The services we provide comprise general radiology (using DR and CR), CT scanning, MR scanning, ultrasound, interventional radiology and nuclear medicine including PET-CT. As a support service to the hospital’s groundbreaking research, the radiology department provides input to more than 100 active clinical trials at any one time, across all the disease groups.Our consultant radiologists provide support to the Christie’s clinical teams through multi-disciplinary teams, with a named consultant leading for each disease group.

Recent Submissions

  • The role of positron emission tomography in management of small cell lung cancer.

    Thomson, David J; Hulse, Paul; Lorigan, Paul C; Faivre-Finn, Corinne; Department of Clinical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK. (2011-08)
    Accurate radiological staging of small-cell lung cancer (SCLC) is of paramount importance in selection of individual patients with limited stage disease for potentially curative treatment while avoiding toxic treatment in those with distant metastatic disease. [(18)F] flurodeoxy-D-glucose (FDG) positron emission tomography (PET) is an attractive tool for this purpose but there is limited evidence to support its use in the routine staging of SCLC. Whether therapeutic decisions based on FDG-PET imaging should be made remains uncertain. There is only preliminary evidence for use of FDG-PET as a prognostic biomarker, in the assessment of response to treatment and delineation of disease in conformal radiation planning.
  • Assessment of circulating biomarkers for potential pharmacodynamic utility in patients with lymphoma.

    Greystoke, Alastair; O'Connor, James P B; Linton, Kim M; Taylor, M Ben; Cummings, Jeffrey; Ward, Timothy H; Maders, Fran; Hughes, Anthony; Ranson, Malcolm R; Illidge, Timothy M; Radford, John A; Dive, Caroline; Clinical and Experimental Pharmacology Group, The Paterson Institute for Cancer Research, The University of Manchester, Wilmslow Road, Withington, Manchester M20 4BX, UK. (2011-02-15)
    Treatment efficacy and toxicity are difficult to predict in lymphoma patients. In this study, the utility of circulating biomarkers in predicting and/or monitoring treatment efficacy/toxicity were investigated.
  • Is dual-phase abdominal CT necessary for the optimal detection of metastases from renal cell carcinoma?

    Jain, Yatin; Liew, S; Taylor, M B; Bonington, Suzanne C; The Christie NHS Foundation Trust, Manchester, UK. (2011-11)
    To determine whether dual-phase abdominal computed tomography (CT) detected more metastases than portal-phase CT alone in patients with renal cell carcinoma (RCC).
  • Serum vascular endothelial growth factor (VEGF) is elevated in GH deficient adults.

    Murray, Robert D; Randeva, Harpal S; Lewandowski, Krzysztof C; Komorowski, Jan; Lawrance, Jeremy A L; Adams, Judith E; Shalet, Stephen M; Department of Endocrinology, Christie Hospital, Manchester, UK. Robert.Murray@leedsth.nhs.uk (2011-04)
    GHD adults exhibit a number of adverse surrogate markers of vascular risk culminating in excess vascular morbidity and mortality. Vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs) have been implicated in the pathogenesis of a number of vascular morbidities. Furthermore, serum levels decrease following GH replacement in GHD adults, though it remains unclear if levels are significantly elevated in untreated individuals.
  • A retrospective analysis of selective internal radiation therapy (SIRT) with yttrium-90 microspheres in patients with unresectable hepatic malignancies.

    Omed, A; Lawrance, Jeremy A L; Murphy, G; Laasch, Hans-Ulrich; Wilson, G; Illidge, Timothy M; Tipping, Jill; Zivanovic, M; Jeans, S; Manchester Medical School, University of Manchester, Stopford Building, Manchester, UK. aliomed0101@doctors.org.uk (2010-09)
    AIM: To evaluate the efficacy and safety of selective internal radiation therapy (SIRT). MATERIALS AND METHODS: A retrospective analysis was undertaken of all patients who underwent SIRT at a single institution. Diagnostic and therapeutic angiograms, computed tomography (CT) images, positron-emission tomography (PET) images, and planar isotope images were analysed. The response to SIRT was analysed using radiological data and tumour markers. Overall survival, complications, and side effects of SIRT were also analysed. RESULTS: The initial 12 patients were included on an intention-to-treat basis, between 21/09/2005 and 07/05/2008. All patients had advanced disease and multiple prior courses of chemotherapy. One patient did not receive yttrium-90 due to complex vascular anatomy; the remaining 11 patients underwent 13 SIRT treatment episodes following work-up angiography. A response was seen using PET in 80% of patients. Using CT, the response of the tumour to therapy in the treated hepatic segments demonstrated a 20% partial response, stable disease in 50%, and progressive disease in 30%. Estimated median survival was 229 days, with 64% of patients still alive at the time of writing. No major complications were observed, although 82% of patients experienced side-effects following SIRT, mainly nausea, vomiting, and abdominal pain. CONCLUSIONS: There have been no complications in the 12 SIRT patients. Tumour response was seen in four out of five patients who underwent PET. Objective CT response rates were mixed and are perhaps partially explained by advanced disease and limitations of using measurements to assess response. This complex and potentially hazardous service has been successfully and safely established.
  • Role of FDG PET/CT in imaging of renal lesions.

