hyland
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Hannah Lambie
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Evgenia Mainta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Uday Patel
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - James Pilcher
- Department of Radiology, St George's University Hospitals NHS Trust, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - François Porté
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Harbir Sidhu
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Stuart Taylor
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| |
Collapse
|
6
|
Affiliation(s)
- Ian Zealley
- Western General Hospital, Edinburgh and Ninewells Hospital, Dundee,
| |
Collapse
|
7
|
Yeap PM, Szewczyk-Bieda M, Zealley I. Findings beyond Crohn's disease encountered on magnetic resonance enterography: a pictorial review of diseases inside and outside the bowel. Singapore Med J 2021; 62:173-181. [PMID: 33948670 DOI: 10.11622/smedj.2021038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Phey Ming Yeap
- Department of Radiology, Sengkang General Hospital, Singapore
| | | | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| |
Collapse
|
8
|
|
9
|
Taylor SA, Mallett S, Bhatnagar G, Morris S, Quinn L, Tomini F, Miles A, Baldwin-Cleland R, Bloom S, Gupta A, Hamlin PJ, Hart AL, Higginson A, Jacobs I, McCartney S, Murray CD, Plumb AA, Pollok RC, Rodriguez-Justo M, Shabir Z, Slater A, Tolan D, Travis S, Windsor A, Wylie P, Zealley I, Halligan S. Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn's disease patients: the METRIC diagnostic accuracy study. Health Technol Assess 2020; 23:1-162. [PMID: 31432777 DOI: 10.3310/hta23420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Magnetic resonance enterography and enteric ultrasonography are used to image Crohn's disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn's disease was compared. OBJECTIVE To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn's disease. DESIGN Prospective multicentre cohort study. SETTING Eight NHS hospitals. PARTICIPANTS Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn's disease or with established Crohn's disease and suspected relapse. INTERVENTIONS Magnetic resonance enterography and ultrasonography. MAIN OUTCOME MEASURES The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn's disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease extent, and sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. RESULTS Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn's disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn's disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn's disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn's disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn's disease presence and extent were similar in the two cohorts. For colonic Crohn's disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn's disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. LIMITATIONS Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. CONCLUSIONS Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn's disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn's disease. TRIAL REGISTRATION Current Controlled Trials ISRCTN03982913. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Sue Mallett
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Florian Tomini
- Applied Health Research, University College London, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Rachel Baldwin-Cleland
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Peter John Hamlin
- Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Ilan Jacobs
- Independent patient representative, c/o Centre for Medical Imaging, University College London, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Charles D Murray
- Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Ao Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Hospital, London, UK
| | | | - Zainib Shabir
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andrew Slater
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
10
|
Salahia G, Chin SC, Zealley I, White RD. The Role of Interventional Radiology in the Management of Pancreatic Pathologies. Journal of Gastrointestinal and Abdominal Radiology 2020. [DOI: 10.1055/s-0039-3401335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractPancreatic pathologies are varied and wide-ranging, and a multidisciplinary approach is essential for effective diagnosis and management. We describe image-guided percutaneous (nonendoscopic) interventions in the management of pancreatic disease, with emphasis on inflammatory and neoplastic pancreatic pathologies and on the transplanted pancreas. Image-guided treatments for the complications of pancreatitis include percutaneous interventions on simple and complex peripancreatic collections, pseudocysts, and fistulas. Vascular interventions predominantly focus on the treatment of pseudoaneurysms, hemorrhagic pseudocysts, and arteriovenous malformations. Emerging ablative techniques for pancreatic cancer are promising and include percutaneous radiofrequency ablation, microwave ablation, irreversible electroporation, and electrochemotherapy. Image-guided interventions on the transplanted pancreas commonly include percutaneous biopsy and drainage in addition to endovascular treatments of vascular complications.
