Clinical research

Imaging evaluation of therapeutics

We have pioneered the use of hyperpolarised gases and proton lung MRI for the evaluation of regional lung response to therapeutics in Asthma, CF, COPD and PH.

The techniques are free from ionising radiation and highly sensitive to changes in lung function, and as such are ideally suited for therapy assessment.

Collaborations are in place with Novartis and GSK in this area and we have a track record in delivering commercial contract work with pharma using clinical lung imaging as outcome measures in trials.

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Clinical imaging research in respiratory diseases

Sheffield performed the first clinical studies in the UK using hyperpolarised helium and xenon gas.

This work has expanded significantly over recent years with the advent of a new imaging laboratory and now attracts clinical referrals from local clinicians, as well as respiratory physicians, from around the UK.

Evaluation of a broad range of respiratory conditions is undertaken, from common conditions such as asthma, to rarer cases such as primary ciliary dyskinesia and ‘horseshoe lung.’

Research into these techniques is ongoing and areas of interest include:

• Cystic fibrosis (CF): A follow up study of children with CF is demonstrating that our MRI techniques demonstrate excellent sensitivity to ventilation changes in the lungs, compared with usual clinical techniques. MRI does not use radiation, making it an ideal imaging tool for use in younger populations. A further cohort study in children and adults is underway.
• Idiopathic pulmonary fibrosis: Traditional tests of lung function are insensitive in demonstrating disease progression. Our research looks at how novel MR imaging techniques may be used as microstructural and functional biomarkers of disease severity and progression.

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MRI of pulmonary vascular disease

Pulmonary hypertension is a severe condition caused by narrowing of the blood vessels to the lungs.

The Sheffield Pulmonary Vascular Unit  - the largest referral clinic in the UK - routinely scan patients with cardiopulmonary MRI protocols developed by our group. This is the largest pulmonary vascular MRI cohort in the world.

We have developed cardiac models of pulmonary haemodynamics that have diagnostic utility and have identified markers with prognostic sensitivity.

The MRI lung perfusion scans and MR angiograms developed have reduced the need for nuclear medicine V/Q for screening for chronic thrombo-embolic pulmonary hypertension, and catheter pulmonary angiograms are now rarely performed in Sheffield when planning for pulmonary endarterectomy.

Our techniques provide superior image quality whilst saving patients an unnecessary radiation dose (1-2 and 6 mSv respectively) and an invasive catheter procedure with associated morbidity (serious adverse events 1% and mortality <0.1%).

Key publications:

• Swift AJ, Rajaram S, Hurdman J, Hill C, Davies C, Sproson TW, Morton AC, Capener D, Elliot C, Condliffe R, Wild JM, Kiely DG. Noninvasive Estimation of PA Pressure, Flow, and Resistance With CMR Imaging: Derivation and Prospective Validation Study From the ASPIRE Registry. JACC Cardiovasc Imaging, 2013 8. doi
• Rajaram S, Swift AJ, Davies C, Hill C, Jenkins D, Goddard M, Condliffe R, Elliot CA, Wild JM, Kiely DG. Primary pulmonary artery sarcoma and coexisting chronic thromboembolic pulmonary hypertension. American Journal of Respiratory and Critical Care Medicine, 2013  1;188(5):e7-8. doi
• Rajaram S, Swift AJ, Telfer A, Hurdman J, Marshall H, Lorenz E, Capener D, Davies C, Hill C, Elliot C, Condliffe R, Wild JM, Kiely DG. 3D contrast-enhanced lung perfusion MRI is an effective screening tool for chronic thromboembolic pulmonary hypertension: results from the ASPIRE Registry. Thorax, 2013 doi

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