Ultrasound Elastography Lab

Ultrasound elastography shows promise as a potential adjunct to conventional ultrasound in the evaluation of various tissue injuries and diseases. This evolving technique enhances the conventional ultrasound examination by providing additional information on the elastic properties of tissue alongside the morphological and vascular information obtained from B-mode and Doppler imaging. Our area of interest is in evaluating the clinical utility of ultrasound elastography in the diagnosis and treatment monitoring of various musculo-tendinous diseases; assessment of chronic liver disease and portal hypertension, post-irradiation neck fibrosis in patients with head and neck cancer, as well as allograft fibrosis in renal transplant recipients. 

Our team, comprising of radiologists and sonographers, has been collaborating with various institutions, such as the Division of Surgical Oncology, NCCS, SingHealth's ViREMiCS core facility at Duke-NUS, National University of Singapore's Paediatrics Department-Immunology Programme, and the National University Centre for Organ Transplantation (NUCOT). Their combined expertise underpins our translational approach, bridging imaging research with clinical impact.

Contact

Kindly contact the team consisting of Dr Png Meng Ai, Dr Ooi Chin Chin, Dr Lim Sze Ying, and Ms Azizah Mohd Afif for more information.

• Dr Png Meng Ai - png.meng.ai@singhealth.com.sg
• Dr Ooi Chin Chin - ooi.chin.chin@sgh.com.sg
• Dr Lim Sze Ying - lim.sze.ying@singhealth.com.sg
• Ms Azizah Bte Mohamed Afif - azizah.mohd.afif@sgh.com.sg

SUPER - Skin lesion Ultrasound ProspectivE Registry for audit, research and machine learning

This project focuses on establishing a patient registry and clinical service for affordable, accessible and excellent locoregional skin lesion evaluation. It also aims to identify potential sonographic prognostication factors for malignant skin lesions, enhancing diagnostic accuracy and patient outcomes through standardised imaging protocols and collaborative clinical assessment approaches that integrate radiological expertise with specialist dermatological and surgical knowledge.This study is supported by the RADSC ACP PFF research grant; a multi-institution, multidisciplinary collaboration with the Department of Vascular and Interventional Radiology (DVIR), Department of Radiography, Department of Dermatology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRint), Department of Plastic, Reconstructive and Aesthetic Surgery, and Department of Anatomical Pathology, alongside industry partner Canon Medical Systems. 

Contact 

Please contact the following for more information.       

• Dr Dorinda Chew Chee Yee - dorinda.chew.c.y@singhealth.com.sg      
• Kho Ying Ying - kho.ying.ying@sgh.com.sg

Using two-dimensional Shear wave elastography, as a predictive diagnostic tool for assessing allograft fibrosis in renal transplant recipients

Interstitial fibrosis with tubular atrophy (IFTA) is the end result of any chronic disease process in a kidney transplant allograft. IFTA increases over time and can be detected in 90% of kidney transplants at 10 years after transplantation. The presence of IFTA portends a poor prognosis and is associated with a 3-fold higher risk for graft loss. This study aimed to determine the optimal Shear Wave Elastography (SWE) threshold value for diagnosing fibrosis, investigate the correlation of ultrasound SWE values with IFTA scores determined from kidney transplant allograft biopsy samples, and one-year monitoring of kidney transplant function using clinical biomarkers. This study was supported by the Master of Clinical Investigation Student Fund, MOH and the Lee Foundation Grant. This research project was led by Principal Investigator Azizah Mohamed Afif, in collaboration with the Department of Anatomical Pathology and the Department of Renal Medicine. The study is in the validation phase with National University Centre for Organ Transplantation (NUCOT).

Contact

Please contact the following for more information. 

