• Journal of the Korean Society of Radiology
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• v.83 no.5
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• pp.1059-1070
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• 2022

Purpose To compare the sensitivity of tumor detection and inter-observer agreement between acquired diffusion-weighted imaging (aDWI) b2000 and computed DWI (cDWI) b2000 in patients with prostate cancer (PCa). Materials and Methods Eighty-eight patients diagnosed with PCa by radical prostatectomy and having undergone pre-operative 3 Tesla-MRI, including DWI (b, 0, 100, 1000, 2000 s/mm²), were included in the study. cDWI b2000 was obtained from aDWI b0, b100, and b1000. Two independent reviewers performed a review of the aDWI b2000 and cDWI b2000 images in random order at 4-week intervals. A region of interest was drawn for the largest tumor on each dataset, and a Prostate Imaging-Reporting and Data System (PI-RADS) score based on PI-RADS v2.1 was recorded. Histologic topographic maps served as the reference standard. Results The study population's Gleason scores were 6 (n = 16), 7 (n = 53), 8 (n = 9), and 9 (n = 10). According to the reviewers, the sensitivities of cDWI b2000 and aDWI b2000 showed no significant differences (for reviewer 1, both 94% [83/88]; for reviewer 2, both 90% [79/88]; p = 1.000, respectively). The kappa values of cDWI b2000 and aDWI b2000 for the PI-RADS score were 0.422 (95% confidence interval [CI], 0.240-0.603) and 0.495 (95% CI, 0.308-0.683), respectively. Conclusion cDWI b2000 showed comparable sensitivity with aDWI b2000, in addition to sustained moderate inter-observer agreement, in the detection of PCa.

• Korean Journal of Radiology
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• v.23 no.2
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• pp.226-236
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• 2022

Objective: This study aimed to explore the myelin volume change in patients with mild traumatic brain injury (mTBI) with post-concussion syndrome (PCS) using a multidynamic multiecho (MDME) sequence and automatic whole-brain segmentation. Materials and Methods: Forty-one consecutive mTBI patients with PCS and 29 controls, who had undergone MRI including the MDME sequence between October 2016 and April 2018, were included. Myelin volume fraction (MVF) maps were derived from the MDME sequence. After three dimensional T1-based brain segmentation, the average MVF was analyzed at the bilateral cerebral white matter (WM), bilateral cerebral gray matter (GM), corpus callosum, and brainstem. The Mann-Whitney U-test was performed to compare MVF and myelin volume between patients with mTBI and controls. Myelin volume was correlated with neuropsychological test scores using the Spearman rank correlation test. Results: The average MVF at the bilateral cerebral WM was lower in mTBI patients with PCS (median [interquartile range], 25.2% [22.6%-26.4%]) than that in controls (26.8% [25.6%-27.8%]) (p = 0.004). The region-of-interest myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (1.87 cm³ [1.70-2.05 cm³] vs. 2.21 cm³ [1.86-3.46 cm³]; p = 0.003) and brainstem (9.98 cm³ [9.45-11.00 cm³] vs. 11.05 cm³ [10.10-11.53 cm³]; p = 0.015). The total myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (0.45 cm³ [0.39-0.48 cm³] vs. 0.48 cm³ [0.45-0.54 cm³]; p = 0.004) and brainstem (1.45 cm³ [1.28-1.59 cm³] vs. 1.54 cm³ [1.42-1.67 cm³]; p = 0.042). No significant correlation was observed between myelin volume parameters and neuropsychological test scores, except for the total myelin volume at the bilateral cerebral WM and verbal learning test (delayed recall) (r = 0.425; p = 0.048). Conclusion: MVF quantified from the MDME sequence was decreased at the bilateral cerebral WM in mTBI patients with PCS. The total myelin volumes at the corpus callosum and brainstem were decreased in mTBI patients with PCS due to atrophic changes.

