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.

새로운 심근관류 영상 화합물로서 99mTc - Ethyl - 3 - Isocyanobutyrate의 합성 , 표지 및 체내동태에 대한 연구

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),임상무(Sang Moo Lim),이경한(Kyung Han Lee),정재민(Jae Min Jeong),조정혁(Jung Hyuck Cho),오승준(Seung Joon Oh),정수욱(Soo Wook Chung) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.2

N/A Technetium labeled isonitrile analogues are widely used as myocardial perfusion imaging agents. We synthesized and characterized a new isonitrile compound, ethyl 3-isocyanobutyrate (EIB). Proton and 13C NMR spectroscopy and thin layer chromatography with a C18 coat was performed. EIB was easily labeled with 99mTcO4-with sodium dithionite. The labeling efficiency measured by RP-HPLC was over 95%. The labeled product was stable with dilution in normal saline and with prolonged incubation at room temperature. There was no formation of secondary products or free 99mTcO4. In vivo kinetics study of Tc-99m(I) labeled EIB in rabbits showed adequate myocardial uptake, good contrast against lung background, and relatively rapid liver clearance. The heart to lung ratio was over 2.5 and the heart to liver ratio was approximately from 0.4 to 5 at 60 minutes post injection. Hepatic clearance of Tc-99m-MIBI was faster (t1/2,=6 minutes) than that of Tc-99m-MIBI. In vivo kinetics observed in dog was similar to that in rabbit but there was faster gallbladder filling, and thus lower liver background. SPECT imaging of the canine myocardium showed favorable imaging characteristics. However, biodistribution in mice demonstrated a myocardial % injected dose/organ of less than 0.1%. This was thought to be due to interspecies difference in plasma esterase activity. In human plasma, Tc-99m(I) labeled EIB was stable for at least 2 hours, without production of secondary products by HPLC. We conclude that ethyl 3-isocyanobutyrate may be a potential new myocardial perfusion imaging agent and deserves further investigation as to its usefulness for clinical use.

발작기와 발작간기 뇌 관류 SPECT 감산영상을 이용한 간질원인 병소 진단

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),이상건(Sang Kun Lee),서종모(Jong Mo Seo),이재성(Jae Sung Lee),김현집(Hyun Jip Kim) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.1

N/A A robust algorithm to disclose and display the difference of ictal and interictal perfusion may facilitate the detection of ictal hyperfusion foci. Diagnostic performance of localizing epileptogenic zones with subtracted SPECT images was compared with the visual diagnosis using ictal and interictal SPECT, MR, or PET. Ictal and interictal Tc-99m-HMPAO cerebral perfusion SPECT images of 48 patients(pts) were processed to get parametric subtracted images. Epileptogenic foci of all pts were diagnosed by seizure free state after resection of epileptogenic zones. In subtraction SPECT, we used normalized difference ratio of pixel counts((ictal-interictal)/interictal×100%) after correcting coordinates of ictal and interictal SPECT in semi-automatized 3-dimensional fashion. We found epileptogenic zones in subtraction SPECT and compared the performance with visual diagnosis of ictal and interictal SPECT, MR and PET using post-surgical diagnosis as gold standard. The concordance of subtraction SPECT and ictal-interictal SPECT was moderately good(kappa=0.49). The sensitivity of ictal-interictal SPECT was 73% and that of subtraction SPECT 58%. Positive predictive value of ictal-interictal SPECT was 76% and that of subtraction SPECT was 64%. There was no statistical difference between sensitivity or positive predictive values of subtraction SPECT and ictal-interictal SPECT, MR or PET. Such was also the case when we divided patients into temporal lobe epilepsy and neocortical epilepsy. We conclude that subtraction SPECT we produced had equivalent diagnostic performance compared with ictal-interictal SPECT in localizing epileptogenic zones. Additional value of these subtraction SPECT in clinical interpretation of ictal and interictal SPECT should be further evaluated.

