• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.67-72
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• 2010

Purpose: In Asan Medical Center we perform myocardial perfusion SPECT to evaluate cardiac event risk level for non-cardiac surgery patients. In case of patients with cancer, we check tumor metastasis using whole body bone scan and whole body PET scan and then perform myocardial perfusion SPECT to reduce unnecessary exam. In case of short term in patients, we perform $^{201}Tl$ myocardial perfusion SPECT after whole body bone scan a minimum 16 hours in order to reduce hospitalization period but it is still the actual condition in which the evaluation about the affect of the crosstalk contamination due to the each other dissimilar isotope administration doesn't properly realize. So in our experiments, we try to evaluate crosstalk contamination influence on $^{201}Tl$ myocardial perfusion SPECT using anthropomorphic torso phantom and patient's data. Materials and Methods: From 2009 August to September, we analyzed 87 patients with $^{201}Tl$ myocardial perfusion SPECT. According to $^{201}Tl$ myocardial perfusion SPECT yesterday whole body bone scan possibility of carrying out, a patient was classified. The image data are obtained by using the dual energy window in $^{201}Tl$ myocardial perfusion SPECT. We analyzed $^{201}Tl$ and $^{99m}Tc$ counts ratio in each patients groups obtained image data. We utilized anthropomorphic torso phantom in our experiment and administrated $^{201}Tl$ 14.8 MBq (0.4 mCi) at myocardium and $^{99m}Tc$ 44.4 MBq (1.2 mCi) at extracardiac region. We obtained image by $^{201}Tl$ myocardial perfusion SPECT without gate method application and analyzed spatial resolution using Xeleris ver 2.0551. Results: In case of $^{201}Tl$ window and the counts rate comparison result yesterday whole body bone scan of being counted in $^{99m}Tc$ window, the difference in which a rate to 24 hours exponential-functionally notes in 1:0.114 with Ventri (GE Healthcare, Wisconsin, USA), 1:0.249 after the bone tracer injection in 12 hours in 1:0.411 with 1:0.79 with Infinia (GE healthcare, Wisconsin, USA) according to a reduction a time-out was shown (Ventri p=0.001, Infinia p=0.001). Moreover, the rate of the case in which it doesn't perform the whole body bone scan showed up as the average 1:$0.067{\pm}0.6$ of Ventri, and 1:$0.063{\pm}0.7$ of Infinia. According to the phantom after experiment spatial resolution measurement result, and an addition or no and time-out of $^{99m}Tc$ administrated, it doesn't note any change of FWHM (p=0.134). Conclusion: Through the experiments using anthropomorphic torso phantom and patients data, we found that $^{201}Tl$ myocardium perfusion SPECT image later carried out after the bone tracer injection with 16 hours this confirmed that it doesn't receive notable influence in spatial resolution by $^{99m}Tc$. But this investigation is only aimed to image quality, so it needs more investigation in patient's radiation dose and exam accuracy and precision. The exact guideline presentation about the exam interval should be made of the validation test which is exact and in which it is standardized about the affect of the crosstalk contamination according to the isotope use in which it is different later on.

• Journal of Chest Surgery
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• v.24 no.9
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• pp.881-889
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• 1991

The ideal goal of the coronary artery bypass surgery is complete revascularization. To estimate the numerical degree of completeness of revascularization, the following formula was used in 50 patients having aorta-coronary bypass grafting for the treatment of unstable angina. myocardial perfusion score of revascularized area Degree of Completeness = ----------------------------------------------------------------------------- x100[%] preoperative myocardial perfusion score Randomized patients who underwent revascularization procedures in 19Hb were compared with the patients who received similar elective operation each year from 1988 through 1991. To obtain these data, the patients aged 38 ~ 75[mean 54$\pm$9.1years], composed of 31 males and 19 females were randomly sampled. The number of grafts per patient increased from 2.30 in 1986, to 3.07 in 1988 - 89, to 3.21 in 1990, and to 3.50 in 1991. [0.05 The degree of completeness improved from 75.4% to 81.4%, 91.6% and 88.6% respectively. It improved significantly in the last two years, [P<0.05, Mann-Whitney U test] At a follow-up of three months, 90 percent[45/50] of patients remained angina, free, 6 percent[3/50] had residual angina, and 4 percent[2/50] died. The last two patients degree of completeness corresponded to 43% and 30% respectively As a conclusion, the degree of completeness seems to improve year by year, and to have close relationship with the clinical results.

