Dept of Diagnostic Radiology

DEPT OF DIAGNOSTIC RADIOLOGY

Researcher : Anthony M

Project Title:	Ultrashort TE imaging of degenerative disease of the lumbar spine
Investigator(s):	Anthony M, Kim M, Cheung KMC, Khong PL, Samartzis D
Department:	Diagnostic Radiology
Source(s) of Funding:	Seed Funding Programme for Basic Research
Start Date:	04/2010

Abstract:

The ultrashort TE (UTE) MRI sequence detects short T2 components in body tissues, providing complementary information to conventional sequences (eg FSE, DWI) that detect long T2 tissue components. UTE pulse sequences provide a new approach to imaging a group of tissues and tissue components that previously received little attention in technique development. We aim to explore use of this new technique in the lumbar spine, for which research has only just started to emerge. Specifically, we intend to assess the technique compared to conventional imaging for use in degeneration-associated conditions of the lumbar spine, including Schmorl’s nodes, Modic changes and degenerative disc disease (DDD). Conventional clinical sequences involve the use of heavily T2- weighted (T2W) pulse sequences. These sequences detect signal from long T2 relaxation components in normal tissue, and increased/ decreased signal from these components in abnormal tissue. Even with newer pulse sequences, such as FSE, echo planar, FLAIR and DWI, the main diagnostic emphasis is on detecting the signal from normal and abnormal tissues with long T2. However, there are also tissues with short T2. The MRI signal from these tissues decays rapidly, such that conventional sequences show little or no detectable signal, and the tissues appear dark. Whilst these tissues provide a useful background against which to recognise abnormalities that increase T2, it may not be possible to differentiate between different tissues with short T2. In the human musculoskeletal system, there are a variety of tissues. Some have relatively long T2 components, and can be visualised with conventional MRI techniques. However some have short T2 relaxation times. These are often tissues with highly ordered structure and limited water mobility. Pathology in these tissues (eg tears, fibrillation) increases local water content and disorganization, thereby increasing local T2 values, with subsequent increased signal on conventional sequences. It would be useful however, to have direct visualisation of ordered structures before degeneration is initiated. The short T2 tissues in the musculoskeletal (MSK) system are often classified into 2 groups, being those with the majority of short T2 components, and those with a minority of T2 components. Those with a majority of short T2 components include: cortical bone, tendons (eg Achilles), ligaments, menisci (knee), periosteum, entheses, deep radial and calcified layers of articular cartilage, intervertebral discs (spine). An example of a tissue with a minority of short T2 components is skeletal muscle. These short T2 tissues are crucial in the MSK system. For example, calcified cartilage is intimately associated with superficial cartilage and subchondral bone, serving as a transition tissue between compliant unmineralised superficial cartilage and the stiffer bone; and helps prevent large stress concentrations at the interface between these two biomechanically diverse tissues. Changes in the calcified layer could compromise the superficial layer, causing degeneration. However calcified layers of cartilage have not been studied with MRI due to their short T2 relaxation times. In disease of the musculoskeletal system, the concentration of short T2 components may increase or decrease. Generally, an increase in T2 signal observed in long T2W sequences is accompanied by decreased signal from short T2 components. However there are diseases that increase the short T2 components, including: fibrosis (chronic), iron deposition, some stages of haemorrhage, some stages of calcification, various deposition diseases (eg amyloidosis) and cellular infiltration. In the lumbar spine, we aim to examine the utility of UTE sequences in assessment of various common pathologies associated with degeneration that may have increased short T2 components, namely Schmorl’s nodes, Modic changes and intervertebral degenerative disc disease (DDD). We aim to characterize the UTE appearances of pathologic findings in these conditions, as compared to conventional sequence appearances. We aim to compare the clinical utility UTE imaging, and assess its additional role and potential increased sensitivity in imaging the lumbar spine for degeneration. Work that has been done in the spine Gatehouse et al, using TE= 0.08ms, scanned 5 normal subjects and 14 with DDD. Intravenous contrast was administered to 11 subjects. Being a new technique, findings were divided into normal and abnormal. Normal findings were found to be high signal in the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), cartilagenous end-plates, annulus fibrosis (AF) (nucleus pulposus (NP) had low signal, consistent with higher water content), ligamentum flavum, interspinous ligaments and insertions of ligaments. Abnormal findings were found to be: enhancement of hypertrophied ligaments and scar tissue; enhancement of intervertebral discs, more obviously than in conventional sequences; subtraction/ long T2-suppressed images showed reduced signal from blood, and made signal from scar tissue more obvious; severe DDD subjects had thickening of the ALL and PLL, increased scar tissue adjacent to the disc, enlarged ligamentum flava, loss intervertebral disc height (NP>AF) and enhancement, consistent with neovascularisation. Robson et al, using TE= 0.08ms, showed that disc protrusion more obvious on UTE. Hall-Craggs et al, using TE= 0.08ms, examined patients with thalassaemia, and found that there were high signal bands parallel to the vertebral end-plates. They suggested these may represent iron deposition in discs, fibrosis or susceptibility from iron in the vertebral bodies. Messiou et al, using TE= 0.07ms, examined patients with sclerotic bone metastases pre- and post-treatment, and found that with no change in T2WI, there was an increase in short T2 tissues in the involved vertebrae, increased sclerosis (confirmed on CT); and they were able to demonstrate a healing response (PSA fell).

List of Research Outputs

Anthony M., Khong P.L. and Mak H.K.F., An unusual case of synchronous renal cell carcinoma in a horseshoe kidney and intrahepatic cholangiocarcinoma, Clinical Nuclear Medicine. in press, 2009, 34: 922-923.

Anthony M., Zhang Z., Feng S.T., Yau K.K.W., Khong P.L. and Mak H.K.F., Comparison of 3T diffusion weighted magnetic resonance imaging and 18F-fluoro-2-deoxyglucose positron emission tomography/ computed tomography in cervical lymphadenopathy of patients with nasopharyngeal carcinoma, 110th Annual Meeting of the American Roentgen Ray Society, San Diego, CA, USA. 2-7 May 2010.

Anthony M., Singham S., Soans B. and Tyler G., Diffuse Panbronchiolitis: Not Just An Asian Disease. , Biomedical Imaging and Intervention Journal. 2009, 5(4).

Anthony M., Kwong Y.L. and Khong P.L., FDG-PET/CT for the assessment of type II enteropathy-associated T-cell lymphoma, 3rd Joint Scientific Meeting of The RCR & HKCR and 17th ASM of HKCR, 31 October-1 November 2009.

Anthony M., Imaging for Students , Hodder Education, United Kingdom, 2009 . 2009.

Anthony M., Zhang J. and Khong P.L., PET/CT appearance of intestinal Behcet's disease, Clinical Nuclear Medicine. 2009, 34: 825-826.

Anthony M., Khong P.L. and Zhang J., Spectrum of 18F-FDG-PET/CT Appearances in peritoneal disease, American Journal of Roentgenology. 2009, 193: W523-529.

Anthony M., Zhang J. and Khong P.L., Spectrum of FDG-PET/CT Appearances in Malignant and Benign Peritoneal Pathology , RSNA 95th Scientific Assembly and Annual Meeting, Radiological Society of North America (RSNA), November 2009.

Anthony M., Use of [18]F-FDG-PET/CT when imaging infection , Hong Kong Medical Journal. 2009.

Chan Q., Kim M., Anthony M., Cheung K.M.C., Chan A., Chan T. and Khong P.L., Quantitative comparison of T1r with T2 in intervertebral disc in vivo at 3T, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Chan Q., Anthony M., Zhang Z., Cheung K.M.C. and Kim M., Quantitative evaluation of diffusion tensor imaging at 3T in the human lumbar intervertebral disc degeneration , Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Kim M., Chan Q., Anthony M., Cheung K.M.C., Samartzis D., Chan T. and Khong P.L., Assessment of glycosaminoglycan distribution in human lumbar intervertebral discs using chemical exchange saturation transfer, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Lau Y.C., Ho C.L., Leung Y.L., Cheng T., Yeung W.D., Anthony M. and Khong P.L., The Utility of 19F-Fluoride PET/CT for the detection of skull base involvement in nasopharyngeal carcinoma, SNM 57th Annual Meeting, Salt Lake City, Utah, USA, 5-9 June 2010.

Wang L., Anthony M., Wenderoth J. and Parkinson R., Onyx embolisation of Spinal AVM , Royal Australian and New Zealand Annual Scientific Meeting, Brisbane, Australia, 2009.

Researcher : Chan CWA

List of Research Outputs

Kim M., Chan C.W.A., Mak H.K.F., Chan Q. and Chan K.H., Magnetization Transfer MRI measurements of Cervical Spinal Cord abnormalities in patients with Neuromyelitis Optica, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May. Stockholm, Sweden, 2010.

Researcher : Chan KS

List of Research Outputs

Chan K.S., Mak H.K.F., Huang B., Yeung D.W.C., Kwong D.L.W. and Khong P.L., Nasopharyngeal carcinoma: relationship between 18F-FDG PET-CT maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis, and TNM classification, Nuclear Medicine Communication . 2010, 31: 206-210.

Lee V.H.F., Kwong D.L.W., Khong P.L., Chua D.T.T., Ng C.Y., Wong G.K.W., Chan K.S., Leung T.W. and Au G.K.H., Co-registration and application of positron emission tomography (PET), computed tomography (CT) as compared with magnetic resonance imaging (MRI) in target localization for undifferentiated carcinoma of the nasopharynx (NPC), ASTRO 2009 Annual Meeting, Chicago, USA, 1-5 November 2009.

Lee V.H.F., Kwong D.L.W., Khong P.L., Chua D.T.T., Ng C.Y., Wong G.K.W., Chan K.S., Leung T.W. and Au G.K.H., The optimal window-setting of Positron Emission Tomography when co-registered with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in Target Localization For Undifferentiated Carcinoma of the Nasopharynx (NPC). , European Society of Therapeutic Radiology and Oncology. The Netherlands, ESTRO, European Society of Therapeutic Radiology and Oncology, 2010.

Researcher : Chan T

Project Title:	Development of Computer Aided Diagnosis Scheme for Monitoring of Malignancy Using PET-CT Examinations
Investigator(s):	Chan T
Department:	Diagnostic Radiology
Source(s) of Funding:	Seed Funding Programme for Basic Research
Start Date:	05/2009

Abstract:

PET-CT is a hybrid imaging method using both PET (positron emission tomography) that image metabolic function in a quantifiable manner and CT (computed tomography) that image body anatomy. It has been proven to be sensitive in diagnosis and surveillance of various cancers. However, there are a few difficulties associated with interpretation of these examinations. First of all, every examination produces literally thousands of images that the radiologists need to read, which is not only time consuming and tiring, but are prone to human errors including oversight, distraction, as well as change in reading environment. Secondly, malignancy can have different degree of metabolism and hence may show variable signal on PET images, which can sometimes blends into the range of normal tissues, but is only distinguishable on comparison with some internal reference in the same series of images. Thirdly patients can move during or between scanning, hence correlation between the PET and CT images may not be perfect. This becomes even more troublesome when studies from two time points are to be compared, e.g. in follow-up of malignancy after treatment, when the patients are often imaged at somewhat different postures. Computer aided diagnosis (CAD) schemes as used in medical imaging are computer programs that aims to assist human readers, usually radiologists, in identifying abnormality and making correct interpretation. They are first conceptualized more than 2 decades ago. Since then it has grown from research projects in universities to FDG approved products. Nowadays, commercially available CAD systems including those used in mammography, chest radiography, CT thorax, and CT colography. Generally a CAD scheme consist of the following steps: (1) image processing, which prepares the images for subsequent manipulation, (2) image segmentation, in which the regions of interest or candidate lesions are isolated from the rest of the image, (3) image analysis, in which the isolated regions are characterized in quantifiable parameters, e.g. size, contrast, shape, etc., (4) data processing, in which the candidate lesions are identified based on the quantifiable parameters in prior step, and distinction is made between normal and abnormal patterns. The performance of the CAD scheme as a whole depends on the efficiency of each of the mentioned step, which in turn depends on use of various mathematical techniques with vastly different parameters. All these require extensive training of the system and continuous refinement, depending on the images available and the target of detection. Therefore almost all CAD need to be specifically developed for different kind of imaging modality and even specific application. CAD can provide the consistent methodical search for abnormal signals across the whole range of thousands of images, which is required to combat many human errors. It has long been recognized that errors in image interpretation, including erroneous perception or analysis, are inevitable even for the best human observers. Such errors may be exacerbated as results of fatigue, inexperience, or environmental factors. CAD also improves efficiency when quantification of abnormality can be readily provided by the program. Also the identification of abnormal signals can be readily made against internal reference according to preset criteria incorporated into the CAD scheme, hence avoiding the need to scroll across different regions as would be needed in the case of human readers. Erroneous registration due to movements during of between scanning can be reduced by introduction of advanced registration procedure based on knowledge of human anatomy and range of possible movements, which can facilitate comparison examinations obtained in two time points.

Project Title:	Automatic Liver Volume Measurement from CT/MRI Images
Investigator(s):	Chan T
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	09/2009

Abstract:

Volume of the whole or part of liver reflects the quantity of contained liver cells and indirectly the associated functional capacity. Measurement of the liver volume, or liver volumetry, can be performed in live subjects based on cross sectional imaging methods of computed tomography (CT) or magnetic resonance imaging (MRI). Volumetry has been proven useful in preoperative assessment for liver resection and liver transplant, determining if resection of part of liver is tolerable, based on the volume of total volume and future remaining liver volume. Volumetry based on CT/MRI is usually obtained by summating the areas of liver on continuous sections. The areal measurements are usually performed using simple software program that count the number of pixels within manually drawn outline of liver, which is limited in efficiency and accuracy. The purpose of the proposed project is to produce a computerized system that can : 1. read and process CT or MRI of body 2. automatically identify and isolate regions that represent liver 3. automatically divide liver into its anatomical segments 4. automatically calculate the volume of the whole and different anatomical segments of liver Key issues and problems being addressed: The conventional method of CT volumetry depends on laborious inputs of highly skilled human observer, who are usually radiologists or specially trained radiographers. The manual tracing of liver outline on dozens of images is very time consuming. It also limits the number of sections that can be practically included for processing and calculation. This translates into use of thicker sectional images. Usually, 5-10 mm thick images are reconstructed for the purpose of volumetry, from sub millimeter images that are producible by modern machines and used for clinical diagnosis. Also, for ease of manual tracing, vascular structures within the liver, which should be excluded from volumetry because they do not represent liver cells, are often included because of the trouble involved in removing them. For these reasons, accuracy of measurements possibly achievable from the imaging data that is already at hand are compromised. Still, the whole process can take anywhere from 15 to 30 minutes depending on the number of sections involved and the skills of individuals. In addition, interobserver variation is inevitable because individual operator need to make decisions as the exact edge of liver contour and if small vascular structures are to be removed during the process of manual outlining.

Project Title:	24th International Congress and Exhibition (CARS 2010) A Novel Framework for Automatic Matching of PET/CT Images using Grid-based SIFT Algorithm
Investigator(s):	Chan T
Department:	Diagnostic Radiology
Source(s) of Funding:	URC/CRCG - Conference Grants for Teaching Staff
Start Date:	06/2010
Completion Date:	06/2010

Abstract:

N/A

List of Research Outputs

Chan Q., Kim M., Anthony M., Cheung K.M.C., Chan A., Chan T. and Khong P.L., Quantitative comparison of T1r with T2 in intervertebral disc in vivo at 3T, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Chan T., Clinical Usage Considerations in the Development and Evaluation of a Computer Aided Diagnosis System for Acute Intracranial Hemorrhage on Brain CT, In: D. Zhang and M. Sonka, International Conference on Medical Biometrics 2010. Heidelberg, Springer Berlin, 6165/2010: 268-275.

