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Choida V, Bray TJP, van Vucht N, Abbasi MA, Bainbridge AP, Parry T, Sen D, Mallett S, Ciurtin C, Hall-Craggs MA. A simple, clinically usable whole-body MRI system of joint assessment in adolescents and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2024:keae117. [PMID: 38426363 DOI: 10.1093/rheumatology/keae117] [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: 09/22/2023] [Revised: 12/11/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES To introduce and evaluate a simple method for assessing joint inflammation and structural damage on whole-body MRI (WBMRI) in juvenile idiopathic arthritis (JIA), which is usable in clinical practice. METHODS The proposed system utilises post-contrast Dixon WBMRI scans. Joints are assessed for synovitis (grade 0-2) and structural damage (present/absent) at 81 sites. The synovitis grading is based on features including above-normal intensity synovial enhancement, synovial hypertrophy, joint effusion, subarticular bone marrow oedema and peri-articular soft tissue oedema.This system was evaluated in a prospective study of 60 young people (47 patients with JIA and 13 controls with non-inflammatory musculoskeletal pain) who underwent a WBMRI. Three readers (blinded to diagnosis) independently reviewed all images and re-reviewed 20 individual scans. The intra- and inter-reader overall agreement (OA) and the intra- and inter-reader Gwet's agreement coefficients 2 (GAC2) were measured for the detection of a) participants with ≥1 joint with inflammation or structural damage and b) joint inflammation or structural damage for each joint. RESULTS The inter-reader OA for detecting patients with ≥1 joint with inflammation, defined as grade 2 synovitis (G2), and ≥1 joint with structural damage were 80% and 73%, respectively. The intra-reader OA for readers 1-3 were 80-90% and 75-90% respectively. The inter-reader OA and GAC2 for joint inflammation (G2) at each joint were both ≥85% for all joints but were lower if grade 1 synovitis was included as positive. CONCLUSION The intra- and inter-reader agreements of this WBMRI assessment system are adequate for assessing objective joint inflammation and damage in JIA.
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Affiliation(s)
- Varvara Choida
- Centre for Medical Imaging, University College London, University College London, London, UK
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, University College London, London, UK
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Niels van Vucht
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maaz Ali Abbasi
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alan P Bainbridge
- Centre for Medical Imaging, University College London, University College London, London, UK
- Department of Medical Physics, University College Hospitals Trust, London, UK
| | - Thomas Parry
- Centre for Medical Imaging, University College London, University College London, London, UK
| | - Debajit Sen
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, University College London, London, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Margaret A Hall-Craggs
- Centre for Medical Imaging, University College London, University College London, London, UK
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
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Bray TJP, Eddison J, Hamilton J, Webb D, Bennett A, Machado PM, Gaffney K, Sengupta R, Hall-Craggs MA, Marzo-Ortega H. Evaluation of the current use of MRI to aid the diagnosis of axial spondyloarthritis in the UK: results from a freedom of information request. Clin Radiol 2024; 79:107-116. [PMID: 37968226 DOI: 10.1016/j.crad.2023.10.009] [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] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/17/2023]
Abstract
AIM To evaluate the impact of recommendations from the 2019 consensus exercise conducted by radiologists and rheumatologists on the use of magnetic resonance imaging (MRI) to investigate axial spondyloarthritis (axSpA) in clinical practice. MATERIALS AND METHODS A freedom of information (FOI) request was used to assess the use of MRI in the diagnosis of axSpA and radiologists' awareness of the 2019 guidance across all NHS Trusts and Health Boards in the UK, including England, Scotland, Northern Ireland, and Wales. RESULTS The FOI request was sent to 150 Trusts/Health Boards, and 93 full responses were received. Of the 93 respondents (97%), 90 reported familiarity with the term axSpA and 70/93 (75%) reported familiarity with the 2019 recommendations. Awareness of recommendations regarding specific MRI features supportive of the diagnosis of axSpA was 74/93 (80%) for the sacroiliac joints (SIJs) and 66/93 (71%) for the spine. The median wait for MRI acquisition was 2-3 months. Fifty-two of the 93 (56%) reported at least some outsourcing of axSpA MRI (33%/29% for specialist/non-specialist outsourcing respectively); 32/93 (34%) reported some scans being reported in-house by non-musculoskeletal radiologists. CONCLUSION There have been several positive developments in the understanding and use of MRI for the diagnosis of axSpA in the UK since the 2017 survey, although substantial scope for further improvement remains. Several new challenges have also emerged, including the increase in waiting times, reliance on outsourcing, and the reporting of MRI by non-musculoskeletal radiologists.
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Affiliation(s)
- T J P Bray
- Centre for Medical Imaging, University College London, London, UK; Department of Imaging, University College London Hospital, London, UK.
| | - J Eddison
- National Axial Spondyloarthritis Society, London, UK
| | - J Hamilton
- National Axial Spondyloarthritis Society, London, UK
| | - D Webb
- National Axial Spondyloarthritis Society, London, UK
| | - A Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Unit, Loughborough, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - P M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
| | - K Gaffney
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - R Sengupta
- Royal National Hospital for Rheumatic Diseases and University of Bath, Bath, UK
| | - M A Hall-Craggs
- Centre for Medical Imaging, University College London, London, UK; Department of Imaging, University College London Hospital, London, UK
| | - H Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Choida V, Bray TJP, van Vucht N, Abbasi MA, Bainbridge A, Parry T, Sen D, Mallett S, Ciurtin C, Hall-Craggs MA. Detection of inflammation by whole-body MRI in young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2024:keae039. [PMID: 38244609 DOI: 10.1093/rheumatology/keae039] [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: 09/22/2023] [Revised: 11/21/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES To assess the frequency of joint inflammation detected by whole-body MRI (WBMRI) in young people (YP) with JIA and controls, and to determine the relationship between WBMRI-detected inflammation and clinical findings. METHODS YP aged 14-24 years, with JIA (patients) or arthralgia without JIA (controls), recruited from one centre, underwent a WBMRI scan after formal clinical assessment. Consensus between at least two of the three independent radiologists was required to define inflammation and damage on WBMRI, according to predefined criteria. YP with JIA were deemed clinically active as per accepted definitions. The proportions of YP with positive WBMRI scans for joint inflammation (≥1 inflamed joint) as well as serum biomarkers were compared between active vs inactive JIA patients and controls. RESULTS Forty-seven YP with JIA (25 active and 22 inactive patients) and 13 controls were included. WBMRI detected joint inflammation in 60% (28/47) patients with JIA vs 15% (2/13) controls (difference: 44%, 95% CI 20%, 68%). More active than inactive JIA patients had WBMRI-detected inflammation [76% (19/25) vs 41% (9/22), difference: 35% (95% CI 9%, 62%)], and this was associated with a specific biomarker signature. WBMRI identified inflammation in ≥ 1 clinically inactive joint in 23/47 (49%) patients (14/25 active vs 9/22 inactive JIA patients). CONCLUSIONS WBMRI's validity in joint assessment was demonstrated by the higher frequency of inflammation in JIA patients vs controls, and in active vs inactive JIA patients. WBMRI found unsuspected joint inflammation in 49% YP with JIA, which needs further investigation of potential clinical implications.
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Affiliation(s)
- Varvara Choida
- Centre for Medical Imaging, University College London, University College London, London, UK
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, University College London, London, UK
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Niels van Vucht
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maaz Ali Abbasi
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alan Bainbridge
- Centre for Medical Imaging, University College London, University College London, London, UK
- Department of Medical Physics, University College Hospitals Trust, London, UK
| | - Thomas Parry
- Centre for Medical Imaging, University College London, University College London, London, UK
| | - Debajit Sen
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, University College London, London, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Margaret A Hall-Craggs
- Centre for Medical Imaging, University College London, University College London, London, UK
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
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Jones A, Bray TJP, Sakai NS, Bainbridge AJP, Ciurtin C, Hall-Craggs MA. Measuring response to treatment in axial spondyloarthritis using quantitative imaging biomarkers: a prospective observational cohort study. Br J Radiol 2023; 96:20220530. [PMID: 37751217 PMCID: PMC10646635 DOI: 10.1259/bjr.20220530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Objective assessments of disease activity and response to treatment in axial spondyloarthritis (axSpA) remain a challenge; quantitative imaging biomarkers (QIBs) of inflammation could enhance assessments of disease activity and therapeutic response. We aimed to determine the responsiveness of QIBs obtained from diffusion-weighted imaging (DW-MRI) and chemical shift-encoded MRI (CSE-MRI) using the partially automated Bone Edema and Adiposity Characterisation with Histograms (BEACH) software tool in axSpA patients undergoing biologic therapy. METHODS We conducted a prospective longitudinal cohort study, including 30 patients with axSpA undergoing biologic therapy. Patients were scanned before and after biologic therapy using conventional MRI, DWI and CSE-MRI at 3T. Apparent diffusion coefficient (ADC) and proton density fat fraction (PDFF) were assessed using the BEACH tool (https://github.com/TJPBray/BEACH), and conventional MR images were assessed using established visual scoring methods by expert radiologists. Responsiveness - the ability of the MRI measurements to capture changes in disease occurring as a result of biologic therapy - was assessed using the standardized response mean (SRM). Inter-reader reliability of the ADC and PDFF maps was assessed using Bland-Altman limits of agreement analysis and the intraclass correlation coefficient. RESULTS Responsiveness to therapy was moderate for ADC-based parameters (SRM 0.50) and comparable to established visual scoring methods for bone marrow oedema (SRM 0.53). Interobserver variability was lower for QIBs compared with conventional visual scores methods. CONCLUSIONS QIBs measured using the BEACH tool are sensitive to changes in inflammation in axSpA following biologic therapy, with similar responsiveness and lower interobserver variability to visual scoring by expert radiologists. ADVANCES IN KNOWLEDGE QIBs measured using the partially automated BEACH tool offer an objective measure of response to biologic therapy in axSpA.
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Affiliation(s)
- Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Timothy JP Bray
- Centre for Medical Imaging, University College London, London, UK
| | - Naomi S Sakai
- Centre for Medical Imaging, University College London, London, UK
| | - Alan JP Bainbridge
- Department of Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
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Chaiyasoot K, Sakai NS, Zakeri R, Makaronidis J, Crisóstomo L, Alves MG, Gan W, Firman C, Jassil FC, Hall-Craggs MA, Taylor SA, Batterham RL. Weight-loss Independent Clinical and Metabolic Biomarkers Associated with Type 2 Diabetes Remission Post-bariatric/metabolic Surgery. Obes Surg 2023; 33:3988-3998. [PMID: 37910328 PMCID: PMC10687127 DOI: 10.1007/s11695-023-06905-8] [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: 09/10/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Remission of type 2 diabetes (T2D) can be achieved by many, but not all, people following bariatric/metabolic surgery. The mechanisms underlying T2D remission remain incompletely understood. This observational study aimed to identify novel weight-loss independent clinical, metabolic and genetic factors that associate with T2D remission using comprehensive phenotyping. MATERIALS AND METHODS Ten patients without T2D remission (non-remitters) were matched to 10 patients with T2D remission (remitters) for age, sex, type of surgery, body weight, BMI, post-operative weight loss, duration from surgery and duration of T2D. Detailed body composition assessed using magnetic resonance imaging, gut hormones, serum metabolomics, insulin sensitivity, and genetic risk scores for T2D and anthropometric traits were assessed. RESULTS Remitters had significantly greater β-cell function and circulating acyl ghrelin levels, but lower visceral adipose tissue (VAT): subcutaneous adipose tissue (SAT) ratio than non-remitters. Branched-chain amino acids (BCAAs) and VLDL particle size were the most discriminant metabolites between groups. A significant positive correlation between, VAT area, VAT:SAT ratio and circulating levels of BCAAs was observed, whereas a significant negative correlation between BCAAs and β-cell function was revealed. CONCLUSION We highlight a potentially novel relationship between VAT and BCAAs, which may play a role in glucoregulatory control. Improvement in β-cell function, and the role ghrelin plays in its recovery, is likely another key factor influencing T2D remission post-surgery. These findings suggest that adjunctive approaches that target VAT loss and restoration of BCAA metabolism might achieve higher rates of long-term T2D remission post-surgery.