• Journal of the Korean Society of Radiology
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• v.18 no.3
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• pp.257-265
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• 2024

In this study, we applied AEC(Auto Exposure Control), which is used in many chest examinations, to evaluate whether medical devices inserted into the body affect the dose and image quality of chest images. After attaching three HIMD(Human implantable medical devices) to the ion chamber, the Monte Carlo methodology-based program PCXMC(PC Program for X-ray Monte Carlo) 2.0 was applied to measure the effective dose by inputting the DAP(Dose Ares Product) value derived from the Pacemaker and CRT and Chemoport Additionally, to evaluate image quality, we set three regions of interest and one noise region on the chest and measured SNR and CNR. The final study results showed significant differences in DAP and Effective dose. There was a significant difference between Pacemaker and CRT when AEC was applied and not applied. (p<0.05) When applied, the dose increased by 37% for Pacemaekr and 52% for CRT. Chemoport showed a 10% increase in effective dose depending on whether AEC was applied, but there was no significant difference. (p>0.05) In the image quality evaluation, there was no significant difference in image quality between all HIMD insertions and AEC applied or not. (p>0.05) Therefore, when the HIMD was inserted into the chest during a chest x ray and overlapped with the ion chamber sensor, the effective dose increased, and there was no difference in image quality even at a low dose without AEC. Therefore, when performing a chest X-ray examination of a patient with a HIMD inserted, it is considered that performing the examination without applying AEC is a method that can be considered to reduce the patient's radiation exposure.

• Korean Journal of Radiology
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• v.21 no.7
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• pp.880-890
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• 2020

Objective: Patients with chronic obstructive pulmonary disease (COPD) are known to be at risk of osteoporosis. The purpose of this study was to evaluate the association between thoracic vertebral bone density measured on chest CT (D_Thorax) and clinical variables, including survival, in patients with COPD. Materials and Methods: A total of 322 patients with COPD were selected from the Korean Obstructive Lung Disease (KOLD) cohort. D_Thorax was measured by averaging the CT values of three consecutive vertebral bodies at the level of the left main coronary artery with a round region of interest as large as possible within the anterior column of each vertebral body using an in-house software. Associations between D_Thorax and clinical variables, including survival, pulmonary function test (PFT) results, and CT densitometry, were evaluated. Results: The median follow-up time was 7.3 years (range: 0.1-12.4 years). Fifty-six patients (17.4%) died. D_Thorax differed significantly between the different Global Initiative for Chronic Obstructive Lung Disease stages. D_Thorax correlated positively with body mass index (BMI), some PFT results, and the six-minute walk distance, and correlated negatively with the emphysema index (EI) (all p < 0.05). In the univariate Cox analysis, older age (hazard ratio [HR], 3.617; 95% confidence interval [CI], 2.119-6.173, p < 0.001), lower BMI (HR, 3.589; 95% CI, 2.122-6.071, p < 0.001), lower forced expiratory volume in one second (FEV₁) (HR, 2.975; 95% CI, 1.682-5.262, p < 0.001), lower diffusing capacity of the lung for carbon monoxide corrected with hemoglobin (DL_CO) (HR, 4.595; 95% CI, 2.665-7.924, p < 0.001), higher EI (HR, 3.722; 95% CI, 2.192-6.319, p < 0.001), presence of vertebral fractures (HR, 2.062; 95% CI, 1.154-3.683, p = 0.015), and lower D_Thorax (HR, 2.773; 95% CI, 1.620-4.746, p < 0.001) were significantly associated with all-cause mortality and lung-related mortality. In the multivariate Cox analysis, lower D_Thorax (HR, 1.957; 95% CI, 1.075-3.563, p = 0.028) along with older age, lower BMI, lower FEV₁, and lower DL_CO were independent predictors of all-cause mortality. Conclusion: The thoracic vertebral bone density measured on chest CT demonstrated significant associations with the patients' mortality and clinical variables of disease severity in the COPD patients included in KOLD cohort.

• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.2
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• pp.22-27
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• 2014

Purpose There is the recent PET/CT scan in tendency that use low dose to reduce patient's exposure along with development of equipments. We diminished $^{18}F$-FDG dose of patient to reduce patient's exposure after setting up GE Discovery 690 PET/CT scanner (GE Healthcare, Milwaukee, USA) establishment at this hospital in 2011. Accordingly, We evaluate acquisition time per proper bed by change of infusion dose to maintain quality of image of PET/CT scanner. Materials and Methods We inserted Air, Teflon, hot cylinder in NEMA NU2-1994 phantom and maintained radioactivity concentration based on the ratio 4:1 of hot cylinder and back ground activity and increased hot cylinder's concentration to 3, 4.3, 5.5, 6.7 MBq/kg, after acquisition image as increase acquisition time per bed to 30 seconds, 1 minute, 1 minute 30 seconds, 2 minute, 2 minutes 30 seconds, 3 minutes, 3 minutes 30 seconds, 4 minutes, 4 minutes 30 seconds, 5 minutes, 5 minutes 30 seconds, 10 minutes, 20 minutes, and 30 minutes, ROI was set up on hot cylinder and back radioactivity region. We computated standard deviation of Signal to Noise Ratio (SNR) and BKG (Background), compared with hot cylinder's concentration and change by acquisition time per bed, after measured Standard Uptake Value maximum ($SUV_{max}$). Also, we compared each standard deviation of $SUV_{max}$, SNR, BKG following in change of inspection waiting time (15minutes and 1 hour) by using 4.3 MBq phantom. Results The radioactive concentration per unit mass was increased to 3, 4.3, 5.5, 6.7 MBqs. And when we increased time/bed of each concentration from 1 minute 30 seconds to 30 minutes, we found that the $SUV_{max}$ of hot cylinder acquisition time per bed changed seriously according to each radioactive concentration in up to 18.3 to at least 7.3 from 30 seconds to 2 minutes. On the other side, that displayed changelessly at least 5.6 in up to 8 from 2 minutes 30 seconds to 30 minutes. SNR by radioactive change per unit mass was fixed to up to 0.49 in at least 0.41 in 3 MBqs and accroding as acquisition time per bed increased, rose to up to 0.59, 0.54 in each at least 0.23, 0.39 in 4.3 MBqs and in 5.5 MBqs. It was high to up to 0.59 from 30 seconds in radioactivity concentration 6.7 MBqs, but kept fixed from 0.43 to 0.53. Standard deviation of BKG (Background) was low from 0.38 to 0.06 in 3 MBqs and from 2 minutes 30 seconds after, low from 0.38 to 0 in 4.3 MBqs and 5.5 MBqs from 1 minute 30 seconds after, low from 0.33 to 0.05 in 6.7 MBqs at all section from 30 seconds to 30 minutes. In result that was changed the inspection waiting time to 15 minutes and 1 hour by 4.3 MBq phantoms, $SUV_{max}$ represented each other fixed values from 2 minutes 30 seconds of acquisition time per bed and SNR shown similar values from 1 minute 30 seconds. Conclusion As shown in the above, when we increased radioactive concentration per unit mass by 3, 4.3, 5.5, 6.7 MBqs, the values of $SUV_{max}$ and SNR was kept changelessly each other more than 2 minutes 30 seconds of acquisition time per bed. In the same way, in the change of inspection waiting time (15 minutes and 1 hour), we could find that the values of $SUV_{max}$ and SNR was kept changelessly each other more than 2 minutes 30 seconds of acquisition time per bed. In the result of this NEMA NU2-1994 phantom experiment, we found that the minimum acquisition time per bed was 2 minutes 30 seconds for evaluating values of fixed $SUV_{max}$ and SNR even in change of inserting radioactive concentration. However, this acquisition time can be different according to features and qualities of equipment.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.3
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• pp.192-200
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• 2008

