Head & Neck

Our department has a long-standing world-wide reputation for Head & Neck imaging covering all diseases especially Head & Neck cancer, including nasopharyngeal carcinoma (NPC).
Over the past 30 years we have been at the forefront of research and development in MRI and Ultrasound. We have published numerous papers, obtained competitive grants and disseminated our knowledge through national and international meetings and workshops. 

Since 1995 our pioneering work in MRI Head & Neck Cancer imaging, under Professor Ann King has focused on the following areas; 

• MRI of nasopharyngeal carcinoma (patterns of spread, staging, predictors of treatment response; treatment-induced complications; early detection and screening).
• MRI of head & neck squamous cell carcinoma, lymphoma, glandular and radiation-induced tumours. 
• MRI of the post-treatment neck.
• Precision medicine using functional MRI (DWI, MRS, DCE-MRI, CEST and T1rho) for tumour characterization and for prognostication/prediction and monitoring treatment response (pre-treatment, intra-treatment & post-treatment).
• Currently, we are focusing on MRI of nasopharyngeal carcinoma for early detection & screening and advances in nodal staging; applications of AI and radiomics in the Head & Neck; TIrho imaging.

NPC screening

• Recently established new role of MRI in screening for early detection of NPC to find cancers hidden on endoscopy (MRI detects up to 34% more cancers than endoscopy).  Retrospective study (2006); one prospective study in symptomatic patients (Radiology 2011/ follow up AJNR 2015); three prospective studies in asymptomatic individuals from EBV-related NPC population screening programs (NEJM 2017/follow-up Annals Oncology 2019; Cancer 2021; newly completed study evaluating a fast contrast-free screening MRI 2023). Currently, performing a prospective study using our AI algorithm to automatically detect and report NPC on our fast contrast-free screening MRI.
• Established differences in MRI appearances between early-stage cancer and benign hyperplasia (AJNR 2006, Radiology 2011 & 2012, AJNR 2018)
• Established the only MRI grading system for NPC detection based on a likelihood grade, recently updated from a four-grade (Radiology 2012) to a five-grade (AJNR 2020) system to improve discrimination of early-stage NPC and benign hyperplasia.
• Collaboration with Department of Chemical Pathology on EBV-DNA screening (Early stage NPC stage I/II, 70% screened vs 30% non-screened). New England Journal of Medicine, Notable article of 2017 (9 in top 10 worldwide.
• Joint organizer with the Department of Chemical Pathology of the 1st international consensus meeting on EBV-Screening for NPC, resulting in the publication of the first consensus paper (J Natl Cancer Inst. 2023)

References (11 selected)

(Selected publications, for other publications refer to other sections and PUBMED)

Lam WKJ, King AD, Miller JA, Liu Z, Yu KJ, Chua MLK, Ma BBY, Chen MY, et al. Recommendations for Epstein-Barr virus-based screening for nasopharyngeal cancer in high- and intermediate-risk regions. J Natl Cancer Inst. 2023 Apr 11;115(4):355-364. doi: 10.1093/jnci/djad012. 

Liu Z, Li H, Yu KJ, Xie SH, King AD, Ai QH, Chen WJ, Chen XX, Lu ZJ, Tang LQ, Wang L, Xie CM, Ling W, Lu YQ, Huang QH, Coghill AE, Fakhry C, Pfeiffer RM, Zeng YX, Cao SM, Hildesheim A. Comparison of new magnetic resonance imaging grading system with conventional endoscopy for the early detection of nasopharyngeal carcinoma. Cancer 2021;127(18):3403-3412  doi: 10.1002/cncr.33552

Ai QY, King AD, So TY, Lam WKJ, Mo FKF, Tse IOL, Woo JKS, Chan KCA. MRI of benign hyperplasia in the nasopharynx: is there an association with Epstein-Barr virus?  Clin Radiol. 2020 Jun 19:711.e13-711. Doi: 10.1016/j.crad.2020.05.011.

King AD, Woo JKS, Ai QY, Mo FKF, So TY, Lam WKJ, Tse IOL, Vlantis AC, Yip KWN, Hui EP, Ma BBY, Chiu RWK, Chan ATC, Lo YMD, Chan KCA. Early Detection of Cancer: Evaluation of MR Imaging Grading Systems in Patients with Suspected Nasopharyngeal Carcinoma.  Am J Neuroradiol. 2020 Mar;41(3):515-521. Doi: 10.3174/ajnr. A6444 Nominee for the annual Lucien Levy Best Research Article Award. 

King AD, Woo JKS, Ai QY, Chan JSM, Lam WKJ, Tse IOL, Bhatia KS, Zee BCY, Hui EP, Ma BBY, Chiu RWK, Van Hasselt AC, Chan ATC, Lo YMD, Chan KCA. Complementary roles of MRI and endoscopic examination in the early detection of nasopharyngeal carcinoma. Ann Oncol. 2019 Jun 1;30(6):977-982. Doi: 10.1093/annonc/mdz106.

King AD, Wong LYS, Law BKH, Bhatia KS, Woo JKS, Ai QY, Tan TY, Goh J, Chuah KL, Mo FKF, Chan KCA, Chan ATC, Vlantis AC. MR Imaging Criteria for the Detection of Nasopharyngeal Carcinoma: Discrimination of Early-Stage Primary Tumors from Benign Hyperplasia. Am J Neuroradiol. 2018;39:515-523. Doi: 10.3174/ajnr.A5493.

