악성종양에서 골수면역신티그라피를 이용한 골수전이의 평가 : 99mTc-MDP 뼈스캔과의 비교

고창순(Chang Soon Koh),김노경(Noe Kyeong Kim),김병국(Byoung Kook Kim),최창운(Chang Woon Choi),정준기(Jun Key Chung),방영주(Yung Jue Bang),이경한(Kyung Han Lee),정홍근(Hong Keun Chung),이명철(Myoung Chul Lee) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

N/A 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, 99mTc labeled anti-granulocyte rnonoclonal antibody (anti-NCA-95 MAb) has been introdueed as a new bone marrow imaging agent. To evaluate the usefulness of 99mTc anti-NCA MAb bone marrow scans for detecting skeietal metastasis, bone marrow scans of 44 malignant tumor patients were evaluated and compared with bone scan fmdings. 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 rernaining 50% did not. Most of these non matched lesions were suggested to be nonspecific 1esions such as rib fractures or degenerative change. Meanwhile bone marrow scan was able to detect 6 new lesions not detected by bone scan, but 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 99mTc 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.

Dipyridamole 부하 심근 SPECT에서 Dipyridamole의 작용과 부작용

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),최창운(Chang Woon Choi),배상균(Sang Kyun Bae),양형인(Hyung In Yang),여정석(Jeong Suk Yeo) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.2

N/A Dipyridamole is an agent that may be used to noninvasively evaluate coronary artery disease. The effect of dipyridamole infusion its generally related to its induced peripheral vasodilatory effect. In normal person, heart rate is generally increased slightly while blood pressure decrease, but the achieved double product and related myocardial oxygen consumption have no significant change. The purpose of this study is to examine the effect and side effect of dipyridamole, and to compare different response to dipyridamole among the patients. We evaluated 847 patients who underwent dipyridamole stress myocardial SPECT. 93.6% of them had induced hypotension 0.9% showed no change of blood pressure, 5.5% had increased blood pressure 8.3% had no change of pulse rate more than 10% of basal pulse rate. Among diabetes, 16.9% was not change of pulse rate, 6.7% in non-diabetes. There was no significant correlation between age and rate pressure product rest(RPPr), in patients without perfusion defects on SPECT(y=7.1x+48.4r=0.13 p>0.01). As increasing age, RPPs/RPPr was declined(y=-11.6x+68.9 r=0.17 p〈0.01), similar results were obtained in patients with perfusion defect. The size of perfusion defect on myocardial SPECT have no correlation between RPPr and RPPs/RPPr. The side effects of dipyridamole included chest pain and chest tightness, headache, abdominal pain, dizzness, nausea, and dyspnea. As increasing age, dipyridamole-induced cardiac work at rest was increased, cardiac response to dipyridamole was decreased.

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.

소아 폐쇄성 요로질환에서 이뇨 신 신티그라피의 정량적 분석

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),최창운(Chang Woon Choi),최용(Yong Choi),이경한(Kyung Han Lee),곽철은(Cheol Eun Kwark),김종호(Jong Ho Kim),최황(Hwang Choi) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.2

N/A Differentiating the various causes of hydronephrosis from that of obstruction can be very difficult. The decision-marking process for those instances of urinary tract dilatation that require surgical correction and those that do not is based in part on the findings of diuresis renography. The methodology for performing this test has differed among nuclear medicine practitioners and the surgical findings are occasionally discrepant from the diuretic renogram interpretation. Consequently we made an automatic computer software program that calculates the slope of the response curve. The quantitative indices, such as the injection and response t1/2 by linear-fitting and monoexponential-fitting, were compared with the visual assessment of the diuretic cinerenography and clinical outcome in 50 children (62 kidneys) with ureteropelvic junction obstruction. Pooled diuresis renogram data indicated that: (1) Visual evaluation of the diuretic cinerenography is a sensitive (87%, 54/62) tool to differentiate obstruction in suspected ureteropelvic junction obstruction. (2) The cut-off value (maximum washout t1/2 with non- obstruction) of injection and response t1/2 by linear-fitting were 40 min. (3) The sensitivity and specificity using injection and response t1/2 by linear-fitting for obstruction were 89%(23/26) and 100%(30/30), respectively. (4) Response t1/2 as well as injection t1/2 by monoexponential-fitting do not stratify children with possible ureteropelivic junction obstruction. In conclusion, quantitative assessment of diuretic renography as well as visual assessment of diuretic cinerenography correlate well with surgical and clinical outcome of suspected ureteropelvic junction obstruction.

