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Light A, Mayor N, Cullen E, Kirkham A, Padhani AR, Arya M, Bomers JGR, Dudderidge T, Ehdaie B, Freeman A, Guillaumier S, Hindley R, Lakhani A, Pendse D, Punwani S, Rastinehad AR, Rouvière O, Sanchez-Salas R, Schoots IG, Sokhi HK, Tam H, Tempany CM, Valerio M, Verma S, Villeirs G, van der Meulen J, Ahmed HU, Shah TT. The Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET): A Systematic Review and International Consensus Recommendations. Eur Urol 2024; 85:466-482. [PMID: 38519280 DOI: 10.1016/j.eururo.2024.02.001] [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: 05/03/2023] [Revised: 11/29/2023] [Accepted: 02/04/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Magnetic resonance imaging (MRI) can detect recurrences after focal therapy for prostate cancer but there is no robust guidance regarding its use. Our objective was to produce consensus recommendations on MRI acquisition, interpretation, and reporting after focal therapy. METHODS A systematic review was performed in July 2022 to develop consensus statements. A two-round consensus exercise was then performed, with a consensus meeting in January 2023, during which 329 statements were scored by 23 panellists from Europe and North America spanning urology, radiology, and pathology with experience across eight focal therapy modalities. Using RAND Corporation/University of California-Los Angeles methodology, the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) were based on consensus for statements scored with agreement or disagreement. KEY FINDINGS AND LIMITATIONS In total, 73 studies were included in the review. All 20 studies (100%) reporting suspicious imaging features cited focal contrast enhancement as suspicious for cancer recurrence. Of 31 studies reporting MRI assessment criteria, the Prostate Imaging-Reporting and Data System (PI-RADS) score was the scheme used most often (20 studies; 65%), followed by a 5-point Likert score (six studies; 19%). For the consensus exercise, consensus for statements scored with agreement or disagreement increased from 227 of 295 statements (76.9%) in round one to 270 of 329 statements (82.1%) in round two. Key recommendations include performing routine MRI at 12 mo using a multiparametric protocol compliant with PI-RADS version 2.1 standards. PI-RADS category scores for assessing recurrence within the ablation zone should be avoided. An alternative 5-point scoring system is presented that includes a major dynamic contrast enhancement (DCE) sequence and joint minor diffusion-weighted imaging and T2-weighted sequences. For the DCE sequence, focal nodular strong early enhancement was the most suspicious imaging finding. A structured minimum reporting data set and minimum reporting standards for studies detailing MRI data after focal therapy are presented. CONCLUSIONS AND CLINICAL IMPLICATIONS The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting. PATIENT SUMMARY Magnetic resonance imaging (MRI) scans can detect recurrent of prostate cancer after focal treatments, but there is a lack of guidance on MRI use for this purpose. We report new expert recommendations that may improve practice.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nikhil Mayor
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Cullen
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Manit Arya
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joyce G R Bomers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Behfar Ehdaie
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Richard Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Amish Lakhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Douglas Pendse
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | | | - Olivier Rouvière
- Department of Vascular and Urinary Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine, Université de Lyon, Lyon, France
| | | | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Heminder K Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Henry Tam
- Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Massimo Valerio
- Department of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Rao M, Pakpoor J, Pendse D, von Stempel C. Severe emphysematous pyelonephritis as a complication of klebsiella pneumonia and uncontrolled diabetes mellitus. BJR Case Rep 2023; 9:20220158. [PMID: 37928706 PMCID: PMC10621577 DOI: 10.1259/bjrcr.20220158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023] Open
Abstract
A female in her 40s, with poorly controlled Type I diabetes mellitus, was brought to our tertiary hospital by ambulance after being found drowsy. Six days prior, she had self-discharged from the Intensive Care Unit whilst being treated for a Klebsiella pneumonia. At re-admission, she had an acute kidney injury with abdominal pain and clinical features of sepsis. Her presentation was attributed to ongoing Klebsiella pneumoniae infection; however, a chest radiograph showed marked improvement of pulmonary consolidations and an unusual subdiaphragmatic gas pattern. A CT scan demonstrated severe bilateral emphysematous pyelonephritis. The patient was unfit for bilateral nephrectomy and was medically managed in the Intensive Care Unit for 41 days, before transfer to a specialist renal unit for life-long haemodialysis. This case highlights the importance of considering emphysematous pyelonephritis in patients presenting with uncontrolled diabetes mellitus and acute kidney injury and/or infection, the role of imaging in its diagnosis, and the challenges of complex social circumstances in health management.