Chan KCA, Woo JKS, King AD, Zee B, Lam JWK, Chan SL, Chu SWI,1,2,3 Mak C, Tse IOL, Leung SYM, Chan G, Hui EP, Ma BB, Chiu RWK, Leung SF, van Hasselt CA, Chan ATC, Lo YMD. Analysis of Plasma Epstein-Barr Virus DNA to Screen for Nasopharyngeal Cancer.
New England Journal of Medicine 2017; 377:513-522 Doi: 10.1056/NEJMx180004  Notable article of 2017 (9 in the top 10 worldwide). 

King AD, Vlantis AC, Yuen TWC, Law BKH, Bhatia KS, Zee BCY, Woo JKS, Chan ATC, Chan KCA, Ahuja AT. Detection of nasopharyngeal carcinoma by MR imaging: Diagnostic Accuracy of MRI compared with endoscopy and endoscopic biopsy based on long-term follow-up. Am J Neuroradiol 2015;36:2380-2385; doi: 10.3174/ajnr.A4456.

Bhatia KS, King AD*, Vlantis AC, Ahuja AT, Tse GM. Nasopharyngeal mucosa and adenoids: appearance at MR imaging. Radiology 2012;263:437-443; doi: 10.1148/radiol.12111349.

King AD, Vlantis AC, Bhatia KS, Zee BC, Woo JK, Tse GM, Chan AT, Ahuja AT. Primary Nasopharyngeal Carcinoma: Diagnostic Accuracy of MR Imaging versus that of Endoscopy and Endoscopic Biopsy. Radiology 2011;258:531-537; doi: 10.1148/radiol.10101241.

King AD, Vlantis AC, Tsang RKY, Tse GM, Au AKY, Chan CY, Kok SY, Kwok WT, Lui HK, Ahuja AT. Magnetic resonance imaging for the detection of nasopharyngeal carcinoma. Am J Neuroradiol 2006; 27: 1288-1291. (award collection of best 45 articles published in AJNR over the last 10 years)

NPC Staging

MRI NPC research began in our department in 1995 with the arrival of our first departmental MRI scanner. First/amongst the first to report;

• Detailed patterns of primary and nodal NPC spread on MRI, and compare MRI and FDG PET for staging,
•  Predictive value of advanced extranodal extension and nodal volume on NPC survival.

References (15 selected)

(Selected publications, for other publications refer to the section on AI/Radiomics and functional MRI below, and to PUBMED)

King AD. MR Imaging of Nasopharyngeal Carcinoma. Magn Reson Imaging Clin N Am. 2022 Feb;30(1):19-33. Doi: 10.1016/j.mric.2021.06.015 One of the four most read articles

Wong K, Hui E, Lo KW, Lam WK, Johnson D, Li L, Tao Q, Chan KC, To KF, King AD, Ma B, Chan A. Nasopharyngeal Carcinoma: An Evolving Paradigm. Nature Reviews Clinical Oncology. 2021;18:679-695. Doi: 10.1038/s41571-021-00524-x

Ai QY, King AD, Poon DMC, Mo FKF, Hui EP, Tong M, Ahuja AT, Ma BBY, Chan ATC. Extranodal extension is a criterion for poor outcome in patients with metastatic nodes from cancer of the nasopharynx. Oral Oncology 2019;88:124-130; doi: 10.1016/j.oraloncology.2018.11.007.

Ai QY, King AD, Mo FKF, Law BKH, Bhatia KS, Poon DMC, Kam MKM, Ma BB. Staging nodal metastases in nasopharyngeal carcinoma: which method should be used to measure nodal dimension on MRI? Clinical Radiology 2018;73:640-646; doi: 10.1016/j.crad.2017.12.015.

Ai QY, Hu CW, Bhatia KS, Poon DMC, Hui EP, Mo FKF, Law BKH, Tong M, Ma BB, Chan ATC, King AD. Nasopharyngeal carcinoma: relationship between invasion of the prevertebral space and distant metastases. Eur Arch Otorhinolaryngol 2018;275:497-505. Doi: 10.1007/s00405-017-4825-z.

Ai Q-Y, King AD, Mo FK, Law BKH, Bhatia KSS, Ma BB, Poon DMC, Kam MKM. Prediction of distant metastases from nasopharyngeal carcinoma: improved diagnostic performance of MRI using nodal volume in N1 and N2 stage disease. Oral Oncology, 2017; 69:74-79. Doi: 10.1016/j.oral oncology.2017.04.008.

Abdel Razek A, King AD. MRI and CT of nasopharyngeal carcinoma. Am J Roentgenol 2012;198:11-18; doi: 10.2214/AJR.11.6954

King AD, Bhatia KS. Magnetic resonance imaging staging of nasopharyngeal carcinoma in the head and neck. World Journal of Radiology. 2010;2:159-165; doi: 10.4329/WJR.V2.I5.159

King AD, Ma BB, Yau YY, Zee B, Leung SF, Wong JKT, Kam MKM, Ahuja AT, Chan ATC. The impact of 18F-FDG PET/CT on assessment of nasopharyngeal carcinoma at diagnosis. The British Journal of Radiology 2008;81:291-298. Doi: 10.1259/bjr/73751469.

King AD, Zee B, Yuen EH, Leung SF, Yeung DK, Ma BB, Wong JK, Kam MK, Ahuja AT, Chan AT. Nasopharyngeal cancers: which method should be used to measure these irregularly shaped tumors on cross-sectional imaging? International Journal of Radiation Oncology Biology Physics 2007; 69:148-154. Doi: 10.1016/j.ijrobp.2007.02.032. 