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Affiliation(s)
- Kusuma Chaiyasoot
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- Division of Nutrition, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- The Siriraj Center of Research Excellence for Diabetes and Obesity (SiCORE-DO), Mahidol University, Bangkok, Thailand
| | | | - Roxanna Zakeri
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
| | - Janine Makaronidis
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Luís Crisóstomo
- Department of Immunophysiology and Pharmacology, ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Marco G Alves
- Department of Immunophysiology and Pharmacology, ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Wei Gan
- Genetics Department, Novo Nordisk Research Centre Oxford, Innovation Building, Old Road Campus, Headington, OX37LQ, UK
| | - Chloe Firman
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
| | - Friedrich C Jassil
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
| | - Margaret A Hall-Craggs
- UCL Centre for Medical Imaging, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Stuart A Taylor
- UCL Centre for Medical Imaging, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK.
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK.
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Gollifer RM, Bray TJP, Kruezi A, Markus J, Choida V, Hall-Craggs MA, Bainbridge A. A multiparametric alternative to short inversion-time inversion recovery for imaging inflammation: T 2water and fat fraction measurement using chemical shift-encoded turbo spin-echo MRI. Magn Reson Med 2023. [PMID: 37246478 DOI: 10.1002/mrm.29689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Short-inversion-time inversion-recovery MRI is used widely for imaging bone and soft-tissue inflammation in rheumatic inflammatory diseases, but there is no widely available quantitative equivalent of this sequence. This limits our ability to objectively assess inflammation and distinguish it from other processes. To address this, we investigate the use of the widely available Dixon turbo spin echo (TSE Dixon) sequence as a practical approach to simultaneous water-specific T2 (T2water ) and fat fraction (FF) measurement. METHODS We use a series of TSE Dixon acquisitions with varying effective TEs (TEeff ) to quantify T2water and FF. The validity of this approach is assessed in a series of phantom and in vivo experiments, with reference values provided by Carr-Purcell-Meiboom-Gill acquisitions, MRS, and phantoms. The effect of inflammation on parameter values is evaluated in patients with spondyloarthritis. RESULTS The T2water estimates obtained from TSE Dixon were accurate compared with the reference values from Carr-Purcell-Meiboom-Gill and spectroscopy in both fat-free environments and in the presence of fat. FF measurements with T2water correction from TSE Dixon were accurate from 0% to 60% FF and were not confounded by T2water variations. In vivo imaging produced good quality images that were artifact free, produced plausible T2 values, separating and quantifying the effect of inflammation on T2water and FF. CONCLUSION The T2water and FF measurements based on TSE Dixon with effective TE increments are accurate over a range of T2 and FF values and could provide a widely available quantitative alternative to the short-inversion-time inversion-recovery sequence for imaging inflamed tissue.
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Affiliation(s)
- Ruaridh M Gollifer
- Center for Medical Imaging, University College London, London, UK
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
- Advanced Research Computing Center, University College London, London, UK
| | - Timothy J P Bray
- Center for Medical Imaging, University College London, London, UK
- Department of Imaging, University College London Hospital, London, UK
| | - Ariona Kruezi
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Julia Markus
- Center for Medical Imaging, University College London, London, UK
- Department of Imaging, University College London Hospital, London, UK
| | - Varvara Choida
- Center for Medical Imaging, University College London, London, UK
- Department of Rheumatology, University College London Hospital, London, UK
| | - Margaret A Hall-Craggs
- Center for Medical Imaging, University College London, London, UK
- Department of Imaging, University College London Hospital, London, UK
| | - Alan Bainbridge
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
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Bray TJP, Bainbridge A, Lim E, Hall-Craggs MA, Zhang H. MAGORINO: Magnitude-only fat fraction and R * 2 estimation with Rician noise modeling. Magn Reson Med 2023; 89:1173-1192. [PMID: 36321525 PMCID: PMC10092287 DOI: 10.1002/mrm.29493] [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: 04/29/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Magnitude-based fitting of chemical shift-encoded data enables proton density fat fraction (PDFF) and R 2 * $$ {R}_2^{\ast } $$ estimation where complex-based methods fail or when phase data are inaccessible or unreliable. However, traditional magnitude-based fitting algorithms do not account for Rician noise, creating a source of bias. To address these issues, we propose an algorithm for magnitude-only PDFF and R 2 * $$ {R}_2^{\ast } $$ estimation with Rician noise modeling (MAGORINO). METHODS Simulations of multi-echo gradient-echo signal intensities are used to investigate the performance and behavior of MAGORINO over the space of clinically plausible PDFF, R 2 * $$ {R}_2^{\ast } $$ , and SNR values. Fitting performance is assessed through detailed simulation, including likelihood function visualization, and in a multisite, multivendor, and multi-field-strength phantom data set and in vivo. RESULTS Simulations show that Rician noise-based magnitude fitting outperforms existing Gaussian noise-based fitting and reveals two key mechanisms underpinning the observed improvement. First, the likelihood functions exhibit two local optima; Rician noise modeling increases the chance that the global optimum corresponds to the ground truth. Second, when the global optimum corresponds to ground truth for both noise models, the optimum from Rician noise modeling is closer to ground truth. Multisite phantom experiments show good agreement of MAGORINO PDFF with reference values, and in vivo experiments replicate the performance benefits observed in simulation. CONCLUSION The MAGORINO algorithm reduces Rician noise-related bias in PDFF and R 2 * $$ {R}_2^{\ast } $$ estimation, thus addressing a key limitation of existing magnitude-only fitting methods. Our results offer insight into the importance of the noise model for selecting the correct optimum when multiple plausible optima exist.
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Affiliation(s)
- Timothy J P Bray
- Centre for Medical Imaging, University College London, London, United Kingdom.,Department of Imaging, University College London Hospital, London, United Kingdom
| | - Alan Bainbridge
- Centre for Medical Imaging, University College London, London, United Kingdom.,Department of Medical Physics, University College London Hospitals, London, United Kingdom
| | - Emma Lim
- Department of Imaging, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Margaret A Hall-Craggs
- Centre for Medical Imaging, University College London, London, United Kingdom.,Department of Medical Physics, University College London Hospitals, London, United Kingdom
| | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, University College London, London, United Kingdom
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Thorley N, Jones A, Ciurtin C, Castelino M, Bainbridge A, Abbasi M, Taylor S, Zhang H, Hall-Craggs MA, Bray TJP. Quantitative magnetic resonance imaging (qMRI) in axial spondyloarthritis. Br J Radiol 2023; 96:20220675. [PMID: 36607267 PMCID: PMC10078871 DOI: 10.1259/bjr.20220675] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Imaging, and particularly MRI, plays a crucial role in the assessment of inflammation in rheumatic disease, and forms a core component of the diagnostic pathway in axial spondyloarthritis. However, conventional imaging techniques are limited by image contrast being non-specific to inflammation and a reliance on subjective, qualitative reader interpretation. Quantitative MRI methods offer scope to address these limitations and improve our ability to accurately and precisely detect and characterise inflammation, potentially facilitating a more personalised approach to management. Here, we review quantitative MRI methods and emerging quantitative imaging biomarkers for imaging inflammation in axial spondyloarthritis. We discuss the potential benefits as well as the practical considerations that must be addressed in the movement toward clinical translation of quantitative imaging biomarkers.
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Affiliation(s)
- Natasha Thorley
- Imaging Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Madhura Castelino
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alan Bainbridge
- Department of Medical Physics, University College London Hospitals, London, United Kingdom
| | - Maaz Abbasi
- Imaging Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stuart Taylor
- Centre for Medical Imaging (CMI), University College London, London, United Kingdom
| | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, University College London, London, United Kingdom
| | | | - Timothy J P Bray
- Centre for Medical Imaging (CMI), University College London, London, United Kingdom
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Ciurtin C, Bray T, Choida V, Hall-Craggs MA. Whole-body MRI for juvenile idiopathic arthritis. Lancet Rheumatol 2023; 5:e6-e8. [PMID: 38251509 DOI: 10.1016/s2665-9913(22)00342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospital, London, UK.
| | - Timothy Bray
- Department of Radiology, University College London Hospital, London, UK
| | - Varvara Choida
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospital, London, UK
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Hepburn C, Jones A, Bainbridge A, Ciurtin C, Iglesias JE, Zhang H, Hall-Craggs MA, Bray TJP. Volume of hyperintense inflammation (VHI): A quantitative imaging biomarker of inflammation load in spondyloarthritis, enabled by human-machine cooperation. PLoS One 2023; 18:e0284508. [PMID: 37075028 PMCID: PMC10115260 DOI: 10.1371/journal.pone.0284508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
Qualitative visual assessment of MRI scans is a key mechanism by which inflammation is assessed in clinical practice. For example, in axial spondyloarthritis (axSpA), visual assessment focuses on the identification of regions with increased signal in the bone marrow, known as bone marrow oedema (BMO), on water-sensitive images. The identification of BMO has an important role in the diagnosis, quantification and monitoring of disease in axSpA. However, BMO evaluation depends heavily on the experience and expertise of the image reader, creating substantial imprecision. Deep learning-based segmentation is a natural approach to addressing this imprecision, but purely automated solutions require large training sets that are not currently available, and deep learning solutions with limited data may not be sufficiently trustworthy for use in clinical practice. To address this, we propose a workflow for inflammation segmentation incorporating both deep learning and human input. With this 'human-machine cooperation' workflow, a preliminary segmentation is generated automatically by deep learning; a human reader then 'cleans' the segmentation by removing extraneous segmented voxels. The final cleaned segmentation defines the volume of hyperintense inflammation (VHI), which is proposed as a quantitative imaging biomarker (QIB) of inflammation load in axSpA. We implemented and evaluated the proposed human-machine workflow in a cohort of 29 patients with axSpA who had undergone prospective MRI scans before and after starting biologic therapy. The performance of the workflow was compared against purely visual assessment in terms of inter-observer/inter-method segmentation overlap, inter-observer agreement and assessment of response to biologic therapy. The human-machine workflow showed superior inter-observer segmentation overlap than purely manual segmentation (Dice score 0.84 versus 0.56). VHI measurements produced by the workflow showed similar or better inter-observer agreement than visual scoring, with similar response assessments. We conclude that the proposed human-machine workflow offers a mechanism to improve the consistency of inflammation assessment, and that VHI could be a valuable QIB of inflammation load in axSpA, as well as offering an exemplar of human-machine cooperation more broadly.