Collapse
Affiliation(s)
- Ghali Salahia
- Department of Radiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Sook Cheng Chin
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| | - Richard D. White
- Department of Radiology, University Hospital of Wales, Cardiff, United Kingdom
| |
Collapse
|
11
|
Zealley I, Wang H, Donnan PT, Bell S. Exposure to contrast media in the perioperative period confers no additional risk of acute kidney injury in surgical patients. Nephrol Dial Transplant 2019; 33:1751-1756. [PMID: 29237046 DOI: 10.1093/ndt/gfx325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background Iodinated contrast media (CM) used in angiography and computed tomography (CT) scans is an important cause of acute kidney injury (AKI) in hospitalized patients undergoing surgery. Contrast-induced nephropathy leads to AKI soon after CM administration. The aim of the study was to determine whether the timing of contrast media exposure related to diagnostic imaging during the immediate perioperative period influences the risk of post-operative AKI. Methods All patients aged 18 years or above who underwent diagnostic imaging within 7 days of non-cardiac surgery between 1 January 2003 and 31 December 2013 in the Tayside region of Scotland, UK were included in the analysis. The primary outcome of AKI was defined using the Kidney Disease: Improving Global Outcomes creatinine-based criteria. Multiple logistic regressions were performed to identify predictors for AKI. Results Of 9300 patients, 6224 were exposed to CM in the immediate perioperative period and 3076 were not. Post-operative AKI occurred in 678 (10.9%) of the 6224 patients who were exposed to CM. On multiple logistic regression, independent predictors of post-operative AKI were increasing age, male gender, lower baseline renal function and treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Timing of CM exposure did not affect risk of developing AKI, odds ratio 0.972 (95% confidence interval 0.935-1.010), P = 0.146. Conclusions For patients who have either just had or are soon to undergo general surgical procedures there appears to be no need to limit CT scan quality by avoiding the administration of CM. These patients may benefit from the increased diagnostic utility of contrast-enhanced CT scans without increasing their risk of perioperative AKI.
Collapse
Affiliation(s)
- Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Huan Wang
- Population Health Sciences, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Population Health Sciences, University of Dundee, Dundee, UK
| | - Samira Bell
- Population Health Sciences, University of Dundee, Dundee, UK.,Renal Unit, Ninewells Hospital, Dundee, UK
| |
Collapse
|
12
|
Bowness J, Seeley J, Varsou O, McKinnie A, Zealley I, McLeod G, Grant C. Arterial Anatomy of the Anterior Abdominal Wall: Evidence-Based Safe Sites for Instrumentation Based on Radiological Analysis of 100 Patients. Clin Anat 2019; 33:350-354. [PMID: 31444816 DOI: 10.1002/ca.23463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/19/2019] [Accepted: 08/01/2019] [Indexed: 11/08/2022]
Abstract
Multiple medical interventions require percutaneous instrumentation of the anterior abdominal wall, all of which carry a potential for vascular trauma. We assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries to determine the safest site with respect to vascular anatomy of the rectus sheath. In a review of 100 arterial phase, contrast-enhanced abdominal computed tomography scans, anterior abdominal wall arteries were assessed bilaterally at three axial planes: transpyloric, umbilicus, and anterior superior iliac spine (ASIS). The mean age of patients was 69.2 years (SD ± 15), with 62 male and 38 female. An artery was visible least frequently at the transpyloric plane (5%), compared with the umbilicus (72-79%) and ASIS (93-96%), on the left (χ2 (4) = 207.272; P < 0.001) and right (χ2 (4) = 198.553; P < 0.001), with a moderate strength association (Cramer's V = 0.588 (left) and 0.575 (right)). The arteries were most commonly observed within the rectus abdominis muscle at the level of the umbilicus and ASIS on both sides (62-68%). The inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it travelled superiorly. These data suggest that the safest site to instrument the rectus sheath, with respect to vascular anatomy, is at the transpyloric plane. This information on anatomical variation of the anterior abdominal wall vasculature may be of particular interest to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion. Clin. Anat. 33:350-354, 2020. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- James Bowness
- Institute of Academic Anaesthesia, University of Dundee, Dundee, United Kingdom.,Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| | - Jonathan Seeley
- Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| | - Ourania Varsou
- Anatomy Facility, School of Life Sciences, University of Glasgow, United Kingdom
| | - Angela McKinnie
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| | - Graeme McLeod
- Institute of Academic Anaesthesia, University of Dundee, Dundee, United Kingdom.,Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| | - Calum Grant
- Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| |
Collapse
|
13
|
Taylor SA, Halligan S, Bhatnagar G, Gupta A, Higginson A, Slater A, Tolan D, Wylie P, Zealley I, Mallett S. Diagnostic accuracy of MRE and ultrasound for Crohn's disease - Authors' reply. Lancet Gastroenterol Hepatol 2019; 4:96. [PMID: 30647017 DOI: 10.1016/s2468-1253(18)30389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London W1W 7TS, UK.