Lee FK, Yeung DK, King AD, Leung SF, Ahuja AT. Segmentation of nasopharyngeal carcinoma (NPC) lesions in MR images. International Journal of Radiation Oncology Biology Physics 2005; 61:608-620. Doi: 10.1016/j.ijrobp.2004.09.024.

King AD, Teo P, Lam WWM, Leung SF and Metreweli C. Paranasopharyngeal space involvement in nasopharyngeal carcinoma: detection by CT and MRI. Clinical Oncology 2000; 12:397-402. Doi: 10.1053/clon.2000.9199.

King AD, Ahuja AT, Leung SF, Lam WWM, Teo P, Chan YL and Metreweli C. Neck node metastases from nasopharyngeal carcinoma: MR imaging of patterns of disease. Head and Neck 2000; 22:275-281. Doi: 10.1002/(sici)1097-0347(200005)22:3<275:aid-hed10>3.0.co;2-n.

King AD, Lam W, Leung SF, Chan YL, Teo P, Metreweli C. MRI of local disease in nasopharyngeal carcinoma: tumour extent vs tumour stage. British Journal Radiology 1999; 72: 734-741. Doi: 10.1259/bjr.72.860.10624338

King AD, Lam W, Chan YL, Leung SF, Metreweli C. Comparison of T2 weighted fat suppressed turbo spin echo and contrast enhanced T1 weighted spin echo MRI in nasopharyngeal carcinoma. British Journal Radiology 1997; 70: 1208-1214. Doi: 0.1259/bjr.70.840.9505838.

Books and Book chapters

Hermans R, Bhatia KS and King AD. Tumours of the pharynx, tongue, and mouth. In: Anju Sahdev, Sarah Vinnicomb, eds. Husband and Reznek’s Imaging in Oncology. Third Edition CRC Press 2020, 578-608 ; Ann D King, Jiling Zeng and Fan Wei Imaging in the Diagnosis of NPC. In : Jun Ma, Jiade Lu, Nancy Lee. Diagnosis and Treatment of Nasopharyngeal Carcinoma — A Practical Textbook for Clinicians 2023; King AD, SF Leung, Cancer of the Nasopharynx “Imaging in Head and Neck Cancer. A Practical Approach”. In; Ahuja AT, Evans R, A King AD, van Hasselt CA eds. Greenwich Medical Media, London UK, San Francisco USA 2003; King AD, AC Vlantis, Cancer of the Skull Base “Imaging in Head and Neck Cancer. A Practical Approach”.  In; Ahuja AT, Evans R, A King AD, van Hasselt CA eds. Greenwich Medical Media, London UK, San Francisco USA 2003;Lam WWM and King AD. Computed tomography and magnetic resonance imaging, In: Nasopharyngeal carcinoma. van Hasselt CA and Gibb AG, eds. Book chapter Vol (2) :127-148. Hong Kong: The Chinese University Press, 1999.

NPC Functional MRI and Post-treatment imaging  

First/amongst the first to report;

•  Functional MRI predictive markers, especially in relationship to development of distant metastases (see functional MRI below).
• Document MRI appearances of treatment induced complications (see post-treatment section below).

Deep learning and radiomics in NPC screening

• First to demonstrate a specific patch-based convolutional neural network (CNN) with texture and patch-position information embedded to enable automatic primary NPC segmentation with a delineation accuracy comparable to a clinical expert.
• First to demonstrate that AI segmentation of primary NPC can be achieved on a plain T2w-fs protocol with a Dice similarity score, similar to that obtained from a contrast-enhanced T1w protocol.  
• Among the first to show AI can discriminate NPC and benign hyperplasia using plain scans. This was achieved by devising a slice-wise attention mechanism which takes into account the varying diagnostic importance of different scanned slices. This AI algorithm showed a high performance in discriminating NPC from benign hyperplasia similar to that of a radiologist who was also evaluating the same MRI scans.
• Among the first to show an ensemble radiomic model built solely from plain MRI radiomic features has the potential to discriminate between stage T1 NPC and benign hyperplasia
• Developed an AI algorithm for automatic detection of NPC and report generation using a fast contrast-free screening MRI protocol dedicated to the nasopharynx, which is currently undergoing evaluation in a prospective study.

Radiomics in salivary gland tumours

• Showed that a radiomic model has the potential to discriminate between various types of salivary gland tumors (SGTs).

Repeatability of radiomics and radiomic features of H&N cancers

• Showed the number of feature categories introduced into the radiomic pipeline can be reduced without reducing performance to improve stability of features in the final radiomic signature for discrimination of salivary gland tumours. 
• Showed our current radiomic model for discriminating stage T1 NPC and benign hyperplasia can be extended for use in all T stage NPCs, by fine-tuning feature normalization parameters.
• Conducted inter-scanner repeatability analysis of radiomic features in salivary gland tumors

References (6 selected)

Wong LM, Ai QYH, Mo FKF, Poon DMC, & King AD. Convolutional neural network in nasopharyngeal carcinoma: how good is automatic delineation for primary tumor on a non-contrast-enhanced fat-suppressed T2-weighted MRI? Jpn J Radiol (2021),  39(6), 571-579. doi:10.1007/s11604-021-01092-x 

