반복 게이트 심근 Tc - 99m - MIBI SPECT로 확인한 디피리다몰 부하에 의한 일과성 심근기절현상

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(Jung Key Chung),이동수(Dong Soo Lee),이원우(Won Woo Lee),윤석남(Seok Nam Yoon),이명묵(Myoung Mook Lee) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.1

N/A We performed 1st day Tc-99m-sestamibi gated SPECT with dipyridamole/rest T1-201 SPECT and 2nd day 24 hour delay T1-201 SPECT/rest Tc-99m-sestamibi gated SPECT in 27 patients with coronary artery disease(24) or having chest pain(3). Stress and rest Tc-99m- sestamibi gated SPECT was acquired at 60min post-injection. A 4-point scoring system(0 to 3 for normal to absent tracer uptake) for 17 segments was used. Wall motion was scored on another 4 point scale(0 to 3 for normal to dyskinesia) in the lst day post-stress gated and the 2nd day rest gated SPECT. Post-stress gated SPECT showed wall motion abnormality in 94 segments(20%). Fifty-five segments among these 94 showed the same wall motion between post-stress and rest gated SPECT:i.e. 1-1: 23 segments, 2-2: 29 segments, 3-3: 3 segments. Re-maining 39 segments (41.5%) showed different wall motion between post-stress and rest Tc-99m-sestamibi gated SFECT. Twenty one segments with wall motion abnormality had normal perfusion(rest:15 segments, 24 hour delay: 6 segments) at either rest or 24 hour delay. Fifteen among these 21 segments showed persistent post-stress and the 2nd day rest wall motion abnormality(persistent stunning). However, in 6 segments with prolonged (1 hour after stress) stunning, abnormal wall motion did improve in the 2nd day rest Tc-99m-sestamibi gated SPECT(transient prolonged stunning). These 6 segments had normal perfusion at rest(n=4) or at 24 hour delay(n=2). Post stress wall motions showed significantly higher scores in persistent stunning than in prolonged transient stunning(P value〈0.05). It was concluded that we could find stunned myocardium with gated Tc-99m-sestamibi SPECT at either post-stress or rest and that some myocardial walls of post-stress 1 hour gated SPECT did not show truly rest wall motion. So, we should be cautious if we use post-stress Tc-99m-sestamibi wall motion to assess rest wall motion.

관동맥질환에서 디피리다몰부하 99mTc - MIBI 심근 SPECT 극성지도와 관동맥 조영소견의 비교

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),최창운(Chang Woon Choi),손대원(Dae Won Sohn),이명용(Myung Yong Lee),이명욱(My 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.1

N/A We have anlayzed the polar maps of dipyridamole stress/rest Tc-99m-MIBI SPECT and compared the quantitated perfusion defects of dipyridamole stress polar map and the findings of coronary angiograraphy in 56 pateints with coronary artery diseases. We performed the same day dipyridamole stress-rest myocardial SPECT, reconstructed the polar maps according to Cedars-Sinai method and quantitated perfusion defects of total myocardium and the territory of each artery, comparing the polar maps of patients with normal files. Stenosis more than 50 percent was considered significant and myocardial ischemic score was calculated as summed score of percents of main coronary arteries. Positive concordance of myocardial SPECT with coronary angiography were 82.6% with left anterior descending artery(LAD), 85.7% with left circumflex artery(LCx) and 78.6% with right coronary artery(RCA). Perfusion defect of SPECT polar map and the stenosis of coronary artery showed the contingency phi of 0.55(p〈0.0001) with total atreries, 0.38(p=0.016) with LAD, 0.50(p〈0.0001) with LCx and 0.40 (p=0.007) with RCA. Dipyridamole stress percent defect of polar map was correlated with myocardial ischemic score with Spearman's rho of 0.47(p=0.001) in total arteries, 0.48(p=0.001) in LAD, 0.56 (p〈0.001) in LCx and 0.38(p=0.002) in RCA. These findings revealed that defect of the dipyridamole stress myocardial Tc-99m-MIBI SPECT and the percent extent of this defect were related with significant artery stenosis of individual arteries and the degree of stenosis. We thought that we could use the defects in the polar map of dipyridamole stress Tc-99m-MIBI SPECT for the quantification of myocardial perfusion decrease.

