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악성종양에서 골수면역신티그라피를 이용한 골수전이의 평가 : $^{99m}Tc$-MDP 뼈스캔과의 비교
이경한,최창운,방영주,정준기,정홍근,이명철,김병국,김노경,고창순,Lee, Kyung-Han,Choi, Chang-Woon,Bang, Yung-Jue,Chung, Jun-Key,Chung, Hong-Keun,Lee, Myoung-Chul,Kim, Byoung-Kook,Kim, Noe-Kyeong,Koh, Chang-Soon 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1
Although bone scan is a highly sensitive test for detecting bone metastasis, its findings are often limited in specificity and cannot be used for assessing the bone marrow. Bone marrow scintigraphy may provide useful information but previous experience with radiolabelled colloid has been disappointing. Recently, $^{99m}Tc$ labeled anti-granulocyte monoclonal antibody (anti-NCA-95 MAb) has been introduced as a new bone marrow imaging agent. To evaluate the usefulness of $^{99m}Tc$ anti-NCA MAb bone marrow scans for detecting skeletal metastasis, bone marrow scans of 44 malignant tumor patients were evaluated and compared with bone scan findings. Bone scan showed abnormal lesions in 26(59%) cases, and 18 of these patients also had an abnormal bone marrow scan. Seven of the 8 patients who had normal bone marrow scan despite bone scan lesions were confirmed to be free from metastasis. There was one case with a marrow defect despite normal bone scan but the presence of metastasis was not determined due to loss of follow up. Bone scan demonstrated a total of 64 lesions while bone marrow scan showed 38 lesions. Fifty percent (32/64) of the bone scan lesions had matching marrow defects while the remaining 50% did not. Most of these non matched lesions were suggested to be nonspecific lesions such as rib fractures or degenerative change. Meanwhile bone marrow scan was able to detect 6 new lesions not detected by bone scan, bit metastasis in each lesion was not confirmed. Bone marrow scan was also helpful in assessing equivocal bone scan lesions to be of metastatic nature in 10 patients by demonstrating a matched marrow defect. Thus $^{99m}Tc$ anti-NCA MAb bone marrow scan can help exclude metastasis in patients with nonspecific bone scan lesions and may be able to detect metastatic lesions not seen with bone scan. It appears useful as a complementary study to bone scan in evaluating malignant tumor patients.
이경한(Kyung Han Lee),김호정(Ho Jong Kim),추길연(Kil Yeon Choo),김정한(Jung Han Kim),김재명(Jae Myung Kim),원종현(Chong Hyun Won),박권택(Gwun Taek Park),김승욱(Seoung Wok Kim) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.2
N/A Anorexia, nausea, and vomiting are one of the most frequent symptoms in viral hepatits patients. These may be due to poorly detoxified substances by dysfunctioned hepatocytes or by gastritis, but the pathophysiology is not totally understood. The symptoms interfere with adequate nutrient intake and are managed by metoclopramide, which accelerates gastric emptying. Thus delayed gastric emptying may well be a contributing factor to such symptoms. To determine such a relationship, we measured gastric emptying time in 11 normal subjects, 9 acute (AVH), and 12 chronic B viral hepatitis (CVH) patients. All were males with a mean age of 23 years. An egg was labeled with 0.5 mCi of Tc-99m-sulfur colloid, fried, then eaten between 2 slices of bread with 100cc of water. Anterior and posterior images were taken at 20 minute intervals over a 2 hour period. A geometric mean of activity pertaining to the gastric region was measured, and T1/2 was calculated from the time activity curve. T1/2 for normal the group was 57.8±6.3 minutes while that for the AVH and CVH group was 58.2±8.2 (p=0.40) and 64.1±10.5 (p=0.09), respectively. There was 1 AVH patient and 4 CVH patients with prolonged T1/2. Anorexia and nausea was seen in 71% and 46% of the patients, respectively. 80% and 60% of the patients with prolonged T1/2 had anorexia and nausea, respectively.
심부정맥 혈전증 및 폐전색증의 핵의학적 진단 및 임상상에 관한 분석
이경한(Kyung Han Lee),최창운(Chang Woon Choi),정준기(June Key Chung),이명철(Myung Chul Lee),김건열(Keun Youl Kim),고창순(Chang Soon Koh),한용철(Yong Chol Han) 대한내과학회 1989 대한내과학회지 Vol.37 No.4
N/A Pulmonary embolism (PE) is a disease caused by occlusion of the pulmonary vascular bed, usually by a dislodged thrombus whose origin is most commonly from the deep venous system of the lower extremities. It is a serious medical problem and is often the cause of significant morbidity or mortality in clinical practice. Its potential for significant sequelae necessitates its prompt recognition and managemnt. Unfortunately, however, there are many difficult problems in the accurate diagnosis of pulmonary embolism, and controversy exists as to which method of approach is best. Futhermore, the low reliability of clinical signs and symptoms adds to the confusion, In an attempt to better understand the clinical features of pulmonary embolism and to reevaluate the diagnostic value of radionuclide studies in this disease entity, we reviewed the clinical features, lung perfusion scans and radionuclide venographic studies of 71 patients who were diagnosed as having deep vein thrombosis (DVT). The results were as follows; 1) The DVTs were most commonly located in the lower extremities (67%), and of these, the left side showed a significantly higher incidence compared to the right (77% vs 23%). 2) Of the DVT patients, 40% showed high probability pulmonary embolism (HPPE) on lung perfusion scans. 3) DVTs involving the iliofemoral veins were more likely to present HPPE compared to those confined to the calf area. 4) Of the patients presenting with HPPE, 70% showed no chest symptoms. Thus, the high incidence of HPPE in patients with DVT and the few, if any, specific presenting symptoms in the majority of PE patients call for a high level of suspicion on the part of the physician. The combined use of radionuclide venography and lung perfusion scan seems to be a reasonable approach for patients suspected of DVT in order to evaluate the possibilitu of pulmonary embolism.
