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Research Catalogue

September 2020


Evidence of Added Value of Chest CT in Coronavirus Disease (COVID-19) Pneumonia with Initial Negative RT-PCR Results.

Chan LL, Tan EK

We read with interest the article by Chen et al. [1], who retrospectively examined the chest CT findings of 21 patients with confirmed coronavirus disease (COVID-19) pneumonia and found differences in CT features between the groups with negative and positive initial reverse transcription–polymerase chain reaction (RT-PCR) results. The swab RT-PCR tests were all performed within 3 days of CT. The authors concluded that CT showed less pulmonary consolidation in the group with negative initial RT-PCR results. They highlighted that CT is useful for patient screening if COVID-19 is clinically suspected.

A Rare Case of Acute Hemorrhagic Leukoencephalitis in a COVID-19 Patient.
Yong MH, Chan YFZ, Liu J, Sanamandra SK, Kheok SW, Lim KC, Sewa DW

Dear Editor, Neurological manifestations associated with severe COVID-19 infection in the current SARS-CoV-2 pandemic have been gaining attention, with encephalopathy and stroke [1,2] featuring prominently, and a recent account of acute necrotizing encephalopathy [3]. We report a rare case of a Singaporean male with severe COVID-19 pneumonia who developed Acute Hemorrhagic Leukoencephalitis.


Chest Radiographs and CTs in the Era of COVID-19: Indications, Operational Safety Considerations and Alternative Imaging Practices

Chia AQX, Cheng LTE, Wijaya L, Png MA, Sim WY, Hong WL, Chen RC

Coronavirus disease-19 (COVID-19) is a pathogen that has shown an ability for sustained community transmission. To ensure utmost safety, radiology services will need to adapt to this disease in the coming months and possibly years ahead. This will include learning how to perform radiographs and CT in a safe and sustainable manner. Due to the risk of nosocomial spread of disease, the judicious use and implementation of strict infection protocols is paramount to limit healthcare worker and patient transmission. Between 28 January 2020 and 8 June 2020, our institution performed 12,034 radiographs and 178 CT scans for suspected or confirmed COVID-19 patients. As of 8 June 2020, there have been no documented instances of healthcare staff acquiring COVID-19 during the course of work. In this article, we present the indications and operational considerations used by our institution to safely image patients with suspected or confirmed COVID-19. Alternative practices for imaging radiographs are also discussed.

Evaluation of trigeminal nerve tractography using two-fold-accelerated simultaneous multi-slice readout-segmented echo planar diffusion tensor imaging

Koh YH, Shih YC, Lim SL, Kiew YS, Lim EW, Ng SM, Ooi LQR, Tan WQ, Chung YC, Rumpel H, Tan EK, Chan LL.

Objectives: Simultaneous multi-slice (SMS) imaging with short repetition time (TR) accelerates diffusion tensor imaging (DTI) acquisitions. However, its impact when combined with readout-segmented echo planar imaging (RESOLVE) on the cranial nerves given the challenging skull base/posterior fossa terrain is unexplored. We evaluated the reliability of trigeminal nerve DTI metrics using SMS with RESOLVE-DTI.

Adapting lessons from SARS for the COVID-19 pandemic - Perspectives from Radiology Nursing in Singapore.

Wong ASK, Ooi CC, Leow MQH, Kiew YS, Yeo KCW, Tan SG, Tay KH

When severe acute respiratory syndrome (SARS) hit Singapore in 2003, we began to formulate rigorous protocols and reconfigure our facilities to prevent in-hospital transmission. This became the foundation of our practices in COVID-19. However, some adaptations were made to suit the current needs of the department, and technology has been used for communication. This article describes the preparation and response of nursing in the radiology department in Singapore in SARS and coronavirus 2019 (COVID-19) outbreak. Protocols and measures taken during SARS and COVID-19 outbreak are described…

Radiographic Features of Coronavirus Disease 2019 (COVID-19) Based on an Initial Cohort of 96 Patients in Singapore.

