• The Korean Journal of Nuclear Medicine
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• v.35 no.1
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• pp.69-74
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• 2001

Purpose: $^{99m}Tc$-HMPAO is a radiopharmaceutical for imaging cerebral blood flow. HMPAO (RR, SS)-4.8-diaza-3,6,6,9-tetramethylundecan-2,10- dione bisoxime) has three stereoismers such as, meso-. d-, and l-HMPAO. Techentium complexes of meso-HMPAO and d,l-HMPAO are known to have different in vivo brain uptakes. In this study, enantiomers of HMPAO (d-HMPAO and l-HMPAO) were separated from d,l-HMPAO. These enantiomers were labeled with $^{99m}Tc$ and the biodistribution studies were performed in mice. Materials and Methods: An intermediate imine product was produced from 2,3-butanedione monooxime and 2,2-dimethyl-1,3-propanediamine (54% yield) and was reduced into a mixture of three isomers (35% yield). The meso-isomer was separated from d,l-mixture by repeated fractional crystallization (11 % yield). The d- and l-enantiomers were subsequently separated by co-crystallization with optical isomers of tartaric acid (25% and 5% yield. respectively). Each enantiomeric HMPAO was labeled with $^{99m}Tc$ by reacting with $SnCI_2{\cdot}2H_2O\;and\;^{99m}Tc$-pertechnetate. Biodistribution study was performed 1 hr after tail vein injection to ICR mice. Results: Radiochemical purities of each compound were over 80%. In biodistribution study. the brain uptakes of d,l- d- and l-form were 1.34, 1.12 and 1.67% ID/g, respectively. In case of l-lsomer the brain uptake was higher (1.5 fold) than d-isomer. Conclusion: We successfully purified each enantiomeric HMPAO. In biodistribution study of stereoismers of $^{99m}Tc$-HMPAO in mice, l-HMPAO may show better brain image than d,l-HMPAO which was supplied in a commercial kit.

• The Korean Journal of Nuclear Medicine
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• v.37 no.6
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• pp.355-363
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• 2003

Purpose: Regional contractility can be calculated using the regional volume change of left ventricle measured by gated myocardial SPECT image and curve of central artery pressure obtained from radial artery pressure data. In this study, a program to obtain the regional contractility was developed, and reproducibility of regional contractility measurement was assessed. Materials and Methods: Seven patients(male:female=5:2, $58{\pm}11.9$ years) with coronary artery diseases underwent gated Tc-99m MIBI myocardial SPECT twice without delay between two scans. Regional volume change of left ventricle was estimated using CSA (Cardiac SPECT Analyzer) software developed in this study. Regional contractility was iteratively estimated from the time-elastance curve obtained using the time-pressure curve and regional time-volume curve. Reproducibility of regional contractility measurement assessed by comparing the contractility values measured twice from the same SPECT data and by comparing those measured from the pair of SPECT data obtained from a same patient. Results: Measured regional contractility was $3.36{\pm}3.38{mm}Hg/mL$ using 15-segment model, $3.16{\pm}2.25{mm}Hg/mL$ using 7-segment model, and $3.11{\pm}2.57{mm}Hg/mL$ using 5-segment model. The harmonic average of regional contractility value was almost identical to the global contractility. Correlation coefficient of regional contractility values measured twice from the same data was greater than 0.97 for all models, and two standard deviations of contractility difference on Bland Altman plot were 1.5%, 1.0%, and 0.9% for 15-, 7-, and 5-segment models, respectively. Correlation coefficient of regional contractility values measured from the pair of SPECT data obtained from a same patient was greater than 0.95 for all models, and two standard deviations on Bland Altman plot were 2.2%, 1.0%, and 1.2%. Conclusion: Regional contractility of left ventricle measured using developed software in this study was reproducible. Regional contractility of left ventricle will be a new useful index for myocardial function after analysis of the clinical data.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.5
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• pp.257-262
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• 2006