두부외상 환자에서 HMPAO - SPECT를 이용한 국소 뇌혈류 변화의 평가
이경한(Kyung Han Lee),김철희(Chul Hee Kim),장하성(Ha Sung Chang) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.2
N/A Patterns of abnormality in regional cerebral perfusion and its relation to clinical severity was evaluated with 32 head injury patients using Tc-99m-HMPAO single photon emission tomography (SPECT). The findings were compared with computed tomography (CT) done within 48 hours of each SPECT study. The initial SPECT study was done within 7 days of injury in 16 cases, between 1 week and 2 months in 12, and after over 2 months in 4. Nineteen of the patients underwent follow up SPECT and CT after a mean interval of 1 to 2 months. The initial SPECT showed abnormalities in 96% (31/32) of the patients while CT showed abnormal findings in only 81% (26/32). There were a total of 54 supratentorial SPECT lesions in all. Ninity percent (49/54) of these were of regional hypoperfusion, while 5 lesions showed focal hyperperfusion. The lesions were most often localized in the frontal and temporal lobes. Fifty five percent (30/54) were areas not detected as a lesion on CT. Cerebellar diaschisis was observed in 50% (16/32) of the patients. The degree of perfusion abnormality was quantified by the product of differential activity and a size factor. Correlation between the degree of perfusion abnormality and the clinical severity (Glasgow coma scale) failed to show statistical significance (p=0.053). The amount of change in the degree of perfusion abnormality on follow up SPECT was compared to the amount of change in clinical severity. Perfusion abnormality showed a tendancy to improve in most patients, and the degree of improvement showed significant correlation with the amount of clinical improvement (p〈0.01).
Tc-99m-MIBI 심근 SPECT 의 분절 육안 분석시 판독자간의 일치도
여정석,이동수,이경한,김종호,손경수,조성욱,곽철은,정준기,이명철,서정돈,고창순 ( Jeong Seok Yeo,Dong Soo Lee,Kyung Han Lee,Jong Ho Kim,Kyung Soo Shon,Sung Wook Cho,Cheol Eun Kwark,June Key Chung,Myung Chul Lee,Jeong Don Seo,Chang Soon 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.3
The accuracy of dipyridamole stress/rest 99mTc-MIBI myocardial imaging for detection of ischemia depends on reproducible image interpretation. To evaluate the reproducibility of visual assessment, agreement in interpretation among two independent obervers, blinded to clinieal data, was evaluated in SPECT images of 131 patients (94 males, 38 fe- males, mean age 58+7 yr) with suspected coronary artery disease who underwent both dipyridamole st,ress/rest 99mTc-MJBI myocardial SPECT and coronary angiography, The left ventricle was divided into twenty-nine segments in stress and rest SPECT images and each segment was visually graded according to a five point scale (segmental score : O=normal, 1 =equivocal, 2=mild decrease, 3=severe decrease and 4=absent uptake). Overall concordance of segmental scoring between the two observers was 80%. The Pear- sons correlat.ion coefficient (r) of the segmental scores for stress and rest images were 0.67 and 0.65, respectively, while the difference in score between the two images showed a correlat,ion of 0.45 (all p<0,001). Agreement between two observers in final SPECT diagnosis as absence or presence of disease was 93%. The degree of agr eement in segmental scoring showed no difference between patients with or without agreement as to the presence of disease. Therefore it appeared that cases with inconcordant diagnosis between the 2 observers were mainly due to a difference in individual threshold for interpretating the significance of a particular decreased uptake area rather (han to a difference in perceiving the degree of the hypoactivity, Thus, establishment of individual optimum thresholds in visual interpretation of myocardial SPECT may be helpful to improve reproducibility and acruracy of scan ditagnosis.
이명철(Myung Chul Lee),이경한(Kyung Han Lee),윤병우(Byung Woo Yoon),이원용(Won Yong Lee),이기형(Ki Hyeong Lee),이상복(Sang Bok Lee),전범석(Beom S . Jeon) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1
N/A Progressive supranuclear palsy (PSP) is a parkinson-plus syndrome characterized clinically by supranuclear ophthalmoplegia, pseudobulbar palsy, axial rigidity, bradykinesia, postural instability and dementia. Presence of dementia and lack of cortical histopathology suggest the derangement of cortical function by pathological changes in subcortical structures in PSP, which is supported by the pattern of behavioral changes and measurement of brain metabolism using positron emission tomography. This study was done to examine whether there are specific changes of regional cerebral perfusion in PSP and whether there is a correlation between severity of motor abnorma- ility and degree of changes in cerebral perfusion. We measured regional cerebral perfusion indices in 5 cortical and 2 subcortical areas in 6 patients with a clinical diagnosis of PSP and 6 healthy age and sex matched controls using Tc-99m-HMPAO SPECT. Compared with age and sex matched controls, only superior frontal regional perfusion index was significantly decreased in PSP (p〈0.05). There was no correlation between the severity of the motor abnormility and any of the regional cerebral perfusion indices (p〉0.05). We affirm the previous reports that perfusion in superior frontal cortex is decreased in PSP. Based on our results that there was no correlation between severity of motor abnormaility and cerebral perfusion in the superior frontal cortex, nonmotoric symptoms including dementia needs to be looked at whether there is a correlation with the perfusion abnormility in superior frontal cortex.