Rathy Kirke

Royal Derby Hospital

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Susan Addley

University Hospitals of Derby and Burton NHS Foundation Trust

Arumugam Rajesh

University Hospitals of Leicester NHS Trust

R Vaidhyanath

University Hospitals of Leicester NHS Trust

Viren Asher

Royal Derby Hospital

Summi Abdul

University Hospitals of Derby and Burton NHS Foundation Trust

Anish Bali

University Hospitals of Derby and Burton NHS Foundation Trust

Adam G. Thomas

National Institutes of Health

M. Hickey

Brigham and Women's Hospital

Andrew Phillips

University Hospitals of Derby and Burton NHS Foundation Trust

James Entwisle

Wellington Hospital

Cooperative Institutions

University Hospitals of Derby and Burton NHS Foundation Trust

Glenfield Hospital

University Hospitals of Leicester NHS Trust

University of Leicester

Royal Derby Hospital

Leicester Royal Infirmary

University of British Columbia

Leicester General Hospital

University of Nottingham

OBS Medical (United Kingdom)

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Extranodal Lymphoma From Head to Toe: Part 2, The Trunk and Extremities

American Journal of Roentgenology (2011)

Adam G. Thomas R Vaidhyanath Rathy Kirke Arumugam Rajesh

Lymphoma can affect virtually every tissue in the body, producing a variety of imaging appearances. In this article, the extranodal manifestations of this disease in the trunk and extremities are illustrated and the imaging features that aid in the diagnosis are reviewed.Knowledge of the imaging appearances of extranodal lymphoma can aid the differential diagnosis of mass lesions encountered in tissues throughout the body on different imaging modalities.

10.2214/ajr.11.6738

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Citations (30)

Non-invasive assessment of liver fibrosis using ARFI with pathological correlation, a prospective study

Annals of Hepatology (2013)

Wan Wan Yap Rathy Kirke Eric M. Yoshida David Owen Alison Harris

ARFI is a new technique that uses acoustic push pulse to generate tissue displacement resulting in shear wave propagation, can be used to measure elasticity of tissue. We aim to assess feasibility of ARFI as a non-invasive method to measure liver fibrosis compared to histological fibrosis scores and to compare our results with the published pooled-meta-analysis cut off values.Prospective study to compare median velocities of ARFI shear wave measurements (Virtual Touch Imaging™ ACUSON S2000, Siemens, Mountain View CA) with Batts and Ludwig liver fibrosis scoring system F0-F4.70 patients (mean = 49 years) were included. Etiologies were chronic hepatitis C (n = 43), chronic hepatitis B (n = 7) and others (n = 20). Median ARFI values (m/sec) for fibrosis stages and inflammatory stages measured were F0: 1.52, 1.42; F1: 1.50, 1.37; F3: 2.36, 2.41 and F4: 2.61. Areas under the curve for grade 3 = 0.875, stage 3 = 0.867; grade 2 = 0.4, stage 2 = 0.3.Using the cut-off ARFI value of 1.34 m/s for F ≥ 2 suggested in the meta-analysis, we found sensitivity of detecting true F ≥ 2 is 68%, specificity 66%, PPV 74% and NPV 59%. For F ≥ 3 using the cut-off ARFI value of 1.55 m/s, we found sensitivity of 95%, specificity 86%, PPV 74% and NPV 98%. No stage 4 was compared due to insufficient cases.ARFI has strong correlation with higher fibrosis scores compared to lower. When compared to the pooled meta-analysis cut off values, the sensitivity and specificity for detecting true F ≥ 3 are higher than that of F ≥ 2.

