• Nuclear Medicine and Molecular Imaging
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• 제42권2호
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• pp.153-163
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• 2008

다중영상기기는 1990년대 초에 처음 개발되어 현재 주요 영상 장비 회사에서 상품으로 개발되어 판매되고 있다. 단순한 소프트웨어적인 정합과 융합을 통해 해부학적 영상과 기능적 영상의 상호 보완하는 단계에서 발전하여 하드웨어적으로 정합하는 하드웨어의 개발은 새로운 연구의 시작이다. 다중영상기기의 발전 이전에는 해부학적 구조를 보여주는 영상 장비와 기능적 영상을 표현하는 장비가 각각 고 분해능과 고 해상도로 많은 발전을 이루어 왔다. 현재는 각 영상 장비의 특징을 살려 효과적으로 결합시킨 다중영상기기의 개발이 활발하게 이루어지고 있다. 다중영상기기는 단순하게 두 장비를 결합시키는 개념에서 기능적 영상에서 필요한 감쇠 보정을 하면서 동시에 해부학적 위치를 융합 영상 형태로 표현하는 새로운 영상 장비로 발전하고 있다 다중영상기기의 특징을 살릴 수 있는 프로토콜이 개발되고 하드웨어적으로도 상호 보완적으로 결합되고 있다. 실제로 PET/CT와 같은 다중영상기기는 임상적으로 중요한 역할을 하고 있으며 PET 영상기기를 대체하고 있다. PET/CT 스캐너는 PET에서 나오는 기능적 영상과 CT에서 나오는 해부학적 영상뿐만 아니라 융합 영상을 함께 보여 주므로 임상적으로 유용한 정보를 제공하고 있다. 현재 SPECT/CT는 아직 보급이 많이 되지 않았으나 PET/CT와 같이 임상적으로 유용한 SPECT와 CT 장비가 결합된 상품들이 나오고 있어 그 시장이 점점 성장할 것으로 기대된다. 다중영상기기는 각각의 단독 영상장비에서 갖고 있는 문제뿐만 아니라 두 영상 장비를 결합시키므로 인해 새로운 문제들이 발생하고 있다. 대표적으로 호흡에 의한 움직임, 조영제의 영향, 금속 물질의 영향과 환자의 피폭에 관한 문제가 있다. 이를 해결하기 위해 새로운 프로토콜과 프로세싱 방법이 개발되고 있다. 뇌를 동시에 촬영할 수 있는 PET/MR의 개발은 뇌 과학에 많은 발전을 줄 것으로 기대된다. PET/MR의 개발은 PET/CT 에서 촬영한 영상의 일부분을 대체할 것으로 예상된다. MR 영상이 CT 영상보다 우수한 분해능을 보이는 분야에서는 PET/MR을 이용한 검사와 연구가 활발하게 진행될 것으로 보인다. 해부학적 영상과 기능적 영상을 결합시킨 융합 영상을 함께 제공하는 다중영상기기는 환자의 질병을 진단뿐만 아니라 치료 후의 효과를 보는데 있어서 중요한 역할을 할 것으로 기대된다. 또 앞으로 검사 목적에 맞는 다양한 다중영상기기의 개발이 이루어질 것으로 기대된다.

• Korean Journal of Radiology
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• 제24권11호
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• pp.1142-1150
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• 2023

Objective: To evaluate ^99mtechnetium-three polyethylene glycol spacers-arginine-glycine-aspartic acid (^99mTc-3PRGD₂) single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging for diagnosing lymph node metastasis of primary malignant lung neoplasms. Materials and Methods: We prospectively enrolled 26 patients with primary malignant lung tumors who underwent ^99mTc-3PRGD₂ SPECT/CT and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/CT imaging. Both imaging methods were analyzed in qualitative (visual dichotomous and 5-point grades for lymph nodes and lung tumors, respectively) and semiquantitative (maximum tissue-to-background radioactive count) manners for the lymph nodes and lung tumors. The performance of the differentiation of lymph nodes with and without metastasis was determined at the per-lymph node station and per-patient levels using histopathological results as the reference standard. Results: Total 42 stations had metastatic lymph nodes and 136 stations had benign lymph nodes. The differences between metastatic and benign lymph nodes in the visual qualitative and semiquantitative analyses of ^99mTc-3PRGD₂ SPECT/CT and ¹⁸F-FDG PET/CT were statistically significant (all P < 0.001). The area under the receiver operating characteristic curve (AUC) in the semi-quantitative analysis of ^99mTc-3PRGD₂ SPECT/CT was 0.908 (95% confidence interval [CI], 0.851-0.966), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.86 (36/42), 0.88 (120/136), 0.69 (36/52), and 0.95 (120/126), respectively. Among the 26 patients (including two patients each with two lung tumors), 15 had pathologically confirmed lymph node metastasis. The difference between primary lung lesions in patients with and without lymph node metastasis was statistically significant only in the semi-quantitative analysis of ^99mTc-3PRGD₂ SPECT/CT (P = 0.007), with an AUC of 0.807 (95% CI, 0.641-0.974). Conclusion: ^99mTc-3PRGD₂ SPECT/CT imaging may notably perform in the direct diagnosis of lymph node metastasis of primary malignant lung tumors and indirectly predict the presence of lymph node metastasis through uptake in the primary lesions.