Dione Bisoxime 계통의 화합물에 대한 테크네슘표지 원리에 관한 연구

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),이경한(Kyung Han Lee),정재민(Jae Min Jeong),곽철은(Cheol Eun Kwark),오승준(Seung Joon Oh),정수욱(Soo Wook Chung),조정혁(Jung Hyuk Cho) 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.1

N/A Tc-99m Labeled hexamethylenepropyleneamineoxime ([Tc-99m-HAMPAO) is a famous amine -oxime compound and is widely used to construct SPECT images of cerebral blood flow. To investigate the relationship between chemical structure and radiolabeling in these kind of diamine -oxime compounds, we synthesized seven compounds by Schiff's base formation and successive reduction with sodium borohydride. They wese (RR/SS)-4,8-diaza-3,6,6,9-tetramethylundecane- 2,10-dione bisoxime (2), (RR/SS/meso)-4,8-diaza-3,9-dimethy-lundecane-2,10-dione bisoxime (4), (RR/SS/meso)-4,8-diaza-3,10-dimethyldodecane-2,11-dione bisoxime (6), (RR/SS/meso)-4,7-diaza- 3,6,6,8-tetramethyldecane-2,9-dione bisoxime (8), (RR/SS/meso)-4,7-diaza-5,6-cyclohexyl-3,8-dime- thyldecane-2,9-dione bisoxime(10),(RR/SS/meso)-3,4-bis (l-aza-2-methyl-3-oxime-l-butyl)-benzoic acid (12), and (RR/SS/meso)-2,3-bis(1-aza-2-methyl-3-oxime-l-butyl) benzophenone (14). Chem- ical structures of al1 the synthesized compounds were identified by taking 1H spectrum. Among them, 2 and 4 are propyleneamine oxime(PnAO), 6 is butyleneamine oxime(BnAO) and 8, 10, 12 and 14 are ethyleneamine oxime (EnAO), Each compound (0.5 mg) was incubated with stannous chloride(0.5 g - 8 g), carbonate-bicarbonate buffer (final concentration = 0.1 M, pH7 - pH 10 ) and Tc-9mm- pertechenate ( 1 ml). Tc-99m labeling of these compounds were checked by ITLC (acetone), ITLC (normal saline), reverse phase TLC (50% acetonitrile) and ITLC (ethyl acetate). According to the results, EnAO's were not labeled by Tc-99m in any of above condition. About 11 % of maximum labeling efficiency was obtained with BnAO. However, 4 (PnAO) was labeled with Tc-99m to 85 % which is similar to the labeling efficiency of 2 (HMPAO). Hydrophilic impurity (9 %) was the most significant problem with the labeling of 4, however, pertechnetate (3 %) and colloid (3 %) were minor problem. In conclusion, we synthesized seven diamine bisoxime compounds, Among them, four EnAO compounds were not labeled by Tc-99m. A BnAO was labeled poor.

두뇌혈류영상용 방사성의약품인 Ethylcystein Dimer ( ECD ) 의 합성과 99mTc 표지 및 뇌단일광자단층영상 구성

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),이경한(Kyung Han Lee),정재민(Jae Min Jeong),곽철은(Cheol Eun Kwark),조정혁(Jung Hyuck Cho),정수욱(Soo Wook Chung) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.2

N/A Et.hylcystein dimer(ECD) was synthesized by dimerization of L-thiazo1idine-4-carboxylic acid in liquid ammania with sodium metal and successive esterification in ethanolic solution of hydrogen chlorde. The purified product was labeled with Tc in the presence of sodium glucarate(pH=5.6) and stannous chloride. Best result was obtained from the preparation consisting of O.lmg ECD, 40 ul of 0.4M sodium glucarate (pH=5.6), and 20 ug of stannous chloride. The labeling efficiency was 90% with previous condition. The labeled 99mTc-ECD was stable at least for 3 hours in PBS(pH 7.4) at roorn temperature. About. 10mCi of 99mTc-ECD was inject.ed to normal volunteer, and SPECT image of brain was obtained by triple head camera 10 minutes after inectian. The image showed similar distribution of radioact.ivity in brain with that of HMPAO image.

