• The Korean Journal of Nuclear Medicine
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• v.7 no.2
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• pp.27-34
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• 1973

Pulmonary perfusion scan with radioactive $^{113m}In$-iron hydroxide particle was performed in the 25 cases of heart disease which had been diagnosed by cardiac catheterization prior to surgery from July, 1972 to July, 1973 at the Department of Radiology and Nuclear Medicine, Yonsei Medical College. It consists of 7 mitral stenosis, 2 mitral insufficiency, 1 aortic insufficiency, 3 atrial septal defect, 5 ventricular septal defect, 2 patent ductus arteriosus, 1 transposition of great vessel and 4 Tetralogy of Fallot. Findings of pulmonary perfusion scan in relation to hemodynamic data of cardiac catheterization were examined. 1) Out of 10 cases of acquired valvular heart disease, In 6 cases of mitral stenosis and 1 case of aortic insufficiency, radioactivity was increased at both upper lung. This finding is noted when pulmonary wedge or venous pressure was elevated above 22 mmHg and arterial systolic pressure above 33 mmHg. 2) Out of 15 cases of congenital heart disease. In almost all cases of atrial septal defect and ventricular septal defect except 2 cases, radioactivity was even at both entire lung. In 2 cases of patent ductus arteriosus, radioactivity was decreased especially at the left lung. It is observed that in acyanotic congenital heart disease, radioactivity of lung is not related with pulmonary arterial pressure. In 3 cases of Tetralogy of Fallot, radioactivity was even at both entire lung and in 2 of them, extrapulmonary radioactivity of liver or kidney which depends on size of defect and volume of right to left shunt reversible, was noted.

• The Korean Journal of Nuclear Medicine
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• v.1 no.2
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• pp.1-25
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• 1967

In 20 normal cases and 39 pulmonary tuberculosis cases, regional pulmonary arterial blood flow measurements and lung perfusion scans by $^{131}I$-Macroaggregated albumin, lung inhalation scans by colloidal $^{198}Au$ and spirometries by respirometer were done at the Radiological Research Institute. The measured lung function tests were compared and the results were as the following: 1. The normal distribution of pulmonary blood flow was found to be $54.5{\pm}2.82%$ to the right lung and $45.5{\pm}2.39%$ to the left lung. The difference between the right and left pulmonary arterial blood flow was significant statistically (p<0.01). In the minimal pulmonary tuberculosis, the average distribution of pulmonary arterial blood flow was found to be $52.5{\pm}5.3%$ to the right lung and $47.5{\pm}1.0%$ to the left lung when the tuberculous lesion was in the right lung, and $56.2{\pm}4.4%$ to the right lung and $43.8{\pm}3.1%$ to the left lung when the tuberculous lesion was in the left lung. The difference of pulmonary arterial blood flow between the right and left lung was statistically not significant compared with the normal distribution. In the moderately advanced pulmonary tuberculosis, the average distripution of pulmonary arterial blood flow was found to be $26.9{\pm}13.9%$ to the right lung and $73.1{\pm}13.9%$ to the left lung when the tuberculous lesion was more severe in the right lung, and $79.6{\pm}12.8%$ to the right lung and $20.4{\pm}13.0%$ to the left lung when the tuberculous lesion was more severe in the left lung. These were found to be highly significant statistically compared with the normal distribution of pulmonary arterial blood flow (p<0.01). When both lungs were evenly involved, the average distribution of pulmonary arterial blood flow was found to be $49.5{\pm}8.01%$ to the right lung and $50.5{\pm}8.01%$ to the left lung. In the far advanced pulmonary tuberculosis, the average distribution of pulmonary arterial blood flow was found to be $18.5{\pm}11.6%$ to the right lung and $81.5{\pm}9.9%$ to the left lung when the tuberculous lesion was more severe in the right lung, and $78.2{\pm}8.9%$ to the right lung and $21.8{\pm}10.5%$ to the left lung when the tuberculous lesion was more severe in the left lung. These were found to be highly significant statistically compared with the normal distribution of pulmonary arterial blood flow (p<0.01). When both lungs were evenly involved the average distribution of pulmonary arterial blood flow was found to be $56.0{\pm}3.6%$ to the right lung and $44.0{\pm}3.2%$ to the left lung. 2. Lung perfusion scan by $^{131}I$-MAA in patients with pulmonary tuberculosis was as follows: a) In the pretreated minimal pulmonary tuberculosis, the decreased area of pulmonary arterial blood flow was corresponding to the chest roentgenogram, but the decrease of pulmonary arterial blood flow was more extensive than had been expected from the chest roentgenogram in the apparently healed minimal pulmonary tuberculosis. b) In the pretreated moderately advanced pulmonary tuberculosis, the decrease of pulmonary arterial blood flow to the diseased area was corresponding to the chest roentgenogram, but the decrease of pulmonary arterial blood flow was more extensive in the treated moderately advanced pulmonary tuberculosis as in the treated minimal pulmonary tuberculosis. c) Pulmonary arterial blood flow in the patients with far advanced pulmonary tuberculosis both before and after chemotherapy were almost similar to the chest roentgenogram. Especially the decrease of pulmonary arterial blood flow to the cavity was usually greater than had been expected from the chest roentgenogram. 3. Lung inhalation scan by colloidal $^{198}Au$ in patients with pulmonary tuberculosis was as follows: a) In the minimal pulmonary tuberculosis, lung inhalation scan showed almost similar decrease of radioactivity corresponding to the chest roentgenogram. b) In the moderately advanced pulmonary tuberculosis the decrease of radioactivity in the diseased area was partly corresponding to the chest roentgenogram in one hand and on the other hand the radioactivity was found to be normally distributed in stead of tuberculous lesion in the chest roentgenogram. c) In the far advanced pulmonary tuberculosis, lung inhalation scan showed almost similar decrease of radioactivity corresponding to the chest roentgenogram as in the minimal pulmonary tuberculosis. 4. From all these results, it was found that the characteristic finding in pulmonary tuberculosis was a decrease in pulmonary arterial blood flow to the diseased area and in general decrease of pulmonary arterial blood flow to the diseased area was more extensive than had been expected from the chest roentgenogram, especially in the treated group. Lung inhalation scan showed almost similar distribution of radioactivity corresponding to the chest roentgenogram in minimal and far advanced pulmonary tuberculosis, but there was a variability in the moderately advanced pulmonary tuberculosis. The measured values obtained from spirometry were parallel to the tuberculous lesion in chest roentgenogram.

