ORCID Profile
0000-0001-6906-588X
Current Organisations
Flinders University
,
BreastScreen WA
,
Envision Medical Imaging
,
Sir Charles Gairdner Hospital
,
Western Ultrasound For Women
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Publisher: Wiley
Date: 06-06-2023
Abstract: The MRI appearances of the human placenta in the absence of maternal or fetal pathology have not been extensively studied, with only a few studies reporting findings in the uncomplicated pregnancy. The purpose of this study is to review the placental MRI appearances in low‐risk pregnancies in a prospective study. A prospective observational study of placental MRI in low‐risk pregnancies was initially planned, however recruitment was terminated early due to the COVID19 pandemic. The protocol was subsequently modified to compare the placental appearances in the enrolled cohort with pregnancies having had MRI for non‐placental pathologies. The data from the two groups were then pooled to assess the range of normal placental appearances. Eighty‐three pregnancies were prospectively assessed with MRI at a median gestation of 29 weeks (range 14–39) from a mixed group of prospective cases ( n = 28) and retrospectively recruited obstetric MRI ( n = 55). Placental thickness in the third trimester ranged from 18 to 35 mm. T2 heterogeneity was seen in 75% (25/33) at second trimester and by the third trimester 50% (25/50) were moderately or markedly heterogenous. T2 dark bands ( mm) were seen in 9% (3/33) and 20% (10/50) of second and third trimester pregnancies, respectively. Undetectable myometrium or loss of the subplacental myometrial plane was present in 15% (5/33) of second and 38% (19/50) of third trimester placentae. This qualitative study of normal placental MRI appearances expands the current knowledge base by confirming they vary, evolve with gestation, and can overlap with signs of placenta accreta spectrum.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.ULTRASMEDBIO.2016.01.025
Abstract: This study aimed to evaluate the utility of dynamic contrast-enhanced ultrasound (DCE-US) in measuring early tumor response of advanced hepatocellular carcinoma to axitinib. Twenty patients were enrolled (aged 18-78 y median 65). DCE-US was performed with bolus injection and infusion/disruption replenishment. Median overall survival was 7.1 mo (1.8-27.3) and progression free survival was 3.6 mo (1.8-17.4). Fifteen patients completed infusion scans and 12 completed bolus scans at 2 wk. Among the perfusion parameters, fractional blood volume at infusion (INFBV) decreased at 2 wk in 10/15 (16%-81% of baseline, mean 47%) and increased in 5/15 (116%-535%, mean 220%). This was not significantly associated with progression free survival (p = 0.310) or progression at 16 wk (p = 0.849), but was borderline statistically significant (p = 0.050) with overall survival, limited by a small s le size. DCE-US is potentially useful in measuring early tumor response of advanced hepatocellular carcinoma to axitinib, but a larger trial is needed.
Publisher: Wiley
Date: 02-02-2022
Abstract: Preoperative imaging of patients with endometriosis allows adequate counselling, referral to appropriate centres of expertise and workforce planning. The objective of this study was to assess the feasibility of simplified three‐category preoperative endometriosis MRI morphological descriptors to predict subsequent surgical management. A single‐centre observational study in 76 patients (median age 38 years, range 18–55) with preoperative endometriosis mapping MRI between 1 Jan 2015 and 31 Dec 2019. MRI studies were prospectively re‐read blind‐to‐surgical outcome to categorise rectosigmoid morphology as normal, spider‐shaped (linear T2‐dark fibrotic bands) superficial endometriosis or typical crescentic or mushroom‐shaped deep infiltrating endometriosis (DIE). Bowel motility was similarly categorised as normal, tethered or distorted/fixed. The reference standard was subsequent surgery within 3 years of MRI, categorised as no bowel surgery, adhesiolysis only or more complex surgeries. Despite three‐quarters of surgical cases having normal bowel morphology on preoperative MRI (72%, 55/76 12% linear superficial endometriosis, 10% crescentic and 5% mushroom‐shaped DIE) more than half showed bowel tethering (54%, 41/76) or distortion/fixation (10%, 8/76) and most patients underwent adhesiolysis (79%, 60/76). Complex surgery such as bowel resection, laparotomy conversion or complex adhesiolysis is predicted by morphology (crescentic or mushroom‐shaped DIE, P 0.001) and motility (tethered or distorted bowel, P = 0.002) descriptors. Comprehensive and clinically relevant diagnostic reporting does not have to be convoluted to have clinical impact: in our study population, categorising bowel morphology as normal, spider‐shaped (superficial) or crescentic/mushroom‐(DIE) shaped and motility as normal, tethered (superficial) or distorted/fixed (deep endometriosis) correlates to subsequent surgical complexity.
