• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.1
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• pp.51-57
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• 2011

Purpose: The aim of this study is to identify clinical usefulness of Wide Beam Reconstruction (WBR) which is called Xpress.cardiac$^{TM}$ to confirm the agreement between segmental perfusion and regional wall motion in myocardium compared to conventional OSEM method. Materials and Methods: Subjects were separated two groups. First group was composed of 20 normal control group. Second group was composed of 10 patients (abnormal group) who had coronary artery disease. Subjects underwent myocardial perfusion SPECT ($^{201}Tl$ rest and $^{99m}Tc$-MIBI stress). Image acquisition and reconstruction were that rest stage was each step per 30, 15 seconds and stress stage was each step per 25, 13 seconds, OSEM and WBR methods were applied. Segmental perfusion and regional wall motion were applied 20-segment model of QPS, QGS algorithm in AutoQuant. Status of perfusion was composed of 5 point scoring system (0=normal, 1=mild, 2=moderate, 3=severe hypokinesia, 4=dyskinesia). Status of regional wall motion was also composed of 5 point scoring (0=normal, 1=mild, 2=moderate, 3=severe hypokinesia, 4=dyskinesia). We evaluated the agreement between conventional OSEM and WBR through automatic quantification value. Results: The agreement of rest segmental perfusion between conventional OSEM and WBR in normal patients was 99% (396/400, k=0.662, p<0.0001) and one of rest regional wall motion was 83.8% (335/400, k=0.283), the agreement of stress segmental perfusion was 95.8%(383/400, k=0.656), one of stress regional wall motion was 87.3% (349/400, k=0.390). The match rate of rest segmental perfusion in abnormal patients was 83% (166/200, k=0.605, p<0.0001) and one of rest regional wall motion was 55.5% (111/200, k=0.385), the agreement of stress segmental perfusion was 79.5% (159/200, k=0.682), one of stress regional wall motion was 63.5% (127/200, k=0.486). Conclusion: Compared to conventional OSEM, WBR method had a good agreement of segmental perfusion in myocardium in normal and abnormal groups. However regional wall motion showed meaningful low agreement. Although WBR offers high resolution and contrast ratio, it is not useful method for gated myocardial perfusion SPECT.

• The Korean Journal of Nuclear Medicine
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• v.28 no.1
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• pp.37-43
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• 1994

The coronary collateral vessels have revealed their significance in terms of reduction of infarct size, preservation left ventricular function, and prevention of left ventricular aneurysm in patients with myocardial infarction. The purpose of this study were to evaluated the relation between collateral circulation and $^{99m}Tc$-MIBI Heart SPECT in patient with acute myocardial infarction and their clinical significance. The fifty six MI patients with antegrade TIMI perfusion grade 0 and 1 were studied. The patients were classified into two groups; Group I inclueded 30 patients with grade 2, 3 Collateral flow. Group II inclueded 26 patients with grade 0, 1 Collateral flow. Collateral filling were graded from 0 to 3: 0- none, 1- Filling of side branch only, 2- Partial filling of the epicardial segment, 3- Complete filling of epicardial segment. Clinical variables, left ventricular function, $^{99m}Tc$-MIBI Heart SPECT were analyzed with angiographic finding. Results were following: 1) Collateral visualization was found to be greater in patient with involvement of right coronary artery (RCA). The collateral development site of infarct related artery was RCA 15 cases, left anterior descending artery (LAD) 10 cases, left circumflex artery (LCX) 5 cases, and the collateral circulation from LAD to RCA was 13 cases (40.6%). 2) There was a tendency to be decreased in peak CK activity with group I. 3) The presence of good collateral channels was more frequently $^{99m}Tc$-MIBI reversible perfusion defect (83.4% vs 15.3%, p<0.05). 4) No differences of left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), ejection fraction (EF) were noted between group I and group II. The presence of good collateral channels did affect the frequency of occurrence of $^{99m}Tc$-MIBI reversible perfusion defect.