관상동맥질환에서 휴식기 심전도게이트혈액풀스캔을 이용한 각종 심기능 지표들의 평가 및 ROC 분석

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이영우(Young Woo Lee),서정돈(Jung Don Seo),박영배(Young Bae Park),이동수(Dong Soo Lee),김상은(Sang Eun Kim),최창운(Chang Woon Choi) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A Gated blood pool scan is frequently used for evaluating the change in cardiac function in various cardiac diseases. But resting gated blood pool scan using only LVEF as a cardiac index has been consitently shown to have a low sensitivity, which is about 50%, in detecting coronary artery disease. So it is recommended to compare exercise gated blood pool scan to resting gated blood pool scan. Exercise tests, however, are not always possible, especially in patients with musculoskeletal diseases, recent myocardial infarction and in elderly persons. We studied the usefulness of resting gated blood pool scan using multiple indices in evaluating the patients with coronary artery disease. Studied cases were 185 patients with coronary artery disease (angina pectoris 31, myocardial infarction 154) and 25 normals with low likelihood of coronary artery disease. We used Tc-90m-labeled RBC, 740 MBq labeled by in vivo method. The data were evaluated by Micro DELTA computer program. The results were as following: 1) The ejection rates (PER, AER) and filling rates (PFR, AFR) were different in normals and patients with angina pectoris or myocardial infarction. 2) Mean phase angie, ejection rates and filling rates could separate normals from coronary artery disease patients with normal LVEF. 3) Regional ejection fraction was decreased at the site of the infarct in patients with myocardial infarction. 4) Peak filling rate was the most detectable index in evaluation of cardiac function in patients with coronary artery disease. 5) The threshold at 1.5 standard deviation of normal range was considered as the most reliable cut-off value from ROC analysis. These data suggest that the resting gated blood pool scan has an important role in the evaluation of cardiac functional changes using various cardiac indices in patients with coronary artery disease.

동위원소 이뇨 요관그람을 이용한 소아 요관폐쇄의 평가

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),최창운(Chang Woon Choi),최용(Yong Choi),이경한(Kyung Han Lee),김종호(Jong Ho Kim),곽철은(Chol Eun Kwark),최항(Hwang Choi) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

N/A The need for assessment of ureteric function in the patient with an obviousely dilated ureter has increased particularly with the added spectrum of asymptomatic patients presenting with hydronephrosis and hydroureter on antenatal and perinatal ultrasound. To assess the influence of ureteral status on kidney washout during Tc-DTPA diuretic renography, ureteral images were reviewed in 80 children referred for hydronephrosis. A scintigraphically abnormal ureter was defined as an intense and continuous image of > 10 min during diuretic renography. Out of them, a total of 16 nephroureter- al systems in 12 children with scintigraphically abnormal ureter were analyzed. A diuretic washout index using response half time (t1/2) by linear fitting after lasix injection, was determined on renal (Ktl/2) and ureteral (Utl/2) curves (diuretic renogram vs. diuretic ureterogram). Diuretic ureterogram curve patterns corresponding to normal (type I), obstructive (II) and non-obstructive (III) cases were described. Compared with X-ray data, diuretic renography was highly sensitive (88%) and specific (99%) for detecting any ureteral abnormality. Despite an obstructive Ktl/2 (> 20 min), no patient with an ahnormal ureter underwent therapy at the ureteropeivic junction because (he hydronephrosis regressed after surgery at the lower level. Our data indicate that the abnormal ureter findings during diuretic renography have to be recognized before therapy for children with hydeonephrosis.