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Affiliation(s)
- Carolyna Hepburn
- Centre for Medical Imaging, University College London, London, United Kingdom
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Alexis Jones
- Centre for Medical Imaging, University College London, London, United Kingdom
- Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Alan Bainbridge
- Department of Medical Physics, University College London Hospitals, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Juan Eugenio Iglesias
- Centre for Medical Image Computing, University College London, London, United Kingdom
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts, United States of America
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hui Zhang
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Margaret A Hall-Craggs
- Centre for Medical Imaging, University College London, London, United Kingdom
- Imaging Department, University College London Hospital, London, United Kingdom
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, London, United Kingdom
- Imaging Department, University College London Hospital, London, United Kingdom
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11
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Choida V, Tattersall RS, Manson JJ, Sen D, Ciurtin C, Hall-Craggs MA. P159 The potential impact of whole-body MRI on the rheumatologists’ disease activity assessment and treatment plan for patients with juvenile idiopathic arthritis. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.158] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Aims
To assess the potential for whole-body MRI (WBMRI) to modify rheumatologists’ impression of disease activity and treatment management in adolescent patients with JIA.
Methods
Two rheumatology consultants experienced in managing people with JIA reviewed anonymised clinical data from an opportunistic sample of 30 patients with JIA (aged 15-24), not under their care. The cohort were clinically assessed by a senior rheumatology fellow before undergoing a research WBMRI scan, reported for musculoskeletal inflammation by a radiologist blinded to clinical information. The clinical findings and patient-reported outcomes recorded on that visit, alongside the patients’ present and past treatments, imaging and laboratory results were included in the clinical summaries examined by each rheumatologist. They then independently rated their impression of disease activity (See Table 1) and documented their resulting treatment recommendations per patient, in a two-stage approach. The first stage data analysis did not include the WBMRI reports. In stage two, the rheumatologists re-rated disease activity and treatment suggestions in light of WBMRI findings. The responses without and with the WBMRI findings were compared for each consultant and between them.
Results
Disease activity ratings were changed after reviewing the WBMRI reports in 16/30 and 17/30 patients by the rheumatologist A and B respectively. The activity category (‘active’ to ‘inactive’ or vice versa) changed in 7/16 and 4/17 cases, respectively. The certainty in the activity status increased for both rating clinicians (from ‘likely’ to ‘definitely’ in the same category or from ‘not sure’ to any other category) in 7/16 and 11/17 cases, respectively, whilst decreased for both in two cases. Disease activity assessments and treatment recommendations with and without WBMRI, are summarised in Table 1. Inter-rater agreement without and with WBMRI regarding disease activity (active/inactive) was 84.00% and 82.1% respectively, and regarding the intention to change treatment (yes/no) was 63.3% and 83.3%, respectively.
Conclusion
WBMRI scan findings changed the rheumatologists’ impression or level of certainty regarding disease activity in about half the patients and treatment plan in about one-third. Therefore, a larger study involving a greater number of rheumatologists across the country, should be considered to validate these results.
Disclosure
V. Choida: None. R.S. Tattersall: None. J.J. Manson: None. D. Sen: None. C. Ciurtin: None. M.A. Hall-Craggs: None.
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Affiliation(s)
- Varvara Choida
- Centre for Medical Imaging, University College London, London, UNITED KINGDOM
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, UNITED KINGDOM
| | - Rachel S Tattersall
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM
- Department of Rheumatology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Jessica J Manson
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UNITED KINGDOM
| | - Debajit Sen
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, UNITED KINGDOM
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UNITED KINGDOM
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, UNITED KINGDOM
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UNITED KINGDOM
| | - Margaret A Hall-Craggs
- Centre for Medical Imaging, University College London, London, UNITED KINGDOM
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UNITED KINGDOM
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12
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Choida V, Madenidou AV, Sen D, Hall-Craggs MA, Ciurtin C. The role of whole-body MRI in musculoskeletal inflammation detection and treatment response evaluation in inflammatory arthritis across age: A systematic review. Semin Arthritis Rheum 2022; 52:151953. [PMID: 35038643 DOI: 10.1016/j.semarthrit.2022.151953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the relation between whole-body MRI (WBMRI) outcomes and disease activity measures, including clinical examination, composite scores, and other imaging outcomes, and the ability of WBMRI to detect treatment response in patients with inflammatory arthritis (IA) across age. METHODS Human studies published as full text or abstract in the PubMed and MEDLINE and Cochrane databases from inception to 11th April 2021 were systematically and independently searched by two reviewers. Studies including patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondyloarthritis (SpA), juvenile idiopathic arthritis (JIA) or unclassified inflammatory arthritis (UA) who underwent WBMRI and which reported on disease outcomes were included. RESULTS Nineteen full-text studies were eligible for inclusion: 2 interventional, 7 retrospective and 10 prospective observational studies, comprising 540 participants (SpA 38.7%, RA 24.8%, JIA 17.8%, PsA 11.5%, healthy controls 5.9%, UA 1.3%). Abstracts of 6 conference papers were reported separately. Five studies in PsA and SpA and 4 in RA measured the frequency of WBMRI-detected and clinically-detected synovitis, and all found the former to be more frequent. Less enthesitis was detected by WBMRI than clinical examination in 5/8 studies. After biologic treatment, the WBMRI inflammation scores declined in 3 studies in SpA and 2 in RA, whilst in 3 studies the results were equivocal. CONCLUSION The ability of WBMRI to assess disease activity and treatment response in IA was adequate overall. Further studies are needed to corroborate WBMRI findings with IA outcomes and investigate the clinical value of subclinical inflammation.
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Affiliation(s)
- Varvara Choida
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK
| | - Anastasia-Vasiliki Madenidou
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK
| | - Debajit Sen
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK
| | - Margaret A Hall-Craggs
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; Department of Radiology, University College London Hospital, Ground Floor 235 Euston Road, London NW1 2BU, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK.
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13
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Epstein SC, Bray TJP, Hall-Craggs MA, Zhang H. Task-driven assessment of experimental designs in diffusion MRI: A computational framework. PLoS One 2021; 16:e0258442. [PMID: 34624064 PMCID: PMC8500429 DOI: 10.1371/journal.pone.0258442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
This paper proposes a task-driven computational framework for assessing diffusion MRI experimental designs which, rather than relying on parameter-estimation metrics, directly measures quantitative task performance. Traditional computational experimental design (CED) methods may be ill-suited to experimental tasks, such as clinical classification, where outcome does not depend on parameter-estimation accuracy or precision alone. Current assessment metrics evaluate experiments’ ability to faithfully recover microstructural parameters rather than their task performance. The method we propose addresses this shortcoming. For a given MRI experimental design (protocol, parameter-estimation method, model, etc.), experiments are simulated start-to-finish and task performance is computed from receiver operating characteristic (ROC) curves and associated summary metrics (e.g. area under the curve (AUC)). Two experiments were performed: first, a validation of the pipeline’s task performance predictions against clinical results, comparing in-silico predictions to real-world ROC/AUC; and second, a demonstration of the pipeline’s advantages over traditional CED approaches, using two simulated clinical classification tasks. Comparison with clinical datasets validates our method’s predictions of (a) the qualitative form of ROC curves, (b) the relative task performance of different experimental designs, and (c) the absolute performance (AUC) of each experimental design. Furthermore, we show that our method outperforms traditional task-agnostic assessment methods, enabling improved, more useful experimental design. Our pipeline produces accurate, quantitative predictions of real-world task performance. Compared to current approaches, such task-driven assessment is more likely to identify experimental designs that perform well in practice. Our method is not limited to diffusion MRI; the pipeline generalises to any task-based quantitative MRI application, and provides the foundation for developing future task-driven end-to end CED frameworks.
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Affiliation(s)
- Sean C. Epstein
- Department of Computer Science & Centre for Medical Image Computing, University College London, London, United Kingdom
- * E-mail:
| | - Timothy J. P. Bray
- Centre for Medical Imaging, University College London, London, United Kingdom
| | | | - Hui Zhang
- Department of Computer Science & Centre for Medical Image Computing, University College London, London, United Kingdom
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14
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Choida V, Ciurtin C, Bray TJP, Sen D, Fisher C, Leandro M, Hall-Craggs MA. O14 Frequency and site of clinically unsuspected synovitis on whole-body MRI in juvenile idiopathic arthritis. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab246.013] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Magnetic resonance imaging can facilitate the diagnosis of JIA, but is also increasingly used for monitoring disease activity in individual joints. This prospective study aims to measure the frequency of subclinical synovitis on whole-body MRI, in adolescent patients with JIA.
Methods
JIA patients were recruited from a tertiary adolescent and young adult rheumatology clinic, between September 2019 and August 2020. All patients were examined by a senior rheumatology registrar, before undergoing a contrast enhanced whole-body MRI scan. Patients were assigned to a clinically active or inactive group, depending on their active joint count (AJC); active patients had AJC≥ 1, while the clinically inactive patients had an AJC =0. The post-contrast, water-only mDixon images were assessed for synovitis by one radiologist, blinded to clinical information. Only joints that were definitely abnormal were counted as synovitic. Eighty-one joints per patient were examined with both methods. The presence of subclinical synovitis in a patient was defined as synovitis in one or more joints on MRI, which were not active clinically.
Results
Thirty-two patients aged 15 to 24 were included in the analysis. The patient characteristics and the frequency of subclinical synovitis are summarised in the table. Subclinical synovitis was detected in a similar proportion of JIA patients in both active and inactive groups (46.7% vs. 41.2%, P = 0.76). The most frequent region with subclinical synovitis was the hindfoot, detected in 22% (7/32) of JIA patients and 17.2% (11/64) of hindfoot joints assessed by MRI. The second most common joint with clinically unsuspected inflammation was the knee, found in 19% (6/32) of JIA patients and 14% (9/64) knee joints. Similarly, 16% (5/32) of the adolescent patients had active disease in the hip, ankle or midfoot joints. The frequency of elbow involvement was also considerable, with 12% (7/58) of joints with subclinical synovitis in 14% (4/29) of JIA patients.
Conclusion
In conclusion, 43.8% of JIA patients had subclinical synovitis on whole-body MRI scan with no significant difference between the clinically active vs. inactive JIA patients. Large joints were predominantly affected. Further research is required to validate our findings in a larger cohort of JIA patients.
Disclosure
V. Choida: None. C. Ciurtin: None. T.J.P. Bray: None. D. Sen: None. C. Fisher: None. M. Leandro: None. M.A. Hall-Craggs: None.