Chan T., Image Distribution in Electronic Patient Record at an Enterprise Level - Benefits to Clinical Practice with Special Focus on Radiology, 22nd European Congress of Radiology. 2010.

Chan T., Imaging Techniques and Cancer Diagnosis, Explore the World of Medicine Public Lecture Series 2010 . 2010.

Chan T., Medical Imaging of Common Medical Emergencies, Hong Kong Academy of Medicine. 2010.

Chan T., Reviewer, Hong Kong Medical Journal. 2010.

Chan T., Reviewer, Journal of the Hong Kong College of Radiologists. 2010.

Deshpande R.R., Fernandez J.R., Lee J.K., Chan T., Liu B.J. and Huang H.K., Multi-site evaluation of a computer aided detection (CAD) algorithm for small acute intra-cranial hemorrhage and development of a stand-alone CAD system ready for deployment in a clinical environment, Proceedings of SPIE. 2010, 7628: 76280H 1-8.

Feng S.T., Chan T., Ching A.S.C., Sun C.H., Guo H.Y., Fan M., Meng Q.F. and Li Z.P., CT and MR imaging characteristics of infantile hepatic hemangioendothelioma, European Journal of Radiology. 2010, 2010 Jun 22. [Epub ahead of print].

Feng S.T., Chan T., Sun C.H., Li Z.P., Guo H.Y., Yang G.Q., Peng Z.P. and Meng Q.F., Findings of small bowel volvulus on MDCT and CTA, 22nd European Congress of Radiology. 2010.

Feng S.T., Chan T., Sun C.H., Li Z.P., Guo H.Y., Yang G.Q., Peng Z.P. and Meng Q.F., MDCT in Small Bowel Volvulus, European Journal of Radiology. 2009, Epub ahead of print.

Fernandez J.R., Chan T., Brazaitis M., Munter F., Deshpande R., Lee J., Liu B. and Huang H.K., 3-D Computed Aided Detection (CAD) algorithm for detection of Acute Intracranial Hemorrhage (AIH) in Computed Tomography (CT), 24th International Congress and Exhibition of Computer Assisted Radiology and Surgery. 2010.

Gu J., Kwong Y.L., Chan T., Au W.Y., Chan Q., Zhang J., Liang R.H.S. and Khong P.L., Comparison of DWIBS and 18F-FDG PET/CT in newly diagnosed lymphoma, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Kim M., Chan Q., Anthony M., Cheung K.M.C., Samartzis D., Chan T. and Khong P.L., Assessment of glycosaminoglycan distribution in human lumbar intervertebral discs using chemical exchange saturation transfer, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Li A., Chan T., Chan G., Poon W.L. and Lam C.S., Response of the Non-stressed Ventricle, 3rd Joint Scientific Meeting of The Royal College of Radiologists & Hong Kong College of Radiologists and 17th Annual Scientific Meeting of Hong Kong College of Radiologists. 2009.

Tsui K.W. and Chan T., A novel framework for automatic matching of PET/CT images using grid-based SIFT algorithm, 24th International Congress and Exhibition of Computer Assisted Radiology and Surgery. Geneva, Switzerland, 2010.

Yan F.K. and Chan T., Segmentation of Individual Liver Segments Based on Automatic Identification of Hepatic Vascular Structures, 24th International Congress and Exhibition of Computer Assisted Radiology and Surgery. Geneva, Switzerland, 2010.

Researcher : Ching ASC

List of Research Outputs

Feng S.T., Chan T., Ching A.S.C., Sun C.H., Guo H.Y., Fan M., Meng Q.F. and Li Z.P., CT and MR imaging characteristics of infantile hepatic hemangioendothelioma, European Journal of Radiology. 2010, 2010 Jun 22. [Epub ahead of print].

Researcher : Chiu SSH

List of Research Outputs

Mok T.M.Y., Chiu S.S.H., Lo Y., Mak H.K.F., Wong R.W.S., Khong P.L. and Lau W.C.S., Coronary atherosclerosis using CT coronary angiogram in patients with systemic sclerosis. Rely letter to Editor., Scand J Rheumatol . 2010, 38(5): 381-385.

Researcher : Chu FSK

List of Research Outputs

Chok K.S.H., Chu F.S.K., Cheung T.T., Lam V.W.T., Yuen W.K., Ng K.K.C., Chan S.C., Poon R.T.P., Yeung C., Lo C.M. and Fan S.T., Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis, ANZ Journal of Surgery. 2010, 80(4): 280-283.

Ng K.K.C., Poon R.T.P., Cheung T.T., Chu F.S.K., Tso W.K. and Fan S.T., High efficacy of high intensity focused ultrasound without transarterial embolization for hepatocellular carcinoma (Poster Presentation), International Liver Cancer Association 3rd Annual Conference, Milan, Italy, 4 - 6 September 2009.

Ng K.K.C., Poon R.T.P., Chok K.S.H., Cheung T.T., Tung H., Chu F.S.K., Tso W.K., Yu W.C. and Fan S.T., High efficacy of high-intensity focused ultrasound without transarterial embolization for hepatocellular carcinoma - Hong Kong experience (Abstract), The 1st International Summit of Noninvasive Ultrasound Treatment, Chongqing, China, 22-23 October 2009.

Researcher : Gu J

List of Research Outputs

Gu J., Kwong Y.L., Chan T., Au W.Y., Chan Q., Zhang J., Liang R.H.S. and Khong P.L., Comparison of DWIBS and 18F-FDG PET/CT in newly diagnosed lymphoma, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Gu J., Khong P.L., Wang S., Liu K.Y., Law W.L., Chan Q. and Zhang J., Correlation study of quantitative indexes from DWI and PET-CT in primary rectal cancer, 3rd Joint Scientific Meeting of The RCR & HKCR and 17th ASM of HKCR, 31 October-1 November 2009.

Gu J., Khong P.L., Wang S., Chan Q., Law W.L., Liu K.Y. and Zhang J., Dynamic Contrast-enhanced MRI of Primary Rectal Cancer at 3T: Correlation with Positron Emission Tomography, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Gu J., Khong P.L., Wang S., Liu K.Y., Law W.L., Chan Q. and Zhang J., Dynamic contrast-enhanced MRI of primary rectal cancer at 3T: correlation with positron emission tomography, 16th Hong Kong International Cancer Congress and 6th Annual Meeting Centre for Cancer Research ,The University of Hong Kong Li Ka Shing Faculty of Medicine, 4-6 November 2009.

Gu J., Khong P.L., Wang S., Chan Q., Law W.L., Liu K.Y. and Zhang J., Quantitative analysis of indexes from DWI and PET/CT in primary rectal cancer, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Wang S., Wu E.X., Lau H.F., Gu J., Zhou J.Y. and Khong P.L., Characterization of mild hypoxic-ischemic injury in multiple white matter tracts in a neonatal rat model by diffusion tensor MR imaging, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Researcher : Ho WY

List of Research Outputs

Yung A.W.Y., Wong V.C.N., Khong P.L., Mak H.K.F., Hung K.N., Chan P.H., Ho W.Y. and Fan Y.W., Paediatric Epilepsy Surgery Program in Hong Kong - a single centre experience, Annual Scientific Meeting 2009, The Hong Kong Neurological Society, Hong Kong, 7 November 2009.

Researcher : Huang B

List of Research Outputs

Chan K.S., Mak H.K.F., Huang B., Yeung D.W.C., Kwong D.L.W. and Khong P.L., Nasopharyngeal carcinoma: relationship between 18F-FDG PET-CT maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis, and TNM classification, Nuclear Medicine Communication . 2010, 31: 206-210.

Feng S.T., Law M.W., Huang B., Ng S., Li Z.P., Meng Q.F. and Khong P.L., Radiation dose and cancer risk from pediatric CT examinations on 64-slice CT: A phantom study, European Journal of Radiology (Epub). 2010.

Huang B., Law M.W.M., Mak H.K.F., Kwok S.P.F. and Khong P.L., Pediatric 64-MDCT coronary angiography with ECG-modulated tube current radiation dose and cancer risk, American Journal of Roentgenology . 2009, 193: 539-544.

Huang B., Li J., Law M.W.M., Zhang J., Shen Y. and Khong P.L., Radiation dose and cancer risk in retrospectively and prospectively ECG-gated coronary angiography using 64-slice MDCT, British Journal of Radiology. 2009, 83: 152-158.

Researcher : Khong PL

Project Title:	To establish the use of magnetic resonance imaging for assessing the degree of brain damage following hypoxic ischemic insult with or without neuroprotective therapies
Investigator(s):	Khong PL, Cheung PT
Department:	Diagnostic Radiology
Source(s) of Funding:	Other Funding Scheme
Start Date:	06/2002

Abstract:

To evaluate the neuroprotective effects of one purified component of Traditional Chinese Medicine (TCM), caspase inhibitor (CI) and cyclosporin A (CA), in combination or alone.

Project Title:	PET/CT scanning for lymphoma patients
Investigator(s):	Khong PL, Liang RHS
Department:	Diagnostic Radiology
Source(s) of Funding:	Hong Kong Blood Cancer Foundation - General Award
Start Date:	05/2007

Abstract:

Currently in Hong Kong, all but one PET-CT scan services is provided by Private radiology practices where the patient bears the cost of the examination. The only 'Public' PET-CT scan service is available in Queen Elizabeth Hospital (QEH), where the cost of the scan is not covered by the Hospital Authority (HA), and therefore, scans are performed at the patient's own cost. However, patients who have financial difficulties are able to apply for Assistance by Samaritan Fund/Special Grant under the Comprehensive Social Security Assistance Scheme administered by HA. HKU has been advised that this fund will not be available to patients referred to the HKU PET-CT centre. Therefore, the centre at QEH currently serves all the financially needy patients of Hong Kong who require this service. Sick and poor patients who require the services of the HKU PET-CT centre currently have no access to the facilities of the centre as this is normally a fee-paying service costing about $12,000, in-line with Hong Kong wide PET-CT services in Private Radiology practices and in QEH. In view of the high cost of this examination technique and current recommendations for PET-CT in the management of lymphoma, we would like to set up a financial assistance fund to address the medical needs of financially needy patients.

Project Title:	Imaging iron stores in the brain using susceptibility-weighted MR imaging (SWI) in patients with B-thalassaemia major (TM) and correlation with cognitive function
Investigator(s):	Khong PL, Chan GCF, Fung ASM, Ha SY
Department:	Diagnostic Radiology
Source(s) of Funding:	Children's Thalassaemia Foundation - General Awards
Start Date:	07/2007

Abstract:

To evaluate a new MR imaging technique, susceptibility weighted imaging (SWI) for the evaluation of brain iron stores in B-thalassaemia major (TM) patients: (1) To determine if SWI is sensitive in detecting iron stores in the brain of TM patients compared to conventional MR methods (namely GRE MR imaging). (2) To quantitate iron stores in the brain using SWI and T2-relaxometry. (3) To determine the incidence and pattern of cognitive abnormalities in TM patients by using Weschler intelligence and quotient (IQ) scores. (4) To evaluate if quantitation of iron stores using SWI or T2-relaxomtery correlates with IQ scores or other parameters of iron overload such as serum ferritin and liver iron, and life-time transfusional iron burden.

Project Title:	Comparing whole body imaging modalities; MRI and PET-CT, in the staging of paediatric cancer
Investigator(s):	Khong PL, Chiang AKS, Chan GCF
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	01/2008
Completion Date:	12/2009

Abstract:

The optimal and appropriate therapy for patients with cancer is dependent on accurate tumour staging with whole body imaging. Both magnetic resonance imaging (MRI) and combined modality Positron emission tomography (PET)-Computed tomography (CT) are able to provide whole-body imaging in a single session. Whole body MRI is now feasible because of new developments in software, i.e. fast scan techniques, and hardware, i.e. rolling table platform (1-2). With these advances, acquisition times can be reduced substantially without compromises in spatial resolution, allowing MR imaging of the whole body to be performed within 30mins. Compared to other imaging modalities, MRI holds the advantages of superior contrast resolution for soft tissue, thereby providing more specific tumour characterization, multiplanar capabilities, and of great importance in imaging children, the lack of ionizing radiation. However, the information obtained is mainly structural and focused on the assessment of morphological characteristics of tissue. On the other hand, glucose analog 18F-fluorodeoxyglucose (FDG) PET provides functional information on tumour metabolism, thereby detecting changes in cellular function. The main limitation of PET is the poor spatial resolution, which is now overcome with the introduction of hybrid dual-modality PET imaging combined with CT scan. CT scan which is performed at the same setting serves the purposes of attenuation correction, as well as providing accurate anatomical localization of the disease processes, and hence, PET combined with CT improves diagnostic accuracy. Both PET and CT scans impart ionizing radiation, with effective dose of the combined paediatric scan estimated to be about 20msV (data from HKU PET-CT scanner). Both imaging techniques have been separately evaluated for tumour staging, mostly in the adult maligancies. In paediatric tumour literature, whole body MRI has been evaluated for lymphoma (3), small cell neoplasms (4) and for bone metastases in a mixed cohort of paediatric tumours (5), and PET and PET-CT for lymphomas (6-9), neuroblastomas (10), sarcomas (11), hepatic tumours (12) etc. Separately, both imaging techniques have been found advantageous to conventional imaging, and are promising methods for cancer staging. There are only been two main publications directly comparing these two new imaging modalities, both in adult cancers (13, 14). Moreover, most of the previous studies have evaluated stand alone PET scanners, and not the combined PET-CT modality, which is expected to improve diagnostic accuracy. Dalrup-Link et al compared WB MRI, FDG PET and skeletal scintigraphy for the evaluation of bony metastases in paediatric cancers, and found FDG PET to be the most sensitive modality, followed by WB MRI (5). Other studies in adult populations have found the contrary to be true. In the evaluation of 98 adult patients with various malignancies (13), it was found that PET-CT was superior in the evaluation of local tumour extent (T-stage), and nodal involvement (N-stage), but both modalities showed similar performance for detecting distant metastases (M-stage). PET-CT was more reliable for the detection of pulmonary metastases, but MRI was more accurate in the detection of liver and bone metastases. The role of whole body MRI and PET-CT, and the comparisons between these two whole imaging modalities depend greatly on the tumour type, the imaging protocol used and the site of metastases. We aim to directly compare these two new imaging modalities in paediatric cancers to determine the diagnostic accuracy and role of each modality in staging paediatric cancers. References: 1. Schmidt GP, Schoenberg SO, Reiser MF, et al. Whole-body MR imaging of bone marrow. Eur J Radiol 2005;55:33-40. 2. Lauenstein TC, Goehde SC, Herborn CU, et al. Whole-body MR imaging: evaluation of patients for metastases. Radiology 2004;233:139-148. 3. Kellenberger CJ, Miller SF, Khan M, et al. Initial experience with FSE STIR whole-body MR imaging for staging lymphoma in children. European Radiology 2004; online publication. 4. Mazumdar A, Siegel MJ, Narra V, et al. Whole-body fast inversion recovery MR imaging of small cell neoplasms in pediatric patients : A pilot study. AJR 2002; 179:1261-1266. 5. Daldrup-Link HE, Franzius C, Link TM, et al. Whole-body MR imaging for detection of bone metastases in children and young adults : Comparison with skeletal scintigraphy and FDG PET. AJR 2001; 177:229-236. 6. Kabickova E, Sumerauer D, Cumlivska E, et al. Comparison of 18F-FDG-PET and standard procedures for the pretreatment staging of children and adolescents with Hodgkin’s disease. European Journal of Nuclear Medicine and Molecular Imaging 2006; 33:1023-1031. 7. Rhodes MM, Delbeke D, Whitlock JA. Utility of FDG-PET/CT in follow-up of children treated for Hodgkin and Non-Hodgkin lymphoma. J Pediatr Hematol Oncol 2006; 28:300-306. 8. Depas G, De Barsy C, Jerusalem G, et al. 18F-FDG PET in children with lymphomas. European Journal of Nuclear Medicine and Molecular Imaging 2005; 32:31-38. 9. Montravers F, McNamara D, Parker L, et al. [18F]FDG in childhood lymphoma : clinical utility and impact on management. European Journal of Nuclear Medicine 2002; 29:1155-1165. 10. Kushner BH, Yeung HWD, Larson SM, et al. Extending positron emission tomography scan utility to high-risk neuroblastoma: Fluorine-18 fluorodeoxyglucose positron emission tomography as sole imaging modality in follow-up of patients. Journal of Clinical Oncology 2001; 19:3397-3405. 11. McCarville MB, Christie R, Daw NC, et al. PET/CT in the evaluation of childhood sarcomas. AJR 2005; 184:1293-1304. 12. Mody RJ, Pohlen JA, Malde S, et al. FDG PET for the study of primary hepatic malignancies in children. Pediatr Blood Cancer 2005; 47:51-55. 13. Antoch G, Vogt FM, Freudenberg LS, etal. Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology. JAMA, 2003; 290:3199-3205. 14. Schmidt GP, Baur-Melnyk A, Herzog P, et al. High-resolution whole-body magnetic resonance image tumor staging with the use of parallel imaging versus dual-modality positron emission tomography-computed tomography. Experience on a 32-channel system. Investigative Radiology 2005; 40:743-753.