    Kochhar, Rohit; Brown, R K; Wong, C O; Dunnick, N R; Frey, K A; Manoharan, Prakash; Department of Radiology, The Christie, NHS Foundation Trust, Manchester, UK. (2010-08)
    Focal incidental renal lesions are commonly encountered on positron emission tomography (PET)/computed tomography (CT) imaging. The vast majority of these lesions are benign. However, the interpretation of renal lesions can be problematic if the imaging criteria of simple cysts are not met. Limited literature exists on the characterisation of renal masses with metabolic imaging. The purpose of this article is to focus on the imaging features of benign and malignant renal masses with PET/CT. The lesions discussed include renal cyst, angiomyolipoma, oncocytoma, renal cell carcinoma, renal metastases and other infiltrating neoplastic processes affecting the kidney. Both the anatomical and metabolic features which characterise these benign and malignant entities are described. We emphasise the importance of viewing the CT component to identify the typical morphological features and discuss how to best use hybrid imaging for management of renal lesions. Metabolic imaging has a promising role in the imaging of renal lesions and can help prevent unnecessary biopsies and ensure optimal management of suspicious lesions.
  • The accuracy of the sentinel node procedure after excision biopsy in squamous cell carcinoma of the vulva.

    Crosbie, Emma J; Winter-Roach, Brett; Sengupta, Partha; Sikand, Kanwal A; Carrington, Bernadette M; Murby, Brian; Slade, Richard J; Department of Gynaecological Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK. (2010-12)
    INTRODUCTION: Restricting inguinofemoral lymphadenectomy to patients with malignant nodes would reduce treatment-related morbidity in vulval cancer patients. A prospective study was conducted to determine the diagnostic accuracy of the Sentinel Lymph Node (SLN) procedure in vulval cancer patients referred following either diagnostic or excision biopsy. METHODS: Patients with clinical stage I and II squamous cell carcinoma of the vulva underwent SLN identification with peri-scar/lesional injection of (99m)Technetium-labelled nanocolloid (pre-operative lymphoscintigraphy and intra-operative use of a hand-held probe) and intra-operative blue dye. Radical excision of the vulval tumour or scar and formal inguinofemoral lymphadenectomy was then performed as necessary. SLN were processed separately and further examined at multiple levels to exclude micrometastases (H&E/cytokeratin staining) if negative on routine analysis. Clinical follow-up was carried out to identify and treat recurrences or treatment-related morbidity. RESULTS: Thirty-two women took part. Fifteen were referred following excision biopsy and seventeen following diagnostic biopsy of their primary vulval tumour. One or more SLN was successfully detected intra-operatively in 31 patients (97%) and 45 groins. An SLN could not be identified intra-operatively in one case (re-excision of scar). On average, more SLN were identified in patients with their primary vulval lesion in situ compared with those whose tumour had previously been excised (2.6 vs. 1.8, p = 0.03). Midline tumours were more likely (15/17) than lateral tumours (1/15) to have bilateral SLN identified pre-operatively. Two patients with midline tumours previously excised had unilateral SLN. Seven patients (23%) and ten groins had inguinofemoral lymph node metastases. The SLN procedure correctly identified inguinofemoral metastases in six patients (nine groins). In one case (midline tumour, re-excision of scar) the sentinel node was positive on one side but false negative on the other. CONCLUSIONS: The SLN procedure may be used to identify malignant groins in selected patients with vulval cancer. The extent to which previous vulval surgery might influence the accuracy of the SLN procedure deserves further investigation.
  • Imaging in gastrointestinal stromal tumours: current status and future directions.

