F V Gleeson

Oxford University Hospitals NHS Trust, Oxford, England, United Kingdom

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Publications (106)604.58 Total impact

  • Journal of Hepatology 04/2015; 62:S859-S860. DOI:10.1016/S0168-8278(15)31520-8 · 10.40 Impact Factor
  • D. Grant · J. Franklin · L. Watts · N. Rahman · FV Gleeson
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    ABSTRACT: Objectives Incidental pulmonary emboli (iPE) are detected in a significant minority of contrast CT scans performed during the management of patients with cancer. These patients are reported to have an increased mortality compared to matched controls. This study investigates outcomes and predictors of mortality following iPE. Methods Reports of all contrast-enhanced CT scans including the chest, excluding dedicated CT pulmonary angiography, performed between 1st May 2012 and 30th September 2013, were searched for prospectively identified iPE. Clinical data was collected from multiple sources, including clinic letters, discharge summaries, and the hospital patient database. Patients presenting with acute symptoms consistent with PE or those already receiving therapeutic anticoagulation were excluded. Potential clinical and radiological predictors of mortality were defined pre-hoc and tested using Student’s t-test and Cox proportional-hazard regression. Results There were 160 cancer patients with iPE. Anticoagulation treatment was given in 97% of cases. Overall 30-day and 6-month mortality following iPE was 20.6% (95% confidence interval 15.0–27.6%) and 52.5% (44.8–60.1%), respectively. Increased 30-day and 6-month mortality was observed in scans performed on inpatients compared to outpatients (38.2% vs 11.4%, p = 0.0004 and 78.2% vs 40.0%, p < 0.0001). 6-month mortality was also increased if this was a new diagnosis of malignancy at the time of the CT scan compared to patients with known malignancy (69.4% vs 46.0%, p = 0.0046), or if metastases were present at the time of CT scan (58.3% vs 26.7%, p = 0.0012). There were 86 (53.8%) central (main or lobar pulmonary arteries), 60 (37.5%) segmental, and 14 (8.8%) subsegmental pulmonary emboli. No significant mortality difference was observed between these radiological features. Conclusion This study has assessed potential poor prognostic features in patients with cancer and iPE. Despite the vast majority receiving therapeutic anticoagulation, there is a high 30-day and 6-month mortality. The benefits of conventional treatment in this clinical situation are as yet unclear.
    Thorax 12/2014; 69(Suppl 2):A147-A148. DOI:10.1136/thoraxjnl-2014-206260.296 · 8.56 Impact Factor
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    ABSTRACT: Multidisciplinary team (MDT) meetings are becoming the model of care for cancer patients worldwide. While MDTs have improved the quality of cancer care, the meetings impose substantial time pressure on the members, who generally attend several such MDTs. We describe Lung Cancer Assistant (LCA), a clinical decision support (CDS) prototype designed to assist the experts in the treatment selection decisions in the lung cancer MDTs. A novel feature of LCA is its ability to provide rule-based and probabilistic decision support within a single platform. The guideline-based CDS is based on clinical guideline rules, while the probabilistic CDS is based on a Bayesian network trained on the English Lung Cancer Audit Database (LUCADA). We assess rule-based and probabilistic recommendations based on their concordances with the treatments recorded in LUCADA. Our results reveal that the guideline rule-based recommendations perform well in simulating the recorded treatments with exact and partial concordance rates of 0.57 and 0.79, respectively. On the other hand, the exact and partial concordance rates achieved with probabilistic results are relatively poorer with 0.27 and 0.76. However, probabilistic decision support fulfils a complementary role in providing accurate survival estimations. Compared to recorded treatments, both CDS approaches promote higher resection rates and multimodality treatments.
    Journal of The Royal Society Interface 09/2014; 11(98). DOI:10.1098/rsif.2014.0534 · 3.86 Impact Factor
  • J.S.Z. Lee · F.V. Gleeson
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    ABSTRACT: The chest radiograph – better known as the chest X-ray or CXR – remains one of the most important imaging tools in patients with suspected or known cardiac disease. This article provides a guide to the systematic interpretation of a chest radiograph and a review of the classic radiological signs of cardiac disease. Its use and limitations in patients with known or suspected cardiac disease will be discussed with updates from the latest guidelines.
    Medicine 08/2014; 34(4). DOI:10.1016/j.mpmed.2014.05.012 · 4.35 Impact Factor
