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.

갑상선암에서 PET 의 역할

여정석(Jeong Seok Yeo) 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.3

The role of PET in the diagnosis and management of thyroid cancer is discussed. The major role of F-18 FDG PET is in patients with discordant negative I-131 scan and a positive serum thyroglobulin values. F-18 FDG PET scan localized metastatic sites in I-131 scan-negative thyroid carcinoma patients with high accuracy. F-18 PET is also valuable in medullary thyroid cancer with high calcitonin level. Focal thyroid uptake in patients with non-thyroidal diseas has high likelihood of thyroid cancer. (Korean J Nucl Med 2002;36;147-54)

Tc-99m 표지 항과립구항체 면역신티그라피를 이용한 골수염의 진단

강원준,정준기,여정석,홍미경,정재민,이동수,이상훈,최인호,이명철 ( Won Jun Kang,June Key Chung,Jeong Seok Yeo,Mee Kyoung Hong,Jae Min Jeong,Dong Soo Lee,Sang Hoon Lee,In Ho Choi,Myung Chul Lee ) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.4

Purpose: The purpose of this study was to evaluate the diagnostic accuracy of Tc-99m labeled antigranulocyte antibody immunoscintigrapy in the diagnosis of osteomyelitis and compare with the results of triphasic bone scan. Materials and Methods: The study popula- tion was 39 patients (22 male, 17 female) who had uncertain diagnoses of osteomyelitis. Fifteen patients had history of orthopedic surgery, and 5 had previous fracture. One milligram of monoclonal antibody against NCA-95 was labeled with 370 MBq of Tc-99m, injected intravenously, and 4 hour images were obtained. Triphasic bone scan images were obtained in 30 p;tients. The final diagnosis was confirmed by bacteriologic culture, biopsy or long term clinical follow up. Results: Twenty one patients were confirmed to have osteomyelitis (1 acute, 20 chronic). Eighteen patients were without osteomyelitis. Antigranulocyte antibody immunoscintigraphy had a sensitivity of 71% (15/21), and a specificity of 89% (16/18), while the sensitivity and specificity of triphasic bone scan was 93% (13/14) and 38% (6/16), respectively. Antigranulocyte antibody scan showed higher specificity of 100% (11/11) in comparison with 33% (3/9) of triphasic bone scan in patients with history of orthopedic surgery or fracture. Conclusion: Antigranulocyte antibody immunoscintigraphy is more specific than that of triphasic bone scan and may be helpful in patients with history of surgery or fracture. However, sensitivity is lower than triphasic bone scan in the detection of chronic osteomyelitis. (Korean J Nucl Med 1998;32:344-53)

Prediction of Salvaged Myocardium in Patients with Acute Myocardial Infarction after Primary Percutaneous Coronary Angioplasty using early Thallium-201 Redistribution Myocardial Perfusion Imaging

최준영,양유정,최승진,여정석,박성욱,송재관,문대혁,Choi, Joon-Young,Yang, You-Jung,Choi, Seung-Jin,Yeo, Jeong-Seok,Park, Seong-Wook,Song, Jae-Kwan,Moon, Dae-Hyuk The Korea Society of Nuclear Medicine 2003 핵의학 분자영상 Vol.37 No.5

