P D Griffiths

The University of Sheffield, Sheffield, England, United Kingdom

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Publications (120)400.17 Total impact

  • P. D. Griffiths · S. Sharrack · K. L. Chan · J. Bamfo · F. Williams · M. D. Kilby
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    ABSTRACT: Objective The aim of this study was to quantify the risk of brain abnormalities in single twin demise of monochorionic pregnancies and to describe the type of brain injuries. using ultrasound and in utero MR imaging (iuMR).Methods Monochorionic twin pregnancies complicated by demise of one twin referred between 2004-2013 were reviewed. Ultrasound was performed in a tertiary centre prior to iuMR The cases were subdivided into those associated with co-twin loss following fetoscopic laser ablative treatment for twin/twin transfusion syndrome (TTTS) and those associated with spontaneous fetal demiseResultsSixty-eight cases were identified, 27/68 following treatment for TTTS and 41/68 with spontaneous fetal demise. Nine (13.2%) had brain abnormalities on iuMR and the rate of brain abnormalities was similar in the two groups. Expert ultrasound and iuMR findings agreed in 3/9 of those cases and in 6/9 cases ultrasound underestimated or missed the pathology.Conclusion Monochorionic twin pregnancies with single fetal demise are complex pregnancies with increased risk of acquired brain pathology, although the rate of brain abnormalities in our study is lower than other publications. iuMR in such complicated pregnancies is a useful adjuvant imaging technique which appears to detect brain pathologies better than prenatal ultrasonography. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 02/2015; 35(6). DOI:10.1002/pd.4577 · 3.27 Impact Factor
  • I Craven · M J Bradburn · P D Griffiths
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    ABSTRACT: To estimate the diagnostic performance of ultrasound in detecting agenesis of the corpus callosum (ACC). A retrospective review was performed of 1722 in utero MRI examinations. All cases were identified in which the fetus had been referred from ultrasonography with a diagnosis of ACC and those in which ACC was given as a diagnosis on the in utero MRI study. The MRI was assumed to provide the correct diagnosis of ACC and descriptive statistics of diagnostic accuracy for ultrasound were calculated. Of the 1722 ultrasound examinations performed, 121 had a diagnosis of ACC and approximately 50% were confirmed at MRI. Forty-two fetuses with ACC not suspected at ultrasonography were also identified at MRI. Ultrasonography had a positive predictive value of 47% (95% CI: 38-56%) and a negative predictive value of 97% (95% CI: 96-98%) for detecting ACC. Ultrasound is poor in diagnosing ACC and in utero MRI should be performed if there is any suspicion on antenatal ultrasonography. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
    Clinical Radiology 12/2014; 70(3). DOI:10.1016/j.crad.2014.11.004 · 1.76 Impact Factor
  • D.A. Jarvis · P Armitage · A Dean · P D Griffiths
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    ABSTRACT: MRI of the foetal brain in utero is performed in routine clinical practice using sequences that produce two-dimensional (2D) images. Recent developments in image post-processing have allowed the construction of three-dimensional (3D) volume data sets from 2D images acquired in different anatomical planes, but these have limitations due to the unpredictable nature of foetal movement. These limitations have been overcome by development of several different advanced computer techniques, which require specialist knowledge, software, and processing methods, which are rarely available in routine clinical settings. Our aim was to develop a technique that can be used in routine clinical situations without the need for custom-developed or expensive software by utilizing MRI sequences that can produce a 3D data set in "ultrafast" timescales. The 3D dataset, combined with versatile image post-processing and visualization techniques, has resulted in the production of high-resolution images of foetal brain surfaces in utero. The aim of this paper is to demonstrate our methods and early results by way of a pictorial review illustrating a range of developmental brain disease in utero.
    Clinical Radiology 07/2014; 69(10). DOI:10.1016/j.crad.2014.06.014 · 1.76 Impact Factor
  • A.R. Hart · M F Smith · E H Whitby · S Alladi · S Wilkinson · M N Paley · P D Griffiths
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    ABSTRACT: Aim: To study the associations between magnetic resonance proton spectroscopy (MRS) data and apparent diffusion coefficients (ADC) from the preterm brain with developmental outcome at 18 months corrected age and clinical variables. Materials and methods: A prospective observational cohort study of 67 infants born before 35 weeks gestational age who received both magnetic resonance imaging of the brain between 37 and 44 weeks corrected gestational age and developmental assessment around 18 months corrected age. Results: No relationships were found between ADC values and MRS results or outcome. MRS ratios involving N-acetyl aspartate (NAA) from the posterior white matter were associated with "severe" and "moderate to severe" difficulties, and fine motor scores were significantly lower in participants with a visible lactate doublet in the posterior white matter. The presence of a patent ductus arteriosus (PDA) was the only clinical factor related to NAA ratios. Conclusion: Altered NAA levels in the posterior white matter may reflect subtle white matter injury associated with neuro-developmental difficulties, which may be related to a PDA. Further work is needed to assess the longer-term neuro-developmental implications of these findings, and to study the effect of PDAs on developmental outcome in later childhood/adolescence.