관상동맥질환에서 운동부하 Gated Blood Pool Scan 에 의한 좌심실 기능의 분석

최창운(Chang Woon Choi),정준기(June Key Chung),박영배(Young Bae Park),이명철(Myung Chul Lee),조보연(Bo Youn Cho),이영우(Young Woo Lee),고창순(Chang Soon Koh) 대한내과학회 1987 대한내과학회지 Vol.32 No.6

N/A Rest and exercise ECG gated blood pool scans were obtained in 26 normals and in 35 patients with coronary artery disease (CAD) (15 with angina, 20 with myocardial infarction), 31 Patients with CAD were undergone radionuclide cineventriculography and 23 patients were undergone cardiac catheterization. LVEF, AEF and regional wall motion were measured during rest and exercise. The results were as follows: 1) LVEF of young normals (below 30 years of age) was significantly higher than that of older (above 30 years of age) during exercise. 2) Between normals (above 30 years of age) and patients with CAD there was significant difference in LVEF during rest and exercise. 3) LVEF was increased during exercise above 5% in all normals, but increased less than 5% or even decreased in 71% of the patients with CAD. 4) There was no difference in LVEF during rest and exercise between single vessel CAD and multivessel CAD. 5) LVEF was more decreased in anterior myocardial infarction than in inferior myocardial infraction during rest and exercise. 6) Regional wall motion was abnormal in 58% of CAD patients during exercise and there was abnormal regional wall motion even in CAD patients with normal DEF and LVEF.

99mTC 표지 향과립구단일클론항체를 이용한 골수신티그라피법의 개발

최창운(Chang Woon Choi),정준기(June Key Chung),이명철(Myung Chul Lee),김병국(Byung Kook Kim),고창순(Chang Soon Koh),정홍근(Hong Keun Chung) 대한내과학회 1994 대한내과학회지 Vol.46 No.1

N/A Objectives: The purpose of the present study was to determine the immunologic characteristics of a home made anti-CEA monoclonal antibody (MAB) called CEA-79 which was considered to bind with the epitope of nonspecific cross-reacting antigen (NCA) in human granulocytes, and to evaluate the potential of 99mmTc- labeled CEA-79 as an immunoscintigraphic agent for bone marrow imaging. Methods: In order to evaluate the immunologic characteristics of this MAb, western blotting and immunohistochemical staining were performed. Periph eral blood smears of 6normals and bone marrow aspirates of 3normals, 12leukemic patients, and 1multiple myeloma patient were immunohistochemically stained by the alkaline phosphatase anti-alkaline phosphatase method. CEA-79 MAbs were labeled with 99mmTc by a transchelation method using β-mercaptoethanol as a reducing agent and glucarate as a chelator. With this 99mmTc-labeled CEA-79, scatchard analysis for affinity constant, immunoreactivity test and in vitro stability studies were performed. Formazan test was done for the evaluation of effect of CEA-79 to superoxide formation of granulocytes. Results: Western blotting of human granulocyte extracts with the MAb showed a single band at a site equivalent to a molecular weight of 95,000 daltons, suggesting that the binding was with an epitope of the NCA-95. Positive staining with CEA-79 antibody was shown in 93% of the peripheral granulocytes. Positively stained cells were derived from promyelocytes, myelocytes, metamyelocytes, band forms and segment forms. Erythroblasts of all maturation stages and normal lymphocytes were not stained. Leukemic blasts from patients with ALL, and Ml, M2, M5 subtypes of AML were also not stained. With a direct labeling method by transchelation of 99mmTc, the labeling efficiency of CEA-79 MAb with 99mmTc was 60 to 85%. Scatchard analysis of the MAb with granulocytes yielded an affinity constant of 1.10 to 4,75±10(10) 1/mol. Immunoreactivity was 60~65% which was similar to that of 131 I -labeled monoclonal antibodies prepared by the chloramine-T method(60%). The antibody was stable for 24 hours, with over 90% of the MAb remaining labeled at 24hours. And CEA-79 antibody did not change the granulocyte function of superoxide formation. Conclusion: It can be concluded that CEA-79 reacts specifically with an epitope of NCA-95 on human granulocytes and can be successfully labeled with 99mmTc by a direct labeling method. This indicates that 99mmTc-labeled CEA-79 MAb may be useful as an immunoscintigraphic agent for bone marrow imaging.

