Centre for Medical Imaging

Medicine News

Major Grants from 1st August 2013

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Rajiv Jalan

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Research Groups

Lower Gastrointestinal Imaging

CTC image
CTC CAD
CTC image matching

CT Colonography

CT Colonography (CTC) is an advanced imaging technique for the diagnosis of colorectal cancer and its precursor, the adenomatous polyp. It involves rapid CT scanning of the cleansed, distended colon. Modern computing technology allows 3D rendering of the inside of the colon – “virtual colonoscopy”. The SIGGAR trials showed that CT colonography is superior to the older alternative imaging test, barium enema, because CTC detects more cancers and large polyps and patients prefer it. Furthermore, CTC is a good alternative to colonoscopy (a camera test of the large bowel) because it detects a similar number of cancers and large polyps.

Key research areas:

CTC in symptomatic patients

The paired SIGGAR trials showed that CT colonography is superior to the older alternative imaging test, barium enema, because CTC detects more cancers and large polyps and patients prefer it. Furthermore, CTC is a good alternative to colonoscopy (a camera test of the large bowel) because it detects a similar number of cancers and large polyps.

CTC for asymptomatic screenees

The recently-established national Bowel Cancer Screening Programme uses CTC to investigate individuals who have tested positive for faecal occult blood but who are unable to undergo full colonoscopy. We are investigating the current use of CTC in this setting.

Evidence-based assessment of high technology imaging platforms

Our work in CAD (see section below) highlighted some problems when existing statistical methods are used to determine the benefit, or otherwise of high technology imaging platforms. We are currently developing and investigating the use of net-benefit methods as an alternative to receiver operator characteristic (ROC) curves, using CT colonography as an example. Collaborators are Professor Douglas Altman and Dr Susan Mallet, Oxford University.   

Advanced image visualization

CTC images are routinely acquired in two positions. Matching different parts of the colon between the two positions is difficult but important, since it helps confirm a suspected polyp is genuine. Furthermore, small polyps may now undergo imaging surveillance with CTC rather than colonoscopic removal, so rapid identification of the same polyp on follow-up studies would be clinically valuable. In conjunction with the Centre for Medical Image Computing at UCL, we are developing and validating techniques to match CTC images in different positions and at different times.

Patient preferences for colorectal cancer investigations

In collaboration with the UCL Health Behaviour Research Centre, we are researching patient views on the various different tests available for the diagnosis of colorectal cancer and polyps. We are currently interested in how people weigh up the importance of test sensitivity (i.e. its ability to find disease) versus its specificity (i.e. its ability to avoid making false diagnoses) and how this interacts with other factors such as convenience and discomfort. 

Eye tracking radiologist interpretation of CTC

Occasionally CTC misses polyps or cancers. Sometimes this might be because a polyp is overlooked by a radiologist, whereas on other occasions the radiologist might see the lesion but incorrectly dismiss it. To help distinguish these possibilities, and investigate if more experienced radiologists visually interrogate the images in a different manner, we are developing eye-tracking methods to quantitatively evaluate eye movements during CTC interpretation. Collaboration is with Dr Sue Mallett, University of Oxford, Professor Alastair Gale, Loughborough University and Dr Peter Phillips, University of Cumbria.

Whole-body MRI for colorectal cancer staging

Please see the Oncology section for further details.

Contact  Dr Andrew Plumb, Prof Steve Halligan

Small Bowel

Small Bowel Motility Map (colour)

The small bowel is a complex organ and can be afflicted by a range of structural and functional diseases. It is relatively inaccessible to even modern endoscopic techniques, and imaging is pivotal to diagnosis and assessment. Lead by Professor Stuart Taylor, the small bowel imaging group in the Centre for Medical imaging has an active research program using advanced imaging techniques, notably MRI to investigate the small bowel. Crohn’s disease is a major research interest with a full translational pipeline from development of new imaging biomarkers of biological activity through to a multicentre study comparing MRI and ultrasound in the diagnosis and staging of Crohn’s disease funded by the NIHR HTA. Working in collaboration with CMIC, we have developed a validated novel software which can quantitate global and segmental enteric motility which has applications not just in structural small bowel disorders, but in disease affecting global enteric function such as Parkinson’s disease, pseudo-obstruction and refractory constipation.

