Imaging in the AHSC: Focus on Clinical Translation

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Imaging in the AHSC Focus on Clinical
Translation

• Reza Razavi
• Head of Division of Imaging Sciences and
  Consultant Paediatric Cardiologist

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Imaging in the Academic Health Science Centre

• We are bringing together the
• Imaging (Radiology, Nuclear Medicine and Medical
  Physics) Departments of Guys and St Thomas and
  Kings College Hospitals
• Imaging Sciences Division of Kings College
  London (over 100 researchers 4/5 of whom are
  basic scientists in physics, computer science,
  mathematics, chemistry and biology)
• into an integrated entity which will deliver
  excellence in research, clinical service and
  training with a joint clinical academic
  leadership
• Clinical Neuroimaging at Kings College Hospital
  and the Centre for Neuroimaging Sciences at the
  Institute of Psychiatry are also forming a
  separate joint clinical academic grouping

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Areas of research and clinical translation

• Cardiovascular Imaging
• BHF Centre of Excellence with Cardiovascular and
  Randall Divisions 2008
• Cancer Imaging
• CRUK/EPSRC Cancer Imaging Centre with Cancer
  Division 2008
• Bone and Osteoporosis Imaging
• Transplantation Imaging
• MRC Centre for Transplantation with Immunology,
  Infection and Inflammatory Disease and Genetics
  Divisions 2007
• Asthma and Allergy Imaging
• NIHR Comprehensive Biomedical Research Centre
  program grant with the Asthma, Allergy and Lung
  Biology Division 2009

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Cardiac MRI Imaging in Myocardial Ischemia
Late enhancement
Infarct
Cine, Tag
Angina pectoris
Spectroscopy
ECG changes
Perfusion
Local systolic dysfunction
Diastolic dysfunktion
Metabolic changes
Hypoperfusion
Time
Nesto A et al. Am J Card 1987
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Sparse Sampling
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are miss?ng.
1) For example, some letters in this sentence
are ???????.
sparse sampling
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Sparse Sampling
?or exa?ple, s?me lett?rs in thi? sent?nce are
miss?ng.
Training or Model
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k-t SENSE Perfusion imaging
1
2
3
5x k-t SENSE (1.1 x 1.1 mm2, 3 Tesla)
Slice 3
Slice 2
Slice 1
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Vulnerable Plaque Features Potential Targets
A)
B)
A) Pathogenesis of atherosclerosis. Falk E et al.
J Am Coll Cardiol 2006 47C7-12 B) The popcorn
plaques. Jagat Narula H William Strauss. Nature
Medicine 13, 532 - 534 (2007)
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Atherosclerosis Plaque Imaging
Clinical Translation
Clinical Translation
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MR-Guided Electrophysiology procedures
MR

• MR-guided catheterization of RA and RV with
  active tip tracking
• Simultaneous EP recording with two MR-EP
  catheters
• Catheter 1 in RV
• Catheter 2 in RA

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RF-safe Diagnostic MR-EP catheter

• Highly resistive wires to EP electrodes
• Dedicated robust highly resistive wires
• 150µm diameter, 6kOhms/m
• Transformer-based cable to tip tracking coil
• Micro-coaxial cable
• Dedicated 500µm wide transformers

EP electrode
HR wire
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In-vivo safe MR-EP pacing
Native rhythm
Ventricular Pacing
Surface ECG
Cath1 in RV
Cath2 in RA
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MR-guided EP Tracking and Mapping
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MRI derived activation map of right ventricle
during sinus rhythm
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3D visualisation of Ablation points using
Gadolinium late-enhancement
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Over 240 patients XMR guided catheterisations
Diagnostic (n180)
Interventional (n60)
EP studies
PVR studies
Device placement
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Cardiac Resynchronisation Therapy for Congestive
Heart Failure