Khoo HW, Hui TCH, Haja Mohideen S, Liew CJY, Kok SSX, Young BE, Ong SWX, Kalimuddin S, Tan SY, Loh J, Chan LP, Poh ACC, Wong SBS, Leo Y, Lye DC, Kaw GJL, Tan CH.

Introduction: Chest radiographs (CXR) are widely used for the screening and management of the coronavirus disease 2019 (COVID-19). This paper determinates the radiographic features of COVID-19 based on an initial national cohort of patients.


August 2020

Clinical placements for undergraduate diagnostic radiography students amidst the COVID-19 pandemic in Singapore: Preparation, challenges and strategies for safe resumption.

Tay YX, Sng LH, Chow HC, Zainuldin MR.

Introduction: The COVID-19 pandemic resulted in the suspension of clinical training for undergraduate radiography students in Singapore. Coordinated preparation plans and strategies between the university and hospitals were needed to safely resume clinical placements within national and hospitals’ risk control measures against COVID-19 transmission.


July 2020

Messaging Fatigue and Desensitisation to Information During Pandemic.

Koh PK, Chan LL, Tan EK.

To the editor, the current COVID-19 pandemic which has afflicted more than 6 million people has led to many mental, societal and economic consequences. The physical and mental fatigue of frontline workers in places constrained by manpower shortage are well recognized. Public healthcare communication has played a crucial role in engaging the public to partake in this crisis. However, the challenges and repercussions of messaging fatigue has received little attention.

Chest CT in asymptomatic COVID-19: benefits and concerns.

Chan LL, Tan EK

We read with interest the paper by Liu et al. who argued that it is not justified to use Chest CT as a screening Tool for COVID-19 in unrelated patients and symptomatic subjects without contact history. The authors highlighted that a number of hospitals outside Wuhan in China used chest CT scan to screen for COVID-19 for hospitalized patients with illnesses un-related to COVID-19 and without respiratory symptoms.

Clinical utility of chest radiography for severe COVID-19

Hui, T., Khoo, H. W., Young, B. E., Haja Mohideen, S. M., Lee, Y. S., Lim, C. J., Leo, Y. S., Kaw, G., Lye, D. C., & Tan, C. H.

Background: Chest radiography (CXR) is performed more widely and readily than CT for the management of coronavirus disease (COVID-19), but there remains little data on its clinical utility. This study aims to assess the diagnostic performance of CXR, with emphasis on its predictive value, for severe COVID-19 disease.

Fully Automated Hybrid Approach to Predict the IDH Mutation Status of Gliomas via Deep Learning and Radiomics

Choi YS, Bae S, Chang JH, Kang S, Kim SH, Kim J, Rim TH, Choi SH, Jain R, Lee S

Background: Glioma prognosis depends on isocitrate dehydrogenase (IDH) mutation status. We aimed to predict the IDH status of gliomas from preoperative MR images using a fully automated hybrid approach with convolutional neural networks (CNNs) and radiomics.

Olfactory Loss of Function as a Possible Symptom of COVID-19

Kheok SW, Teo WYN.

To the Editor There is increasing interest in the cause of anosmia in patients with coronavirus disease 2019 (COVID-19), and the article written by Dr Eliezer et al,1 presents an interesting finding of a patient with bilateral obstruction of the olfactory clefts. This is different from another report of a COVID-19 patient with isolated anosmia whose magnetic resonance imaging results showed normal olfactory bulb and no corresponding inflammation in the olfactory clefts or paranasal sinuses.

