Your Donations in Action: Harjit Singh, MD

Developing from various benign or malignant conditions, biliary strictures pose a significant diagnostic challenge. Conventional imaging modalities such as US, CT and MRI often fail to reliably differentiate benign from malignant disease, particularly because 15% to 24% of strictures lack visible mass.

This diagnostic uncertainty can lead to unnecessary interventions and increased morbidity.

For his 2022 RSNA Research Seed Grant project, “Assessment of Indeterminate Biliary Strictures Using Ultrahigh‐Resolution Optical Coherence Tomography,” Harjit Singh, MD, professor of radiology, surgery and medicine at Penn State College of Medicine and Penn State Health, in Hershey, PA, investigated the feasibility of integrating ultra-high resolution optical coherence tomography (UHR-OCT) with fluoroscopic and cholangioscopic imaging to characterize indeterminate biliary strictures.

Dr. Singh, who conducted the study while on faculty at Johns Hopkins University School of Medicine in Baltimore, and colleagues performed UHR-OCT imaging during routine minimally invasive biliary interventions on 10 individuals. Of those imaged, seven had benign strictures and three had malignant strictures.

On average, UHR-OCT averaged eight minutes, with imaging duration remaining consistent even in complex cases. The technique provided detailed visualization of the biliary epithelium, enabling differentiation between normal, inflamed and malignant tissue, and improving diagnostic sensitivity.

“Our findings suggest that UHR-OCT can provide structural insights beyond conventional imaging techniques, with characteristic alterations observed in malignant biliary strictures, including basement membrane disruption, increased vascularity and loss of normal epithelial layering,” Dr. Singh said.

Dr. Singh added that by reducing diagnostic uncertainty, UHR-OCT may help mitigate the need for repeat biopsies and guide more targeted interventions.

Dr. Singh credits the R&E Foundation grant with making this work possible. “The grant was instrumental in allowing us to work with one of the most well-respected OCT labs in the country. We were able to support a variety of needs from their lab as well as having the supplies and manpower to sustain the project from the radiology perspective,” Dr. Singh said.

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