    Kochhar, Rohit; Manoharan, Prakash; Leahy, Michael G; Taylor, Malcolm B; Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK. rohit.kochhar@christie.nhs.uk (2010-08)
    Gastrointestinal stromal tumours (GISTs) have distinct biological and treatment-related features posing challenges for imaging. In this review the importance of imaging in different stages of patient management is discussed, emphasizing the unique characteristics of GISTs. Potential pitfalls of using the standard response criteria on conventional imaging have been highlighted. These include size measurements, which may not adequately reflect response rates, pseudo-progression, and spurious new lesions. Furthermore, the role of positron emission tomography/computed tomography (PET/CT) in early response evaluation and in the detection of both primary and acquired resistance is explored. The current role and future directions of use of both conventional and metabolic imaging in the management of GISTs are discussed.
  • Improving survival with thoracic radiotherapy in patients with small cell lung cancer. The CONVERT and the REST Trials.

    Faivre-Finn, Corinne; Blackhall, Fiona H; Snee, Michael; Harden, S; Hulse, Paul; Lorigan, Paul C (2010-09)
  • Efficacy of photodynamic therapy as a treatment for Gorlin syndrome-related basal cell carcinomas.

    Loncaster, Juliette A; Swindell, Ric; Slevin, F; Sheridan, Linda; Allan, Donald; Allan, Ernest; Department of Clinical Oncology, Christie Hospital, Manchester M20 4BX, UK. juliette.loncaster@christie.nhs.uk (2009-08)
    AIMS: The management of the multiple basal cell carcinomas (BCCs) that develop throughout life of patients with Gorlin syndrome can be challenging. Surgical excision can result in significant disfigurement from scarring and tissue defects. Radiotherapy is contraindicated because of enhanced radiation tumourigenesis in these patients. Photodynamic therapy (PDT) is a simple, repeatable out-patient procedure, which is associated with minimal skin deterioration. It is now routinely used to treat superficial sporadic BCCs, using a topically-applied photosensitiser and external light, but its role in the management of Gorlin syndrome-related BCCs has yet to be established. In particular, Gorlin syndrome is often associated thick, nodular lesions which can be resistant to treatment with topical PDT. MATERIALS AND METHODS: We report our outcome data for 33 Gorlin patients (138 lesions) treated with PDT. Lesion thicknesses were assessed using ultrasound, both prior to treatment and during follow-up, to quantify treatment response and to guide the choice of treatment methods. Topical PDT was used to treat superficial lesions (<2 mm thick) and a systemic photosensitiser +/- light delivered by interstitially-placed optical fibres was employed for thicker lesions (>2 mm). RESULTS AND CONCLUSIONS: Local control rates of 56.3% at 12 months were achieved overall. The use of a systemic photosensitiser +/- interstitial light delivery extended the remit of PDT, allowing thicker lesions (>2 mm) to be treated, resulting in local control rates of 59.3% in this group. PDT can be considered as a treatment option for patients with multiple BCCs as a result of Gorlin syndrome. The use of ultrasound to accurately assess lesion thickness helps to select the optimum treatment method. Systemic photosensitisers and interstitial optical fibres can be used to treat thicker lesions, offering a treatment option for patients with thick nodular tumours who wish to avoid surgery.
  • Radiological balloon dilatation of post-treatment benign pharyngeal strictures.

    Williams, L R; Kasir, D; Penny, S; Homer, Jarrod J; Laasch, Hans-Ulrich; Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK. luke.williams@srft.nhs.uk (2009-11)
    AIMS: To assess the technical success, clinical outcomes and complications of radiologically guided balloon dilatation of benign strictures developing after treatment for head and neck cancer. MATERIALS AND METHODS: Forty-six balloon dilatations were performed in 20 patients. All dilatations were performed over a guidewire. RESULTS: Technical success was 100 per cent. Fifteen of the 20 patients demonstrated clinical improvement in dysphagia scores. Improvement in dysphagia was temporary in all patients (median 102 days), with multiple dilatations usually required (total dilatations ranged from one to seven). Immediate complications were encountered in six of the 46 (13 per cent) dilatations and were all minor. Late complications occurred after two procedures (4 per cent): localised perforation (later complicated by secondary infection) and recurrence of a previous, small, pharyngo-cutaneous fistula. CONCLUSION: Radiologically guided balloon dilatation is straightforward to perform and is well tolerated, but there is a small risk of perforation. Relief of symptoms is likely to be temporary, requiring multiple subsequent dilatations. A minority of patients will obtain no symptomatic relief.
  • Metastatic cutaneous malignant melanoma: spectrum of imaging findings and the role of multimodality imaging.