Publisher: Radiological Society of North America (RSNA)
Date: 10-2017
DOI: 10.1148/RADIOL.2017161103
Abstract: Purpose To evaluate the value of mammography in detecting breast cancer in high-risk women undergoing screening breast magnetic resonance (MR) imaging. Materials and Methods An ethics-approved, retrospective review of prospective databases was performed to identify outcomes of 3934 screening studies (1977 screening MR imaging examinations and 1957 screening mammograms) performed between January 2012 and July 2014 in 1249 high-risk women. Performance measures including recall and cancer detection rates, sensitivity, specificity, and positive predictive values were calculated for both mammography and MR imaging. Results A total of 45 cancers (33 invasive and 12 ductal carcinomas in situ) were diagnosed, 43 were seen with MR imaging and 14 with both mammography and MR imaging. Additional tests (further imaging and/or biopsy) were recommended in 461 screening MR imaging studies (recall rate, 23.3% 95% confidence interval [CI]: 21.5%, 25.2%), and mammography recalled 217 (recall rate, 11.1% 95% CI: 9.7%, 12.6%). The cancer detection rate for MR imaging was 21.8 cancers per 1000 examinations (95% CI: 15.78, 29.19) and that for mammography was 7.2 cancers per 1000 examinations (95% CI: 3.92, 11.97 P < .001). Sensitivity and specificity of MR imaging were 96% and 78% respectively, and those of mammography were 31% and 89%, respectively (P < .001). Positive predictive value for MR imaging recalls was 9.3% (95% CI: 6.83%, 12.36%) and that for mammography recalls was 6.5% (95% CI: 3.57%, 10.59%). Conclusion Contemporaneous screening mammography did not have added value in detection of breast cancer for women who undergo screening MR imaging. Routine use of screening mammography in women undergoing screening breast MR imaging warrants reconsideration.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.ACRA.2015.09.010
Abstract: Breast magnetic resonance imaging (MRI) is recommended for the screening of women with a history of chest radiotherapy and consequent increased breast cancer risk. The purpose of this study was to evaluate the impact of prior chest radiotherapy on breast tissue background parenchymal enhancement (BPE) at screening breast MRI. A departmental database was reviewed to identify asymptomatic women with either a history of chest radiotherapy for Hodgkin's lymphoma or age-matched controls who underwent screening breast MRI between 2009 and 2013. MRI studies were analyzed on an automated breast MRI viewing platform to calculate breast BPE and breast density. A total of 61 cases (mean age 41.6 ± 6.75 years) and 61 controls (mean age 40.8 ± 6.99 years) were included. The age of patients at the time of chest radiotherapy was 22.6 ± 8.17 years. Screening MRI was performed 19.0 ± 7.43 years after chest radiotherapy. BPE was significantly higher in patients who received chest radiotherapy (50% vs. 37%, P 0.3 P < 0.03) was found between BPE and number of years post radiotherapy. There was a trend toward significant difference between the two groups in the correlation of BPE and age (P = 0.05). Breast density was not significantly different between the two groups. BPE is significantly greater in women who receive chest radiotherapy for childhood Hodgkin's lymphoma, and unexpectedly, it positively correlates with the number of years passed after radiation therapy. Long-term biological effects of radiation therapy on breast parenchyma need further research.
Publisher: Wiley
Date: 26-04-2023
DOI: 10.1111/AJO.13682
Abstract: Transvaginal hysterosalpingo‐foam sonography (HyFoSy) assesses tubal patency in an outpatient setting and without ionising radiation, unlike traditional hysterosalpingography (HSG) under fluoroscopy. Like HSG, HyFoSy may be complicated by uterine intramural contrast leak, leading to venous intravasation. Intravasation of particulate contrast agents risks pulmonary or cerebral emboli. We aimed to assess the intravasation rate of HyFoSy using ExEm® Foam and association with endometrial thickness, ExEm® Foam volume, uterine length, adenomyosis severity, uterine morphology or pain score. An ethics‐approved retrospective study on all HyFoSy examinations between 23 January 2018 and 27 October 2021 on sub‐fertile patients, trying to conceive. Initial transvaginal sonography confirmed anatomy, uterine morphology, adenomyosis severity and endometrial thickness. Subspecialist radiologists performed HyFoSy with sonographer assistance. Intravasation was identified in real time but also checked for afterwards. Patients were asked to rate instillation pain/discomfort from one to ten immediately afterward. Four hundred and thirty‐six ( n = 436) patients met inclusion criteria. Thirty (6.9%) experienced intravasation. Endometrial thickness and pain score were associated with intravasation. For every millimetre increase in endometrial thickness, the odds of intravasation decreased by 26% ( P = 0.010). For every point increase on the pain scale, the odds of intravasation increased by 22% ( P = 0.032). There was no evidence of an association between instilled ExEm® Foam volume or the other previously published parameters with intravasation. A 6.9% rate of intravasation was observed. Both endometrial thickness and pain score were significantly associated with intravasation. There was no evidence of an association between ExEm® Foam volume and intravasation.