Purpose: The standard protocol using large volume of oral contrast media may cause gastrointestinal discomfort and contrast-related artifacts in PET/CT. The aim of this study was to evaluate the usefulness of low dose oral contrast in $^{18}F-FDG$ PET/CT. Materials and Methods: We retrospectively reviewed the whole-body PET/CT images in a total of 435 patients. About 200 ml of oval contrast agent (barium sulfate) was administered immediately before injection of $^{18}F-FDG$. The FDG uptake of intestines was analyzed by visual and semi- quantitative method on transaxial, coronal and saggital planes. Results: Seventy (16%, 113 sites) of 435 images showed high FDG uptake (peak SUV > 4); 50 (74%, 84 sites) with diffuse and 20 (15%, 29 sites) with focal uptake. The most commonly delivered site of oral contrast media was small bowel (n=27, 39%). On PET/CT images, FDG uptake coexisted with oral contrast media in 26 patients (54%, 38 sites) with diffuse pattern and 9 (45%, 9 sites) with focal pattern, and by sites, those were 38 (45%) and 9 (31%), respectively. In small bowel regions, the proportion of coexistence reached as high as 61% (29/47 sites). A visual analysis of available non-attenuation corrected PET images of 27 matched regions revealed no contrast-related artifact. Conclusion: We concluded that the application of low dose contrast media could be helpful in the evaluation of abdominal uptake in the FDG PET/CT image.

• The Korean Journal of Nuclear Medicine
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• v.32 no.3
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• pp.225-237
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• 1998

Purpose: We investigated the statistical methods to compose the functional brain map of human working memory and the principal factors that have an effect on the methods for localization. Materials and Methods: Repeated PET scans with successive four tasks, which consist of one control and three different activation tasks, were performed on six right-handed normal volunteers for 2 minutes after bolus injections of 925 MBq $H_2^{15}O$ at the intervals of 30 minutes. Image data were analyzed using SPM96 (Statistical Parametric Mapping) implemented with Matlab (Mathworks Inc., U.S.A.). Images from the same subject were spatially registered and were normalized using linear and nonlinear transformation methods. Significant difference between control and each activation state was estimated at every voxel based on the general linear model. Differences of global counts were removed using analysis of covariance (ANCOVA) with global activity as covariate. Using the mean and variance for each condition which was adjusted using ANCOVA, t-statistics was performed on every voxel To interpret the results more easily, t-values were transformed to the standard Gaussian distribution (Z-score). Results: All the subjects carried out the activation and control tests successfully. Average rate of correct answers was 95%. The numbers of activated blobs were 4 for verbal memory I, 9 for verbal memory II, 9 for visual memory, and 6 for conjunctive activation of these three tasks. The verbal working memory activates predominantly left-sided structures, and the visual memory activates the right hemisphere. Conclusion: We conclude that rCBF PET imaging and statistical parametric mapping method were useful in the localization of the brain regions for verbal and visual working memory.

• The Korean Journal of Nuclear Medicine
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• v.33 no.6
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• pp.475-483
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• 1999

Purpose: Complete fibrovascular ingrowth within the hydroxyapatite ocular implant is necessary for peg drilling which is performed to Prevent infection and to provide motility to the ocular prosthesis. We compared planar bone scintigraphy and SPECT for the evaluation of the vascularization within hydroxyapatite ocular implants. Materials and Methods: Seventeen patients (M:F: 12:5, mean age; $50.4{\pm}17.5$ years) who had received a coralline hydroxyapatite ocular implant after enucleation surgery were enrolled. Patients underwent Tc-99m MDP planar bone and SPECT imaging by dual head gamma camera after their implant surgery (interval: $197{\pm}81$ days). Uptake on planar and SPECT images was graded visually as less than (grade 1), equal to (grade 2), and greater than (grade 3) nasal bridge activity. Quantitative ratio of implanted to non-implanted intraorbital activity was also measured. Vascularization within hydroxyapatite implants was confirmed by slit lamp examination and ocular movement. Results: All but three patients were considered to be vascularized within hydroxyapatite implants. In visual analysis of planar image and SPECT, grade 1 was noted in 9/18 (50%) and 6/18 (33%), respectively. Grade 2 pattern was 7/18 (39%) and 4/18 (22%), and grade 3 pattern was 2/18 (11%) and 8/18 (44%) respectively. When grade 2 or 3 was considered to be positive for vascularization, the sensitivity of planar and SPECT imaging were 60% (9/15) and 80% (12/15), respectively. In 3 patients with incomplete vascularization, both planar and SPECT showed grade 1 uptake The orbital activity ratios on planar imaging were not significantly different between complete and incomplete vascularization ($1.96{\pm}0.87$ vs $1.17{\pm}0.08$, p>0.05), however, it was significantly higher on SPECT in patients with complete vascularization ($8.44{\pm}5.45$ vs $2.20{\pm}0.87$, p<0.05). Conclusion: In the assessment of fibrovascular ingrowth within ocular implants by Tc-99m MDP bone scintigraphy, SPECT image appears to be more effective than planar scintigraphy.