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    ABSTRACT: The definitive diagnosis of pleural malignancy depends upon histological confirmation by pleural biopsy. CT is reported to have a high sensitivity and specificity for the diagnosis of malignant pleural disease, and is part of the routine diagnostic workup of these patients. The aim of this study was to assess the sensitivity and specificity of CT in detecting pleural malignancy prior to definitive histology obtained via thoracoscopy in a large cohort of patients with suspected malignant pleural disease. Retrospective review of thoracoscopies between January 2008 and January 2013 at two UK tertiary referral centres: Oxford and Preston. The histological results were compared with the CT reported diagnosis before the procedure. CT scan reports were assessed by independent respiratory physicians as to whether the radiologist concluded evidence of malignant pleural disease or benign features only. 211 (57%) of 370 patients included in the analysis had malignant disease: CT scans were reported as 'malignant' in 144, giving a sensitivity of 68% (95% CI 62% to 75%). Of the 159 patients with benign disease, 124 had CT scans reported as benign: specificity 78% (72% to 84%). The positive predictive value of a malignant CT report was 80% (75% to 86%), with a negative predictive value of 65% (58% to 72%). A significant proportion of patients being investigated for malignant disease will have malignancy despite a negative CT report. The use of CT alone in determining which patients should have invasive pleural biopsies should be re-evaluated, and further studies to define the diagnostic pathway are now required.
    Thorax 07/2014; 70(2). DOI:10.1136/thoraxjnl-2014-206054 · 8.56 Impact Factor
  • E. Teh · J. Mitchell · F. Gleeson · N. Rahman · E. Black · E. Belcher
    Interactive Cardiovascular and Thoracic Surgery 06/2014; 18(suppl 1):S41-S41. DOI:10.1093/icvts/ivu167.157 · 1.11 Impact Factor
  • E. Teh · J. Mitchell · F. Gleeson · N. Rahman · E. Black · E. Belcher
    Lung Cancer 01/2014; 83:S72. DOI:10.1016/S0169-5002(14)70195-3 · 3.74 Impact Factor
  • Thorax 11/2013; 68(Suppl 3):A78-A78. DOI:10.1136/thoraxjnl-2013-204457.158 · 8.56 Impact Factor
  • J. S. Z. Lee · K. M. Bradley · F. V. Gleeson
    Thorax 11/2013; 68(Suppl 3):A99-A99. DOI:10.1136/thoraxjnl-2013-204457.203 · 8.56 Impact Factor
  • J.S. Lee · O.S. Thein · F. Sheerin · R. Macpherson · K. Bradley · F.V. Gleeson
    Lung Cancer 01/2013; 79:S22. DOI:10.1016/S0169-5002(13)70064-3 · 3.74 Impact Factor
  • Lung Cancer 01/2013; 79:S48. DOI:10.1016/S0169-5002(13)70143-0 · 3.74 Impact Factor
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    ABSTRACT: A comprehensive framework for predicting response to therapy on the basis of heterogeneity in dceMRI parameter maps is presented. A motion-correction method for dceMRI sequences is extended to incorporate uncertainties in the pharmacokinetic parameter maps using a variational Bayes framework. Simple measures of heterogeneity (with and without uncertainty) in parameter maps for colorectal cancer tumours imaged before therapy are computed, and tested for their ability to distinguish between responders and non-responders to therapy. The statistical analysis demonstrates the importance of using the spatial distribution of parameters, and their uncertainties, when computing heterogeneity measures and using them to predict response on the basis of the pre-therapy scan. The results also demonstrate the benefits of using the ratio of K trans with the bolus arrival time as a biomarker.
  • D M L Tse · N Joshi · E M Anderson · M Brady · F V Gleeson
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    ABSTRACT: The aim of this study was to demonstrate the principle of supporting radiologists by using a computer algorithm to quantitatively analyse MRI morphological features used by radiologists to predict the presence or absence of metastatic disease in local lymph nodes in rectal cancer. A computer algorithm was developed to extract and quantify the following morphological features from MR images: chemical shift artefact; relative mean signal intensity; signal heterogeneity; and nodal size (volume or maximum diameter). Computed predictions on nodal involvement were generated using quantified features in isolation or in combinations. Accuracies of the predictions were assessed against a set of 43 lymph nodes, determined by radiologists as benign (20 nodes) or malignant (23 nodes). Predictions using combinations of quantified features were more accurate than predictions using individual features (0.67-0.86 vs 0.58-0.77, respectively). The algorithm was more accurate when three-dimensional images were used (0.58-0.86) than when only middle image slices (two-dimensional) were used (0.47-0.72). Maximum node diameter was more accurate than node volume in representing the nodal size feature; combinations including maximum node diameter gave accuracies up to 0.91. We have developed a computer algorithm that can support radiologists by quantitatively analysing morphological features of lymph nodes on MRI in the context of rectal cancer nodal staging. We have shown that this algorithm can combine these quantitative indices to generate computed predictions of nodal status which closely match radiological assessment. This study provides support for the feasibility of computer-assisted reading in nodal staging, but requires further refinement and validation with larger data sets.