• Tuberculosis and Respiratory Diseases
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• v.43 no.1
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• pp.54-62
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• 1996

Background: $^{99m}Tc$ MIBI(Methoxyisobutylisonitrile complex), a member of the isonitrile class of coordination compounds, is a lipophilic cation presently under investigation for clinical use as myocardial perfusion imaging agent and is widely used to detect myocardial infarction. Preliminary reports indicate that $T_1$-201 accumulate in human neoplasm and several authors reported $^{99m}Tc$ MIBI may also localized in primary malignant tumor and metastatic deposits from lung cancer. We evaluated the uptake of $^{99m}Tc$ MIBI in lung cancer and localization of mediastinal and other site metastasis, and compared the benign lesion of the lung. Method: Thirty four patients of lung cancer and ten patients of benign lung lesion were studied with chest CT and $^{99m}Tc$ MIBI Lung SPECT. $^{99m}Tc$ MIBI uptake ratio was assessed by TR/NL(Lung lesion/ Normal area), HT/NL (Heart/Normal area) and HT/TR(Heart/Lung lesion). Results: 1) All lung cancer patients showed increased uptakes of $^{99m}Tc$ MIBI in malignant lung lesion and Tc-99m MIBI uptake was also increased in mediastinal and lymph node metastasis except two cases. 2) There was significant different ratio of TR/NL between malignant and benign lesion, $3.79{\pm}1.82$ and $1.67{\pm}0.63$ on planar images, respectively(p<0.001). 3) There was no significant difference of $^{99m}Tc$ MIBI uptake ratio between squamous cell carcinoma, small cell carcinoma and adeno carcinoma($3.64{\pm}1.66$, $3.57{\pm}0.72$, $4.31{\pm}2.28$ respectively). Conclusion: $^{99m}Tc$ MIBI lung SPECT was useful in the localization of tumor and mediastinal or other site metastatic lesion in lung cancer and also in the differential diagnosis between benign and malignant lesion.

• The Korean Journal of Nuclear Medicine Technology
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• v.19 no.2
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• pp.87-92
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• 2015

Purpose When the patients takes myocardial perfusion SPECT using $^{201}Tl$, the operator gives the patients an injection of $^{201}Tl$. But the uniformity correction map in SPECT uses $^{99m}Tc$ uniformity correction map. Thus, we want to compare the image quality when it uses $^{99m}Tc$ uniformity correction map and when it uses $^{201}Tl$ uniformity correction map. Materials and Methods Phantom study is performed. We take the data by Asan medical center daily QC condition with flood phantom including $^{201}Tl$ 21.3 kBq/mL. After postprocessing with this data, we analyze CFOV integral uniformity(I.U) and differential uniformity(D.U). And we take the data with Jaszczak ECT Phantom by American college of radiology accreditation program instruction including $^{201}Tl$ 33.4 kBq/mL. After post processing with this data, we analyze spatial Resolution, Integral Uniformity(I.U), coefficient of variation(C.V) and Contrast with Interactive data language program. Results In the flood phantom test, when it uses $^{99m}Tc$ uniformity correction map, Flood I.U is 3.6% and D.U is 3.0%. When it uses $^{201}Tl$ uniformity correction map, Flood I.U is 3.8% and D.U is 2.1%. The flood I.U is worsen about 5%, but the D.U is improved about 30% inversely. In the Jaszczak ECT phantom test, when it uses $^{99m}Tc$ uniformity correction map, SPECT I.U, C.V and contrast is 13.99%, 4.89% and 0.69. When it uses $^{201}Tl$ uniformity correction map, SPECT I.U, C.V and contrast is 11.37%, 4.79% and 0.78. All of data are improved about 18%, 2%, 13% The spatial resolution was no significant changes. Conclusion In the flood phantom test, Flood I.U is worsen but Flood D.U is improved. Therefore, it's uncertain that an image quality is improved with flood phantom test. On the other hand, SPECT I.U, C.V, Contrast are improved about 18%, 2%, 13% in the Jaszczak ECT phantom test. This study has limitations that we can't take all variables into account and study with two phantoms. We need think about things that it has a good effect when doctors decipher the nuclear medicine image and it's possible to improve the image quality using the uniformity correction map of other radionuclides other than $^{99m}Tc$, $^{201}Tl$ when we make other nuclear medicine examinations.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.150-154
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• 2010

