February 2, 2001

Getting inside people's heads

Benjamin C.P. Lee is a leader in developing MRI and MRS, which allow noninvasive examination of the brain and other organs

**Benjamin C.P. Lee, M.B.B.S., associate professor of radiology and of pediatrics, views a brain specimen for congenital abnormalitites with research coordinator, Marcia Hendrix.**

Benjamin C.P. Lee, M.B.B.S., savors the intellectual challenge of neuroradiology. "You're presented with a problem and you have to find the right tool to solve it," he explained.

Lee, associate professor of radiology and of pediatrics in the School of Medicine, has contributed to the development of many tools that allow physicians to view the brain without breaking the skin, looking for early signs of cancer, stroke and other disorders. These imaging methods also help scientists learn about the organization of the brain and guide surgeons in delicate procedures.

"Dr. Lee has contributed substantially to neuroradiology and specifically to magnetic resonance imaging (MRI)," said Victor M. Haughton, M.D., professor of radiology at the University of Wisconsin Medical Center in Madison.

A long road

When Lee returns to his birth city of Hong Kong to visit family, he finds few traces of the city in which he grew up - a British colony that lived under the threat of invasion from mainland China. Lee's father was a physician who hoped Benjamin, the second of six children, would carry on the tradition. The younger Lee wryly recalls that he was not altogether enthusiastic. "It looked like a long road to become a doctor," he said.

And it was, not just in years but in miles. After being sent to boarding school in England as a teen-ager, Lee would make the journey home only once a year. Contact with the British in Hong Kong had given him a lasting distaste for colonialism, but fortunately, he took to the Britons rather more than he expected to.

"The British in their homeland are very different," Lee said. "Once they accept you, they're very friendly."

His school was Spartan, but its proximity to the lovely Georgian resort of Bath allowed an occasional glimpse of elegance. The strong education provided Lee with a solid base in the sciences.

In the British system, medical education begins immediately after high school. Lee went to the University of London and in five years earned the equivalent of an M.D. And, unlike many American graduates, he was not burdened with debt. He believes the system benefited him by giving him plenty of time to choose the right specialty.

"It's not as structured over there," Lee said. "You create your own training more, going after the jobs that appeal to you." The jobs that appealed to Lee were increasingly in neurology and neurosurgery.

He was reading a great deal of philosophy at the time. Fascinated by the concepts of consciousness and free will, he speculated that neurology could be used to explore their physical connections. "When we're young, we have these big, vague ideas," Lee said with a chuckle.

He soon learned that the neurosciences deal with more concrete matters. "As a neuroradiologist, I have become very practical," he said. "I want to develop tools to help guide clinicians."

Today, one of Lee's main areas of research is MRI. This noninvasive viewing method has become a mainstay in the clinic because it provides sharp detail of the complex anatomy of the brain and other organs. It also gives a frame of reference for methods such as functional MRI (fMRI), which highlights active brain regions. Lee has worked on fMRI, improving the way it is used to study the development of children's brains and to identify the language regions to be avoided during surgery. His method is now also used on adults and for localizing other brain functions.

Functional MRI picks up increased levels of oxygen in brain's blood vessels. By processing computer data from this technique differently, researchers at the School of Medicine developed high-resolution blood-oxygen-level-dependent venography. Lee was lead author of a study that showed how this method might be used to spot malformed blood vessels that make a person vulnerable to stroke, and to measure the growth of tumors.

Another adaptation of MRI is magnetic resonance spectroscopy (MRS), which looks at the chemical composition of the brain. Lee participated in a recent multicenter study that, by solving many practical problems, made MRS more usable in a clinic. Physicians increasingly employ MRS as a supplement to MRI in assessing the malignancy of tumors and detecting metabolic disorders of the brain.

Lee is helping explore other MRS uses. One is the study of myelination, the formation of sheaths around neurons in the developing brain. If these coatings do not properly insulate the neurons, they malfunction, as in multiple sclerosis. MRS is also useful in epilepsy, to help surgeons pinpoint the site of the disease.

Lee is presently evaluating the effectiveness of MRS in early diagnosis of Alzheimer's disease. The work is part of a major National Institutes of Health grant to the medical school's Alzheimer's Disease Research Center.

"We're hoping to develop ways to detect the disease early," Lee said. "If it can be caught before symptoms appear, treatment may be much more effective."

Coming to America

After completing his training at the National Hospital for Nervous Diseases in London, Lee took a fellowship at Cornell University Medical College in New York City. He had never been to America before. New York struck him as a madhouse, but he came to enjoy Carnegie Hall and the Metropolitan Opera.

He also adapted to the pace at which American researchers worked. "Tea breaks became a thing of the past," he joked.

Following 10 years in New York and faculty appointments at the universities of California and Minnesota, Lee came to Washington University in 1991. "I knew that the Mallinckrodt Institute of Radiology was an excellent department," he said. "And I found that pediatric radiology needed building up."

Lee has worked on strengthening rapport among radiologists, neurologists and neurosurgeons. He has installed a new all-digital system for storage and retrieval of images, doing away with film entirely. And he has set high standards for the training of residents and fellows.

Now the department at St. Louis Children's Hospital sees so many patients, it is purchasing a second MR scanner. Only one other children's hospital in North America has two.

"Dr. Lee has always been quick to introduce new imaging techniques at the hospital," said Tae Sung Park, M.D., the Shi H. Huang Professor of Neurological Surgery. "We have all benefited from his consistent efforts in the last decade. He has laid a solid foundation for future growth of pediatric neuroradiology at the School of Medicine."

Lee's wife, Stella, grew up a half-mile from him in Hong Kong. But they did not meet until they were graduate students in London.

"As children, we had friends in common, but they neglected to introduce us," Lee said with a smile. The Lees have a son, Gerald, who works for an Internet company in San Francisco.

The Lees live in the Central West End. They enjoy the city's cultural venues, particularly the symphony and Opera Theater of St. Louis.

What keeps him busiest - and what he calls the most enjoyable part of his job - is teaching research fellows. "Young people ask the difficult questions," Lee said. "It's always a challenge to stay one step ahead of them."

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