IMAGING IN DEMENTIAVenue: British Dental Association, London

CPD: 5 CREDITS

18 MAY 2015

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View the full programme and register:

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• Room1Primers for the non-specialistsSessionorganisedbyDrDavid

Wilson,ConsultantInterventional

MSKRadiologist,OxfordUniversity

HospitalsNHSTrust

• Room2Radiation protection — current issues in molecular imaging and radiotherapySessionorganisedbyMrAndy

Rogers,HeadofRadiationPhysics,

NottinghamUniversityHospitals

NHSTrust

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• Room1Clinical hybrid imaging inoncologySessionorganisedbyDrGopinath

Gnanasegaran,Consultant

PhysicianinNuclearMedicine,

StThomas’Hospital

• Room2Emergency radiology — advances in trauma imaging and Essentials for the radiology traineeSessionorganisedbyDrHardi

Madani,RadiologyRegistrar,Royal

FreeLondonHospitaland

DrAusamiAbbas,Cardiothoracic

RadiologyPostCCT

Day 2Day 1

BIR ANNUAL CONGRESS 20154–5 NOVEMBER

LONDON

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Welcomeandthankyouforcomingto“Imagingindementia”organisedbyTheBritishInstituteofRadiology.

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BIR Annual Congress 2015: 4–5 November, London

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Day 2

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Programme

09:30 Registration and refreshments

09:55 Welcome and introduction DrAdamWaldman,ConsultantNeuroradiologist,ImperialCollegeLondon

10:00 Clinical MRI in dementia DrAdamWaldman,ConsultantNeuroradiologist,ImperialCollegeLondon

10:40 Refreshments

11:10 Volumetric/quantitative MRI ProfessorFrederikBarkhof,ProfessorofNeuroradiologyandScientificDirector oftheImageAnalysisCenter,VrijeUniversityMedicalCenter

11:50 Imaging of metabolism and blood flow in dementia (MRI/PET) DrMarionSmits,AssociateProfessorofNeuroradiology,ErasmusUniversity, Rotterdam

12:30 Lunch

13:30 Clinical amyloid imaging DrZarniWin,ConsultantNuclearMedicineRadiologist,ImperialCollege HealthcareNHSTrust

14:10 Imaging tau and other pathological pathways ProfessorAlisonMurray,ProfessorofRadiology,UniversityofAberdeen

14:50 Refreshments

15:20 Imaging in clinical trials ProfessorFrederikBarkhof,ProfessorofNeuroradiologyandScientificDirector oftheImageAnalysisCenter,VrijeUniversityMedicalCenter

16:00 Clinical impact of imaging in dementia—a clinician’s perspective DrRichardPerry,ConsultantNeurologist,ImperialCollegeHealthcare NHSTrust

16:30 Questions and discussion

17:15 Close of event

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Certificate of attendance

Thismeetinghasbeenawarded5RCRcategoryICPDcredits.

Yourcertificateofattendancewillbeemailedtoyouwithinthenext2weeksonceyouhavecompletedtheonlineeventsurveyat:

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BIR Annual Congress 2015: 4–5 November, London

Join the BIR today and receive 20% off your membership fee

Asathankyouforattendingtoday’seventwewouldliketoofferyouthisgreatdeal

Be part of the only multi-disciplinary membership organisation for everyone interested in medical imaging

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Speaker profiles

Professor Frederik BarkhofProfessor of Neuroradiology and Scientific Director of the Image Analysis Center, Vrije University Medical Center

FrederikBarkhofreceivedhisMDfromVUUniversity,Amsterdam,theNetherlandsin1988anddefendedhisPhDthesisin1992,forwhichhereceivedthePhilipsPrizeforRadiologyin1992andtheLucienAppelPrizeforNeuroradiologyin1994.Since2001heservesasafullProfessorinNeuroradiologyatthedepartmentofRadiologyandNuclearMedicineattheVUUniversityMedicalCenter(VUmc).HeisaseniorstaffmemberoftheMSCenterAmsterdam,andSeniorConsultantoftheAlzheimerCenter,VUmc.HeistheScientificDirectoroftheImageAnalysisCentre(IAC),involvedinanalysisofmulticentredrugtrials.ProfessorBarkhofwasthechairmanoftheDutchSocietyofNeuroradiologyandtheMAGNIMSstudygroupformanyyears.HeservesontheEditorialboardsofRadiology,Brain,MultipleSclerosisJournal,NeuroradiologyandNeurology.