Wong LM, Ai QYH, Poon DMC, Tong M, Ma BBY, Hui EP, Shi L, & King AD. A convolutional neural network combined with positional and textural attention for the fully automatic delineation of primary nasopharyngeal carcinoma on non-contrast-enhanced MRI. Quant Imaging Med Surg (2021),  11(9), 3932-3944. doi:10.21037/qims-21-196 

Wong LM, Ai QYH, Zhang R, Mo F, & King AD. Radiomics for Discrimination between Early-Stage Nasopharyngeal Carcinoma and Benign Hyperplasia with Stable Feature Selection on MRI. Cancers (Basel) (2022),  14(14). doi:10.3390/cancers14143433 

Wong LM, King AD, Ai QYH, Lam WKJ, Poon DMC, Ma BBY, Chan KCA, & Mo FKF. Convolutional neural network for discriminating nasopharyngeal carcinoma and benign hyperplasia on MRI. Eur Radiol (2021),  31(6), 3856-3863. doi:10.1007/s00330-020-07451-y 

Ai QYH, Zhang H, Jiang B, So TY, Mo FKF, Qamar S, Chen W, King AD. Test-retest repeatability of T1rho (T1ρ) MR imaging in the head and neck. Eur J Radiol. 2021 Feb;135:109489. Epub 2020 Dec 24. Doi: 10.1016/j.ejrad.2020.109489

Zhang R, Ai QYH, Wong LM, Green C, Qamar S, So TY, Vlantis AC, King AD. Radiomics for Discriminating Benign and Malignant Salivary Gland Tumors; Which Radiomic Feature Categories and MRI Sequences Should Be Used?  Cancers (Basel). 2022 Nov 25;14(23):5804. doi: 10.3390/cancers14235804.

• Pioneering research began in 2002 into proton magnetic resonance spectroscopy (MRS) and diffusion weighted imaging (DWI), followed later by dynamic contrast enhanced MRI (DCE), chemical exchange saturation transfer imaging (CEST) and T1 rho imaging.
• Publications include development and refinement of techniques, image analysis and imaging markers for tumor characterization and personalized treatment. Firsts/amongst the first to report in the Head & Neck
• Functional MRI imaging markers for distinguishing lymphoma, SCC and NPC
• Pre-treatment prognostic/predictive imaging markers for treatment response; ADC (DWI) predicts poor outcome and presence of distant metastases (NPC) and APT predicts poor outcome (NPC).
• Early intra-treatment predictive markers for treatment response; % change ADC (DWI) predicts poor outcome (squamous cell carcinoma) and % change APT predicts poor outcome (NPC)
• Post-treatment DWI, DCE and MRS markers that identify residual cancer including in the early post-treatment period (squamous cell carcinoma).
• Since 2002 functional MRI has grown into a vast field of research in precision medicine, DWI is routinely used for head and neck characterization/post-treatment assessment and close to acceptance for intra-treatment response. Currently working on the role of T1Rho in Head & Neck cancer imaging

References (40 selected)

(Selected publications, for other publications refer to post-treatment below and PUBMED)

Reviews 

Dai E, King AD. State of the art MRI in Head and Neck Cancer. Clinical Radiology 2018;73:45-59. Doi: 10.1016/j.crad.2017.05.020

King AD, Thoeny HC. Functional MRI for the prediction of treatment response in head and neck squamous cell carcinoma: potential and limitations. Cancer Imaging. 2016 Aug 19;16(1):23. Review doi: 10.1186/s40644-016-0080-6.

Yuan J, Lo G, King AD. Functional magnetic resonance imaging techniques and their development for radiation therapy planning and monitoring in the head and neck cancers. Quant Imaging Med Surg. 2016 Aug;6(4):430-448. Review. Doi: 10.21037/qims.2016.06.11

Thoeny HC, De Kayzer F, King AD.  Diffusion-weighted MR imaging in the head and neck. Radiology 2012;263:19-32; doi: 10.1148/radiol.11101821

King AD. Multimodality Imaging of Head and Neck Cancer. Cancer Imaging  2007; 1:7 Spec No A:S37-46. Doi: 10.1102/1470-7330.2007.9013.

Nasopharyngeal Carcinoma 

Ai QY, Chen W, So TY, Lam WKJ, Jiang B, Poon DMC, Qamar S, Mo FKF, Blu T, Chan Q, Ma BBY, Hui EP, Chan KCA, King AD. Quantitative T1rho MRI of the head and neck discriminates carcinoma and benign hyperplasia in the nasopharynx. American Journal of Neuroradiology.  2020, DOI: https://doi.org/10.3174/ajnr.A6828 

Qamar S, King AD, Ai QH, Mo FKF, Chen W, Poon DMC, Tong M, Ma BB, Yeung DK, Wang YX, Yuan J. Pre-treatment amide proton transfer imaging predicts treatment outcome in nasopharyngeal carcinoma. Eur Radiol. 2020 30(11):6339-6347 Doi: 10.1007/s00330-020-06985-5

So TY, Ai QH, Lam WKJ, Qamar S, Poon DMC, Hui EP, Mo FKF, Chan KCA, King AD. Intravoxel incoherent motion diffusion-weighted imaging for discrimination of benign and malignant retropharyngeal nodes. Neuroradiology 2020 62(12):1667-1676. Doi: 10.1007/s00234-020-02494-w

So T, Ai QY, Ma BB, King AD. Early intra-treatment diffusion weighted magnetic resonance imaging in patients with recurrent nasopharyngeal carcinoma treated with nivolumab. International Journal of Otorhinolaryngology and Head and Neck Surgery 2020; 6:568-573  Doi: 10.18203/issn.2454-5929.ijohns20200637

Ai QY, King AD, Chan JSM, Chen WT, Chan AKC, Woo JKS, Zee BCY, Chan ATC, Poon DMC, Ma BBY, Hui EP, Ahuja AT, Vlantis AC, Yuan J. Distinguishing early-stage nasopharyngeal carcinoma from benign hyperplasia using intravoxel incoherent motion diffusion-weighted MRI. Eur Radiol. 2019 Oct;29(10):5627-5634; doi: 10.1007/s00330-019-06133-8. 