Thallium - 201 SPECT 뇌종양 영상

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),김상은(Sang Eun Kim),최창운(Chang Woon Choi),노재규(Jae Kyu Roh),정희원(Hee Won Jung),윤병우(Byung Woo Yoon) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A Thal1ium-201 (201TI) SPECT Studies were performed on a normal volunteer and 12 patients with intracerebral lesions: 3 patients with gliomas, 3 patients with meningiomas, 1 patient each with metastatic tumor, brain abscess, and cerebral infarction, and 3 postirradiation patients. (2 with metastatic tumors, I with lymphoma). A 201T1 index, based on the ratio of 201T1 uptake in the brain lesion Versus the homologous contralateral brain, was calculated and compared with tumor histology and CT/MRI findings. The SPECT 201T1 Scan showed minimal uptake of tracer in a normal brain. There was substantial uptake of 201T1 in high-grade gliomas (index〉l.5) with little uptake in low-grade lesions. A previously irradiated patient with recurrent astrocytoma, in whom MRI study was unable to distinguish tumor recurrence from necrosis, showed the lesions with high 201T1 indices in both hemispheric regions (2.50/1.93), suggesting tumor recurrence. Two meningiomas and a metastatic tumor showed varying degrees of 201T1 uptake (index 1.71-8.15), revealing that 201Tl uptake is not exclusive to high-grade gliomas. In 2 postirradiation patients with metastatic tumors, no abnormal 201T1 uptake was found in the cerebral lesions, shortly after the initiation of radiation therapy or despite the persistence of enhancing lesions-though improved-on MR images, suggesting that 201T1 uptake may reflect the metabolic and possibly clonogenic activities of tumors and the brain 201T1 SPECT imaging might be valuable for the evaluation of tumor responsiveness to the therapy and for early detection of tumor recurrence. A patient with brain abscess on antibiotic treatment, showing increased uptake of 201T1 in the resolving lesions(index 2.87/1.52) is discussed. In a patient with cerebral infaraction, there was no abnormal uptake of 201T1 in infarcted tissue. When using a threshold index of 1.5, correlation rate between 201T1 uptake and contrast enhancement of the cerebral lesions on CT/MRI was 73%(8/11). In conclusions, the brain 201T1 SPECT imaging may be useful for assessment of tumor response to the therapy and to predict low or high-grade lesions.

99mTc - HMPAO 뇌혈류 SPECT 영상의 부위별 체적 혈류 평가에 관한 기초 연구

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),최창운(Chang Woon Choi),박석건(Seok Gun Park),이경한(Kyung Han Lee),곽철은(Cheol Eun Kwark),양형인(Hyung In Yang) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.2

N/A The quantitative methods for the assessment of the cerebral blood flow using Tc-99m- HMPAO brain SPECT utilize the measured count distribution in some specific reconstructed tomographic slice or in algebraic summation of a few neighboring slices, rather than the true volumetric distribution, to estimate the relative regional cerebral blood flow, and consequently produce the biased estimates of the true regional cerebral blood flow. This kind of biases are thought to originate mainly from the arbitrarily irregular shape of the cerebral region of interest(ROI) which are analyzed. In this study, a semi-automated method for the direct quantification of the volumetric regional cerebral blood flow estimate is proposed, and the results are compared to those calculated by the previous planar approaches. Bias factors due to the partial volume effect and the uncertainty in ROI determination are not considered presently for the methodological comparison of planar/volumetric assessment protocol.