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.

원발성 악성 골양종의 99mTc - MDP 골스캔 소견

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),현인영(In Young Hyun),강흥식(Heung Sik Kang),이경한(Kung Han Lee),이상훈(Sang Hoon Lee),이한구(Han Koo Lee) 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.1

N/A Tc-99m-MDP bone scan was performed in 31 patients with primary malignant bone tumors, 22 patients with osteogenic sarcoma, 5 patients with chondrosarcoma and 4 patients with Ewing's sarcoma. The findings were classified by isotope intensity of accumulation in tumor as grade 1 to 3, overall pattern of isotope distribution in tumor as grade 1 to 3, and distortion of bony outline as grade 1 to 3. Histologic classifications were correlated with scan findings in 22 patients with osteogenic sarcoma. The results were as follows. 1) In 22 patients with osteogenic sarcoma, markedly increased isotope intensity higher than sacroiliac joint with patchy areas of decreased intensity and severe bony distortion were found in 16 patients. The correlations between histologic classification and scan findings were not discovered. 2) In 5 patients with chondrosarcoma, mildly increased isotope intensity with patchy areas of increased intensity and mild bony distortion were found in 4 patients. 3) In 4 patients with Ewing's sarcoma, markedly increased homogenous intensity with moderate bony distortion were found in 3 patients. Conclusively there were common findings in each 3 primary malignant bone tumors and Tc-99m-MDP bone scan was complemented with radiologic studies in differentiating primary malignant bone tumors.

99mTc-HMPAO SPECT 를 이용한 알쯔하이머병의 진단에서 허혈성 뇌병변이 미치는 영향

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),이경한(Kyung Han Lee),김종호(Jong Ho Kim),권준수(June Soo Kwon),우종인(Jong In Woo) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.3

N/A Brain perfsion SPECT shows typical regional perfusion abnormalities in Alzheimer's disease(AD) and is useful for its diagnosis. However, there is also arguement that these patterns show significant overlap with other causes, and the accuracy for SPECT in differentiating AD has shown conflicting results. We postulate that the variation in reported results are partly due to a difference in patient or control selection with specia reference to the mixture of ischemic cerebral disease in the atudied poulation. To determine the effect of ischemic lesions and the nature of control subjects on SPECT studies for AD, we performed 99mTc-HMPAO single photon emission computed tomography(SPECT) in 11 probable AD patients with a low (<4) Hachinski ischemic score and 12non-demented age matched controls. Magnetic resonance imaging(MRI) disclosed ischemic cerebral lesions in 27%(3/11) of the PAD group and 25%(3/12) of the control group. Regional perfusion indices were quantitated from the SPECT images as follows and the distribution of perfusion indices from both groups were compared. This was repeated with controls after excluding those with significant ischemic lesions by MRI: regional perfusion index=average regional count/average cerebellar coung All PAD patients showed perfusion abnormality in SPECT. However, 83% (10/12)of controls also showed perfusion abnormalities, and no pattern could reliably differentiate the two groups. After excluding controls with significant cerebral ischemia, the difference in temporal and perietal perfusion index was increased. A decreased temporo-parietal and any parietal or temporal perfusion index had a sensitivity of 18% and 36% in detecting AD, respectively. When using a separate group of normal age mathced controls, the indices showed an even more difference in the temporal and parietal lobes and the sensitivity of a decreased temporoparietal and any parietal or temporal perfusion index had a sensitivity of 36% and 55% in detecting AD, respectively. Thus, the type of control with special reference to the presence of ischemic cerebral lesions contribute significantly to the accuracy of perfusion SPECT in diagnosing AD. This may have particular importance in the diagnosis of AD in populations where the prevalance of cerebrovascular disease in high.

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.