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Affiliation(s)
- Varvara Choida
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
- Centre for Adolescent Rheumatology, University College London, London, UNITED KINGDOM
| | - Coziana Ciurtin
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
- Centre for Adolescent Rheumatology, University College London, London, UNITED KINGDOM
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, London, UNITED KINGDOM
| | - Debajit Sen
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
- Centre for Adolescent Rheumatology, University College London, London, UNITED KINGDOM
| | - Corinne Fisher
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
- Centre for Adolescent Rheumatology, University College London, London, UNITED KINGDOM
| | - Maria Leandro
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
- Centre for Adolescent Rheumatology, University College London, London, UNITED KINGDOM
| | - Margaret A Hall-Craggs
- Radiology, University College London Hospitals, London, UNITED KINGDOM
- Centre for Medical Imaging, University College London, London, UNITED KINGDOM
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15
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Abstract
While perinatal risk factors are widely used to help identify those at risk for developmental dysplasia of the hip (DDH) within the first 6 to 8 weeks of life, limited data exist about their association with radiographic evidence of dysplasia in childhood. The purpose of this study was to determine which perinatal risk factors are associated with acetabular dysplasia in children who are ≥2 years of age.
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Affiliation(s)
- Simon Humphry
- Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Timothy Hall
- Department of Diagnostic Imaging, University College London Hospital, London, United Kingdom
| | - Margaret A Hall-Craggs
- Department of Diagnostic Imaging, University College London Hospital, London, United Kingdom
| | - Andreas Roposch
- Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.,Institute of Child Health, University College London, London, United Kingdom
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16
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Sakai NS, Bhagwanani A, Bray TJP, Hall-Craggs MA, Taylor SA. Assessment of body composition and association with clinical outcomes in patients with lung and colorectal cancer. BJR Open 2021; 3:20210048. [PMID: 35707759 PMCID: PMC9185845 DOI: 10.1259/bjro.20210048] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/17/2021] [Accepted: 11/09/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: To assess body composition in patients with non-small cell lung cancer (NSCLC) and colorectal cancer using whole-body MRI and relate this to clinical outcomes. Methods: 53 patients with NSCLC (28 males, 25 females; mean age 66.9) and 74 patients with colorectal cancer (42 males, 32 females; mean age 62.9) underwent staging whole-body MRI scans, which were post-processed to derive fat mass (FM), fat free mass (FFM) and skeletal muscle (SM) indices and SM fat fraction (FF). These were compared between the two cancer cohorts using two-sided t-tests and the chi-squared test. Measurements of body composition were correlated with outcomes including length of hospital stay, metastatic status and mortality. Results: Patients with NSCLC had significantly lower FFM (p = 0.0071) and SM (p = 0.0084) indices. Mean SM FF was greater in patients with NSCLC (p = 0.0124) and was associated with longer hospital stay (p = 0.035). There was no significant relationship between FM, FFM and SM indices and length of hospital stay, metastatic status or mortality. Conclusions: Patients with NSCLC had lower FFM and SM indices than patients with colorectal cancer and greater SMFF, indicating lower SM mass with fatty infiltration. These findings reflect differences in the phenotype of the two groups and suggest patients with lung cancer are more likely to require additional nutritional support. Advances in knowledge: Body composition differs between NSCLC and colorectal cancer. Patients with NSCLC have both a reduced SM mass and greater SM FF suggesting that they are more nutritionally deplete than patients with colorectal cancer.
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Affiliation(s)
- Naomi S Sakai
- UCL Centre for Medical Imaging, London, UK
- University College London Hospital, London, UK
| | | | - Timothy JP Bray
- UCL Centre for Medical Imaging, London, UK
- University College London Hospital, London, UK
| | - Margaret A Hall-Craggs
- UCL Centre for Medical Imaging, London, UK
- University College London Hospital, London, UK
| | - Stuart Andrew Taylor
- UCL Centre for Medical Imaging, London, UK
- University College London Hospital, London, UK
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17
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Bray TJP, Bainbridge A, Sakai NS, Hall-Craggs MA, Zhang H. An information-based comparison of diffusion attenuation models in normal and inflamed bone marrow. NMR Biomed 2020; 33:e4390. [PMID: 32749017 DOI: 10.1002/nbm.4390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
Diffusion-weighted imaging has received attention as a method for characterizing inflammatory exudates in bone marrow in immune-mediated inflammatory diseases and reveals an increase in diffusivity in regions of bone marrow oedema. Various models of diffusion attenuation have been investigated but the model providing the best description of tissue pathophysiology in regions of marrow oedema is unknown. Determining the most appropriate model is an important step towards protocol optimization and the development of a robust and clinically useful method. We aimed to determine which of three candidate models of diffusion attenuation most accurately describes the acquired signal from normal and inflamed bone marrow. 11 subjects with spondyloarthritis and evidence of active inflammation (ie bone marrow oedema) on MRI and 17 patients with no evidence of active inflammation underwent diffusion-weighted imaging of the sacroiliac joints (b-values 0, 50, 100, 300 and 600 s/mm2 ). Monoexponential, intravoxel incoherent motion (IVIM) and kurtosis models were fitted to the acquired signal from regions of interest in areas of bone marrow oedema and normal marrow. The three models were compared in terms of sum of squared error and information content (corrected Akaike information criterion). Model parameters were compared between regions of bone marrow oedema and regions of normal marrow. f the three models investigated, the IVIM model provided the best description of the signal over the 0-600 s/mm2 range across normal and inflamed bone marrow. There was a particular advantage of the IVIM model in normal marrow, where it was best able to capture the pronounced fast diffusion component observed in several cases. However, IVIM and kurtosis effects both became smaller and the signal behaviour became closer to monoexponential in the presence of bone marrow oedema. Our data suggest that increases in Dtissue (in the IVIM framework) might account for the reduced deviation from monoexponential behaviour in oedematous bone.
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Affiliation(s)
- Timothy J P Bray
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Alan Bainbridge
- Department of Medical Physics, University College London Hospitals, London, United Kingdom
| | - Naomi S Sakai
- Centre for Medical Imaging, University College London, London, United Kingdom
| | | | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, University College London, London, United Kingdom
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18
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Jones A, Bray TJP, Mandl P, Hall-Craggs MA, Marzo-Ortega H, Machado PM. Performance of magnetic resonance imaging in the diagnosis of axial spondyloarthritis: a systematic literature review. Rheumatology (Oxford) 2020; 58:1955-1965. [PMID: 31046102 DOI: 10.1093/rheumatology/kez172] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 12/16/2018] [Revised: 04/04/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To summarize the evidence on the performance of MRI for the diagnosis of axial SpA. METHODS This was a systematic literature review of all studies from January 2013 to March 2017 including adult patients with clinically suspected axial SpA undergoing MRI. Studies from a previously published systematic literature review up to January 2013 were also included. RESULTS Thirty-one studies were included. Six studies demonstrated good sensitivity and specificity for SI joint (SIJ) bone marrow oedema (BMO). Specificity was increased by the presence of other structural lesions alongside BMO, particularly erosions or fat infiltration. Four studies addressed the utility of SIJ fat infiltration, finding good sensitivity but poor specificity. SIJ erosions showed good specificity in five studies. Studies addressing high T1 signal in the SIJ, fluid signal in the SIJ, ankylosis, sclerosis, capsulitis, backfill and vacuum phenomenon reported limited diagnostic value. In the spine, four studies reported moderate sensitivity and specificity for corner inflammatory lesions, and four reported poor sensitivity and specificity for spinal fat infiltration. Five studies evaluated the added value of spinal MRI over SIJ MRI alone, with variable results depending on the cohort. Six studies addressed the effect of acquisition parameters on diagnostic accuracy: fat-saturated T2-weighted imaging and short tau inversion recovery (STIR) imaging showed comparable utility in identifying BMO. Three studies showed that gadolinium was of minimal added value in the detection of BMO. CONCLUSIONS These results confirmed the diagnostic utility of MRI in axial SpA. Performance varied according to the characteristics of the cohort and the number and combination of MRI lesions considered.
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Affiliation(s)
- Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, London, UK
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, London.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, London
| | - Pedro M Machado
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London.,Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
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19
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Singh S, Pilavachi E, Dudek A, Bray TJP, Latifoltojar A, Rajesparan K, Punwani S, Hall-Craggs MA. Whole body MRI in multiple myeloma: Optimising image acquisition and read times. PLoS One 2020; 15:e0228424. [PMID: 31999774 PMCID: PMC6992198 DOI: 10.1371/journal.pone.0228424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/14/2020] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To identify the whole-body MRI (WB-MRI) image type(s) with the highest value for assessment of multiple myeloma, in order to optimise acquisition protocols and read times. METHODS Thirty patients with clinically-suspected MM underwent WB-MRI at 3 Tesla. Unenhanced Dixon images [fat-only (FO) and water-only (WO)], post contrast Dixon [fat-only plus contrast (FOC) and water-only plus contrast (WOC)] and diffusion weighted images (DWI) of the pelvis from all 30 patients were randomised and read by three experienced readers. For each image type, each reader identified and labelled all visible myeloma lesions. Each identified lesion was compared with a composite reference standard achieved by review of a complete imaging dataset by a further experienced consultant radiologist to determine truly positive lesions. Lesion count, true positives, sensitivity, and positive predictive value were determined. Time to read each scan set was recorded. Confidence for a diagnosis of myeloma was scored using a Likert scale. Conspicuity of focal lesions was assessed in terms of percent contrast and contrast to noise ratio (CNR). RESULTS Lesion count, true positives, sensitivity and confidence scores were significantly higher when compared to other image types for DWI (P<0.0001 to 0.003), followed by WOC (significant for sensitivity (P<0.0001 to 0.004), true positives (P = 0.003 to 0.049) and positive predictive value (P< 0.0001 to 0.006)). There was no statistically significant difference in these metrics between FO and FOC. Percent contrast was highest for WOC (P = 0.001 to 0.005) and contrast to noise ratio (CNR) was highest for DWI (P = 0.03 to 0.05). Reading times were fastest for DWI across all observers (P< 0.0001 to 0.014). DISCUSSION Observers detected more myeloma lesions on DWI images and WOC images when compared to other image types. We suggest that these image types should be read preferentially by radiologists to improve diagnostic accuracy and reporting efficiency.