    The British journal of radiology 09/2012; 85(1017):1272-8. DOI:10.1259/bjr/13374146 · 2.02 Impact Factor
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    ABSTRACT: Reports have suggested that a reduction in tumour 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) examination during or after neoadjuvant chemotherapy may predict pathological response in oesophageal cancer. Our aim was to determine whether metabolic response predicts pathological response to a standardised neoadjuvant chemotherapy regimen within a prospective clinical trial. Consecutive patients staged with potentially curable oesophageal cancer who underwent treatment within a non-randomised clinical trial were included. A standardised chemotherapy regimen (two cycles of oxaliplatin and 5-fluorouracil) was used. PET/CT was performed before chemotherapy and repeated 24-28 days after the start of cycle 2. Forty-eight subjects were included: mean age 65 years; 37 male. Using the median percentage reduction in SUV(max) (42%) to define metabolic response, pathological response was seen in 71% of metabolic responders (17/24) compared with 33% of non-responders (8/24; P = 0.009, sensitivity 68%, specificity 70%). Pathological response was seen in 81% of subjects with a complete metabolic response (13/16) compared with 38% of those with a less than complete response (12/32; P = 0.0042, sensitivity 52%, specificity 87%). There was no significant histology-based effect. There was a significant association between metabolic response and pathological response; however, accuracy in predicting pathological response was relatively low.
    European Radiology 05/2012; 22(9):2035-43. DOI:10.1007/s00330-012-2459-5 · 4.34 Impact Factor
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    ABSTRACT: Positron emission tomography combined with computed tomography (PET-CT) is increasingly being used in the staging of oesophageal cancer. Some recent reports suggest it may be used to predict survival. None of these studies, however, reported on the prognostic value of PET-CT performed before neoadjuvant chemotherapy and surgery. The aim of this study was to determine whether pretreatment PET-CT could predict survival. Consecutive patients with oesophageal adenocarcinoma who underwent PET-CT before neoadjuvant chemotherapy and resection were included. Maximum standardized uptake value (SUV(max)), fluorodeoxyglucose (FDG)-avid tumour length and the presence of FDG-avid local lymph nodes were determined for all patients. Kaplan-Meier survival analysis was performed and multivariable analysis used to identify independent prognostic factors. A total of 121 patients were included (mean age 63 years, 97 men) of whom 103 underwent surgical resection. On an intention-to-treat basis, overall survival was significantly worse in patients with FDG-avid local lymph nodes (P < 0·001). SUV(max) and FDG-avid tumour length did not predict survival (P = 0·276 and P = 0·713 respectively). The presence of FDG-avid local lymph nodes was an independent predictor of poor overall survival (hazard ratio (HR) 4·75, 95 per cent confidence interval 2·14 to 10·54; P < 0·001) and disease-free survival (HR 2·97, 1·40 to 6·30; P = 0·004). The presence of FDG-avid lymph nodes, but not SUV(max) or FDG-avid tumour length, was an independent adverse prognostic factor.
    British Journal of Surgery 02/2012; 99(2):239-45. DOI:10.1002/bjs.7758 · 5.21 Impact Factor
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    ABSTRACT: PET-CT scans are routinely performed in patients with lung cancer after investigation by chest x-ray (CXR) and CT scan, when these have demonstrated potentially curable disease. If the majority of patients with lung cancer potentially suitable for curative treatment could be identified earlier in the diagnostic pathway on the basis of CXR findings they could be referred for PET-CT imaging without a prior CT scan. We investigated the clinical and financial implications of adopting such a strategy. The details of 1187 patients referred with suspected lung cancer between July 2006 and August 2009 were analysed. The initial CXR and subsequent imaging of patients fit for curative treatment (Performance Status 0/1, FEV1 > 1.0) were reviewed (n = 251). The clinical and financial implications of referring patients for first line PET-CT if deemed potentially curable based on CXR findings were assessed. 107 of 1187 patients had potentially curable lung cancer on PS, lung function, CT and PET-CT. 96 of these 107 patients (90%) were correctly identified on CXR. 149 patients overall were diagnosed as potentially curable on CXR. Referring suitable patients for an immediate PET-CT scan resulted in a reduction in the time to complete staging investigations. Early PET-CT scanning for patients with suspected lung cancer, potentially suitable for curative therapy could result in more efficient staging with little additional cost.