목적: 심근경색증 후 재관류술에 의해 구조된 심근의 범위는 중요한 예후 인자중의 하나이다. 급성심근경색증의 일차적 관동맥성형술 후 조기 Tl-201 재분포영상이 구조심근과 심근벽운동 호전을 예측할 수 있는지 알아보았다. 대상 및 방법: 흉통 발생 $5.2{\pm}2.8$시간에 급성심근경색증으로 일차적 관동맥성형술을 시행한 36명을 대상으로 관동맥성형술 후 $5.8{\pm}2.1$일에 디피리다몰 부하 -4 시간 재분포 Tl-201 SPECT 영상을 얻었다. Tl-201 재분포 영상은 좌심실을 16분절로 나누고, 각 분절의 섭취를 5등급으로 평가하였다. 심초음파는 내원 당시, 경색 후 7일, 30일, 7개월에 시행하였고, 구조심근 분절은 내원 당시 심초음파상 벽 운동 이상이 있으면서 30일 또는 7개월 심초음파에서 벽 운동이 호전된 분절로 정의하였다. 결과: 내원 당시 212분절에서 벽운동 이상을 보였다(저운동 41분절, 무운동 171분절). 이중 1개월에는 78분절(36.8%)에서, 7개월에는 97분절(45.8%)에서 벽 운동이 호전되어 구조심근으로 판정하였다. 구조심근을 찾는 Tl-201 재분포 영상의 수신자판 단특성곡선면적은 1개월에 대해서는 $0.79{\pm}0.03$, 7개월에 대해서는 $0.83{\pm}0.03$이었다. Tl-201 섭취 40%를 경계로 정할 때 재분포 영상의 구조심근을 찾는 예민도, 특이도는 1개월에서는 84.6%(66/68), 55.2%(74/134), 7개월에서는 87.6%(85/97), 64.3%(74/115)였다. 재분포영상에서 Tl-201의 섭취정도와 벽 운동의 호전될 확률은 서로 비례하는 경향을 나타내었다. 결론: 급성심근경색증의 일차적 관동맥성형술 후 10일 이내에 시행한 조기 Tl-201 재분포영상은 구조심근과 심근벽운동 호전 예측 판정에 높은 예민도로 유용하게 사용될 수 있는 검사이다.EX>$100{\mu}M$)는 각각 11.9배와 6.8배, K562(Adr) 세포에서($50{\mu}M$)는 각각 14.3배와 8배, K562(Vcr) 세포에서($10{\mu}M$)는 각각 7배와 5.7배 증가하였다. Cyclosporin A에 의한 MIBI와 tetrofosmin의 섭취율(30분)을 기저치(30분)와 비교해 본 결과 HCT15/CL02세포에서($50{\mu}M$)는 각각 10배와 2.4배, K562(Adr)세포에서($50{\mu}M$)는 각각 44배와 13배, K562(Vcr)세포에서($10{\mu}M$)는 각각 18.8배와 11.8배 증가하여, MIBI의 섭취율이 tetrofosmin보다 1.2배에서 4배정도 높게 나타났다. 결론: 이러한 결과로 보아 MIBI와 tetrofosmin은 다약제내성의 발현을 평가할 수 있는 방사성의약품으로 판단되며, 다약제내성 극복제의 효능평가에는 MIBI가 tetrofosmin보다 더 우수할 것으로 사료되나, 세포추에 따른 차이가 있을 수 있으므로 보다 많은 세포주에서의 추가적인 연구가 필요할 것이다.여 후 구한 MPD는 평균 $13.3{\pm}1.9GBq\;(9.7{\sim}16GBq)$ 이였고, 치료용량 방사성옥소 투여 후 구한 MPD는 평균 $13.8{\pm}2.1GBq(10.4{\sim}16.3GBq)$로 유의한 차이가 얻었으며 (p=0.20), 두 수치간에는 유의한 상관 관계가 있었다(r=0.8, p<0.0001). 7명의 환자에서 말초혈액림프구 중기염색체 분석법으로 MPD를 측정하였는데 혈액의 피폭선량은 $1.78{\pm}0.03Gy$였으며, 같은 환자에서 혈중 방사능소실곡선으로부터 구한 피폭선량은 $1.54{\pm}0.03Gy$로 유의하게 낮았으나 (p=0.01), 두 Purpose: The amount of salvaged myocardium is an important prognostic factor in patients with acute myocardial infarction (MI). We investigated if early Tl-201 SPECT imaging could be used to predict the salvaged myocardium and functional recovery in acute MI after primary PTCA. Materials and Methods: In 36 patients with first acute MI treated with primary PTCA, serial echocardiography and Tl-201 SPECT imaging ($5.8{\pm}2.1$ days after PTDA) were performed. Regional wall motion and perfusion were quantified with on 16-segment myocardial model with 5-point and 4-point scaling system, respectively. Results: Wall motion was improved in 78 of the 212 dyssynergic segments on 1 month follow-up echocardiography and 97 on 7 months follow-up echocardiography, which were proved to be salvaged myocardium. The areas under receiver operating characteristic curves of Tl-201 perfusion score for detecting salvaged myocardial segments were 0.79 for 1 month follow-up and 0.83 for 7 months follow-up. The sensitivity and specificity of Tl-201 redistribution images with optimum cutoff of 40% of peak thallium activity for detecting salvaged myocardium were 84.6% and 55.2% for 1 month follow-up, and 87.6% and 64.3% for 7 months follow-up, respectively. There was a linear relationship between the percentage of peak thallium activity on early redistribution imaging and the likelihood of segmental functional improvement 7 months after reperfusion. Conclusion: Tl-201 myocardial perfusion SPECT imaging performed early within 10 days after reperfusion can be used to predict the salvaged myocardium and functional recovery with high sensitivity during the 7 months following primary PTCA in patients with acute MI.

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.