Publisher: British Institute of Radiology
Date: 2016
DOI: 10.1259/BJR.20150844
Publisher: Wiley
Date: 15-02-2023
Publisher: Wiley
Date: 09-02-2020
Publisher: Wiley
Date: 27-04-2021
DOI: 10.1111/ANS.16887
Abstract: Breast magnetic resonance imaging (MRI) use for surgical staging is increasing, though remains controversial. We aimed to evaluate the accuracy of MRI in surgical decision‐making to determine if mastectomy prompted by MRI was appropriate. A single‐centre observational study in Perth, Western Australia, with the inclusion of all preoperative and postoperative studies (e.g. involved margins after breast‐conserving surgery) undergoing staging breast MRI from 1 January 2015 to 26 August 2019. A standard protocol using gadolinium contrast was used. The reference standard was postoperative histopathology or, for studies without additional surgery after MRI following breast‐conserving surgery, the next and subsequent annual screening episodes. By reviewing the final histopathology, the medical case notes and multidisciplinary team decision process, we evaluated whether the reported MRI disease extent was accurate in prompting an appropriate upgrade to mastectomy. Outcomes are reported with descriptive statistics. Of 130 cancers staged with MRI seven were excluded as information was incomplete, 104 were performed preoperatively and 19 postoperatively. The majority (60%) staged lobular carcinoma (invasive 59%, in situ 1%) compared to ductal carcinoma (invasive 31%, in situ 8%). For preoperative MRI, half (54% – 56/104) underwent subsequent mastectomy. Of these, MRI prompted mastectomy in 45% (25/56), all appropriate for disease extent. In the postoperative staging group, two mastectomies were performed, one planned before imaging, the other prompted when MRI diagnosed residual disease and confirmed on histopathology. No false‐negative staging MRI was identified. In our cohort, MRI prompted an upgrade to mastectomy in 21% (26/123), appropriate for cancer extent.
Publisher: Informa UK Limited
Date: 03-07-2022
Publisher: Wiley
Date: 22-02-2018
Abstract: There is controversy on the optimal work-up of screen-detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen-detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value. Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were s led within the same lesion were included. Percentage agreement and Cohen's Kappa were calculated. A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86%) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85%, 86% and 92% for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post-hoc second target biopsy cases. While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14% there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post-hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological-pathological concordant discordance still requires repeat s ling.
Publisher: Elsevier BV
Date: 2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2019
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.CRAD.2012.07.011
Abstract: The aim of this review is to illustrate the mammographic and sonographic appearances of squamous metaplasia of the lactiferous ducts (SMOLD) and to discuss the disease processes of this uncommon breast disease, which shows a strong correlation with smoking. The most common mammographic appearance is of a retro-areolar asymmetrical density. Ultrasonography of the symptomatic breast typically shows a retro-areolar, predominately medial, ill-defined, hypoechoic lesion with either abscess or sinus/fistula formation. Duct dilatation and continuity with lactiferous ducts is commonly seen. Increased vascularity is occasionally seen on colour Doppler ultrasound. Pathology tissue confirmation is always required and this can be by histology of a core biopsy or excision specimen, or fine-needle aspiration (FNA) cytology. Occasionally smears of an associated abundant nipple or sinus discharge may be of value.
