Thallium - 201 심근 단층영상의 정량적 분석

이명철(Myung Chul Lee),정준기(June Key Chung),안규리(Cu Rie Ahn),이동수(Dong Soo Lee),김상은(Sang Eun Kim),최창운(Chang Woon Choi),고창순,이영우,서정돈,박영배,최윤식,이명묵(Myoung Mook Lee),남기병(Gi Byoung Nam),최기준(Kee Joon Choi),손대원(Dae 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.2

N/A The purpose of this study was to assess the ability of quantitative Tl-201 tomography to identify and localize coronary artery disease (CAD). The study population consisted of 4l. patients (31 males, 10 females; mean age 55 +- 7 yr) including 14 with prior myocardial infarction who underwent both exercise Tl-201 myocardium SPECT and coronary angiography for the evaluation of chest pain. From the short axis and vertical long axis tomograms, stress extent polar maps were generated by Cedars-Sinai Medical Center prograrn, and the 9 stress defect extent (SDE) was quantified for each coronary artery territory. For the purpose of this study, the coronary circulation was divided into 6 arterial segments, and the myocardial ischemic score (MIS) was calculated from the coronary angiogram. Sensitivity for the detection of CAD (>50% coronary stenosis by angiography) by stress eXtent polar map was 95% in single vessel disease, and 100% in double and triple vessel deseases. Overall sensitivity was 97%<. Sensitivity and specificity for the detection of individual diseased vessels werc, respectively, 87% and 90% for the left anterior descending artery (LAD), 36% and 93% for the left circumflex artery (LCX), and 71% and 70%, for the right coronary artery (RCA). Concordance for the detection of individual diseased vessels between the coronary angiography and stress polar map was fair for the LAD (kappa=0.70), and RCA (kappa=0.41) lesions, whereas it was poor for the LCK lesions (kappa =0.32) There were siginificant correlations between the MIS and SDE in LAD (rs=0. 56, p=0.0027), and RCA territory (rs=0.60, p=0.0094). No significant correlation was found in LCX territory. When total vascular territories were combined, there was a significant correlation between the MIS and SDE (rs=0.42, p=0,0116). In conclusion, the quantitative analysis of TI-201 tomograms appears to be accurate for determining the presence and location of CAD.

관상동맥질환에서 휴식기의 심근관류 정도와 휴식기 심기능 변화의 비교 - Dipyridamole 부하 99mTc - MIBI SPECT와 휴식기 Gated Blood Pool Scan -

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),이명묵(Myoung Mook Lee),고창순(Chang Soon Ko),배상균(Sa 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.2

N/A Rest gated blood pool scan (Rest GBP scan) and dipyridamole Tc-99m-MIBI SPECT were performed in 34 patients with or suspected coronary artery disease. Both studies were performed within 2∼32 days (mean 8.1 days). A significant correlation was present between left ventricular ejection fraction (r=-0.7356, p〈0.001) and peak ejection rate and peak filling rate in rest GBP scan and perfusion defect in MIBI SPECT. And there were acceptable correlations (0.05〈p〈0.001) between regional ejection fractions and perfusion defects corresponding to the regions. There were 39 segments of fixed (rest) perfusion defects in MIBI SPECT and there was a significant difference in perfusion defect according to the regional wall motion (normal or mild hypokinesia in 23 regions: 26.2±10.8%, severe hypokinesia, akinesia or dyskinesia in 16 regions: 78.2±23.7, p〈0.001). These data indicate there is a significant coupling between the degree of myocardial perfusion and the myocardial functional change in coronary artery disease.

증례 : 선천성 일측폐발육부전증 ( 좌측 ) 의 1 예 보고

이영 ( Young Lee ),한만청 ( Man Chung Han ),양주석 ( Joo Sock Yang ),한용철 ( Yong Chul Han ),이명철 ( Myoung Chul Lee ),양기민 ( Kee Min Yang ) 대한내과학회 1975 대한내과학회지 Vol.18 No.8

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.