• Ms Azizah Bte Mohamed Afif - azizah.mohd.afif@sgh.com.sg

A Multimodal Non-Invasive Model for Early Identification of Kidney Allograft Fibrosis: Imaging and Biomarker Integration in a Cohort Study

The project models fibrosis development in kidney transplant allografts, combining proteomics and ultrasound. These non-invasive quantitative methods will assess allograft condition across the three stages of fibrosis (acute, intermediate and late phase). This study is the first in this field using a multimodal longitudinal study design, high-throughput proteomics approach with ultrasound Shear Wave Elastography (SWE) to assess kidney transplant fibrosis. This study is funded by the SGH Research Grant, with a multidisciplinary collaboration with Professor Angela Wang Yee Moon and Professor Terence Kee Yi Shern from Department of Renal Medicine, Dr Eugenia Ong from SingHealth's ViREMiCS core facility at Duke-NUS, Dr Makoto Yawata from the National University of Singapore, Immunology Programme, and industry partner Canon Medical Systems. The Principal Investigator, Azizah, is also supported by the NMRC Research Training Fellowship.

Contact

Please contact the following for more information.       

• Ms Azizah Bte Mohamed Afif - azizah.mohd.afif@sgh.com.sg

Developing methods to reduce functional loss in Transplant kidney: using non-invasive Shear Wave Elastography (SWE) as a predictive tool

This research aims to improve health outcomes in patients with kidney transplants. This project will commence with clinical detection to assess the feasibility of transplant fibrosis detection using SWE and determine the threshold values to define kidney fibrosis on SWE. We later progress to clinical prognostication to identify biomarkers to prognosticate fibrosis and assessing other diagnostic biomarkers to predict graft dysfunction. The potential machine variability and causes of errors will later be explored. Exploration for the evaluation in chronic native kidney using ultrasound shear wave elastography can be implemented to rule out early fibrosis in native kidneys. Finally, the next step is clinical prevention. Annual diagnostic assessment of fibrosis in chronic kidney disease may improve the management and screening for chronic kidney disease. By screening for kidney fibrosis non-invasively to diagnose early fibrosis, prevention and reduction of its progression through early and more personalised therapeutic approaches can be done by enabling precision medicine through establishing evidence-based guidelines. Early intervention may help to reduce the burden of kidney failure (Figure 1). This project involves a multicentre collaboration with Duke-NUS, NUS Yong Loo Lin Medical School, and National University Hospital Singapore. The Principal Investigator Azizah Mohamed Afif is a recipient of the NMRC RTF award.

Contact

Please contact the following for more information.       

• Ms Azizah Bte Mohamed Afif - azizah.mohd.afif@sgh.com.sg

Shear wave elastography of the liver and spleen stiffness in healthy volunteers

Shear wave elastography usefulness is based on the assumption that pathological changes tend to be harder and less elastic than the surrounding healthy tissue. The integration of elastography software into the conventional ultrasound system allows quick elasticity data acquisition and enables the assessment of tissue elasticity in real-time as a colour map of stiffness superimposed over the grey scale B-mode. This study aims to define the normal values of liver and spleen stiffness across gender and two ultrasound platforms, led by Principal Investigator Dr Ooi Chin Chin in collaboration with Singapore Institute of Technology. 

Contact

Please contact the following for more information. 

• Dr Ooi Chin Chin - ooi.chin.chin@sgh.com.sg

Diagnostic Performance of Quantitative Ultrasound Attenuation Imaging in Hepatic Steatosis: Correlation with Magnetic Resonance Imaging Proton Density Fat Fraction

Hepatic steatosis has emerged as a global health epidemic affecting over 30% of the population worldwide, with the potential to progress from hepatic steatosis to serious complications, including cirrhosis and hepatocellular carcinoma if left untreated. In Singapore, up to 40% of the population may present with fatty liver disease, and those affected have a risk of cirrhosis and/or liver failure. This study aims to determine the diagnostic accuracy of Ultrasound Attenuation Imaging for liver fat quantification, using Magnetic Resonance Imaging Proton Density Fat Fraction as the reference standard. We will also be evaluating the correlation between Ultrasound Attenuation Imaging and liver stiffness using Shear Wave Elastography, to determine whether Ultrasound Attenuation Imaging can be influenced by fibrosis. Led by Principal Investigator Ma Voon Chee, this project is in collaboration with Monash University, Australia. 

Contact

Please contact the following for more information.       