Qamar S, King AD, Ai QY, So T, Mo FK, Chen WT, Poon DMC, Tong M, Ma BB, Hui EP, Yeung DKW, Wang YX, Yuan J. Pre-treatment intravoxel incoherent motion diffusion-weighted imaging predicts treatment outcome in nasopharyngeal carcinoma. European Journal of Radiology 2020;129:109127; doi: 10.1016/j.ejrad.2020.109127

Ai QY, King AD, Chan JSM, Chen WT, Chan AKC, Woo JKS, Zee BCY, Chan ATC, Poon DMC, Ma BBY, Hui EP, Ahuja AT, Vlantis AC, Yuan J. Distinguishing early-stage nasopharyngeal carcinoma from benign hyperplasia using intravoxel incoherent motion diffusion-weighted MRI. Eur Radiol. 2019 Oct;29(10):5627-5634; doi: 10.1007/s00330-019-06133-8. 

Qamar S, King AD, Ai QY, Law BKH, Chan JSM, Poon DMC, Tong M, Mo FKF, Chen W, Bhatia KS, Ahuja AT, Ma BBY, Yeung DK, Wang YX, Yuan J. Amide proton transfer MRI detects early changes in nasopharyngeal carcinoma: providing a potential imaging marker for treatment response. Eur Arch Otorhinolaryngol. 2019;276:505-512 Doi: 10.1007/s00405-018-5231-x

Law BKH, King AD, Ai QY, Poon DMC, Chen W, Bhatia KS, Ahuja AT, Ma BB, Yeung DKW, Mo FK, Wang YX, Yuan J. Head and neck tumors: Amide proton transfer MRI. Radiology 2018; 288:782–790.  Doi: 10.1148/radiol.2018171528.

Law BK, King AD, Bhatia KS, Ahuja AT, Kam MK, Ma BB, Ai QY, Mo FK, Yuan J, Yeung DK. Diffusion-Weighted Imaging of Nasopharyngeal Carcinoma: Can Pretreatment DWI Predict Local Failure Based on Long-Term Outcome? Am J Neuroradiol. 2016;37(9):1706-1712 Doi: 10.3174/ajnr.A4792.

Ai QY, King AD, Law BK, Yeung DK, Bhatia KS, Yuan J, Ahuja AT, Wong LY, Ma BB, Mo FK, Kam MK. Diffusion-weighted imaging of nasopharyngeal carcinoma to predict distant metastases. Eur Arch Otorhinolaryngol. 2017;274:1045-1051; doi: 10.1007/s00405-016-4333-6

Law BK, King AD, Bhatia KS, Ahuja AT, Kam MK, Ma BB, Ai QY, Mo FK, Yuan J, Yeung DK. Diffusion-Weighted Imaging of Nasopharyngeal Carcinoma: Can Pretreatment DWI Predict Local Failure Based on Long-Term Outcome? Am J Neuroradiol. 2016;37(9):1706-1712 Doi: 10.3174/ajnr.A4792.

Fong D, Bhatia KS, Yeung D, King AD. Diagnostic accuracy of diffusion-weighted MR imaging for nasopharyngeal carcinoma, head and neck lymphoma and squamous cell carcinoma at the primary site. Oral Oncololgy 2010;46(8):603-606; Doi: 10.1016/j.oraloncology.2010.05.004.

King AD, Yeung DK, Ahuja AT, Leung SF, Tse GM, van Hasselt AC. In vivo proton MR spectroscopy of primary and nodal nasopharyngeal carcinoma. American Journal of Neuroradiology 2004; 25:484-489

King AD, Lam W, Chan YL, Leung SF, Metreweli C. Nasopharyngeal carcinoma: dynamic MR imaging with gadolinium. Chinese Medical Journal 1998; 111:593-598 

Head & Neck Squamous cell carcinoma 

King AD, Chow SKK, Yu KH, Mo FKF, Yeung DKW, Yuan J, Law BKH, Bhatia KS, Vlantis AC, Ahuja AT. DCE-MRI for pre-treatment prediction and post-treatment assessment of treatment response in sites of squamous cell carcinoma in the head and neck. PLoS One 2015 Dec 10;10(12):e0144770; doi: 0.1371/journal.pone. 0144770.

King AD, Chow KK, Yu KH, Mo FK, Yeung DK, Yuan J, Bhatia KS, Vlantis AC, Ahuja AT. Head and Neck squamous cell carcinoma: diagnostic performance of diffusion-weighted MR imaging for the prediction of treatment response. Radiology 2013;266:531-538 Doi: 10.1148/radiol.12120167

Bhatia KS, King AD, Yeung DK, Mo F, Vlantis AC, Yu KH, Wong JK, Ahuja AT. Can diffusion-weighted imaging distinguish between normal and squamous cell carcinoma of the palatine tonsil: a preliminary study. British Journal of Radiology 2010;83:753-758 Doi: 10.1259/bjr/58331222.

