Kieran George Foley

Intravoxel incoherent motion (IVIM) is sensitive to tissue diffusion and perfusion and has spurred great interest in various pathologies such as prostate cancer. However, poor repeatability and reproducibility of IVIM parameters hamper its wide‐scale adoption in the clinics. To address this, improvements to the IVIM data acquisition and analysis are necessary. The purpose of this study was to develop a framework for high‐quality IVIM imaging of the prostate. To boost signal precision and quality of IVIM parameter maps, we used a custom pulse sequence to combine velocity‐compensated diffusion encoding with spiral readout at a high‐performance 3 T MRI system with 300 mT/m gradients. IVIM parameters were evaluated in a cohort of five men with and without prostate cancer. Technical performance was assessed in terms of the signal‐to‐noise ratio (SNR), visual quality of IVIM parameter maps and parameter repeatability. High in‐plane resolution images of the prostate were obtained with SNR > 3 (i.e., noise floor level) in 91% of voxels at the highest b‐value of 500 s/mm ² . The parameter maps exhibited high quality with fine features recovered in tissue diffusivity and perfusion fraction maps. Voxel‐wise and ROI‐based analysis revealed high repeatability of the parameters at single subject and group level across main prostatic tissue classes (peripheral and transitional zones) and prostate cancer. A combination of velocity‐compensated diffusion encoding, spiral readout and strong gradients enables high‐quality IVIM imaging in the prostate. Our framework may advance IVIM as a reliable imaging biomarker in prostate.

Background Cancers of the oesophagus and stomach are a major cause of morbidity and mortality. Research is crucial to improving outcomes. However, to maximise value and impact, areas of focus should be prioritised in partnership with patients. Objective We undertook a comprehensive analysis of UK and Ireland patient and healthcare professional (HCP) priorities for research into oesophagogastric cancers across the domains of prevention, diagnosis and staging, treatment, palliative care and survivorship. Design A scoping exercise sourced research questions from patients and HCPs. These were consolidated and then confirmed by systematic review to represent a true research uncertainty. Research questions were scored on potential impact by an interdisciplinary group of HCPs and prioritised using a weighting derived from a patient survey. Results There were 835 (395 HCP, 440 patient) respondents to the scoping (n=455) and prioritisation (n=380) surveys. Across these, 4295 suggested research uncertainties were consolidated to 92 uncertainties that were prioritised. HCP respondents represented 25 professional groups from community and hospital settings. Patient weighting changed 22.2–46.3% of priority rankings established by HCPs. All domains were represented by the 20 highest priority questions, 5 of which focused on personalising and optimally combining treatment modalities. Two other key themes related to optimising nutrition and improving quality of life during and after treatment, including in patients not cured of their cancer. Conclusion This work highlights the impact of patient input on HCP-ranked research priorities and provides a robust list of priorities to guide funders, policymakers and researchers to support and undertake impactful research.

Objectives: To evaluate current UK practice for inflammatory bowel disease (IBD) imaging against recommendations from published international literature. Methods: A retrospective multi-centre audit was undertaken evaluating imaging modalities, protocols, and pathways used to investigate IBD both in outpatient and inpatient settings during January-December 2022. Reporting practices and training provisions were also recorded. Results: Forty-one centres contributed: 35 centres provided complete data, whereas 6 centres provided incomplete data. Magnetic resonance enterography (MRE) was the most common modality for small bowel imaging across UK centres, comprising 13 099/18 784 (69.7%) investigations. There was regional variability in other modalities used, with 5 centres performing 81% of all intestinal ultrasound and 3 centres performing 65% of all small bowel follow-through. Compared with outpatients, inpatients with suspected IBD were significantly more likely to be imaged with techniques imparting ionising radiation whether scanned either in-hours (p = 0.005) or out-of-hours (p < 0.001). Non-ionising radiation imaging modalities were significantly less available out-of-hours (p < 0.0001). Sequences included in MRE protocols were variable. Disparity in imaging follow-up for patients prescribed biologic therapies was observed. Conclusions: Considerable variation in UK IBD imaging practice has been identified. Improvements must be made to reduce the regional inequality of patient access to different imaging modalities and decrease reliance on ionising radiation for inpatients. Further research to standardise and optimise imaging pathways should be undertaken to improve uniformity, with emphasis placed on training and education. Advances in knowledge: This multi-centre audit showed considerable IBD imaging practice variation between UK centres, particularly for imaging modalities used between inpatient and outpatient groups and in-hours versus out-of-hours.