• Korean Journal of Radiology
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• v.19 no.6
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• pp.1007-1020
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• 2018

Objective: To compare the diagnostic performance of cardiovascular magnetic resonance (CMR) myocardial perfusion at 1.5- and 3-tesla (T) for detecting significant coronary artery disease (CAD), with invasive coronary angiography (ICA) as the reference method. Materials and Methods: We prospectively enrolled 281 patients (age $62.4{\pm}8.3$ years, 193 men) with suspected or known CAD who had undergone 1.5T or 3T CMR and ICA. Two independent radiologists interpreted perfusion defects. With ICA as the reference standard, the diagnostic performance of 1.5T and 3T CMR for identifying significant CAD (${\geq}50%$ diameter reduction of the left main and ${\geq}70%$ diameter reduction of other epicardial arteries) was determined. Results: No differences were observed in baseline characteristics or prevalence of CAD and old myocardial infarction (MI) using 1.5T (n = 135) or 3T (n = 146) systems. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) for detecting significant CAD were similar between the 1.5T (84%, 64%, 74%, 76%, and 0.75 per patient and 68%, 83%, 66%, 84%, and 0.76 per vessel) and 3T (80%, 71%, 71%, 80%, and 0.76 per patient and 75%, 86%, 64%, 91%, and 0.81 per vessel) systems. In patients with multi-vessel CAD without old MI, the sensitivity, specificity, and AUC with 3T were greater than those with 1.5T on a per-vessel basis (71% vs. 36%, 92% vs. 69%, and 0.82 vs. 0.53, respectively). Conclusion: 3T CMR has similar diagnostic performance to 1.5T CMR in detecting significant CAD, except for higher diagnostic performance in patients with multi-vessel CAD without old MI.

• Journal of Radiopharmaceuticals and Molecular Probes
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• v.8 no.2
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• pp.63-70
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• 2022

The development of myocardial perfusion imaging (MPI) agents has been motivated because coronary artery disease has been one of the leading causes of death worldwide since the 1960s. Several positron emission tomography (PET) MPI agents were developed, and ¹⁸F-labeled phosphonium cations were reported actively among them. In this study, we synthesized novel ¹⁸F-labeled phosphonium cations, (5-[¹⁸F]fluoropentyl)diphenyl(pyridin-2-yl)phosphonium and (2-(2-[¹⁸F]fluoroethoxy)ethyl)diphenyl(pyridin-2-yl)phosphonium, and evaluated potential as MPI agents. Two labeled compounds were synthesized via nucleophilic substitution reactions of ¹⁸F-fluoride with the appropriate tosylate precursor in the presence of Kryptofix 2.2.2 and K₂CO₃. MicroPET studies were performed in normal rats to evaluate in vivo distribution of radiolabeled phosphonium cations for 60 min. The radiolabeled compounds were synthesized with 5%-10% yield. The radiochemical purity of labeled compounds was > 98% by analytical HPLC, and the specific activity was > 11.8 GBq/µmol. The result of microPET studies of these labeled compounds in rats showed intense uptake in the myocardium at 30 and 60 min. The results suggest that these ¹⁸F-labeled novel phosphonium cations would have potential as promising candidates for myocardial perfusion imaging.