    Clinical Radiology 06/2014; 69(8). DOI:10.1016/j.crad.2014.04.001 · 1.76 Impact Factor
  • F Williams · P D Griffiths
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    ABSTRACT: To review our experience of diagnosing hemimegalencephaly (HME) using in utero magnetic resonance imaging (MRI). The MRI database in the Academic Unit of Radiology, University of Sheffield was searched using "hemimegalencephaly" and "in utero MR" as search terms. The antenatal histories and reports of ultrasound imaging were reviewed as well as the in utero MRI images. Nine cases of foetal HME were located. One case was referred after ultrasound with the diagnosis of HME, one as a "complex brain malformation", and one as a "mass lesion". The other six were referred as "unilateral ventriculomegaly". A common finding in foetuses imaged in the second trimester was disruption of the normal "transient structures" found in the developing cerebral hemispheres. HME is a difficult diagnosis to make using antenatal ultrasound and in utero MRI should be considered in cases of unilateral ventriculomegaly diagnosed at ultrasound. Disruption of the transient structures of the cerebral hemispheres is a common finding on in utero MRI and can sometimes produce mass-like appearances in the region of the germinal matrix/ganglionic eminence.
    Clinical Radiology 03/2014; 69(6). DOI:10.1016/j.crad.2014.01.026 · 1.76 Impact Factor
  • P D Griffiths · D Jarvis · H McQuillan · F Williams · M Paley · P Armitage
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    ABSTRACT: Objective: To evaluate the capacity of a rapid T2 weighted three-dimensional (3D) sequence to diagnose foetal brain abnormalities by comparing the results with current two-dimensional (2D) methods. We have also made assessments of the estimates of energy deposition using those methods. Methods: 50 pregnant females were included in this study under the guidance of the institutional review board. All their foetuses had suspected brain abnormalities on antenatal ultrasonography or were at increased risk of a brain malformation based on the results of an earlier pregnancy. All the foetuses had a routine MR protocol that includes three orthogonal plane single-shot fast-spin echoes and 2D steady-state sequences. In addition, a 3D rapid steady-state sequence of the foetal brain was performed (acquisition time approximately 40 s), and the standard and 3D sequences were reported independently and the results were compared. The specific absorption rate (SAR) predicted by the scanner was recorded in 12 cases in order to estimate the energy deposited by the three sequences. Results: The 3D rapid steady-state sequences produced diagnostic-quality images in 41/50 (82%) cases. All the failures were in second trimester foetuses (9/26-35% failure rate). There was a discrepancy between the standard report and findings using the 3D sequence in 2/41 of the foetuses with good-quality 3D imaging. The predicted SAR deposition of the 3D steady-state sequences was comparable with the single-shot fast-spin echo sequence. Conclusion: Our initial assessments of a 3D rapid steady-state sequence to image the foetus are encouraging in terms of diagnostic information and acceptable energy deposition values. The high failure rate in second trimester foetuses probably relates to the greater mobility of the smaller foetuses, and improvements in the 3D sequence are required in terms of reduced acquisition time and higher resolution. Advances in knowledge: We have shown that 3D T2 weighted images of the foetal brain can be acquired in a clinical setting and produce diagnostic-quality imaging in a high proportion of cases. The success rate in acquiring diagnostic-quality images is related to gestational age. Good-quality images were obtained in all third trimester foetuses but only in approximately two-thirds of second trimester foetuses. This probably reflects the problem of the greater mobility of second trimester foetuses. 3D T2 weighted acquisitions have great potential for improving the antenatal diagnosis of foetal brain abnormalities and may reduce the time that a pregnant female needs to spend on the MR scanner.