• Congestive Heart Failure
• Increasing prevalence 3.4 M in the UK (2 of
  Healthcare costs)
• Poor outcome 50 3 yr mortality after 1st
  hospital admission
• CRT shown to be the most effective treatment but
  very expensive (30K)
• Only 60 success rate (identify patients who will
  benefit)
• Large number excluded under current criteria
  (increase patient who benefit)
• Not optimise for each individual patient
  (maximise benefit for each patient)

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Simulating Electromechanics
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Simulation of the effect of pacing on electrical
polarisation
Baseline Measurements
Predicted BiV Pacing
Measured BiV Pacing
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Simulation of the effect of pacing on mechanics
of contraction
Measured (solid red) and simulated (dashed blue)
dP/dt curves during systole in sinus rhythm.
Measured (solid red) and simulated (dashed blue)
pressure curves in sinus rhythm.
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Simulation of the effect of pacing on mechanics
of contraction
Coronary sinus catheter
ms
Endocardial catheter
Measured isochrones for biventricular pacing
with simultaneous endocardial left ventricular
pacing
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Simulation of the effect of pacing on mechanics
of contraction
Measured (solid red) and simulated (dashed blue)
dP/dt curves during systole with pacing.
Measured (solid red) and simulated (dashed blue)
pressure curves with pacing.
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Conclusion

• There is huge potential for translation of basic
  science developments in imaging into better
  diagnostics and treatments for both local
  patients and into the wider NHS and
  internationally
• Our aim is to show real patient benefit in a
  quick timescale
• First in man studies
• Larger studies both using imaging biomarkers
  and the use of imaging in improving outcomes of
  disease

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Current Research Staff and PhD students Division
of Imaging Sciences
Reza Razavi Eike Nagel Phil Blower Tobias
Schaeffter Rene Botnar Sebastian Kozerke Andy
Adam Ignac Fogelman
Edward Baker Philipp Beerbaum Gerald Greil
Philip Batchelor Greg Mullen Graeme Penney Sven
Plein Andrea Wiethoff Stephen Keevil Glen
Blake Michael ODoherty Sally Barrington Paul
Marsden Kawal Rhode Maxime Sermesant Rick
Southworth Geoff Charles-Edwards Michelle Frost
Giancarlo Amati Hannah Bellsham-Revell Nuno
Bettencourt Dennis Caulfield Kazumi Chia Amedeo
Chiribiri Marcel Cleij Sarah Defrietas Simon
Duckett Joel Dunn Matthew Ginks Tarique
Hussain Christian Jansen Geraint Morton Harris
Papadopoulou Victoria Parish Gabriella
Passacquale Andreas Schuster Aphrodite
Tzifa Maite Jauregui Andy King YingLiang Ma Kat
Mattock Rowena Paul Andrea Protti Kavitha
Sunassee Paul Schleyer Rafael Torres Harry
Tsoumpas Claudia Vásquez Amanda Weeks Amelia
Moore Ed Somer
Marcelo Andia Adam Badar Dave Berry Ulrike
Blume Kevin Brownhill Christian Buerger Niall
MacDougall Maxwell Handley Markus
Henningsson Chengliang Hu Ben Knowles Jane
MacKewn Marcus Makowski Levente
Meszaros Alexander O'Neil Sarah Peel Michael
Phillips Carsten Schirra Eshan Sharif Gareth
Smith Katrina Soderquest Richard Tavare Nicolas
Toussaint Michael Truong Sergio Uribe Muhammad
Usman Gopal Varma Peter Williamson Cheng Yao
Emily Serra Margaret Dakin Mick Barnes Cathy
Worton Sheila Foolheea Roshni Patel Carly
Glowotz Luca Biason John Totman Stephen
Sinclair Davide Poccecai David Thakor Stacey
Baker Randeep Sagoo Joemon John Armidita
Jacob Elzanne Strachan Kam Kahlon Liz Webb Neria
Ossoulyan Cathy Barrett Ray Khan Faten
Hathroubi Phil Halsted Mick Kelly Tony Page