ProfessorBarkhof’sresearchinterestsfocusonchildhoodwhitematterdisease,onmultiplesclerosis(spinalcordMRI,greymatter,atrophy,histopathologycorrelations),onageing(whitematterlesionsandmicrobleeds)anddementia(hippocampalatrophyinAlzheimer’sandfunctionalMR).He(co)authoredmorethan750papersreferencedinPubMed,hasanH-factorof86andisauthorofthebooks“NeuroimaginginDementia”and“ClinicalapplicationsoffunctionalbrainMRI”.

Cumulatively,hehasreceivedmorethan10millioneurograntmoneyfromvariousnationalandinternationalfundingagenciesandperformedcontractresearchforallmajorpharmaceuticalcompanieswithcumulativecontractvalueofmorethan15millioneuros.Morethan30PhDstudentsgraduatedunderhissupervisionand2ofthemhavesubsequentlyattainedafullprofessorship.

Professor Alison MurrayProfessor of Radiology, University of Aberdeen

AlisonMurrayistheRolandSuttonProfessorofRadiologyattheUniversityofAberdeen.SheisDirectoroftheAberdeenBiomedicalImagingCentre(www.abdn.ac.uk/ims/research/abic).ABICcomprisesadiverserangeofimagingscientistsandcliniciansandhasastronghistoryofnovelimagingdevelopment.Facilitiesincludepre-clinicalandclinicalMRI,novelradiochemistry,cyclotronandpre-clinicalandclinicalPETCT,fieldcyclingMRIandretinalimaging.Sheleadsclinicalbrainimagingresearchinstructural,functionalandmolecularimagingcorrelatesofcognitiveageinganddementia,whichincludesMRIintheAberdeenBirthCohorts,andMRIandmolecularimaginginclinicaltrialsofnoveltauaggregationinhibitortherapiesinAlzheimer’sdisease.ParticularinterestsaretherelativecontributionsofvascularriskfactorsandsubclinicalAlzheimer’spathologytocognitiveageingandearlylifeandlife-coursepredictorsofcognitivereserveanddementiarisk.SheisafoundingandexecutivememberoftheScottishImagingNetwork:APlatformforScientific

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Excellence(SINAPSE)(www.sinapse.ac.uk)asuccessfulbrainimagingpoolinginitiative,anexecutivememberoftheScottishDementiaResearchConsortiumandPresidentoftheScottishRadiologicalSociety.

Dr Richard PerryConsultant Neurologist, Imperial College Healthcare NHS Trust

RichardPerryisaConsultantNeurologistandHonorarySeniorLectureratImperialCollegeNHSTrust.DrPerrygainedhisspecialistclinicalandresearchexperienceincognitionandmemorydisordersattheUniversityofCambridgeNeurologyUnitandtheUniversityofCaliforniaSanFrancisco.

SincereturningtoLondonhehasrunmemoryclinicsatCharingCrossHospitalandhisareaofspecialinterestisintheearlydiagnosisandtreatmentofAlzheimer’sdisease.HerunsaclinicaltrialsteamatCharingCrossthatspecialiseinnewdiseasemodifyingagentsforAlzheimer’sdiseaseandotherdementias.OverthelastyearhehasbeenoneoftheearlyadoptersofamyloidPETimagingindementiaassessmentandworkswithneuroradiologicalandnuclearmedicinecolleaguesintheirdementianeuroimagingMDT.Hisclinicalneurologicalworkalsoincludesassessmentandcareofpatientswithtraumaticbraininjury.Hehasbothaspecialistandgeneralclinicalneurologypractice.

Dr Marion Smits Associate Professor of Neuroradiology, Erasmus University, Rotterdam

MarionSmitsisAssociateProfessorofNeuroradiologyandcombinesherclinicalworkasaNeuroradiologistwithscientificresearchintoadvancedMRneuroimaging,suchasfunctionalMRI,diffusiontensorimaging(DTI)andperfusionimaging.Sheusesthesetechniquestovisualisethebrain’sfunctionandmicrostructure,andtostudypathophysiologicalandregenerativeprocessesinavarietyofneurologicaldiseases,suchasstroke,dementiaandbraintumours.