    The British journal of radiology 10/2013; 86(1030):20130168. DOI:10.1259/bjr.20130168 · 2.03 Impact Factor
  • F Williams · P.D. Griffiths
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    ABSTRACT: Spinal neural tube defects are a heterogeneous group of disorders, which remain relatively common, with a prevalence of 1-2 per 1000 live births despite advances in maternal antenatal care. They range from mild disorders with limited neurodevelopmental sequelae to extensive abnormalities with significant morbidity and mortality. The advent of in utero magnetic resonance imaging has enabled accurate anatomical characterization of an increasing number of abnormalities with increasing confidence. Recognition of the salient radiological features of these disorders and their relationship to the embryogenesis of the spinal cord and its coverings is now possible. This review describes the radiological appearances of these disorders with examples from Fetal Imaging Unit, University of Sheffield to illustrate the key anatomical and radiological features to aid the radiologist in their recognition.
    Clinical Radiology 09/2013; 68(12). DOI:10.1016/j.crad.2013.07.019 · 1.76 Impact Factor
  • R N Joseph · R Batty · A Raghavan · S Sinha · P D Griffiths · D J A Connolly
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    ABSTRACT: Objective: To assess the natural history of isolated syringomyelia in children. Methods: MRI reports from February 2007 to August 2011 mentioning syrinx were identified on Sheffield Children's PACS database. Scans with syringes having an AP diameter of > 1 mm and extending over at least two vertebral bodies were reviewed. Patients with an identifiable cause such as a Chiari malformation were then excluded. Results: Thirty-nine patients were included with a mean age at diagnosis of 10.6 years. The average syrinx AP diameter was 3.30 mm. The rostrocaudal length of the syringes varied between 2 and 19 vertebral bodies. Twenty-seven out of 39 syringes were thoracic in origin. There were 3 and 6 syringes involving the cervicothoracic and thoracolumbar regions, respectively, with 3 involving the cervical area only. Eleven out of 39 (Group I) patients were found "incidentally" during work-up for adolescent idiopathic scoliosis and these were considered as a separate group. These patients did not have any significant symptoms and were discharged following their scoliosis correction surgery. Syrinx was incidental in 14 further patients (Group II). Of the 14 patients, 11 remained asymptomatic with no change in syrinx morphology throughout follow up. Of the 14 patients, 3 were lost to follow-up. Of the 39 patients, 14 (Group III) presented with progressive back pain without any obvious clinical cause. Of the 14, 10 either improved or remained the same. Of the 14 patients, 3 underwent lumbar puncture, 1/14 having myelography. All 4/14 patients reported significant pain reduction on follow up following intervention. Conclusion: Idiopathic syrinx is a benign pathology, which can be managed expectantly. Most cases remain stable or improve over time. In a small minority who have progressive back pain, we have found that lumbar puncture may be helpful in reducing symptoms.
    British Journal of Neurosurgery 03/2013; 27(5). DOI:10.3109/02688697.2013.771728 · 0.96 Impact Factor
  • P D Griffiths · M Porteous · G Mason · S Russell · J Morris · E M Fanou · M J Reeves
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    ABSTRACT: Objectives: It is widely accepted that the diagnosis of foetal central nervous system (CNS) abnormalities can be improved by performing MRI examinations in utero. Most of the published literature has concentrated on pregnancies in which a developmental abnormality has been detected (or suspected) on ultrasound in an otherwise low-risk pregnancy. In this paper, we test the hypothesis that in utero MRI of the foetal brain in high-risk pregnancies will detect abnormalities not shown by ultrasound at a rate that justifies its use in clinical practice. Methods: 100 females were recruited into the study from foeto-maternal or clinical genetic departments. They all had a foetus/child with a CNS malformation from an earlier pregnancy, which led to an increased risk of recurrence being quoted for the present pregnancy. All in utero MRI examinations were performed on 1.5 T clinical MRI systems at 18 weeks gestational age or later. Results: In 78% of cases, the ultrasound and MRI results agreed and showed no abnormality. In 13%, ultrasound and MRI described identical abnormal findings. In 9%, the ultrasound and MRI examinations had discrepant findings; in all these cases the MRI findings described more serious CNS pathology. The effects on management were judged to be major, by at least one assessor, in 7/9 of those cases. Conclusion: As in many other situations involving antenatal detection of CNS abnormalities, in utero MRI should be considered in females with increased risk of foetal CNS malformation based on the results of an earlier pregnancy. Advances in knowledge In utero MRI of the foetus has an important role in antenatal diagnosis of females carrying a foetus with an increased risk of a brain abnormality.