알쯔하이머형 치매환자에서 SPM 방법을 이용한 뇌 관류 SPECT 와 정신 - 인지기능 수행성능의 상관

강혜진(Hye Jin Kang),강은주(Eun Joo Kang),이재성(Jae Sung Lee),여정석(Jeong Seok Yeo),김진영(Jin Yeong Kim),이동수(Dong Soo Lee),이동우(Dong Woo Lee),조맹제(Maeng Ja Cho),정준기(June Key Chung),이명철(Myung Chul Lee),이명훈 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.2

N/A Purpose: The aim of this study was to identify the brain areas in which reductions of regional cerebral blood flow (rCBF) were correlated with decline of general mental function, measured by Mini-Mental State Examination (MMSE). Materials and Methods: Tc-99m HMPAO brain SPECT was performed in 9 probable AD patients at the initial and follow-up periods of 1.8 years (average) after the first study. MMSE scores were also measured in both occasions. The mean MMSE score of the initial study 16.4 (range: 5 - 24) and the mean MMSE score of the follow-up was 8.1 (range: 0 - 17). Each SPECT image was nomalized to the cerebellar activity and a correlation analysis was performed between the level of rCBF in AD patients and the MMSE scores by voxel-based analysis using SPM99 software. Results: Significant correlation was found between the blood-flow decrease in left inferior prefrontal region (BA 47) and left middle temporal region (BA 21) and the MMSE score changes. Additional areas such as anterior and posterior cingulate cortices, precuneus, and bilateral superior and middle prefrontal regions showed the similar trends. Conclusions: A relationship was found between reduction of regional cerebral blood flow in left prefrontal and temporal areas and decline of cognitive function in Alzheimer`s disease(AD) patients. This voxel-based analysis is useful in evaluating the progress of cognitive function in Alzheimer`s disease. (Korean J Nucl Med 2002;36;91-101)

주기성 구토 증후군 환아에서 보인 F - 18 FDG PET 에서의 뇌 포도당 대사 소견

김유경(Yu Kyeong Kim),이동수(Dong Soo Lee),강은주(Eun Joo Kang),서정기(Jeong Kee Seo),여정석(Jeong Seok Yeo),정준기(June Key Chung),이명철(Myung Chul Lee) 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.3

Cyclic Vomiting Syndrome (CVS) is characterized by recurrent, periodic, self-limiting vomiting. However, its pathogenesis is not yet established. We investigated the changes of the cerebral glucose metabolism using F-18 FDG during the vomiting attack and symptom free period in two children with CVS. FDG PET study showed the markedly increased metabolism in both temporal lobes and also in the medulla and cerebellum during the vomiting period. Also, FDG PET showed the decreased metabolism in the parieto-occipital and occipital areas during the vomiting period. The area with decreased metabolism seemed to be related with the region showing abnormalities in EEG and perfusion SPECT studies. We expect that what we observed would be a helpful finding in clarifying the pathogenesis of the CVS. (Korean J Nucl Med 200135:198-204)

전두엽 간질에서 F - 18 - FDG PET 의 간질병소 국소화 성능 ; 육안 판독과 SPM 에 의한 분석

김유경(Yu Kyeong Kim),이동수(Dong Soo Lee),이상건(Sang Kun Lee),정천기(Chun Kee Chung),여정석(Jeong Seok Yeo),정준기(June Key Chung),이명철(Myung Chul Lee) 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.3

N/A Purpose: We evaluated the sensitivity of the F-18 FDG PET by visual assessment and statistical parametric mapping (SPM) analysis for the localization of the epileptogenic zones in frontal lobe epilepsy. Materials and Methods: Twenty-four patients with frontal lobe epilepsy were examined. All patients exhibited improvements after surgical resection (Engel class I or II). Upon pathological examination, 18 patients revealed cortical dysplasia, 4 patients revealed tumor, and 2 patients revealed cortical scar. The hypometabolic lesions were found in F-18 FDG PET by visual assessment and SPM analysis. On SPM analysis, cutoff threshold was changed. Results: MRI showed structural lesions in 12 patients and normal results in the remaining 12. F-18 FDG PET correctly localized epileptogenic zones in 13 patients (54%) by visual assessment. Sensitivity of F-18 FDG PET in MR-negative patients (50%) was similar to that in MR-positive patients (67%). On SPM analysis, sensitivity decreased according to the decrease of p value. Using uncorrected p value of 0.05 as threshold, sensitivity of SPM analysis was 63%, which was not statistically different from that of visual assessment. Conclusion: F-18 FDG PET was sensitive in finding epileptogenic zones by revealing hypometabolic areas even in MR-negative patients with frontal lobe epilepsy as well as in MR-positive patients. SPM analysis showed comparable sensitivity to visual assessment and could be used as an aid in the diagnosis of epileptogenic zones in frontal lobe epilepsy. (Korean J Nucl Med 200135:131-141)