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.EJRAD.2018.05.020
Abstract: Endometriosis is a disease of significant burden among pre-menopausal women characterised by the appearance of functional endometrial tissue in locations outside the uterus. Deep infiltrating endometriosis (DIE) is an invasion of the endometriotic lesion that exceeds 5 mm in depth into the peritoneum. In most cases, pelvic MRI is the imaging modality of choice for the pre-operative workup for DIE to guide surgery. The recommended standard for pelvic MRI images is at 1.5 T with patient preparations in the form of laxatives, anti-spasmodics and/or rectal contrast. However, there appears to be equally diagnostic quality imaging obtainable with a 3 T system using fast imaging acquisition without any patient preparation. This reduces imaging time, movement artefacts, is more comfortable for the patient and is easier for workflow coordination. This study aims to confirm that this approach reaches diagnostic performance outcomes comparable to reported international standards, particularly in the detection of endometriotic bowel lesions, in order to guide surgical pre-operative planning. Pre-operative diagnostic radiology reports were identified by a search of the Radiology Information System (RIS) for all pelvic MRI studies performed at a tertiary referral centre, King Edward Memorial Hospital for Women, between January 2015 to April 2017 that contained the keyword "endometriosis". Reported sites of endometriotic deposits at MRI findings were tallied based on anatomical location and correlated to laparoscopic surgical report findings and/or pathology report as a reference standard. Pooled sensitivities and specificities were then calculated and compared with established studies. Ninety-eight MRI studies were identified, of which 76 identified DIE and 22 were normal studies. Sixty-one patients did not have a surgical or pathology record. Of the remainder who underwent laparoscopy, operative and/or pathology reports were obtainable in 37 female patients, with a median age of 35 years (range: 24 to 49 years). The average time interval from MRI report to surgical operation was 195 days (range: 5 to 563 days). Middle compartment estimated sensitivity was 79.4% (95% CI = (69.4%, 89.4%)), specificity 95.1% (95% CI = (91.2%, 98.9%)). Posterior compartment estimated sensitivity was 76.5% (95% CI = (66.4%, 86.6%)), specificity 99.4% (95% CI = (98.1%, 100%)). Overall sensitivity 76.9% (95% CI = (69.7%, 84.0%)), specificity 98.5% (95% CI = (97.3%, 99.6%)). Sensitivity and specificity of detecting bowel endometriosis were estimated to be 94.4% (95% CI = (83.9%, 100%) and 94.7% (84.7%, 100%)) respectively. Using a 3 T MRI system without patient preparation is feasible and achieves benchmark diagnostic performance outcomes in the pre-operative assessment for DIE, especially in detecting posterior compartment lesions and bowel DIE to correctly guide surgical planning.
Publisher: Wiley
Date: 09-07-2022
Abstract: Surgical excision of deep infiltrating endometriosis (DIE) is complex and associated with morbidity. Diagnostic imaging plays an important role in the preoperative workup. We sought to determine the utility of single sagittal T2‐weighted MRI motion sequence in the preoperative assessment of pelvic mobility in patients with endometriosis. An observational study at a single tertiary public referral centre in Australia. Eighty‐one MRI studies from 1 May 2019 to 3 December 2019, were enrolled. Studies were included if they were performed to stage endometriosis, including a T2‐weighted motion series, adequately covering a uterus, cervix and rectum. Fifty‐seven studies met inclusion criteria. The reference standard was a contemporaneous transvaginal ultrasound (TVUS) reporting on pelvic organ mobility. Three subspecialist radiologists were then blindly asked to identify, on the cine loop: rectouterine immobility, superficial endometriosis (pelvic bowel adhesions), rectosigmoid Deep Infiltrating Endometriosis (DIE). Fleiss’ Kappa assessed interobserver agreement. Consensus MRI sensitivity and specificity were estimated against the reference standard (TVUS). Median age was 35 years (range 19–51). Forty‐three cases had a contemporaneous TVUS 14 reporting a sliding sign, 29 with fixed pelves. Interobserver agreement was ‘substantial’ ( k = 0.79) for absent MRI sliding sign and ‘almost perfect’ ( k = 0.90) for absence of DIE. Consensus MRI had 90% sensitivity (95% CI 73–98%) for pelvic immobility at TVUS (absent sliding sign). Interobserver agreement and consensus MRI sensitivity were higher for adhesions and immobility than normal findings. An MRI motion sequence can identify patients with pelvic adhesions and immobility, helping determine surgical difficulty when TVUS is not diagnostic.
Publisher: Public Library of Science (PLoS)
Date: 10-06-2021
DOI: 10.1371/JOURNAL.PONE.0252898
Abstract: Research efforts in the initial months of the COVID-19 pandemic focused on the actual and potential impacts on societies, economies, sectors, and governments. Less attention was paid to the experiences of in iduals and less still to the impact of COVID-19 on an in idual’s wellbeing. This research addresses this gap by utilising a holistic wellbeing framework to examine the impact of COVID-19 on the overall wellbeing of in iduals in the Australian state of South Australia through an online survey. The research framework for the survey comprises six dimensions: psychological and emotional health, physical health, living standards, family and community vitality, governance, and ecological ersity and resilience. The results show that most respondents (71%) were able to maintain overall wellbeing during the pandemic. However, more than a half of the respondents could not maintain wellbeing in psychological and emotional health. Further examination of the drivers of inability to maintain overall wellbeing reveals that low-income in iduals, younger respondents (aged 18–24) and women suffer disproportionate hardships. Defining poverty in terms of multi-dimensional deprivations in wellbeing enables a nuanced analysis of the unequal impacts of COVID-19 mitigation policies that can be used to improve policymaking.
No related grants have been discovered for Glen Lo.