MarioncombinesherclinicalexpertisewithscientificresearchandactiveparticipationinkeyEuropeanorganisations,includingtheEuropeanSocietyofRadiology(ESR),theEuropeanSocietyofNeuroradiology(ESNR),theEuropeanSocietyforMagneticResonanceinMedicineandBiology(ESMRMB),andtheEuropeanOrganisationforResearchandTreatmentofCancer(EORTC).

ThroughhercurrentresearchandpositionintheEuropeanCOST-AIDactionBM1103ArterialSpinLabeling(ASL)indementia,sheworkstowardstranslatingthisperfusiontechniquefromtheresearcharenatoclinicalpractice.HerworkhascontributedtoarecentwhitepaperonrecommendationsforclinicalimplementationofASL.

AsapermanentfacultymemberofseveralEuropeanandnationalcourseorganisationsshelecturesfrequentlyonadvancedMRneuroimaging.SheisCourseDirectoroftheEuropeanSchoolofMRIfMRI&DTIcourse,andScientificProgramme

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CommitteeChairoftheESMRMBscientificannualmeeting2015inEdinburgh(UK).ShehasrecentlybeenelectedasCongressPresidentforthe2018annualmeetingoftheESNR.

Fulllistofpublications:www.marionsmits.net/publicationsLinkedIn:nl.linkedin.com/in/marionsmits

Dr Adam WaldmanConsultant Neuroradiologist, Imperial College London

AdamWaldmangainedaPhDandundertookpost-doctoralresearchinbiophysicsbeforetraininginmedicineatCambridge.HetrainedinradiologyatUniversityCollegeHospitalsandsubsequentlyinneuroradiologyattheNationalHospitalforNeurologyandNeurosurgery,QueenSquare,London.

DrWaldmanhasbeenConsultantNeuroradiologistatImperialCollegeHealthcareNHSTrust(formerlyHHNT)since2001.Since2006hehasbeendepartmentalacademicleadasResearchDirectorforRadiology,andhasalsofoundedanacademictrainingprogrammeinclinicalradiology.

Hewasawardedthe2009RoyalCollegeofRadiologistsRoentgenProfessorshipandmedal,andholdshonorarysenioracademicappointmentsatImperialCollegeLondon.Hismainresearchinterestsareinquantitativeandphysiologicalneuroimaging,particularlyasappliedtoneuro-oncologyandneurodegenerativedementiasandneuroinflammatorydisease.

Dr Zarni WinConsultant Nuclear Medicine Radiologist, Imperial College Healthcare NHS Trust

ZarniWinisaDualSpecialistConsultantRadiologistandConsultantNuclearMedicinePhysician,andistheChiefofNuclearMedicineServiceatImperialCollegeHealthcareNHSTrust(Hammersmith,CharingCrossandStMary’sHospital).HetrainedinbothspecialitiesattheHammersmithHospital.HegainedanMScinnuclearmedicineatKing’sCollegeLondon,specialisinginPETimagingandaBScinpsychologyasanundergraduate.HeisanexpertinclinicalamyloidplaquePETimagingwithAmyvid,scanningthefirstclinicalpatientintheUKinDecember2013andhavingthelargestseriesofclinicalamyloidPETscanstodate.HeisanAmyvidPETtrainer,forEliLily,trainingotherradiologistsandclinicianstoreadAmyvidPETscans,andalsoparticipatesintheiradvisorypanel.HeisanexpertinothernovelPETtracers,suchasgallium-68DOTATATE,usedintheinvestigationofneuroendocrinetumoursandalsorunsnuclearmedicinetherapyclinicsatCharingCrossandStMary’shospitals.

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Abstracts

Clinical MRI in dementiaDr Adam Waldman

TheroleofclinicalMRIindementiainvestigationwillbediscussed,withreferencetodifferentialdiagnosis,cerebrovasculardisease,commonandrareneurodegenerativedementias,andothercausesofcognitiveimpairment.Theimportanceofclinicalinformation,appropriateimagingprotocolsandreportingwillbeexplored.Theroleandtranslationofemergingandquantitativemethodswillbeintroduced.