Re-188과 Tc-99m 표지 단일클론항체 CEA79.4의 생체외 특성과 생체내 분포

이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),정재민(Jae Min Jeong),장영수(Young Soo Chang),홍미경(Mee Kyoung Hong),여정석(Jeong Seok Yeo),이용진(Yong Jin Lee),김경민(Kyung Min Kim),이승진(Seung Jin Lee) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.6

N/A Purpose: Radiolabeled CEA79.4 antibody has a possibility to be used in radioimmunoscintigraphy or radioimmunotheraphy of cancer. We investigated the in vitro properties and biodistribution of CEA79.4 antibody labeled with Re-188 or Tc-99m. Materials and Methods: CEA79.4 was reduced by 2-mercaptoethanol to produce-SH reside, and was labeled with Re-188 or Tc-99m. For direct labeling of Tc-99m, methylene-diphosphonate was used as transchelating agent. CEA79.4 in 50 mM Acetate Buffered Saline (ABS, pH 5.3) was labeled with Re-188, using stannous tartrate as reducing agent. In order to measure immunoreactivity and the affinity constant of radiolabeled antibody, cell binding assay and Scatchard analysis using human colon cancer cells SNU-C4, were performed. Biodistribution study of labeled CEA79.4 was carried out at 1, 14 and 24 hr in ICR mice. Results:. Labeling efficiencies of Tc-99m and Re-188 labeled antibodies were 92.4±5.9% and 84.7±4.6%, respectively. In vitro stability of Tc-99m-CEA79.4 in human serum was higher than Re-188-CEA79.4. Immunoreactivity and affinity constant of Tc-99m-CEA79.4 were 59.2% and 6.59×109 M-1, respectively, while those of Re-188-CEA79.4 were 41.6% and 4.2×109 M-1, respectively. After 24 hr of administrations of Re-188 and Tc-99m labeled antibody, the remaining antibody, the remaining antibodies in blood were 6.32 and 9.35% ID/g respectively. The biodistribution of each labeled antibody in other organs was similar because they did not accumulate in non-targeted organs. Conclusion: In vitro properties and biodistribution of Re-188-CEA79.4 were similar to those of Tc-99m-CEA79.4. It appears that Re-188-CEA79.4 can be used as a suitable agent for radioimmunotherapy.

방실결절회귀빈맥의 치료에서 Slow Pathway 의 Radiofrequency Catheter Ablation 에 관한 연구

손경수(Kyeong Soo Sohn),구성회(Seong Hoe Koo),성지동(Ji Dong Seong),송종민(Jong Min Song),여정석(Jeong Seok Yeo),김동운(Dong Woon Kim),조성욱(Seong Wook Cho),현민수(Min Su Hyon),손대원(Dae Won Sohn),오병희(Byung Hee Oh),이명묵(Myoung 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Atrioventricular(AV) nodal reentry is a common cause of supraventricular tachycardia. For the treatment of atrioventricular nodal reentrant tachycardia (AVNRT), antiarrhythmic drug therapy requires long-term use of drugs and surgical ablation may be curative therapy but has problems of open heart surgery. Radiofrequency catheter ablation(RFCA) is reported to be safe and effective treatment modality for the frequently recurrent and severely symptomatic AVNRT. The results of treatment of AVNRT by RFCA of slow pathway is as follows. 1) The study consisted of 32 participants and the sex ratio (M: F) waw 8:24, the mean age was 40.9±15.8 yrs(19-72yrs). 2) At the electrophysiological study before RFCA, the type of reentry was common in 29 cases, uncommon in 1 case and in 2 cases were both common and uncommon type. 3) The applied modes of RFCA were constant power mode in 2 cases and temperature mode in 30 cases. 4) The number of radiofrequency current application till successful ablation was 12.1±9.1(3-39)and the mean power of applicated radiofequency current was 28.7±10.8W(8.2-41.3W). 5) Effective refractory period of antegrade fast pathwy (ERPfa) after ablation (220.0±43.3msec), in comparison with that before ablation(253.3±55. 8msec), has no statistical significance but has reducing tendency. The other parameters such as AH interval of antegrade fast pathway (AHfa), antegrade Wenckebach block cycle length (AWBCL), effective refractory period period of ventriculoatrial conduction system (ERPvacs) and ventriculoatrial block cycle length (VABCL) have no significant differences. 6) Complete AV block developed in only 1 patient who had underlying sinus dysfunction. 7) The follow-up duration was 7±3 months(1-13 months)and there was no AVNRT recurrence during this period. We conclude that the selective RFCA of slow pathway is a safe and effective treatment of AVNRT.