To evaluate the hemodynamic changes and the predictive factors of the clinical outcome in pediatric patients with moyamoya disease, we analyzed pre/post basal/acetazolamide stress brain perfusion SPECT with automated volume of interest (VOIs) method. Methods: Total fifty six (M:F = 33:24, age $6.7{\pm}3.2$ years) pediatric patients with moyamoya disease, who underwent basal/acetazolamide stress brain perfusion SPECT within 6 before and after revascularization surgery (encephalo-duro-arterio-synangiosis (EDAS) with frontal encephalo-galeo-synangiosis (EGS) and EDAS only followed on contralateral hemisphere), and followed-up more than 6 months after post-operative SPECT, were included. A mean follow-up period after post-operative SPECT was $33{\pm}21$ months. Each patient's SPECT image was spatially normalized to Korean template with the SPM2. For the regional count normalization, the count of pons was used as a reference region. The basal/acetazolamide-stressed cerebral blood flow (CBF), the cerebral vascular reserve index (CVRI), and the extent of area with significantly decreased basal/acetazolamide- stressed rCBF than age-matched normal control were evaluated on both medial frontal, frontal, parietal, occipital lobes, and whole brain in each patient's images. The post-operative clinical outcome was assigned as good, poor according to the presence of transient ischemic attacks and/or fixed neurological deficits by pediatric neurosurgeon. Results: In a paired t-test, basal/acetazolamide-stressed rCBF and the CVRI were significantly improved after revascularization (p<0.05). The significant difference in the pre-operative basal/acetazolamide-stressed rCBF and the CVRI between the hemispheres where EDAS with frontal EGS was performed and their contralateral counterparts where EDAS only was done disappeared after operation (p<0.05). In an independent student t-test, the pre-operative basal rCBF in the medial frontal gyrus, the post-operative CVRI in the frontal lobe and the parietal lobe of the hemispheres with EDAS and frontal EGS, the post-operative CVRI, and ${\Delta}CVRI$ showed a significant difference between patients with a good and poor clinical outcome (p<0.05). In a multivariate logistic regression analysis, the ${\Delta}CVRI$ and the post-operative CVRI of medial frontal gyrus on the hemispheres where EDAS with frontal EGS was performed were the significant predictive factors for the clinical outcome (p =0.002, p =0.015), Conclusion: With probabilistic map, we could objectively evaluate pre/post-operative hemodynamic changes of pediatric patients with moyamoya disease. Specifically the post-operative CVRI and the post-operative CVRI of medial frontal gyrus where EDAS with frontal EGS was done were the significant predictive factors for further clinical outcomes.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.57-61
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• 2012

Purpose: The multi-gated cardiac blood pool scan is to evaluate the function of left ventricle (LV) and usefully observe a value of ejection fraction (EF) for a patient who is receiving chemotherapy. To calculate LVEF, we should adjust an angle of left anterior oblique (LAO) view to separate both ventricles. And by overlapped ventricles, it is possible to affect LVEF. The purpose of this study is to investigate and compare quantitative indices by changing an angle of LAO view. Materials and methods: We analyzed the 49 patients who were examined by multi-gated cardiac blood pool scan in department of nuclear medicine at Asan Medical Center from June to September 2011. Firstly, we acquired "Best septal" view. And then, we got images by addition and subtraction of angle for LAO view to anterior and lateral. We compared three LAO views for 20 people by 5 degrees and 39 people by 10 degrees. And we analyzed quantitative indices, EF, end diastole and end systole counts, by automated and manual region of interest (ROI) modes. Results: Firstly, we analyzed quantitative indices by automated ROI mode. In case of 5 degrees, the averages of EF are $61.0{\pm}7.5$, $62.1{\pm}7.1$, $60.9{\pm}6.7%$ ($p$=0.841) in LAO, LAO $-5^{\circ}$ and LAO $+5^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). In case of 10 degrees, the averages of EF are $62.4{\pm}9.5$, $62.3{\pm}10.8$, $61.6{\pm}.9.3%$ ($p$=0.938) in LAO, LAO $-10^{\circ}$ and LAO $+10^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). Secondly, we analyzed quantitative indices by manual ROI mode. In case of 5 degrees, the averages of EF are $62.8{\pm}7.1$, $63.6{\pm}7.5$, $62.7{\pm}7.3%$ ($p$=0.903) in LAO, LAO $-5^{\circ}$ and LAO $+5^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). In case of 10 degrees, the averages of EF are $65.5{\pm}9.0$, $66.3{\pm}8.7$, $63.5{\pm}.9.3%$ (p=0.473) in LAO, LAO $-10^{\circ}$ and LAO $+10^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). Conclusion: When an image is nearly "Best septal" view, the difference of LAO angle would not affect to change LVEF. Although there was no difference in quantitative analysis, deviations could happen when to interpret wall motion qualitatively by reading physicians.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.102-107
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• 2012