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Affiliation(s)
- Mihir Rao
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Jina Pakpoor
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Douglas Pendse
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Conrad von Stempel
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Stavrinides V, Eksi E, Finn R, Texeira-Mendes L, Rana S, Trahearn N, Grey A, Giganti F, Huet E, Fiard G, Freeman A, Haider A, Allen C, Kirkham A, Cole AP, Collins T, Pendse D, Dickinson L, Punwani S, Pashayan N, Emberton M, Moore CM, Orczyk C. Magnetic Resonance Imaging Follow-up of Targeted Biopsy-negative Prostate Lesions. Eur Urol Focus 2023; 9:781-787. [PMID: 37031096 DOI: 10.1016/j.euf.2023.03.011] [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: 11/22/2022] [Revised: 03/03/2023] [Accepted: 03/23/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The optimal radiological follow-up of prostate lesions negative on magnetic resonance imaging (MRI)-targeted biopsy (MRI-TB) is yet to be optimised. OBJECTIVE To present medium-term radiological and clinical follow-up of biopsy-negative lesions. DESIGN, SETTING, AND PARTICIPANTS The records for men who underwent multiparametric MRI at the UCLH one-stop clinic for suspected prostate cancer between September 2017 and March 2020 were reviewed (n = 1199). Patients with Likert 4 or 5 lesions were considered (n = 495), and those with a subsequent negative MRI-TB comprised the final study population (n = 91). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline and follow-up MRI and biopsy data (including prostate-specific antigen [PSA], prostate volume, radiological scores, and presence of any noncancerous pathology) were extracted from reports. The last follow-up date was the date of the last test or review in clinic. RESULTS AND LIMITATIONS Median follow-up was 1.8 yr (656 d, interquartile range [IQR] 359-1008). At baseline, the median age was 65.4 yr (IQR 60.7-70.0), median PSA was 7.1 ng/ml (IQR 4.7-10.0), median prostate volume was 54 ml (IQR 39.5-75.0), and median PSA density (PSAD) was 0.13 ng/ml2 (IQR 0.09-0.18). Eighty-six men (95%) had Likert 4 lesions, while the remaining five (5%) had Likert 5 lesions. Only 21 men (23%) had a single lesion; most had at least two. Atrophy was the most prevalent pathology on MRI-TB, present in 64 men (74%), and followed by acute inflammation in 42 (46%), prostatic intraepithelial neoplasia in 33 (36%), chronic inflammation in 18 (20%), atypia in 13 (14%), and granulomatous inflammation in three (3%). Fifty-eight men had a second MRI study (median 376 d, IQR 361-412). At the second MRI, median PSAD decreased to 0.11 ng/ml2 (IQR 0.08-0.18). A Likert 4 or 5 score persisted only in five men (9%); 40 men (69%) were scored Likert 3, while the remaining 13 (22%) were scored Likert 2 (no lesion). Of 45 men with a Likert ≥3 score, most only had one lesion at the second MRI (28 men; 62%). Of six men with repeat MRI-TB during the study period, two were subsequently diagnosed with prostate cancer and both had persistent Likert 4 scores (at baseline and at least one follow-up MRI). CONCLUSIONS Most biopsy-negative MRI lesions in the prostate resolve over time, but any persistent lesions should be closely monitored. PATIENT SUMMARY Lesions in the prostate detected via magnetic resonance imaging (MRI) scans that are negative for cancer on biopsy usually resolve. Repeat MRI can indicate persistent lesions that might need a second biopsy.
