Publications by authors named "Adrian K P Lim"

Ultrasound practice is a longstanding tradition for radiology departments, being part of the family of imaging techniques. Ultrasound is widely practiced by non-radiologists but becoming less popular within radiology. The position of ultrasound in radiology is reviewed, and a possible long-term solution to manage radiologist expectations is proposed.

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Article Synopsis
  • Most ultrasound methods for assessing liver fibrosis need validation, with liver biopsy as the standard for accuracy.
  • The study evaluates the accuracy of three shear wave elastography methods: Philips Elast Point Quantification, Siemens Virtual Touch Quantification, and transient elastography using Fibroscan, involving 160 patients before liver biopsy.
  • Results suggest fewer measurements (6 for ElastPQ and 7 for VTQ) are sufficient for reliable studies, and while TE and ElastPQ show good diagnostic performance, VTQ has lower accuracy in detecting liver fibrosis.
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Purpose: The Controlled Attenuation Parameter (CAP score) is based on ultrasonic properties of retropropagated radiofrequency signals acquired by Fibroscan (Echosens, Paris, France). Since ultrasound propagation is influenced by the presence of fat, CAP score was developed to quantify steatosis. The aim of this study was to delineate the accuracy of CAP in diagnosing hepatic steatosis, compared to the gold standard of liver biopsy.

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Background: Lumbar Disc Degeneration (LDD) is associated with recurrent low back pain (LBP) (symptomatic). However, in some instances of LDD, people do not experience LBP (asymptomatic).

Research Question: As a step towards understanding why some people with LDD experience LBP and others do not, the primary aim of this study was to examine differences in anticipatory (APA) and compensatory postural adjustments (CPA), between symptomatic LDD patients (LDD pain) and asymptomatic LDD controls (LDD no pain) during postural perturbation.

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People with chronic low back pain (LBP) exhibit changes in postural control. Stereotypical muscle activations resulting from external perturbations include anticipatory (APAs) and compensatory (CPAs) postural adjustments. The aim and objective of this study was to determine differences in postural control strategies (peak amplitude, APAs and CPAs) between symptomatic and asymptomatic adults with and without Lumbar Disc Degeneration (LDD) using surface electromyography during forward postural perturbation.

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Background: There have been isolated reports of hepatotoxicity, usually manifested by transient liver function test abnormalities. While the European Food Safety Authority has recommended that whole leaf products containing the rind of the plant should not be used for human oral consumption, those gels made of the treated plant pulp alone are considered safe for daily consumption, provided recommended quantities are not exceeded. We aimed to assess hepatic function in healthy volunteers consuming the purified plant pulp gel over a 60 day period.

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Article Synopsis
  • Lumbar disc degeneration (LDD) leads to recurrent low back pain (LBP), and the study aimed to investigate if the shape of the lumbar spine is related to LDD and its clinical outcomes in symptomatic adults.
  • Using advanced MRI techniques, researchers analyzed the lumbar spine shapes of 70 LDD patients and healthy controls, identifying specific variations that correlate with the severity of LDD and other health metrics like quality of life.
  • Findings indicated that certain spine shapes, like increased lumbar lordosis and larger anterior-posterior vertebral diameters, were associated with worse clinical outcomes, suggesting that spine morphology could be a risk factor in LDD patients, warranting further longitudinal research.
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Non-linear propagation of ultrasound creates artifacts in contrast-enhanced ultrasound images that significantly affect both qualitative and quantitative assessments of tissue perfusion. This article describes the development and evaluation of a new algorithm to correct for this artifact. The correction is a post-processing method that estimates and removes non-linear artifact in the contrast-specific image using the simultaneously acquired B-mode image data.

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Objectives. Early change in rheumatoid arthritis (RA) is characterised by periarticular osteopenia. We investigated the relationship of early metacarpal digital X-ray radiogrammetry bone mineral density (DXR-BMD) change rate (RC-BMD, mg/cm(2)/month) to longitudinal changes in hand and feet radiographic and wrist MRI scores over 1 year.

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Rational And Objective: Dynamic contrast enhanced (DCE)-MRI has great potential to provide quantitative measure of inflammatory activity in rheumatoid arthritis. There is no current benchmark to establish the stability of signal in the joints of healthy subjects when imaged with DCE-MRI longitudinally, which is crucial so as to differentiate changes induced by treatment from the inherent variability of perfusion measures. The objective of this study was to test a pixel-by-pixel parametric map based approach for analysis of DCE-MRI (Dynamika) and to investigate the variability in signal characteristics over time in healthy controls using longitudinally acquired images.

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Objective: To review the indications, efficacy and follow-up for gestational trophoblastic tumor (GTT) patients treated for uterine arteriovenous vascular malformations (AVMs) and bleeding vaginal metastases with modern polyvinyl alcohol particle (PVA)-based radiological embolization.

Study Design: GTT patients undergoing embolization were identified from the Charing Cross Hospital database. The patients' records were assessed for indication, technique used, primary and overall success in controlling bleeding, complications and subsequent pregnancy outcome.