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London W1W 7TS, UK
| | - Gauraang Bhatnagar
- Centre for Medical Imaging, University College London, London W1W 7TS, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare National Health Service (NHS) Trust, Harrow, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Susan Mallett
- Institute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
14
|
Taylor SA, Mallett S, Bhatnagar G, Baldwin-Cleland R, Bloom S, Gupta A, Hamlin PJ, Hart AL, Higginson A, Jacobs I, McCartney S, Miles A, Murray CD, Plumb AA, Pollok RC, Punwani S, Quinn L, Rodriguez-Justo M, Shabir Z, Slater A, Tolan D, Travis S, Windsor A, Wylie P, Zealley I, Halligan S. Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol 2018; 3:548-558. [PMID: 29914843 PMCID: PMC6278907 DOI: 10.1016/s2468-1253(18)30161-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Magnetic resonance enterography (MRE) and ultrasound are used to image Crohn's disease, but their comparative accuracy for assessing disease extent and activity is not known with certainty. Therefore, we did a multicentre trial to address this issue. METHODS We recruited patients from eight UK hospitals. Eligible patients were 16 years or older, with newly diagnosed Crohn's disease or with established disease and suspected relapse. Consecutive patients had MRE and ultrasound in addition to standard investigations. Discrepancy between MRE and ultrasound for the presence of small bowel disease triggered an additional investigation, if not already available. The primary outcome was difference in per-patient sensitivity for small bowel disease extent (correct identification and segmental localisation) against a construct reference standard (panel diagnosis). This trial is registered with the International Standard Randomised Controlled Trial, number ISRCTN03982913, and has been completed. FINDINGS 284 patients completed the trial (133 in the newly diagnosed group, 151 in the relapse group). Based on the reference standard, 233 (82%) patients had small bowel Crohn's disease. The sensitivity of MRE for small bowel disease extent (80% [95% CI 72-86]) and presence (97% [91-99]) were significantly greater than that of ultrasound (70% [62-78] for disease extent, 92% [84-96] for disease presence); a 10% (95% CI 1-18; p=0·027) difference for extent, and 5% (1-9; p=0·025) difference for presence. The specificity of MRE for small bowel disease extent (95% [85-98]) was significantly greater than that of ultrasound (81% [64-91]); a difference of 14% (1-27; p=0·039). The specificity for small bowel disease presence was 96% (95% CI 86-99) with MRE and 84% (65-94) with ultrasound (difference 12% [0-25]; p=0·054). There were no serious adverse events. INTERPRETATION Both MRE and ultrasound have high sensitivity for detecting small bowel disease presence and both are valid first-line investigations, and viable alternatives to ileocolonoscopy. However, in a national health service setting, MRE is generally the preferred radiological investigation when available because its sensitivity and specificity exceed ultrasound significantly. FUNDING National Institute of Health and Research Health Technology Assessment.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London (UCL), London, UK.