• The Korean Journal of Nuclear Medicine
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• v.33 no.6
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• pp.519-526
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• 1999

Purpose: This study was designed to evaluate the usefulness of a technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) single photon emission computed tomography (SPECT) performed on transplanted kidney. Materials and Methods: Thirty renal transplant patients were included in this study. Planar scan was performed for 30 minutes using 555 MBq Tc-99m MAG3. A post-voiding SPECT scan was acquired on the third, seventh, fourteenth and twenty eighth day after transplantation. Results: SPECT scan showed interpretable image quality in 26 of 30 patients (86.7%) and 84 in 120 scans (70%). Fourteen of 26 patients with interpretable SPECT image showed decreased or increased radioactivity, but only 5 had abnormal findings on the planar scan. Focal SPECT defects were seen in allografts with normal function (n=3), acute tubular necrosis (n=3), and acute rejection (n=2). The defects are thought to reflect focally underperfused renal parenchyme or, in normal allografts, an artifact from uneven radioactivity distribution. Four of 10 patients with renal arterial variation showed focally decreased radioactivity and SPECT helped guide funker studies that confirmed the exact cause. Five of 10 patients with acute tubular necrosis or acute rejection showed focally decreased radioactivity, but its relation to the patients' clinical course was not clear. Focally increased radioactivity was observed in 5 allografts with normal function and 1 with double ureter in which local clearance delay was observed. Conclusion: Tc-99m MAG3 SPECT renal scan can detect additional focal abnormalities compared to planar scan. Further study is necessary to elucidate the exact clinical significance of the SPECT findings.

• Journal of the Korean Society of Radiology
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• v.5 no.5
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• pp.295-302
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• 2011

To n the field of nuclear medicine, with regard to checking regular patients, from the moment they register up to the doctor's diagnosis, the person in charge of the checks can find errors in the diagnosis, reexamine, reanalyze the results or save images to PACS. Through this process, the results obtained from the readings are delayed due to checks and additional tests which occur in hospitals, causing patient satisfaction and affected reliability. Accordingly, the purpose is to include visual inspection of the results to minimize error, improve efficiency and increase patient satisfaction. Nuclear medicine and imaging tests from examines at Asan Medical Center, Seoul, from March 2008 to December 2008, were analyzed for errors. The first stage, from January 2009 to December 2009, established procedures and know-how. The second stage from January 2010 until June 2010 conducted Pre-and Post-filtering assessment, and the third stage from July 2010 until October 2010 consisted of cross-checks and attaching stickers and comparing error cases. Of 92 errors, the 1st, 2nd and 3rd stage had 32 cases, and there were 46 cases after the 4th stage, with the overall errors reduced by 74.3% from 94.6%. In the field of general nuclear medicine, where various kinds of checks are performed according to the patient's needs, analysis, image composition, differing images in PACS, etc, all have the potential for mistakes to be made. In order to decrease error rates, the image can continuously Cross-Check and Confirm diagnosis.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.34-37
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• 2012

Purpose: To verify the optimal scan time per bed for clinical application, we evaluated the quality of $^{18}F$-FDG images with varying scan times in a phantom and 20 patients with 38 lesions using a Philips (TOF) PET/CT scanner. Materials and Methods: The PET/CT images of a NEMA IEC body phantom and 20 patients (16 males, 4 females) were acquired for 5 different scan times of 20-100 sec per bed with intervals of 20 sec. The activity ratio of hot spheres (diameter of 17 [H1], 22 [H2] and 28 [H3] mm) to the background region in the IEC body phantom was 8-to-1. The contrast recovery coefficient (CRC) and standard uptake value (SUV) based on ROIs of hot spheres and background region were calculated. The noise in each background region was estimated as the ratio of SD of counts to the mean counts in the background region. On the patient image, the injected dose of $^{18}F$-FDG was $444{\pm}74$ MBq and the SUVs in the 38 hot lesions were measured. Results: The two scan time groups (LT-60 [<60 sec] and GT-60 [${\geq}60$ sec]) were compared. In the phantom study, the coefficient of deviations (CVs, %) of CRC and SUV in LT-60 (H1: 14.2 and 7.3, H2: 11.4 and 7.8, H3: 4.9 and 3.2) were higher than GT-60 (H1: 8.9 and 2.8, H1: 8.2 and 5.0, H3: 2.0 and 1.6). In the patient study, the mean CV of CRC and SUV in LT-60 (4.0) was higher than GT-60 (1.2). Conclusion: This study showed that noise increased as the scan time decreased. High noise for the scan time <60 sec per bed yielded high variation of SUV and CRC. Therefore, considering PET/CT image quality, the scan time per bed in the TOF PET/CT scanner should be at least ${\geq}60$ sec.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.2
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• pp.36-41
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• 2016