• Journal of the Optical Society of Korea
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• 제20권6호
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• pp.663-668
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• 2016

In single-photon-emission computed tomography (SPECT) with a pixelated semiconductor detector (PSD), not only pinhole collimators but also parallel-hole collimators are often used in preclinical nuclear-medicine imaging systems. The purpose of this study was to evaluate and compare pinhole and parallel-hole collimators in a PSD. For that purpose, we paired a PID 350 (Ajat Oy Ltd., Finland) CdTe PSD with each of the four collimators most frequently used in preclinical nuclear medicine: (1) a pinhole collimator, and (2) low-energy high-resolution (LEHR), (3) low-energy general-purpose (LEGP), and (4) low-energy high-sensitivity (LEHS) parallel-hole collimators. The sensitivity and spatial resolution of each collimator was evaluated using a point source and a hot-rod phantom. The highest sensitivity was achieved using LEHS, followed by LEGP, LEHR, and pinhole. Also, at a source-to-collimator distance of 2 cm, the spatial resolution was 1.63, 2.05, 2.79, and 3.45 mm using pinhole, LEHR, LEGP, and LEHS, respectively. The reconstructed hot-rod phantom images showed that the pinhole collimator and the LEHR parallel-hole collimator give a fine spatial resolution for preclinical SPECT with PSD. In conclusion, we successfully compared different types of collimators for a preclinical pixelated semiconductor SPECT system.

• 대한방사성의약품학회지
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• 제1권1호
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• pp.62-73
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• 2015

We developed an evans blue-indocyanine green-$^{99m}Tc$-human serum albumin conjugate for sentinel lymph node mapping and we describe its unique potential usage for clinical implications. This conjugate has combined the strengths of visible blue dye, near-infrared fluorescence and radioisotope into one single conjugate without any additional weakness/disadvantage. All the components of evans blue-indocyanine green-$^{99m}Tc$-human serum albumin are safe and of low cost, and they have already been clinically used. This conjugate was stable in the serum, it showed a long retention time in the lymphatic system and the lymph nodes showed a much higher signal-to-noise ratio after the conjugate was injected intradermally into the paw of mice. Both the single-photon emission computed tomography and near-infrared fluorescent images of the mice were successfully obtained at the same time as the excised sentinel lymph nodes showed blue color. The visual color, near-infrared fluorescence and gamma ray from this agent could be complementary for each other in all the steps of sentinel lymph node sampling: exploring and planning sentinel lymph node before excision with visualization of the exact sentinel lymph node location during an operation. Therefore, the triple modal agent will possibly be very ideal for sentinel lymph node mapping because of the high signal-to-noise ratio for non-invasive imaging and its complementary multimodal nature, easy preparation and safety. It is promising for clinical applications and it may have great advantages over the traditional single modal methods.

• 대한핵의학회지
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• 제26권2호
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• pp.235-243
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• 1992

Patterns of abnormality in regional cerebral perfusion and its relation to clinical severity was evaluated with 32 head injury patients using $^{99m}Tc-HMPAO$ single photon emission tomography (SPECT). The findings were compared with computed tomography (CT) done within 48 hours of each SPECT study. The initial SPECT study was done within 7 days of injury in 16 cases, between 1 week and 2 months in 12, and after over 2 months in 4. Nineteen of the patients underwent followup SPECT and CT after a mean interval of 1 to 2 months. The initial SPECT showed abnormalities in 96% (31/32) of the patients while CT showed abnormal findings in only 81% (26/32). There were a total of 54 supratentorial SPECT lesions in all. Ninity percent (49/54) of these were of regional hypoperfusion, while 5 lesions showed focal hyperperfusion. The lesions were most often localized in the frontal and temporal lobes. Fifty five percent (30/54) were areas not detected as a lesion on CT. Cerebellar diaschisis was observed in 50% (16/32) of the patients. The degree of perfusion abnormality was quantified by the product of differential activity and a size factor. Correlation between the degree of perfusion abnormality and the clinical severity (Glasgow coma scale) failed to show statistical significance (p=0.053). The amount of change in the degree of perfusion abnormality on follow up SPECT was compared to the amount of change in clinical severity. Perfusion abnormality showed a tendancy to improve in most patients, and the degree of improvement showed significant correlation with the amount of clinical improvement (p < 0.01).