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Affiliation(s)
- Saurabh Singh
- Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Elly Pilavachi
- Department of Radiology, University College Hospital, London, United Kingdom
| | - Alexandra Dudek
- Department of Radiology, University College Hospital, London, United Kingdom
| | - Timothy J. P. Bray
- Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Arash Latifoltojar
- Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Kannan Rajesparan
- Department of Radiology, University College Hospital, London, United Kingdom
| | - Shonit Punwani
- Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Margaret A. Hall-Craggs
- Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
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Bainbridge A, Bray TJP, Sengupta R, Hall-Craggs MA. Practical Approaches to Bone Marrow Fat Fraction Quantification Across Magnetic Resonance Imaging Platforms. J Magn Reson Imaging 2020; 52:298-306. [PMID: 31944469 DOI: 10.1002/jmri.27039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/26/2019] [Revised: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Quantification of fat by proton density fat fraction (PDFF) measurements may be valuable for the quantification and follow-up of pathology in multicenter clinical trials and routine practice. However, many centers do not have access to specialist methods (such as chemical shift imaging) for PDFF measurement. This is a barrier to more widespread trial implementation. PURPOSE/HYPOTHESIS To determine the agreement between fat fraction (FF) measurements derived from 1) basic vendor-supplied sequences, 2) basic sequences with offline correction, and 3) specialist vendor-supplied methods. STUDY TYPE Prospective. POPULATION Two substudies with ten and five healthy volunteers. FIELD STRENGTH/SEQUENCE Site A: mDixon Quant (Philips 3T Ingenia); Site B: IDEAL and FLEX (GE 1.5T Optima MR450W); Site C: DIXON, with additional 5-echo gradient echo acquisition for offline correction (Siemens 3T Skyra); Site D: DIXON, with additional VIBE acquisitions for offline correction (Siemens 1.5T Avanto). The specialist method at site A was used as a standard to compare to the basic methods at sites B, C, and D. ASSESSMENT Regions of interest were placed on areas of subchondral bone on FF maps from the various methods in each volunteer. STATISTICAL TESTS Relationships between FF measurements from the various sites and Dixon methods were assessed using Bland-Altman analysis and linear regression. RESULTS Basic methods consisting of IDEAL, LAVA FLEX, and DIXON produced FF values that were linearly related to reference FF values (P < 0.0001), but produced mean biases of up to 10%. Offline correction produced a significant reduction in bias in both substudies (P < 0.001). DATA CONCLUSION FF measurements derived using basic vendor-supplied methods are strongly linearly related with those derived using specialist methods but produce a bias of up to 10%. A simple offline correction that is accessible even when the scanner has only basic sequence options can significantly reduce bias. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;52:298-306.
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Affiliation(s)
- Alan Bainbridge
- Department of Medical Physics, University College London Hospitals, London, UK
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, London, UK
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Bath, UK
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Hall-Craggs MA, Bray TJP, Jones A, Marzo-Ortega H, Machado PM. Comment on: Recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial spondyloarthritis in the UK: reply. Rheumatology (Oxford) 2020; 59:261-262. [PMID: 31665492 DOI: 10.1093/rheumatology/kez510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, London, UK
| | - Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Pedro M Machado
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS trust, London, UK
- Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
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22
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Bray TJP, Ciurtin C, Hall-Craggs MA. Reply. Arthritis Rheumatol 2019; 71:2130-2131. [PMID: 31328427 DOI: 10.1002/art.41049] [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: 11/09/2022]
Affiliation(s)
| | - Coziana Ciurtin
- Arthritis Research UK Centre for Adolescent Rheumatology and University College London
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Bray TJP, Jones A, Bennett AN, Conaghan PG, Grainger A, Hodgson R, Hutchinson C, Leandro M, Mandl P, McGonagle D, O’Connor P, Sengupta R, Thomas M, Toms A, Winn N, Hall-Craggs MA, Marzo-Ortega H, Machado PM. Recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial spondyloarthritis in the UK. Rheumatology (Oxford) 2019; 58:1831-1838. [DOI: 10.1093/rheumatology/kez173] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/04/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To develop evidence-based recommendations on the use of MRI in the diagnosis of axial SpA (axSpA).
Methods
A working group comprising nine rheumatologists and nine musculoskeletal radiologists with an interest in axSpA was established, with support from the British Society of Spondyloarthritis (BRITSpA). Two meetings were held. In the first meeting, research questions were formulated. In the second meeting, the results of a systematic literature review designed to inform the recommendations were reviewed. An anonymized Delphi process was used to formulate the final set of recommendations. For each recommendation, the level of evidence and strength of recommendation was determined. The level of agreement was assessed using a 0–10 numerical rating scale.
Results
Two overarching principles were formulated, as follows: The diagnosis of axSpA is based on clinical, laboratory and imaging features (overarching principle 1), and patients with axSpA can have isolated inflammation of either the sacroiliac joints or the spine (overarching principle 2). Seven recommendations addressing the use of MRI in the assessment of patients with suspected axSpA were formulated, covering topics including recommended sequences, anatomical coverage, acquisition parameters and interpretation of active and structural MRI lesions. The level of agreement for each recommendation was very high (range 8.8–9.8).
Conclusion
A joint rheumatology and radiology consensus on the acquisition and interpretation of MRI in axSpA diagnosis was achieved, and a research agenda formulated. This consensus should help standardize practice around MRI and ensure a more informed, consistent approach to the diagnosis of axSpA.
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Affiliation(s)
| | - Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Nottinghamshire
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London
| | - Philip G Conaghan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Andrew Grainger
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Richard Hodgson
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Sciences Centre, Manchester
| | - Charles Hutchinson
- Department of Radiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Maria Leandro
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Denis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Phill O’Connor
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Raj Sengupta
- The Royal National Hospital for Rheumatic Diseases, Bath
| | | | - Andoni Toms
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
| | - Naomi Winn
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Pedro M Machado
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London
- Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
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Bray TJP, Jones A, Bennett A, Conaghan P, Grainger A, Hodgson R, Hutchinson CE, Leandro M, Mandl P, McGonagle D, O’Connor P, Sengupta R, Thomas M, Toms A, Winn N, Marzo-Ortega H, Hall-Craggs MA, Machado PM. O33 Recommendations for acquisition and considerations for interpretation of MRI of the spine and sacroiliac joints in the investigation of axial spondyloarthritis in the UK. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez105.032] [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: 11/12/2022] Open
Affiliation(s)
- Tim J P Bray
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Alexis Jones
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Alex Bennett
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Philip Conaghan
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Andrew Grainger
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Richard Hodgson
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | | | - Maria Leandro
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Peter Mandl
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Dennis McGonagle
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Philip O’Connor
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Raj Sengupta
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Marianna Thomas
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Andoni Toms
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | - Naomi Winn
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
| | | | | | - Pedro M Machado
- British Society of Spondyloarthritis, BRITSpA, UK, United Kingdom
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Jones A, Ciurtin C, Hall-Craggs MA. 036 MRI in axial spondyloarthritis: the case for contrast. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez106.035] [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: 11/12/2022] Open
Affiliation(s)
- Alexis Jones
- Department of Rheumatology, University College London Hospital, London, UNITED KINGDOM
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospital, London, UNITED KINGDOM
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Bray TJP, Lopes A, Fisher C, Ciurtin C, Sen D, Hall-Craggs MA. Sacroiliac Joint Ankylosis in Young Spondyloarthritis Patients Receiving Biologic Therapy: Observation of Serial Magnetic Resonance Imaging Scans. Arthritis Rheumatol 2019; 71:594-598. [PMID: 30295426 PMCID: PMC6915840 DOI: 10.1002/art.40750] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/02/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess the temporal relationship between initiating biologic therapy and magnetic resonance imaging (MRI) scores of inflammation and structural damage in young patients with spondyloarthritis. METHODS A local adolescent/young adult patient rheumatology database was searched for patients ages 12-24 years who had evidence of sacroiliitis on MRI and a clinical diagnosis of enthesitis-related arthritis (ERA) with axial involvement or nonradiographic axial spondyloarthritis. Patients treated with tumor necrosis factor inhibitor (TNFi) therapy who had undergone a minimum of 1 MRI scan before and 2 MRI scans after starting TNFi therapy (over ≥2 years) were included. Images of the sacroiliac joints were scored for inflammation and structural abnormalities (including erosions, fat metaplasia, and fusion). The effects of TNFi therapy and of time since initiation of TNFi therapy on inflammation and structural abnormalities were assessed using a mixed-effects regression analysis. RESULTS Twenty-nine patients (ages 12-23 years) with ERA or nonradiographic axial spondyloarthritis who underwent TNFi therapy were included. Inflammation scores were significantly lower in patients receiving TNFi treatment (P = 0.013), but there was no significant effect of time from TNFi initiation on inflammation (P = 0.125). Conversely, there was no significant effect of active TNFi treatment on fusion scores (P = 0.308), but fusion scores significantly increased with time from TNFi initiation (P < 0.001); a similar positive relationship between time since biologic start and fat metaplasia scores was observed. CONCLUSION TNFi therapy failed to prevent the eventual development of joint ankylosis in this cohort of young patients with spondyloarthritis, despite a substantial reduction in inflammation with TNFi therapy.
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Bray TJP, Chouhan MD, Punwani S, Bainbridge A, Hall-Craggs MA. Fat fraction mapping using magnetic resonance imaging: insight into pathophysiology. Br J Radiol 2018; 91:20170344. [PMID: 28936896 PMCID: PMC6223159 DOI: 10.1259/bjr.20170344] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/18/2017] [Accepted: 09/06/2017] [Indexed: 02/06/2023] Open
Abstract
Adipose cells have traditionally been viewed as a simple, passive energy storage depot for triglycerides. However, in recent years it has become clear that adipose cells are highly physiologically active and have a multitude of endocrine, metabolic, haematological and immune functions. Changes in the number or size of adipose cells may be directly implicated in disease (e.g. in the metabolic syndrome), but may also be linked to other pathological processes such as inflammation, malignant infiltration or infarction. MRI is ideally suited to the quantification of fat, since most of the acquired signal comes from water and fat protons. Fat fraction (FF, the proportion of the acquired signal derived from fat protons) has, therefore, emerged as an objective, image-based biomarker of disease. Methods for FF quantification are becoming increasingly available in both research and clinical settings, but these methods vary depending on the scanner, manufacturer, imaging sequence and reconstruction software being used. Careful selection of the imaging method-and correct interpretation-can improve the accuracy of FF measurements, minimize potential confounding factors and maximize clinical utility. Here, we review methods for fat quantification and their strengths and weaknesses, before considering how they can be tailored to specific applications, particularly in the gastrointestinal and musculoskeletal systems. FF quantification is becoming established as a clinical and research tool, and understanding the underlying principles will be helpful to both imaging scientists and clinicians.
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Affiliation(s)
- Timothy JP Bray
- Centre for
Medical Imaging, University College London,University College London,
London, UK
| | - Manil D Chouhan
- Centre for
Medical Imaging, University College London,University College London,
London, UK
| | - Shonit Punwani
- Centre for
Medical Imaging, University College London,University College London,
London, UK
| | - Alan Bainbridge
- Department
of Medical Physics, University College London
Hospitals,University
College London Hospitals, London,
UK
| | - Margaret A Hall-Craggs
- Centre for
Medical Imaging, University College London,University College London,
London, UK
- Department
of Medical Physics, University College London
Hospitals,University
College London Hospitals, London,
UK
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Hall-Craggs MA, Bray TPJ, Bainbridge AP. Quantitative imaging of inflammatory disease: are we missing a trick? Ann Rheum Dis 2018; 77:1689-1691. [DOI: 10.1136/annrheumdis-2018-213614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 11/04/2022]
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Hall-Craggs MA. i160 Quantitative imaging of sacroiliitis in adolescence. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.160] [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: 11/13/2022] Open
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Bray TJP, Fisher C, Sen D, Ioannou Y, Hall-Craggs MA. 4. The Natural History of Enthesitis-related Arthritis on Biologic Therapy. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/kex390.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Bray TJP, Singh S, Latifoltojar A, Rajesparan K, Rahman F, Narayanan P, Naaseri S, Lopes A, Bainbridge A, Punwani S, Hall-Craggs MA. Diagnostic utility of whole body Dixon MRI in multiple myeloma: A multi-reader study. PLoS One 2017; 12:e0180562. [PMID: 28672007 PMCID: PMC5495520 DOI: 10.1371/journal.pone.0180562] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/16/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine which of four Dixon image types [in-phase (IP), out-of-phase (OP), fat only (FO) and water-only (WO)] is most sensitive for detecting multiple myeloma (MM) focal lesions on whole body MRI (WB-MRI) images. METHODS Thirty patients with clinically-suspected MM underwent WB-MRI at 3 Tesla. Unenhanced IP, OP, FO and WO Dixon images were generated and read by four radiologists. On each image type, each radiologist identified and labelled all visible myeloma lesions in the bony pelvis. Each identified lesion was compared with a reference standard consisting of pre- and post-contrast Dixon and diffusion weighted imaging (read by a further consultant radiologist) to determine whether the lesion was truly positive. Lesion count, true positives, sensitivity, and positive predictive value were compared across the four Dixon image types. RESULTS Lesion count, true positives, sensitivity and confidence scores were all significantly higher on FO images than on IP images (p>0.05). DISCUSSION FO images are more sensitive than other Dixon image types for MM focal lesions, and should be preferentially read by radiologists to improve diagnostic accuracy and reporting efficiency.