    Clinical Radiology 01/2012; 67(6):564-73. DOI:10.1016/j.crad.2011.10.032 · 1.66 Impact Factor
  • J M Franklin · E M Anderson · F V Gleeson
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    ABSTRACT: To describe the post-chemoradiotherapy magnetic resonance imaging (MRI) features of locally advanced rectal carcinoma (LARC) in which there has been a complete histopathological response to neoadjuvant chemoradiotherapy (CRT). This retrospective cohort study was performed between January 2005 and November 2009 at a regional cancer centre. Consecutive patients with LARC and a histopathological complete response to long-course CRT were identified. Pre- and post-treatment MRI images were reviewed using a proforma for predefined features and response criteria. ymrT0 was defined as the absence of residual abnormality on MRI. Twenty patients were included in the study. Seven (35%) ypT0 tumours were ymrT0. All 13 ypT0 tumours not achieving ymrT0 appearances had a good radiological response, with at least 65% tumour reduction. The appearances were heterogeneous: in 11/13 patients the tumour was replaced by a region of at least 50% low signal on MRI, with 8/13 having ≥80% low signal, and 3/13 with 100% low signal. MRI may be useful in identifying a complete histopathological response. However, the MRI appearances of ypT0 tumours are heterogeneous and conventional MRI complete response criteria will not detect the majority of patients with a complete histopathological response.
    Clinical Radiology 01/2012; 67(6):546-52. DOI:10.1016/j.crad.2011.11.004 · 1.66 Impact Factor
  • F Murphy · F V Gleeson · M R Middleton
    Annals of Oncology 12/2011; 23(3):545-6. DOI:10.1093/annonc/mdr577 · 6.58 Impact Factor
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    ABSTRACT: Introduction and Objectives Several studies have described the typical imaging features of empyema on CT, including pleural thickening, pleural enhancement, septation and loculation. However, there are further CT features of empyema which are less well described, or have only been reported in small groups of patients. The aim of this study was to establish the prevalence of the different CT imaging features of empyema in a large, well-characterised cohort of empyema patients. Methods This was a retrospective cohort study comprising a subgroup of patients from the MIST 2 trial, who underwent a pre-treatment thoracic CT at a single institution. Patients in this trial had confirmed empyema using consistent diagnostic criteria. To ensure consistent and reliable image interpretation, each CT examination was assessed for predefined imaging features by three independent Thoracic Radiologists using a proforma. These features are listed in Abstract S62 table 1. We explored the sensitivity of the presence of five “classic” features of empyema described by Kearney et al (2000): loculation, parietal pleural thickening and enhancement and increased extrapleural fat thickness and attenuation. Results 97 patients were included in the study. Imaging features are summarised in Abstract S62 table 1. 98.5% (95% CI 90.9% to 99.9%) of patients had at least two of five classic CT features of empyema. Additionally, we noted a significant number of patients with visceral pleural enhancement (66%), with indrawing/tenting of the visceral pleural (30%) and with subvisceral oedema (34%). Parenchymal changes were seen in the majority of patients. Associated consolidation was seen in the ipsilateral lung in 63% of patients; which was adjacent to the empyema in 87% of cases. Conclusion This study describes the prevalence of multiple CT features of empyema and highlights the frequency of associated visceral changes. Many of the typical features of empyema were highly prevalent in this population but we also noted a high frequency of several other, less well-reported features. Subvisceral oedema is a previously unreported feature of empyema. These features may have implications for both diagnosis and prognosis.
    Thorax 12/2011; 66(Suppl 4):A30-A31. DOI:10.1136/thoraxjnl-2011-201054b.62 · 8.56 Impact Factor
  • Tom Havelock · Richard Teoh · Diane Laws · Nick Maskell · Fergus Gleeson
    Thorax 09/2011; 66(9):829-829. DOI:10.1136/thx.2010.156398 · 8.56 Impact Factor

Publication Stats

2k Citations
604.58 Total Impact Points

Institutions

  • 1999–2014
    • Oxford University Hospitals NHS Trust
      • Department of Radiology
      Oxford, England, United Kingdom
  • 1998–2013
    • Churchill College
      Cambridge, England, United Kingdom
  • 2012
    • National Institute for Health Research
      Londinium, England, United Kingdom
    • NIHR Oxford Biomedical Research
      Oxford, England, United Kingdom
  • 2010
    • University of Southampton
      Southampton, England, United Kingdom
  • 2009–2010
    • University of Oxford
      • Oxford e-Research Centre
      Oxford, England, United Kingdom
  • 2004
    • Royal Brompton and Harefield NHS Foundation Trust
      Harefield, England, United Kingdom