• The Korean Journal of Nuclear Medicine
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• v.34 no.1
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• pp.30-38
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• 2000

Purpose: We investigated the role of myocardial perfusion SPECT in prediction of ventricular dilatation and the role of revascularization including thrombolytic therapy and PTCA in prevention of ventricular dilatation after an acute myocardial infarction (AMI). Materials and Methods: We performed dipyridamole stress, 4 hour redistribution, and 24 hour reinjection Tl-201 SPECT in 16 patients with AMI two to nine days after attack. Perfusion and wall motion abnormalities were quantified by perfusion index (PI) and wall motion index (WMI). Left ventricular ejection fraction (LVEF), WMI and ventricular volume were measured within 1 week of AMI and after average of 6 months. According to serial changes of left ventricular end-diastolic volume (LVEDV), patients were divided into two groups. We compared WMI, PI and LVEF between the two groups. Relationships among degree of volume, stress-rest PI, WMI, CKMB, Q wave, LVEF and revascularization were analysed using multivariate analysis. Results: Only initial rest perfusion index was significantly different between the two groups (p<0.05). While initial LVEF, stress PI, CKMB, trial of revascularization procedure, presence of Q wave and WMI were not significantly different between the two groups. Eight of 16 patients (50%) showed LV dilatation on follow-up echocardiography. Three of 3 patients (100%) who did not undergo revascualrization procedure documented LV dilatation. And only 5 (38%) of the remaining 13 patients who underwent revascularization revealed LV dilatation. There was no difference in infarct location between the two groups. By multivariate linear regression analysis in patients only undergoing revascularization, rest perfusion index was the only significant factor. Conclusion: Myocardial perfusion SPECT performed prior to revascularization was useful in prediction of LV dilatation after an AMI. Rest perfusion index on myocardial perfusion plays as a significant predictor of left ventricular dilatation after AMI. And revascularization appears to be a valuable procedure in alleviating LV dilatation after AMI with or without viable myocardium in a limited number of patients studied retrospectively.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.605-612
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• 2000

Background: Ischemic preconditioning enhances the tolerance of myocardium against ischemia/reperfusion injury, with the enhancement of the recovery of post-ischemic myocardial function. This study was disigned to assess whether the protective effect of ischemic preconditioning could provide one additional hour of myocardial preservation in four hour myocardial ischemia in a rate heart. Material and method: Fourty four Spargue-Dawley rats, weighing 300~450gm, were divided into four groups. Group 1(n=7) and group 3(n=12) were subjected to 30 minutes of aerobic Langendorff perfusion without ischemic preconditioning and then preserved in saline solution at 2~4$^{\circ}C$ for 4 hours and 5 respectively. Group 2(n=7) and group 4(n=18) were perfused in the same way for 20 minutes, followed by 3 minutes of global mormothermic ischemia and 10 minutes of perfusion and then preserved in the same cold saline solution for 4 hours and 5 hours respectively. Heart rate, left ventricular developed pressure(LVDP), and coronary flow were measured at 15 minutes during perfusion as baseline. Spontaneous defibrillation time was measured after reperfusion. Heart rate, LVDP, and coronary flow were also recorded at 15 minutes, 30 minutes, and 45 minutes during reperfusion. Samples of the apical left ventricular wall were studied using a transmission electron microscope. Result: Time of spontaneous defibrillation(TSD) was significantly longer in group 4 than in group 1(p<0.001), and TSD in group 1 was significantly longer in comparision to that of group 2(p<0.05). Heart rate at 45 minutes was significantly higher in group 1 than in group 4(p<0.05). Heart rate at 15 min was significantly higher in group 2 than in group 1(p<0.001) and in group 4 than in group 3(p<0.05). Left ventricular developed pressure(LVDP) at 30 minutes and 45 minutes was higher in group 1 than in group 4(p<0.01), LVDP at 45 minutes was higher in group 4 than in group 3(p<0.05). Rate-pressure product(RPP) at 30 minutes and 45 minutes was higher in group 1 than in group 4(p<0.05). RPP at 15 minutes was higher in group 2 than in group 1(p<0.01). RPP at 30 minutes and 45 minutes was higher in group 4 than in group 3(p<0.05). Group 2 showed relatively less sarcoplasmic edema and less nuclear chromatin clearance than group 1. Group 4 showed less myocardial cell damage than group 3, group 4 showed less myocardial cell damage than group 3, group 4 showed more myocardial cell edema than group 1. Conclusion: Ischemic preconditioning enhanced the recovery of postischemic myocardial function after 4 hours and 5 hours preservation. However, it was not demonstrated that ischemic preconditioning could definitely provide one additional hour of myocardial preservation in four hour myocardial ischemia in a rat heart.