Tse GM, King AD, Yu AM, Lam CC, Chan AW, Chen GG, Yeung DK, Yu KH, Bhatia KS, Chan AB. Correlation of biomarkers in head and neck squamous cell carcinoma. Otolaryngology Head and Neck Surgery 2010;143:795-800; doi: 10.1016/j.otohns.2010.08.028.

King AD, Yeung DK, Yu KH, Mo FK, Bhatia KS, Tse GM, Vlantis AC, Wong JK, Hu CW, Ahuja AT. Pretreatment and early intratreatment prediction of clinicopathologic response of head and neck cancer to chemoradiotherapy using 1H-MRS. Journal of Magnetic Resonance Imaging 2010;32:199-203;doi: 10.1002/jmri.22224.

King AD, Mo FK, Yu KH, Yeung DKW, Zhou Hua, Bhatia KS, Tse GMK, Vlantis AC, Wong JKT, Ahuja AT. Squamous cell carcinoma of the head and neck: diffusion-weighted MR imaging for prediction and monitoring of treatment response. European Radiology 2010;20:2213-2220 Doi: 10.1007/s00330-010-1769-8.

King AD, Yeung DK, Yu KH, Mo FK, Hu CW, Bhatia KS, Tse GM, Vlantis AC, Wong KT, Ahuja AT. Monitoring of treatment response after chemoradiotherapy for head and neck cancer using in vivo (1)HMR spectroscopy. European Radiology 2010;20:165-172 Doi: 10.1007/s00330-009-1531-2.

King AD, Ahuja AT, Yeung DKW, Fong DKY, Lee YYP, Lei KIK, Tse GMK. Malignant cervical lymphadenopathy: Diagnostic accuracy of MR diffusion weighted imaging (DWI). Radiology 2007; 245:806-813. Doi: 10.1148/radiol.2451061804 

Other Head & Neck tumours

Yuan J, Chow SK, Yeung DK, King AD. A five-colour colour-coded mapping method for DCE-MRI analysis of head and neck tumours. Clin Radiol 2012;67:216-223 Doi: 10.1016/j.crad.2011.07.052.

Lee FK, King AD, Ma BB, Yeung DK. Dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) for differential diagnosis in head and neck cancers. European Journal of Radiology 2012;81:784-788; doi: 10.1016/j.ejrad.2011.01.089.

King AD, Yeung DK, Ahuja AT, Tse GMK, Yuen HY, Wong KT, van Hasselt CA. Salivary gland tumors at in vivo proton MR spectroscopy. Radiology 2005; 237: 563-569. Doi: 10.1148/radiol.2372041309.

King AD, Yeung DK, Ahuja AT, Yuen EH, Ho SF, Tse GM, van Hasselt. Human cervical lymphadenopathy: evaluation with in vivo 1H-MRS at 1.5T. Clinical Radiology 2005; 60:592-598. Doi: 10.1016/j.crad.2004.11.012.

King AD, Yeung DK, Ahuja AT, Tse GM, Chan AB, Lam SS, van Hasselt AC. In vivo ¹H MR spectroscopy of thyroid carcinoma. European Journal of Radiology 2005; 54:112-117. Doi: 10.1016/j.ejrad.2004.05.003.

Technique

Yeung DK, Fong KY, Chan QC, King AD. Chemical shift imaging in the head and neck at 3T: initial results. Journal of Magn Reson Imaging. 2010;32:1248-1254; doi: 10.1002/jmri.22365

Yuan J, Chen SZ, King AD, Zhou JY, Bhatia KS, Zhang QW, Yeung DK, Wei J, Mok G, Wang YX. Amide proton transfer-weighted imaging of the head and neck at 3T: a feasibility study on healthy human subjects and patients with head and neck cancer. NMR In Biomedicine 2014; 27:1239-1247; doi: 10.1002/nbm.3184

Yuan J, Yeung DK, Mok GS, Bhatia KS, Wang YX, Ahuja AT, King AD. Non-Gaussian analysis of diffusion weighted imaging in head and neck at 3T: a pilot study in patients with nasopharyngeal carcinoma. PLoS One 2014;9:e87024; doi: 10.1371/journal.pone.0087024.

Shi L, Wang D, Liu W, Fang K, Wang YX, Huang W, King AD, Heng PA, Ahuja AT. Automatic detection of arterial input function in dynamic contrast enhanced MRI based on affinity propagation clustering. J Magn Reson Imaging 2014;39:1327-1337 Doi: 10.1002/jmri.24259.

Yuan J, Chow SK, Zhang Q, Yeung DK, Ahuja AT, King AD. The use of dynamic tracer concentration in veins for quantitative DCE-MRI kinetic analysis in head and neck. PLoS One 2013;8:e59885; doi: 10.1371/journal.pone.0059885.

Yuan J, Chow SK, Yeung DK, Ahuja AT, King AD. Quantitative evaluation of dual-flip-angle T1 mapping on DCE-MRI kinetic parameter estimation in head and neck. Quant Imaging Med Surg 2012;2:245-253; doi: 10.3978/j.issn.2223-4292.2012.11.04

Yuan J, Chow SK, King AD, Yeung DK. Heuristic linear mapping of physiological parameters in dynamic contrast-enhanced MRI without T1 measurement and contrast agent concentration. J Magn Reson Imaging. 2012;35:916-925; doi: 10.1002/jmri.22885.

