• The Korean Journal of Nuclear Medicine
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• v.28 no.2
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• pp.177-185
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• 1994

Pharmacologic coronary vasodilation in conjunction with myocardial perfusion scintigraphy has become an alternative to dynamic exercise test for the diagnosis and risk stratification of coronary artery disease, especially in patients who are unable to perform adequate exercise. Dipyridamole and adenosine have been used for pharmacologic stress testing with myocardial perfusion imaging. Adenosine is a potent coronary vasodilator with rapid onset of action, short half-life, near maximal coronary vasodilation and less serious side effects. ST segment depression has been reported in about 7-15% of patients with coronary artery disease receiving dipyridamole in conjunction with myocardial perfusion imaging. The exact cause and clinical significance are not known. In order to evaluate the relationship between adenosine-induced ST segment depression during $^{99m}Tc$-MIBI myocardial perfusion scintigraphy and the severity of coronary artery disease, we performed $^{99m}Tc$-MIBI imaging after intravenous Infusion of adenosine In 120 patients with suspected coronary artery disease. Of the 120 patients, 28 also performed coronary angiography. There were 24 patients with ST segment depression during $^{99m}Tc$-MIBI scintigraphy and 96 patients without ST segment depression. Adenosine was infused Intravenously at a dose of 0.14mg/kg per minute lot 6minutes and $^{99m}Tc$-MIBI was injected at 3 minute. We then com-pared the hemodynamic changes, side effects, scintigraphic and angiographic findings. Heart rate increased $90{\pm}19$ beats/minute in the group with ST depression compared with $80{\pm}16$ beats/minute in the group without ST depression(p<0.05). Baseline systolic blood pressure was significantly higher in the group with ST depression($152{\pm}27$ mmHg) than in the group without 57 depression($140{\pm}21$mmHg, p<0.05). Double product at baseline($10.90{\pm}2.77$ versus $9.55{\pm}2.34\;beats/minute{\times}mmHg$) and during adenosine infusion($12.72{\pm}3.89$ versus $10.83{\pm}2.98\;beats/minute{\times}mmHg$) were significantly higher in the group with ST depression(p<0.05). The incidence of anginal chest pain was also significantly higher in the group with ST depression(ST versus 29%, p<0.0001). The $^{99m}Tc$-MIBI images were abnormal in 23(96%) patients with ST segment depression and 66(69%) patients without ST segment depression(p<0.05). In patients with ST segment depression, there were more reversible perfusion defects than in patients without ST segment depression(83 versus 55%, p<0.05). The number of abnormal segments were significantly higher in the group with ST depression($3.05{\pm}2.01$ versus $1.51{\pm}1.45$, p<0.005). In patients with ST segment depression, there were more segments of reversible perfusion defects than in patients without segment depression($2.15{\pm}2.11$ versus $0.89{\pm}1.24$, p<0.05). There were no differences in the angiographic severity by vessel(p ; NS). We concluded that ST segment depression during $^{99m}Tc$-MIBI myocardial perfusion scintigraphy with Intravenous adenosine is related to the severity of coronary artery disease.

• 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.

• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.223-232
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• 1993

Technetium labeled isonitrile analogues are widely used as myocardial perfusion imaging agents. We synthesized and characterized a new isonitrile compound, ethyl 3-isocyanobutyrate(EIB). Proton and $^{13}C$ NMR spectroscopy and thin layer chromatography with a $C_{18}$ coat was performed. EIB was easily labeled with $^{99m}TcO_4^-$- with sodium dithionite. The labeling efficiency measured by RP-HPLC was over 95%. The labeled product was stable with dilution in normal saline and with prolonged incubation at room temperature. There was no formation of secondary products or free $^{99m}TcO_4^-$. In vivo kinetics study of $^{99m}Tc$ (I) labeled EIB in rabbits showed adequate myocardial uptake, good contrast against lung background, and relatively rapid liver clearance. The heart to lung ratio was over 2.5 and the heart to liver ratio was approximately from 0.4 to 5 at 60 minutes post injection. Hepatic clearance of $^{99m}Tc-MIBI$ was faster ($t_{1/2}$=6 minutes) than that of $^{99m}Tc-MIBI$. In vivo kinetics observed in dog was similar to that in rabbit but there was faster gallbladder filling, and thus lower liver background. SPECT imaging of the canine myocardium showed favorable imaging characteristics. However, biodistribution in mice demonstrated a myocardial % injected dose/organ of less than 0.1%. This was thought to be due to interspecies difference in plasma esterase activity. In human plasma, $^{99m}Tc$ ( I ) labeled EIB was stable for at least 2 hours, without production of secondary products by HPLC. We conclude that ethyl 3-isocyanobutyrate may be a potential new myocardial perfusion imaging agent and deserves further investigation as to its usefulness for clinical use.

