• Nuclear Medicine and Molecular Imaging
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• 제43권3호
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• pp.159-164
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• 2009

Coronary artery disease is on the rise over the world. Myocardial perfusion SPECT is a well established technique to detect coronary artery disease and to assess left ventricular function. In addition, it has the unique ability to predict the prognosis of the patients. Moreover, the application of ECC-gated images provided the quantitatve data and improved the accuracy. This approach has been proved to be cost-effective and suitable for the emerging economies as well as developed countries. However, the utilization of nuclear cardiology procedures vary widely considering the different countries and region of the world. Korea exits 2-3 times less utilization than Japan, and 20 times than the United States. Recently, with the emerging of new technology, namely cardiac CT, cardiac MR and stress echocardiography, the clinical usefulness of nuclear cardiology has been called in question and its role has been redefined. For the proper promotion of nuclear cardiology, special educations should be conducted since the nuclear cardiology has the contact points between nuclear medicine and cardiology. Several innovations are in horizon which will impact the diagnostic accuracy as well as imaging time and cost savings. Development of new tracers, gamma camera technology and hybrid systems will open the new avenue in cardiac imaging. The future of nuclear cardiology based on molecular imaging is very exciting. The newly defined biologic targets involving atherosclerosis and vascular vulnerability will allow the answers for the key clinical questions. Hybrid techniques including SPECT/CT indicate the direction in which clinical nuclear cardiology may be headed in the immediate future. To what extent nuclear cardiology will be passively absorbed by other modalities, or will actively incorporate other modalities, is up to the present and next generation of nuclear cardiologists.

• Journal of Cardiovascular Imaging
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• 제26권4호
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• pp.238-246
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• 2018

BACKGROUND: Kawasaki disease (KD) sometimes presents with only fever and cervical lymphadenopathy before other clinical signs materialize. This lymphadenopathy-first-presenting Kawasaki disease (LKD) may be misdiagnosed as bacterial cervical lymphadenitis (BCL). We investigated characteristic imaging and clinical data for factors differentiating LKD from BCL. METHODS: We compared imaging, clinical, and laboratory data of patients with KD and BCL. We included patients admitted to a single tertiary center between January 2015 and July 2018. RESULTS: We evaluated data from 51 patients with LKD, 63 with BCL, and 218 with typical KD. Ultrasound imaging revealed multiple enlarged lymph nodes in both LKD and BCL patients. On the other hand, computed tomography (CT) showed more abscesses in patients with BCL. Patients with LKD were younger and showed higher systemic and hepatobiliary inflammatory markers and pyuria than BCL patients. In multivariable logistic regression, younger age and higher C-reactive protein (CRP) retained independent associations with LKD. A comparison of the echocardiographic findings in LKD and typical KD showed that patients with LKD did not have a higher incidence of coronary artery abnormalities (CAA). CONCLUSIONS: LKD patients tend to have no abscesses on CT and more elevated systemic hepatobiliary inflammatory markers and pyuria compared to BCL patients. The absence of abscess on CT, younger age, and elevated CRP were the most significant variables differentiating LKD from BCL. There was no difference in CAA between LKD and typical KD.

• 대한영상의학회지
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• 제83권1호
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• pp.3-27
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• 2022

심장 전산화단층촬영은 비약적인 기술발전과 다양한 연구 결과를 바탕으로 심혈관위험 계층화와 치료 결정을 위한 관상동맥 질환의 진단과 예후 평가성능이 입증되었다. 전산화단층촬영 관상동맥조영술은 폐쇄성 관상동맥 질환에 대한 음성 예측도가 높아서 침습적 혈관조영술의 빈도를 줄일 수 있는 관상동맥 질환 관련 검사의 관문으로 부상했지만, 진단특이도가 상대적으로 낮다. 하지만 심장 전산화단층촬영을 이용한 분획혈류예비력과 심근관류를 분석하여 관상동맥 질환의 혈역학적 유의성을 확인하는 기능적 평가를 통해 그 한계를 극복할 수 있다. 최근에는 이를 보다 객관적이고 재현 가능하도록 인공지능을 접목하는 연구들이 활발히 진행되고 있다. 본 종설에서는 심장 전산화단층촬영의 기능적 영상화 기법들에 대해 알아보고자 한다.