당뇨병성 신부전 환자의 골 스캔 소견의 특징

소영(Young So),이동수(Dong Soo Lee),현인영(In Yong Hyun),강원준(Won Jun Kang),이원우(Won Woo Lee),정준기(June Key Chung),김성권(Suhng Gwon Kim),이명철(Myung Chul Lee),이정상(Jung Sang Lee),고창순(Chang Soon Koh) 대한내과학회 1997 대한내과학회지 Vol.53 No.2

N/A Objectives: It is suggested that frequency of low turnover bone disease is much higher in diabetic renal osteodystrophy. We tried to find out whether bone scan images show less 99mTc-MDP uptake in diabetic renal ostwdystrophy. Methods: We compared bone scan images of renal failure patients with and without diabetes. The number of patients studied was 134 (43 patients had diabetes and 91 patients did not). Two experienced nuclear physicians read Tc-99m-MDP bone scan twice separately and gave the score either 1 or 0 on 6 areas; axial skeleton, long bone, skull & mandible, periarticular areas, costochondral junction and sternum. The means of summed scores were compared using Students t-test. To exclude the effects of sex, age and serum creatinine concentration, we analysed these factors together with the effect of diabetes using analysis of covariance. We also interpreted on bone scan images, as classical renal osteodystrophy, renal failure and normal. Results: The intra- and interobserver variations were very low. Patients of diabetes group showed significantly lower mean of summed score(2.0±0.95) compared to patients of non-DM group(3.3±1.2). Analysis of covariance revealed that lower score of diabetes group was independent of sex, age and serum creatinine level. of diabetes group, 2 nuclear physicians interpreted bone scans as classical renal osteodystrophy in 60% and 56%, However, they interpreted bone scans of non-DM group in 80%, 88%(between-observer k: 0.74). Chi-square test showed that this difference was statistically significant (p<0.05). Conclusion: Bone scan image of diabetic renal osteodystrophy showed less 99mTc-MDP uptake, which meant low osteoblastic activity. This influence of diabetes upon bone uptake was significant after considering other confounding factors.

휴식 Tl - 201 / 부하 Tc - 99m MIBI 심근 SPECT의 관상동맥질환 진단 정확성

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),오병희(Byung Hee Oh),손대원(Dae Won Sohn),강건욱(Keon Wook Kang),여정석(Jeong 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1

N/A Objective: Standard stress/rest Tc-99m MIBI and T1-201 myocardial perfusion study have some limitations such as stress/rest image overlap for Tc-99m-MIBI, low energy for T1-201 and long period of study time for two separate studies. Separate acquisition rest T1-20l/stress Tc-99m MIBI dual isotope study is a potentially efficient myocardial perfusion imaging protocol that combines the high resolution of Tc-99m for stress perfusion assessment and T1-201 for viability assessment. This study assessed the usefulness and diagnostic accuracy for this new approach. Methods: We tried to evaluate sensitivity and specificity of dual isotope separate acquisition protocol in 67 patients. Immediately after resting T1-201 SPECT data was acquired, dipyridamole stress Tc-99m MIBI myocardial perfusion study was performed. Visual analysis was carried out qualitatively with 0 to 3 scoring system for 17 segments of left ventricle in the reconstructed horizontal long axis and short axis slices. Results: Total study was complete within 3 hours. In angiographic correlation, dual isotope SPECT demonstrated high sensitivity(85%) and in a small group of patients, high specificity was also obseved (100%). Conclusion: Combined thallium- 20l/stress Tc-99m MIBI SPECT displayed similiar diagnostic accuracy to protocol using stress/rest Tc-99m MTBI SPECT. This protocol was completed in shorter period than the previous protocols and therefore enhance laboratory throughput and patients convenience.