• 대한핵의학회:학술대회논문집
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• 1999.11a
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• pp.25.2-25.2
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• 1999

• 대한핵의학회:학술대회논문집
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• 2003.11a
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• pp.12.2-12.2
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• 2003

• Nuclear Medicine and Molecular Imaging
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• v.41 no.5
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• pp.364-372
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• 2007

Purpose: This study was designed to investigate the cellular uptake of various tumor imaging radiopharmaceuticals in human breast cancer cells before and after paclitaxel exposure considering viable cell number. Materials and Methods: F-18-fluorodeoxyglucose, C-11-methionine, Tl-201, Tc-99m-MIBI, and Tc-99m-tetrofosmin were used to evaluate the cellular uptake in MCF-7 cells. MCF-7 cells were cultured in multi-well plates. Wells were divided into DMSO exposure control group, and paclitaxel exposure group. The exposure durations of paclitaxel with 10 nM or 100 nM were 2 h, 6 h, 12 h, 24 h, and 48 h. Results: Viable cell fraction was reduced as the concentration and exposure time of paclitaxel increased. After 10 nM paclitaxel exposure, the cellular uptake of all 5 radiopharmaceuticals was not reduced significantly, irrespective of exposure time and viable cell fraction. After 100 nM paclitaxel exposure, the cellular uptake of all 5 radiopharmaceuticals was enhanced significantly irrespective of viable cell fraction. The peak uptake was observed in experimental groups with paclitaxel exposure for 6 to 48 h according the type of radiopharmaceutical. When the cellular uptake was adjusted for the viable cell fraction and cell count, the peak cellular uptake was observed in experimental groups with paclitaxel exposure for 48 h, irrespective of the type of radiopharmaceutical. Conclusion: The cellular uptake of F-18-fluorodeoxyglucose, C-11-methionine, Tl-201, Tc-99m-MIBI, and Tc-99m-tetrofosmin did not reflect viable cell number in MCF-7 cells after paclitaxel exposure for up to 48 h.

• Journal of Yeungnam Medical Science
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• v.11 no.1
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• pp.146-152
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• 1994

We performed the same day dipyridamole stress/rest myocardial SPECT in 14 healthy young men, reconstructed the polar maps according to Cedars-Sinai method and quantitated the radioactivity of myocardial wall. We divided the whole myocardium to 9 sectors. The latero-anterior wall contains the highest count. The infero-septal wall contains the lowest count. There isn't any significant differences of radioactivity in each segment between stress and rest polar map. The hemodynamic parameters after dipyridamole injection in the subjects were significantly changed except systolic blood pressure : the heart rate was increased and diastolic blood pressure was decreased. Adverse effects were reported in 85.7%. We suggest that these data can be used to dectect perfusion defect in the coromary artery disease.

• The Korean Journal of Nuclear Medicine
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• v.34 no.6
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• pp.487-496
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• 2000

Purpose: The aim of this study is to investigate the reproducibility of the quantitative assessment of segmental wall motion and systolic thickening provided by an automatic quantitation algorithm. Materials and Methods: Tc-99m-MIBI gated myocardial SPECT with dipyridamole stress was performed in 31 patients with known or suspected coronary artery disease (4 with single, 6 with two, 11 with triple vessel disease; ejection fraction $51{\pm}14%$) twice consecutively in the same position. Myocardium was divided into 20 segments. Segmental wall motion and systolic thickening were calculated and expressed in mm and % increase respectively, using $AutoQUANT^{TM}$ software. The reproducibility of this quantitative measurement of wall motion and thickening was tested. Results: Correlations between repeated measurements on consecutive gated SPECT were excellent for wall motion (r=0.95) and systolic thickening (r=0.88). On Bland-Altman analysis, two standard deviation was 2 mm for repeated measurement of segmental wall motion, and 20% for that of systolic thickening. The weighted kappa values of repeated measurements were 0.807 for wall motion and 0.708 for systolic thickening. Sex, perfusion, or segmental location had no influence on reproducibility. Conclusion: Segmental wall motion and systolic thickening quantified using $AutoeUANT^{TM}$ software on gated myocardial SPECT offers good reproducibility and is significantly different when the change is more than 2 mm for wall motion and more than 20% for systolic thickening.