| | - Susan Mallett
- Institute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Rachel Baldwin-Cleland
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK
| | - Peter J Hamlin
- Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Charles D Murray
- Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew A Plumb
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Hospital, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Laura Quinn
- Institute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Zainib Shabir
- Comprehensive Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Holborn, London, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | | | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London (UCL), London, UK
| |
Collapse
|
15
|
Ghaneh P, Hanson R, Titman A, Lancaster G, Plumpton C, Lloyd-Williams H, Yeo ST, Edwards RT, Johnson C, Abu Hilal M, Higginson AP, Armstrong T, Smith A, Scarsbrook A, McKay C, Carter R, Sutcliffe RP, Bramhall S, Kocher HM, Cunningham D, Pereira SP, Davidson B, Chang D, Khan S, Zealley I, Sarker D, Al Sarireh B, Charnley R, Lobo D, Nicolson M, Halloran C, Raraty M, Sutton R, Vinjamuri S, Evans J, Campbell F, Deeks J, Sanghera B, Wong WL, Neoptolemos JP. PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer. Health Technol Assess 2018; 22:1-114. [PMID: 29402376 PMCID: PMC5817411 DOI: 10.3310/hta22070] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [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] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pancreatic cancer diagnosis and staging can be difficult in 10-20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. OBJECTIVE To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. DESIGN A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. PARTICIPANTS Patients with suspected pancreatic malignancy. INTERVENTIONS All patients to undergo PET/CT following standard diagnostic work-up. MAIN OUTCOME MEASURES The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients' diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. RESULTS Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval -0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. CONCLUSION PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. STUDY REGISTRATION Current Controlled Trials ISRCTN73852054 and UKCRN 8166. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Paula Ghaneh
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Robert Hanson
- Liverpool Cancer Research UK Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Andrew Titman
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Gill Lancaster
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Huw Lloyd-Williams
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Colin Johnson
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohammed Abu Hilal
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Tom Armstrong
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Smith
- Department of Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Colin McKay
- Department of Surgery, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Ross Carter
- Department of Surgery, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Robert P Sutcliffe
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Bramhall
- Department of General Surgery, Wye Valley NHS Trust, Hereford, UK
| | - Hemant M Kocher
- Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - David Cunningham
- Gastrointestinal and Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Stephen P Pereira
- Institute for Liver and Digestive Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Brian Davidson
- Department of Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - David Chang
- Department of Surgery, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Saboor Khan
- Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ian Zealley
- Department of Surgery, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - Debashis Sarker
- Department of Oncology, King's College Hospital NHS Foundation Trust, London, UK
| | - Bilal Al Sarireh
- Department of Surgery, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Richard Charnley
- Department of Surgery, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dileep Lobo
- Faculty of Medicine and Life Sciences, University of Nottingham, Nottingham, UK
| | - Marianne Nicolson
- Department of Oncology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Christopher Halloran
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Michael Raraty
- Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Robert Sutton
- Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Sobhan Vinjamuri
- Department of Nuclear Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jonathan Evans
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Fiona Campbell
- Department of Pathology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jon Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Bal Sanghera
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK
| | - Wai-Lup Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK
| | - John P Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
16
|
Bell S, Wang H, Donnan P, Zealley I. SP201TIMING OF CONTRAST ENHANCED RADIOLOGICAL PROCEDURES AND RISK OF AKI IN POST-OPERATIVE PATIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx143.sp201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
17
|
Blundred R, Yap C, Corner C, Lawton P, Cassell O, McGarr C, Zealley I, Pirrie S, Bowden S, Babrah J, Rodwell S, Harwood C, Steven N. Designing a practice-changing trial for a rare cancer population: The Rational MCC trial of first definitive treatment for Merkel cell carcinoma. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
18
|
Choi S, Goh HL, Zealley I. An observational study of interruptions in the inpatient CT reporting room. Clin Radiol 2015. [DOI: 10.1016/j.crad.2015.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Dobbs NW, Budak M, Vinnicombe S, Zealley I. CT scanning in acute pancreatitis: do we comply with the national guideline and does it matter? Clin Radiol 2015. [DOI: 10.1016/j.crad.2015.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Abstract
In the treatment of severely injured patients, the term 'damage control radiology' has been used to parallel the modern concept of damage control surgery and the allied development of continuous damage control resuscitation from patient retrieval, through all transfers, to appropriate primary treatment. The aims of damage control radiology are (i) rapid identification of life-threatening injuries including bleeding sites, (ii) identification or exclusion of head or spinal injury, and (iii) prompt and accurate triage of patients to the operating theatre for thoracic, abdominal, or both surgeries or the angiography suite for endovascular haemorrhage control. If we are to achieve these aims, patients must have immediate access to modern multidetector computed tomography (MDCT) which is without doubt the most potent weapon in the diagnostic armamentarium. The most severely injured patients are those who have the most to benefit from early diagnosis and life-saving therapies. The traditional teaching that these patients should go immediately to surgery is challenged by technological developments in MDCT and recent clinical evidence.
