Neuro-Oncology Research

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The team utilizes Dynamic Contrast Enhanced (DCE) MR perfusion, H1 MR spectroscopy, diffusion imaging and lipid imaging to study focal brain and spinal lesions. The higher-grade angiogenic tumours have hallmarks of increased number of microvessels and irregular branching with poorly formed endothelial walls, contributing to microvascular hyperpermeability. The SGH team collaborates with the NCC Oncologic Imaging Team on the use of distributed parameter model in DCE-MRI to interrogate tumour leakiness which allows for quantification of more perfusion parameters. We also integrate other MRI techniques as adjunct to provide additional information on the tumour characteristics such as diffusion imaging to reflect tumour cellularity and vascularity, and magnetic resonance spectroscopy (MRS) that provide additional information on neurometabolite concentrations. On top of that, lipid metabolism change has unexplored potentials for the characterisation of tumours given the important role of lipid in cancer metabolism and tumour development. In-and opposed-phase is a simple alternative to lipid quantification which reflects lipid metabolic change other than MRS.

Brain tumor patient with a non-specific enhancing right occipital lesion (a-d) delineated on (a) post-contrast T1-weighted and (b) T2 FLAIR images, demonstrating low and high signal on the (c) v1 (ratio of blood plasma volume to tissue volume) and (d) v2 (ratio of extra-vascular extracellular space volume to tissue volume) maps of dynamic contrast-enhanced (DCE) scan favouring post treatment change.

The SGH team also collaborates with University of Pennsylvania on detection of 2-hydroxyglutarate (2HG) oncometabolite in low grade-gliomas, using Magnetic Resonance Spectroscopy (MRS) on clinical 3 Tesla MRI scanners. The detection of 2HG biomarker implies IDH mutation, which is key to diagnosing lower grade Astrocytomas and Oligodendrogliomas from more aggressive Glioblastoma Multiforme. This non-invasive capability on clinical scanners will greatly enhance our armamentarium in the diagnosis and treatment of adult diffuse gliomas.

Contact

Please contact the team consisting of Dr Lim Kheng Choon, Dr Septian Hartono and Dr Seow Poh Choo for more information.

• Dr Lim Kheng Choon - [email protected]

• Septian Hartono - [email protected]

• Seow Poh Choo - [email protected]

Publications:

1. de Godoy LL*, Lim KC*, Rajan A et. al. Non-Invasive Assessment of Isocitrate Dehydrogenase-Mutant Gliomas Using Optimized Proton Magnetic Resonance Spectroscopy on a Routine Clinical 3-Tesla MRI. Cancers. 2023;15(18):4453. *shared first authorship
2. Seow P, Narayanan V, Hernowo AT, Wong JHD, Ramli N. (2018). Quantification and Visualisation of Lipid Landscape in Glioma using In -and Opposed-Phase Imaging. Neuroimage: Clinical. 2018 (20): 531-536
3. Rumpel H, Chong Y, Porter DA, Chan LL. Benign versus metastatic vertebral compression fractures: combined diffusion-weighted MRI and MR spectroscopy aids differentiation. Eur Radiol. 2013 Feb;23(2):541-50. doi: 10.1007/s00330-012-2620-1.
4. Rumpel H, Chan LL, Tan JS, Ng IH, Lim WE.  Clinical functional magnetic resonance imaging for pre-surgical planning--the Singapore General Hospital experience with the first 30 patients.  Ann Acad Med Singapore. 2009 Sep;38(9):782-6.
5. Tan HM, Chan LL, Chuah KL, Goh NS, Tang KK. Monophasic, solitary tumefactive demyelinating lesion: neuroimaging features and neuropathological diagnosis. Br J Radiol 2004;77(914):153-6.
6. Tan EK, Chan LL, Auchus AP, Wong MC. Reversible choreoathetosis in primary cerebral lymphoma: clinicoradiologic correlation. Eur Neurol 2003;50(1):53-4.