• The Korean Journal of Nuclear Medicine
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• v.32 no.6
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• pp.497-508
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• 1998

Purpose: Using rest T1-201/dipyridamole stress gated Tc-99m-MIBI/ 24 hour delay T1-201 SPECT, we investigated the predictive values of the markers of the stress-rest reversibility (Rev), T1-201 rest perfusion (Rest), T1-201 24 hour redistribution (Del) and Tc-99m-MIBI gated systolic thickening (Thk) for wall motion improvement after coronary artery bypass surgery. Materials and Methods: In 39 patients (M;F= 34:5, age $58{\pm}8$), preoperative and postoperative (3 months) SPECT were compared. 24 hour delayed SPECT was done in 16 patients having perfusion defects at rest. Perfusion or wall motion was scored from 0 to 3 (0: normal to 3: defect or dyskinesia). Wall motion was abnormal in 142 segments among 585 segments of 99 artery territories which were surgically revascularized. Results: After bypass surgery, ejection fraction increased from $37.8{\pm}9.0%$ to $45.5{\pm}12.3%$ in 22 patients who had decreased ejection fraction preoperatively. Wall motion improved in 103 (72.5%) segments among 142 dysfunctional segments. Positive predictive values (PPV) of Rev, Rest, Del, and Thk were 83%, 76%, 43%, and 69% respectively. Negative predictive values (NPV) of Rev, Rest, Del, and Thk were 48%, 44%, 58%, and 21%, respectively. Rest/gated stress/delay SPECT had PPV of 74% and NPV of 46%. Though univariate logistic regression analysis revealed Rev (p=0.0008) and Rest (p=0.024) as significant predictors, stepwise multivariate test found Rev as the only good predictor (p=0.0008). Conclusion: Among independent predictors obtained by rest T1-201/ stress gated Tc-99m-MIBI/ delayed T1-201 myocardial SPECT for wall motion improvement after bypass surgery, stress-rest reversibility was the single most useful predictor.

• The Korean Journal of Nuclear Medicine
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• v.37 no.6
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• pp.364-373
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• 2003

Purpose: For good quality of myocardial perfusion images, an approximately 30 min to 1 hour of waiting time after radiopharmaceutical injection and ingestion of fatty meal are asked of the patients. The aim of this study was to investigate the shortening of waiting time after radiopharmaceutical injection and improvement of image quality using natural plant extracts that promote bile excretion. Materials and Methods: Ten volunteers participated in protocol 1 (7 men, 3 women; mean age, $24.1{\pm}2.4$ years) and protocol 2 (8 men, 2 women; mean age, $26.1{\pm}2.9$ years), respectively. For the modified method of both protocols, subjects took natural plant extracts 15 minutes before the first injection of $^{99m}Tc$ MIBI without laking fatty meals. Control (Conventional) methods were peformed with intake of a fatty meal 20 to 30 minutes after $^{99m}Tc$ MIBI injection. Results: As the results of protocol 1 and 2, the ratio of myocardial to lung ratio were not different between modified and conventional method. Liver to lung ratio of modified method showed significantly lower value than that of conventional method. In modified method, myocardial to liver ratio was higher persistently. In protocol 2, natural plant extracts took before the first injection of $^{99m}Tc$ MIBI exerted accelerating effect of excretion of bile juice into Intestine until the end of examination. Conclusion: These results represent that natural plant extracts for facilitation of bile excretion before injection of $^{99m}Tc$ MIBI may provide better quality of myocardial perfusion images without the need for preparations such as ingestion of fatty meal within the 2 hours compared with conventional method.