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Liver Imaging Program

Liver Cancer

Primary liver cancer or hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the second leading cause of cancer mortality. This high case mortality attests to the paucity of efficacious systemic therapy in HCC which is largely attributed to the highly diverse inter and intra-tumoral genomic heterogeneity in this cancer. We have previously shown that the current approach adopted by most research groups in using single biopsy samples to decode the genomics of HCC significantly underestimates intra-tumoral heterogeneity and do not fully recapitulate the global genomic landscape of the patient tumor. To address this, our current NMRC TCR Flagship multi-disciplinary PLANet program, has adopted a novel multi-region sampling approach to identify the key biological events that drive clinical trajectories in a prospective, surgically resected HCC cohort. The aim of this project is to develop AI-based algorithms for (i) diagnosis of Hepatocellular carcinoma (HCC) and (ii) prediction of driver genomic events underlying HCC. Radiologists from SGH and NCC play a key role in developing the AI algorithm for imaging biomarkers.


Please contact Dr Lim Kheng Choon at for more information.


  1. Lim KC, Wang VW, Siddiqui FJ et. al. Cost-Effectiveness Analysis of Liver Resection Versus Transplantation for Early Hepatocellular Carcinoma Within the Milan Criteria. Hepatology. 2015 Jan; 61(1): 227-37.

  2. Lim KC, Chow PK, Allen JC et. al. Systematic Review of Outcomes of Liver Resection for Early Hepatocellular Carcinoma Within the Milan Criteria. British Journal of Surgery. 2012, 99:1622-1629.

Non-Alcoholic Fatty Liver Disease (NAFLD) & Portal Hypertension

Obesity, metabolic syndrome, and therefore NAFLD are prevalent in modern society globally. Novel methods of therapy such as Bariatric surgery and newer pharmaceuticals are being trialled for clinical disease management. To assess therapeutic effectiveness, quantitative hepatic MRI for fat content and parenchymal stiffness which are now the non-invasive gold standards for such parameters provide for comprehensive, robust and reproducible follow-up assessment along with other key clinical and biochemical tools.  There are currently several Pharma trials and a Bariatric surgery trial ongoing (2021) and Dr Albert Low and Dr Lionel Cheng are co-investigators and collaborators working with other clinical colleagues in diverse fields of IR, hepatology, endocrinology and surgery.

58 years old, male with severe non-alcoholic steatohepatitis (NASH) on Pharma drug trial:

1) MRI

  • PDFF: 12-14% mild steatosis

  • Elastography: stage 4 fibrosis/ cirrhosis

  • morphologically occult for cirrhosis (incl. US) 

 2) Histopathology on needle biopsy

  • Visually moderate steatosis
  • NAFLD activity score 7/8
  • NASH fibrosis stage ¾

MRI and US shear-wave elastography has also been trialled for the assessment of splenic stiffness as a possible surrogate for grading the severity of portal hypertension while it is still not commercially available tool approved for clinical use.      


Please feel free to contact Dr Albert Low, and Dr Lionel Cheng for more information.


  1. E.H.T. Cheong, A.S.C. Low, C.C. Ooi, M.F. Tay, L. Cheng, Y. Hao, D.S. Lau, R.B. Abu Bakar, S.Y. Lim, A. Gogna, C.W. Too, H.K. Tan, C.K. Tan, J.P.E. Chang. Prospective comparison of spleen size and stiffness measured by magnetic resonance elastography versus shearwave elastography for non-invasive assessment of clinically significant portal hypertension. Paper presented at : European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Virtual Congress 2020; Singapore; Abstract 306.