Volumetric/quantitative MRIProfessor Frederik Barkhof

ComparedtoCT,thesuperiortissuecontrastprovidedbyMRIallowsaccuratesegmentationofgreymatterstructuresrelevantinthesettingofdementia.Robustsegmentationtechniquesexistthatallowvolumetricassessmentofcrucialstructureslikethehippocampus.Especiallyatlas-basedsegmentationshavemarkedlyimprovedtheaccuracyofsegmentation,althoughcomputationtimescanbeprohibitiveandoff-linereconstructionshampertheirimplementationintoaclinicalsetting.Vascularwhitematterlesionscanalsobequantified,whichisinformativeespeciallyinpatientswithstrongvascularloading,wherevisualratingscalesshowceilingeffects.Beyondvisiblelesionandatrophypatterns,thequalityofthe(normal-appearing)braintissuecanbeprobedwithquantitativeMRtechniqueslikediffusiontensorimaging(DTI),whichmayrevealwidespreaddamage,oftenwithadiseasespecificpattern(e.g.temporallobeabnormalitiesinADandfrontallobeinvolvementinFTD).Finally,quantitativeperfusioninformationcanbeobtainedusingarterialspinallabelling(ASL)withsimilardiagnosticpotentialasFDG-PET.

Suggestedreading:• BarkhofF,FoxNC,Bastos-LeiteAJ,ScheltensP.NeuroimaginginDementia.

Springer-VerlagBerlinHeidelberg(2011)

Imaging of metabolism and blood flow in dementia (MRI/PET)Dr Marion Smits

Thereisnosinglediagnostictestorbiomarkertodefinitivelydiagnosedementiaanditsunderlyingneurodegenerativedisorder.Thedifferentialdiagnosisbetweendementiaandmoretreatableconditionsmaybeproblematic.Differentiationbetweentheseveralneurodegenerativedisordersisoftendifficult,especiallyinayoungdementiapopulationinwhichatypicalpresentationsprevail.

Moreaccuratediagnosiscanbeobtainedbymetabolicbrainimaging,suchasfluorodeoxyglucose(FDG)positronemissiontomography(PET).Arterialspinlabeling(ASL)isanon-invasiveMRimagingtechniquethatmeasuresbrainperfusion.ASLhasclearadvantagesoverPET:patientburdenandcostsaremuchlowerand

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availabilityofMRIismuchwider.Crucially,ASLcaneasilybeaddedtotheroutinelyperformedstructuralMRIexamination.FeasibilitystudiesshowthatASLprovidesreliableperfusionmapsindementia.InpatientswithestablishedAlzheimer’sdiseaseandfrontotemporaldementia,hypoperfusionpatternsareseenthataresimilartohypometabolismpatternsseenwithFDG-PET.

Learningobjectives:• Toknowtheaddedvalueofmetabolic/perfusionimagingforthediagnosticwork-

upofpatientswithsuspecteddementia• Toknowtheimagingabnormalitiesrelatedtocommonneurodegenerative

disordersunderlyingdementiawithmetabolic/perfusionimaging• ToknowthetheoreticalbackgroundandrecommendedimplementationofASL

forclinicalapplications

Clinical amyloid imagingDr Zarni Win

ThefirstclinicalamyloidPETscanwasperformedintheUKatCharingCrossHospital,ImperialCollegeHealthcareNHSTrust,thefollowingdayaftertheG8DementiaSummitinLondoninDecember2013,hostedbyDavidCameron.Sincethen,wehavescannedover50patients,whohavebeencarefullyselectedfromourdementiaMDT.TheclinicalimpactofamyloidPEThasbeensignificantfromdayone,especiallythosewithindeterminateclinicalhistories,andMRIscans.Itisprovingtobeareliablebiomarkerofamyloidplaqueleadingtochangeinmanagementinasignificantnumberofpatientsscanned.ItisalsoprovingtoprovideabetterpatientexperiencecomparedtoothermoreinvasivetestssuchaslumbarpunctureforCSFanalysis,whichitissuperceding.