Cryptic Asymptomatic Parasellar High Signal on Time-of-Flight MR Angiography: How to Resolve the Clinical Conundrum

Lim KC, Santhosh RS, Kee TP, Sim S, Ho MI, Ho JXM, Mcadory LE, Lim WEH, Chan LL

Purpose: Hyperintense parasellar signal on time-of-flight MR angiography (TOF-MRA) in asymptomatic patients may be due to a variety of nonpathological causes and mimic parasellar high flow signal in pathological arteriovenous shunts at the cavernous sinus (CSAVS). This creates a clinical conundrum between diagnosing an aggressive yet asymptomatic CSAVS subtype against exposing patients without CSAVS to potential complications of an invasive angiographic evaluation…

Appropriateness of MRI Brain Orders: Application of American and British Guidelines

Lim JLL, McAdory LE, Tang PH, Conceicao EP, Lim WEH, De Silva DA, Tan EK, Chan LL

Globally, MRI utilization is proliferating [1], as it yields superior soft tissues contrast without any radiation, making it ideal for evaluation of the brain. MRI, however, is expensive and scarce with significant costs incurred if used inappropriately, especially in publicly funded systems. MRI overutilization is an increasingly recognized problem of interest to many. We investigate if (1) brain MRI scans performed were ordered appropriately by clinicians according to radiological guidelines, (2) identify the most common indications and imaging outcomes for appropriate and inappropriate orders, (3) assess the relationship between appropriateness of orders and imaging outcomes.

Machine Learning and Radiomic Phenotyping of Lower Grade Gliomas: Improving Survival Prediction

Choi YS, Ahn SS, Chang JH, Kang S, Kim EH, Kim SH, Jain R, Lee S

Background and purpose: Recent studies have highlighted the importance of isocitrate dehydrogenase (IDH) mutational status in stratifying biologically distinct subgroups of gliomas. This study aimed to evaluate whether MRI-based radiomic features could improve the accuracy of survival predictions for lower grade gliomas over clinical and IDH status.


June 2020

A dynamic immune response shapes COVID-19 progression.

Ong EZ, Chan YFZ, Leong WY, Lee NMY, Kalimuddin S, Haja Mohideen S, Chan KS, Tan AT, Bertoletti A, Ooi EE, Low JGH

The inflammatory response to SARS-coronavirus-2 (SARS-CoV-2) infection is thought to underpin COVID-19 pathogenesis. We conducted daily transcriptomic profiling of three COVID-19 cases and found that the early immune response in COVID-19 patients is highly dynamic. Patient throat swabs were tested daily for SARS-CoV-2, with the virus persisting for 3 to 4 weeks in all three patients. Cytokine analyses of whole blood revealed increased cytokine expression in the single most severe case. However, most inflammatory gene expression peaked after respiratory function nadir…

Evaluating Potential Deceased Donor Renal Transplant Recipients for Asymptomatic COVID-19

Ho QY, Chung SJ, Low SCS, Chen RC, Tee SP, Chan FZY, Tan BH, Kee TYS

We present a case of asymptomatic coronavirus disease 2019 (COVID-19) diagnosed in a hemodialysis patient during deceased donor renal transplantation (DDRT) evaluation and discuss the challenges of excluding COVID-19 before transplantation.

Effect of Myocardial Viability Assessed by Cardiac Magnetic Resonance on Survival in Patients With Severe Left Ventricular Dysfunction

Yap J, Lim FY, Gao F, Wang SZ, Low SCS, Le TT, Tan R

Background: Myocardial viability assessment in revascularization of ischemic heart failure remains controversial. This study evaluated the prognostic utility of cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) in ischemic heart failure.

Touch me not: safe distancing in Radiology during Coronavirus Disease 2019 (COVID-19)

Chen RC, Cheng LTE, Lim JLL, Gogna A, Ng DCE, Teo LZY, Tan BS

In the era of COVID-19, "social distancing" has become a buzzword. Strictly speaking, social distancing refers to physically distancing by 1 to 2 m, but the overall concept is more important: disrupting the infectious chain by separating those with the disease from those without. Epidemiologists have espoused the term, believing in its ability to "flatten the curve." By reducing the exponential rise in cases, the health care system is not overwhelmed and can function sustainably over the long term. Although this concept’s main intention is to control disease, in the hospital setting, it provides the equally important added benefit of ensuring continuity of vital services should intrahospital transmission occur. We are part of a 1,700-bed hospital, with a radiological service strength of over 600 (41 residents, 77 attending physicians [nuclear medicine, interventional, diagnostic], 273 radiographers, and 240 nurses and administrative support staff). This article describes our measures and early experiences with safe distancing in our radiology service.
  