    The British journal of radiology 07/2012; 85(1019):e1038-45. DOI:10.1259/bjr/23696508 · 2.03 Impact Factor
  • E Craig · D J A Connolly · P D Griffiths · A Raghavan · V Lee · R Batty
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    ABSTRACT: To establish whether paediatric centres within the Children's Cancer and Leukaemia Group (CCLG) network employ magnetic resonance imaging (MRI) protocols for brain tumours according to the revised guidance. Questionnaires were sent to both consultants and superintendent radiographers in the 21 centres within the CCLG network that perform MRI on paediatric brain tumour patients. Information was requested as to whether the centre had a protocol for imaging paediatric brain tumours, which sequences were performed, and whether these were used by all consultants. Twenty-seven completed questionnaires out of the 42 sent were returned, which included responses from 17 of the 21 UK centres. The majority of centres had a protocol for MRI of paediatric brain tumours at all stages of treatment. The standardized CCLG MRI sequences were incorporated in full at only five of the 17 centres. The standard sequences of the CCLG brain imaging protocol are poorly adhered to nationally. Further awareness of the revised protocol is needed, with improved access to the guidelines for non-CCLG members on the CCLG and Royal college of Radiologists website.
    Clinical Radiology 06/2012; 67(9):829-32. DOI:10.1016/j.crad.2012.03.018 · 1.76 Impact Factor
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    ABSTRACT: Clinical guidelines suggest that all patients diagnosed with localised seizures should be investigated with MRI to identify any epileptogenic structural lesions, as these patients may benefit from surgical resection. There is growing impetus to use higher field strength scanners to image such patients, as some evidence suggests that they improve detection rates. We set out to review the detection rate of radiological abnormalities found by imaging patients with localised seizures using a high-resolution 3.0 T epilepsy protocol. Data were reviewed from 2000 consecutive adult patients with localisation-related epilepsy referred between January 2005 and February 2011, and imaged at 3.0 T using a standard epilepsy protocol. An abnormality likely to be related to seizure activity was identified in 403/2000 (20.2%) patients, with mesial temporal sclerosis diagnosed in 211 patients. 313/2000 (15.6%) had lesions potentially amenable to surgery. Abnormalities thought unrelated to seizure activity were found in 324/2000 (16.1%), with 8.9% having evidence of ischaemic disease. Since the introduction of the then National Institute for Clinical Excellence guidelines in 2004, the detection rate of significant pathology using a dedicated 3.0 T epilepsy protocol has not fallen, despite the increased numbers of patients being imaged. This is the largest study of epilepsy imaging at 3.0 T to date and highlights the detection rates of significant pathology in a clinical setting using a high-strength magnet. The prevalence of ischaemic disease in this population is significantly higher than first thought, and may not be incidental, as is often reported.
    The British journal of radiology 05/2012; 85(1017):1236-42. DOI:10.1259/bjr/30177037 · 2.03 Impact Factor
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    K J Lee A · M N Paley A · P D Griffiths A
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    ABSTRACT: We describe an iterative algorithm for reducing EPI ghost artifacts using image-based phase corrections. Ghosts outside the parent object are set to the background level and a model k-space is obtained from the Fourier transform of the resulting image. The phase offsets in each k-space line are estimated by comparison with the corresponding line in the model k-space. We hypothesise that iteration will result in a convergence towards an image in which the ghost is minimised.
  • M N J Paley · A R Hart · M Lait · P D Griffiths
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    ABSTRACT: To develop a neonatal MR-compatible incubator for transporting babies between a neonatal intensive care unit and an MRI unit that is within the same hospital but geographically separate. The system was strapped to a standard MR-compatible patient trolley, which provides space for resuscitation outside the incubator. A constant-temperature exothermic heat pad was used to maintain temperature together with a logging fluoro-optic temperature monitor and alarm system. The system has been designed to accommodate standard knee-sized coils from the major MR manufacturers. The original incubator was constructed from carbon fibre, but this required modification to prevent radiofrequency shading artefacts due to the conducting properties of the carbon fibre. A high-tensile polyester material was used, which combined light weight with high impact strength. The system could be moved onto the patient bed with the coils and infant in place by one technologist. Studies in eight neonatal patients produced high quality 1.5 T MR images with low motion artefacts. The incubator should also be compatible with imaging in 3 T MR systems, although further work is required to establish this. Images were acquired using both rapid and high-resolution sequences, including three-dimensional volumes, proton spectra and diffusion weighting. The incubator provides a safe, quiet environment for neonates during transport and imaging, at low cost.