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2004년도 제29회 추계학술대회 발표논문집
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• pp.91-95
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• 2004

알츠하이머병에서는 전산화 단층촬영영상이나 자기공명영상을 이용하여 구조적, 비특이적 뇌 위축등의 병변을 진단할 수는 있으나 뇌 당대사 및 혈류 분포에 의한 이상 유무를 진단하기 위해서는 단일광자방출 단층촬영술 (single photon emission computed tomography, SPECT) 이나 양전자 방출 단층촬영술 (positron emission tomography, PET)을 이용한 국소 뇌혈류나 뇌 당대사 변화를 관찰한 진단이 필수적이다. 따라서 SEPCT나 PET영상 위에 직접 관심영역(region of interest, ROI)를 그려서 ROI를 관찰하여 해부학적 뇌위축과 국소 뇌혈류나 뇌 당대사 변화를 분석하였으나 ROI 방법은 주관적인 영향과 많은 분석 시간을 요하는 단점이 있다. 따라서 통계적 분석 방법을 이용한 맵핑방법으로 voxel based morphometry 방법을 수행하였고 MMSE 값을 분산분석변수로 하여 영상분석하여 $^{18}$F-labeled 2-deoxyglucose ($^{18}$F-FDG) positron emission tomography(PET)-CT 영상을 분석하였다. MMSE 값을 변수로 분석한 voxel based morphemetry 방법에서는 MMSE 값에 의한 대사저하의 변화는 무의미하였다. 알츠하이머병에서는 측두두정엽(temporoparietal cortex)의 cerebral blood flow, oxygen utilization, glucose metabolism은 줄어들고, 일차시각피질, 일차감각피질, 기저핵, 시상, 소뇌는 유지되며 voxel based morphometry 방법은 알츠하이머병을 분석하는데 유용한 분석방법이다.

• Journal of Yeungnam Medical Science
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• 제16권2호
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• pp.237-243
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• 1999

연구목적: 연구목적: $^{99m}Tc$ d,l-hexamethylpropyleneamine oxime(HMPAO)와 $^{99m}Tc$ ethyl cysteinate dimer(ECD)의 뇌세포에 의한 섭취는 뇌혈류량에 비례를 한다. 그러나 뇌혈류량이 아주 높은 경우에는 뇌세포에 의한 섭취가 그 만큼 증가를 하지 않기 때문에 뇌혈류량이 과소평가 될 수 있다. 이를 보안하기 위하여 Lassen이 linearization algorithm을 만들었다. 그러나 이 방정식은 뇌의 상태에 따라 사용되는 알파값으로 표현되는 변수가 변할 수 있다. 저자들은 뇌경색이 있는 10명의 환자를 대상으로 가장 적절한 ${\alpha}$값을 구하고자 하였다. 재료 및 방법: 10명의 환자들은 모두 0.1에서 10까지의 알파값을 이용하여 교정한 $^{99m}Tc$-HMPAO와 $^{99m}Tc$-ECD 뇌관류 단일광자방출 단층촬영(single photon emission computed tomography: SPECT) 영상을 구하고, 양전자방출단층촬영술로 뇌혈류영상을 구하였다. 그리고 상호정보의 최대화에 의한 multi-modal volume registration을 이용하는 컴퓨터프로그램으로 양전자방출단층촬영술로 구한 뇌혈류와 SPECT 영상에서 다양한 알파값을 대입하여 Lassen의 linearization algorithm으로 구한 뇌혈류값을 픽셀단위로 서로 비교하였다. 결과: Lassen의 linearization algorithm을 이용하여 구한 $^{99m}Tc$-HMPAO와 $^{99m}Tc$-ECD 뇌관류 SPECT의 국소 뇌혈류량은 알파값이 각각 1.4와 2.1일때 양전자방출전산화단층촬영술로 구한 뇌혈류량과의 상관관계가 가장 높았다. 결론: Lassen의 linearization algorithm을 이용하여 뇌혈류량을 정량화하는 경우에는 $^{99m}Tc$-HMPAO의 경우는 1.4, $^{99m}Tc$-ECD의 경우는 2.1을 사용할 때 뇌혈류량을 가장 잘 반영할 것으로 생각된다.