게이트 심근 SPECT의 관동맥우회로술후 심근 벽운동 호전 예측능

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),송호천(Ho Cheon Song),윤석남(Seok Nam Yoon),김기봉(Ki Bong Kim),이명묵(Myoung Mook Lee) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.1

N/A 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 SPECT 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(LCx) aggravated more often(p〈0.0l) than others and segments having operative angioplasty did less often(p〈0.0l). Multivariate logistic regression revealed that 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 arterial territories which were operated, 27(25.5%) aggravated. The territories having aggravated had similar characteristics 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 graft was associated with more frequency of the aggravation of perfusion after operation.

디피리다몰 부하 99mTc - MIBI 심근 SPECT 극성결손지도를 이용한 광동맥질환 진단의 남녀 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),이명묵(Myoung Mook Lee),오병희(Byung Hee Oh),배상균(Sang Kyun Bae) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.1

N/A To evaluate the usefulness and differences in diagnosing coronary artery disease (CAD) between men and women of intravenous dipyridamole Tc-99m-MIBI myocardial SPECT, we obtained Tc-99m-MIBI myocardial SPECT and compared with the findings of coronary angiographies. Ninety eight male and 37 female patients who underwent dipyridamole Tc-99m- MIBI myocardial imaging within one month of cardiac catheterization were studied. Scans were considered abnormal if perfusion defect was detected and the defect size was more than 12% for left anterior descending artery (LAD) and circumflex(LCX) and 8% for right coronary artery (RCA) territories. Lesions≥50% luminal diameter narrowing were considered significant CAD. Overall sensitivity for detection of CAD was 94.3% in men and 96.4% in women; specificity was 70% in men and 52.6% in women (P=not significant, ns). Vessel-matched sensitivity was 75.3% in men and 72.7% in women (P=ns); specificity was 84.6% in men and 67.9% in women (P〈0.025). For individual coronary artery, the sensitivity in men and women was 87.7%, 81.8% for LAD; 78%, 83.3% for RCA and 52.2%, 46.7% for LCX (P=ns); the specificity was 80%, 40% for LAD (P〈0.01), 82.5%, 68.4% for RCA, 88.9%, 86.4% for LCX (P=ns). The hemodynamic parameter after intravenous dipyridamole in men and women were significantly changed; the heart rate was increased and systolic, diastolic blood pressure was decreased. Adverse effects were reported in 58.8% of men and 72.7% in women (P=ns). The incidence of chest pain and headache were higher in women. There was no significant difference in the incidences of nausea, abdominal pain, dizziness, facial flushing, dyspnea. In conclusion, dipyridamole Tc-99m-MIBI myocardial SPECT is a safe, noninvasive test for evaluation of CAD. There was no gender difference to detect CAD, but more false-positive rate in women especially in the territory of LAD.

게이트 심근 관류 SPECT의 관상 동맥 질환 진단 성능

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),이명묵(Myoung Mook Lee),강원준(Won Jun Kang) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.1

N/A We studied to investigate the predictive values of gated SPECT for the improvement of wall motion after bypass surgery. As we compared postoperative SPECT with preoperative ones, we defined viability as wall motion improvement. We performed rest T1-20l/stress Tc-99m-MIBI gated SPECT in 25 patients before and 3 months after bypass surgery. Myocardial wall motion was graded as normal, hypokinesia, a kinesia, and dyskinesia by pair-wise visual analysis of gated pre and postoperative SPECT's on the same monitor wall motion abnormalities before operation, 69 (75%) improved and 23 did not. Before operation, we could find segments with good systolic thickenining 64 segments among total 92. Thickening of the remaining 28 was poor. Wall motion improved postoperatively in 45 segments (70%) among 64 with good thickening, Twenty four(86%) among 28 segments with poor thickening had also improved. We grouped segments into mild(hypokinetic) and severe(akinetic/dyskinetic) ones. Among 33 segments with severe motion abnormalities, 14 had good thickening and 19 did not. Nine(60%) improved out of 14 segments having severe abnormality with good thickening. However, 16(84%) segments out of 19 having severe abnormality with poor thickening also improved. Neither degree of perfusion decrease nor severity of wall motion abnormalities could explain the high rate of false negatives. In conclusion, as we defined viability as wall motion improvement by comparing pre and postoperative SPECT, systolic thickening observed by gated Tc-99m-MIBI SPECT in myocardial segments with wall motion abnormalities predicted wall motion improvement after bypass surgery. However, poor thickening could not be referred as evidence of nonviable myocardium both in mild and severe contractile dysfunction, so that we might need stimulation study such as dobutamine echocardiography or dobutamine gated SPECT.

