http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
Nuclear Imaging for Cardiac Amyloidosis: Bone Scan, SPECT/CT, and Amyloid-Targeting PET
팽진철,최준영 대한핵의학회 2021 핵의학 분자영상 Vol.55 No.2
Cardiac amyloidosis (CA) is a type of systemic amyloidosis, in which abnormal amyloid fibril is deposited in extracellular space of myocardium. Most common subtypes of CA are amyloidosis of immunoglobulin light chain (AL) and amyloidosis of transthyretin (ATTR). With increase in incidence of CA and development of new drugs, the needs of early and accurate diagnosis of CA are increasing. In CA, bone scan and SPECT/CT have long been used for diagnosis. Currently, bone scan is included in almost all practice guidelines as one of key diagnostic examinations for ATTR CA. In some specific scenarios, bone scan can be used as even a substitute for endomyocardial biopsy. Recently, amyloid-targeting PET that is used for Alzheimer dementia has also been attempted as an imaging method for CA. Although the study results are still insufficient, amyloid-targeting has shown promising potential as an imaging method for CA, particularly in AL. Here, imaging method and clinical application and implication of bone scan, SPECT/CT, and amyloid-targeting PET/CT in CA are reviewed.
만성 무릎관절 통증환자에서 내측 반월상연골 손상과 관절 퇴행성 변화의 감별을 위한 ^99mTc-MDP 무릎관절 SPECT의 진단기준
팽진철,정준기,정환정,유재호,강원준,소영,이동수,이명철,성상철,이명철 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.2
목적 : 만성 무릎관절 통증환자에서 관절의 퇴행성 변화로 인하여 ^99mTc-MDP SPECT를 이용한 관절 내 장애의 진단성능이 떨어지게 된다. 이 연구에서는 내측 구획의 섭취 증가가 관찰될 때 이를 내측 반월상연골 손상(MMI)과 퇴행성 변화(DC)로 감별 진단하기 위한 진단기준을 찾고자 하였다. 대상 및 방법 : 3개월 이상의 만성 통증으로 무릎관절 SPECT를 시행하고 이후 관절경 검사를 통해 관절 병소의 확진을 받은 환자 중 SPECT 상 내측 구회에 섭취 증가를 보인 47명, 49예의 영상을 대상으로 하였다. SPECT 영상에서 내측 경골 고원부에 초승달 모양의 섭취가 관찰될 때 MMI로 진단하는 기준(진단기준 Ⅰ), 초승달 모양 섭취 양상에 따라 전측, 중앙측, 후측 및 미만성으로 구분하고 이 중 중앙측, 후측, 미만성만을 MMI로 진단하는 기준(진단기준 Ⅱ), 이에 더해 섭취의 정도를 등급화하여 내측 구획에서 대퇴골 부위보다 경골 고원부의 섭취가 더 높을 때만 MMI로 진단하는 기준(진단기준 Ⅲ)의 세 가지 진단기준을 설정하고 이들의 진단성능을 비교하였다. 결과 : MMI 진단의 예민도와 특이도가 진단기준 Ⅰ에서 각각 93%, 14%, 진단기준 Ⅱ에서 각각 89%, 38%, 진단기준 Ⅲ에서 75%. 67%로 형태학적 기준과 섭취 정도에 의한 기준을 첨가할수록 진단성능이 향상되었다. 결론 : 이 연구에서는 무릎관절 SPECT가 적용되는 실제 임상 적응중에 가까운 만성 무릎관절 통증에서, 퇴행성 변화와 관절 내 장애를 감별하는 향상된 진단기준을 제시하였다. 이를 통하여 선별검사로서 무릎관절 SPECT의 진단적 가치를 더욱 높일 것으로 기대된다. Purpose: In patients with chronic knee pain, the diagnostic performance of ^99mTc-MDP knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake is increased in medial compartment. Materials and Methods: A total of 49 knee SPECT of the patients with chronic (more than 3 months) knee pain, which showed increased ^99mTc-MDP uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion Ⅰ, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion Ⅱ, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid posterior, and diffuse patterns were diagnosed as MMI. In Criterion Ⅲ, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. Results: The sensitivity and specificity were 93% and 14% in Criterion Ⅰ, 89% and 38% in Criterion Ⅱ, and 75% and 67% in Criterion Ⅲ, respectively. Criterion Ⅲhad significantly improved diagnostic performance, especially, specificity. Conclusion: In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The result is helpful to improve the diagnostic value of knee SPECT as a screening test for chronic knee pain.
갑상선암의 방사성요오드 치료에서 선량평가에 기반한 치료용량 결정의 방법과 임상적 유효성
팽진철,정준기 대한갑상선학회 2013 International Journal of Thyroidology Vol.6 No.1
Radioiodine (RI) therapy is one of the key factors for the good prognosis of differentiated thyroid cancers. Currently, most of RI treatments are performed with predetermined fixed dose of RI, whereas strict dose adjustment is made in chemotherapy or external radiotherapy for cancer treatment. Although fixed dose methods have been practically effective in RI therapy hitherto, dose determination with individual radiation dosimetry is theoretically superior to use of empirical fixed dose, for maximization of treatment effect and minimization of adverse events. The theoretical superiority of dosimetry-based dose determination is not yet directly supported by clinical data of real world; however, indirect results support the use of dosimetry-based dose determination in several specific patient groups. In this review, the basis of dosimetry is briefly discussed with regard to necessity and practical methods. Additionally, the efficacy of dosimetry is also discussed through the data of clinical studies so far.
이환희,팽진철,천기정,이동수,정준기,강건욱 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.5
Purpose In malignant melanoma, recurrence is often observed in distant areas from the primary site. While FDG PET is asensitive imaging for detecting malignant lesions, the role of FDG PET in posttreatment surveillance period has not beeninvestigated sufficiently. The aim of this study was to evaluate the value of PET during posttreatment surveillance in melanoma. Methods A total of 76 melanoma patients who underwent FDG PET during surveillance period after completion of the firsttreatment were retrospectively enrolled. PET scans were grouped according to the purpose and clinical situations, routinesurveillance, or evaluating clinical suspicion. Final diagnosis of recurrence was determined by complete clinical evaluation orlong-term follow-up. In each situation, the diagnostic role of FDG PET was assessed. Results A total of 143 scans of 76 patients were analyzed: 51 for clinical suspicion and 92 for routine surveillance. In the clinicalsuspicion group, PET correctly diagnosed non-recurrence in 10 cases (20%). In routine surveillance group, 16 cases (17%)presented recurrence, all of which was correctly diagnosed on PET. NPVand PPV were 100% and 76%, respectively. In subgroupanalysis, sensitivity and NPV were higher in the low-risk group (stages I–IIA) than in the high-risk group (stages IIB–IV), whilespecificity and PPV were higher in the high-risk group. Conclusion In conclusion, FDG PET is an effective diagnostic tool in posttreatment surveillance of melanoma. Even in caseswithout clinical suspicion, melanoma recurs in a considerable proportion of patients, which can be sensitively diagnosed on PET.