Project Title:	The University of Hong Kong PET/CT scan: a state-of-the-art imaging facility available to all
Investigator(s):	Khong PL, Leong Fung LLY, Pang CBY
Department:	Diagnostic Radiology
Source(s) of Funding:	S.K. Yee Medical Foundation - General Award
Start Date:	03/2008

Abstract:

To provide PET/CT imaging service free-of-charge to the poor and sick and at the same maintain financial self-sustainability of the facility.

Project Title:	ISMRM 16th Scientific Meeting & Exhibition Diffuse tensor imaging: clinical applications to children
Investigator(s):	Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	URC/CRCG - Conference Grants for Teaching Staff
Start Date:	05/2008

Abstract:

N/A

Project Title:	18F-FDG PET-CT in prognostication and response assessment of aggressive mature T-cell and NK-cell lymphomas
Investigator(s):	Khong PL, Au WY, Kwong YL, Liang RHS, Yao TJ, Yeung DWC
Department:	Diagnostic Radiology
Source(s) of Funding:	General Research Fund (GRF)
Start Date:	08/2008

Abstract:

(1) In a prospective study of consecutive newly diagnosed or relapsed histologically proven mature T-cell and NK-cell lymphoma patients, we aim to determine 1) the utility of 18F-FDG PET-CT for monitoring treatment response and prognostication by evaluating initial, mid-treatment and end-treatment scans 2) the accuracy of measures of response assessment, by a) qualitative visual inspection of PET uptake (positive or negative) b) semi-quantitative methods of measurement of standardized uptake value (SUV), which is used to determine 18F-FDG uptake in attenuation corrected PET images. Lesion SUVmax and total lesion glycolysis (SUVmean x lesion volume) will be evaluated. Progression free survival at 2-years will be used as the gold-standard.

Project Title:	Radiation Dose and Cancer Risk from CT and PET-CT Scan
Investigator(s):	Khong PL, Mak HKF, Zhang J
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	09/2008

Abstract:

The use of diagnostic imaging in patient management has increased rapidly becoming an essential armamentarium in patient care, especially with the advent of state-of-the-art imaging tools, including multi-detector computed tomography (MDCT) and combined positron emission tomography and computed tomography (PET-CT). Indeed, the University of Hong Kong, Department of Diagnostic Radiology has in the recent years begun operation of a PET-CT scanner with a 64-MDCT which is able to provide PET-CT scan and stand alone diagnostic CT scan for patient care and research. The 64-MDCT is especially advantageous for cardiac CT scans because of the superior temporal resolution. However, both these techniques are a source of radiation exposure to the patient and the public. Also, it is well known that cancer risk is induced from ionizing radiation. Therefore, we aim to conduct experiments to calculate the dose exposure from examinations on the scanner, in particular, to estimate the radiation exposure of patients undergoing (a) whole-body PET-CT examinations in adults (b) 64-slice retrospectively electrocardiograph (ECG)-gated cardiac CT scan in children. Also, we will evaluate the United States (US) and Hong Kong (HK) patients’ cancer risk induced by the radiation exposure, and compare the results between these populations. As the demographic factors in Hong Kong and South China are similar, we believe that our results can be extended to the population in the rest of South China, and therefore relevant to a wider population base.

Project Title:	Medical cyclotron for the production of radiopharmaceuticals for positron emission tomography imaging in an academic medical center
Investigator(s):	Khong PL, Yeung DWC, Liang RHS, Kwong YL, Fan ST, Chu LW, Wu EX
Department:	Diagnostic Radiology
Source(s) of Funding:	UGC One-off Special Equipment Grant Scheme
Start Date:	12/2008

Abstract:

Primary Objective: 1) This is to establish a Molecular Imaging Center in The University of Hong Kong by the installation of a medical cyclotron for the production of various kinds of positron emission tomography (PET) radiopharmaceuticals including short half life PET radiopharmaceutical so that molecular imaging can be performed. Since some of these radiopharmaceuticals have short half life e.g. [11C] (20 minutes), an onsite cyclotron would be necessary for the use of these radiopharmaceuticals. The cyclotron can be potentially also used to provide short half life radiopharmaceuticals for small animal PET imaging research. 2) To provide the radiopharmaceutical necessary for performing specific researches as described but not limited to those specified in the secondary objectives. Secondary Objectives: 1) Lymphoma Core: 18F-FDG PET-CT in aggressive mature T-cell and NK-cell lymphomas; 2) Liver Cancer Core: To compare the accuracy of [18F]-Fluorocholine (FCH), [11C]-Acetate (CAC) and FDG in the diagnosis of well differentiated Hepatocellular carcinoma; 3) Thyroid Cancer Core: To determine the value of [11C]-Tyrosine (C11T) PET Imaging in predicting the therapeutic response in patients receiving multi-receptor Tyrosine Kinase Inhibitor (TKI) in patients with metastatic thyroid carcinoma; 4) Neurology Core: To establish a system for diagnosing Alzheimer’s Disease in Chinese using PET scan.

Project Title:	Web-based PET-CT imaging educational case-files
Investigator(s):	Khong PL, Zhang J, Anthony M, Mak HKF, Ching ASC, Chan T
Department:	Diagnostic Radiology
Source(s) of Funding:	Run Run Shaw Research and Teaching Endowment Fund - Teaching Grants
Start Date:	05/2009

Abstract:

The PET-CT scan is a hybrid scanner, which comprise a PET scan and a CT scan. The PET component uses radioisotopes to image metabolic and physiologic processes. This allows detection of changes in cellular function, which typically take place before anatomical changes. The CT component provides detailed anatomical images, which is fused with the PET image for accurate anatomical localization of the disease process. By combining the imaging capabilities of PET and CT, PET-CT fusion provides more definitive information about the disease process than either method alone. This imaging modality is the cornerstone of molecular imaging and it has revolutionized patient management, especially for cancer and also for infectious diseases. PET-CT imaging has been used in clinical practice since the late 90s in USA. Our department was fortunate to have recieved a donation for a state-of-the art PET-CT scanner which has been in operation in Queen Mary Hospital since April 2007, and it was the first unit to be installed in an academic center in Hong Kong. The clinical case-load has exponentially increased and we now perform more than 150 scans per month (see attachment for case-load). Clearly, this is an imaging modality which is of increasing importance in clinical practice and this is also evident from published literature. As this is a relatively new imaging modality, especially to Hong Kong, we strongly feel that our department is in a unique position and holds the responsibility to educate undergraduate and post-graduate students, doctors and medical specialists in its applications. The collection of cases from our unit, a tertiary referral center and an academic medical center, will serve to illustrate the spectrum of diseases seen in the Hong Kong population, which is unique to the West. We aim to collate the cases performed in our unit as teaching case-files (about 150 cases) in a web-based interactive format and with teaching points to highlight and illustrate the applications and clinical utility, and diagnostic interpretation and pitfalls of the scans. As the case-files will comprise mainly images for illustration and these are digitally formatted, web-based/digital method of presentation will be most effective. We aim to launch the material in the department and faculty education website, and publish the material in CDs. These may be distributed to students, doctors and medical specialists, including physicians, radiologists and nuclear physicians.

Project Title:	Upgrade of the HKU MRI scanner and imaging coils
Investigator(s):	Khong PL, Luk KDK, Poon RTP, Tse HF, Kwong YL, Cheung RTF, Sham PC, Chan GCF, Wu EX, Tan LH
Department:	Diagnostic Radiology
Source(s) of Funding:	University Development Fund - General Award
Start Date:	06/2009

Abstract:

The HKU 3T MRI unit serves as a core-facility for the support and promotion of MRI research in The University of Hong Kong. It has been invaluable in interdisciplinary, inter-departmental and inter-faculty cutting edge MRI research. In order to provide the expertise for this endeavour, the unit has since it’s inception in Feb 2008 grown several fold and now has full time research staff to serve as principle investigators, provide post-processing data analysis, program and implement novel MRI pulse sequences. Apart from five academic radiologists with special interest in neuroimaging, body imaging, musculoskeletal imaging, head and neck imaging and paediatric imaging, the unit has recruited one Research Assistant professor who is a trained MRI physicist, formerly in the MRI research team at Johns Hopkins University, one post-doctoral fellow who obtained his PhD in diffusion tensor MR imaging in the department of Diagnostic Radiology, and two research assistants. In addition, the unit supports the research of multiple post-graduate students from various faculties. The current MR scanner in the 3T-MRI Unit of the University of Hong Kong is a 3-Tesla Philips Achieva scanner, with the main MRI system platform version R2.1, which was installed in 2005. Since the installation, several software and hardware upgrades have been available in the market. The newest software system platform, version R2.6, allows for critical improvement of scanner performance to meet the rapidly-developing demands of clinical services and research, and is the standard capability of MRI research scanners in other academic institutions in Hong Kong, and in the region. Our current version is limited in temporal and spatial resolution and an upgrade would especially enhance functional neuroimaging, whole body imaging by allowing complete coverage, as well as speedier examination by its ultrafast dynamic ability. Moreover, almost all novel research sequences are written for this latest software platform, and therefore cannot be implemented in the old version. This is critical for successful international collaboration with renowned research institutions including Johns Hopkins from which our RAP comes. Currently, the scanner is utilized by the following faculties and research centers in HKU for more than 25 research projects that span clinical and basic science research. Grant funding sources for the research projects are from both internal and external grant sources (NIH, RGC GRF, ITF, HK thalassaemia foundation) and this is projected to amount to at least HKD 1 million per year. The number of research cases that are performed in the scanner have increased steadily to about 50 cases per month, and is still on the uptrend. • Faculty of Medicine (diagnostic radiology, medicine, orthopedics and traumatology, paediatrics, surgery, psychiatry, eye institute) • Faculty of Engineering (Laboratory of biomedical imaging and signal processing, electrical and electronic engineering) • Faculty of Arts (linguistics) • Faculty of Social sciences (psychology) • State key lab of brain and cognitive sciences, HKU • Biomedical Engineering SRT, HKU MRI unit is a core-facility in the SRT Such an upgrade would be of strategic importance for cutting-edge research in the unit, to maintain and further develop our stronghold in MR imaging research in Hong Kong and the region, and allow our participation in multi-center studies with other research centers of excellence.

Project Title:	PET/CT scan - a state-of-the-art imaging facility available to all
Investigator(s):	Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	S.K. Yee Medical Foundation - General Award
Start Date:	11/2009

Abstract:

n/a

Project Title:	Dynamic FDG-PET-CT imaging for the evaluation of nasopharyngeal carcinoma (NPC): a pilot study
Investigator(s):	Khong PL, Kwong DLW, Huang B
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	12/2009

Abstract:

We aim to investigate the application of FDG kinetics in NPC patients using dynamic FDG PET scanning, by correlating the kinetic parameters with tumour staging and outcome. Improving the accuracy of diagnosis and prognostication will allow more appropriate, and individualized treatment to be performed on patients. Nasopharyngeal carcinoma (NPC) is an aggressive head and neck cancer with a high incidence in Hong Kong. The most commonly used parameter, standard uptake value (SUV), is a semiquantitative measure of fluorine-18 fluorodeoxyglucose (FDG) concentration in the tumor at an arbitrary time point post injection, normalized for injected tracer dose and patient weight, and hence may not always accurately reflect the glucose metabolism [1]. We have found no correlation between SUV and TNM staging in the cohort of NPC patients in our unit [2]. Glucose metabolism is more accurately measured by the evaluation of FDG kinetics by dynamic PET using the parameter, net rate of influx of FDG (Ki) from Patlak graphical analysis, and other glucose metabolism rate constants (K1, k2, k3, k4, etc) from kinetic analysis. Ki from Patlak graphical analysis have been found useful in the management of patients with breast cancer [3], and it provided superior information for therapy monitoring than SUV alone [4]. Glucose metabolism rate constants (K1, k2, k3, k4, etc) from kinetic analysis, especially k3, was found to be significantly different between high-grade glioma and CNS lymphom [5]. We hypothesize that the quantitative parameters of FDG kinetics measured by dynamic PET will be able to reflect the molecular biomarkers of NPC aggressiveness and hence, staging and prognostication. References: 1. Weber WA, Schwaiger M, Avril N (2000). Quantitative assessment of tumor metabolism using FDG-PET imaging. Nucl Med Biol 27:683-687. 2. Chan WKS, Mak HKF, Huang B et al, Nasopharyngeal carcinoma: relationship between 18F-FDG PET-CT SUVmax and lesion size with TNM classification (in submission). 3. Krak NC, van der Hoeven JJ, Hoekstra OS et al (2003). Measuring [(18)F]FDG uptake in breast cancer during chemotherapy: comparison of analytical methods. Eur J Nucl Med Mol Imaging 30:674-681. 4. Romer W, Hanauske AR, Ziegler S et al (1998). Positron emission tomography in non-Hodgkin's lymphoma: assessment of chemotherapy with fluorodeoxyglucose. Blood 91:4464-4471. 5. Kimura N, Yamamoto Y, Kameyama R et al (2009). Diagnostic value of kinetic analysis using dynamic 18F-FDG-PET in patients with malignant primary brain tumor. Nucl Med Commun 30:602-609.

