• The Korean Journal of Nuclear Medicine Technology
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• v.27 no.2
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• pp.99-109
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• 2023

Purpose: CT scan makes up for the weak point of the nuclear medicine image having a low resolution and also were used for attenuation correction on image reconstruction. Recently, many studies try to make use of CT images additionally, one of them is to measure the bone mineral density(BMD) using Quantitative CT(QCT) software. BMD exams are performed to scan lumbar and femur with DXA(Dual-Energy X-Ray Absorptiometry) in order to diagnose bone disease such as osteopenia, osteoporosis. The purpose of this study is to identify the usefulness of QCT_BMD analyzed with low dose CT images on L-spine Bone SPECT/CT comparing with DXA_BMD. Materials and Methods: Fifty five women over 50 years old (mean 66.4 ± 9.1) who took the both examinations(L-spine Bone SPECT/CT with SIEMENS Intevo 16 and DXA scan with GE Lunar prodigy advance) within 90 days from April 2017 to July 2022, BMD, T-score and disease classification were analyzed. Three-dimensional BMD was analyzed with low dose CT images acquired on L-spine Bone SPECT/CT scan on Mindways QCT PRO^TM software and two-dimensional BMD was analyzed on DXA scan. Basically, Lumbar 1-4 were analyzed and the patients who has lesion or spine implants on L-spine were excluded for this study. Pearson's correlation analysis was performed in BMD and T-score, chi-square test was performed in disease classification between QCT and DXA. Results: On 55 patients, the minimum of QCT_BMD was 18.10, maximum was 166.50, average was 82.71 ± 31.5 mg/cm³. And the minimum of DXA-BMD was 0.540, maximum was 1.302, average was 0.902 ± 0.201 g/cm², respectively. The result shows a strong statistical correlation between QCT_BMD and DXA_BMD(p<0.001, r=0.76). The minimum of QCT_T-score was -5.7, maximum was -0.1, average was -3.2 ± 1.3 and the minimum of DXA_T-score was -5.0, maximum was 1.7, average was -2.0 ± 1.3, respectively. The result shows a statistical correlation between QCT T-score and DXA T-score (p<0.001, r=0.66). On the disease classification, normal was 5, osteopenia was 25, osteoporosis was 25 in QCT and normal was 10, osteopenia was 25, osteoporosis was 20 in DXA. There was under-estimation of bone decrease relatively on DXA than QCT, but there was no significant differences statistically by chi-square test between QCT and DXA. Conclusion: Through this study, we could identify that the QCT measurement with low dose CT images QCT from L-Spine Bone SPECT/CT was reliable because of a strong statistical correlation between QCT_BMD and DXA_BMD. Bone SPECT/CT scan can provide three-dimensional information also BMD measurement with CT images. In the future, rather than various exams such as CT, BMD, Bone scan are performed, it will be possible to provide multipurpose information via only SPECT/CT scan. In addition, it will be very helpful clinically in the sense that we can provide a diagnosis of potential osteoporosis, especially in middle-aged patients.

• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.3
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• pp.214-221
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• 2008