Objectives: Gallbladder polyps (GBPs) are commonly detected with trans-abdominal ultrasound (TAUS). Gallbladder cancer (GBC) is associated with GBPs but the risk of malignancy is low. International guidelines recommend ultrasound surveillance (USS) in selected cases of GBPs <10 mm, with cholecystectomy advised if the polyp size increases. USS (including potential cholecystectomies) is resource intense. We evaluated the costs and potential cost-effectiveness of USS in a theoretical UK patient cohort with GBPs. Methods: A health economic model mapped expected management pathways over 2 years for 1000 GBP patients with and without USS, stratified by the initial size of GBP (<6 mm and 6–9 mm). We estimated USS resource and costs under alternate referral thresholds for cholecystectomy. Clinical data were extracted from a large-scale cohort study. TAUS and cholecystectomy costs were based on NHS tariffs. GBC costs were estimated from the literature. Outcomes included USS costs, expected numbers of GBC, and incremental cost for each case of GBC avoided. Results: The 2-year additional cohort costs of USS (n = number of cholecystectomies) were estimated between £213 441 (n = 50) and £750 045 (n = 253) in GBPs <6 mm and between £420 275 (n = 165) and £531 297 (n = 207) in GBPs 6–9 mm, balanced against avoidance of 1.3 (<6 mm) and 8.7 (6–9 mm) cases of GBC. Model findings were robust to plausible changes in inputs. Conclusions: Using published data, we demonstrated that, in patients with GBPs <10 mm, the costs of USS to avoid GBC outweigh potential GBC cost offsets and would result in high rates of cholecystectomy. Additional evidence is needed to establish the formal cost-effectiveness of GBP USS in the UK. Advances in knowledge: • We developed a health economic model, based on published data, to evaluate the cost-effectiveness of guideline-recommended ultrasound surveillance (USS) in patients with gallbladder polyps measuring less than 10 mm in the UK. • The analysis provides a transparent platform to explore potential numbers of trans-abdominal ultrasound studies and cholecystectomies that might be expected if USS protocols are adhered to and discovers important gaps in current evidence that could be filled by additional targeted research.

Objectives: Over 9000 patients are diagnosed with oesophageal cancer annually in the United Kingdom (UK). Decision-making about treatment options is influenced by radiological staging, which may include computed tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS). The use of EUS varies considerably around the UK and, since the introduction of PET-CT, the added value of EUS has been questioned. The VALUE study aims to understand this variation and determine how often and why EUS changes treatment decisions. VALUE will also evaluate patient and clinician experiences and opinions of EUS. Methods: This is a prospective, observational study investigating EUS in oesophageal cancer staging. Patients will be recruited at up to eleven sites in the UK, where they will be consented (if eligible) and registered onto iMedidata RAVE. Clinical and demographic data, TNM staging, pre and post EUS treatment decisions, and complications will be collected. We will attempt to sample patients from ethnic minority backgrounds in the study population, as they are underrepresented in research. Up to 30 patients and 30 clinicians will be interviewed to evaluate the use of EUS and experiences of both patient and clinician. The primary endpoint is the proportion of cases that EUS changes treatment decisions. Secondary endpoints include identification of factors that clinicians’ and patients consider when deciding if EUS should be used, the time from diagnosis to treatment decision before and after EUS, and the reasons why EUS changed management. The study has been registered on Clinicaltrials.gov: NCT06440174. The trial is open to recruitment. Results: In total, 180 patients with potentially curable oesophageal cancer who are suitable for EUS will participate. Recruitment is currently planned until September 2025 and study results will be reported after June 2026. Conclusion: The VALUE study will enable a better understanding of how and why EUS is used in oesophageal cancer. This research will identify important factors that clinicians and patients consider when deciding EUS use and determine the frequency that EUS changes treatment decisions in the modern staging pathway. Advances in knowledge: The VALUE study is a prospective, multi-centre observational study investigating the use of EUS in the modern era of oesophageal cancer staging. The study aims to determine how often and why EUS changes treatment decisions. A qualitative component will explore both clinician and patient attitudes towards EUS.

Diffusion‐weighted MRI (dMRI) is universally recommended for the detection and classification of prostate cancer (PCa), with PI‐RADS recommendations to acquire b‐values of ≥1.4 ms/μm². However, clinical dMRI suffers from a low signal‐to‐noise ratio (SNR) as the consequence of prolonged echo times (TEs) attributable to the limited gradient power in the range of 40–80 mT/m. To overcome this, MRI systems with strong gradients have been designed but so far have mainly been applied in the brain. The aim of this work was to assess the feasibility, data quality, SNR and contrast‐to‐noise ratio (CNR) of measurements in PCa with a 300 mT/m whole‐body system. A cohort of men without and with diagnosed PCa were imaged on a research‐only 3T Connectom Siemens MRI system equipped with a gradient amplitude of 300 mT/m. dMRI at high b‐values were acquired using high gradient amplitudes and compared with gradient capabilities mimicking clinical systems. Data artefacts typically amplified with stronger gradients were assessed and their correction evaluated. The SNR gains and lesion‐to‐healthy tissue CNR were statistically tested investigating the effect of protocol and b‐value. The diagnostic quality of the images for different dMRI protocols was assessed by an experienced radiologist using a 5‐point Likert scale and an adapted PI‐QUAL scoring system. The strong gradients for prostate dMRI allowed a significant gain in SNR per unit time compared with clinical gradients. Furthermore, a 1.6–2.1‐fold increase in CNR was observed. Despite the more pronounced artefacts typically associated with strong gradients, a satisfactory correction could be achieved. Smoother and less biased parameter maps were obtained with protocols at shorter TEs. The results of this study show that dMRI in PCa with a whole‐body 300‐mT/m scanner is feasible without a report of physiological effects, SNR and CNR can be improved compared with lower gradient strengths, and artefacts do not negate the benefits of strong gradients and can be ameliorated. This assessment provides the first essential step towards unveiling the full potential of cutting‐edge scanners, now increasingly becoming available, to advance early detection and diagnostic precision.