• The Korean Journal of Nuclear Medicine
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• v.39 no.2
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• pp.69-74
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• 2005

Ever since it was first introduced as a method of scintigraphically measuring regional myocardial perfusion, myocardial perfusion study has been widely used in patients diagnosed or suspected with coronary artery diseases, and continuously improved upon. In addition to the technological enhancement of nuclear medicine equipments, the innovation of radiopharmaceuticals used in the cardiac exams were important contributors to such improvement. Besides the cardiac perfusion studies, new radiopharmaceuticals that visualize fat metabolism or receptors of the sympathetic nervous system have successfully been applied to clinical practice. More information can be collected before diagnosing coronary vascular disease, evaluating the patient's condition, or assessing therapeutic effects. In this review article, the clinical efficacy and characteristics of radiopharmaceutical products tailored for cardiac SPECT that are commonly used in Korea currently, plus the ones not being used yet but have proven value are briefly described.

• The Korean Journal of Nuclear Medicine
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• v.29 no.1
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• pp.41-47
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• 1995

Tc-99m-MIBI(Sestamibi) myocardial SPECT along with T1-201 tomographic imaging has demonstrated wide application and high image qualify sufficient for the diagnosis of myocardial perfusion defect, which consequently reflects regional myocardial blood flow, The qualitative values of myocardial SPECT with Tc-99m-MIBI as well as the quantitative cases depend in some degree on the reconstruction techniques of multiple projections. Filtered backprojection(FBP) is the common standard for reconstruction rather than the complicated and time-consuming arithmetic methods. In FBP it Is known that the distribution of radioactivity in reconstructed transverse slices varies with the selected filter parameters such as cutoff frequencies and order(Butterworth case). The cutoff frequencies basically remove and decrease the true radioactive distribution and alter the pixel counts, which lead to underestimation of true counts in specific myocardial regions. In this study, we have investigated the effect of cutoff frequencies of reconstruction filter on the artifactually induced perfusion defects, which are often demonstrated near inferior and/or inferoseptal cardiac walls due to the intense hepatic uptake of Tc-99m-MIBI. A computerized method for identifying the relative degree of artifactual perfusion defect and for comparing those degrees along with the relative amount of hepatic uptake to myocardium was developed and patient images were studied to observe the quantitative degree of underestimation of myocardial perfusion, and to propose some reasonable thresh-old of cutoff frequency in the diagnosis of perfusion defect quantitatively. We concluded that from the quantitative viewpoint cutoff frequencies may be used as high as possible with the sacrifice of homogeneity of image quality, and those frequencies lower than the common 0.3 Nyquist frequency would reveal severe degradation of radio-active distribution near inferior and/or Inferoseptal myocardium when applying Butterworth or low pass filter.

• Investigative Magnetic Resonance Imaging
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• v.11 no.1
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• pp.1-9
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• 2007

The obstacles for cardiac imaging are motion artifacts due to cardiac motion, respiration, and blood flow, and low signal due to small tissue volume of heart. To overcome these obstacles, fast imaging technique with ECG gating is utilized. Cardiac exam using MRI comprises of morphology, ventricular function, myocardial perfusion, metabolism, and coronary artery morphology. During cardiac morphology evaluation, double and triple inversion recovery techniques are used to depict myocardial fluidity and soft tissue structure such as fat tissue, respectively. By checking the first-pass enhancement of myocardium using contrast-enhanced fast gradient echo technique, myocardial blood flow can be evaluated. In addition, delayed imaging in 10 - 15 minutes can inform myocardial destruction such as chronic myocardial infarction. Ventricular function including regional and global wall motion can be checked by fast gradient echo cine imaging in quantitative way. MRI is acknowledged to be practical for integrated cardiac evaluation technique except coronary angiography. Especially delay imaging is the greatest merit of MRI in myocardial viability evaluation.

• 대한핵의학회:학술대회논문집
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• 2004.11a
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• pp.389.1-389.1
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• 2004