Purpose: We make a qualitative analysis of whether Fusion SPECT/CT can find lesion's anatomical sites better than existing SPECT or not, and we want to show the usefulness of SPECT/CT through finding out effects of CT attenuation correction on SPECT images. Materials and Method: 1. The evaluation of fusion images: This study comprised patients who was tested $^{131}I$-MIBG, Bone, $^{111}In$-Octreotide, Meckel's diverticulum, Parathyroid MIBI with Precedence 16 or Symbia T2 from 2008 Jan to Aug. We compared SPECT/CT image with non fusion image and make a qualitative analysis. 2. The evaluation of attenuation correction: We classified 38 patients who was tested 201Tl myocardial exam with Symbia T2 into 5 sections by using Cedars Sinai' QPS program - Ant, Inf, Lat, Septum, Apex. And we showed each section's perfusion states by percentage. We compared the each section's perfusion-states differences between CT AC and Non AC by average${\pm}$standard deviation. Results: 1. The evaluation of fusion images : In high energy $^{131}I$ cases, it was hard to grasp exact anatomical lesions due to difference between regions and surrounding lesions' uptake level. After combining with CT, we could grabs anatomical lesion more exactly. And in meckel's diverticulum case or to find lesions around bowels or organs with $^{111}In$ cases, it demonstrates its superiority. Bone SPECT/CT images help to distinguish between disk spaces certainly and give correct results. 2. The evaluation of attenuation correction: There is no significant difference statistically in Ant and Lat (p>0.05), but there is a meaningful difference in Inferior, Apex and Septum (p<0.05). AC perfusion at inferior wall in the 5 sections of myocardium: The perfusion difference between Non AC perfusion image ($68.58{\pm}7.55$) and CT corrected perfusion image ($76.84{\pm}6.52$) was the largest by $8.26{\pm}4.95$ (p<0.01, t=10.29). Conclusion: Nuclear medicine physicians can identify not only molecular image which shows functional activity of lesions but also anatomical location information of lesions with more accuracy using the combination of SPECT and CT systems. Of course this combination helps nuclear medicine physician find out the abnormal parts. Moreover combined data sets help separate between normal group and abnormal group in complicated body part. So clinicians can carry out diagnosis and treatment planning at the same time with a single test image. In addition, when we examine a myocardium in thorax where attenuation can occur easily, we can trust perfusion more in a certain region in SPECT test because CT provides the capability for accurate attenuation correction. In these reasons, we think we can prove the justice after treatment fusion image.

• The Korean Journal of Pain
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• v.24 no.2
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• pp.81-86
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• 2011

Background: Facet joint disease plays a major role in axial low-back pain. Few diagnostic tests and imaging methods for identifying this condition exist. Single photon emission computed tomography (SPECT) is reported that it has a high sensitivity and specificity in diagnosing facet disease. We prospectively evaluated the use of bone scintigraphy with SPECT for the identification of patients with low back pain who would benefit from medial branch block. Methods: SPECT was performed on 33 patients clinically suspected of facet joint disease. After SPECT, an ultrasound guided medial branch block was performed on all patients. On 28 SPECT-positive patients, medial branch block was performed based on the SPECT findings. On 5 negative patients, medial branch block was performed based on clinical findings. For one month, we evaluated the patients using the visual analogue scale (VAS) and Oswestry disability index. SigmaStat and paired t-tests were used to analyze patient data and compare results. Results: Of the 33 patients, the ones who showed more than 50% reduction in VAS score were assigned 'responders'. SPECT positive patients showed a better response to medial branch blocks than negative patients, but no changes in the Oswestry disability index were seen. Conclusions: SPECT is a sensitive tool for the identification of facet joint disease and predicting the response to medial branch block.

• Korean Journal of Radiology
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• v.23 no.2
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• pp.264-270
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• 2022

Objective: This study aimed to investigate the usefulness of bone single-positron emission tomography/computed tomography (SPECT/CT) of the hip in predicting the later occurrence of avascular necrosis (AVN) after slipped capital femoral epiphysis (SCFE) or femoral neck fracture in pediatric patients. The quantitative parameters of SPECT/CT useful in predicting AVN were identified. Materials and Methods: Twenty-one (male:female, 10:11) consecutive patients aged < 18 years (mean age ± standard deviation [SD], 11.0 ± 2.7 years) who underwent surgery for SCFE or femoral neck fracture and postoperative bone SPECT/CT were included. The maximum standardized uptake value (SUV), mean SUV, and minimum SUV of the femoral head were measured. The ratios of the maximum SUV, mean SUV, and minimum SUV of the affected femoral head to the contralateral side were determined. Patients were followed up for > 1 year after the surgery. The SPECT/CT parameters were compared between patients who developed AVN and those who did not. The accuracy of SPECT/CT parameters for predicting AVN was assessed. Results: Six patients developed AVN. There was a significant difference in the ratio of the mean SUV among patients who developed AVN (mean ± SD, 0.8 ± 0.3) and those who did not (1.1 ± 0.2, p = 0.018). However, there were no significant differences in the ratios of the maximum and minimum SUV between the groups (all p = 0.205). For the maximum, mean, and minimum SUVs, no significant differences were observed between the groups (p = 0.519, 0.733, and 0.470, respectively). The cutoff mean SUV ratio of 0.87 yielded a 66.7% sensitivity and 93.2% specificity for predicting AVN. Conclusion: Quantitative bone SPECT/CT is useful for evaluating femoral head viability in pediatric patients with SCFE or femoral neck fractures. Clinicians should consider the high possibility of later AVN development in patients with a decreased mean SUV ratio.