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Muscle-sparing perforator free flap breast reconstruction with the use of an inferior epigastric or gluteal perforating artery to create a vascular pedicle is increasingly popular because it obviates breast implants and results in lower donor site morbidity than breast reconstruction with myocutaneous flaps. The tissue harvesting procedure for a perforator free flap involves dissecting the subcutaneous fat of the anterior abdominal wall or the buttock to locate and visually evaluate the perforating arteries so as to decide which one is most suitable for the vascular pedicle. The vessel selected depends on multiple anatomic and surgical considerations, and the decision-making process can be exceptionally time-consuming, in part because of the wide variation that occurs in vascular anatomy.

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Article Synopsis
  • - Liver disease is becoming a bigger global health issue, making accurate diagnosis crucial; currently, biopsies are the standard method for assessing liver conditions, but they come with risks.
  • - There is growing interest in non-invasive diagnostic methods, with advances in imaging technologies like ultrasound, CT, and MRI, which could potentially replace or enhance traditional biopsies.
  • - Recent research has highlighted the improvements in imaging for diffuse liver diseases, particularly in detecting conditions such as fibrosis and steatosis, which could prevent serious complications like cirrhosis or liver cancer.
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  • Advances in imaging technology enhance the ability to identify and characterize liver lesions using the liver's dual blood supply.
  • The review covers various imaging techniques like contrast-enhanced ultrasound, CT, and MRI for diagnosing liver cancers (hepatocellular carcinoma and cholangiocarcinoma) and distinguishing benign lesions.
  • Each imaging method's benefits and drawbacks are discussed, emphasizing their role in accurate diagnosis and staging of liver conditions.
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Aim: To assess the clinical feasibility of utilizing the presence of perihepatic lymphadenopathy, seen on ultrasound, as a marker of response to antiviral treatment in patients with hepatitis C virus (HCV)-related liver disease.

Methods: Eighty-five patients with HCV-related liver disease [51 men and 34 women; mean age 47 years (range 26-67)] underwent liver biopsy and baseline ultrasound scans. Twenty-two of these patients were followed up longitudinally with 6-monthly ultrasound scans, whereas they were receiving anti-HCV eradication therapy with interferon and ribavirin.

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Objective: To assess the accuracy of Doppler ultrasound (DU) compared with magnetic resonance imaging (MRI) in high-risk patients with gestational trophoblastic neoplasia (GTN).

Study Design: From January 2005 to October 2007, patients with proven high-risk GTN or suspicion of relapse who had both DU and MRI of the pelvis were reviewed retrospectively for tumor detection and tumor extent and vascularity.

Results: There were a total of 54 patients who had both DU and MRI performed; of these, 40 were first-time presentation and 14 had either residual disease not responding to chemotherapy or suspicion of recurrent GTN based on rising human chorionic gonadotropin (hCG).

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Objective: An increase in the ratio of phosphomonoester (PME) to phosphodiester (PDE) during 31P MR spectroscopy of the liver has been observed with increasing severity of hepatitis C-related liver disease. The purpose of this study was to investigate the utility of 31P MR spectroscopy as a biomarker of response to interferon and ribavirin treatment.

Subjects And Methods: Forty-seven patients with biopsy-proven hepatitis C undergoing viral eradication treatment with interferon and ribavirin underwent hepatic 31P MR spectroscopy at 1.

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Article Synopsis
  • * This article reviews different assessment methods, including liver biopsy, serological markers, and imaging techniques, with a focus on ultrasound.
  • * The use of microbubble ultrasound contrast agents enhances imaging quality and helps evaluate liver damage, potentially becoming more available in clinical practice in the future.
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Purpose: To prospectively compare transit times of Levovist and SonoVue in healthy volunteers and patients with biopsy-proved hepatitis C-related liver disease.

Materials And Methods: Institutional review board approval and informed consent were obtained. Forty patients and 25 healthy volunteers were examined.

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Objective: Many authors have claimed that Doppler sonography indexes are of value in grading and assessing diffuse liver disease. However, there is much controversy regarding the reliability and reproducibility of these techniques. We performed a prospective study to evaluate whether these methods can grade disease in a well-stratified cohort of patients with hepatitis C virus (HCV)-related liver disease.

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Purpose: To evaluate the pharmacokinetics of the microbubble contrast agent BR1.

Materials And Methods: Twenty healthy volunteers were injected via arm vein with a 1.2-mL bolus of BR1.

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Liver biopsy remains the gold standard for characterizing diffuse liver disease and is associated with significant morbidity and, rarely, mortality. Our aim was to investigate whether a noninvasive technique, in vivo phosphorus 31 ((31)P)-magnetic resonance spectroscopy (MRS), could be used to assess the severity of hepatitis C virus (HCV)-related liver disease. Fifteen healthy controls and 48 patients with biopsy-proven HCV-related liver disease were studied prospectively.

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Article Synopsis
  • Radiological surveillance for detecting hepatocellular carcinoma (HCC) in cirrhosis is challenging due to a lack of reliable imaging techniques.
  • Ultrasound (US) is commonly used but is less accurate than other methods, leading to potential missed diagnoses.
  • A case study highlights a patient where US with liver-specific microbubbles successfully identified HCC before it was detected by MRI, suggesting that this new approach could improve HCC detection in chronic liver disease.
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