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Affiliation(s)
- Vasilis Stavrinides
- Division of Surgery & Interventional Science, University College London, London, UK; The Alan Turing Institute, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Ece Eksi
- CEDAR, Knight Cancer Institute, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Ron Finn
- Division of Surgery & Interventional Science, University College London, London, UK
| | | | - Sarina Rana
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Alistair Grey
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eric Huet
- TRePCa, Université Paris Est-Créteil, Créteil, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble, France
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alexander P Cole
- Division of Urological Surgery, Harvard Medical School, Boston, MA, USA
| | - Tom Collins
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Douglas Pendse
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology & Health, University College London, London, UK
| | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Gaze MN, Smeulders N, Ackwerh R, Allen C, Bal N, Boutros M, Cho A, Eminowicz G, Gill E, Fittall MW, Humphries PD, Lim P, Mushtaq I, Nguyen T, Peet C, Pendse D, Polhill S, Rees H, Sands G, Shankar A, Slater O, Sullivan T, Hoskin PJ. A National Referral Service for Paediatric Brachytherapy: An Evolving Practice and Outcomes Over 13 Years. Clin Oncol (R Coll Radiol) 2023; 35:237-244. [PMID: 36588012 DOI: 10.1016/j.clon.2022.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 01/01/2023]
Abstract
AIMS Most children requiring radiotherapy receive external beam treatment and few have tumours suitable for brachytherapy. No paediatric radiotherapy centre will treat enough patients from its own normal catchment population for expertise in brachytherapy to be developed and sustained. Following discussion and agreement in the national paediatric radiotherapy group, a service for paediatric brachytherapy in the UK has been developed. We report the process that has evolved over more than 10 years, with survival and functional outcome results. MATERIALS AND METHODS Since 2009, potential patients have been referred to the central paediatric oncology multidisciplinary team meeting, where imaging, pathology and treatment options are discussed. Since 2013, the National Soft Tissue Sarcoma Advisory Panel has also reviewed most patients, with the principal aim of advising on the most suitable primary tumour management for complex patients. Clinical assessment and examination under anaesthetic with biopsies may be undertaken to confirm the appropriateness of brachytherapy, either alone or following conservative surgery. Fractionated high dose rate brachytherapy was delivered to a computed tomography planned volume after implantation of catheters under ultrasound imaging guidance. Since 2019, follow-up has been in a dedicated multidisciplinary clinic. RESULTS From 2009 to 2021 inclusive, 35 patients (16 female, 19 male, aged 8 months to 17 years 6 months) have been treated. Histology was soft-tissue sarcoma in 33 patients and carcinoma in two. The treated site was pelvic in 31 patients and head and neck in four. With a median follow-up of 5 years, the local control and overall survival rates are 100%. Complications have been few, and functional outcome is good. CONCLUSION Brachytherapy is effective for selected paediatric patients, resulting in excellent tumour control and good functional results. It is feasible to deliver paediatric brachytherapy at a single centre within a national referral service.
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Affiliation(s)
- M N Gaze
- University College London Hospitals NHS Foundation Trust, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - N Smeulders
- University College London Hospitals NHS Foundation Trust, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - R Ackwerh
- University College London Hospitals NHS Foundation Trust, London, UK
| | - C Allen
- University College London Hospitals NHS Foundation Trust, London, UK
| | - N Bal
- University College London Hospitals NHS Foundation Trust, London, UK
| | - M Boutros
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A Cho
- University College London Hospitals NHS Foundation Trust, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - G Eminowicz
- University College London Hospitals NHS Foundation Trust, London, UK
| | - E Gill
- University College London Hospitals NHS Foundation Trust, London, UK
| | - M W Fittall
- University College London Hospitals NHS Foundation Trust, London, UK
| | - P D Humphries
- University College London Hospitals NHS Foundation Trust, London, UK
| | - P Lim
- University College London Hospitals NHS Foundation Trust, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - I Mushtaq
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - T Nguyen
- University College London Hospitals NHS Foundation Trust, London, UK
| | - C Peet
- University College London Hospitals NHS Foundation Trust, London, UK
| | - D Pendse
- University College London Hospitals NHS Foundation Trust, London, UK
| | - S Polhill
- University College London Hospitals NHS Foundation Trust, London, UK
| | - H Rees
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - G Sands
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A Shankar
- University College London Hospitals NHS Foundation Trust, London, UK
| | - O Slater
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - T Sullivan
- University College London Hospitals NHS Foundation Trust, London, UK
| | - P J Hoskin