10.1016/s1665-2681(19)31345-6

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Citations (24)

Extranodal Lymphoma From Head to Toe: Part 1, The Head and Spine

American Journal of Roentgenology (2011)

Adam G. Thomas R Vaidhyanath Rathy Kirke Arumugam Rajesh

Extranodal Lymphoma From Head to Toe: Part 1, The Head and SpineAdam G. Thomas1, Ramachandran Vaidhyanath1, Rathy Kirke1 and Arumugam Rajesh1Audio Available | Share Claim CME/SAMClaim CME

10.2214/ajr.10.7266

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Citations (38)

Internal mammary artery-to-vein fistula diagnosed by multidetector computed tomography angiography

European Journal of Cardio-Thoracic Surgery (2007)

Rathy Kirke Richard Keal M. Hickey

A woman aged 79 years presented with a loud grade 4/6 continuous murmur in the upper left precordium, due to an internal mammary arteriovenous fistula after an aortic valve replacement (Fig. 1).Puncture by a wire during sternal closure is a probable cause (Fig. 2).This is important to diagnose due to associated potential late complications such as pseudo aneurysm formation, endocarditis and rupture.

Multidetector computed tomography

Mammary artery

Computed Tomography Angiography

10.1016/j.ejcts.2007.03.042

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Citations (1)

Adrenal incidentaloma multi-disciplinary investigation and management at University Hospitals of Derby and Burton Foundation Trust

Endocrine Abstracts (2019)

Amy Morrison Ye Lynn Ko Adnan Agha Rathy Kirke Suma Sugunendran

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Foundation (evidence)

Discipline

10.1530/endoabs.65.p69

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Citations (0)

Retraction to ‘The complications of repeat median sternotomy in paediatrics: six-months follow-up of consecutive cases’

Interactive Cardiovascular and Thoracic Surgery (2014)

Maqsood M. Elahi Rathy Kirke Darren Lee Ramana Dhannapuneni M. Hickey

Repeat median sternotomy in paediatrics though associated with increased perioperative risks, yet the incidence of injury to the underlying structures during sternal re-entry is poorly quantified. We reviewed 108 patients undergoing repeat sternotomies (group-I) and a control group of 516 patients undergoing first time sternotomy (group-II) over six years with six-months follow-up. Overall mean age was 17 months (range 1 day-16 years). Uncontrollable bleeding was encountered in 4 patients (3.7%), non-fatal cardiac laceration in 10 (9.2%), minor injuries to aorta in 7 (6.4%) and right atrium in 8 (7.4%) in Group-I. Forty-one times (38%) pericardial sac was closed and 55 times (51%) artificial materials (Dacron/Gortex) were used in initial procedures. The incidence of injuries during sternal re-entry was significantly lower in those patients where pericardial sac was closed initially (P<0.001). Hospital mortality was 3.7% in Group-I and 2.7% in Group-II, however, overall survival was 95% (group-I) and 97% (group-II) at 6 months' follow-up. Complete heart block, neurological problems and persistence of shunts being the most common reported morbidities in both groups. In conclusion, low incidence of morbidity and mortality in repeat median sternotomy is possible with careful surgical approach. The closure of pericardial sac in initial procedure provides many potential and practical advantages with regard to lesser trauma to underlying structures.

Median sternotomy

10.1093/icvts/ivu349

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Citations (2)

Complications Related to Intra-aortic Balloon Pump in Cardiac Surgery: A Decade Later

European Journal of Vascular and Endovascular Surgery (2005)

Maqsood M. Elahi Govind Chetty Rathy Kirke Tariq Azeem Richard Hartshorne

Intra-aortic balloon pump

Aortic surgery

10.1016/j.ejvs.2005.01.013

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Citations (50)

Focal Liver Lesions

The Canadian journal of medical sonography. (2011)

Rathy Kirke Alison Harris

A high proportion of focal liver lesions are detected using ultrasonography. Many of them have characteristic sonographic appearances and can be diagnosed confidently in association with an accurate clinical history. Others require confirmation with computed tomography or magnetic resonance imaging. Contrast-enhanced ultrasonography has an increasing role in assessing these lesions. Typical and atypical features are described in this article, and correlative imaging is discussed.