Project Title:	Joint ISMRM-ESMRMB Annual Meeting 2010 Susceptibility of the optic nerve and the involvement of retrograde neuronal degeneration in a delayed radiation induced injury model: evidence from a diffusion tensor imaging study
Investigator(s):	Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	URC/CRCG - Conference Grants for Teaching Staff
Start Date:	05/2010
Completion Date:	05/2010

Abstract:

N/A

List of Research Outputs

Anthony M., Khong P.L. and Mak H.K.F., An unusual case of synchronous renal cell carcinoma in a horseshoe kidney and intrahepatic cholangiocarcinoma, Clinical Nuclear Medicine. in press, 2009, 34: 922-923.

Anthony M., Zhang Z., Feng S.T., Yau K.K.W., Khong P.L. and Mak H.K.F., Comparison of 3T diffusion weighted magnetic resonance imaging and 18F-fluoro-2-deoxyglucose positron emission tomography/ computed tomography in cervical lymphadenopathy of patients with nasopharyngeal carcinoma, 110th Annual Meeting of the American Roentgen Ray Society, San Diego, CA, USA. 2-7 May 2010.

Anthony M., Kwong Y.L. and Khong P.L., FDG-PET/CT for the assessment of type II enteropathy-associated T-cell lymphoma, 3rd Joint Scientific Meeting of The RCR & HKCR and 17th ASM of HKCR, 31 October-1 November 2009.

Anthony M., Zhang J. and Khong P.L., PET/CT appearance of intestinal Behcet's disease, Clinical Nuclear Medicine. 2009, 34: 825-826.

Anthony M., Khong P.L. and Zhang J., Spectrum of 18F-FDG-PET/CT Appearances in peritoneal disease, American Journal of Roentgenology. 2009, 193: W523-529.

Anthony M., Zhang J. and Khong P.L., Spectrum of FDG-PET/CT Appearances in Malignant and Benign Peritoneal Pathology , RSNA 95th Scientific Assembly and Annual Meeting, Radiological Society of North America (RSNA), November 2009.

Chan K.S., Mak H.K.F., Huang B., Yeung D.W.C., Kwong D.L.W. and Khong P.L., Nasopharyngeal carcinoma: relationship between 18F-FDG PET-CT maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis, and TNM classification, Nuclear Medicine Communication . 2010, 31: 206-210.

Chan Q., Kim M., Anthony M., Cheung K.M.C., Chan A., Chan T. and Khong P.L., Quantitative comparison of T1r with T2 in intervertebral disc in vivo at 3T, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Cheung C., Chua S.E., Cheung V., Khong P.L., Tai K.S., Wong T.K.W., Ho T.P. and McAlonan G.M., White matter fractional anisotrophy differences and correlates of diagnostic symptoms in autism, Journal of Child Psychology and Psychiatry. 2009, 50: 1102-1112.

Cheung J., Au W.Y., Ha S.Y., Jensen J., Kim D., Ding A., Zhou I., Guo H., Brown T., Chu W., Rasalkar D. and Khong P.L., Monitoring iron chelation effect in hearts of thalassaemia patients with improved sensitivity using reduced transverse relaxation rate (RR2), Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Cheung V., Chiu C.P.Y., Law C.W., Cheung C., Hui C.L.M., Chan K.K.S., Sham P.C., Deng Y., Tai K.S., Khong P.L., McAlonan G.M., Chua S.E. and Chen E.Y.H., Positive symptoms and white matter microstructure in never-medicated first episode schizophrenia, Psychological Medicine. 2010, 40: 1-12.

Feng S.T., Law M.W., Huang B., Ng S., Li Z.P., Meng Q.F. and Khong P.L., Radiation dose and cancer risk from pediatric CT examinations on 64-slice CT: A phantom study, European Journal of Radiology (Epub). 2010.

Garcia-Barcelo M.M., Lui V.C.H., So M.T., Miao X., Leon Y.Y., Yuan Z.W., Ngan E.S.W., Ehsan T., Chung P.H.Y., Khong P.L., Wong K.K.Y. and Tam P.K.H., MNX1 (HLXB9) mutations in Currarino patients, Journal of Pediatric Surgery. 2009, 44(10): 1892-1898.

Gu J., Kwong Y.L., Chan T., Au W.Y., Chan Q., Zhang J., Liang R.H.S. and Khong P.L., Comparison of DWIBS and 18F-FDG PET/CT in newly diagnosed lymphoma, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Gu J., Khong P.L., Wang S., Liu K.Y., Law W.L., Chan Q. and Zhang J., Correlation study of quantitative indexes from DWI and PET-CT in primary rectal cancer, 3rd Joint Scientific Meeting of The RCR & HKCR and 17th ASM of HKCR, 31 October-1 November 2009.

Gu J., Khong P.L., Wang S., Chan Q., Law W.L., Liu K.Y. and Zhang J., Dynamic Contrast-enhanced MRI of Primary Rectal Cancer at 3T: Correlation with Positron Emission Tomography, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Gu J., Khong P.L., Wang S., Liu K.Y., Law W.L., Chan Q. and Zhang J., Dynamic contrast-enhanced MRI of primary rectal cancer at 3T: correlation with positron emission tomography, 16th Hong Kong International Cancer Congress and 6th Annual Meeting Centre for Cancer Research ,The University of Hong Kong Li Ka Shing Faculty of Medicine, 4-6 November 2009.

Gu J., Khong P.L., Wang S., Chan Q., Law W.L., Liu K.Y. and Zhang J., Quantitative analysis of indexes from DWI and PET/CT in primary rectal cancer, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Guo H., Au W.Y., Cheung J.S., Kim D., Jensen J.H., Khong P.L., Chan Q., Chan K.C., Tosti C., Tang H., Brown T.R., Lam W.W.M., Ha S.Y., Brittenham G.M. and Wu E.X., Myocardial T2 quantitation in patients with iron overload at 3 tesla, Journal of Magnetic Resonance Imaging . 2009, 30: 394-400.

Huang B., Law M.W.M., Mak H.K.F., Kwok S.P.F. and Khong P.L., Pediatric 64-MDCT coronary angiography with ECG-modulated tube current radiation dose and cancer risk, American Journal of Roentgenology . 2009, 193: 539-544.

Huang B., Li J., Law M.W.M., Zhang J., Shen Y. and Khong P.L., Radiation dose and cancer risk in retrospectively and prospectively ECG-gated coronary angiography using 64-slice MDCT, British Journal of Radiology. 2009, 83: 152-158.

Khong P.L., Annals of Neurology, Journal Reviewer. 2010.

Khong P.L., Applications of diffusion tensor imaging (DTI) in paediatric imaging, Korean Congress of Radiology (KCR) in Seoul, 21-23 October 2009. 2009.

Khong P.L., Clinical Cancer Research, Journal Reviewer. 2010.

Khong P.L., DTI of treatment-induced white matter injury in childhood medulloblastoma survivors, Invited lecture at the University Hospital Geneva, Switzerland, 8 September 2009. 2009.

Khong P.L., Diffusion tensor MR imaging of treatment-induced white matter injury in childhood cancer survivors, 13th Asian Oceanian Congress of Radiology meeting in Taipei, Taiwan, 20-23 March 2010. 2010.

Khong P.L., Human Brain Mapping, Journal Reviewer. 2010.

Khong P.L., Imaging in HIE, 9th Asian Oceanic Society of Paediatric Radiology (AOSPR) Congress Kuala Lumpur, 19-21 November 2009. 2009.

Khong P.L., Imaging of lymphoma, SUMS Guangzhou, 24 April 2010. 2010.

Khong P.L., Imaging of malignant lymphoma, 13th Asian Oceanian Congress of Radiology meeting in Taipei, Taiwan, 20-23 March 2010. 2010.

Khong P.L., Interactive workshop: Utility of CT-PET scanning in oncology, Postgraduate Diploma in Diagnosic and Therapeutics in Internal Medicine Course organized by Department of Medicine, HKU on 4 - 5 July 2009 . 2009.

Khong P.L., Journal of Pediaatric Gastroenterology and Nutrition, Journal Reviewer. 2010.

Khong P.L., Journal of Pediatric Neuroradiology, Journal Reviewer. 2010.

Khong P.L., MR imaging of neonatal encephalopathy, Korean Congress of Radiology (KCR) in Seoul, 21-23 October 2009. 2009.

Khong P.L., PET-CT imaging for nasopharyngeal cancer, The Hong Kong Head and Neck Society Scientific Meeting, Hong Kong, 9 March 2010. 2010.

Khong P.L., PET-CT in malignant lymphoma: updates and local experience, 16th Hong Kong International Cancer Congress, Hong Kong, 4-6 Nov 2009. 2009.

Khong P.L., Pediatric Radiology, Editorial Board. 2010.

Khong P.L., Pediatric Radiology, Journal Reviewer. 2010.

Khong P.L., Pediatric Research, Journal Reviewer. 2010.

Khong P.L., Golay X. and Melhem E.R., Physiological MR of the pediatric brain: overview, In J Gillard, A Waldman and P Parker (2nd edition). Clinical MR Neuroimaging. Cambridge, Cambridge University Press, 2010, 705-726.

Khong P.L., Radiology Research and Practice, Editorial Board. 2010.

Khong P.L., Recent advances in radiologic imagingand diagnosis of cancer, Postgraduate Diploma in Diagnosic and Therapeutics in Internal Medicine Course organized by Department of Medicine, HKU on 4 - 5 July 2009. 2009.

Khong P.L., Reviewer of Samantha Dickson Brain Tumour Trust (SDBTT) grant. 2009.

Khong P.L., The Hong Kong Journal of Paediatrics, Journal Reviewer. 2010.

Khong P.L., The Hong Kong Medical Journal, Journal Reviewer. 2010.

Khong P.L., The Journal of the Hong Kong College of Radiologists, Associate Editor. 2009.

Khong P.L., The Journal of the Hong Kong College of Radiologists, Journal Reviewer. 2009.

Khong P.L., The Open Medical Imaging Journal. Editorial Board. . 2009.

Khong P.L., Translational DTI studies in white matter diseases, The 1st International Workshop on Engineering Biomedical Imaging – Addressing Tomorrow’s Medical Challenges at The University of Hong Kong, Hong Kong, 12 December 2009. 2009.

Khong P.L., Translational studies of paediatric white matter pathologies using diffusion tensor MR imaging (DTI) in animal models, 13th Asian Oceanian Congress of Radiology meeting in Taipei, Taiwan, 20-23 March 2010. 2010.

Kim M., Chan Q., Anthony M., Cheung K.M.C., Samartzis D., Chan T. and Khong P.L., Assessment of glycosaminoglycan distribution in human lumbar intervertebral discs using chemical exchange saturation transfer, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Lau Y.C., Ho C.L., Leung Y.L., Cheng T., Yeung W.D., Anthony M. and Khong P.L., The Utility of 19F-Fluoride PET/CT for the detection of skull base involvement in nasopharyngeal carcinoma, SNM 57th Annual Meeting, Salt Lake City, Utah, USA, 5-9 June 2010.

Lee V.H.F., Kwong D.L.W., Khong P.L., Chua D.T.T., Ng C.Y., Wong G.K.W., Chan K.S., Leung T.W. and Au G.K.H., Co-registration and application of positron emission tomography (PET), computed tomography (CT) as compared with magnetic resonance imaging (MRI) in target localization for undifferentiated carcinoma of the nasopharynx (NPC), ASTRO 2009 Annual Meeting, Chicago, USA, 1-5 November 2009.

Lee V.H.F., Ng C.Y., Chua D.T.T., Kwong D.L.W., Khong P.L., Ng T.M.C., Leung T.W. and Au G.K.H., Shrinkage of Volumes of Parotid and Submandibular Glands but Elevated Radiation Doses during Intensity Modulated Radiation Therapy (IMRT) for Nasopharyngeal Carcinoma., Hong Kong International Cancer Congress. Hong Kong, 16th Hong Kong International Cancer Congress, 2009.

Lee V.H.F., Kwong D.L.W., Khong P.L., Chua D.T.T., Ng C.Y., Wong G.K.W., Chan K.S., Leung T.W. and Au G.K.H., The optimal window-setting of Positron Emission Tomography when co-registered with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in Target Localization For Undifferentiated Carcinoma of the Nasopharynx (NPC). , European Society of Therapeutic Radiology and Oncology. The Netherlands, ESTRO, European Society of Therapeutic Radiology and Oncology, 2010.

Mok T.M.Y., Chiu S.S.H., Lo Y., Mak H.K.F., Wong R.W.S., Khong P.L. and Lau W.C.S., Coronary atherosclerosis using CT coronary angiogram in patients with systemic sclerosis. Rely letter to Editor., Scand J Rheumatol . 2010, 38(5): 381-385.

Ngan S.S.C., Hu X., Tan L.H. and Khong P.L., Improvement of spectral density-based activation detection of event-related fMRI data, Magnetic Resonance Imaging. 2009, 27: 879–894.

Qiu D., Wang S., So K.F., Wu E.X., Leung L. and Khong P.L., Susceptibility of the optic nerve and the involvement of retrograde neuronal degeneration in a delayed radiation induced injury model: evidence from a diffusion tensor imaging study, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Qiu D., Chan G.C.F., Chan Q., Ha S.Y. and Khong P.L., Susceptibility weighted imaging (SWI) for the assessment of iron loading in the brain of beta-thalassemia major patients., 1st meeting of the Asia-Pacific Iron Academy, Chiang Mai, 23-26 Nov 2009.

Qiu D., Chan G.C., Chan Q., Ha S.Y. and Khong P.L., Susceptibility weighted imaging (SWI) for the assessment of iron loading in the brain of beta-thalassemia major patients, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Tang B., Douglas-Nikitin V., Balon H., Wong C.O., Khong P.L. and Wong C.Y., Exceptionally low metabolic activity in aggressive peripheral T-cell lymphoma, Nuclear Medicine Communications . 2010, 31: 838-840.

Wang S., Wu E.X., Lau H.F., Gu J., Zhou J.Y. and Khong P.L., Characterization of mild hypoxic-ischemic injury in multiple white matter tracts in a neonatal rat model by diffusion tensor MR imaging, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Wang S., Wu E.X., Cai K., Lau H.F., Cheung P.T. and Khong P.L., Mild hypoxic-ischemic injury in the neonatal rat brain: longitudinal valuation of white matter using diffusion tensor MR imaging, American Journal of Neuroradiology. 2009, 30: 1907-1913.

Wang S., Yiu K.H., Mok T.M.Y., Ooi C.G.C., Khong P.L., Mak H.K.F., Lau C.P., Lam K.F., Lau W.C.S. and Tse H.F., Prevalence and extent of calcification over aorta, coronary and carotid arteries in patients with rheumatoid arthritis, Journal of Internal Medicine . 2009, 266: 445-452.

Wu E.X., Wang S., Lau H., Gu J., Zhou J. and Khong P.L., Characterization of mild hypoxic-ischemic injury in multiple white matter tracts in a neonatal rat model by diffusion tensor MRI imaging, 2010 Proceedings of International Society of Magnetic Resonance in Medicine. Stockholm, 2010, 4492.

Wu E.X., Chan C.W., Khong P.L., Lau H.F. and Cheung P.T., Late measures of microstructural alterations in severe neonatal hypoxic-ischemic encephalopathy by MR diffusion tensor imaging, International Journal Developmental Neuroscience. 2009, 27: 607-615.

Wu E.X., Cheung S.C., Au W.Y., Ha S.Y., Jensen J.H., Kim D., Ding A.Y., Zhou Y., Guo H., Brown T.R., Chu W.C., Rasalkar D.D., Khong P.L. and Brittenham G.M., Monitoring iron chelation effect in hearts of thalassaemia patients with improved sensitivity using reduced transverse relaxation rate (RR2), 2010 Proceedings of International Society of Magnetic Resonance in Medicine . Stockholm, 2010, 3660.