• 대한핵의학회지
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• 제28권2호
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• pp.177-185
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• 1994

Pharmacologic coronary vasodilation in conjunction with myocardial perfusion scintigraphy has become an alternative to dynamic exercise test for the diagnosis and risk stratification of coronary artery disease, especially in patients who are unable to perform adequate exercise. Dipyridamole and adenosine have been used for pharmacologic stress testing with myocardial perfusion imaging. Adenosine is a potent coronary vasodilator with rapid onset of action, short half-life, near maximal coronary vasodilation and less serious side effects. ST segment depression has been reported in about 7-15% of patients with coronary artery disease receiving dipyridamole in conjunction with myocardial perfusion imaging. The exact cause and clinical significance are not known. In order to evaluate the relationship between adenosine-induced ST segment depression during $^{99m}Tc$-MIBI myocardial perfusion scintigraphy and the severity of coronary artery disease, we performed $^{99m}Tc$-MIBI imaging after intravenous Infusion of adenosine In 120 patients with suspected coronary artery disease. Of the 120 patients, 28 also performed coronary angiography. There were 24 patients with ST segment depression during $^{99m}Tc$-MIBI scintigraphy and 96 patients without ST segment depression. Adenosine was infused Intravenously at a dose of 0.14mg/kg per minute lot 6minutes and $^{99m}Tc$-MIBI was injected at 3 minute. We then com-pared the hemodynamic changes, side effects, scintigraphic and angiographic findings. Heart rate increased $90{\pm}19$ beats/minute in the group with ST depression compared with $80{\pm}16$ beats/minute in the group without ST depression(p<0.05). Baseline systolic blood pressure was significantly higher in the group with ST depression($152{\pm}27$ mmHg) than in the group without 57 depression($140{\pm}21$mmHg, p<0.05). Double product at baseline($10.90{\pm}2.77$ versus $9.55{\pm}2.34\;beats/minute{\times}mmHg$) and during adenosine infusion($12.72{\pm}3.89$ versus $10.83{\pm}2.98\;beats/minute{\times}mmHg$) were significantly higher in the group with ST depression(p<0.05). The incidence of anginal chest pain was also significantly higher in the group with ST depression(ST versus 29%, p<0.0001). The $^{99m}Tc$-MIBI images were abnormal in 23(96%) patients with ST segment depression and 66(69%) patients without ST segment depression(p<0.05). In patients with ST segment depression, there were more reversible perfusion defects than in patients without ST segment depression(83 versus 55%, p<0.05). The number of abnormal segments were significantly higher in the group with ST depression($3.05{\pm}2.01$ versus $1.51{\pm}1.45$, p<0.005). In patients with ST segment depression, there were more segments of reversible perfusion defects than in patients without segment depression($2.15{\pm}2.11$ versus $0.89{\pm}1.24$, p<0.05). There were no differences in the angiographic severity by vessel(p ; NS). We concluded that ST segment depression during $^{99m}Tc$-MIBI myocardial perfusion scintigraphy with Intravenous adenosine is related to the severity of coronary artery disease.