• Journal of the Korean Physical Society
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• 제73권9호
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• pp.1393-1398
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• 2018

In conventional single-photon emission computed tomography (SPECT), only the photoelectric events in the detectors are used for image reconstruction. However, if the $^{131}I$ isotope, which emits high-energy radiations (364, 637, and 723 keV), is used in nuclear medicine, both photoelectric and Compton scattering events can be used for image reconstruction. The purpose of our work is to perform simulations for Compton SPECT by using the Geant4 application for tomographic emission (GATE). The performance of Compton SPECT is evaluated and compared with that of conventional SPECT. The Compton SPECT unit has an area of $12cm{\times}12cm$ with four gantry heads. Each head is composed of a 2-cm tungsten collimator and a $40{\times}40$ array of CdZnTe (CZT) crystals with a $3{\times}3mm^2$ area and a 6-mm thickness. Compton SPECT can use not only the photoelectric effect but also the Compton scattering effect for image reconstruction. The correct sequential order of the interactions used for image reconstruction is determined using the angular resolution measurement (ARM) method and the energies deposited in each detector. In all the results of simulations using spherical volume sources of various diameters, the reconstructed images of Compton SPECT show higher signal-to-noise ratios (SNRs) without degradation of the image resolution when compared to those of conventional SPECT because the effective count for image reconstruction is higher. For a Derenzo-like phantom, the reconstructed images for different modalities are compared by visual inspection and by using their projected histograms in the X-direction of the reconstructed images.

• Nuclear Engineering and Technology
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• 제54권8호
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• pp.3006-3016
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• 2022

In this study, the images of specific prompt gamma (PG)-rays of 719 keV emitted from proton-boron reactions were analyzed using single-photon emission computed tomography (SPECT). Quantitative evaluation of the images verified the detection of anatomical changes in tumors, one of the important factors in daily adaptive proton therapy (DAPT) and verified the possibility of application of the PG-ray images to DAPT. Six scenarios were considered based on various sizes and locations compared to the reference virtual tumor to observe the anatomical alterations in the virtual tumor. Subsequently, PG-rays SPECT images were acquired using the modified ordered subset expectation-maximization algorithm, and these were evaluated using quantitative analysis methods. The results confirmed that the pixel range and location of the highest value of the normalized pixel in the PG-rays SPECT image profile changed according to the size and location of the virtual tumor. Moreover, the alterations in the virtual tumor size and location in the PG-rays SPECT images were similar to the true size and location alterations set in the phantom. Based on the above results, the tumor anatomical alterations in DAPT could be adequately detected and verified through SPECT imaging using the 719 keV PG-rays acquired during treatment.

• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.117-121
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• 2016

Objective : Hemorrhagic moyamoya disease (hMMD) is associated with a poor clinical course. Furthermore, poorer clinical outcomes occur in cases of recurrent bleeding. However, the effect of hemodynamic insufficiency on rebleeding risk has not been investigated yet. This study evaluated the prognostic implications of the perfusion status during the clinical course of adult hMMD. Methods : This retrospective study enrolled 52 adult hMMD patients between April 1995 and October 2010 from a single institute. Demographic data, clinical and radiologic characteristics, including hemodynamic status using single photon emission computed tomography (SPECT), and follow up data were obtained via a retrospective review of medical charts and imaging. Statistical analyses were performed to explore potential prognostic factors. Results : Hemodynamic abnormality was identified in 44 (84.6%) patients. Subsequent revascularization surgery was performed in 22 (42.3%) patients. During a 58-month (median, range 3-160) follow-up assessment period, 17 showed subsequent stroke (hemorrhagic n=12, ischemic n=5, Actuarial stroke rate $5.8{\pm}1.4%/year$). Recurrent hemorrhage was associated with decreased basal perfusion (HR 19.872; 95% CI=1.196-294.117) and omission of revascularization (10.218; 95%; CI=1.532-68.136). Conclusion : Decreased basal perfusion seems to be associated with recurrent bleeding. Revascularization might prevent recurrent stroke in hMMD by rectifying the perfusion abnormality. A larger-sized, controlled study is required to address this issue.