    Kochhar, Rohit; Ali, H; Mak, Soo K; Manoharan, Prakash; Department of Radiology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK. (2009-10)
    Cutaneous malignant melanoma is one of the most lethal and widely metastasising cancers with unpredictable pathways of spread. One of the most significant factors associated with survival in patients who have distant metastases is the number of organ sites involved. Innovative treatment options are now available for metastatic melanoma, and diagnostic imaging has become crucial for accurate staging and restaging of disease. The objective of this pictorial review is to illustrate the imaging spectrum of metastatic cutaneous malignant melanoma including both the common and the relatively ubiquitous sites of involvement using both conventional cross-sectional and metabolic molecular imaging. This review also highlights the importance of combining multiple imaging methods for accurate staging of metastatic melanoma.
  • Primary Radiotherapy for Carcinoma of the Retromolar Trigone; A Useful Alternative to Surgery.

    Bayman, Neil A; Sykes, Andrew J; Bonington, Suzanne C; Blackburn, T; Patel, M; Swindell, Ric; Slevin, Nicholas J; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK. (2009-12-03)
    AIMS: Squamous cell carcinoma of the retromolar trigone is uncommon. The standard initial treatment is primary surgery, which usually involves microvascular reconstruction with a composite flap. Some patients are considered unsuitable for this procedure. This retrospective study examined the outcome and toxicity for patients with squamous cell carcinoma of the retromolar trigone treated with definitive radiotherapy in a single centre. MATERIALS AND METHODS: Between 1991 and 2000, 43 patients were treated with definitive radiotherapy with a median dose of 50Gy in 16 fractions over 21 days. Hospital case notes and radiotherapy records were analysed. RESULTS: The median age was 66 years (range 39-84 years). Nodal disease was evident in 13 (30.2%) patients. Twenty-one patients (51.2%) had stage I/II disease and 20 patients (48.8%) had stage III/IV disease. After a median follow-up of 59 months, 13 (30.2%) patients were alive and well, nine (20.9%) patients had died of an intercurrent illness and 21 (48.8%) had died of their disease. Five-year locoregional control was 46.5% (95% confidence interval 29.7-61.7), cause-specific survival was 45.7% (95% confidence interval 29.1-60.8) and overall survival was 30.9% (95% confidence interval 17.5-46.3). Osteoradionecrosis was documented in two patients. DISCUSSION: This hypofractionated regimen is convenient for this patient population and produced comparable outcomes to longer fractionation schedules without an increase in late toxicity.
  • Myofibroblast transformation in metastatic extramedullary chronic myeloid leukemia: a case report.

    Ru, Yong-Xin; Eyden, Brian P; Li, Qing-Hua; Mao, Bing-Yu; Liu, En-Bin; Pang, Tian-Xiang; Institute of Hematology & Blood Diseases Hospital, Peking Union Medical College, Tianjin, China. (2009)
    Primary and metastatic carcinomas have a reactive stroma characterized by many myofibroblasts. These cells have also been documented in nonepithelial malignancies, such as sarcomas, malignant melanoma, and lymphoid tumors but in generally far fewer numbers. In non-Hodgkin's lymphoma, Hodgkin's disease, and leukemia, myofibroblasts are rather rarely documented. In particular, there appear to be no reports of myofibroblasts in either primary bone-marrow/peripheral blood leukemia or secondary deposits of leukemia. In this paper, a case of a relapsed chronic myeloid leukemia appearing in an inguinal lymph node is described, containing many myofibroblasts. The case is detailed and presented with a discussion on the role of myofibroblasts in the progression of nonepithelial cancers.
  • Testicular seminoma with mediastinal lymphadenopathy -- a diagnostic pitfall.