Thetalkaimstodiscussthepathophysiologyofamyloidplaquedeposition;seminaltrialsinvolvingthelicencedamyloidPETproducts;thedifferentbinaryreadingmethodofthecurrentlicencedtracers;examplesofpositive,negative,and“difficult”PETscans;theprognosisafterapositiveoranegativescan;comparisonofamyloidbrainPETorFDGbrainPETinADandFTD;andnewusesofamyloidPET.ThetalkwillalsohighlighttheimportanceofcarefulpatientselectionthroughadedicateddementiaMDT,therebyeffectivelyutilisingwhatisaverypowerfulbiomarkerofAlzheimer’sdisease.

Imaging tau and other pathological pathwaysProfessor Alison Murray

Thispresentationwilldiscusstheroleofneuropathologiesotherthanamyloidandcerebrovasculardiseaseindementia,focussingonabnormaltau.Itwillillustratehowneuroimagingcancontributetoroutinediagnosis,toresearchandtoclinicaltrialsofnoveltherapies.

Thefollowingthreeareaswillbecovered:• Alzheimer’sdisease(AD):evidenceforabnormaltau,ratherthanamyloidas

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themaindriverofcognitivedeclineanddementiainAD;resultsfromaphase2clinicaltrialofanoveltauaggregationinhibitor;currentmethodsofdiagnosingtaupathologyusingstructuralandmolecularimaging

• Frontotemporaldementias(FTD):commonclinicalfeatures;thedifferentneuropathologiesthatcanresultinfrontotemporallobardegeneration;characteristicimagingfindingsonstructuralandmolecularimagingandthemainfeaturesthatdistinguishFTDfromAD

• Lewybodydisease(LBD):includingParkinson’sdiseasedementiaanddementiawithLewybodies;thelimitedroleofstructuralbrainimaginginthesediseasesandtheindicationsforandtypicalfindingsonmolecularimaging

Learningpoints:• HyperphosphorylatedtauneuropathologydistributioninADisthesameasthe

patternofatrophyonstructuralimagingandmolecularimagingdeficitsonFDGPETandbloodflowSPECT

• Frontotemporallobardegenerationhasdifferentsubtypeswitharoundhalfhavingbehaviouralvariantandhalfhavingprimaryprogressiveaphasia.Familyhistoryispresentinaroundhalfandgeneticcausesareincreasinglybeingfound

• ThedistinctionbetweenParkinson’sdiseasedementiaanddementiawithLewybodies,bothduetoasynucleiopathy,ismadeduetothetimebetweenonsetofdementiawithrespecttomotorsymptoms

Imaging in clinical trialsProfessor Frederik Barkhof

BothMRIandPETcanbeusedbeyonddiagnosticpurposes.Imagesharbourprognosticinformationandlongitudinalimagingmayrevealchangeswellbeforeclinicaldeteriorationoccurs,providingasurrogateoutcomefordiseaseprogressionthatismoresensitiveandobjective.

Theroleofimagingintrialsencompassesfourdomains:

• Enrichmentstrategy—e.g.includeonlysubjectswithsomedegreeofhippocampalatrophy

• In/exclusion—e.g.excludesubjectsthatareamyloidnegativeorhavevascularloading

• Outcomemeasure—e.g.slowingatrophyrateorremovingamyloid(targetengagement)

• Safetymonitoring—e.g.developmentofARIA(amyloid-relatedimagingabnormalities)

Clinical impact of imaging in dementia—a clinician’s perspectiveDr Richard Perry

Imagingtechniquesareonesetoftoolsthataclinicianwilluseinassessingpatientswithmemoryorothercognitivesymptoms.Whichimagingtechniquedependsonthequestionbeingasked.

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Ataverybasicleveltheclinicianmayhavetoanswerthequestionofwhetherthepatienthas‘dementia’.Dementiaisaclinicalsyndromecharacterisedbyprogressivelossofmemoryandothercognitivefunctionswithimpairmentofeverydayactivities,andassuch,imagingcontributesmostlyintermsofexcludingnon-neurodegenerativecausesofcognitiveimpairmentsuchashydrocephalusorspaceoccupyinglesions.StructuralimagingwithCTorMRIissufficientforthis.AlthoughtheNHSseemstobecurrentlyfocusedonimprovingratesofdementiadiagnosis,manypatientsandcliniciansareinterestedinaddressingtwootherquestionsthatarisewhenapatientsisseenforassessment.Firstly,aclinicianmayhavetodeterminewhetherapatient’ssymptomsareduetoanunderlyingbraindisease,orwhethertheycouldbearesultofapsychologicallybasedproblemsuchasanxietyordepression.Toanswerthisquestionaclinicianneedstoolsthataremarkersofneuronalloss.Ifitlooksasthoughthesymptomsmaybesecondarytoaformofbraindisease,thenextquestioniswhatisthenature,orunderlyingpathologyofthebraindisease.Inansweringthesetwoquestionsacliniciancanattempttoreachanaccuratesub-typediagnosisofdementia.Inthissituation,theinvestigativetoolsneedtobepathologysensitive.