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Affiliation(s)
- Timothy J. P. Bray
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Saurabh Singh
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Arash Latifoltojar
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Kannan Rajesparan
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Farzana Rahman
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Priya Narayanan
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Sahar Naaseri
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Andre Lopes
- Cancer Research UK and UCL Clinical Trials Centre, London, United Kingdom
| | - Alan Bainbridge
- Medical Physics Department, University College London Hospitals, London, United Kingdom
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, United Kingdom
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J P Bray T, Vendhan K, Ambrose N, Atkinson D, Punwani S, Fisher C, Sen D, Ioannou Y, Hall-Craggs MA. Diffusion-weighted imaging is a sensitive biomarker of response to biologic therapy in enthesitis-related arthritis. Rheumatology (Oxford) 2017; 56:399-407. [PMID: 27994095 DOI: 10.1093/rheumatology/kew429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Indexed: 11/14/2022] Open
Abstract
Objective The aim was to evaluate diffusion-weighted imaging (DWI) as a tool for measuring treatment response in adolescents with enthesitis-related arthropathy (ERA). Methods Twenty-two adolescents with ERA underwent routine MRI and DWI before and after TNF inhibitor therapy. Each patient's images were visually scored by two radiologists using the Spondyloarthritis Research Consortium of Canada system, and sacroiliac joint apparent diffusion coefficient (ADC) and normalized ADC (nADC) were measured for each patient. Therapeutic clinical response was defined as an improvement of ⩾ 30% physician global assessment and radiological response defined as ⩾ 2.5-point reduction in Spondyloarthritis Research Consortium of Canada score. We compared ADC and nADC changes in responders and non-responders using the Mann-Whitney-Wilcoxon test. Results For both radiological and clinical definitions of response, reductions in ADC and nADC after treatment were greater in responders than in non-responders (for radiological response: ADC: P < 0.01; nADC: P = 0.055; for clinical response: ADC: P = 0.33; nADC: P = 0.089). ADC and nADC could predict radiological response with a high level of sensitivity and specificity and were moderately sensitive and specific predictors of clinical response (the area under the receiver operating characteristic curves were as follows: ADC: 0.97, nADC: 0.82 for radiological response; and ADC: 0.67, nADC: 0.78 for clinical response). Conclusion DWI measurements reflect the response to TNF inhibitor treatment in ERA patients with sacroiliitis as defined using radiological criteria and may also reflect clinical response. DWI is more objective than visual scoring and has the potential to be automated. ADC/nADC could be used as biomarkers of sacroiliitis in the clinic and in clinical trials.
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Affiliation(s)
- Timothy J P Bray
- University College London Centre for Medical Imaging (Academic Radiology), NW1 2PG.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London
| | - Kanimozhi Vendhan
- University College London Centre for Medical Imaging (Academic Radiology), NW1 2PG
| | - Nicola Ambrose
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London
| | - David Atkinson
- University College London Centre for Medical Imaging (Academic Radiology), NW1 2PG
| | - Shonit Punwani
- University College London Centre for Medical Imaging (Academic Radiology), NW1 2PG
| | - Corinne Fisher
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London
| | - Debajit Sen
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London
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Bray TJP, Bainbridge A, Punwani S, Ioannou Y, Hall-Craggs MA. Simultaneous Quantification of Bone Edema/Adiposity and Structure in Inflamed Bone Using Chemical Shift-Encoded MRI in Spondyloarthritis. Magn Reson Med 2017; 79:1031-1042. [PMID: 28589660 PMCID: PMC5811922 DOI: 10.1002/mrm.26729] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/08/2017] [Accepted: 03/31/2017] [Indexed: 12/19/2022]
Abstract
Purpose To evaluate proton density fat fraction (PDFF) and R2* as markers of bone marrow composition and structure in inflamed bone in patients with spondyloarthritis. Methods Phantoms containing fat, water, and trabecular bone were constructed with proton density fat fraction (PDFF) and bone mineral density (BMD) values matching those expected in healthy bone marrow and disease states, and scanned using chemical shift‐encoded MRI (CSE‐MRI) at 3T. Measured PDFF and R2* values in phantoms were compared with reference FF and BMD values. Eight spondyloarthritis patients and 10 controls underwent CSE‐MRI of the sacroiliac joints. PDFF and R2* in areas of inflamed bone and fat metaplasia in patients were compared with normal bone marrow in controls. Results In phantoms, PDFF measurements were accurate over the full range of PDFF and BMD values. R2* measurements were positively associated with BMD but also were influenced by variations in PDFF. In patients, PDFF was reduced in areas of inflammation and increased in fat metaplasia compared to normal marrow. R2* measurements were significantly reduced in areas of fat metaplasia. Conclusion PDFF measurements reflect changes in marrow composition in areas of active inflammation and structural damage and could be used for disease monitoring in spondyloarthritis. R2* measurements may provide additional information bone mineral density but also are influenced by fat content. Magn Reson Med 79:1031–1042, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Timothy J P Bray
- Centre for Medical Imaging, University College London, London, United Kingdom.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Alan Bainbridge
- Department of Medical Physics, University College London Hospitals, London, United Kingdom
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
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Anninga B, White SH, Moncrieff M, Dziewulski P, L. C. Geh J, Klaase J, Garmo H, Castro F, Pinder S, Pankhurst QA, Hall-Craggs MA, Douek M. Erratum to: Magnetic Technique for Sentinel Lymph Node Biopsy in Melanoma: The MELAMAG Trial. Ann Surg Oncol 2016. [DOI: 10.1245/s10434-016-5170-y] [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: 11/18/2022]
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Bray TJP, Vendhan K, Roberts J, Atkinson D, Punwani S, Sen D, Ioannou Y, Hall-Craggs MA. Association of the apparent diffusion coefficient with maturity in adolescent sacroiliac joints. J Magn Reson Imaging 2016; 44:556-64. [PMID: 26898474 PMCID: PMC4988410 DOI: 10.1002/jmri.25209] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 12/14/2015] [Accepted: 02/09/2016] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To determine the extent to which apparent diffusion coefficient (ADC) values vary with skeletal maturity in adolescent joints. MATERIALS AND METHODS A retrospective study was performed with Institutional Review Board (IRB) approval. We used a picture archiving and communication system (PACS) search to identify and recruit all adolescents who had undergone 1.5T magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) between January 2010 and June 2015, and had no evidence of sacroiliitis and normal inflammatory markers. In all, 55 individuals were assessed. For each patient, coronal and sagittal images of the sacrum were visually analyzed to determine sacral maturity. Patients were divided into three groups depending on the degree of fusion of the sacral segmental apophyses: "Fused," "Partial," and "Unfused." For each group, SIJ ADC was measured using a linear region-of-interest technique. RESULTS Mean ADC values were 690 × 10(-6) mm(2) /s in the fused group, 720 × 10(-6) mm(2) /s in the partial group, and 842 × 10(-6) mm(2) /s in the unfused group. ADC values were significantly higher in the unfused group than in the fused group (P = 0.046). ADC values were also higher in unfused subjects than partially fused subjects (P = 0.074). CONCLUSION Joint ADC values are higher in skeletally immature (unfused) patients than in skeletally more mature (fused) patients. ADC values measured in the unfused group overlap with those previously reported in sacroiliitis. These results suggest that ADC measurements in adolescent joints must be interpreted in light of joint maturity. Joint immaturity may lead to misdiagnosis of sacroiliitis, since immature juxta-articular bone may appear similar to inflammation. J. Magn. Reson. Imaging 2016. J. Magn. Reson. Imaging 2016;44:556-564.
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Affiliation(s)
- Timothy J P Bray
- UCL Centre for Medical Imaging (Academic Radiology), London, UK
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | | | - James Roberts
- UCL Centre for Medical Imaging (Academic Radiology), London, UK
| | - David Atkinson
- UCL Centre for Medical Imaging (Academic Radiology), London, UK
| | - Shonit Punwani
- UCL Centre for Medical Imaging (Academic Radiology), London, UK
| | - Debajit Sen
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
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Bray TJP, Amies T, Vendhan K, Humphries P, Sen D, Ioannou Y, Hall-Craggs MA. Discordant inflammatory changes in the apophyseal and sacroiliac joints: serial observations in enthesitis-related arthritis. Br J Radiol 2016; 89:20160353. [PMID: 27376529 DOI: 10.1259/bjr.20160353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine the extent to which inflammation of the sacroiliac joints (SIJs) and apophyseal joints (AJs) changes concordantly after treatment in enthesitis-related arthritis (ERA). METHODS A retrospective study was performed with institutional review board approval. 31 young patients with ERA who had been scanned between March 2009 and November 2014 were included. All patients had post-contrast imaging of the SIJs and lumbar spine and short tau inversion-recovery (STIR) images of the SIJs. The severity of sacroiliitis was scored using a modification of an established technique, and inflammation of the AJs was evaluated using a recently described grading system. The changes in SIJ and AJ scores after treatment were classified as either concordant or discordant, and the proportion of scan pairs in these groups was recorded. In addition, the correlation between change in SIJ STIR score (Δnfla) and change in AJ score (ΔAJ) was assessed using Spearman's correlation coefficient. RESULTS Of a total of 43 scan pairs, the changes in inflammation were concordant in 16 scan pairs and discordant in 27 scan pairs. There was no significant correlation between Δnfla and ΔAJ (R = 0.14, p = 0.37). CONCLUSION Inflammatory changes in the SIJs and AJs are often discordant. This may be a reason why patients experience ongoing back pain despite apparent improvement in one or the other site. ADVANCES IN KNOWLEDGE Inflammation may behave differently at different anatomical sites. The SIJs and AJs should both be imaged in patients with ERA with back pain.
