ORCID Profile
0000-0002-5870-1446
Current Organisations
Nottingham University Hospitals NHS Trust
,
University of Nottingham
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 08-08-2017
DOI: 10.1002/MRM.26837
Abstract: 3T magnetic resonance scanners have boosted clinical application of 1 H‐MR spectroscopy (MRS) by offering an improved signal‐to‐noise ratio and increased spectral resolution, thereby identifying more metabolites and extending the range of metabolic information. Spectroscopic data from clinical 1.5T MR scanners has been shown to discriminate between pediatric brain tumors by applying machine learning techniques to further aid diagnosis. The purpose of this multi‐center study was to investigate the discriminative potential of metabolite profiles obtained from 3T scanners in classifying pediatric brain tumors. A total of 41 pediatric patients with brain tumors (17 medulloblastomas, 20 pilocytic astrocytomas, and 4 ependymomas) were scanned across four different hospitals. Raw spectroscopy data were processed using TARQUIN. Borderline synthetic minority overs ling technique was used to correct for the data skewness. Different classifiers were trained using linear discriminative analysis, support vector machine, and random forest techniques. Support vector machine had the highest balanced accuracy for discriminating the three tumor types. The balanced accuracy achieved was higher than the balanced accuracy previously reported for similar multi‐center dataset from 1.5T magnets with echo time 20 to 32 ms alone. This study showed that 3T MRS can detect key differences in metabolite profiles for the main types of childhood tumors. Magn Reson Med 79:2359–2366, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher: Wiley
Date: 05-05-2023
DOI: 10.1002/HBM.26314
Abstract: Acute exercise suppresses appetite and alters food‐cue reactivity, but the extent exercise‐induced changes in cerebral blood flow (CBF) influences the blood‐oxygen‐level‐dependent (BOLD) signal during appetite‐related paradigms is not known. This study examined the impact of acute running on visual food‐cue reactivity and explored whether such responses are influenced by CBF variability. In a randomised crossover design, 23 men (mean ± SD: 24 ± 4 years, 22.9 ± 2.1 kg/m 2 ) completed fMRI scans before and after 60 min of running (68% ± 3% peak oxygen uptake) or rest (control). Five‐minute pseudo‐continuous arterial spin labelling fMRI scans were conducted for CBF assessment before and at four consecutive repeat acquisitions after exercise/rest. BOLD‐fMRI was acquired during a food‐cue reactivity task before and 28 min after exercise/rest. Food‐cue reactivity analysis was performed with and without CBF adjustment. Subjective appetite ratings were assessed before, during and after exercise/rest. Exercise CBF was higher in grey matter, the posterior insula and in the region of the amygdala/hippoc us, and lower in the medial orbitofrontal cortex and dorsal striatum than control (main effect trial p ≤ .018). No time‐by‐trial interactions for CBF were identified ( p ≥ .087). Exercise induced moderate‐to‐large reductions in subjective appetite ratings (Cohen's d = 0.53–0.84 p ≤ .024) and increased food‐cue reactivity in the paracingulate gyrus, hippoc us, precuneous cortex, frontal pole and posterior cingulate gyrus. Accounting for CBF variability did not markedly alter detection of exercise‐induced BOLD signal changes. Acute running evoked overall changes in CBF that were not time dependent and increased food‐cue reactivity in regions implicated in attention, anticipation of reward, and episodic memory independent of CBF.
Publisher: Elsevier BV
Date: 2007
Publisher: Routledge
Date: 03-11-2016
Publisher: American Society of Clinical Oncology (ASCO)
Date: 04-2018
Abstract: Bevacizumab (BEV) is approved in more than 60 countries for use in adults with recurrent glioblastoma. We evaluated the addition of BEV to radiotherapy plus temozolomide (RT+TMZ) in pediatric patients with newly diagnosed high-grade glioma (HGG). The randomized, parallel group, multicenter, open-label HERBY trial ( ClinicalTrials.gov identifier: NCT01390948) enrolled patients age ≥ 3 years to ≤ 18 years with localized, centrally neuropathology-confirmed, nonbrainstem HGG. Eligible patients were randomly assigned to receive RT + TMZ (RT: 1.8 Gy, 5 days per week, and TMZ: 75 mg/m 2 per day for 6 weeks 4-week treatment break then up to 12 × 28-day cycles of TMZ [cycle 1: 150 mg/m 2 per day, days 1 to 5 cycles 2 to 12: 200 mg/m 2 per day, days 1 to 5]) with or without BEV (10 mg/kg every 2 weeks). The primary end point was event-free survival (EFS) as assessed by a central radiology review committee that was blinded to treatment. We report findings of EFS at 12 months after the enrollment of the last patient. One hundred twenty-one patients were enrolled (RT+TMZ [n = 59] BEV plus RT+TMZ [n = 62]). Central radiology review committee–assessed median EFS did not differ significantly between treatment groups (RT+TMZ, 11.8 months 95% CI, 7.9 to 16.4 months BEV plus RT+TMZ, 8.2 months 95% CI, 7.8 to 12.7 months hazard ratio, 1.44 P = .13 [stratified log-rank test]). In the overall survival analysis, the addition of BEV did not reduce the risk of death (hazard ratio, 1.23 95% CI, 0.72 to 2.09). More patients in the BEV plus RT+TMZ group versus the RT+TMZ group experienced one or more serious adverse events (n = 35 [58%] v n = 27 [48%]), and more patients who received BEV discontinued study treatment as a result of adverse events (n = 13 [22%] v n = 3 [5%]). Adding BEV to RT+TMZ did not improve EFS in pediatric patients with newly diagnosed HGG. Our findings were not comparable to those of previous adult trials, which highlights the importance of performing pediatric-specific studies.