Wu E.X., Guo H., Au W.Y., Cheung S.C., Kim D., Jensen J.H., Khong P.L., Chang K.C., Chan Q., Tosti C., Tang H., Brown T.R., Lam W.W.M., Ha S.Y. and Brittenham G.M., Myocardial T2 quantitation in patients with thalassaemia major at 3 Tesla, Journal of Magnetic Resonance Imaging. 2009, 23: 394-400.

Wu E.X., Qui D., Wang S., So K.F., Leung L. and Khong P.L., Susceptibility of the optic nerve and the involvement of retrograde neuronal degeneration in a delayed radiation induced injury model: evidence from a diffusion tensor imaging study, 2010 Proceedings of International Society of Magnetic Resonance in Medicine . Stockholm, 2010, 469.

Yau T.O., Leung T.H.Y., Lam S.G.S., Cheung O.F., Tung K.K., Khong P.L., Lam A.K.M., Chung S.K. and Ng I.O.L., Deleted in liver cancer 2 (DLC2) was dispensable for development and its deficiency did not aggravate hepatocarcinogenesis., PLoS One. 2009, 4(8): e6566.

Yiu K.H., Wang S.L., Mok T.M.Y., Ooi C.G.C., Khong P.L., Mak H.K.F., Lam K.F., Lau W.C.S. and Tse H.F., Pattern on atherosclerosis for coronary, carotid and aortic arteries calcification in rheumatoid arthritis: a multidetector CT study, Journal of American College of Cardiology. 2009, 53: A432.

Yiu K.H., Wang S., Mok T.M.Y., Ooi C.G.C., Khong P.L., Lau C.P., Lai W.W., Wong L.Y., Lam K.F., Lau W.C.S. and Tse H.F., Role of circulating endothelial progenitor cells in patients with rheumatoid arthritis with coronary calcification, Journal of Rheumatology . 2010, 37: 529-535.

Yung A.W.Y., Wong V.C.N., Khong P.L., Mak H.K.F., Hung K.N., Chan P.H., Ho W.Y. and Fan Y.W., Paediatric Epilepsy Surgery Program in Hong Kong - a single centre experience, Annual Scientific Meeting 2009, The Hong Kong Neurological Society, Hong Kong, 7 November 2009.

Zhang Z., Mak H.K.F., Khong P.L. and Chu L.W., Structural changes in the Chinese patients with Alzheimer’s disease by using VBM method, 3rd Joint Scientific Meeting of The RCR & HKCR and 17th ASM of HKCR, 31 October-1 November 2009.

Researcher : Kim M

Project Title:	Quantitative Evaluation of Magnetization Transfer and Diffusion Tensor Imaging at 3T in the Cervical Spinal Cord of Patients with Neuromyelitis Optica
Investigator(s):	Kim M, Mak HKF, Chan KH, Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	Seed Funding Programme for Basic Research
Start Date:	06/2009

Abstract:

The goal of this research is to apply magnetization transfer (MT) and diffusion tensor imaging (DTI) for assessing the pathological mechanism of normal appearing cervical spinal cord tissue damage in patients with severe and mild neuromyelitis optica (NMO) and furthermore to differentiate them from multiple sclerosis (MS). MS is one of the most common disorders among inflammatory demyelinating diseases of the central nervous system (CNS) which occur throughout the world and are the foremost reason for non-traumatic neurological disability in young and adults. The diagnosis of MS requires confirmation that the symptoms and signs of CNS white matter involvement are disseminated in time and space, supportive evidence from magnetic resonance imaging (MRI) and cerebrospinal fluid analysis, if needed, and the exclusion of other diagnoses. Until recently any relapsing idiopathic demyelinating disease of CNS has been diagnosed as MS [1]. NMO (also known as Devic’s disease) is an inflammatory and demyelinating disease of CNS that preferentially affects the optic nerve and spinal cord [1]. The traditional concept of NMO was that it is a monophasic disorder, in which near-simultaneous bilateral optic neuritis and transverse myelitis arise. Nowadays, NMO is recognized as a discrete, relapsing, demyelinating disease, with clinical, neuroimaging, and laboratory findings that can distinguish it from MS [2, 3]. Moreover, the detection of NMO immunoglobulin G (NMO-IgG), an autoantibody, in the serum of patients with NMO, distinguishes NMO from other demyelinating disorders [4]. NMO-IgG binds to aquaporin-4 [5], which is the main channel that regulates water homoeostasis in CNS [6]. NMO-IgG is also detected in the serum of patients with disorders related to neuromyelitis optica, including Asian optic-spinal MS, recurrent myelitis associated with longitudinally extensive spinal cord lesions, recurrent isolated optic neuritis, and optic neuritis or myelitis in the context of certain organ-specific and non-organ-specific autoimmune diseases. Because NMO involves severe attacks of optic neuritis and myelitis, which, unlike the attacks in MS, diagnostic distinction between them is critical in order to provide the proper treatment. In recent years, diagnostic criteria used to distinguish NMO from MS have required “no evidence of clinical disease outside the optic nerve or spinal cord” as an absolute criterion and “negative brain MRI at onset” as a supportive criterion which may not be sensitive to reflect the early stage of NMO [7]. Recently using quantitative MRI techniques, some authors have investigated whether NMO has occult damage in the brain. Filippi et al. [8] did not find any significant changes in 8 NMO patients using MT imaging. Rocca et al. [9] found occult damage in the normal appearing gray matter (NAGM) of 10 patients with NMO with the use of MT and DTI. Using DTI histogram analysis, Yu et al. [10] found significant abnormalities in the normal appearing white matter (NAWM) and NAGM in NMO patients. Then using region of interest (ROI) analysis, they found that NMO patients had a higher average mean diffusivity (MD) and a lower average fractional anisotropy (FA) in ROIs being the continuation of the spinal white matter tracts or optic nerve and a normal average MD and FA in corpus callosum without direct connection with them. To further explain the diffusion abnormalities of brain NAWM in NMO, Yu et al. [11] studied diffusion indices of the corticospinal tract (CST), corpus callosum (CC), optic radiation (OR) and cingulum in NMO patients without visible lesions in the brain. Compared with controls, both global and regional analyses showed significant increases in MD and λ23 of the CST and OR in NMO, but not in any of the diffusion indices of the CC and cingulum. In NMO, MD and of the CST were correlated with motor function scores and MD and λ1 of the OR were correlated with visual function scores. However, normal appearing tissue damage in cervical spinal cord using MT and DTI has not been widely investigated due to technical limitations although understanding pathological mechanism in the cervical spinal cord is crucial in research of NMO. In this study, we aim to investigate: 1) Whether patients with NMO can be distinguished in normal appearing cervical spinal cord tissue damage from normal subjects using MT and DTI 2) Whether patients with NMO and MS can be distinguished in normal appearing cervical spinal cord tissue damage using MT and DTI 3) Whether patients with mild and severe cases of NMO can be distinguished in normal appearing cervical spinal cord tissue damage using MT and DTI We hypothesize that MT and DTI measurement will provide complementary information to conventional ways of diagnosis for patients with NMO and a further insight into the pathological mechanisms involved.

Project Title:	MRI detection of glycogen in vivo in diabetic mice
Investigator(s):	Kim M, Khong PL, Chung SK
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	09/2009

Abstract:

The goal of this research is to develop and validate a novel magnetic resonance imaging (MRI) method for imaging the glycogen content of in vivo tissue non-invasively. Glycogen, the primary storage form of glucose in mammalian tissues, plays a central role in systemic glucose homeostasis. Abnormalities of glycogen metabolism occur in certain rare inherited disorders [1], but glycogen content may also be abnormal in conditions such as obesity, insulin resistance, and type 2 diabetes (T2D). Thus, methods to quantify glycogen in vivo will be key to understanding the pathophysiology of these common diseases. Presently, to our best knowledge, the only non-invasive approach to study glycogen levels and/or glycogen metabolism in vivo is magnetic resonance spectroscopy (MRS) using natural abundance 13C-labeled isomers of glycogen in situ. However, 13C MRS is available only in specialized research sites because it requires equipment not available on most instruments. Quantification of the glycogen content in liver and other organs would be useful for a wide variety of applications if it could be performed with a standard clinical MRI scanner. Recently a water-signal-based glycogen imaging approach called chemical exchange saturation transfer (CEST) for glycogen was suggested by van Zijl et al. [2]. CEST has been emerged as an alternative contrast mechanism for MRI since early 2000 [3-11]. In this approach, selective radiofrequency (RF) irradiation of exchangeable solute protons, such as amide (NH) and hydroxyl (OH) groups [12-15], is detected through progressive saturation of the water signal consequential to chemical exchange. Although van Zijl et al. demonstrated significant correlation in glycogen signal between CEST imaging and 13C MRS measurement ex vivo, it is crucial to develop glycogen detection in vivo using CEST imaging as none of the research studies has been reported for in vivo glycogen metabolism. In this study, we chose transgenic mouse model to investigate glycogen metabolism in diabetes using CEST imaging. Diabetes is one of the most common and serious syndromes characterized by disordered metabolism, and hyperglycemia and can be a leading cause of other complications [16, 17]. T2D, accounting for about 90% of all cases of diabetes, is associated with increased insulin resistance and deficiency. Although the dysfunction of certain organ(s) and/or tissues associated with glucose metabolism may vary across diabetic patients, it is difficult to obtain specific therapeutic information by plasma data alone. In addition, the mechanisms that lead to obesity, insulin resistance, and metabolic resistance in the development of T2D are still unclear [16]. As the first step to understand glycogen metabolism in the development of T2D, we aim to investigate: 1) Whether CEST imaging can quantify liver glycogen level in vivo and further discriminate between normal and diabetic mice groups in wild type. 2) Whether glycogen detection using CEST imaging correlates with direct and conventional measurement of glycogen content. We hypothesize that CEST imaging and its validation study using mice model will enable us to investigate glycogen metabolism in vivo and in completely non-invasive manner, and further provide insight into the pathological mechanisms of many disorders which would be critical for the future human studies. References: 1. Wolfsdorf, J.I. and D.A. Weinstein, Glycogen storage diseases. Rev Endocr Metab Disord, 2003. 4(1): p. 95-102. 2. van Zijl, P.C., et al., MRI detection of glycogen in vivo by using chemical exchange saturation transfer imaging (glycoCEST). Proc Natl Acad Sci U S A, 2007. 104(11): p. 4359-64. 3. Ward, K.M., A.H. Aletras, and R.S. Balaban, A new class of contrast agents for MRI based on proton chemical exchange dependent saturation transfer (CEST). J Magn Reson, 2000. 143(1): p. 79-87. 4. Ward, K.M. and R.S. Balaban, Determination of pH using water protons and chemical exchange dependent saturation transfer (CEST). Magn Reson Med, 2000. 44(5): p. 799-802. 5. Goffeney, N., et al., Sensitive NMR detection of cationic-polymer-based gene delivery systems using saturation transfer via proton exchange. J Am Chem Soc, 2001. 123(35): p. 8628-9. 6. Zhou, J. and P.C. van Zijl, Chemical exchange saturation transfer imaging and spectroscopy Progr NMR Spectr 2006. 48(2-3): p. 109-136. 7. Zhang, S., et al., PARACEST agents: modulating MRI contrast via water proton exchange. Acc Chem Res, 2003. 36(10): p. 783-90. 8. Aime, S., et al., Paramagnetic lanthanide(III) complexes as pH-sensitive chemical exchange saturation transfer (CEST) contrast agents for MRI applications. Magn Reson Med, 2002. 47(4): p. 639-48. 9. Aime, S., et al., A paramagnetic MRI-CEST agent responsive to lactate concentration. J Am Chem Soc, 2002. 124(32): p. 9364-5. 10. Yoo, B. and M.D. Pagel, A PARACEST MRI contrast agent to detect enzyme activity. J Am Chem Soc, 2006. 128(43): p. 14032-3. 11. Liu, G., Y. Li, and M.D. Pagel, Design and characterization of a new irreversible responsive PARACEST MRI contrast agent that detects nitric oxide. Magn Reson Med, 2007. 58(6): p. 1249-56. 12. Zhou, J., et al., Using the amide proton signals of intracellular proteins and peptides to detect pH effects in MRI. Nat Med, 2003. 9(8): p. 1085-90. 13. van Zijl, P.C., et al., Mechanism of magnetization transfer during on-resonance water saturation. A new approach to detect mobile proteins, peptides, and lipids. Magn Reson Med, 2003. 49(3): p. 440-9. 14. Zhou, J., et al., Amide proton transfer (APT) contrast for imaging of brain tumors. Magn Reson Med, 2003. 50(6): p. 1120-6. 15. Ling, W., et al., Assessment of glycosaminoglycan concentration in vivo by chemical exchange-dependent saturation transfer (gagCEST). Proc Natl Acad Sci U S A, 2008. 105(7): p. 2266-70. 16. Guyton, A.C., Insulin, glucagon and diabetes mellitus. In: A.C. Guyton and J.E. Hall, Editors, Textbook of medical physiology (11th ed.), Elsevier Inc., Philadelphia, 2005. p. 961–977. 17. Wyckoff, J., et al., Diabetic complications: clinical aspects. In: C.R. Kahn, G.C. Weir, G.L. King, A.M. Jacobson, A.C. Moses and R.J. Smith, Editors, Joslin's diabetes mellitus (14th ed.), Lippincott Williams & Wilkins, Philadelphia (2005), pp. 885–1068.

Project Title:	Joint ISMRM-ESMRMB Annual Meeting 2010 Assessment of glycosaminoglycan distribution in human lumbar intervertebral discs using chemical exchange saturation transfer
Investigator(s):	Kim M
Department:	Diagnostic Radiology
Source(s) of Funding:	URC/CRCG - Conference Grants for Teaching Staff
Start Date:	05/2010
Completion Date:	05/2010

Abstract:

N/A

List of Research Outputs

Chan Q., Kim M., Anthony M., Cheung K.M.C., Chan A., Chan T. and Khong P.L., Quantitative comparison of T1r with T2 in intervertebral disc in vivo at 3T, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Chan Q., Anthony M., Zhang Z., Cheung K.M.C. and Kim M., Quantitative evaluation of diffusion tensor imaging at 3T in the human lumbar intervertebral disc degeneration , Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Kim M., Chan Q., Anthony M., Cheung K.M.C., Samartzis D., Chan T. and Khong P.L., Assessment of glycosaminoglycan distribution in human lumbar intervertebral discs using chemical exchange saturation transfer, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Kim M., Chan C.W.A., Mak H.K.F., Chan Q. and Chan K.H., Magnetization Transfer MRI measurements of Cervical Spinal Cord abnormalities in patients with Neuromyelitis Optica, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May. Stockholm, Sweden, 2010.

Kim M., Reliability and reproducibility of perfusion MRI in cognitively normal subjects, Magnetic Resonance Imaging. Elsevier, 2010.

Qian W., Mak H.K.F., Chan Q., Chan K.H. and Kim M., Quantitative assessment of the cervical spinal cord damage in neuromyelitis optica using diffusion tensor imaging at 3T , Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May. 2010.

Researcher : Kwok SPF

List of Research Outputs

Huang B., Law M.W.M., Mak H.K.F., Kwok S.P.F. and Khong P.L., Pediatric 64-MDCT coronary angiography with ECG-modulated tube current radiation dose and cancer risk, American Journal of Roentgenology . 2009, 193: 539-544.