• The Korean Journal of Nuclear Medicine
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• v.36 no.3
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• pp.185-194
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• 2002

Purpose: We studied clinical aspects and courses of patients with pulmonary radioactivity on liver scintigraphy and speculated the mechanism of pulmonary uptake of radiocolloids. Materials and Methods: Forty-nine patients with pulmonary radioactivity were classified into 5 disease groups-liver disease, infection, cancer, ischemic necrosis of liver, etc.- and their presence or absence of chronic liver disease (CLD), Child-Pugh class, serum levels of AST and ALT, results of follow-up liver scintigraphy and clinical course were checked. Results: Of total 49 patients 25 had CLD; there were 23 liver disease patients, 16 infection patients, 7 advanced cancer patients, 2 ischemic necrosis of liver patients, and 1 hemolytic anemia patient. Reversible rise of serum levels of AST and ALT was observed in all patients with liver disease and ischemic necrosis of liver; on one-way ANOVA, these rise were statistically significant (p<0.01). Serum level of ALT of liver disease group patients without CLD was significantly higher than that of infection group patients without CLD (p<0.05). Among 17 patients who underwent follow-up liver scintigraphy, 13 showed no pulmonary radioactivity. Total 12 patients died during follow-up and most of them were terminal cancer patients or CLD patients of Child-Pugh class C. Conclusion: Pulmonary radioactivity of radiocolloid liver scintigraphy could be attributed to the mobilization of reticuloendothelial system (RES) cells by the activation of RES cells in severe infection and terminal cancer, and also by the extensive liver destruction in liver diseases.

• The Korean Journal of Nuclear Medicine
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• v.36 no.2
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• pp.140-142
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• 2002

A 67-year-old woman who had undergone anterior resection for a moderately differentiated adenocarcinoma of the rectum and wedge resection for liver metastasis presented with hematogenous lung metastasis. Metastatic pulmonary nodules in both lung fields were shown on plain chest radiograph and CT. Ga-67 SPECT images revealed accumulation of radioactivity corresponding to the pulmonary nodules. The authors present an unusual case of accumulation of Ga-67 in metastatic pulmonary nodules in a patient with a moderately differentiated adenocarcinoma of the rectum.