Collapse
Affiliation(s)
- S Chakraverty
- Department of Radiology, Ninewells Hospital, Dundee DD1 9SY, UK
| | - I Zealley
- Department of Radiology, Ninewells Hospital, Dundee DD1 9SY, UK
| | - D Kessel
- Department of Radiology, St James University Hospital, Beckett St., Leeds LS9 7TF, UK
| |
Collapse
|
21
|
Taylor S, Mallett S, Bhatnagar G, Bloom S, Gupta A, Halligan S, Hamlin J, Hart A, Higginson A, Jacobs I, McCartney S, Morris S, Muirhead N, Murray C, Punwani S, Rodriguez-Justo M, Slater A, Travis S, Tolan D, Windsor A, Wylie P, Zealley I. METRIC (MREnterography or ulTRasound in Crohn's disease): a study protocol for a multicentre, non-randomised, single-arm, prospective comparison study of magnetic resonance enterography and small bowel ultrasound compared to a reference standard in those aged 16 and over. BMC Gastroenterol 2014; 14:142. [PMID: 25110044 PMCID: PMC4134460 DOI: 10.1186/1471-230x-14-142] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 12/13/2022] Open
Abstract
Background Crohn’s disease (CD) is a lifelong, relapsing and remitting inflammatory condition of the intestine. Medical imaging is crucial for diagnosis, phenotyping, activity assessment and detecting complications. Diverse small bowel imaging tests are available but a standard algorithm for deployment is lacking. Many hospitals employ tests that impart ionising radiation, of particular concern to this young patient population. Magnetic resonance enterography (MRE) and small bowel ultrasound (USS) are attractive options, as they do not use ionising radiation. However, their comparative diagnostic accuracy has not been compared in large head to head trials. METRIC aims to compare the diagnostic efficacy, therapeutic impact and cost effectiveness of MRE and USS in newly diagnosed and relapsing CD. Methods METRIC (ISRCTN03982913) is a multicentre, non-randomised, single-arm, prospective comparison study. Two patient cohorts will be recruited; those newly diagnosed with CD, and those with suspected relapse. Both will undergo MRE and USS in addition to other imaging tests performed as part of clinical care. Strict blinding protocols will be enforced for those interpreting MRE and USS. The Harvey Bradshaw index, C-reactive protein and faecal calprotectin will be collected at recruitment and 3 months, and patient experience will be assessed via questionnaires. A multidisciplinary consensus panel will assess all available clinical and imaging data up to 6 months after recruitment of each patient and will define the standard of reference for the presence, localisation and activity of disease against which the diagnostic accuracy of MRE and USS will be judged. Diagnostic impact of MRE and USS will be evaluated and cost effectiveness will be assessed. The primary outcome measure is the difference in per patient sensitivity between MRE and USS for the correct identification and localisation of small bowel CD. Discussion The trial is open at 5 centres with 46 patients recruited. We highlight the importance of stringent blinding protocols in order to delineate the true diagnostic accuracy of both imaging tests and discuss the difficulties of diagnostic accuracy studies in the absence of a single standard of reference, describing our approach utilising a consensus panel whilst minimising incorporation bias. Trial registration METRIC - ISRCTN03982913 – 05.11.13.
Collapse
Affiliation(s)
- Stuart Taylor
- Center for Medical Imaging, University College London, 250 Euston Rd, London NW1 2PG, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Parcell BJ, Ratnayake L, Zealley I, Phillips G. Development of a core team for the management of peripherally inserted central catheters. Infect Control Hosp Epidemiol 2013; 34:1328-9. [PMID: 24225623 DOI: 10.1086/673996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Benjamin J Parcell
- Medical Microbiology, Ninewells Hospital and Medical School, National Health Service Tayside, Dundee DD1 9SY, Scotland, United Kingdom
| | | | | | | |
Collapse
|
23
|
Corfield AR, Lees F, Zealley I, Houston G, Dickie S, Ward K, McGuffie C. Utility of a single early warning score in patients with sepsis in the emergency department. Emerg Med J 2013; 31:482-7. [DOI: 10.1136/emermed-2012-202186] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
24
|
Khorsandi M, Beatson K, Dougherty S, Zealley I, Kulli C. Interventional radiology in acute pancreatitis: friend or foe? JOP 2012; 13:91-93. [PMID: 22233956] [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] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 11/24/2011] [Indexed: 05/31/2023]
Abstract
CONTEXT Peripancreatic fluid collections are known complications of pancreatitis. The majority of fluid collections can be drained percutaneously under radiological guidance. Although radiological percutaneous drainage is regarded as safe, here it resulted in catastrophic haemorrhage from the colon due to an iatrogenic injury. CASE REPORT We present a case of a 70-year-old man who presented with acute alcohol-related severe necrotizing pancreatitis and an associated massive peripancreatic fluid collection. The drainage of this collection was attempted under computed tomography (CT) scan guidance. During the procedure the splenic artery and the splenic flexure of the colon were inadvertently damaged leading to life threatening per rectal bleeding requiring emergency angiographic embolisation of the splenic artery. CONCLUSION Radiological drainage of peripancreatic fluid collections is generally regarded as having lower rates of complications compared to surgical necrosectomy. However, in this case it leads to a life threatening per rectal bleed requiring emergency splenic artery embolisation.