Researcher : Lam WWM

List of Research Outputs

Liang X., Lam W.W.M., Cheung E.W.Y., Wu A.K.P., Wong S.J. and Cheung Y.F., Restrictive Right Ventricular Physiology and Right Ventricular Fibrosis as Assessed by Cardiac Magnetic Resonance and Exercise Capacity After Biventricular Repair of Pulmonary Atresia and Intact Ventricular Septum , Clinical Cardiology . 2010, 33: 104-110.

Researcher : Lau YC

List of Research Outputs

Lau Y.C., Ho C.L., Leung Y.L., Cheng T., Yeung W.D., Anthony M. and Khong P.L., The Utility of 19F-Fluoride PET/CT for the detection of skull base involvement in nasopharyngeal carcinoma, SNM 57th Annual Meeting, Salt Lake City, Utah, USA, 5-9 June 2010.

Researcher : Lee R

List of Research Outputs

Teo K.C., Mahboobani N.R., Lee R., Cheung R.T.F., Ho S.L., Tse C.T. and Chan K.H., Intracerebral hemorrhage complicating anticoagulant therapy among Hong Kong Chinese, 15th Medical Research Conference, Faculty of Medicine, The University of Hong Kong. 2010.

Researcher : Mak HKF

Project Title:	Susceptibility-weighted and diffusion-tensor MR imaging in mild traumatic brain injury – a correlative study with cognitive clinical outcome.
Investigator(s):	Mak HKF, Khong PL, Leung GKK
Department:	Diagnostic Radiology
Source(s) of Funding:	Seed Funding Programme for Basic Research
Start Date:	04/2008
Completion Date:	04/2010

Abstract:

Traumatic head injuries (TBI) are among the commonest type of trauma seen in the emergency departments worldwide (1,2). In United Kingdom, the majority of these cases have mild or minor head injury (1) and similarly, in the United States, approximately 80% of these injuries are classified as mild (3). Minor head injury is defined as a patient with a history of loss of consciousness, amnesia or disorientation and a Glasgow Coma Scale (GCS) score of 13-15. Computed tomography (CT) of head is commonly used and a previous study of 3121 patients after minor head injury found 8% of clinically significant brain injury and 3% of clinically unimportant injury(4). Although most patients recover fully from mild head injury, cognitive symptoms known collectively as post-concussion syndrome are seen in a subgroup of patients, ranging from 7% to 33% (5). Therefore, it is in the symptomatic mild TBI patients with negative clinical imaging that a search for more sensitive imaging techniques or biomarkers continues. Magnetic resonance imaging (MRI) is a more sensitive technique than computed tomography (CT) in revealing shear injury in the white matter (6, 7). Diffuse axonal injury (DAI) often occurs in the absence of a direct impact to the cranium and is caused by inertial forces that are commonly associated with road traffic accidents, although it may rarely be associated with falls and assaults (8). With the advent of new MR techniques such as diffusion tensor imaging (DTI), Inglese et al showed that subtle functional abnormalities were present in brain areas that were frequent sites of DAI (9). Another study by Nakayama et al (10) revealed that DTI detected disruption of the corpus callosum and fornix in patients with TBI without macroscopic lesion. Although elusive in literature, it is believed that conventional imaging findings based on CT and MRI cannot accurately predict functional recovery and patients with deep white matter and brainstem lesions are more likely to suffer poor outcome (11). Nakayama et al found that there was a marked correlation between the mini-mental state examination and fractional anisotropy value in the splenium of the corpus callosum (10). However, a recent study by Scheid et al suggested a correlation between the amount of traumatic microbleeds and specific or global cognitive performance was absent (12). Another emerging MRI technique, susceptibility-weighted imaging have shown to be more sensitive than conventional GE imaging for detecting hemorrhagic DAI lesions in children (13,14). Tong et al found that SWI imaging yields useful additional information that can improve the evaluation, treatment and management of patients with traumatic brain injury and suspected DAI. In patients with extracerebral haematoma after head injury, it is currently believed that the cerebral mantel is probably not significantly injured in the absence of any CT evidence of parenchymal injury. However, many of these patients may present with post-concussion symptoms upon follow-up. So the suspicion is that although the initial findings of the brain parenchyma on CT may be normal, it remains possible that a degree of parenchymal injury exists after the impact. In our present study, we aim: (1) To explore the degree of injury to the cerebral parenchyma in patients suffered from post-traumatic extra-cerebral haematoma using advanced MRI techniques i.e. diffusion tensor imaging (DTI) and susceptibility weighted imaging (SWI). (2) To correlate these radiological findings with clinical cognitive assessment.

Project Title:	Comparison of cerebral blood flow patterns in mild cognitive impairment patients with or without previous stroke by using pulsatile arterial spin-labeling magnetic resonance imaging
Investigator(s):	Mak HKF, Cheung RTF, Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	01/2009

Abstract:

Background and Objectives: Neurodegenerative disease and/or cerebrovascular disorders causing dementia are becoming a worldwide public health problem as the geriatric population is increasing. The commonest degenerative cause of dementia is Alzheimer’s disease (AD) but a large proportion of patients have a varied combination of degenerative and vascular pathology (1). The conceptual introduction of mild cognitive impairment (MCI) preceding dementia is of clinical importance (2). Firstly, although this clinical condition is recognized as a transitional stage to fully developed dementia, not all MCI patients progress to clinically defined AD or decline at an identical rate (3). Secondly, such an early detection is warranted as the rapid decline of the cognitive function of some of these patients might be arrested if intervention were introduced at an earlier stage. Structural brain changes in the MCI patients had been studied extensively using Magnetic Resonance Imaging (4,5). Previous studies found that MCI patients have a reduction in the volumes of anatomical structures such as entorhinal cortex and hippocampus, residual size being either intermediate between normal elders and AD or similar to AD (6). Volumetry was found to be a predictor for conversion of MCI to AD by several prospective studies (6,7). Functional brain imaging employing FDG-PET and SPECT studied altered cerebral glucose metabolism and altered cerebral blood flow respectively. FDG-PET found substantial reduction in glucose metabolism in the limbic structures of MCI patients (8) and predicted decline of normal subjects to MCI and AD in a longitudinal study (9). Similar prediction was made by SPECT in distinguishing MCI convertors from non-convertors (10). The recent introduction of a magnetic resonance imaging technique into clinical practice, arterial spin labeling (ASL), has opened up a new arena for assessment of cerebral blood flow (CBF). This quantitatively MRI perfusion imaging method has an advantage of being non-invasive as it does not require intravenous injection of an exogenous tracer (11). ASL MRI uses electromagnetic labeling of the naturally occurring water in the blood to acquire images sensitive to flow. In gist, the endogenous perfusion contrast in the images gathered by this technique comes from the subtraction of two successively acquired images: one with and the other without proximal labeling of arterial water spins after a small delay time. A preliminary study of the utility of ASL MRI for detection of cerebral blood flow abnormalities in AD found that the cognitive decline correlate with decrease in CBF in posterior parietal and posterior cingulate but not temporal (12). Further studies are required for validating the method and its application in MCI and AD. We attempt to assess the cerebral blood flow patterns in MCI patients with or without previous stroke using this non-invasive technique and compare them with elderly normal controls. References: 1. Bastos Leite AJ, Scheltens P, Barkhof F. Pathological Aging of the Brain: an overview. Topics in Magnetic Resonance Imaging 2004; 15: 369-389. 2. Peterson RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56: 303-308. 3. Larrieu S, Letenneur L, Orgogozo JM, et al. Incidence and outcome of mild cognitive impairment in a population-based prospective cohort. Neurology 2002; 59: 1594-1599. 4. Schuff N, Zhu XP. Imaging of mild cognitive impairment and early dementia. British Journal of Radiology 2007; 80: S109- S114. 5. Ramani A, Jensen JH, Helpern JA. Quantitaive MR imaging in Alzheimer Disease. Radiology 2006; 241; 26-42. 6. Jack Jr CR, Peterson RC, Xu YC, et al. Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment. Neurology 1999; 52:1397-1403. 7. Devanand DP, Pradhaban G, Liu X, et al. Hippocampal and entorhinal atrophy in mild cognitive impairment: prediction of Alzheimer disease. Neurology 2007; 68: 828-836. 8. Nestor PJ, Fryer TD, Smielewski P, et al. Limbic hypometabolism in Alzheimer’s disease and mild cognitive impairment. Ann Neurol 2003; 54: 343- 351. 9. Chetelat G, Desgranges B, de la Sayette V, et al. Mild cognitive impairment: can FDG-PET predict who is to rapidly convert to Alzheimer’s disease. Neurology 2003; 60: 1374-1377. 10. Huang C, Eidelberg D, Habeck C, et al. Imaging markers of mild cognitive impairment: multivariate analysis of CBF SPECT. Neurobiol Aging 2007; 28: 1062-69. 11. Golay X, Hendrikse J, Lim T. Perfusion imaging using arterial spin labeling. Top Magn Reson Imaging 2004; 15: 10-27. 12. Paiva FF, Tannus A, Silva AC. Measurement of cerebral perfusion territories using arterial spin-labeling. NMR Biomed 2007; 20: 633-642.

Project Title:	Volumetric and Advanced Functional MR Imaging in Neuropsychiatric Systemic Lupus Erythematosis(NPSLE)
Investigator(s):	Mak HKF, Mok TMY
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	11/2009

Abstract:

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects predominantly young women that can cause significant disease complications and may even lead to death.. SLE is more commonly found in the Chinese than the Caucasian population. This disease is characterized by multiple body organ involvement and a autoantibodies with different cellular targets. Among the different organ involvement, nervous system involvement (occurring in 14-75% of SLE patients), neuropsychiatric lupus (NPSLE), carries poor prognosis and is the least understood in presentation and pathogenesis compared to other organ involvement. NPSLE are heterogeneous syndromes with a wide spectrum of clinical presentations. Diffuse presentation of NPSLE may lead to cognitive dysfunction which is recognized as organ damage in lupus. Moreover, cognitive dysfunction has also been described in SLE patients with no history of NPSLE. There are no reliable biomarkers for diagnosis of this condition. Current diagnosis relies on a combination of modalities of investigations, including cerebrospinal fluid analysis, CT scan and MRI scan of the brain. A number of autoantibodies have been found to be associated with NPSLE but with inconsistent results. As the clinical course and predictive factors of cognitive dysfunction in patients with NPSLE has not been well addressed, this study aims to examine cognitive dysfunction in SLE patients with NPSLE and to describe its clinical course by longitudinal evaluation for 2 years and to examine radiological biomarkers for prediction of cognitive dysfunction, its relation with underlying medical and psychiatric conditions and impact of this condition in terms of work productivity and psychosocial problems. Prevalence of global atrophy in NPSLE vary widely (11-82%), probably due to the subjective natureof the methods used for measuring global atrophy and differences in patient populations. Recently, due to rapid development in computer science, computational MR (magnetic resonance) neuroanatomy has gained widespread acceptance in neuroscience. The advantages are of two-fold: firstly, these methods have become increasingly automated, avoiding error- prone and labour intensive manual measurements and secondly, such algorithms have unprecedented precision and can detect brain volume differences of 0.5% between images from the same individual. One of these methods, voxel-based morphometry (VBM) proposed by Ashburner and Friston, has been employed in evaluation of AD. Neurological and psychiatric involvement is mainly manifested as cerebrovascular disease, seizures, cognitive impairment, headaches and psychosis. Since neurometabolic impairment, neurochemistry and perfusion abnormalities in NPSLE may precede anatomic lesions, new functional techniques such as magnetic resonsance spectroscopy, MR diffusion and perfusion weighted imaging may be useful to identify pathological changes unrevealed by conventional imaging.

List of Research Outputs

Anthony M., Khong P.L. and Mak H.K.F., An unusual case of synchronous renal cell carcinoma in a horseshoe kidney and intrahepatic cholangiocarcinoma, Clinical Nuclear Medicine. in press, 2009, 34: 922-923.

Anthony M., Zhang Z., Feng S.T., Yau K.K.W., Khong P.L. and Mak H.K.F., Comparison of 3T diffusion weighted magnetic resonance imaging and 18F-fluoro-2-deoxyglucose positron emission tomography/ computed tomography in cervical lymphadenopathy of patients with nasopharyngeal carcinoma, 110th Annual Meeting of the American Roentgen Ray Society, San Diego, CA, USA. 2-7 May 2010.

Chan D.T.M., Kan P.K.Y., Lam J.M.K., Zhu X.L., Chan Y.L., Mak H.K.F., Wong T.Y.Y. and Poon W.S., Cerebral motro cortical mapping: Awake procedure is preferable to general anesthesia, Surgical Practice. 2010, 14: 12-18.

Chan K.S., Mak H.K.F., Huang B., Yeung D.W.C., Kwong D.L.W. and Khong P.L., Nasopharyngeal carcinoma: relationship between 18F-FDG PET-CT maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis, and TNM classification, Nuclear Medicine Communication . 2010, 31: 206-210.

Gao J., Cheung R.T.F., Lee T.M.C., Chu L.W., Cheung C., Qiu D., Mak H.K.F. and Chan Y.S., Declined frontal white matter integrity in Alzheimer’s disease: a diffusion tensor imaging study, Medical Research Conference, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, 2010. Hong Kong Medical Journal. 2010, 16 (suppl 1): 21.

Huang B., Law M.W.M., Mak H.K.F., Kwok S.P.F. and Khong P.L., Pediatric 64-MDCT coronary angiography with ECG-modulated tube current radiation dose and cancer risk, American Journal of Roentgenology . 2009, 193: 539-544.

Kim M., Chan C.W.A., Mak H.K.F., Chan Q. and Chan K.H., Magnetization Transfer MRI measurements of Cervical Spinal Cord abnormalities in patients with Neuromyelitis Optica, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May. Stockholm, Sweden, 2010.

Lee T.M.C., Ip K.Y., Wang K., Xi C.H., Hu P.P., Mak H.K.F., Han S.H. and Chan C.C.H., Faux pas deficits in people with medial frontal lesions as related to impaired understanding of a speaker's mental state., Neuropsychologia. 2010, 48: 1670-1671.

Mak H.K.F., 13. AD or not AD- Perspectives from structural and functional imaging by MRI. Alzheimer's disease conference: from public health to therapeutic insights. May 28-29, 2010., Hong Kong University Alzheimer's Disease research network (HKUADRN) and Memory centre, University of Paris 7, France.. 2010.

Mak H.K.F., Imaging in Epilepsy, Macao Chinese Medical Association. 2010.

Mak H.K.F., New Imaging methods for Cerebrovascular Diseases , Department of Diagnostic Imaging (DDI), National University Hospital System, National University of Singapore, Singapore, December 7 to 11, 2009. . 2009.

Mak H.K.F., New Imaging methods for Cerebrovascular Diseases. , 15th Hong Kong Medical Forum, Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong. March 8-9, 2010.. 2010.

Mak H.K.F., The Blood-Brain Barrier- perspectives from Modern Neuroimaging , Department of Diagnostic Imaging (DDI), National University Hospital System, National University of Singapore, Singapore. 2009.

Mok T.M.Y., Chiu S.S.H., Lo Y., Mak H.K.F., Wong R.W.S., Khong P.L. and Lau W.C.S., Coronary atherosclerosis using CT coronary angiogram in patients with systemic sclerosis. Rely letter to Editor., Scand J Rheumatol . 2010, 38(5): 381-385.

