IMAGING IN DEMENTIA - British Institute of Radiology · Emergency radiology — advances in trauma...
Transcript of IMAGING IN DEMENTIA - British Institute of Radiology · Emergency radiology — advances in trauma...
IMAGING IN DEMENTIAVenue: British Dental Association, London
CPD: 5 CREDITS
18 MAY 2015
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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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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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Yourcertificateofattendancewillbeemailedtoyouwithinthenext2weeksonceyouhavecompletedtheonlineeventsurveyat:
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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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