관동맥우회로술 전후의 디피리다몰 부하 / 휴식 심근 SPECT를 이용한 수술 결과의 평가

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),이원우(Won Woo Lee),김기봉(Ki Bong Kim),현인영(In Young Hyun),강건욱(Keon Wook Kang) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1

N/A Coronary angiography should be performed to verify the patency of bypass graft if coronary artery disease is said to be surgically corrected. Rest/stress myocardial SPECT could be used as a noninvasive alternative to prove patency of bypass graft and functional significance of graft patency by showing improvement of rest perfusion and perfusion reserve after operation. We evaluated the outcome of coronary artery bypass graft surgery by comparing rest/dipyridamole- stress myocardial SPECT before and after operation. Myocardial SPECT were performed 19±23 days before and 108±19 days after operation in 44 patients(M:F=25:19). Segmental perfusion were scored with 0(normal) to 3(defect) independently for each image set of rest and stress. Perfusion scores were compared between pre and postoperative images. Rest/stress images of pre and post- operative SPECT were compared in paired sets. Postoperative change of perfusion was determined as no change, improvement or aggravation for each artery territory. Postoperative outcome of patients were analyzed. Overall, 74%(158 segments) of 215 segments which had perfusion decrease before operation showed improvement. Among 60 artery territories, 37 territories(62%) improved. Among 42 patients with perfusion decrease in preoperative SPECT, 21 patients(47%) improved after operation. Severe persistent defects improved in 43%(6/14). We concluded that bypass surgery improved myocardial perfusion in dipyridamole stress induced or persistent decrease and that rest/stress myocardial SPECT could be used as a guide for which artery should be operated.

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.

관상동맥 질환에서 우회로 수술 전 Tl - 201 휴식 - 24시간 지연 심근 관류 SPECT를 이용한 심근생존능의 평가

이명철(Myung Chul Lee),정준기(June Key Chung),서정돈(Jung Don Seo),이동수(Dong Soo Lee),고창순,이원우(Won Woo Lee),윤석남(Seok Nam Yoon),김기봉(Ki Bong Kim) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.4

N/A To assess contribution of T1-201 rest-24 hour delay redistribution in detection of viable myocardium, we studied the predictive value of this redistribution in 17 patients who performed rest-24 hour delay perfusion SPECT before bypass surgery. Regional wall motion was compared with gated SPECT in 10 patients and echocardiography in 7 patients before and after bypass surgery. Rest and 24 hour delayed uptakes were scored from 0 (normal perfusion) to 3 (defect). In rest SPECT, 56 segments showed perfusion decrease. Thirty four segments(61%) improved after surgery and were defined as viable. Nineteen(34%) segments had more uptake of T1-201 at 24 hour delay, and the other 37 segments did not. In 81%(25/31) of segments with mildly decreased perfusion, wall motion after bypass surgery improved, 57% (8/14) of segments with severely decreased perfusion improved, and 9%(1/11) of segments with defects improved. In 14 among 19 segments which had more T1-201 uptakes at 24 hour delay, wall motion was improved (positive predictive value of redistribution: 74%). 20 among 37 segments which had persistent decreases in rest-24 hour redistribution improved and 17 did not(negative predictive value: 46%). Segments having severe perfusion decrease or defects showed improved wall motion after surgery in 64%(7/11), if it had redistribution at delay. Segments with either mildly decreased uptake in resting or rest-delayed redistribution showed improved wall motion in 76%(32/42). Among the 14 segments which showed improvement in wall motion, 10 had partial reversibility in stress-rest images and the other 4 had persistent perfusion defects in stress-rest images. These 4 segments were found viable only with rest-24 hour delayed perfusion SPECT. We concluded that rest T1-201 uptake or redistribution at 24 hour delay should be referred as an evidence to warrant postoperative improvement of abnormal wall motion and we could predict mycardial viability with preoperative rest-24 hour delay perfusion SPECT in the segments with rest perfusion decreases

자가면역성 다선증후군 ( Polyglandular Autoimmune Syndrome ) 1 예

김성연(Seong Yeon Kim),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min),이문규(Moon Kyu Lee),홍성관(Sung Kwan Hong),김원배(Won Bae Kim),이병두(Byoung Doo Rhee),조보연(Bo Youn Cho),이광우(Kwang Woo Lee) 대한내과학회 1989 대한내과학회지 Vol.36 No.6

N/A Polyglandular antoimmune (PGA) syndrome designates endocrine dysfunction involving two or more glands on the basis of autoimmune mechanisms. There are 3 types of PGA syndrome and their etiology or pathogenesis is still not completely understood. We report here a case of polyglandular autoimmune syndrome manifesting insulin-dependent diabetes mellitus, hyperthyroidism and myasthenia gravis, which met the criteria of type III PGA syndrome. HLA-DR4 & -DRw8 were positive and so was the thyroid antimicrosomal antibody. We think that upon further study, additional cases of this syndrome could be found.

