Anthony J Edey

National Heart, Lung, and Blood Institute, Maryland, United States

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Publications (6)23.33 Total impact

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    ABSTRACT: To evaluate the computed tomographic (CT) predictors of a clinically significant yield from microbiological tests in patients with a tree-in-bud pattern. CT examinations in 53 patients (male=34; mean age=52.9±17.3 y) with a tree-in-bud pattern in whom a diagnostic test (sputum analysis, bronchoalveolar lavage or nasopharyngeal aspirates) had been performed within 2 weeks were identified. The following CT patterns were independently quantified by 2 thoracic radiologists: tree-in-bud, bronchiectasis, bronchial wall thickening, consolidation, ground-glass opacification, and nodules. The presence of cavitation (in nodules and/or consolidation) was recorded. Patient charts were reviewed for the presence of a clinically significant positive microbiological result. A clinically significant causal organism was present in 25/53 (47%) patients. The median extent of a tree-in-bud pattern was 5 [range=1 to 16 (maximum range=0 to 18)], and cavitation was present in 14/53 (26%) patients (cavitating nodules=8, cavitation in consolidation=3, and cavitation in consolidation and nodules=3). There was no independent linkage between the extent of a tree-in-bud pattern and the identification of a clinically significant organism. The microbiological yield was significantly higher if there was coexistent cavitation in nodules or consolidation [11/14 (79%) vs. 14/39 (39%); P=0.005]. On stepwise logistic regression, the only CT predictor of a clinically significant microbiological yield was cavitation on CT (odds ratio=9.7; 95% confidence interval=1.9, 49.9; P<0.01); the extent of a tree-in-bud pattern, concurrent use of antibiotics, age, and sex were not independently linked to a significant microbiological yield. A specific clinically significant microbiological diagnosis was obtained in approximately 50% of patients with a tree-in-bud pattern. The microbiological yield rises strikingly when a tree-in-bud pattern coexists with cavitation (in nodules or consolidation) but is not predicted by ancillary CT signs or clinical parameters.
    Journal of thoracic imaging 02/2014; · 1.42 Impact Factor
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    ABSTRACT: Abstract Rationale - Lung clearance index (LCI) is a more sensitive measure of lung function than spirometry in cystic fibrosis (CF) and correlates well with abnormalities in high resolution computed tomography (HRCT) scanning. We hypothesised LCI would be equally sensitive to lung disease in primary ciliary dyskinesia (PCD). Objectives - To test the relationships between LCI, spirometry and HRCT in PCD and to compare them to the established relationships in CF. Methods -Cross sectional study of 127 patients with CF and 33 patients with PCD, all of whom had spirometry and LCI, of which a subset of 21 of each had HRCT performed. HRCT was scored for individual features and these features compared with physiological parameters. Measurements and main results - Unlike in CF, and contrary to our hypothesis, there was no correlation between spirometry and LCI in PCD, and no correlation between HRCT features and LCI or spirometry in PCD. Conclusions - We show for the first time that HRCT, spirometry and LCI have different relationships in different airway diseases, and that LCI does not appear to be a sensitive test of airway disease in advanced PCD. We hypothesise that this results from dissimilarities between the components of large and small airway disease in CF and PCD. These differences may in part lead to the different prognosis in these two neutrophilic airway diseases. Abstract word count: 220 Keywords: spirometry, HRCT, LCI.
    American Journal of Respiratory and Critical Care Medicine 07/2013; · 11.04 Impact Factor
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    ABSTRACT: Pulmonary hypertension (PH) is associated with increased mortality in fibrotic idiopathic interstitial pneumonia (IIP). We hypothesize that baseline K(CO) (diffusing capacity of carbon monoxide/alveolar volume) and 6-month decline in K(CO) reflect PH, thus predicting mortality in IIP. All IIP referrals (2004-2007) were identified (n = 269). 192 had pulmonary function at 6 months. Fifty-two (27%) died during follow-up (median 22.5 months). Outcome was evaluated for early (1 year from 6-month pulmonary function) and overall mortality. A vascular index best predicting mortality was identified (using baseline and 6-month decline in K(CO) ) and evaluated against PH at echocardiography. Baseline and 6-month decline in K(CO) were associated with early and overall mortality. A positive vascular index (baseline K(CO) % ≤ 50% and/or ≥15% decline in K(CO) at 6 months; n = 40) was strongly predictive of early and overall mortality. Neither a diagnosis of idiopathic pulmonary fibrosis nor PH predicted early death when incorporated into this model. In patients without baseline PH, with follow-up echocardiography (n = 60), a positive vascular index was associated with PH at follow-up. A vascular index comprised of baseline and 6-month decline in K(CO) strongly predicted increased mortality and development of PH on echocardiography. In, K(CO) may be an important marker for pulmonary vascular disease and its associated mortality.
    Respirology 12/2011; 17(4):674-80. · 2.78 Impact Factor
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    ABSTRACT: The study aims were to identify CT features that predict outcome of fibrotic idiopathic interstitial pneumonia (IIP) when information from lung biopsy data is unavailable. HRCTs of 146 consecutive patients presenting with fibrotic IIP were studied. Visual estimates were made of the extent of abnormal lung and proportional contribution of fine and coarse reticulation, microcystic (cysts ≤4 mm) and macrocystic honeycombing. A score for severity of traction bronchiectasis was also assigned. Using death as our primary outcome measure, variables were analysed using the Cox proportional hazards model. CT features predictive of a worse outcome were coarse reticulation, microcystic and macrocystic honeycombing, as well as overall extent of lung abnormality (p < 0.001). Importantly, increased severity of traction bronchiectasis, corrected for extent of parenchymal abnormality, was predictive of poor prognosis regardless of the background pattern of abnormal lung (HR = 1.04, CI = 1.03-1.06, p < 0.001). On bivariate Cox analysis microcystic honeycombing was a more powerful determinant of a poor prognosis than macrocystic honeycombing. In fibrotic IIPs we have shown that increasingly severe traction bronchiectasis is indicative of higher mortality irrespective of the HRCT pattern and extent of disease. Extent of microcystic honeycombing is a more powerful determinant of outcome than macrocystic honeycombing.
    European Radiology 03/2011; 21(8):1586-93. · 4.34 Impact Factor
  • A J Edey, D M Hansell
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    ABSTRACT: The widespread use of multidetector computed tomography for imaging of the chest has lead to a significant increase in the number of incidentally detected pulmonary nodules. The significance of these nodules is often uncertain and further investigations may be required. This article will review the spectrum of imaging appearances of small pulmonary nodules, and highlight the few features that allow confident characterization of a nodule as benign or malignant; current guidelines for the management of incidentally detected nodules will also be discussed.
    Clinical radiology 10/2009; 64(9):872-84. · 1.65 Impact Factor
  • A J Edey, D M Hansell
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    ABSTRACT: Lung cancer is the most common cause of cancer-related death in the UK. Despite aggressive primary prevention measures and improved medical care, the 5-year survival rate is less than 10% for patients in the UK who present with symptoms. The possibility of CT screening for lung cancer provides some hope of reducing mortality. However, the case for screening remains unproven. This article explores the issues surrounding lung cancer screening in the context of historical studies, trials in progress and tentative plans for a UK CT lung cancer screening trial.
    The British journal of radiology 08/2009; 82(979):529-31. · 2.11 Impact Factor