Key research activities

Quantification of enteric motility using MRI

Aberrant intestinal motility is seen in a very wide range of disease including structural disorders such a Crohn’s disease and systematic diseases such as autonomic failure and Parkinson’s disease. We have developed novel software to quantify enteric motility in health and disease. Collaborators include Nottingham University. [Magn Reson Med, Radiology]
Contacts: Alex Menys, Dr David Atkinson, and Prof Stuart Taylor

Development of MRI biomarkers of hypoxia and inflammation in Crohns disease.

Part funded by Crohns and Colitis UK, Industrial partners and the EU FP7 framework, in collaboration with Dr Manuel Rodriquez-Justo. Hypoxia and inflammation are fundamental to the pathophysiology of Crohns disease. Contact Dr Jessica Makanyanga, Prof Stuart Taylor

Diagnostic accuracy of MRI for detection and staging of Crohns disease

There are many imaging and endoscopic techniques available to investigate patients which suspected or known Crohn’s disease, many of which exposure patients to ionising radiation. MRI and Ultrasound may be safer alternatives but their utility in clinical practice is not yet elucidated. We are conducting a NIHR HTA funded multicentre study comparing the diagnostic accuracy of MRI and USS for Crohns disease. Contact Dr Gauraang Bhatnagar, Prof Stuart Taylor

Oncology

Whole Body MRI
Key research activities

Multi-parametric Whole Body MRI in Multiple Myeloma, Lymphoma and Prostate Cancer

Development, optimization and implementation of multi-parametric whole body magnetic resonance imaging protocol (mpWB-MRI) in cancer imaging. Initially, investigating the diagnostic accuracy of mpWB-MRI in multiple myeloma, lymphoma and prostate cancer. Analysis of quantitative derived parameters from functional imaging to investigate novel imaging biomarkers in these three type of cancers. Contact Dr Arash Latifoltojar, Dr Shonit Punwani

Multi-parametric MRI in Head & Neck Cancer

MRI Detection and Characterisation of Lung Nodules


MR Image Acquisition, Reconstruction and Analysis

Targeted FOV Kidney DTI
Key research activities

Diffusion weighted MRI for body applications

We are researching methods to reduce the effects of eddy currents, fat artefacts, motion and field non-uniformities to improve Diffusion MRI outside of the head. The image on the left shows a high resolution kidney image and with our collaborators at KCL, we have recently imaged the cardiac fibre orientations in a patient with a systemic right ventricle [European Heart Journal Flashlight ]. Contact: Rachel Chan, David Atkinson.

Robust Image Registration

Incorporating methods from low rank and sparse data decomposition, we have developed a Robust Data Driven Registration (RDDR) that can register time series images in the presence of contrast changes [MIA paper]. Contact: Valentin Hamy, David Atkinson.

Reconstruction of under-sampled MR data

Motility analysis

Please see the section above on Small Bowel.

Equilibrium Imaging

   Contact Dr Steve Bandula

Urology

  Contact Dr Alex Kirkham

Paediatrics

   Contact Dr Paul Humphries

Adolescent Rheumatology

   Contact Prof Margaret Hall-Craggs

Liver 

MRI liver haemodynamics

Imaging offers new opportunities to study vascular pathophysiology underpinning many of the complex clinical sequelae of chronic liver disease. 

Key research activities

Liver Haemodynamic and Quantitative Imaging

CMI boasts a fully translational MR imaging pipeline beginning with development in the preclinical setting on a 9.4T system through collaboration with CABI, extending to larger scale clinical studies. Current studies focussing on portal hypertension using phase contrast, dynamic contrast enchanced and dynamic hepatocyte-specific contrast enhanced MRI (funded by the Wellcome Trust) are underway. Contact Manil Chouhan, Stuart Taylor

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