InthistalkwewillseehowimagingtechniquesthataremarkersofneuronallosssuchasMRIandFDG-PETcanbeusedinclinicalsituationsandhowtheyrelatetonon-imagingtechniquessuchasclinicalassessmentsandneuropsychologicalassessments.Wewilldiscusshowpatternsofregionalatrophy,andwhitematterdiseasecanbehelpfulindiagnosticterms.Morerecently,clinicianshaveaccesstoinvestigativetechniquesthatarepathologysensitivesuchasCSFanalysisoramyloidPETimaging.Bythecombineduseofmarkersofneuronallossandmarkersofspecificpathology,wewilllookathowclinicianscandifferentiatetheearlieststagesofthedifferentdementiasfromnormalageing,andhowtodifferentiatebetweenthedifferentdementiasubtypes,particularlyAlzheimer’sdiseaseandfrontotemporaldementia.

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Platinum sponsors

Philipsisadiversifiedhealthandwell-beingcompanyandaworldleaderinhealthcare,lifestyleandlighting.Ourvisionistomaketheworldhealthierandmoresustainablethroughmeaningfulinnovation.

Wedevelopinnovativehealthcaresolutionsacrossthecontinuumofcare,inpartnershipwithcliniciansandourcustomerstoimprovepatientoutcomes,providebettervalue,andexpandaccesstocare.

Aspartofthismissionwearecommittedtofuellingarevolutioninimagingsolutions,designedtodelivergreatercollaborationandintegration,increasedpatientfocus,andimprovedeconomicvalue.Weprovideadvancedimagingtechnologiesyoucancountontomakeconfidentandinformedclinicaldecisions,whileprovidingmoreefficient,morepersonalisedcareforpatients.

www.philips.co.uk/healthcare

TheSiemensHealthcaresectorisoneoftheworld’slargestsupplierstothehealthcareindustryandatrendsetterinmedicalimaging,laboratorydiagnostics,medicalinformationtechnologyandhearingaids.Siemensoffersitscustomersproductsandsolutionsfortheentirerangeofpatientcarefromasinglesource–frompreventionandearlydetectiontodiagnosis,andontotreatmentandaftercare.Byoptimisingclinicalworkflowsforthemostcommondiseases,Siemensalsomakeshealthcarefaster,betterandmorecost-effective.

www.siemens.co.uk/healthcare

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Silver exhibitors

Lilly,aleadinginnovation-drivencorporation,isdevelopingagrowingportfolioofpharmaceuticalproductsbyapplyingthelatestresearchfromitsownworldwidelaboratoriesandfromcollaborationswitheminentscientificorganisations.HeadquarteredinIndianapolis,Ind.,Lillyprovidesanswers—throughmedicinesandinformation—forsomeoftheworld’smosturgentmedicalneeds.LillyhasalongheritageintheUK,openingitsfirstfacilityoutsideNorthAmericainLondonin1934.TodayLillyhasaround2500staffintheUKworkingacrossthreesites;asalesandmarketingoperationinBasingstoke,aR&DbaseinSurreyandabio-techmanufacturingfacilityinLiverpool.

www.lilly.co.uk

Bronze exhibitors

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FORTHCOMING EVENTS

EMERGENCY AND OUT OF HOURS RADIOLOGY20 MAY 2015

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NEURORADIOLOGY UPDATE AND REFRESHER COURSE18–19 JUNE 2015

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JOINT BNMS AUTUMN MEETING: MOLECULAR IMAGING AND THERAPY - SCINTILLATING FUTURE IN RADIOGUIDED SURGERY AND THERONOSTICS

2 SEPTEMBER 2015LONDON

THE BIR/DMCI HANDS-ON TRAINING SERIES: HRCT OF THE CHEST25 SEPTEMBER 2015

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