    The British journal of radiology 12/2011; 85(1015):952-8. DOI:10.1259/bjr/30017508 · 2.03 Impact Factor
  • P D Griffiths · S A Russell · G Mason · J Morris · E Fanou · M J Reeves
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    ABSTRACT: iuMR has been shown to increase the detection rate of developmental abnormalities of the CNS, though most reports are limited to singleton pregnancies. The hypothesis tested in this study was that iuMR performed in multifetal pregnancies will show additional information about fetal CNS abnormalities in a similar proportion of cases when compared with singleton pregnancies. Fifty women with multifetal pregnancies were recruited consecutively carrying at least 1 fetus with a suspected developmental fetal CNS abnormality on sonography. All had iuMR at the same center by using the same MR imaging protocol. When the sonography and MR imaging reports were discrepant, 1 fetomaternal expert assessed the reports independently to predict in what percentage a change in prognosis/counseling would have occurred if iuMR was included in the diagnostic pathway. There was agreement between the sonography and iuMR reports in 66% and disagreement in 34% of cases. The major cause for discrepancy was the presence or absence of the corpus callosum, which accounted for 10/17 of the disagreements. In 12/17 of the discrepant cases, the effect on management was judged to be significant. We conclude that iuMR has a similar rate of discrepancy to sonography in multifetal pregnancies compared with the published data concerning singleton pregnancies. Our analysis of the effect on management shows that changes in the decision to consider termination of pregnancy would have occurred in 12/17 of the discrepant cases (ie, in 24% of our cases overall).
    American Journal of Neuroradiology 11/2011; 33(2):359-65. DOI:10.3174/ajnr.A2762 · 3.59 Impact Factor
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    ABSTRACT: Previous work using proton MR spectroscopy ((1)H-MRS) of the cerebellum in the ataxias suggested that (1)H-MRS abnormalities and atrophy do not necessarily occur concurrently. To investigate the spectroscopic features of different types of ataxias. Using a clinical MR system operating at 1.5T, we performed (1)H-MRS with a single voxel placed over the right dentate nucleus in 22 patients with gluten ataxia (GA), six patients with Friedreich's ataxia (FA), six patients with spinocerebellar ataxia type 6 (SCA6) and 21 healthy volunteers. Atrophy of the vermis and hemispheres on standard MRI was rated by a neuroradiologist. Any interaction between atrophy and (1)H-MRS was analysed for the three groups of patients and controls. Patients with GA had significant atrophy of the vermis and hemispheres as well as abnormal (1)H-MRS. Patients with SCA6 had more severe overall atrophy of the vermis and hemispheres, but relatively preserved N-acetyl-aspartate/creatine (NAA/Cr). The FA group showed significant atrophy of only the superior vermis with normal (1)H-MRS. This study suggests that (1)H-MRS of the cerebellum in patients with ataxia provides information in addition to the presence of atrophy. There are significant (1)H-MRS differences amongst different types of ataxia with interesting correlations between atrophy and NAA/Cr.
    Acta Neurologica Scandinavica 11/2011; 126(2):138-43. DOI:10.1111/j.1600-0404.2011.01620.x · 2.40 Impact Factor
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    ABSTRACT: Encephalopathy is a common paediatric emergency associated with a high risk of morbidity, mortality and long term neurodevelopmental delay in survivors. Prompt diagnosis of the cause of encephalopathy enables the paediatrician to deliver specific medical or surgical treatment that will facilitate a better short and long term outcome. Diagnostic imaging plays a pivotal role in diagnosis. Encephalopathy has many causes. The differential diagnosis includes non accidental injury, trauma, metabolic syndromes, meningo-encephalitis, toxins, hypoxia, demyelination, stroke, haemorrhage and tumours. We describe an approach that helps us formulate an imaging strategy using US, CT and MRI that facilitates patient care.