Qian W., Mak H.K.F., Chan Q., Chan K.H. and Kim M., Quantitative assessment of the cervical spinal cord damage in neuromyelitis optica using diffusion tensor imaging at 3T , Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May. 2010.

Wang S., Yiu K.H., Mok T.M.Y., Ooi C.G.C., Khong P.L., Mak H.K.F., Lau C.P., Lam K.F., Lau W.C.S. and Tse H.F., Prevalence and extent of calcification over aorta, coronary and carotid arteries in patients with rheumatoid arthritis, Journal of Internal Medicine . 2009, 266: 445-452.

Yeung C.K., Trendell-Smith N.J., Mak H.K.F., Lam C.C.K. and Kwong Y.L., ‘Western’ or ‘Asian’ intravascular large B-cell lymphoma?, Clinical and Experimental Dermatology. 2009, 34(7): e482–e483.

Yiu K.H., Wang S.L., Mok T.M.Y., Ooi C.G.C., Khong P.L., Mak H.K.F., Lam K.F., Lau W.C.S. and Tse H.F., Pattern on atherosclerosis for coronary, carotid and aortic arteries calcification in rheumatoid arthritis: a multidetector CT study, Journal of American College of Cardiology. 2009, 53: A432.

Yung A.W.Y., Wong V.C.N., Khong P.L., Mak H.K.F., Hung K.N., Chan P.H., Ho W.Y. and Fan Y.W., Paediatric Epilepsy Surgery Program in Hong Kong - a single centre experience, Annual Scientific Meeting 2009, The Hong Kong Neurological Society, Hong Kong, 7 November 2009.

Zhang Z., Mak H.K.F., Khong P.L. and Chu L.W., Structural changes in the Chinese patients with Alzheimer’s disease by using VBM method, 3rd Joint Scientific Meeting of The RCR & HKCR and 17th ASM of HKCR, 31 October-1 November 2009.

Researcher : Ngan SSC

List of Research Outputs

Ngan S.S.C., Hu X., Tan L.H. and Khong P.L., Improvement of spectral density-based activation detection of event-related fMRI data, Magnetic Resonance Imaging. 2009, 27: 879–894.

Researcher : Ooi CGC

Project Title:	Nasal T/NK-cell lymphoma: CT and MR imaging features of a new clinico-pathological entity: lethal midline granuloma reclassified
Investigator(s):	Ooi CGC, Liang RHS, Kwong YL, Chim JCS
Department:	Diagnostic Radiology
Source(s) of Funding:	Other Funding Scheme
Start Date:	06/1999

Abstract:

To describe the radiological features with respect to computed tomography (CT) and magnetic resonance imaging (MRI) of nasal T/NK cell lymphoma; to devise a local (T) tumour staging system and evaluate any correlation with survival and prognosis.

Project Title:	Computed tomography (CT) characterization of irreversible asthma with morphologic functional correlation
Investigator(s):	Ooi CGC, Ip MSM, Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	Low Budget High Impact Programme
Start Date:	11/2001

Abstract:

To characterize CT features of irreversible or end stage asthma; to develop a scoring system to quantify these changes on CT; to correlate lung function with CT score of lung changes; to evaluate whether small airways disease seen on CT is an association of end-stage asthma; to evaluate the significance of bronchial wall thickening in this condition.

Project Title:	Prognostic significance of CT-derived tumour volume in oesophageal cancer
Investigator(s):	Ooi CGC, Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	11/2002

Abstract:

To quantify baseline and post chemo-irradiation (post-treatment) tumour volumes (TV) in patients with oesophageal carcinoma using computed tomography (CT); to quantify post-treatment TV based on PET (positron emission tomography)/CT data; to evaluate the relationships between baseline and post-treatment TV, with T-stage, N-stage, overall stage and survival; to evaluate the relationship between SUV (standardised uptake value) uptake in PET and TV; to determine the significance of baseline and post-treatment CT-TV on changes in T and N stage after chemo-irradiation.

Project Title:	Clinical utility of radiological assessment of Severe Acute Respiratory Syndrome: a retrospective and prospective study on a cohort of SARS patients
Investigator(s):	Ooi CGC, Tsang KWT, Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	VCO SARS Research Fund
Start Date:	07/2003

Abstract:

To quantify severity of severe acute respiratory syndrome (SARS) on chest radiograph and to determine its relationship with clinical parameters; to evaluate the predictive value of chest radiographs on oxygen supplementation requirement and treatment response in severe acute respiratory syndrome (SARS); to document serial lung changes on HRCT int he acute and covalescent period; to document and describe irreversible lung changes of HRCT on long term follow-up.

Project Title:	HRCT quantification of lung disease in SARS: correlation with clinical parameters and residual disease
Investigator(s):	Ooi CGC, Tsang KWT, Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	11/2003

Abstract:

To validate a commercially available quantitative technique in measuring normal lung volume and volume of lung abnormalities on high resolution CT (HRCT) scans; to correlate disease volume measured on HRCT at or near maximal lung disease as defined on chest radiograph in SARS with clinical parameters such as exercise tolerance, and amount of residual disease 6 months after discharge.

Project Title:	1st World Congress of Thoracic Imaging and Diagnosis in Chest Disease An Analysis of Acute and Follow-up HRCT Features in 23 Cases of Cryptogenic Organizing Pneumonia (COP) Clinical Utility of Multislice CT in the Investigation of Haemoptysis
Investigator(s):	Ooi CGC
Department:	Diagnostic Radiology
Source(s) of Funding:	URC/CRCG - Conference Grants for Teaching Staff
Start Date:	05/2005

Abstract:

N/A

List of Research Outputs

Lam C.M., Lam B., Yao T.J., Lai A.Y.K., Ooi C.G.C., Tam S., Lam K.S.L. and Ip M.S.M., A randomized controlled trial of nCPAP on insulin sensitivity in obstructive sleep apnea, Eur Respir J. . 2009.

Wang S., Yiu K.H., Mok T.M.Y., Ooi C.G.C., Khong P.L., Mak H.K.F., Lau C.P., Lam K.F., Lau W.C.S. and Tse H.F., Prevalence and extent of calcification over aorta, coronary and carotid arteries in patients with rheumatoid arthritis, Journal of Internal Medicine . 2009, 266: 445-452.

Yiu K.H., Wang S.L., Mok T.M.Y., Ooi C.G.C., Khong P.L., Mak H.K.F., Lam K.F., Lau W.C.S. and Tse H.F., Pattern on atherosclerosis for coronary, carotid and aortic arteries calcification in rheumatoid arthritis: a multidetector CT study, Journal of American College of Cardiology. 2009, 53: A432.

Yiu K.H., Wang S., Mok T.M.Y., Ooi C.G.C., Khong P.L., Lau C.P., Lai W.W., Wong L.Y., Lam K.F., Lau W.C.S. and Tse H.F., Role of circulating endothelial progenitor cells in patients with rheumatoid arthritis with coronary calcification, Journal of Rheumatology . 2010, 37: 529-535.

Researcher : Peh WCG

Project Title:	8th Refresher Course of the British Society of Skeletal Radiology & 6th Scientific Meeting of the European Society of Musculoskeletal Radiology Insufficiency Fractures of the Pelivs (BSSR) MR Imaging og the Hand and Wrist (ESSR) Research Structure in the Far East
Investigator(s):	Peh WCG
Department:	Diagnostic Radiology
Source(s) of Funding:	URC/CRCG - Conference Grants for Teaching Staff
Start Date:	10/1999

Abstract:

N/A

Researcher : Qian W

List of Research Outputs

Qian W., Mak H.K.F., Chan Q., Chan K.H. and Kim M., Quantitative assessment of the cervical spinal cord damage in neuromyelitis optica using diffusion tensor imaging at 3T , Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May. 2010.

Researcher : Qiu D

Project Title:	Diffusion Kurtosis Imaging of Normal Brain Development from Late Childhood to Young Adulthood
Investigator(s):	Qiu D, Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	Small Project Funding
Start Date:	12/2009

Abstract:

Conventional diffusion weighted imaging and diffusion tensor imaging have been widely used in evaluating the integrity of neural tissues and in in-vivo tracking of bulk neural pathways between different brain regions (1, 2). However, as the model underlying these techniques assumes perfect Gaussian distribution of water diffusion, they failed to distinguish whether a change in water diffusivity is due to change in viscosity or in the surrounding micro-environment which restricts the motion of water molecules. In homogenous solution, the diffusion process follows Gaussian distribution; while in tissues, the complex underlying microstructures form barriers to moving water molecules, causing the diffusion process to deviate from Gaussian distribution. Indeed, many studies have shown that the distribution of water diffusion deviates from Gaussian distribution in neural tissues (3). Characterizing such non-Gaussianality can provide additional information about the tissue microstructure and could lead to better characterization of the integrity of neural tissues. There were several previous attempts to quantify such non-Gaussianality, however those techniques either are based on non-realistic assumptions or require too long scan time to be applicable in clinical settings (4, 5). Recently, diffusion kurtosis imaging (DKI) has emerged as a new imaging technique, which approximates the diffusion signal profile using a second-order polynomial model. It is based on physically sound foundations and does not require prolonged scan time. A quantitative index, excess kurtosis, can be obtained from the model, which represents the degree of deviation of water diffusion from Gaussian distribution. As the non-Gaussian behavior of water diffusion stems from barriers of the surrounding micro-environment, excess kurtosis can potentially be used as a sensitive measure reflecting the complexity of tissue microstructures. Indeed, DKI has been used in studying some pathologies including schizophrenia (6) and ADHD (7), and promising results have been shown. As for every new imaging technique, the building of normal standard is the first and an important step towards clinical application. Therefore, the purpose of the proposed study is to 1. Build a normal database of diffusion kurtosis imaging from late childhood to young adulthood covering the whole brain against which data of various pathologies can be compared 2. Evaluate spatial-temporal pattern of age related changes in diffusion kurtosis using advanced image analysis techniques 3. Investigate gender effects on brain development as measured by diffusion kurtosis 4. Develop image processing software for the analysis of DKI images Key points and problems addressed: While there was one study evaluating age-related changes of diffusion kurtosis, only the frontal part of the brain was imaged and evaluated (8). It is well known that brain development varies in spatial-temporal pattern among different regions; measuring age-related change in a single region is therefore in-adequate in painting the whole picture of brain development. Furthermore, compared to the ROI method employed in the previous study, advanced image analysis technique could yield far more detailed and comprehensive information and better characterization of regional pattern of brain maturation (9). Moreover, gender effect on brain maturation as measured by DKI is another interesting issue for investigation. References: 1. Basser PJ, Pajevic S, Pierpaoli C, Duda J, Aldroubi A. In vivo fiber tractography using DT-MRI data. Magn Reson Med 2000;44(4):625-632. 2. Basser PJ, Mattiello J, LeBihan D. Estimation of the effective self-diffusion tensor from the NMR spin echo. J Magn Reson B 1994;103(3):247-254. 3. Karger J. NMR self-diffusion studies in heterogeneous systems. Adv Colloid Interface Sci 1985;23:129-148. 4. Assaf Y, Mayk A, Eliash S, Speiser Z, Cohen Y. Hypertension and neuronal degeneration in excised rat spinal cord studied by high-b value q-space diffusion magnetic resonance imaging. Exp Neurol 2003;184(2):726-736. 5. Mulkern RV, Gudbjartsson H, Westin CF, Zengingonul HP, Gartner W, Guttmann CR, Robertson RL, Kyriakos W, Schwartz R, Holtzman D, Jolesz FA, Maier SE. Multi-component apparent diffusion coefficients in human brain. NMR Biomed 1999;12(1):51-62. 6. Ramani A, Jensen J.H., Szulc KU, Ali O, Hu C, Lu H, Brodle JD, Helpern JA. Assessment of abnormalities inthe cerebral microstructure of schizophrenia patients: a diffusional kurtosis imaging study. Proc Int Soc Magn Reson Med 2007;15:648. 7. Helpern JA, Falangola M.F., Dl Martino A, Ramani A, Babb JS, Hu C, Jensen J.H., Castellanos FX. Alterations in brain microstructure in ADHD by diffusional kurtosis imaging. Proc Int Soc Magn Reson Med 2007;16:3325. 8. Falangola MF, Jensen JH, Babb JS, Hu C, Castellanos FX, Di MA, Ferris SH, Helpern JA. Age-related non-Gaussian diffusion patterns in the prefrontal brain. J Magn Reson Imaging 2008;28(6):1345-1350. 9. Smith SM, Jenkinson M, Johansen-Berg H, Rueckert D, Nichols TE, Mackay CE, Watkins KE, Ciccarelli O, Cader MZ, Matthews PM, Behrens TE. Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data. Neuroimage 2006;31(4):1487-1505.

List of Research Outputs

Qiu D., Wang S., So K.F., Wu E.X., Leung L. and Khong P.L., Susceptibility of the optic nerve and the involvement of retrograde neuronal degeneration in a delayed radiation induced injury model: evidence from a diffusion tensor imaging study, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Qiu D., Chan G.C.F., Chan Q., Ha S.Y. and Khong P.L., Susceptibility weighted imaging (SWI) for the assessment of iron loading in the brain of beta-thalassemia major patients., 1st meeting of the Asia-Pacific Iron Academy, Chiang Mai, 23-26 Nov 2009.

Qiu D., Chan G.C., Chan Q., Ha S.Y. and Khong P.L., Susceptibility weighted imaging (SWI) for the assessment of iron loading in the brain of beta-thalassemia major patients, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Researcher : Tai KS

List of Research Outputs

Cheung V., Chiu C.P.Y., Law C.W., Cheung C., Hui C.L.M., Chan K.K.S., Sham P.C., Deng Y., Tai K.S., Khong P.L., McAlonan G.M., Chua S.E. and Chen E.Y.H., Positive symptoms and white matter microstructure in never-medicated first episode schizophrenia, Psychological Medicine. 2010, 40: 1-12.

Researcher : Tso WK

List of Research Outputs

Chan K.L., Fan S.T., Lo C.M., Wei W.I., Ng W.M., Chung H.Y., Ng K.K.C., Chan S.C., Chan K.W., Tso W.K., Tsoi N.S. and Tam P.K.H., Pediatric liver transplantation in Hong Kong - a domain with scarce deceased donors, Journal of Pediatric Surgery. 2009, 44(12): 2316-2321.

Ng K.K.C., Poon R.T.P., Cheung T.T., Chu F.S.K., Tso W.K. and Fan S.T., High efficacy of high intensity focused ultrasound without transarterial embolization for hepatocellular carcinoma (Poster Presentation), International Liver Cancer Association 3rd Annual Conference, Milan, Italy, 4 - 6 September 2009.

Ng K.K.C., Poon R.T.P., Chok K.S.H., Cheung T.T., Tung H., Chu F.S.K., Tso W.K., Yu W.C. and Fan S.T., High efficacy of high-intensity focused ultrasound without transarterial embolization for hepatocellular carcinoma - Hong Kong experience (Abstract), The 1st International Summit of Noninvasive Ultrasound Treatment, Chongqing, China, 22-23 October 2009.

Wang A.Y.M., Cheung C.W., Chu J.Y.Y., Fok A.N.Y., Lo W.K., Leung J.C.K., Tso W.K. and Lai K.N., Is aortic pulse wave velocity a useful screening test for vascular and valvular calification in end-stage renal disease patients, Journal of American Society of Nephrology. 2009, 20: 443A-444A.