    Jegannathen, Apurna; Taylor, Malcolm B; Jones, M; Logue, John P; Departments of Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester, UK. (2009-05)
    Relapse following adjuvant paraaortic radiation therapy in patients with Stage I seminoma is rare, occurring in approximately 4% of men. The majority of relapses are sited in the pelvis but relapse in the mediastinum is also recognised. As such, radiological imaging using chest radiographs remains commonplace in follow-up. However, there are reports of the association of testicular cancers with sarcoidosis and sarcoid-like processes in the mediastinum, emphasising the importance of making histological diagnosis prior to commencement of any treatment. We report on two men treated for testicular seminoma who on follow-up developed mediastinal lymphadenopathy, which was initially assumed to be metastatic seminoma. Both patients underwent mediastinascopy and biopsy prior to commencement of anti-cancer therapy. In both cases, the biopsies showed sarcoidosis, and unnecessary anti-cancer treatment was avoided.
  • Caecal metastases from cervical cancer--a rare presentation.

    Ansari, H A K; Manoharan, Prakash; Department of Diagnostic Radiology, Christie Hospital, Manchester, UK. doctorkhan75@yahoo.co.uk (2008-08)
  • Pneumoperitoneum following percutaneous biliary intervention: not necessarily a cause for alarm.

    Amonkar, Suraj J; Laasch, Hans-Ulrich; Valle, Juan W; Manchester Radiology Training Scheme, University of Manchester, Manchester, M13 9PL, UK. surajamonkar@hotmail.com (2009-04-21)
    Percutaneous transhepatic cholangiography (PTC) is a well-established technique for assessing and treating obstructive jaundice. Plastic and self-expanding metal stents can be deployed as an alternative when ERCP is not feasible or hilar strictures require an antegrade approach. Complication rates of percutaneous procedures are low, and are usually related to bile leakage or hemorrhage; pneumoperitoneum following PTC is rare and is usually taken to indicate bowel perforation. We describe two cases of pneumoperitoneum without peritonitis following PTC and stenting, both of which resolved spontaneously with conservative management. The literature is reviewed and possible causes discussed.
  • A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei.

    Farquharson, Adam L; Pranesh, Nagarajan; Witham, Gary; Swindell, Ric; Taylor, Malcolm B; Renehan, Andrew G; Rout, Shantanu; Wilson, Malcolm S; O'Dwyer, Sarah T; Saunders, Mark P; Peritoneal Tumour Service, Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK. (2008-08-19)
    Pseudomyxoma peritonei (PMP) is a rare neoplastic process characterised by progressive intra-abdominal dissemination of mucinous tumour, and generally considered resistant to systemic chemotherapy. A phase II study in patients with advanced unresectable PMP was undertaken to evaluate the combination of systemic concurrent mitomycin C (7 mg m(-2) i.v. on day 1) and capecitabine (1250 mg m(-2) b.d. on days 1-14) in a 3-weekly cycle (MCap). Response was determined by semiquantitative assessment of disease volume on serial computed tomographic (CT) scans and serum tumour marker (CEA, CA125, CA19-9) changes at 12 weeks. Between 2003 and 2006, 40 patients were recruited through a national centre for the treatment of peritoneal surface tumours. At baseline, 23 patients had progressive disease and 17 had stable disease. Of 39 assessable patients, 15 (38%, 95% confidence intervals (CIs): 25, 54%) benefited from chemotherapy in the form of either reductions in mucinous deposition or stabilisation of progressive pretreatment disease determined on CT scan. Notably, two patients, originally considered unresectable, following MCap and re-staging underwent potentially curative cytoreductive surgery. Grade 3/4 toxicity rates were low (6%, 95% CIs: 4, 9%). Twenty out of 29 assessed patients (69%, 95% CIs: 51, 83%) felt that their Global Health Status improved during chemotherapy. This is the first trial to demonstrate an apparent benefit of systemic chemotherapy in patients with advanced unresectable PMP.
  • Inaugural meeting of the Society of Gastrointestinal Intervention.

    Laasch, Hans-Ulrich; Department of Radiology, Christie Hospital NHS Foundation Trust, Manchester, M20 4BX, UK. hul@christie.nhs.uk (2008-02)
    The Society of Gastrointestinal Intervention was founded to provide a multidisciplinary forum for medical staff, scientists and allied health professionals involved in minimally invasive gastrointestinal intervention. Besides providing an international meeting, the society aims to establish a clinical, as well as an academic network among the three main disciplines of gastroenterology, surgery and interventional radiology. A further aim is to promote collaboration between healthcare professionals and industry.