• The Korean Journal of Nuclear Medicine
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• v.30 no.1
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• pp.1-14
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• 1996

Since the publication of the first bone scintiscans in 1962 three decades have elapsed. The bone scan has made great strides during this period, becoming one of the most commonly used nuclear imaging tests. In spite of the progress, however, the specificity of bone scan has remained relatively low. As the result it is a common practice to seek additional information from radiograph, CT scan and MR image, which is euphemistically termed as "image fusion or co-location." The basic reason is the inapplicability of the classical piecemeal analysis to interpreting planar and SPECT bone scans. Such analysis has its base on the observation of elemental features of morphology, which include the size, shape, contour, location, topography and internal architecture. The physiochemical profile may well also be included. Understandably, however, the miniatured images of the planar bone scan cannot provide these features in acceptable detail and the same holds true even with SPECT Images which are but sliced views of the reconstructed planar scans. Fortunately pinhole scanning has the capacity to portray both the morphological and chemical profiles of bone and joint diseases in greater detail through true magnification. The magnitude of pinhole scan resolution is practically comparable to that of radiography as far as gross anatomy is concerned. Thus, we feel strongly that pinhole scanning is a potential breakthrough of the long-lamented low specificity of bone scan. This presentation will discuss the fun-damentals, advantages and disadvantages and the most recent advances of pinhole scanning. It high-lights the actual clinical applications of pinhole scanning in relation to the diagnosis of infective and inflammatory diseases of bone and joint.

• Korean Journal of Radiology
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• v.22 no.4
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• pp.604-611
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• 2021

Objective: The aim of this pilot study was to investigate the potential of early-phase single-photon emission computed tomography (SPECT)/computed tomography (CT) using technetium-99m methyl diphosphonate (^99mTc-MDP) for diagnosing osteomyelitis (OM). Materials and Methods: Twenty-one patients with suspected OM were enrolled retrospectively. Three-phase bone scan (TPBS), early-phase SPECT/CT (immediately after blood pool planar imaging), and delayed-phase SPECT/CT (immediately after delayed planar imaging) were performed. The final diagnoses were established through surgery or clinical follow-up for over 6 months. We compared three diagnostic criteria based on (I) TPBS alone, (II) combined TPBS and delayed-phase SPECT/CT, and (III) early-phase SPECT/CT alone. Results: OM was diagnosed in 11 of 21 patients (nine surgically and two clinically). Of the 11 OM patients, criterion-I, criterion-II, and criterion-III were positive in six, seven, and 10 patients, respectively. Of the 10 non-OM patients, criterion-I, criterion-II, and criterion-III were negative in five, five, and seven patients, respectively. The sensitivity/specificity/accuracy of criterion-I, criterion-II, and criterion-III for diagnosing OM were 54.5%/50.0%/55.0%, 63.6%/50.0%/57.1%, and 90.9%/70.0%/87.5%, respectively. Conclusion: This pilot study demonstrated the potential of using the early-phase SPECT/CT to diagnose OM. Based on the results, prospective studies with a larger sample size should be conducted to confirm the efficacy of early-phase SPECT/CT.

• The Korean Journal of Nuclear Medicine
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• v.37 no.3
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• pp.137-146
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• 2003

Rheumatic diseases can be categorized by pathology into several specific types of musculoskeletal problems, including synovitis (e.g. rheumatoid arthritis), enthesopathy (e.g. ankylosing spondylitis) and cartilage degeneration (e.g. osteoarthritis). Skeletal radiographs have contributed to the diagnosis of these articular diseases, and some disease entities need typical radiographic changes as a factor of the diagnostic criteria. However, they sometimes show normal radiographic findings in the early stage of disease, when there is demineralization of less than 30-50 %. Bone scans have also been used in arthritis, but not widely because the findings are nonspecific and it is thought that bone scans do not add significant information to routine radiography. Bone scans do however play a different role than simple radiography, and it is a complementary imaging method in the course of management of arthritis. The Image quality of bone scans can be improved by obtaining regional views and images under a pin-hole collimator, and through a variety of scintigraphic techniques including the three phase bone scan and bone SPECT. Therefore, bone scans could improve the diagnostic value, and answer multiple clinical questions, based on the pathophysiology of various forms of arthritis.