Radiological retrograde ureteric stent exchange in women: a single-centre review

Lai AL, Choong M, Toh LMHW, Irani FG, Damodharan K, Chan SXJM, Too CW, Patel A, Gogna A, S Chandramohan

AIM: To evaluate the safety and efficacy of modified wire loop technique for retrograde stent exchange. MATERIALS AND METHODS: All patients were from the KK Women and Children's Hospital where there is no on-site urology service. Patients were identified retrospectively from the institutional radiological information system (RIS) database. In total, 270 stents were removed and 238 replaced for 79 patients between January 2012 to December 2016. Success rates for stent removal and exchange as well as skin dose and fluoroscopy time were assessed…


May 2020

Extensive Florid Lobular carcinoma in situ presenting as a large breast mass requiring a mastectomy

Tison NRR, Leong L, Tan PH, Tan VKM.

A 39-year-old premenopausal woman presented with a self-palpated right breast mass. Clinical examination revealed a stiff, turgid right breast with a palpable 5 cm mass with indistinct margins at the upper outer quadrant. The overlying skin and nipple areolar complex was  normal. The left breast was unremarkable, and no clinically palpable lymph nodes were noted bilaterally.

Multiparametric MRI-Ultrasound Software Fusion Prostate Biopsy - Initial Results Using A Stereotactic Robotic Assisted Transperineal Prostate Biopsy Platform Comparing Systematic Versus Targeted Biopsy

Lee AY, Yang XY, Lee HJ, Law YM, Hong HH, Lau WK, Lee LS, Ho HS, Tay KJ, Cheng CW, Yuen JS, Chen K.

Objective: To compare the detection rates of prostate cancer between systematic biopsy and targeted biopsy using a stereotactic robot‐assisted transperineal prostate platform…

Multinodular and vacuolating neuronal tumour of the cerebrum: an incidental diagnosis in a child presenting with absence seizures

Tan TSE, Sanamandra SK.

A previously well 7-year-old boy presents with recurrent absence seizures, comprising sudden activity arrest and staring episodes lasting 10–20 s, occurring several times daily. There were no other associated symptoms or history of head trauma, infection or epilepsy. Neurological and electroencephalogram assessment were unremarkable. Further work-up with cranial MRI incidentally revealed several benign-appearing coalescent nodules in the left parietal lobe without any other significant intracranial abnormality (figure 1), consistent with multinodular and vacuolating neuronal tumour (MVNT) of the cerebrum.

How to safely and sustainably reorganise a large general radiography service facing the COVID-19 pandemic?

Sim WY, Chen RC, Aw LP, Abu Bakar Rafidah, Tan CC, Heng AL, Ooi CC

Objectives: This paper aims to share our experience in reorganising our general radiography service during the coronavirus disease (COVID-19) pandemic from the viewpoint of a large tertiary referral medical centre.


April 2020

Parkinson Disease and the Immune System - Associations, Mechanisms and Therapeutics 

Tan EK, Chao Y, West A, Chan LL, Poewe W, Jankovic J

Multiple lines of evidence indicate that immune system dysfunction has a role in Parkinson disease (PD); this evidence includes clinical and genetic associations between autoimmune disease and PD, impaired cellular and humoral immune responses in PD, imaging evidence of inflammatory cell activation and evidence of immune dysregulation in experimental models of PD. However, the mechanisms that link the immune system with PD remain unclear, and the temporal relationships of innate and adaptive immune responses with neurodegeneration are unknown. Despite these challenges…

Radiological Response to the Call of the Pandemic: Clinico-Neuroradiological Correlates of Acute Necrotizing Encephalopathy in COVID-19 Infection.

Chan LL, Tan EK.

We read with interest the neuroimaging findings of the first presumptive case of encephalitis associated with COVID-19 infection in the Mar 2020 issue of Radiology by Dr Neo Poyiadji and thank the authors for documenting and sharing their important findings with the community in the current pandemic…

Radiology Preparedness in the Ongoing Battle Against COVID-19: Experience from Large to Small Singapore Public Hospitals.