Collapse
Affiliation(s)
- Maziar Khorsandi
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
| | | | | | | | | |
Collapse
|
25
|
Zealley I. Re: Phraseology of disk herniation: an inevitable revision. Really? Clin Radiol 2011; 66:389-90. [DOI: 10.1016/j.crad.2010.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 11/15/2010] [Accepted: 11/21/2010] [Indexed: 10/18/2022]
|
26
|
Ramkumar PG, Chakraverty S, Zealley I. Use of a peripherally inserted central catheter as a conduit for central venous access across thrombosed great veins. Cardiovasc Intervent Radiol 2009; 33:157-60. [PMID: 19841972 DOI: 10.1007/s00270-009-9723-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 09/14/2009] [Indexed: 11/26/2022]
Abstract
This report describes a technique of inserting an implantable venous access port (portacath) through a thrombosed and occluded vein employing a pre-existing peripherally inserted central catheter (PICC) as the route of access. The PICC was used as a conduit for venous access in a way that has not been described previously in the literature. This procedure was performed in a young patient with cystic fibrosis in an effort to prevent the use of his virgin contralateral veins, which might be used in the future.
Collapse
Affiliation(s)
- Prasad Guntur Ramkumar
- Department of Clinical Radiology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.
| | | | | |
Collapse
|
27
|
Abstract
Inferior vena cava (IVC) filters are increasingly used for prevention of life-threatening pulmonary emboli in patients who have contraindications to anticoagulation therapy. We report a case of the removal of a permanent IVC filter, which was inadvertently inserted due to an incorrect ultrasound report.
Collapse
|
28
|
Abstract
Retrievable inferior vena cava filters are being increasingly used for the prevention of life-threatening pulmonary emboli in patients who have temporary contraindications to anticoagulation therapy. We report two cases of failure to remove these devices.
Collapse
|
29
|
Marshall JK, Cawdron R, Zealley I, Riddell RH, Somers S, Irvine EJ. Prospective comparison of small bowel meal with pneumocolon versus ileo-colonoscopy for the diagnosis of ileal Crohn's disease. Am J Gastroenterol 2004; 99:1321-9. [PMID: 15233672 DOI: 10.1111/j.1572-0241.2004.30499.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Both endoscopy and barium radiography are used routinely to diagnose terminal ileal (TI) Crohn's disease (CD). A prospective study was undertaken to compare ileoscopy with biopsy to small bowel meal with pneumocolon (SBMP) in patients with suspected TI CD. METHODS A cohort of outpatients investigated for diarrhea with features of TI disease underwent SBMP followed by colonoscopy with ileal intubation and biopsy within 21 days. All results were reported in a standardized, sequential format to assign SBMP TI diagnoses by the duty radiologist and by dual reading with consensus, ileoscopy by the attending endoscopist, and ileoscopy with biopsy by a blinded panel of endoscopists and pathologists. Reference standard TI diagnoses were determined by a consensus panel with full access to medical records. RESULTS Among 120 subjects, the reference standard TI diagnosis was normal in 47 (39.1%), lymphoid nodular hyperplasia (LNH) in 24 (20.0%), CD in 48 (40.0%), and NSAID enteropathy in 1 (0.9%). Colonoscopy provided TI images and/or biopsies in 97 cases (80.8%), while SBMP provided TI images in 119 (99.1%). When ileoscopy with biopsy succeeded, its accuracy was similar to SBMP with dual reading (89.7%vs 89.9%, p = NS) but superior to SBMP if interpreted only by the duty radiologist (80.0%, p < 0.05). Biopsy improved the accuracy of ileoscopy, while dual reading improved that of SBMP. Both ileoscopy with biopsy and SBMP with dual reading are highly accurate for diagnosing TI CD. Choice of initial test should reflect local expertise and availability, and the likelihood of associated disease in the proximal small bowel or colon.