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Affiliation(s)
- Timothy J P Bray
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Thomas Amies
- 1 Centre for Medical Imaging, University College London, London, UK
| | | | - Paul Humphries
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Debajit Sen
- 2 Arthritis UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Yiannis Ioannou
- 2 Arthritis UK Centre for Adolescent Rheumatology, University College London, London, UK
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Hall-Craggs MA, Williams IG, Wilkinson ID, Paley M, Chinn RJ, Chong WK, Kendall BE, Harrison MJ, Baldeweg T, Pugh K, Riccio M, Catalan J, Weller IV. Proton Spectroscopy in a Cross-Section of HIV-Positive Asymptomatic Patients Receiving Immediate Compared with Deferred Zidovudine (Concorde Study). ACTA ACUST UNITED AC 2016; 1:103-13. [PMID: 16873173 DOI: 10.1300/j128v01n03_06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to examine by proton spectroscopy for any difference in cerebral metabolites in patients taking part in the Concorde study (comparing the efficacy of immediate versus deferred treatment with zidovudine on asymptomatic HIV infected individuals). Forty seven HIV positive male patients [29 immediate, 18 deferred zidovudine] were examined in the last 9 months of the therapeutic trial. Magnetic resonance imaging and proton spectroscopy were performed at 1.5 Tesla using a single voxel placed in the parieto-occipital white matter. No significant difference was found in metabolite ratios comparing immediate versus deferred zidovudine (NA/NA+Cho+Cr 0.52 vs. 0.52). High quality spectra were acquired in relatively large numbers of patients and logistically spectroscopy may be applied to clinical therapeutic studies.
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Anninga B, White SH, Moncrieff M, Dziewulski P, L. C. Geh J, Klaase J, Garmo H, Castro F, Pinder S, Pankhurst QA, Hall-Craggs MA, Douek M. Magnetic Technique for Sentinel Lymph Node Biopsy in Melanoma: The MELAMAG Trial. Ann Surg Oncol 2016; 23:2070-8. [DOI: 10.1245/s10434-016-5113-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Indexed: 02/05/2023]
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Vendhan K, Bray TJP, Atkinson D, Punwani S, Fisher C, Sen D, Ioannou Y, Hall-Craggs MA. A diffusion-based quantification technique for assessment of sacroiliitis in adolescents with enthesitis-related arthritis. Br J Radiol 2015; 89:20150775. [PMID: 26642308 PMCID: PMC4986497 DOI: 10.1259/bjr.20150775] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: To investigate the use of a quantitative diffusion-weighted imaging (DWI) tool for measuring inflammation of the sacroiliac joints (SIJs) in enthesitis-related arthritis (ERA). Methods: A retrospective study was performed with institutional review board approval. Subjects were adolescents who had undergone MRI of the SIJs since January 2010. 10 patients with a clinical diagnosis of ERA and 10 controls with a clinical diagnosis of mechanical back pain were assessed. Axial T1 weighted, short tau inversion recovery (STIR) and DWI (b-values 0, 50, 100, 300 and 600 mm2 s−1) images were acquired. Apparent diffusion coefficient (ADC) maps were generated using a monoexponential fit. On each of four slices, two to three linear regions-of-interest were placed on each joint. Normalized ADC (nADC) values were defined as joint ADC divided by a reference ADC derived from normal sacral bone. STIR images were scored using a modification of an established technique. The correlation between nADC values and STIR scores was evaluated using Spearman's rank correlation. Results: Mean nADC values were significantly higher in cases than in controls (p = 0.0015). There was a strong correlation between STIR scores and nADC values (R = 0.85). Conclusion: ADC values are significantly increased in inflamed SIJs compared with controls. There is a good correlation between this diffusion-based method and STIR scores of inflammation. Advances in knowledge: We have described and provisionally validated a method for quantifying the severity of inflammation in the SIJs in ERA using ADC measurements. This method is quick, is reproducible and could potentially be automated.
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Affiliation(s)
- Kanimozhi Vendhan
- 1 Academic Radiology, University College London Centre for Medical Imaging, London, UK
| | - Timothy J P Bray
- 1 Academic Radiology, University College London Centre for Medical Imaging, London, UK.,2 Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - David Atkinson
- 1 Academic Radiology, University College London Centre for Medical Imaging, London, UK
| | - Shonit Punwani
- 1 Academic Radiology, University College London Centre for Medical Imaging, London, UK
| | - Corinne Fisher
- 2 Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Debajit Sen
- 2 Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Yiannakis Ioannou
- 2 Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
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40
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Pouw JJ, Grootendorst MR, Bezooijen R, Klazen CAH, De Bruin WI, Klaase JM, Hall-Craggs MA, Douek M, Ten Haken B. Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: the SentiMAG Multicentre Trial imaging subprotocol. Br J Radiol 2015; 88:20150634. [PMID: 26492466 DOI: 10.1259/bjr.20150634] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Sentinel lymph node biopsy (SLNB) with a superparamagnetic iron oxide (SPIO) tracer was shown to be non-inferior to the standard combined technique in the SentiMAG Multicentre Trial. The MRI subprotocol of this trial aimed to develop a magnetic alternative for pre-operative lymphoscintigraphy (LS). We evaluated the feasibility of using MRI following the administration of magnetic tracer for pre-operative localization of sentinel lymph nodes (SLNs) and its potential for non-invasive identification of lymph node (LN) metastases. METHODS Patients with breast cancer scheduled to undergo SLNB were recruited for pre-operative LS, single photon emission CT (SPECT)-CT and SPIO MRI. T1 weighted turbo spin echo and T2 weighted gradient echo sequences were used before and after interstitial injection of magnetic tracer into the breast. SLNs on MRI were defined as LNs with signal drop and direct lymphatic drainage from the injection site. LNs showing inhomogeneous SPIO uptake were classified as metastatic. During surgery, a handheld magnetometer was used for SLNB. Blue or radioactive nodes were also excised. The number of SLNs and MR assessment of metastatic involvement were compared with surgical and histological outcomes. RESULTS 11 patients were recruited. SPIO MRI successfully identified SLNs in 10 of 11 patients vs 11 of 11 patients with LS/SPECT-CT. One patient had metastatic involvement of four LNs, and this was identified in one node on pre-operative MRI. CONCLUSION SPIO MRI is a feasible technique for pre-operative localization of SLNs and, in combination with intraoperative use of a handheld magnetometer, provides an entirely radioisotope-free technique for SLNB. Further research is needed for the evaluation of MRI characterization of LN involvement using subcutaneous injection of magnetic tracer. ADVANCES IN KNOWLEDGE This study is the first to demonstrate that an interstitially administered magnetic tracer can be used both for pre-operative imaging and intraoperative SLNB, with equal performance to imaging and localization with radioisotopes.
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Affiliation(s)
- Joost J Pouw
- 1 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
| | - Maarten R Grootendorst
- 2 Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands.,3 Research Oncology, Division of Cancer Studies, King's College London, London, UK
| | - Roland Bezooijen
- 4 Department of Radiology, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Wieger I De Bruin
- 5 Department of Nuclear Medicine, Medisch Spectrum Twente, Enschede, Netherlands
| | - Joost M Klaase
- 2 Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Michael Douek
- 3 Research Oncology, Division of Cancer Studies, King's College London, London, UK
| | - Bennie Ten Haken
- 1 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
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Bray TP, Vendhan K, Fisher C, Sen D, Ioannou Y, Hall-Craggs MA. Low Back Pain in Adolescents With Inflammatory Arthritis Can Be Due to Lumbar Spine Apophyseal Joint Inflammation, and This Requires Contrast Enhancement for Adequate Assessment: Comment on the Article by Weiss et al. Arthritis Rheumatol 2015; 68:263. [PMID: 26474090 DOI: 10.1002/art.39452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Corinne Fisher
- University College London and Arthritis Research UK Centre for Adolescent Rheumatology
| | - Debajit Sen
- University College London and Arthritis Research UK Centre for Adolescent Rheumatology
| | - Yiannis Ioannou
- University College London and Arthritis Research UK Centre for Adolescent Rheumatology
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Williams CE, Nakhal RS, Hall-Craggs MA, Wood D, Cutner A, Pattison SH, Creighton SM. Transverse vaginal septae: management and long-term outcomes. BJOG 2014; 121:1653-8. [DOI: 10.1111/1471-0528.12899] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 12/12/2022]
Affiliation(s)
- CE Williams
- Department of Women's Health; University College London Hospital; London UK
| | - RS Nakhal
- Department of Women's Health; University College London Hospital; London UK
| | - MA Hall-Craggs
- Department of Imaging; University College London Hospital; London UK
| | - D Wood
- Department of Urology; University College London Hospital; London UK
| | - A Cutner
- Department of Women's Health; University College London Hospital; London UK
| | - SH Pattison
- Department of Imaging; University College London Hospital; London UK
| | - SM Creighton
- Department of Women's Health; University College London Hospital; London UK
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Vendhan K, Sen D, Fisher C, Ioannou Y, Hall-Craggs MA. Inflammatory changes of the lumbar spine in children and adolescents with enthesitis-related arthritis: magnetic resonance imaging findings. Arthritis Care Res (Hoboken) 2014; 66:40-6. [PMID: 24127385 PMCID: PMC4285164 DOI: 10.1002/acr.22201] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 10/04/2013] [Indexed: 11/10/2022]
Abstract
Objective To describe and profile abnormalities of the lumbar spine in a cohort of patients with enthesitis-related arthritis (ERA) as compared to a control group of adolescents with mechanical back pain. Methods We performed a retrospective review of magnetic resonance imaging (MRI) lumbar spine scans of 79 patients (58 cases, 21 controls). The study was covered by institutional review board approval and informed consent was obtained for review of all clinical investigations. Images were reviewed by an expert MRI reader who was blinded to clinical details. The presence or absence of morphologic features of enthesitis, apophyseal joint synovitis, and inflammation of posterior elements was assessed at each lumbar vertebral level. The apophyseal joint inflammation was graded from 0 to 3 using a grading system that was adapted from one used in adults with inflammatory facet osteoarthropathy. STATA software was used for data analysis. Results One or more abnormalities of the lumbar spine were found in 39 (67%) of 58 cases and sacroiliitis was present in 45 (78%) of the cases. Apophyseal joint synovitis was seen in 22 (38%) cases and in 1 (5%) control patient. This difference was highly significant (P = 0.004). Inflammatory changes in the interspinous ligaments were seen in a higher percentage of cases than controls and this observation was of statistical significance (P = 0.04). Conclusion Statistically significant inflammation of the lumbar apophyseal joints and interspinous ligaments was seen in our cohort of ERA patients, most of whom have concurrent sacroiliitis. This could be contributing to back pain in these patients.