- University College London Hospitals NHS Foundation Trust, London, UK
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Gaze M, Smeulders N, Sands G, Sullivan T, Bal N, Gill E, Peet C, Slater O, Rees H, Nguyen T, Humphries P, Pendse D, Allen C, Polhill S, Ackwerh R, Lim P, Eminowicz G, Hoskin P. Establishment of a UK national referral service for paediatric brachytherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.028] [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: 11/16/2022]
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Stancliffe M, Davda R, Payne H, Mitra A, McGovern U, Pendse D. PO-1387 Diffusion MRI as an early response marker in management of high-risk non-metastatic prostate cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07838-5] [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]
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Stancliffe M, Pendse D, Payne H, Mitra A, McGovern U, Davda R. Early Prostate-specific Antigen Response in Men Undergoing Oncological Management for High-Risk Non-metastatic Prostate Cancer. Clin Oncol (R Coll Radiol) 2020; 32:478-479. [DOI: 10.1016/j.clon.2020.03.003] [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: 01/14/2020] [Revised: 02/19/2020] [Accepted: 03/11/2020] [Indexed: 11/30/2022]
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Odudu A, Nery F, Harteveld AA, Evans RG, Pendse D, Buchanan CE, Francis ST, Fernández-Seara MA. Arterial spin labelling MRI to measure renal perfusion: a systematic review and statement paper. Nephrol Dial Transplant 2018; 33:ii15-ii21. [PMID: 30137581 PMCID: PMC6106644 DOI: 10.1093/ndt/gfy180] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/15/2018] [Indexed: 01/03/2023] Open
Abstract
Renal perfusion provides the driving pressure for glomerular filtration and delivers the oxygen and nutrients to fuel solute reabsorption. Renal ischaemia is a major mechanism in acute kidney injury and may promote the progression of chronic kidney disease. Thus, quantifying renal tissue perfusion is critically important for both clinicians and physiologists. Current reference techniques for assessing renal tissue perfusion have significant limitations. Arterial spin labelling (ASL) is a magnetic resonance imaging (MRI) technique that uses magnetic labelling of water in arterial blood as an endogenous tracer to generate maps of absolute regional perfusion without requiring exogenous contrast. The technique holds enormous potential for clinical use but remains restricted to research settings. This statement paper from the PARENCHIMA network briefly outlines the ASL technique and reviews renal perfusion data in 53 studies published in English through January 2018. Renal perfusion by ASL has been validated against reference methods and has good reproducibility. Renal perfusion by ASL reduces with age and excretory function. Technical advancements mean that a renal ASL study can acquire a whole kidney perfusion measurement in less than 5-10 min. The short acquisition time permits combination with other MRI techniques that might inform drug mechanisms and renal physiology. The flexibility of renal ASL has yielded several variants of the technique, but there are limited data comparing these approaches. We make recommendations for acquiring and reporting renal ASL data and outline the knowledge gaps that future research should address.
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Affiliation(s)
- Aghogho Odudu
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fabio Nery
- Developmental Imaging & Biophysics Section, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roger G Evans
- Department of Physiology, Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Douglas Pendse
- Centre for Medical Imaging, University College London, London, UK
| | - Charlotte E Buchanan
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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Walker-Samuel S, Roberts TA, Ramasawmy R, Burrell JS, Johnson SP, Siow BM, Richardson S, Gonçalves MR, Pendse D, Robinson SP, Pedley RB, Lythgoe MF. Investigating Low-Velocity Fluid Flow in Tumors with Convection-MRI. Cancer Res 2018; 78:1859-1872. [PMID: 29317434 PMCID: PMC6298581 DOI: 10.1158/0008-5472.can-17-1546] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 05/26/2017] [Revised: 08/18/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023]
Abstract
Several distinct fluid flow phenomena occur in solid tumors, including intravascular blood flow and interstitial convection. Interstitial fluid pressure is often raised in solid tumors, which can limit drug delivery. To probe low-velocity flow in tumors resulting from raised interstitial fluid pressure, we developed a novel MRI technique named convection-MRI, which uses a phase-contrast acquisition with a dual-inversion vascular nulling preparation to separate intra- and extravascular flow. Here, we report the results of experiments in flow phantoms, numerical simulations, and tumor xenograft models to investigate the technical feasibility of convection-MRI. We observed a significant correlation between estimates of effective fluid pressure from convection-MRI with gold-standard, invasive measurements of interstitial fluid pressure in mouse models of human colorectal carcinoma. Our results show how convection-MRI can provide insights into the growth and responsiveness to vascular-targeting therapy in colorectal cancers.Significance: A noninvasive method for measuring low-velocity fluid flow caused by raised fluid pressure can be used to assess changes caused by therapy. Cancer Res; 78(7); 1859-72. ©2018 AACR.