10.3138/cjms.v2i1.8

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Citations (0)

543 Correlation between CT, intra-operative assessment and final histopathology in detecting diaphragmatic disease in advanced ovarian cancer. 61 cases

Ovarian cancer (2021)

Susan Addley A Bali Viren Asher S. Abdul Rathy Kirke

Introduction/Background*

Whilst CT scanning is well established in the pre-operative staging of tubo-ovarian or primary peritoneal malignancy, studies suggest CT may be a poor predictor of diaphragmatic involvement.

Methodology

All patients who underwent diaphragmatic surgery for stage III/V tubo-ovarian or primary peritoneal carcinoma in a cancer centre between 2008-2020 were identified. Pre-operative CT, operation notes and histopathology reports were reviewed retrospectively.

Result(s)*

61 patients were identified. In 82.0% (n=50), no diaphragmatic disease was identified on pre-operative CT. This was corroborated by negative histopathology in 6 cases – equating to 9.8% true negatives, 72.1% false negatives and negative predictive value of 12%. Of those with diaphragmatic disease identified radiologically (n=11), this was confirmed on histopathology in 10 cases – equating to 16.3% true positives, 1.6% false positives and positive predictive value of 90.9%. Our data demonstrates a sensitivity of 18.5% and specificity of 85.7% for CT in diaphragmatic assessment. Intra-operative findings were suspicious for diaphragmatic involvement in all cases and confirmed on histopathology in 90.1% (n=55). In 6 (9.8%) patients, however, histopathology returned negative. Statistical analysis of this data was limited by the inclusion criteria – but can be interpreted as 90.2% true positives, 9.8% false positives and positive predictive value of 90.2% for intra-operative detection of diaphragmatic disease

Conclusion*

Whilst it is accepted that CT is a poor predictor of diaphragmatic disease, we suggest our figures may be additionally compounded by a local radiological focus on identification of surgical stopping-points in the context of a unit with a well-established ultra-radical service and experience of diaphragmatic surgery. Gynaecological-oncologists should, however, remain mindful of the limitations of CT and hence approach all relevant cases with the anticipation of encountering diaphragmatic disease.

Histopathology

10.1136/ijgc-2021-esgo.424

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Citations (0)

Multidetector CT imaging of pleura: comparison of two contrast infusion protocols

British Journal of Radiology (2011)

Vimal Raj Rathy Kirke M J Bankart James Entwisle

Imaging of the pleura by multidetector CT (MDCT) can be challenging. There is no clear evidence or guidelines on contrast infusion parameters for imaging pleura. We compared two contrast protocols for assessing pleural pathology on MDCT.This was a prospective study in which consecutive patients with MDCT for suspected pleural disease on chest radiograph were randomised into two groups. The first group received 150 ml of intravenous contrast at a rate of 2.5 ml s(-1) and the second group received 100 ml at 2 ml s(-1). Images were acquired after a 60 s delay. Hounsfield units of the pleura, thoracic aorta, main pulmonary artery, portal vein and superior mesenteric artery were measured and analysed by two independent readers.40 patients (20 in each group) who had pleural enhancement on MDCT were included for final analysis. The mean pleural enhancement value was 83 HU (Group A) vs 59 HU (Group B) (p = 0.0004). The mean aortic enhancement was 241 HU (A) vs 141 HU (B) (p<0.0001); main pulmonary artery enhancement was 208 HU (A) vs 139 HU (B) (p<0.0002); portal venous enhancement was 169 HU (A) vs 115 HU (B) (p<0.0001); and the superior mesenteric artery enhancement was 215 HU (A) vs 128 HU (B) (p<0.0001).Enhancement of the pleura and major vessels was significantly higher in the group receiving more contrast at a greater infusion rate. This technique of a single scan through the entire pleural surface with a delayed acquisition is promising. When pleural disease is suspected, contrast infusion protocols should be modified to achieve the best results and clinicians should be encouraged to specifically request a "pleural CT".

Hounsfield scale

Chest radiograph

Intravenous contrast

Superior mesenteric vein

10.1259/bjr/55980445

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Citations (48)