Purpose : Because of the rapid physical decay of the short half-lived radionuclide, counting of event for image is very limited. In this reason, long scan duration is applied for more accurate quantitative analysis in the relatively low sensitive examination. The aim of this study was to evaluate the difference according to scan duration and investigate the resonable scan duration using the radionuclide of 11C and 18F in PET scan. Materials and Methods : 1994-NEMA Phantom was filled with 11C of $30.08{\pm}4.22MBq$ and 18F of $40.08{\pm}8.29MBq$ diluted with distilled water. Dynamic images were acquired 20frames/1minute and static image was acquired for 20minutes with 11C. And dynamic images were acquired 20frames/2.5minutes and static image was acquired for 50minutes with 18F. All of data were applied with same reconstruction method and time decay correction. Region of interest (ROI) was set on the image, maximum radioactivity concentration (maxRC, kBq/mL) was compared. We compared maxRC with acquired dynamic image which was summed one bye one to increase the total scan duration. Results : maxRC over time of 11C was $3.85{\pm}0.45{\sim}5.15{\pm}0.50kBq/mL$ in dynamic image, and static image was $2.15{\pm}0.26kBq/mL$. In case of 18F, the maxRC was $9.09{\pm}0.42{\sim}9.48{\pm}0.31kBq/mL$ in dynamic image and $7.24{\pm}0.14kBq/mL$ in static. In summed image of 11C, as total scan duration was increased to 5, 10, 15, 20minutes, the maxRC were $2.47{\pm}0.4$, $2.22{\pm}0.37$, $2.08{\pm}0.42$, $1.95{\pm}0.55kBq/mL$ respectively. In case of 18F, the total scan duration was increased to 12.5, 25, 37.5, and 50minutes, the maxRC were $7.89{\pm}0.27$, $7.61{\pm}0.23$, $7.36{\pm}0.21$, $7.31{\pm}0.23kBq/mL$. Conclusion : As elapsed time was increased after completion of injection, the maxRC was increased by 33% and 4% in dynamic study of 11C and 18F respectively. Also the total scan duration was increased, the maxRC was reduced by 50% and 20% in summed image of 11C and 18F respectively. The percentage difference of each result is more larger in study using relatively shorter half-lived radionuclide. It appears that the accuracy of decay correction declined not only increment of scan duration but also increment of elapsed time from a starting point of acquisition. In study using 18F, there was no big difference so it's not necessary to consider error of quantitative evaluation according to elapsed time. It's recommended to apply additional decay correction method considering decay correction the error concerning elapsed time or to set the scan duration of static image less than 5minutes corresponding 25% of half life in study using shorter half-lived radionuclide as 11C.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.2
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• pp.27-31
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• 2016