Researcher : Tsui KW

List of Research Outputs

Tsui K.W. and Chan T., A novel framework for automatic matching of PET/CT images using grid-based SIFT algorithm, 24th International Congress and Exhibition of Computer Assisted Radiology and Surgery. Geneva, Switzerland, 2010.

Researcher : Wang S

List of Research Outputs

Gu J., Khong P.L., Wang S., Liu K.Y., Law W.L., Chan Q. and Zhang J., Correlation study of quantitative indexes from DWI and PET-CT in primary rectal cancer, 3rd Joint Scientific Meeting of The RCR & HKCR and 17th ASM of HKCR, 31 October-1 November 2009.

Gu J., Khong P.L., Wang S., Chan Q., Law W.L., Liu K.Y. and Zhang J., Dynamic Contrast-enhanced MRI of Primary Rectal Cancer at 3T: Correlation with Positron Emission Tomography, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Gu J., Khong P.L., Wang S., Liu K.Y., Law W.L., Chan Q. and Zhang J., Dynamic contrast-enhanced MRI of primary rectal cancer at 3T: correlation with positron emission tomography, 16th Hong Kong International Cancer Congress and 6th Annual Meeting Centre for Cancer Research ,The University of Hong Kong Li Ka Shing Faculty of Medicine, 4-6 November 2009.

Gu J., Khong P.L., Wang S., Chan Q., Law W.L., Liu K.Y. and Zhang J., Quantitative analysis of indexes from DWI and PET/CT in primary rectal cancer, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Qiu D., Wang S., So K.F., Wu E.X., Leung L. and Khong P.L., Susceptibility of the optic nerve and the involvement of retrograde neuronal degeneration in a delayed radiation induced injury model: evidence from a diffusion tensor imaging study, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Wang S., Wu E.X., Lau H.F., Gu J., Zhou J.Y. and Khong P.L., Characterization of mild hypoxic-ischemic injury in multiple white matter tracts in a neonatal rat model by diffusion tensor MR imaging, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Wang S., Wu E.X., Cai K., Lau H.F., Cheung P.T. and Khong P.L., Mild hypoxic-ischemic injury in the neonatal rat brain: longitudinal valuation of white matter using diffusion tensor MR imaging, American Journal of Neuroradiology. 2009, 30: 1907-1913.

Wang S., Yiu K.H., Mok T.M.Y., Ooi C.G.C., Khong P.L., Mak H.K.F., Lau C.P., Lam K.F., Lau W.C.S. and Tse H.F., Prevalence and extent of calcification over aorta, coronary and carotid arteries in patients with rheumatoid arthritis, Journal of Internal Medicine . 2009, 266: 445-452.

Yiu K.H., Wang S., Mok T.M.Y., Ooi C.G.C., Khong P.L., Lau C.P., Lai W.W., Wong L.Y., Lam K.F., Lau W.C.S. and Tse H.F., Role of circulating endothelial progenitor cells in patients with rheumatoid arthritis with coronary calcification, Journal of Rheumatology . 2010, 37: 529-535.

Researcher : Wong CS

Project Title:	Comparison of DWIBS MRI and PET-CT for the diagnostic performance and the accuracy of treatment response monitoring in GISTs
Investigator(s):	Wong CS, Lee VHF, Khong PL, Chu KM
Department:	Diagnostic Radiology
Source(s) of Funding:	Seed Funding Programme for Basic Research
Start Date:	06/2010

Abstract:

GIST is the most common non-epithelial tumor of the GI tract (3, 4). The term ‘GIST’ was first used to describe tumors originally designated as leiomyoma, leiomyoblastoma and leiomyosarcoma (5). With the evolution of the immunochemical staining technique, GIST can now be confidently identified as a distinct subset by the positivity of CD 117 (KIT) which is the tyrosine kinase receptor expressed in 98% of GIST. Histologically, GIST is composed of uncontrolled proliferation of interstitial cells of Cajal (6), which elicit slow wave potential and control the motility of the gastrointestinal smooth muscle. Metastasis is common in GISTs and it can occur in up to 50% at presentation (7). More than 95% of GISTs’ metastasis occurs inside the abdomen with liver being the most common site followed by the peritoneum (5). Brain, lung, bone and lymph node metastasis are generally believed to be extremely rare with only several reported cases in the literatures (8, 9). Whilst surgery remains the main treatment of choice for GISTs (10, 11), the disease-modulating drug Gleevec (Imatinib mesylate), a tyrosine kinase inhibitor, is now known to be very effective by suppressing the tyrosine kinase activity and therefore limiting tumour growth (12-15). PET-CT has been used as the imaging modality of choice in diagnosis, staging and treatment response monitoring in GISTs (1). It provides functional as well as anatomical information about the tumor. SUVmax used in PET-CT is the semi-quantitative measurement of tissue deoxyglucose metabolic rate which in turn reflects the tumor metabolic activity. It is well established that the SUVmax correlates well with disease prognosis and patient outcome. MRI with Diffusion weighted imaging (DWI) is an alternative imaging method recently studied in various oncological diseases. It delineates the anatomical details as well as provides information of tumor cellularity. The solid tumor with higher cellularity would restrict free water diffusion in the extracellular space. ADCmin can be derived which is the quantitative marker of tumor cellularity and hence may reflect tumor aggressiveness. DWI is a well-established imaging modality in studying intra-cranial tumours. However, due to the challenges of movement or susceptibility artefacts in the application of DWI in body MR imaging, this technique has only recently been successfully used for the evaluation of body tumours. (17-20). With the breakthrough of the new sequence called ‘Diffusion Weighted Imaging with Background Body Signal Suppression’ (DWIBS) in 2004 by Takahara et al (21), the aforementioned limitations of DWI have now been largely overcome and allow scanning with free breathing. This new breakthrough carries a promising potential in application of DWIBS sequence in body oncology imaging (23-25). However, to the best of our knowledge, to date, there is no study comparing the diagnostic performance and accuracy of treatment monitoring between MRI DWIBS and PET-CT in metastatic GISTs. The objectives of this study are to establish that MRI with DWIBS is at least comparable to PET-CT in terms of 1) Diagnostic performance; and 2) Treatment response monitoring in metastatic GISTs; and 3) To correlate the SUVmax and ADCmin in the hypermetabolic GIST lesions.

List of Research Outputs

Chu T.Y.C. and Wong C.S., A rare clinical outcome of esophageal gastrointestinal stromal tumour: bony metastasis with PET-CT findings correlation, Journal of Hong Kong College of Radiologists. 2009, 11: 172-175.

Chu Y.C., Wong C.S., Mak W.S., Cheng L.F. and Ma K.F., An appraisal of urgent small bowel follow through protocol using gastrografin in case of small bowel obstruction, Journal of Hong Kong College of Radiologists. 2009, 12: 57-59.

Lai V., Lau H.Y., Chan W.C. and Wong C.S., An ususual presentation in a patient with acute appendicitis complicated by portal and mesenteric thrombophlebitis, Journal of Hong Kong College of Radiologists. 2009, 11: 198-201.

Lau H.Y., Wong C.S., Kan Y.L., Siu K.L. and Ma K.F., Ultrasonographic findings of melamine-related renal disorders in Hong Kong Children, Pediatrics Radiology. 2009, 39: 1188-1193.

Wong C.S., Chu Y.C., Griffith J. and Ng A.W.H., Clinical, pathological & radiological features of pleomorphic hyalinizing angiectatic tumour , Journal of Musculoskeletal Medicine. 2009, 26 (10): 3.

Wong C.S., Differentiation of primary brain tumor from metastasis by perilesional Cho/NAA ratio, Japan Radiological Society, April 2010.

Wong C.S., Gynaecological Surger, Peer reviewer. 2010.

Wong C.S., Yeung T.H., Wong K.W. and Ma K.F., Is ultrasound-guided modified co-axial core biopsy of the breast a better technique?, Hong Kong Medical Journal. 2009, 15: 246-248.

Wong C.S., Chu Y.C. and Tam K.F., Retroperitoneal schwannoma: a common tumour in an uncommon site, Hong Kong Medical Journal. 2010, 16 (1): 66-68.

Yeung T.H., Wong C.S., Tam W., Ma K.F. and Yung W.T., Adenoid cystic carcinoma with multiple pulmonary metastasis, Journal of Hong Kong College of Radiologists. 2009, 12: 68-71.

Researcher : Wong Y

List of Research Outputs

Chan S.C., Lo C.M., Wong Y., Ng K.K.C., Chok K.S.H. and Fan S.T., Validating graft and standard liver size predictions in right liver living donor liver transplantation (Abstract), The 15th Annual International Congress of the International Liver Transplantation Society, New York City, New York, U.S.A., 8 - 11 July 2009. Liver Transplantation. 2009, 15(Suppl 7): S247.

Researcher : Wu AKP

List of Research Outputs

Liang X., Lam W.W.M., Cheung E.W.Y., Wu A.K.P., Wong S.J. and Cheung Y.F., Restrictive Right Ventricular Physiology and Right Ventricular Fibrosis as Assessed by Cardiac Magnetic Resonance and Exercise Capacity After Biventricular Repair of Pulmonary Atresia and Intact Ventricular Septum , Clinical Cardiology . 2010, 33: 104-110.

Tsang H.H., Wong R.W.S., Trendell-Smith N.J., Wu A.K.P. and Mok T.M.Y., Diffuse large B-cell lymphoma of the central nervous system in mycophenolate mofetil-treated patients with systemic lupus erythematosus., HKMJ. 2010, 16: p54 S92.

Researcher : Yan FK

List of Research Outputs

Yan F.K. and Chan T., Segmentation of Individual Liver Segments Based on Automatic Identification of Hepatic Vascular Structures, 24th International Congress and Exhibition of Computer Assisted Radiology and Surgery. Geneva, Switzerland, 2010.

Researcher : Yeung DWC

List of Research Outputs

Chan K.S., Mak H.K.F., Huang B., Yeung D.W.C., Kwong D.L.W. and Khong P.L., Nasopharyngeal carcinoma: relationship between 18F-FDG PET-CT maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis, and TNM classification, Nuclear Medicine Communication . 2010, 31: 206-210.

Wong V.C.N., Sun J.G. and Yeung D.W.C., Randomized Control Trial of Using Tongue Acupuncture in Autism Spectrum Disorder Using PET Scan for Clinical Correlation, The Journal of Alternative and Complementary Medicine. 2010, 16(2): 1-12.

Researcher : Zhang J

Project Title:	Pilot Trial to Evaluate the Utility of Novel Imaging Techniques for the Early Detection of Response to Targeted Chemotherapy in Patients with Hepatocellular Carcinoma
Investigator(s):	Zhang J, Poon RTP, Mak HKF, Khong PL
Department:	Diagnostic Radiology
Source(s) of Funding:	Seed Funding Programme for Basic Research
Start Date:	09/2008

Abstract:

This is a single center, open-label, and investigator-initiated pilot study of novel MR imaging techniques in patients with hepatocellular carcinoma (HCC) who have been recommended to receive treatment with targeted chemotherapy. These imaging tests will be assessed for their ability to provide early evidence of response or progression in study patients. The reference of comparison for both investigative imaging studies will be unidimensional tumor lesion diameter measurements on MR according to RECIST criteria. The protocol is separated into 2 stages, with the first stage being comprised of baseline (pre-treatment) experimental and standard imaging procedures and the second stage consisting of follow-up imaging during chemotherapy treatment. The primary objective is to assess the ability of novel MR imaging procedures to quantify early responses to targeted chemotherapy in patients with HCC. These imaging techniques will include: 1. Dynamic Contrast-Enhanced MRI (DCE-MRI) 2. Diffusion weighted imaging (DWI) 3. Multiphasic Volumetric MRI Secondary objective of the study is to explore the ability of tumor characteristics identified on pre-treatment (baseline) DCE-MRI, DWI and multiphasic volumetric MR exams for the ability to stratify tumor aggressiveness and predict outcomes to chemotherapy treatment.

List of Research Outputs

Anthony M., Zhang J. and Khong P.L., PET/CT appearance of intestinal Behcet's disease, Clinical Nuclear Medicine. 2009, 34: 825-826.

Anthony M., Khong P.L. and Zhang J., Spectrum of 18F-FDG-PET/CT Appearances in peritoneal disease, American Journal of Roentgenology. 2009, 193: W523-529.

Anthony M., Zhang J. and Khong P.L., Spectrum of FDG-PET/CT Appearances in Malignant and Benign Peritoneal Pathology , RSNA 95th Scientific Assembly and Annual Meeting, Radiological Society of North America (RSNA), November 2009.

Fan S., Chow A.M.K., Zhang J., Man K. and Wu E.X., Diffusion tensor imaging of renal ischemia reperfusion injury in an experimental model, NMR in Biomedicine. 2010, 23(5): 496-502.

Gu J., Kwong Y.L., Chan T., Au W.Y., Chan Q., Zhang J., Liang R.H.S. and Khong P.L., Comparison of DWIBS and 18F-FDG PET/CT in newly diagnosed lymphoma, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Gu J., Khong P.L., Wang S., Liu K.Y., Law W.L., Chan Q. and Zhang J., Correlation study of quantitative indexes from DWI and PET-CT in primary rectal cancer, 3rd Joint Scientific Meeting of The RCR & HKCR and 17th ASM of HKCR, 31 October-1 November 2009.

Gu J., Khong P.L., Wang S., Chan Q., Law W.L., Liu K.Y. and Zhang J., Dynamic Contrast-enhanced MRI of Primary Rectal Cancer at 3T: Correlation with Positron Emission Tomography, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Gu J., Khong P.L., Wang S., Liu K.Y., Law W.L., Chan Q. and Zhang J., Dynamic contrast-enhanced MRI of primary rectal cancer at 3T: correlation with positron emission tomography, 16th Hong Kong International Cancer Congress and 6th Annual Meeting Centre for Cancer Research ,The University of Hong Kong Li Ka Shing Faculty of Medicine, 4-6 November 2009.

Gu J., Khong P.L., Wang S., Chan Q., Law W.L., Liu K.Y. and Zhang J., Quantitative analysis of indexes from DWI and PET/CT in primary rectal cancer, Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May 2010.

Huang B., Li J., Law M.W.M., Zhang J., Shen Y. and Khong P.L., Radiation dose and cancer risk in retrospectively and prospectively ECG-gated coronary angiography using 64-slice MDCT, British Journal of Radiology. 2009, 83: 152-158.

Researcher : Zhang Z

List of Research Outputs

Anthony M., Zhang Z., Feng S.T., Yau K.K.W., Khong P.L. and Mak H.K.F., Comparison of 3T diffusion weighted magnetic resonance imaging and 18F-fluoro-2-deoxyglucose positron emission tomography/ computed tomography in cervical lymphadenopathy of patients with nasopharyngeal carcinoma, 110th Annual Meeting of the American Roentgen Ray Society, San Diego, CA, USA. 2-7 May 2010.

Chan Q., Anthony M., Zhang Z., Cheung K.M.C. and Kim M., Quantitative evaluation of diffusion tensor imaging at 3T in the human lumbar intervertebral disc degeneration , Joint ISMRM-ESMRMB Annual Scientific Meeting, Stockholm, Sweden, 1-7 May . 2010.

Zhang Z., Mak H.K.F., Khong P.L. and Chu L.W., Structural changes in the Chinese patients with Alzheimer’s disease by using VBM method, 3rd Joint Scientific Meeting of The RCR & HKCR and 17th ASM of HKCR, 31 October-1 November 2009.

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