• 대한영상의학회지
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• 제85권2호
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• pp.297-307
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• 2024

관상동맥 질환은 죽상동맥경화(atherosclerosis)로 인해 혈관의 내강이 좁아지면서 심근허혈 또는 경색까지 유발할 수 있는 질병이다. 이런 관상동맥 질환은 조기에 진단해서 치료하면 그만큼 예후가 좋기에 정확한 진단이 환자 관리에서 매우 중요하다. 전산화단층촬영 혈관조영술(CT angiography; 이하 CTA)은 높은 해상도와 대조도를 통해 혈관의 구조 및 협착 정도를 세밀하게 평가할 수 있는 비침습적 영상 진단법이다. 여러 임상시험들이 관상동맥 질환에 대한 조기 진단과 평가에 있어 관상동맥 CTA의 유용성을 보고하였다. 최근에 관상동맥 질환이 의심되는 환자들에 대한 보다 효과적인 처치를 위해 CTA에 기반한 관상동맥 질환 진단 분류 체계인 관상동맥 질환 판독과 자료 체계(coronary artery disease-reporting and data system; 이하 CAD-RADS)가 만들어졌다. 이런 CAD-RADS는 관상동맥 CTA를 기반으로 하지만 CAD-RADS는 CTA 결과만으로 관상동맥의 정확한 상태를 해석하는 것이 어려운 경계선 범주를 포함하고 있다. 본 종설은 침습적 관상동맥 조영술 진행 여부를 결정하기에 앞서 추가검사가 필요한 경계선상 CAD-RADS범주들의 CTA의 소견과 이들에 대한 대처를 논하고자 한다.

• Korean Journal of Radiology
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• 제22권11호
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• pp.1764-1776
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• 2021

Objective: This study aimed to validate a deep learning-based fully automatic calcium scoring (coronary artery calcium [CAC]_auto) system using previously published cardiac computed tomography (CT) cohort data with the manually segmented coronary calcium scoring (CAC_hand) system as the reference standard. Materials and Methods: We developed the CAC_auto system using 100 co-registered, non-enhanced and contrast-enhanced CT scans. For the validation of the CAC_auto system, three previously published CT cohorts (n = 2985) were chosen to represent different clinical scenarios (i.e., 2647 asymptomatic, 220 symptomatic, 118 valve disease) and four CT models. The performance of the CAC_auto system in detecting coronary calcium was determined. The reliability of the system in measuring the Agatston score as compared with CAC_hand was also evaluated per vessel and per patient using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. The agreement between CAC_auto and CAC_hand based on the cardiovascular risk stratification categories (Agatston score: 0, 1-10, 11-100, 101-400, > 400) was evaluated. Results: In 2985 patients, 6218 coronary calcium lesions were identified using CAC_hand. The per-lesion sensitivity and false-positive rate of the CAC_auto system in detecting coronary calcium were 93.3% (5800 of 6218) and 0.11 false-positive lesions per patient, respectively. The CAC_auto system, in measuring the Agatston score, yielded ICCs of 0.99 for all the vessels (left main 0.91, left anterior descending 0.99, left circumflex 0.96, right coronary 0.99). The limits of agreement between CAC_auto and CAC_hand were 1.6 ± 52.2. The linearly weighted kappa value for the Agatston score categorization was 0.94. The main causes of false-positive results were image noise (29.1%, 97/333 lesions), aortic wall calcification (25.5%, 85/333 lesions), and pericardial calcification (24.3%, 81/333 lesions). Conclusion: The atlas-based CAC_auto empowered by deep learning provided accurate calcium score measurement as compared with manual method and risk category classification, which could potentially streamline CAC imaging workflows.

• 대한방사선기술학회지:방사선기술과학
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• 제32권1호
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• pp.33-38
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• 2009