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Affiliation(s)
- Simon Walker-Samuel
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK.
| | - Thomas A Roberts
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | - Rajiv Ramasawmy
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | - Jake S Burrell
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, UK
| | | | - Bernard M Siow
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | - Simon Richardson
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | - Miguel R Gonçalves
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
| | | | - Simon P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, UK
| | | | - Mark F Lythgoe
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, London, UK
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Skipworth JRA, Morkane C, Raptis DA, Kennedy L, Johal K, Pendse D, Brennand DJ, Olde Damink S, Malago M, Shankar A, Imber C. Coil migration--a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms. Ann R Coll Surg Engl 2011; 93:e19-23. [PMID: 21944789 DOI: 10.1308/003588411x13008844298652] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION We describe a case of metallic, angiographic coil migration, following radiological exclusion of a gastroduodenal artery pseudoaneurysm secondary to chronic pancreatitis. PATIENTS AND METHODS A 55-year-old man presented to the out-patient clinic with chronic, intermittent, post-prandial, abdominal pain, associated with nausea, vomiting and weight loss. He was known to have chronic pancreatitis and liver disease secondary to alcohol abuse and previously underwent angiographic exclusion of a gastroduodenal artery pseudoaneurysm. During subsequent radiological and endoscopic investigation, an endovascular coil was discovered in the gastric pylorus, associated with ulceration and cavitation. This patient was managed conservatively and enterally fed via naso-jejunal catheter endoscopically placed past the site of the migrated coil. This patient is currently awaiting biliary bypass surgery for chronic pancreatitis, and definitive coil removal will occur concurrently. CONCLUSIONS Literature review reveals that this report is only the eighth to describe coil migration following embolisation of a visceral artery pseudoaneurysm or aneurysm. Endovascular embolisation of pseudoaneurysms and aneurysms is generally safe and effective. More common complications of visceral artery embolisation include rebleeding, pseudoaneurysm reformation and pancreatitis.
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Affiliation(s)
- J R A Skipworth
- Department of Hepatopancreaticobiliary Surgery, University College London Hospital, UK.
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Arumainayagam N, Moore C, Sahu M, Govindaraju S, Pendse D, Ahmed H, Mosse A, Allen C, Bown S, Emberton M. MP-16.13: Vascular-Targeted Photodynamic Therapy Using WST11 in Patients with Localized Prostate Cancer. Urology 2009. [DOI: 10.1016/j.urology.2009.07.827] [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: 12/01/2022]
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Ahmed HU, Stevens D, Barbouti O, Zacharakis E, Illing RO, Pendse D, Allen C, Freeman A, Emberton M. PROSTATE CANCER RISK STRATIFICATION AND CANCER MAPPING – TEMPLATE TRANSPERINEAL PROSTATE MAPPING BIOPSIES. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60444-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ahmed H, Stevens D, Barbouti O, Zacharakis E, Pendse D, Illing R, Allen C, Freeman A, Emberton M. THE ROLE OF TRANSPERINEAL TEMPLATE PROSTATE MAPPING BIOPSIES IN RISK-STRATIFYING MEN WITH LOCALISED PROSTATE CANCER. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1569-9056(08)60810-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pendse D, Allen C, Moore C, Bown S, Emberton M. 1694: Dynamic Contrast-Enhanced Magnetic Resonance Imaging after Vascular Targeted Photodynamic Therapy with Tookad in the Primary Treatment of Prostate Cancer. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31882-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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