• The Korean Journal of Pain
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• v.30 no.3
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• pp.165-175
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• 2017

Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.

• Journal of Oral Medicine and Pain
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• v.30 no.1
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• pp.107-119
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• 2005

Temporomandibular joint arthritides is divided into osteoarthritis, osteoarthrosis and polyarthritis. Because the signs, symptoms and radiographical features of osteoarthritis and osteoarthrosis are similar without arthralgia, diffenential diagnosis is difficult. Also non-radiographically change in early Osteoarthritis leads to misdiagnose. Planar bone scan and SPECT are useful to detect bone change early. This study was carried out in order to make diagnostic criteria of planar bone scan and SPECT. Three hundred and four temporomandibular joints were examined with clinical examination, computerized tomograph, planar bone scan, and SPECT. The obtained results were as follows. 1. If temporomandibular joint simple uptake ratio of patient in twenties is over 1.397%, it's condition may be osteoarthritis. And simple uptake ratio over in thirties-fourties may mean osteoarthritis. 2. It may mean osteoarthritis of temporomandibular joint that the number of coronal and transverse SPECT frame with hot spot is over four. 3. Destructive stage may goes on, if simple uptake ratio is over 1.370% in tweenties and over 1.104% in thirties-fourties. 4. If the number of coronal SPECT frame with hot spot is over four, temporomandibular joint may be on destructive stage in tweenties, thirties-fourties. And if the number of transverse SPECT frame with hot spot is over three, it may be on destructive stage in all ages. 5. When patient complains subjective arthralgia and palpation arthralgia, bone change may be more active than each arthralgia. 6. Osteoarthritis may progress gradually worse in 4.5 anamnesis. And then it may be stable gradually and turn to osteoarthrosis.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.2
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• pp.15-24
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• 2013

Purpose: With the demand of SPECT/CT increasing, the interest in complex diagnostic information of CT is rising along with the expansion of various studies on potential performance value. But the study on reduction of exposure dose generated by CT is not being conducted enough. Therefore, in this study, the goal is to identify how much dose reduction exists when performing the extremity bone SPECT/CT using the flat-panel CT. Materials and Methods: The extremity bone SPECT/CT was performed with two equipments -BrightView XCT (Philips Healthcare, Cleveland, USA) and Brilliance 16 CT (Philips Healthcare, Cleveland, USA)-to identify the exposed dose and image quality resulted by changing scan parameter (mAs) applying for both equipment respectively. The noise value of image and spatial resolution were measured with AAPM CT phantom. Tube voltage (kVp) was fixed to 120 kVp, tube current (mAs) calculated at different mA (20, 30, 40, 50, 60, 70, 80) was applied to both equipments respectively. DLP (dose length product) were calculated at the same distance at respective mAs. Also, we acquired images and % contrast with NEMA IEC body phantom to confirm the effect on image. The output of statistics was analyzed by SPSS ver.18. Results: Regarding AAPM phantom, the noise decreased as the tube current (mAs) increased and flat-panel had less noise than Helical CT. This difference increased at lower dose exposure. As to the evaluation of spatial resolution, we can differentiate the space up to 0.75 mm with both equipments. With scan parameter (mA) growing, the value of DLP increased up to 54-216 mGy cm at flat-panel CT and up to 177-709 mGy cm at Helical CT. Regarding NEMA IEC body phantom, same sphere with varied parameter (mA) shows that similar results. Conclusion: There is no significant differences of image quality in both flat-panel and Helical CT when the scan parameter (mA) is changed respectively. Moreover, we can identify the reduction of exposure dose and confirm %contrast analysis value with maintaining image quality. Therefore, at the extremity bone SPECT/CT requiring high spital resolution without the wide ROI, the flat-panel CT is considered to be more useful and it expected to result in the similar image quality with lower exposure dose compared to Helical CT. Additionally, through this study, we expect to help the reduction of the unnecessary exposure dose.