Publisher: American Association for Cancer Research (AACR)
Date: 15-04-2020
DOI: 10.1158/1078-0432.CCR-19-3154
Abstract: The HERBY trial evaluated the benefit of the addition of the antiangiogenic agent Bevacizumab (BEV) to radiotherapy/temozolomide (RT/TMZ) in pediatric patients with newly diagnosed non-brainstem high-grade glioma (HGG). The work presented here aims to correlate imaging characteristics and outcome measures with pathologic and molecular data. Radiological, pathologic, and molecular data were correlated with trial clinical information to retrospectively re-evaluate event-free survival (EFS) and overall survival (OS). One-hundred thirteen patients were randomized to the RT/TMZ arm (n = 54) or the RT/TMZ+BEV (BEV arm n = 59). The tumor arose in the cerebral hemispheres in 68 patients (Cerebral group) and a midline location in 45 cases (Midline group). Pathologic diagnosis was available in all cases and molecular data in 86 of 113. H3 K27M histone mutations were present in 23 of 32 Midline cases and H3 G34R/V mutations in 7 of 54 Cerebral cases. Total/near-total resection occurred in 44 of 68 (65%) Cerebral cases but in only 5 of 45 (11%) Midline cases (P & 0.05). Leptomeningeal metastases (27 cases, 13 with subependymal spread) at relapse were more frequent in Midline (17/45) than in Cerebral tumors (10/68, P & 0.05). Mean OS (14.1 months) and EFS (9.0 months) in Midline tumors were significantly lower than mean OS (20.7 months) and EFS (14.9 months) in Cerebral tumors (P & 0.05). Pseudoprogression occurred in 8 of 111 (6.2%) cases. This study has shown that the poor outcome of midline tumors (compared with cerebral) may be related to (1) lesser surgical resection, (2) H3 K27M histone mutations, and (3) higher leptomeningeal dissemination.
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-019930
Abstract: To test whether administration of the antifibrinolytic drug tranexamic acid (TXA) in patients with spontaneous intracerebral haemorrhage (SICH) leads to increased prevalence of diffusion-weighted MRI-defined hyperintense ischaemic lesions (primary hypothesis) or reduced perihaematomal oedema volume, perihaematomal diffusion restriction and residual MRI-defined SICH-related tissue damage (secondary hypotheses). MRI substudy nested within the double-blind randomised controlled Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage (TICH)-2 trial ( ISRCTN93732214 ). International multicentre hospital-based study. Eligible adults consented and randomised in the TICH-2 trial who were also able to undergo MRI scanning. To address the primary hypothesis, a s le size of n=280 will allow detection of a 10% relative increase in prevalence of diffusion-weighted imaging (DWI) hyperintense lesions in the TXA group with 5% significance, 80% power and 5% imaging data rejection. TICH-2 MRI substudy participants will undergo MRI scanning using a standardised protocol at day ~5 and day ~90 after randomisation. Clinical assessments, randomisation to TXA or placebo and participant follow-up will be performed as per the TICH-2 trial protocol. The TICH-2 MRI substudy will test whether TXA increases the incidence of new DWI-defined ischaemic lesions or reduces perihaematomal oedema or final ICH lesion volume in the context of SICH. The TICH-2 trial obtained ethical approval from East Midlands - Nottingham 2 Research Ethics Committee (12/EM/0369) and an amendment to allow the TICH-2 MRI sub study was approved in April 2015 (amendment number SA02/15). All findings will be published in peer-reviewed journals. The primary outcome results will also be presented at a relevant scientific meeting. ISRCTN93732214 Pre-results.
Publisher: Radiological Society of North America (RSNA)
Date: 07-2022
Abstract: Background Diffuse midline gliomas (DMG) are characterized by a high incidence of
Publisher: Cold Spring Harbor Laboratory
Date: 19-06-2023
DOI: 10.1101/2023.06.16.545260
Abstract: Despite the huge potential of magnetic resonance imaging (MRI) in mapping and exploring the brain, MRI measures can often be limited in their consistency, reproducibility and accuracy which subsequently restricts their quantifiability. Nuisance nonbiological factors, such as hardware, software, calibration differences between scanners, and post-processing options can contribute to, or drive trends in, neuroimaging features to an extent that interferes with biological variability. Such lack of consistency, known as lack of harmonisation, across neuroimaging datasets poses a great challenge for our capabilities in quantitative MRI. Here, we build a new resource for comprehensively mapping the extent of the problem and objectively evaluating neuroimaging harmonisation approaches. We use a travelling-heads paradigm consisting of multimodal MRI data of 10 travelling subjects, each scanned at 5 different sites on 6 different 3T scanners from all the 3 major vendors and using 5 neuroimaging modalities, providing more comprehensive coverage than before. We also acquire multiple within-scanner repeats for a subset of subjects, setting baselines for multi-modal scan-rescan variability. Having extracted hundreds of image-derived features, we compare three forms of variability: (i) between-scanner, (ii) within-scanner (within-subject), and (iii) biological (between-subject). We characterise the reliability of features across scanners and use our resource as a testbed to enable new investigations that until now have been relatively unexplored. Specifically, we identify optimal pipeline processing steps that minimise between-scanner variability in extracted features (implicit harmonisation). We also test the performance of post-processing harmonisation tools (explicit harmonisation) and specifically check their efficiency in reducing between-scanner variability against baseline standards provided by our data. Our explorations allow us to come up with good practice suggestions on processing steps and sets of features where results are more consistent, while our publicly-released datasets establish references for future studies in this field.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Paul Morgan.