    08/2011; 24(4):483-502. DOI:10.1177/197140091102400403
  • I Craven · P D Griffiths · N Hoggard
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    ABSTRACT: Patients with epilepsy often have a structural cause for their seizures and may benefit from surgical resection. As recommended in the National Institute of Health and Clinical Excellence (NICE) guidelines, magnetic resonance imaging (MRI) is used to screen for structural abnormalities in these patients and there is increasing evidence that 3T MRI has better sensitivity and specificity than 1.5T. This article reviews the imaging findings of many of the common diseases that can cause epilepsy. © 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
    Clinical Radiology 03/2011; 66(3):278-86. DOI:10.1016/j.crad.2010.10.010 · 1.76 Impact Factor
  • S Rajaram · R Batty · C D C Rittey · P D Griffiths · D J A Connolly
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    ABSTRACT: Head injury from physical abuse is unfortunately a common occurrence in our society. It is a major cause of mortality and long-term physical and psychological disability in children. Diagnosis of non-accidental head injury may be difficult, as most infants present with non-specific clinical findings and without external signs of trauma. Neuroimaging plays a fundamental role both for medical management and medicolegal aspects of child abuse. It is therefore imperative for the radiologist to promptly recognise the radiological findings of various forms of non-accidental head injury to render a more accurate opinion. A standardised imaging protocol and good communication between professionals are essential for optimum management.
    Postgraduate medical journal 03/2011; 87(1027):355-61. DOI:10.1136/pgmj.2010.103150 · 1.45 Impact Factor
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    ABSTRACT: Although MR imaging of the fetal brain has been shown to provide additional diagnostic information, the optimal timing of the study and the value of repeat studies remain unclear. The primary purpose of this study was to look for structural abnormalities of the fetal brain shown at 30-32 weeks' gestational age but not on the 20-24 weeks' study in fetuses originally referred with isolated VM. In particular, we wished to study the hypothesis that third-trimester fetal MR imaging studies would not show extra brain abnormalities compared with the second-trimester studies in this group. Ninety-nine women were admitted for a fetal MR study between 20-24 weeks' gestational age, and 46 of these women agreed to return for a second MR imaging examination at 30-32 weeks' gestational age. The other women were either lost to follow-up or declined the invitation to return. Two experienced observers measured the width of the trigones, and the results were compared, to test reliability. Changes in the degree of VM are reported along with changes in the diagnosis of structural brain abnormalities. There was excellent reproducibility of trigone measurements between the 2 observers, with a mean absolute difference of <1 mm in the 40 fetuses that were ultimately shown to have isolated VM. Twenty-eight of 40 fetuses studied had mild VM on the first iuMR imaging examination, but in just more than half, the category of VM changed between the studies (5 had become normal-sized, 7 had progressed to moderate, 3 had become severe, and 13 remained mild). In 1 case, hypogenesis of the corpus callosum was recognized at 30-32 weeks but had not been reported on the 20-24 weeks' examination; the other 5 fetuses had brain pathology recognized on both fetal MR studies. Trigone measurements can be made in a highly repeatable fashion on iuMR imaging. We have not shown any major advantage in repeating iuMR imaging at 30-32 weeks' gestation in terms of improved diagnosis of other structural brain abnormalities. With the converse of that argument, however, our data suggest that there is no advantage in delaying iuMR imaging studies to 30-32 weeks in the hope of improving detection rates.
    American Journal of Neuroradiology 12/2010; 32(3):474-80. DOI:10.3174/ajnr.A2307 · 3.59 Impact Factor
  • D C Hughes · A Raghavan · S R Mordekar · P D Griffiths · D J A Connolly
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    ABSTRACT: Acute bacterial meningitis is a common neurological emergency and a leading cause of death and neurological disability worldwide. Diagnosis is based on clinical and microbiological findings with neuroimaging in the form of CT reserved for those with specific adverse clinical features or when an underlying cause such as mastoiditis is suspected. MRI is extremely useful for detecting and monitoring the complications of meningitis. These can be remembered by the mnemonic HACTIVE (hydrocephalus, abscess, cerebritis/cranial nerve lesion, thrombosis, infarct, ventriculitis/vasculopathy and extra-axial collection). Diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) are useful to distinguish abscess from other ring enhancing lesions.
    Postgraduate medical journal 08/2010; 86(1018):478-85. DOI:10.1136/pgmj.2010.097022 · 1.45 Impact Factor

Publication Stats

2k Citations
400.17 Total Impact Points


  • 1998–2015
    • The University of Sheffield
      • Academic Urology Unit
      Sheffield, England, United Kingdom
    • University of Cambridge
      • Department of Radiology
      Cambridge, England, United Kingdom
  • 2003–2011
    • Royal Berkshire NHS Foundation Trust
      Reading, England, United Kingdom
  • 2009
    • Sheffield Teaching Hospitals NHS Foundation Trust
      Sheffield, England, United Kingdom
  • 1996
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust
      • Department of Neuroradiology
      Newcastle upon Tyne, ENG, United Kingdom