Wang D, Shi L, Wang YX, Yuan J, Yeung DK, King AD, Ahuja AT, Heng PA. Concatenated and parallel optimization for the estimation of T1 map in FLASH MRI with multiple flip angles. Magnetic Resonance in Medicine 2010 May;63(5):1431-1436; Doi: 10.1002/mrm.22294.

• Since 2012 through lectures, papers and workshops have shown the value of T2 weighted (intermediate signal intensity) and DWI sequences (restricted diffusion) in detection of residual/ recurrent tumour (see functional MRI above).
• Assessment of post-treatment nodes; percentage reduction in the size of the solid component discriminates sterile vs residual cancer nodes. 
• Documented range of radiation-induced complications in the Head & Neck on the post treatment MRI.

References (15 selected)

Leung HS, King AD, Chow MWS, Lai CCF, Vlantis AC, Wong KT. Imaging considerations for salvage surgery in nasopharyngeal carcinoma: what surgeons need to know. Clin Radiol. 2022 May 19;S0009-9260(22)00213-6. doi: 10.1016/j.crad.2022.04.009.

King AD, Yu KH, Mo FK, Law BK, Yuen TW, Bhatia KS, Vlantis AC. Cervical nodal metastases from head and neck squamous cell carcinoma: MRI criteria for treatment assessment. Head Neck. 2016 Apr; 38 Suppl 1:E1598-604. Doi: 10.1002/hed.24285.

King AD, Keung CK, Yu KH, Mo FK, Bhatia KS, Yeung DK, Tse GM, Vlantis AC, Ahuja AT. T2-weighted MR imaging early after chemoradiotherapy to evaluate treatment response in head and neck squamous cell carcinoma. AJNR AM J Neuroradiol 2013;34:1237-1241 Doi: 10.3174/ajnr.A3378.

Bhatia KS, King AD, Yu KH, Vlantis AC, Tse GM, Mo FK, Ahuja AT. Does primary tumour volumetry performed early in the course of definitive concomitant chemoradiotherapy for head and neck squamous cell carcinoma improve prediction of primary site outcome? British Journal of Radiology 2010;83:964-970; doi: 10.1259/bjr/27631720.

King AD, Mo FK, Yu KH, Yeung DKW, Zhou Hua, Bhatia KS, Tse GMK, Vlantis AC, Wong JKT, Ahuja AT. Squamous cell carcinoma of the head and neck: diffusion-weighted MR imaging for prediction and monitoring of treatment response. European Radiology 2010;20:2213-2220 Doi: 10.1007/s00330-010-1769-8.

King AD, Griffith JF, Abrigo JM, Leung SF, Yau FK, Tse GMK, Ahuja AT. Osteoradionecrosis of the upper cervical spine: MR imaging following radiotherapy for nasopharyngeal carcinoma. European Radiology 2010;73:629-635 Doi: 10.1016/j.ejrad.2008.12.016

Wang YX, King AD, Zhou H, Leung SF, Abrigo J, Chan YL, Hu CW, Yeung DKW, Ahuja AT. Evolution of radiation-induced brain injury: MR imaging-based study. Radiology 2010;254(1):210-218; Doi: 10.1148/radiol.09090428.

King AD, Yeung DK, Yu KH, Mo FK, Hu CW, Bhatia KS, Tse GM, Vlantis AC, Wong KT, Ahuja AT. Monitoring of treatment response after chemoradiotherapy for head and neck cancer using in vivo (1)HMR spectroscopy. European Radiology 2010;20:165-172 Doi: 10.1007/s00330-009-1531-2.

Abrigo JM, King AD, Leung SF, Vlantis AC, Wong JK, Tong MC, Tse GM, Ahuja AT.  MRI of radiation-induced tumors of the head and neck in post-radiation nasopharyngeal carcinoma. European Radiology 2009;19:1197-1205; doi: 10.1007/s00330-008-1265-6.

King AD, Ahuja AT, Leung SF, Abrigo J, Wong KT, Poon WS, Woo KS, Chan HS, Tse MK. MR imaging of non-malignant polyps and masses of the nasopharynx and sphenoid sinus following radiotherapy for nasopharyngeal carcinoma. American Journal of Neuroradiology 2008;29:1209-1214; doi: 10.3174/ajnr.A1043.

King AD, Ahuja AT, Yeung DK, Wong JK, Lee YY, Lam WW, Ho SS, Yu SC, Leung SF. Delayed complications of radiotherapy treatment for nasopharyngeal carcinoma: imaging findings. Clinical Radiology 2007; 62:195-203. Doi: 10.1016/j.crad.2006.10.011.

King AD, Yuen EHY, Chan PN, Leung SF, Tse GMK, Kam MKM, Ahuja AT. MR mimics of recurrent nasopharyngeal carcinoma. European Journal of Radiology Extra 2005; 55:23-27

King AD, Ahuja AT, Teo P, Tse GMK, Kew J. Radiation induced sarcomas of the head and neck following radiotherapy for nasopharyngeal carcinoma. Clinical Radiology 2000; 55:684-689. Doi: 10.1053/crad.2000.0503.