Tan BP, Lim KC, Goh YG, Kok SXS, Teo SY, Poh CCA, Kaw JLG, Quek ST, Wong BSS, Chan LP, Tan BS

The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented challenge to the healthcare systems of the world. In Singapore, the Radiology community’s early experience on managing this pandemic was shaped by lessons learnt from the earlier SARS outbreak in 2003. This article surveys the operational responses of radiology departments from 6 public hospitals in Singapore.

Adapting to a new normal? Adapting to a New Normal? Key Operational responses of a Radiology service during the COVID-19 epidemic

Chen RC, Tan TT, Chan LP

Singapore’s first case of coronavirus disease-19 (COVID-19) was confirmed on January 23, 2020 and treated at Singapore General Hospital [1]. Given its status as an international hub with close geographical and business ties to China, Singapore was a natural route of dissemination. Indeed, by early February 2020, our densely populated urban island nation had the second most number of confirmed COVID-19 cases outside of China. At the onset, there was admittedly some panic, largely due to gaps in knowledge about the virus. Misinformation being circulated did not help; some early rumors suggested that the primary mode of spread was via aerosol transmission. Most evidence today suggests COVID-19 primarily spreads by way of large droplets.


March 2020


Diffusion Tensor Imaging Radiomics in Lower-grade Glioma: Improving Subtyping of Isocitrate Dehydrogenase Mutation Status   

Park CJ, Choi YS, Park YW, Ahn SS, Kang S, Chang J, Kim SH, Lee S

Purpose: To evaluate whether diffusion tensor imaging (DTI) radiomics with machine learning improves the prediction of isocitrate dehydrogenase (IDH) mutation status of lower-grade gliomas beyond radiomic features from conventional MRI and DTI histogram parameters. Methods: A total of 168 patients with pathologically confirmed lower-grade gliomas were retrospectively enrolled. A total of 158 and 253 radiomic features were extracted from DTI (DTI radiomics) and conventional MRI (T1-weighted image with contrast enhancement, T2-weighted image, and FLAIR [conventional radiomics]), respectively…

AI-based Prognostic Imaging Biomarkers for Precision Neuro-oncology: the ReSPOND consortium

Davatzikos C, Barnholtz-Sloan JS, Bakas S, Colen R, Mahajan A, Quintero CB, Font JC, Puig J, Jain R, Sloan AE, Badve C, Marcus DS, Choi YS, Lee S, Chang JH, Poisson LM, Griffith B, Dicker AP, Flanders AE, Booth TC, Rathore S, Akbari H, Sako C, Bilello M, Shukla G, Kazerooni AF, Brem S, Lustig R, Mohan S, Bagley S, Nasrallah M, O'Rourke DM

Artificial intelligence (AI) and machine learning (ML) methods have begun to reveal that complex imaging patterns can provide individualized biomarkers for diagnosis and prognosis. However, AI methods have been challenged by insufficient training, heterogeneity of imaging protocols across hospitals, and lack of generalization to new patient data. These challenges prompted the development of the ReSPOND (Radiomics Signatures for PrecisiON Diagnostics) consortium on glioblastoma (GBM). This collaboration of over 10 institutions, across 3 continents, is positioned to pool, harmonize, and analyze brain MRIs…

Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from COVID-19 Infection

Goh KJ, Choong MC, Cheong EH, Kalimuddin S, Duu Wen S, Phua GC, Chan KS, Haja Mohideen S

The coronavirus disease 2019 (COVID-19) outbreak that started in Wuhan, Hubei province, China in December 2019 has now extended across the globe with >100,000 cases and 3,000 deaths reported in 93 countries as of 7 March 2020. We report a case of COVID-19 infection in a 64-year-old man who developed rapidly worsening respiratory failure and acute respiratory distress syndrome (ARDS) that required intubation. As the clinical spectrum of COVID-19 ranges widely from mild illness to ARDS with a high risk of mortality, there is a need for more research to identify early markers of disease severity. Current evidence suggests that patients with advanced age, pre-existing comorbidities or dyspnoea should be closely monitored, especially at 1-2 weeks after symptom onset. It remains to be seen if laboratory findings such as lymphopenia or elevated lactate dehydrogenase may serve as early surrogates for critical illness or markers of disease recovery. Management of ARDS in COVID-19 remains supportive while we await results of drug trials. More studies are needed to understand the incidence and outcomes of ARDS and critical illness from COVID-19, which will be important for critical care management and resource planning.