Purpose Sentinel lymphoscintigraphy (SLS) was using only $^{99m}Tc-phytate$. If the supply is interrupted temporarily, there is no alternative radiopharmaceuticals. The aim of this study measure the particle size of radiopharmaceuticals and look for radiopharmaceuticals which can be substituted for $^{99m}Tc-phytate$. Materials and Methods The particle size of radiopharmaceuticals were analyzed by a nano-particle analyzer. This study were selected known radiopharmaceuticals to be useful particle size for SLS. We were divided into control and experimental groups using $^{99m}Tc-DPD$, $^{99m}Tc-MAG3$, $^{99m}Tc-DMSA$ with $^{99m}Tc-phytate$. For in-vivo experiment, radiopharmaceuticals were injected intradermally at both foot to perform lymphoscintigraphy. Imaging was acquired to dynamic and delayed static image and observe the inguinal lymph nodes with the naked eye. Results Particle size was measured respectively Phytate 105~255 nm (81.9%), MAG3 91~255 nm (98.7%), DPD 105~342 nm (77.3%), DMSA 164~ 342 nm (99.2%), MAA 1281~2305 nm (90.6%), DTPA 342~1106 nm (79.4%), and HDP 295~955 nm (94%). In-vivo delayed static image, inguinal lymph nodes of all experiment groups and two control groups are visible to naked eye. however, $^{99m}Tc-MAG3$ of control groups is not visible to naked eye. Conclusion We were analyzed to the particle size of the radiopharmaceuticals that are used in in-vivo. Consequently, $^{99m}Tc-DPD$, $^{99m}Tc-DMSA $are possible in an alternative radiopharmaceuticals of emergency.

• The Korean Journal of Nuclear Medicine Technology
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• v.22 no.1
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• pp.15-22
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• 2018

Purpose Respiratory motion during PET/MRI acquisition may result in image blurring and error in measurement for volume and quantification of lesion. The aim of this study was to evaluate changes of quantitative accuracy, tumor size and image quality by applying MR based respiratory motion correction technique (MBRMCT) using integrated PET/MR scanner. Materials and Methods Data of 30 patients (aged $62.5{\pm}10.2y$) underwent $^{18}F-FDG$ liver PET/MR (Biograph mMR 3.0T, Siemens) study were collected. PET listmode data for 7 minutes was simultaneously acquired with maximum average gate (MAG), minimum time gate (MTG) and non gate (NG) T1 weighted MR images. Gated PET reconstruction was performed using mu-maps generated from MAG and MTG by setting 35% of efficiency window. Maximum SUV ($SUV_{max}$), peak SUV ($SUV_{peak}$), tumor size and full width at half maximum (FWHM) in the z-axis direction of MAG, MTG and NG PET images were evaluated. Results Compared to NG, mean $SUV_{max}$ and $SUV_{peak}$ were increased in MAG 13.15%(p<0.0001), 8.66%(p<0.0001), MTG 13.27%(p<0.0001), 8.80%(p<0.0001) and mean tumor size and FWHM were decreased in MAG 14.47%(p<0.0001), 15.49%(p=0.0004), MTG 14.89%(p<0.0001), 15.79%(p=0.0003) respectively. Mean $SUV_{max}$ and $SUV_{peak}$ of MTG were increased by 0.07%(p=0.8802), 0.13%(p=0.7766). Mean tumor size and FWHM of MTG were decreased by 0.49%(p=0.2786), 0.36%(p=0.2488) compared to MAG. There was no statistically significant difference between MAG and MTG which increase total scan time for about 7 and 2 minutes. Conclusion SUV, accuracy of tumor size and spatial resolution were improved in both of MAG and MTG by applying MBRMCT without installing additional hardware in liver PET/MR study. More accurate information can be provided with the increase of 2 minutes scan time if applying MTG of MBRMCT to various abdominal PET/MR studies affected by respiratory motion.