Purpose: Ejection fraction (EF) is one of the most important factors that evaluate heart function. Recently, according to echocardiography and myocardial perfusion SPECT, the number of gated blood pool scan (planar GBP) is declining. Measurement of left ventricular ejection fraction using gated blood pool SPECT (GBPS) is known as relatively correspond with echocardiography. We compared EF derived from plnar GBP, GBPS and echocadiography using modified simpson method to determine the accuracy. Materials and Methods: From January 2007 to June 2010, planar GBP and GBPS were performed on 34 patients who admitted to Pusan National University Hospital (men 23, women 11, mean age $52.6{\pm}27.2$). Each patient was injected with $^{99m}{TcO_4}^-$ of 20 mCi after pyrophosphate injection and then scanned using both planar GBP and GBPS techniques. For image analysis, we use ADAC Laboratories, Ver. 4.20 software. The result analyzed was processed by SPSS 17.0 Win statistic program and statistical method applied in data analysis is one-way anova, Tukey's post hoc test, pearson correlation test. Results: One-way anova test show no significant difference (planar GBP $56.3{\pm}13.9%$; GBPS $60.4{\pm}16.0%$; echocardiography $59.1{\pm}14.4%$, p=0.486, p>0.05). Tukey's post hoc test show no significant difference (planar GBP-echocardiography p=0.697; GBPS-echocardiography p=0.928; planar GBP-GBPS p=0.469, p>0.05). Values for EF obtained with planar GBP and GBPS correlated well with those obtained with echocardiography (planar-echocardiography r=0.697; GBPS-echocardiography r=0.928; planar GBP-GBPS r=0.469). Conclusion: The problems of accuracy and reproducibility for planar GBP still remain. But planar GBP is a safe and non-invasive method. In addition, planar GBP is useful to evaluate patient with low resolution echocardiography images. GBPS is not appicated clinically. but GBPS can be obtain various left ventricular functional parameters. planar GBP, GBPS and echocardiography show a good correlation between each other. Therefore, planar GBP and GBPS are useful for evaluating left ventricular ejection fraction.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.70-75
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• 2012

Purpose: It is important to acquire accurate data because the SPECT scan affected by various physical factors. The aim of this study was to compare the uniformity when both centers were matched or mismatched differed from position of heart in COR. Materials and methods: The images were acquired with cylindrical uniform phantom (6.7 cm diameter, 9 cm length) and heart insert phantom using Cardio MD SPECT system (Philips, USA). The phantoms were positioned on COR as well as four different points which were 10 cm above, below, left and right side from the COR. The counts from the both edge of cylindrical uniform phantom and those from the both wall of heart insert phantom were compared by using vertical and horizontal line profile. In addition, the qualitative evaluation was performed with heart insert phantom images and volunteer test. Results: In heart insert phantom study, the differences of counts between COR and 10 cm above, below, left and right point of COR were 1.1, 4.1, 4.9, 2.2 and 0.9% using T-A curve for horizontal view. In case of vertical view of COR 3.9, 21.9, 3.5, 23.9, 14.0% were shown. In cylindrical phantom study, the differences of counts between COR and 10 cm above, below, left and right point of COR were 4.3, 0.3, 3.3, 2.6 and 0.7% using T-A curve for horizontal view. In case of vertical view of COR 2.7, 3.0, 1.0, 0.3, 3.4% were shown. For qualitative evaluation, the images at COR were the most uniform for both of heart insert phantom and volunteer test, whereas other four positions showed somewhat distorted images. Conclusion: It showed the most uniform images when COR is matched with the heart. Therefore, we can expect that distortion which increased or decreased of myocardial perfusion will be prevented by matching the heart and COR when positioning. Furthermore, the accuracy of diagnosis will be improved as well.

• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.210-217
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• 1993

To compare the myocardial viability in patients suffering from total occlusion of the right coronry artery (RCA) with the angiographic collaterals, intracoronary injection of Thallium-201 (T1-201) was done to 14 coronary artery disease (CAD) patients (pts) with total occlusion of RCA and into four normal subjects for control. All 14 CAD pts had Grade 2 or 3 collateral circulations. There were 14 male and 4 females, and their ages ranged from 31 to 70 years. In nine pts, T1-201 was injected into left main coronary artery (LCA) ($300{\sim}350{\mu}Ci$) to evaluate the myocardial viability of RCA territory through collateral circulations. The remaining five pts received T1-201 into RCA ($200{\sim}250{\mu}Ci$) because two had intraarterial bridging collaterals and three had previous successful PTCA. Planar & SPECT myocardial perfusion images were obtained 30 minutes, and four to five hours after T1-201 injection. Intravenous T1-201 reinjection (six pts) or $^{99m}Tc-MIBI$ (two pts) were also performed in eight CAD pts. Intracoronary myocardial perfusion images were compared with intravenous T1-201 (IV T1-201) images, ECG, and ventriculography. Intracoronary T1-201 images proved to be superior to that of IV T1-201 due to better myocardial to background uptake ratio and more effective in the detection of viable tissue. We also found that perfusion defects were smaller on intracoronary T1-201 images than those on the IV T1-201. All of the 14 CAD pts had either mostly viable myocardium (seven pts) or large area of T1-201 perfusion (seven pts) in RCA territory, however ventriculographic wall motion and ECG did not correlate well with intracoronary myocardial perfusion images. In conclusion, total RCA occlusion patients with well developed collateral circulation had large area of viable myocardial in the corresponding territory.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.2
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• pp.78-83
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• 2013

Purpose: SPECT/CT, a combination of SPECT and CT, is capable of expressing the results of attenuation correction on images biased by automatic program. As a result, this research evaluates the usefulness of images with CT attenuation correction, using various phantoms and images of patients. Materials and Methods: From July of 2012 to September of 2012, this research was conducted on the contrast, spatial resolution, and images of patients. We studied the contrast with IEC body phantom and Jaszczak phantom, while the spatial resolution was evaluated with NEMA triple line phantom. Further, a comparative study was carried out on the quality of the images, on the difference between the images before and after the CT attenuation correction. Results: Compared the differences between the contrast before and after the CT attenuation correction in IEC body phantom. The contrast was improved by 33.6% at minimum, 89.8% at maximum. In case of Jaszczak Phantom, the contrast was enhanced by 9.9% at minimum, 27.8% at maximum. In NEMA Triple line phantom, the resolution was raised by 4.5% in average: 4.4% in horizontal, 4.5% in vertical. In Anthropomorphic Torso Phantom, the perfusion score of the interior wall with the most severe attenuation was measured to be 29.4%. In the experiment carried out on myocardial perfusion SPECT/CT patients, 9% improvement was discovered in the interior wall, where the most dramatic attenuation occurred, after the CT attenuation correction. Conclusion: SPECT/CT proved its clinical usefulness by enabling the acquisition of images with enhanced contrast and spatial resolution compare to the ones resulted from SPECT.