Quality of Prostate MRI: Is the PI-RADS Standard Sufficient?

Sackett J, Shih JH, Reese SE, Brender JR, Harmon SA, Barrett T, Coskun M, Madariaga M, Marko J, Law YM, Turkbey EB, Mehralivand S, Sanford T, Lay N, Pinto PA, Wood BJ, Choyke PL, Turkbey B

Rationale and Objective: The Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) published a set of minimum technical standards (MTS) to improve image quality and reduce variability in multiparametric prostate MRI. The effect of PIRADSv2 MTS on image quality has not been validated. We aimed to determine whether adherence to PI-RADSv2 MTS improves study adequacy and perceived quality.

Periventricular White Matter Hyperintensity Burden and Cognitive Impairment in Early Parkinson's Disease   

Huang X, Wen MC, Ng SYE, Hartono S, Chia NSY, Choi X, Tay KY, Au WL, Chan LL, Tan EK, Tan LCS

Background and purpose: This study quantified the total brain and periventricular white matter hyperintensity (WMH) burdens in patients with early Parkinson’s disease (PD) and explored their associations with cardiovascular risk factors and cognitive performance. Methods: A total of 175 non‐demented patients with early PD who had undergone baseline brain magnetic resonance imaging were included. Comprehensive neurocognitive testing was conducted to identify PD with mild cognitive impairment (PD‐MCI) and to evaluate performances in individual cognitive domains. Cardiovascular risk was expressed as a modified Framingham 10‐year cardiovascular risk score (mFRS).

Differentiating Parkinson's disease motor subtypes using automated volume-based morphometry incorporating white matter and deep gray nuclear lesion load
Fang E, Ann CN, Marechal B, Lim JX, Tan SYZ, Li H, Gan J, Tan EK, Chan LL.
Background: Periventricular leukoaraiosis may be an important pathological change in postural instability gait disorder (PIGD), a motor subtype of Parkinson's disease (PD). Clinical diagnosis of PIGD may be challenging for the general neurologist. Purpose: To evaluate 1) the utility of a fully automated volume‐based morphometry (Vol‐BM) in characterizing imaging diagnostic markers in PD and PIGD, including, 2) novel deep gray nuclear lesion load (GMab), and 3) discriminatory performance of a Vol‐BM model construct in classifying the PIGD subtype.



February 2020

Stereotactic robot-assisted transperineal prostate biopsy under local anaesthesia and sedation: moving robotic biopsy from operating theatre to clinic

Yang X, Lee AY, Law YM, Sim ASP, Tay KJ, Lau WKO, Ho HSS, Yuen JSP, Chen K.

This IRB-approved prospective pilot study evaluates the safety and feasibility of performing stereotactic robot-assisted transperineal MRI-US fusion targeted prostate biopsy under local anaesthesia (LA) with sedation. 30 patients who underwent robotic transperineal prostate biopsy between September 2017 and June 2018 were recruited. All biopsies were performed with the iSR’obot Mona Lisa® and BK3000 ultrasound system. Intravenous paracetamol 1 g, with midazolam and fentanyl were given at positioning. After administration of 5 mL of 1%-lidocaine into the perineal skin 2 cm above and lateral to the anus, periapical prostatic block with 10 mL mixture of 1%-Lidocaine and 0.5%-Marcaine was given. The median age of patients was 66 years (range 53–80 years)…

Lipid Fraction Derived From MRI In- and Opposed-Phase Sequence as a Novel Biomarker for Predicting Survival Outcome of Glioma.