• The Korean Journal of Nuclear Medicine
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• v.18 no.1
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• pp.45-53
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• 1984

The purpose of this study is to observe the changes of pulmonary capillary permeability and various hemodynamic parameters before and after Positive End-Expiratory Pressure(PEEP) in Adult Respiratory Distress Syndrome (ARDS). Using a canine oleic acid induced ARDS model, we measured the pulmonary capillary permeability with a slope of lung: heart radioactivity ratio, hemodynamic parameters with Swan-Ganz catheter and blood gas tensions. 1) In normal and ARDS dogs, the PEEP didn't significantly influence the slope of lung: heart radioactivity ratio. But in ARDS group the slope index was increased compaired with that of control group (p<0.05). 2) Also in ARDS group, $PaO_2$ was significantly decreased, and $PaCO_2,\;PvCO_2$, MPAP, $AaDO_2$, Qs/Qt were significantly increased compared with those of control group (p<0.05). 3) In normal dogs, the PEEP didn't influence blood pH or gas tension, $AaDO_2$, Qs/Qt, or hemodynamics. 4) In ARDS dogs, however, the PEEP significantly increased $PaO_2$ and decreased $AaDO_2$, Qs/Qt (p<0.05).

• The Korean Journal of Nuclear Medicine
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• v.34 no.2
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• pp.129-134
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• 2000

Purpose: It is difficult to determine the activity of tuberculosis radiologically. Therefore there have been efforts to assess the activity using radiopharmaceuticals such as $^{67}Ga,\;^{99m}Tc-tetrofosmin,\;and\;^{99m}Tc-MIBI$. But there may be some discrepancy in defining the term 'activity' between clinicians and nuclear physicians. While negative conversion of sputum acid fast bacilli (AFB) is defined as 'disappearance of activity' by clinicians, a loss of uptake in previously positive lesion is accepted as 'disappearance of activity' by nuclear physicians. We designed a prospective study to see if the negative conversion of sputum AFB could directly match the disappearance of radioactivity of the lesion. Materials and Methods: Fifteen patients with bacteriologically confirmed active localized pulmonary tuberculosis were scanned 10 and 60 min after intravenous injection of 550 MBq $^{99m}Tc$-MIBI. In 6 patients, who showed negative conversion of sputum AFB after 3-7 months of chemotherapy, $^{99m}Tc$-MIBI scan was repeated. For the purpose of comparison, target/nontarget ratios of the lesions were determined. Results: 12/15 (80%) patients with active pulmonary tuberculosis showed increased uptake of $^{99m}Tc$-MIBI in tuberculous lesion. After negative conversion of sputum AFB, 5/6 (83%) patients still showed increased uptake, although the intensity of uptake decreased. Conclusion: Uptake of radioactivity decreased but did not disappear after negative conversion of sputum AFB. $^{99m}Tc$-MIBI scan may be useful to address the degree of inflammation of pulmonary tuberculous lesion, but the uptake did not directly match the activity defined by positivity of sputum AFB. We nuclear physicians might have used the term 'activity' somewhat differently from clinicians who treat patients with tuberculosis.

• The Korean Journal of Nuclear Medicine
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• v.31 no.3
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• pp.365-371
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• 1997

The aim of this study is to evaluate the efficiency of the pulmonary perfusion scan(Pp scan) in the experimental animal single lung transplantation. Eight left lung transplanted mongrel dogs were included in this study. The serial Pp scan with 111MBq $^{99m}TC-MAA$ were done at the periods of immediate postoperative period, POD 3 days, and POD 10-14 days and finally autopsy was done in each cases. The transplanted lung perfusion was analysed as a percentage radioactivity of trans planted/native lung(T/N) ratio. The Pp scan of a donor mongrel dog was used as a reference(left/right lung (T/N) ratio 85.2%). The average T/N ratio of all cases on immediate postoperative state(reperfusion injury) : 19.2%, three acute rejections. 12.6%, three bronchial dehiscences 6.1% and two pulmonary thromboses : 2.0%. Two cases showed moderate improvement of reperfusion injury as increasing the T/N ratio in POD 3 days Pp scan. The T/N ratio showed sequentially decreased in six cases. As a conclusion, the Pp scan could be a non-invasive method in the evaluation of the experimental one-lung transplanted mongrel dog.