• The Korean Journal of Nuclear Medicine
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• v.38 no.5
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• pp.331-337
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• 2004

Cardiac neurotransmission imaging allows in vivo assessment of presynaptic reuptake, neurotransmitter storage and postsynaptic receptors. Among the various neurotransmitter, I-123 MIBG is most available and relatively well-established. Metaiodobenzylguanidine (MIBG) is an analogue of the false neurotransmitter guanethidine. It is taken up to adrenergic neurons by uptake-1 mechanism as same as norepinephrine. As tagged with I-123, it can be used to image sympathetic function in various organs including heart with planar or SPECT techniques. I-123 MIBG imaging has a unique advantage to evaluate myocardial neuronal activity in which the heart has no significant structural abnormality or even no functional derangement measured with other conventional examination. In patients with cardiomyopathy and heart failure, this imaging has most sensitive technique to predict prognosis and treatment response of betablocker or ACE inhibitor. In diabetic patients, it allow very early detection of autonomic neuropathy. In patients with dangerous arrhythmia such as ventricular tachycardia or fibrillation, MIBG imaging may be only an abnormal result among various exams. In patients with ischemic heart disease, sympathetic derangement may be used as the method of risk stratification. In heart transplanted patients, sympathetic reinnervation is well evaluated. Adriamycin-induced cardiotoxicity is detected earlier than ventricular dysfunction with sympathetic dysfunction. Neurodegenerative disorder such as Parkinson's disease or dementia with Lewy bodies has also cardiac sympathetic dysfunction. Noninvasive assessment of cardiac sympathetic nerve activity with I-123 MIBG imaging nay be improve understanding of the pathophysiology of cardiac disease and make a contribution to predict survival and therapy efficacy.

• The Korean Journal of Nuclear Medicine
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• v.37 no.5
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• pp.269-277
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• 2003

목적: 게이트 심근관류 스펙트는 심근의 관류와 좌심실 기능을 동시에 평가할 수 있는 유용한 방법이다. 현재, 게이트 영상 획득시 8 단위영상이 널리 사용되지만, 아직 가장 적절한 단위영상의 수에 대해서는 논의의 여지가 있다. 본 연구는 동일한 환자에서 8 단위영상과 16 단위영상으로 게이트 심근관류 스펙트를 2회 연속적으로 시행하여 국소적 심근관류, 좌심실 용적과 구혈률등을 비교하였다. 대상 및 방법: 42명(평균 연령: 55세, 남: 녀=26: 16)의 관상동맥 질환이 의심되거나 알려진 환자를 대상으로 안정시 Tc-99m MIBI를 이용한 게이트 스펙트를 8 단위영상과 16 단위영상으로 2회 연속하여 시행하였다. 좌심실의 확장기말 용적, 수축기말 용적과 구혈률을 각각 얻었으며 확장기말의 단층영상을 18 분절로 나누고 각 분절마다 심근의 관류정도를 4등급으로 나누어 국소적 심근관류를 평가하였다. 결과: 8 단위영상과 16 단위영상 게이트 스펙트에서 국소적 심근관류의 일치도는 85.7% (tau-b=0.786, p<0.001)로 우수하였다. 두 방법간에 1등급의 차이는 100 분절(13.2%), 2등급 차이는 8 분절(1.1 %)이 있었고 3등급 차이는 없었다. 좌심실의 확장기말 용적, 수축기말 용적, 구혈률은 두 방법간에 높은 상관성을 보였으며(r=0.993, 0.989, 0.935), 좌심실 구혈률은 8 단위영상을 사용할 때 평균 1.8% 낮게 측정되어 통계적인 유의성은 있었으나(p<0.05), 그 차이는 크지 않았다. 결론: 8 단위영상과 16 단위영상을 사용한 게이트 심근관류 스펙트에서 국소적 심근관류의 일치도는 우수하였으며, 좌심실의 기능적 계수의 차이도 크지 않았다. 비록 높은 단위영상을 사용했을 때 더 정확하고 자세한 정보를 얻을 수 있다 하더라도, 구혈률과 용적 등을 얻는 일상적인 임상검사에는 8 단위영상 또한 그 역할을 충분히 할 수 있을 것으로 사료된다.