Liver Imaging Programme

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 pharmaceutical trials and a bariatric surgery trial ongoing (2021), and Dr Albert Low and A/Prof Lionel Cheng are co-investigators and collaborators working with other clinical colleagues in the 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.      

Contact

Please feel free to contact Dr Albert Low and A/Prof Lionel Cheng for more information.

• Dr Albert Low – albert.low.s.c@singhealth.com.sg
• A/Prof Lionel Cheng – lionel.cheng.t.e@singhealth.com.sg
   

Publications:

1. Tan NYT, Shumbayawonda E, Cheng LT, Low ASC, Lim CH, Eng AKH, Chan WH, Lee PC, Tay MF, Chang JPE, Bee YM, Goh GBB, Ching J, Chua KV, Han SHY, Kovalik JP, Tan HC. The Glutamate-Serine-Glycine Index as a Biomarker to Monitor the Effects of Bariatric Surgery on Non-alcoholic Fatty Liver Disease. J ASEAN Fed Endocr Soc. 2024;39(2):54-60. doi: 10.15605/jafes.039.02.20. Epub 2024 Sep 13. PMID: 39620184; PMCID: PMC11604366.
2. Tan HC, Shumbayawonda E, Beyer C, Cheng LT, Low A, Lim CH, Eng A, Chan WH, Lee PC, Tay MF, Kin S, Chang JPE, Bee YM, Goh GBB. Multiparametric Magnetic Resonance Imaging and Magnetic Resonance Elastography to Evaluate the Early Effects of Bariatric Surgery on Nonalcoholic Fatty Liver Disease. Int J Biomed Imaging. 2023 Jul 19;2023:4228321. doi: 10.1155/2023/4228321. PMID: 37521027; PMCID: PMC10372298.
3. Cheong EHT, Low ASC, Ooi CC, Tay MF, Cheng L, Hao Y, Lau DS, Abu Bakar RB, Lim SY, Gogna A, Too CW, Tan HK, Tan CK, Chang JPE. 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.
4. Ooi CC, Low SC, Schneider-Kolsky M, Lombardo P, Lim SY, Abu Bakar R, Lo RH. Diagnostic accuracy of contrast-enhanced ultrasound in differentiating benign and malignant focal liver lesions: a retrospective study. J Med Imaging Radiat Oncol. 2010 Oct;54(5):421-30. doi: 10.1111/j.1754-9485.2010.02195.x. PMID: 20958940.