Purpose $^{99m}Tc-DMSA$ renal scan is a test for the comparison of the function by imaging the parenchyma of the kidneys by the cortex of a kidney and by computing the intake ratio of radiation by the left and right kidney. Since the distance between the kidneys and the bladder is not far given the bodily structure of an infant, the bladder is included in the examination domain. Research was carried out with the presumption that counts of bladder would impart an influence on the kidneys at the time of this renal scan. In consideration of the special feature that only a trace amount of a RI is injected in a pediatric examination, research on the method of injection was also carried out concurrently. Materials and Methods With 34 infants aged between 1 month to 12 months for whom a $^{99m}Tc-DMSA$ renal scan was implemented on the subjects, a Post IMAGE was acquired in accordance with the test time after having injected the same quantity of DMSA of 0.5mCi. Then, after having acquired an additional image by shielding the bladder by using a circular lead plate for comparison purposes, a comparison was made by illustrating the percentile of (Lt. Kidney counts + Rt. Kidney counts)/ Total counts, by drawing the same sized ROI (length of 55.2mm X width of 70.0mm). In addition, in the format of a 3-way stopcock, a Heparin cap and direct injection into the patient were performed in accordance with RI injection methods. The differences in the count changes in accordance with each of the methods were compared by injecting an additional 2cc of saline into the 3-way stopcock and Heparin cap. Results The image prior to shielding of the bladder displayed a kidney intake rate with a deviation of $70.9{\pm}3.18%$ while the image after the shielding of the bladder displayed a kidney intake rate with a deviation of $79.4{\pm}5.19%$, thereby showing approximately 6.5~8.5% of difference. In terms of the injection method, the method that used the 3-way form, a deviation of $68.9{\pm}2.80%$ prior to the shielding and a deviation of $78.1{\pm}5.14%$ after the shielding were displayed. In the method of using a Heparin cap, a deviation of $71.3{\pm}5.14%$ prior to the shielding and a deviation of $79.8{\pm}3.26%$ after the shielding were displayed. Lastly, in the method of direct injection into the patient, a deviation of $75.1{\pm}4.30%$ prior to the shielding and a deviation of $82.1{\pm}2.35%$ after the shielding were displayed, thereby illustrating differences in the kidney intake rates in the order of direct injection, a Heparin cap and the 3-way methods. Conclusion Since a substantially minute quantity of radiopharmaceuticals is injected for infants in comparison to adults, the cases of having shielded the bladder by removing radiation of the bladder displayed kidney intake rates that are improved from those of the cases of not having shielded the bladder. Although there are difficulties in securing blood vessels, it is deemed that the method of direct injection would be more helpful in acquisition of better images since it displays improved kidney intake rate in comparison to other methods.

• The Korean Journal of Nuclear Medicine Technology
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• v.22 no.1
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• pp.90-97
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• 2018

Purpose The lung segment ratio which is obtained through quantitative analyses of lung perfusion scan images is calculated to evaluate the lung function pre and post surgery. In this Study, the planar image production methods by using Q-Metrix (GE Healthcare, USA) program capable of not only quantitative analysis but also computation of the segment ratio after having performed SPECT/CT are comparatively evaluated. Materials and Methods Lung perfusion scan and SPECT/CT were performed on 50 lung cancer patients prior to surgery who visited our hospital from May 1, 2015 to September 13, 2016 by using Discovery 670(GE Healthcare, USA) equipment. AP(Anterior Posterior)method that uses planar image divided the frontal and rear images into three rectangular portions by means of ROI tool while PO(Posterior Oblique)method computed the segment ratio by dividing the right lobe into three parts and the left lobe into two parts on the oblique image. Segment ratio was computed by setting the ROI and VOI in the CT image by using Q-Metrix program and statistically analysis was performed with SPSS Ver. 23. Results Regarding the correlation concordance rate of Q-Metrix and AP methods, RUL(Right upper lobe), RML(Right middle lobe) and RLL(Right lower lobe) were 0.224, 0.035 and 0.447. LUL(Left upper lobe) and LLL(Left lower lobe) were found to be 0.643 and 0.456, respectively. In the PO method, the right lobe were 0.663, 0.623 and 0.702, respectively, while the left lobe were 0.754 and 0.823. When comparison was made by using the Paired sample T-test, Right lobe were $11.6{\pm}4.5$, $26.9{\pm}6.2$ and $17.8{\pm}4.2$, respectively in the AP method. Left lobe were $28.4{\pm}4.8$ and $15.4{\pm}5.6$. The right lobe of PO had values of $17.4{\pm}5.0$, $10.5{\pm}3.6$ and $27.3{\pm}6.0$, while the left lobe had values of $21.6{\pm}4.8$ and $23.1{\pm}6.6$, thereby having statistically significant difference in comparison to the Q-Metrix method for each of the lobes (P<0.05). However, there was no statistically significant difference in Right middle lobe (P>0.05). Conclusion The AP method showed low concordance rate in correlation with the Q-Metrix method. However, PO method displayed high concordance rate overall. although AP method had significant differences in all lobes, there was no significant difference in Right middle lobe of PO method. Therefore, at the time of production of lung perfusion scan results, utilization of Q-Metrix method of SPECT/CT would be useful in computation of accurate resultant values. Moreover, it is deemed possible to expect obtain more practical sectional computation result values by using PO method at the time of planar image acquisition.