• Journal of Chest Surgery
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• v.17 no.1
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• pp.94-100
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• 1984

The purpose of present study is to investigate the significance of preoperative evaluation with perfusion lung scintigraphy in patients with lung cancer. Lung scans with the use of macroaggregated human serum albumin labeled with technetlum-99m were carried out in 35 patients with lung cancer before thoracotomy at Seoul National University Hospital during the period from November 1981 to September 1983. The relationship between size of the perfusion defect as seen by perfusion lung scan and size of the mass lesion as seen radiologically was correlated with the presence of regional adenopathy and resectability. Among patients with a larger perfusion defect than mass lesion on chest X-ray film.86% were found to have regional lymph node involvement with 29% resectability, whereas among patients in whom a larger defect was not present only 14% had such extension of the disease with 93% resectability. The relative pulmonary arterial perfusion of affected lung was calculated from the counts of radioactivity recorded from affected lung on both anterior and posterior scans expressed as a percentage of the total counts in the scan. The mean relative pulmonary arterial perfusion of the inoperable group [34\ulcorner%] is significantly different from both that of the pneumonectomy group [39\ulcorner%] and that of the lobectomy group [48\ulcorner%].(p<0.01)

• The Korean Journal of Nuclear Medicine
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• v.24 no.2
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• pp.237-243
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• 1990

Pulmonary embolism demands rapid and accurate diagnosis. And ventilation imaging has greatly improved the diagnostic accuracy of pulmonary embolism in addition to perfusion imaging. Agents currently used include xenon-133, krypton-81m and technetium-99m radioaerosols. However radioactive gases are compromised by availability and cost for krypton-81m, radiation dose, gamma energy and non?physiologic behaviour for xenon-133. Radioaerosols of technetium-99m componds are rapidly cleared from the lung after inhalation, and their relative low effeciency (specific radioactivity) and wide distribution of particle sizes make them also suboptimum. A new ventilation agent, Technegas is a suspension of structured graphite ellipsoids with diameter below 20nm, labelled with $^{99m}Tc$ in a carrier gas of Argon. This report describes the authors' clinical experience with Technegas. This is the first reported clinical study of this agent in Korea. A comparison of Technegas and $^{99m}Tc-DTPA$ aerosol was performed in 12 patients with various pulmonary diseases such as COPD, pulmonary tuberculosis and pleural effusion. All patients were studied with $^{99m}Tc-DTPA$ aerosol inhalation and Technegas ventilation. In both studies image quality was assessed (1) semiquantitatively by scoring bronchial and gastric activity, (2) subjectively by direct visual comparison of peripheral lung images and (3) quantitatively by computing the peripheral penetration index(PI) for each lungs. The bronchial activites were seen in 7 out of 12 cases with $^{99m}Tc-DTPA$ aerosol and in 5/12 with Technegas. The gastric activities were seen in 5/12 and 1/12 cases respectively. The average values of PI were 61.26% with $^{99m}Tc-DTPA$ aerosol and 69.20% with Technegas (p>0.05). Using $^{99m}Tc-DTPA$ aerosol, COPD patients showed deposition in the central airways with poor visualization of the peripheral areas of the lungs. In Technegas studies these phenomena were less prominent, and the examination is well tolerated by pateients and requires only a minimum of patient cooperation. With superiority of easy availability and handling, better physical characteristics and favorable Image quality, Technegas is a Promising agent for lung ventilation scanning.

• The Korean Journal of Nuclear Medicine
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• v.6 no.2
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• pp.21-39
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• 1972

The employment of gamma-ray scintillation camera with the use of short-lived radioisotopic pharmaceuticals, sucu as $^{99m}Tc$ sodium pertechnetate, have enabled us to perform RI (radioisotopic) angiocardiography. Although conventional cardiac catheterization or angiocardiography using contrast media have been an important diagnostic tool, they may carry some risks or serious complications. The author investigated on RI angiocardiography in twelve normal and twenty five patients with cardiovascular diseases in an effort to evaluate its diagnostic value. The results obtained with this study are as follows; 1. In normal subjects, the scintillation camera transit time of arm-to-right heart was found to be $2.1{\pm}0.67$ seconds, right heart-to-lung $1.5{\pm}0.40$ seconds and lung-to-left heart $3.5{\pm}0.86$ seconds. 2. Transformation or displacement of the heart and the great vessel are easily discriminated by RI angiocardiography. Both in the cases with tricuspid atresia and tetralogy of Fallot, ventricular septal defects are well recongnized by sequential RI angiocardiography. 3. It is also helpful in determinining the site and extent of obstruction, and estimatiing the postoperative course both in the cases with superior vena cava syndrome and pulmonary stenosis. 4. Pericarditis with effusion is readilly diagnosed by RI angiocardiogram showing characteristic "dead space" between intracardiac and intrapulmonary radioactivity. 5. It was found that the diagnostic accuracy of this study was 78.4%. It is concluded that above results obtained are useful and accurate enough for the diagnostic screening methode for clinical practice.