• Ms Ma Voon Chee - ma.voon.chee@sgh.com.sg

Publications and Presentation:

1. Mohamed Afif A, Si Min DL, Sidek NZ, Tan GM, Cai S, Chang PY, Lee SHE, Loh HL, Kee YST. Enabling sustainable kidney transplant care: non-invasive fibrosis evaluation using Shear wave elastography and biomarkers in a one-year cohort study. ECR 2025. https://dx.doi.org/10.26044/ecr2025/C-16154
2. Kho YY, Ooi CC, Too CW, Ma VC, Abu Bakar R, Lim CY, Tang PY, Oh CC. Advanced multimodal ultrasound for pre-operative assessment of skin tumours: A case series. Ultrasound. 2024 Nov 30:1742271X241289021. doi: 10.1177/1742271X241289021. Epub ahead of print. PMID: 39624619; PMCID: PMC11608425. 
3. Dajti E, Ravaioli F, Zykus R, Rautou PE, Elkrief L, Grgurevic I, Stefanescu H, Hirooka M, Fraquelli M, Rosselli M, Chang PEJ, Piscaglia F, Reiberger T, Llop E, Mueller S, Marasco G, Berzigotti A, Colli A, Festi D, Colecchia A; Spleen Stiffness—IPD-MA Study Group. Accuracy of spleen stiffness measurement for the diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease: a systematic review and individual patient data meta-analysis. Lancet Gastroenterol Hepatol. 2023 Sep;8(9):816-828. doi: 10.1016/S2468-1253(23)00150-4. Epub 2023 Jul 18. PMID: 37478880. 
4. Mohamed Afif A. Ultrasound shearwave elastography: a potential diagnostic tool for detecting kidney transplant fibrosis. Official Proceedings of the AIUM Ultracon. J Ultrasound Med. 2023 Jul;42 Suppl 1:S1. doi: 10.1002/jum.16259. PMID: 37335137
5. Ong CL, Chew LE, Han NR, Ooi CC, Yeo YC, Chew SH, Wong WL, Tang PH, Teo SY. The Characteristics of Real-time Transvaginal Sono-elastography in Endometrial Cancer. J Med Ultrasound. 2022 Jan 6;30(2):101-108. doi: 10.4103/JMU.JMU_74_21. PMID: 35832355; PMCID: PMC9272722. 
6. Ooi CC, Schneider M, Malliaras P, Png MA, Chadwick M, Jones D, Venkatanarasimha NK, Connell D. Real-time sonoelastography evaluation of the Achilles tendon following ultrasound-guided platelet-rich plasma injection and eccentric exercise for the treatment of refractory Achilles tendinopathy. Ultrasound. 2019. 27(3) 138–147
7. Leow MQ, Cui SL, Cao T, Tay SC, Ooi CC. Measuring the effects of acupuncture on muscle stiffness with shear-wave elastography. Acupunct Med. Aug 2017; 35(4), 304-306.
8. Leow MQ, Cao T, Lee SH, Cui SL, Tay SC, Ooi CC. Exploring the physiological and physical effects of acupuncture using ultrasound: Acupunct Med. Jun 2017. 35 (3): 231-233.
9. Ooi CC, Schneider M, Malliaras P, Jones D, Saunders S, McMahon A, Connell D. Sonoelastography of the Achilles tendon: prevalence and prognostic value among asymptomatic elite Australian Rules football players. Clin J Sport Med. Oct 2015. 26(4):299-306
10. Ooi CC, Richards PJ, Maffulli N, Ede D, Schneider ME, Connell D, Morrissey D, Malliaras P. A soft patellar tendon on elastography is associated with pain and functional deficit in athletes at high risk of patellar tendinopathy. J. Sci. Med. Sport. 2015. 19(5):373-8
11. Ooi CC, Schneider ME, Malliaras P, Counsel P, Connell D. Prevalence of morphological and mechanical stiffness alterations of mid Achilles tendons in asymptomatic marathon runners before and after a competition. Skeletal Radiol 2015. 44(8):1119-27
12. Ooi CC, Schneider ME, Malliaras P, Chadwick M, Connell DA. Diagnostic performance of Axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy: Comparison with conventional B-mode US and Color Doppler imaging. Ultrasound Med Bio 2014. 41(1):15-25.
13. Ooi CC, Malliaras P, Schneider ME, Connell DA.  "Soft, hard or just right?" Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skeletal Radiol 2014; 43(1):1-12