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Douek M, Klaase J, Monypenny I, Kothari A, Zechmeister K, Brown D, Wyld L, Drew P, Garmo H, Agbaje O, Pankhurst Q, Anninga B, Grootendorst M, Ten Haken B, Hall-Craggs MA, Purushotham A, Pinder S. Sentinel node biopsy using a magnetic tracer versus standard technique: the SentiMAG Multicentre Trial. Ann Surg Oncol 2013; 21:1237-45. [PMID: 24322530 DOI: 10.1245/s10434-013-3379-6] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The SentiMAG Multicentre Trial evaluated a new magnetic technique for sentinel lymph node biopsy (SLNB) against the standard (radioisotope and blue dye or radioisotope alone). The magnetic technique does not use radiation and provides both a color change (brown dye) and a handheld probe for node localization. The primary end point of this trial was defined as the proportion of sentinel nodes detected with each technique (identification rate). METHODS A total of 160 women with breast cancer scheduled for SLNB, who were clinically and radiologically node negative, were recruited from seven centers in the United Kingdom and The Netherlands. SLNB was undertaken after administration of both the magnetic and standard tracers (radioisotope with or without blue dye). RESULTS A total of 170 SLNB procedures were undertaken on 161 patients, and 1 patient was excluded, leaving 160 patients for further analysis. The identification rate was 95.0 % (152 of 160) with the standard technique and 94.4 % (151 of 160) with the magnetic technique (0.6 % difference; 95 % upper confidence limit 4.4 %; 6.9 % discordance). Of the 22 % (35 of 160) of patients with lymph node involvement, 16 % (25 of 160) had at least 1 macrometastasis, and 6 % (10 of 160) had at least a micrometastasis. Another 2.5 % (4 of 160) had isolated tumor cells. Of 404 lymph nodes removed, 297 (74 %) were true sentinel nodes. The lymph node retrieval rate was 2.5 nodes per patient overall, 1.9 nodes per patient with the standard technique, and 2.0 nodes per patient with the magnetic technique. CONCLUSIONS The magnetic technique is a feasible technique for SLNB, with an identification rate that is not inferior to the standard technique.
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Affiliation(s)
- Michael Douek
- Division of Cancer Studies, Department of Research Oncology, King's College London, London, UK,
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45
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McCormack M, Kadalayil L, Hackshaw A, Hall-Craggs MA, Symonds RP, Warwick V, Simonds H, Fernando I, Hammond M, James L, Feeney A, Ledermann JA. A phase II study of weekly neoadjuvant chemotherapy followed by radical chemoradiation for locally advanced cervical cancer. Br J Cancer 2013; 108:2464-9. [PMID: 23695016 PMCID: PMC3694233 DOI: 10.1038/bjc.2013.230] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: We investigated the feasibility of dose-dense neoadjuvant chemotherapy (NACT) with paclitaxel and carboplatin before radical chemoradiation (CRT) and assessed the response rate to such a regimen. Methods: CxII is a single-arm phase II trial of 46 patients, with locally advanced cervical cancer (stage Ib2-IVa). Patients received dose-dense carboplatin (AUC2) and paclitaxel (80 mg m−2) weekly for six cycles followed by CRT (40 mg m−2 of weekly cisplatin, 50.4 Gy, 28 fractions plus brachytherapy). The primary end point was response rate 12 weeks post-CRT. Results: Baseline characteristics were: median age at diagnosis 43 years; 72% squamous, 22% adenocarcinoma and 7% adenosquamous histologies; FIGO stage IB2 (11%), II (50%), III (33%), IV (7%). Complete or partial response rate was 70% (95% CI: 54–82) post-NACT and 85% (95% CI: 71–94) post-CRT. The median follow-up was 39.1 months. Overall and progression-free survivals at 3 years were 67% (95% CI: 51–79) and 68% (95% CI: 51–79), respectively. Grade 3/4 toxicities were 20% during NACT (11% haematological, 9% non-haematological) and 52% during CRT (haematological: 41%, non-haematological: 22%). Conclusion: A good response rate is achieved by dose-dense weekly NACT with carboplatin and paclitaxel followed by radical CRT. This treatment regimen is feasible as evidenced by the acceptable toxicity of NACT and by the high compliance to radiotherapy (98%).
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Affiliation(s)
- M McCormack
- University College London Hospitals, 250 Euston Road, London NW1 2PG, UK.
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Abstract
OBJECTIVE To describe the spectrum and frequency of renal and urological abnormalities in a cohort of patients with uterine anomalies. MATERIAL AND METHODS We conducted an ethics committee approved review of 164 women referred to the imaging department from a specialist gynaecological anomaly clinic. Imaging acquired over 8 years was assessed and this was sufficient for assessment of the morphology of the gynaecological and renal tracts in 113 patients. RESULTS Absent unilateral kidney was the most common abnormality (31.8%), most frequent in Type 3 uterine anomalies. Absent kidneys occurred in other anomaly types at lower frequency. Pelvic ureteric remnants were found in 9 of 36 patients with absent kidneys; these inserted ectopically, most commonly into the vagina. Urological abnormalities were found in 11 patients with two kidneys, including ectopic ureters, scarred kidneys and dysplastic kidney. Obstructed hemivaginas were associated commonly but not invariably with an absent kidney. CONCLUSION Previously unreported renal and urological abnormalities have been described in patients with congenital uterine anomalies. These have significant clinical impact. Ectopic ureters can cause incontinence, and potentially cause pain and become infected. Knowledge of the ureteric course, including ureteric remnants, is essential before complex laparoscopic and vaginal surgery.
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Affiliation(s)
- Margaret A Hall-Craggs
- Department of Imaging, University College Hospital London NHS Trust, 235 Euston Road, London NW1 2BU, United Kingdom.
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Malone PS, Hall-Craggs MA, Mouriquand PDE, Caldamone AA. The anatomical assessment of disorders of sex development (DSD). J Pediatr Urol 2012; 8:585-91. [PMID: 22995869 DOI: 10.1016/j.jpurol.2012.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Received: 06/29/2012] [Accepted: 08/24/2012] [Indexed: 12/14/2022]
Abstract
The assessment of abnormal anatomy in cases of DSD is important to aid diagnosis, understand the aetiology and severity of the condition, guide management and assess the outcomes of treatment. In this paper we present a systematic approach to this assessment which will provide a means by which the multiple disciplines who manage patients with these rare and complex conditions can communicate and thus improve overall care.
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Affiliation(s)
- P S Malone
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
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Creighton SM, Hall-Craggs MA. Correlation or confusion: the need for accurate terminology when comparing magnetic resonance imaging and clinical assessment of congenital vaginal anomalies. J Pediatr Urol 2012; 8:177-80. [PMID: 21398187 DOI: 10.1016/j.jpurol.2011.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Received: 11/18/2010] [Accepted: 02/07/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the terminology used when describing clinical and magnetic resonance imaging (MRI) findings in the investigation of complex congenital Mullerian anomalies. PATIENTS AND METHODS Forty-four girls and women with complex congenital Mullerian anomalies underwent vaginal examination and pelvic MRI. The findings from both procedures were compared. Different terms used to refer to the vagina were noted. Where clinical and MRI results were discordant, findings and terminology were reviewed by the multidisciplinary team. RESULTS Eleven different terms were used to describe vaginal anatomy. In 10 cases (23%) clinical and MRI findings appeared discordant. On review, it became clear that in all but two cases identical findings were being described using different vocabulary. CONCLUSION At present, there is no standard descriptive terminology recommended for these anomalies and clinical confusion can arise. A uniform protocol for terminology should be agreed between specialists undertaking this work.
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Affiliation(s)
- Sarah M Creighton
- Department of Women's Health, University College Hospital NHS Trust, 250 Euston Road, London NW1 2PG, UK.
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Dandachli W, Ul Islam S, Tippett R, Hall-Craggs MA, Witt JD. Analysis of acetabular version in the native hip: comparison between 2D axial CT and 3D CT measurements. Skeletal Radiol 2011; 40:877-83. [PMID: 21181403 DOI: 10.1007/s00256-010-1065-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [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] [Received: 07/05/2010] [Revised: 10/17/2010] [Accepted: 10/27/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare two-dimensional (2D) axial with three-dimensional (3D) computerized tomography (CT) measurements of acetabular version in native hips. MATERIALS AND METHODS CT scans of 34 hips in 17 consecutive patients being investigated for femoroacetabular impingement were analyzed. Acetabular version was measured using 2D CT at two different axial levels, one cranial (slice 2) and the other at the equator (slice 3). The measurements were repeated after correction for pelvic tilt. The results were compared to the measurements of anatomical version obtained using a 3D CT method that automatically corrects for pelvic tilt. RESULTS The mean acetabular version using the 3D CT method was 15.7° (SD 6.9°). The mean version using slice 2 was 9.3° (SD 6.5°) before correction for pelvic tilt and 15.7° (SD 8.0°) after the correction. The mean version using slice 3 was 16.4° (SD 4.2°) before tilt correction and 19.0° (SD 5.0°) after the correction. In relation to the 3D method, the intraclass correlation coefficient (ICC) was 0.58 for the uncorrected and 0.93 for the corrected slice 2 method. For the uncorrected and corrected slice 3 methods, the ICC was 0.64 and 0.89, respectively. CONCLUSIONS The 2D axial methods produced variable results. The results that correlated best with the 3D method were those of the cranial slice (slice 2) after correction for pelvic tilt. Interpretation of 2D axial CT measurements of acetabular version should be done with caution. The level at which the measurement is done and the presence of pelvic tilt appear to be significant factors.
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Affiliation(s)
- Wael Dandachli
- Department of Orthopaedic Surgery, Imperial College London Hospitals, 7th Floor, East Wing, Fulham Palace Road, London, W6 8RF, UK.
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Tanner C, White M, Guarino S, Hall-Craggs MA, Douek M, Hawkes DJ. Large breast compressions: observations and evaluation of simulations. Med Phys 2011; 38:682-90. [PMID: 21452705 DOI: 10.1118/1.3525837] [Citation(s) in RCA: 20] [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: 11/07/2022] Open
Abstract
PURPOSE Several methods have been proposed to simulate large breast compressions such as those occurring during x-ray mammography. However, the evaluation of these methods against real data is rare. The aim of this study is to learn more about the deformation behavior of breasts and to assess a simulation method. METHODS Magnetic resonance (MR) images of 11 breasts before and after applying a relatively large in vivo compression in the medial direction were acquired. Nonrigid registration was employed to study the deformation behavior. Optimal material properties for finite element modeling were determined and their prediction performance was assessed. The realism of simulated compressions was evaluated by comparing the breast shapes on simulated and real mammograms. RESULTS Following image registration, 19 breast compressions from 8 women were studied. An anisotropic deformation behavior, with a reduced elongation in the anterior-posterior direction and an increased stretch in the inferior-superior direction was observed. Using finite element simulations, the performance of isotropic and transverse isotropic material models to predict the displacement of internal landmarks was compared. Isotropic materials reduced the mean displacement error of the landmarks from 23.3 to 4.7 mm, on average, after optimizing material properties with respect to breast surface alignment and image similarity. Statistically significantly smaller errors were achieved with transverse isotropic materials (4.1 mm, P=0.0045). Homogeneous material models performed substantially worse (transverse isotropic: 5.5 mm; isotropic: 6.7 mm). Of the parameters varied, the amount of anisotropy had the greatest influence on the results. Optimal material properties varied less when grouped by patient rather than by compression magnitude (mean: 0.72 vs. 1.44). Employing these optimal materials for simulating mammograms from ten MR breast images of a different cohort resulted in more realistic breast shapes than when using established material models. CONCLUSIONS Breasts in the prone position exhibited an anisotropic compression behavior. Transverse isotropic materials with an increased stiffness in the anterior-posterior direction improved the prediction of these deformations and produced more realistic mammogram simulations from MR images.
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Affiliation(s)
- Christine Tanner
- Centre of Medical Image Computing, UCL, London WC1E 6BT, United Kingdom.
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