Collapse
Affiliation(s)
- John K Marshall
- Department of Medicine (Division of Gastroenterology), McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
30
|
Sumanac K, Zealley I, Fox BM, Rawlinson J, Salena B, Marshall JK, Stevenson GW, Hunt RH. Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc 2002; 56:190-4. [PMID: 12145595 DOI: 10.1016/s0016-5107(02)70176-4] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Abdominal pain after colonoscopy is a common, distressing symptom resulting from bowel distension by insufflated gas. CO(2), unlike air, is rapidly cleared from the colon by passive absorption. A commercially available CO(2) delivery system has only recently become available. The effects of CO(2) and air insufflation on residual bowel gas and postprocedure pain were compared. METHODS One hundred patients were randomized to undergo colonoscopy with insufflation of air (n = 51) or CO(2) (n = 49) by means of a regulator; 97 patients completed the study. Patients with active GI bleeding, inflammatory bowel disease, or previous colectomy were excluded. Pain scores (ordinal scale: 0 = none, to 5 = extreme) were recorded immediately after colonoscopy and at 1, 6, and 24 hours. Residual colonic gas was evaluated on abdominal radiographs at 1 hour. RESULTS Residual colonic gas and postprocedural pain at 1 and 6 hours were significantly less in the CO(2) group. 71% of patients insufflated with room air had colonic distension in excess of 6 cm versus 4% for those in the CO(2) group. 94% of patients insufflated with CO(2) had minimal colonic gas versus 2% in whom air was used (p < 0.0001). Of patients insufflated with air, 45% and 31% had pain at, respectively, 1 hour and 6 hours, versus 7% and 9%, respectively, for those insufflated with CO(2) (respectively, p < 0.0001 and p < O.02). No complications resulted from use of the CO(2) delivery system. CONCLUSIONS Insufflation of CO(2) rather than air significantly reduces abdominal pain and bowel distension after colonoscopy. CO(2) may be insufflated safely and effectively with the new CO(2) delivery system.
Collapse
Affiliation(s)
- Katica Sumanac
- McMaster University Medical Center, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Sumanac K, Zealley I, Fox BM, Rawlinson J, Salena B, Marshall JK, Stevenson GW, Hunt RH. Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc 2002. [PMID: 12145595 DOI: 10.1067/mge.2002.126391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Abdominal pain after colonoscopy is a common, distressing symptom resulting from bowel distension by insufflated gas. CO(2), unlike air, is rapidly cleared from the colon by passive absorption. A commercially available CO(2) delivery system has only recently become available. The effects of CO(2) and air insufflation on residual bowel gas and postprocedure pain were compared. METHODS One hundred patients were randomized to undergo colonoscopy with insufflation of air (n = 51) or CO(2) (n = 49) by means of a regulator; 97 patients completed the study. Patients with active GI bleeding, inflammatory bowel disease, or previous colectomy were excluded. Pain scores (ordinal scale: 0 = none, to 5 = extreme) were recorded immediately after colonoscopy and at 1, 6, and 24 hours. Residual colonic gas was evaluated on abdominal radiographs at 1 hour. RESULTS Residual colonic gas and postprocedural pain at 1 and 6 hours were significantly less in the CO(2) group. 71% of patients insufflated with room air had colonic distension in excess of 6 cm versus 4% for those in the CO(2) group. 94% of patients insufflated with CO(2) had minimal colonic gas versus 2% in whom air was used (p < 0.0001). Of patients insufflated with air, 45% and 31% had pain at, respectively, 1 hour and 6 hours, versus 7% and 9%, respectively, for those insufflated with CO(2) (respectively, p < 0.0001 and p < O.02). No complications resulted from use of the CO(2) delivery system. CONCLUSIONS Insufflation of CO(2) rather than air significantly reduces abdominal pain and bowel distension after colonoscopy. CO(2) may be insufflated safely and effectively with the new CO(2) delivery system.
Collapse
Affiliation(s)
- Katica Sumanac
- McMaster University Medical Center, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|