Chan YL, Leung SF, King AD, Choi P, Metreweli C. Late radiation injury to the temporal lobes: morphologic evaluation at MR imaging. Radiology 1999; 213: 800-807. Doi: 10.1148/radiology.213.3.r99dc07800 

King AD, Ahuja A, Leung SF, Chan YL, Lam WWM, Metreweli C. MR features of the denervated tongue in radiation induced neuropathy. British Journal of Radiology 1999; 72: 349-353. Doi: 10.1259/bjr.72.856.10474495

• Documented MRI patterns of head and neck lymphoma (nasopharynx, nasal cavity, larynx, glands and nodes)
• Metastatic nodal features including necrosis and ENE 
• MRI appearances in thyroid and salivary gland tumours.

References (18 selected)

Lymphoma

Ko KWS, Bhatia KS, Ai QYH, King AD. Imaging of head and neck mucosa-associated lymphoid tissue lymphoma (MALToma).Cancer Imaging. 2021 Jan 12;21(1):10. Doi:10.1186/s40644-020-00380-5

King AD, Law BK, Tang WK, Mo FK, Raghupathy R, Bhatia KS, Lei KI. MRI of diffuse large B-cell non-Hodgkin’s lymphoma of the head and neck: comparison of Waldeyer’s ring and sinonasal lymphoma. Eur Arch Otorhinolaryngol. 2017;274(2):1079-1087.Doi:10.1007/s00405-016-4337-2

King AD, Lei KI, Ahuja AT. MRI of neck nodes in non-Hodgkin’s lymphoma of the head and neck. British Journal of Radiology 2004; 77:111-115. Doi: 10.1259/bjr/53555208.

King AD*, Yuen HY, Lei KIK, Ahuja AT, van Hasselt A. Non-Hodgkin lymphoma of the larynx: CT and MR imaging findings. American Journal of Neuroradiology 2004; 25:12-15

King AD, Lei KIK, Richards PS, Ahuja AT. Non-Hodgkin’s lymphoma of the nasopharynx: CT and MR Imaging. Clinical Radiology 2003; 59:621-625. Doi: 10.1016/s0009-9260(03)00182-x.

King AD, Lei IK, Ahuja AT. MRI of primary non-Hodgkin’s lymphoma of the palatine tonsil. British Journal of Radiology 2001; 74: 226-229. Doi: 10.1259/bjr.74.879.740226.

King AD, Lei IK, Ahuja AT, Lam WWM, Metreweli C. MR imaging of nasal T-cell / natural killer cell lymphoma. American Journal of Roentgenology 2000; 174:209-211. Doi: 10.2214/ajr.174.1.1740209.

Nodes

Bhatia KS and King AD. Neck nodal disease. In: Robert Hermans, eds. Head and Neck Cancer Imaging, Third edition. Spinger 2020, 405-440

King AD. Neck and distant disease spread. In: Robert Hermans ed. Squamous cell cancer of the neck. Cambridge University Press, London UK 2008, 114-134

Ai QYH, So TY, Hung KF, King AD. Normal size of benign upper neck nodes on MRI: parotid, submandibular, occipital, facial, retroauricular and level IIb nodal groups. Cancer Imaging. 2022 Dec 8;22(1):66. doi: 10.1186/s40644-022-00504-z. 

King AD, Tse GMK, Ahuja AT, Yuen EHY, Vlantis AC, To EWH, van Hasselt AC.  Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging and US. Radiology 2004;230:720-726; doi: 10.1148/radiol.2303030157

King AD, Tse GMK, Yuen E, To EWH, Vlantis AC, Zee B, Chan BW, van Hasselt AC, Ahuja AT. Comparison of CT and MR imaging for the detection of extranodal neoplastic spread in metastatic neck nodes. European Journal of Radiology 2004; 52:264-270. Doi: 10.1016/j.ejrad.2004.03.004.

King AD, Ahuja A, Metreweli C. MRI of tuberculous cervical lymphadenopathy. Journal of Computed Assisted Tomography 1999; 23: 244-247. Doi: 10.1097/00004728-199903000-00013. 

Glandular & Other

King AD. Imaging for staging and management of thyroid cancer. Cancer Imaging 2008;8:57-69. Doi: 10.1102/1470-7330.2008.0007.

King AD, Ahuja AT, To EWH, Tse GMK, Metreweli C. Staging papillary carcinoma of the thyroid: magnetic resonance imaging vs ultrasound of the neck. Clinical Radiology 2000; 55:222-226. Doi: 10.1053/crad.1999.0373.

Lee YYP, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. European Journal of Radiology 2008; 66:419 -436. Doi: 10.1016/j.ejrad.2008.01.027.

Wong KT, Ahuja AT, King AD, Yuen EH, Yu SC. Vascular lesions of parotid gland in adult patients: diagnosis with high-resolution ultrasound and MRI. British Journal of Radiology 2004; 77:600-606. Doi: 10.1259/bjr/15671187.

King AD, Ahuja AT, Tse GMK, van Hasselt AC, Chan ABW. MR imaging features of nasopharyngeal tuberculosis: report of three cases and literature review. American Journal of Neuroradiology 2003; 24:279-282

Our previous esteemed Professors have contributed to the long and world-renowned reputation for Head & Neck Ultrasound. 

Professor Constantine Metreweli is a pioneer of Head & Neck Ultrasound. He started head and neck ultrasound in the 1980s and through his research and observations, many of his early discoveries were integrated into our routine clinical practice long before ultrasound became widely used.

Professor Anil Ahuja over the subsequent decades made major contributions to the subspecialty through teaching, workshops, books and research, establishing the vital role of Head & Neck ultrasound in modern day clinical practice.