본태성고혈압 환자의 적혈구 Na+-Li+ Countertransport 와 Na+-K+ Cotransport 에 대한 연구

김성연(Seong Yeon Kim),김원배(Won Bae Kim),박성욱(Seong Wook Park),오병희(Byung Hee Oh),박영배(Young Bae Park),최윤식(Yun Shik Choi),이홍규(Hong Kyu Lee),서정돈(Jung Don Seo),이영우(Young Woo Lee),고창순(Chang Soon Koh),민헌기(Hun Ki 대한내과학회 1990 대한내과학회지 Vol.39 No.5

N/A To observe membrane Na+ transport abnormalities in erythrocytes of patients with essential hypertension and to verify genetic tendency of these membrane Na+ transports, we measured erythrocyte Na cancentration, Vmax of Na+-Li+ countertransport and Vmax of Na+-K+ cotransport in erythrocytes of 50 hypertensive patients, 30 normotensive controls and 5 normotensives with a family history of hypertension. The results were as follows. 1) Vmax of Na+-Li+ countertransport and Na+-K+ cotransport were significantly higher in male normotensive controls than in female normotensive controls but erythrocyte Na concentrations showed no significant difference. 2) There were no differences in erythrocyte Na concentration, Vmax of Na+-Li+ cauntertransport and Vmax of Na+-K+ catransport between the hypertensive patients and the normotensive controls regardless of a family history of hypertension. 3) The differences in clinical, biochemical and Na+ transport parameters except for serum uric acid level were not found between the hypertensive patients with normal and increased Na+-Li+ countertransport. 4) In multiple linear regression analysis erythrocyte Na concentration was significantly correlated with HDL-cholesterol, Vmax of Na+-Li+ countertransport with serum uric acid and triglyceride levels, and Vmax of Na+-K+ cotransport with HDL-cholesterol among total study population. 5) A weak but significant correlation was found between Vmax of Na+-Li+ countertransport and Na+-K+ cotransport. These results indicate that membrane Na+-Li+ countertransport and Na+-K+ cotransport in erythrocytes may not be useful as genetic marker for essential hypertension in Korea and their pathophysiologic roles in hypertension remain questionable, However, the result that there were considerable jnterindividual differences in these erythrocyte Na+ transports in hyper-tensive patients and a small portion of the hypertensive patients (12%) had increased Na+-Li+ countertransport activity suggests that essential hypertension is heterogenous in etiology.

관동맥우회로술 후에 심근 SPECT에 나타난 관류의 악화 분석

이원우,이동수,윤석남,김기봉,정준기,이명철,고창순 ( Won Woo Lee,Dong Soo Lee,Seok Nam Yoon,Ki Bong Kim,June Key Chung,Myung Chul Lee,Chang Soon Koh ) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.1

Though myocardial perfusion was usually expected to improve after coronary artery bypass graft(CABG) surgery, some myocardial segments were aggravated after operation, as we compared perfusion changes on postoperative SPECT with preoperative ones. In this study, we evaluated perfusion changes after operation in rest and stress myocardial SPCET in 44 patients (M:F=25:19, age 57.1 year +- 8.2) who had CABG before and 3 months after operation. We tried to find out possible causes for perfusion aggravation with multivariate logistic regression analysis regarding whether bypass graft was artery or vein and which coronary artery territory was operated. Among 616 myocardial segments which were operated, 89(14.4%) aggravated after operation In the univariate analysis, myocardial segments in the left circumflex arteries(I Cx) aggravated more often(p<0.01) than others and segments having operative angioplasty did less often(p<0.01). Multivariate logistic regression revealedthat LCx was risk factor for perfusion aggravation [odds ratio=2.54 (95% confidence interval : 1.53-4.22, p<0.01)] However, this was not the case when we analysed in terms of arterial territories. Among 106 coronary rterial territories which were operated. 27(25.5%) aggravated. The territories having aggravated had similar characterstics regarding whether they received arterial or venous grafts. Angioplasty and whether the operated territories were left anterior descending. Right coronary or left circumflex arteries. In conclusion, myocardial segments in the left circumflex artery tended to aggravate more often after bypass surgery than the others. In short-term comparison of perfusion after surgery. We could not find any tendency that arterial or venous fraft was associated with more frequency of the affravation of perfusion after operation.