Seow P, Narayanan V, Romelean RJ, Wong JHD, Win MT, Chandran H, Chinna K, Rahmat K, Ramli N

Rationale and purpose: Our study evaluated the capability of magnetic resonance imaging in- and opposed-phase (IOP) derived lipid fraction as a novel prognostic biomarker of survival outcome in glioma. Materials and methods: We analyzed 46 histologically proven glioma (WHO grades II-IV) patients using standard 3T magnetic resonance imaging brain tumor protocol and IOP sequence. Lipid fraction was derived from the IOP sequence signal-loss ratio. The lipid fraction of solid nonenhancing region of glioma was analyzed, using a three-group analysis approach based on volume under surface of receiver-operating characteristics to stratify the prognostic factors into three groups of low, medium, and high lipid fraction. The survival outcome was evaluated, using Kaplan-Meier survival analysis and Cox regression model.

MR Image Phenotypes may Add Prognostic Value to Clinical Features in IDH Wild-type Lower-grade Gliomas

Park CJ, Han K, Shin H, Ahn SS, Choi YS, Park YW, Chang JH, Kim SH, Jain R, Lee S

Purpose: To identify significant prognostic magnetic resonance imaging (MRI) features and their prognostic value when added to clinical features in patients with isocitrate dehydrogenase wild-type (IDHwt) lower-grade gliomas. Materials and methods: Preoperative MR images of 158 patients (discovery set = 112, external validation set = 46) with IDHwt lower-grade gliomas (WHO grade II or III) were retrospectively analyzed using the Visually Accessible Rembrandt Images feature set. Radiologic risk scores (RRSs) for overall survival were derived from the least absolute shrinkage and selection operator and elastic net…


Large Solitary Lytic Skull Vault Lesions in Adults: Radiological Review with Pathological Correlation

 Kee TP, Liauw L, Sathiyamoorthy S, Lee HY, Tan GSL, Yu WY

The diagnosis of a large solitary lytic skull vault lesion in adults is a challenge due to variable aggressiveness and overlapping features. The purpose of this article is to demonstrate the use of an imaging approach to narrow the differential diagnosis when a large solitary lytic skull vault lesion is encountered. The initial imaging assessment using computed tomography (CT) is invaluable in determining lesion aggressiveness based on bony margins and skull tables involvement. Further assessment with magnetic resonance (MR) imaging including diffusion weighted imaging (DWI) aids in soft tissue characterization. We present cases of large solitary lytic skull vault lesions in adults, emphasizing on salient and atypical imaging features, with pathological correlation for better understanding of the disease processes that underlie the imaging features.

Déjà vu or Jamais Vu? How the Severe Acute Respiratory Syndrome Experience Influenced a Singapore Radiology Department's Response to the Coronavirus Disease (COVID-19) Epidemic

Cheng LTE, Chan LP, Tan BH, Chen RC, Tay KH, Ling ML, Tan BS

OBJECTIVE. This article shares the ground operational perspective of how a tertiary hospital radiology department in Singapore is responding to the coronavirus disease (COVID-19) epidemic. This same department was also deeply impacted by the severe acute respiratory syndrome (SARS) outbreak in 2003.


January 2020

Microstructural abnormalities found in uncinate fasciculus and superior cerebellar tracts in children with global developmental delay: a feasibility study

Ramli N, Yap A, Muridan R, Seow P, Rahmat K, Fong CY, Tan LK, Ong LC.

AIM: To evaluate the microstructural abnormalities of the white matter tracts (WMT) using diffusion tensor imaging (DTI) in children with global developmental delay (GDD). MATERIALS AND METHODS: Sixteen children with GDD underwent magnetic resonance imaging (MRI) and cross-sectional DTI. Formal developmental assessment of all GDD patients was performed using the Mullen Scales of Early Learning. An automated processing pipeline for the WMT assessment was implemented. The DTI-derived metrics of the children with GDD were compared to healthy children with normal development (ND).