우리나라에서 관동맥질환을 진단하는 약물부하 심근관류 SPECT의 비효용과 성능 : 운동부하심전도와 관동맥조영술과 비교

이동수(Dong Soo Lee),강건욱(Keon Wook Kang),장명진(Myung Jin Jang),천기정(Gi Jeong Cheon),이명묵(Myoung Mook Lee),정준기(June Key Chung),이명철(Myung Chul Lee) 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.3

N/A Purpose: Cost-effectiveness of myocardial SPECT f'or the diagniosis of coronary artery disease was investigated considering the present and amended costs of myocardial SPECT and exercise ECG in Korea. Materials and Methods: Four diagnostic tactics such as 1) coronary angiography (CAG) after exercise ECG, 2) CAG after myocardial SPECT, 3) direct CAG, and 4) CAG after myocardial SPECT following exercise ECG were chosen. Costs were calculated using the present costs of various tests and effects represented by Quality Adjusted Life Year (QALY) were estimated. Difference of QALY (ΔQALY) was calculated by subtracting QALY of diagnosed/treated cases from QALY of undiagnosed cases, Cost/Δ QALY was calculated and compared between four different tactics according to pre-test probability, Results: When pre-test probability was equal to or larger than 0.6, direct CAG was the most cost-effective. When pre-test probability was between 0.2 and 0.6, CAG after myocardial SPECT following exercise ECG was the most cost-effective. CAG after myocardial SPECT was the second most cost-effective. Cost-effectiveness was similar when the costs of exercise ECG were doubled or quadrupled. CAG after exercise ECG was always the least cost-effective, Conclusion: Myocardial SPECT with or without preceding exercise ECG was the most cost-effective method to diagnose coronary artery disease in the present or expected amended cost system. (Korean J Nucl Med 2000;34:207-21)

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.

모야모야병에서 EDAS 수술효과의 평가를 위한 수술전후 99mTc-HMPAO SPECT 의 유용성

고창순(Chang Soon Koh),정준기(June Key Chung),이경한(Kyung Han Lee),여정석(Jeong Seok Yeo),이상형(Sang Hyung Lee),곽철은(Chul Eun Kwark),이명철(Myoung Chul Lee),조병규(Byoung Kyu Cho) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

N/A Encephalo-duro-arterio-synangiosis (EDAS) is a relatively new surgical procedure ofr treatment of childhood moyamoya disease. We assessed regional cerebral perfusion in moyamoya patients efore (1.3 mo) and after (6.8 mo) EDAS with 99mTc-HMPAO brain SPECT. A total of 21 EDAS operations in 17 moyamoya patients was included. Preoperative CT or MRI showed cerebral infarction in 14 patients and carotid angiography showed Suzuki grade 1 to V stenosis in 6%, 9%,62%,12% and 12% of the hemispheres respectively. Preoperative SPECT showed regional hypoperfusion in all patients, bilateral frontal and temporal loves being the most frequently involved site. 4*4 pixel sezed ROIs were applied on the frontotemmporal cortex in 3 slice averaged transverse tomographic images. An index of regional perfusion was measured as; PI (%)= average FT activity/average cerebellar activity*100 Pre-EDAS ipsilateral PI ranged from 23.7 to 98.4% (mean:74.3 +- 17%) and increased significantly after operation (81.4 +- 17%, p<0.001). Individual post-EDAS PI improved in 15/21 cases, showed no significant change in 5 and was slightly aggravated in 1. The amount of clinical improvement ( CI) was graded with a scale of 0 to 4 based on frequency and severity of TIA attacks. When patients were grouped according to pre-EDAS PI, group II (PI 70~89) showed a significantly higher CI (3.3) compared to group I (PI<70, 1.57) of group III (PI>90, 0.5) (p<0.001). The amount of perfusion improvement ( PI) showed signifiant correlation with CI (r-0.42, p=0.04). PI did not, however, correlate with the amount of neovascularization assessed angiographically in 8 patiets. Serial HMPAO SPECT is an useful noninvasive study ofr assessing perfusion improvement after EDAS in childhood moyamoya patients.