연구목적 : 흉부 단순촬영 상에서 발견되는 대동맥 궁 석회화가 폐쇄성 관상동맥질환과 관련성이 있는지 알아보고자 하였다. 연구방법 : 관상동맥 조영술을 시행한 사람을 대상으로 흉부 단순촬영 영상을 확인하는 후향적 연구이다. 흉부 단순촬영상은 영상의학과 전문의와 방사선사에 의해 대동맥 궁 석회화 유무를 확인하였고, 관상동맥 조영술 결과와 비교하였다. 또한 대동맥 궁 석회화의 크기를 10 mm 미만군과 이상군으로 나누어 비교하였다. 연구결과 : 총 846명의 대상자 중 폐쇄성 관상동맥 질환을 가진 사람은 남자 417명(88.3%)이었고, 여자 312명(83.4%)으로 남자가 많았다. 대동맥 궁 석회화가 있는 사람 중 폐쇄성 관상동맥 질환을 가질 확률을 나타내는 양성예측도는 91.4%이었고, 대동맥 궁 석회화를 가지고 있는 군이 석회화가 없는 군에 비해 폐쇄성 관상동맥 질환을 가질 위험을 나타내는 상대위험도는 1.10배였다. 대동맥 궁 석회화의 크기가 10 mm 이상인 사람 중 폐쇄성 관상동맥 질환을 가질 확률을 나타내는 양성예측도는 91.9%이었고, 대동맥 궁 석회화의 크기가 10 mm 이상인 군이 10 mm 미만인 군에 비해 폐쇄성 관상질환을 가질 위험을 나타내는 상대위험도는 1.04배였다. 결 론 : 흉부 단순촬영에서 발견되는 대동맥 궁 석회화와 관상동맥 조영술의 결과 폐쇄성 관상동맥 질환이 서로 밀접한 관련성이 있음을 확인하였고, 대동맥 궁 석회화가 있는 사람이 없는 사람보다 폐쇄성관상동맥 질환을 가질 위험이 더 높고, 대동맥 궁 석회화의 크기가 클수록 상대위험도는 높았다. 따라서 흉부 단순촬영 시 대동맥 궁 석회화가 발견되면 폐쇄성 관상동맥 질환의 발생 가능성이 높음을 인지하여 반드시 전문의와 상담을 하여야 한다.

• Korean Circulation Journal
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• 제53권3호
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• pp.189-190
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• 2023

• ETRI Journal
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• 제39권5호
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• pp.662-671
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• 2017

Coronary artery disease (CAD) is a major cause of death in the world. As a non-invasive imaging modality, computed tomography angiography (CTA) is now usually used in clinical practice for CAD diagnosis. Precise quantification of coronary stenosis is of great interest for diagnosis and treatment planning. In this paper, a novel cluster method based on a Modified Student's t-Mixture Model is applied to separate the region of vessel lumen from other tissues. Then, the area of the vessel lumen in each slice is computed and the estimated value of it is fitted with a curve. Finally, the location and the level of the most stenoses are captured by comparing the calculated and fitted areas of the vessel. The proposed method has been applied to 17 clinical CTA datasets and the results have been compared with reference standard degrees of stenosis defined by an expert. The results of the experiment indicate that the proposed method can accurately quantify the stenosis of the coronary artery in CTA.

• 대한핵의학회지
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• 제25권2호
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• pp.177-185
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• 1991

Dipyridamole thallium imaging is one of the most widely accepted means of evaluating patients with suspected or known coronay artery disease. The results of thallium imaging help diagnose coronary artery disesse (CAD), determine the hemodynamic significance of coronary stenosis, evaluate viability of myocardium, assess the outcome of therapeutic interventions and stratify patients according to their risk for luther cardiac events. An increased lung thallium uptake and transient LV dilation has been reported as poor prognostic indicator and associated with extensive and severe coronary artery disease. We quantitated lung/heart uptake ratio (l/HUR) and transient left ventricular dilation ratio in 44 patients and 17 controls undertaking dipyridamole thallium-201 scintigraphy. The results are as follows: 1) The lung/heart uptake ratio was high in patients with CAD and which became higher according to increasing number of diseased vessel. The L/HUR of patients with low LVEF (<35%) was lower than those with normal LVEF. 2) Transient left ventricular dilation ratio of CAD patients had no close relation between numbers of diseased vessels and was not higher than normals. But transient left ventricular dilation ratio of patients with myocardial infartion was higher than normals. We concluded that lung/heart uptake ratio seems to be sensitive marker for severity of CAD and myocardial function, but transient left ventricular dilation ratio alone is not sufficient to be a marker for severe and extensive CAD.