• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.150-154
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• 2010

Purpose: Ejection fraction (EF) is one of the most important factors that evaluate heart function. Recently, according to echocardiography and myocardial perfusion SPECT, the number of gated blood pool scan (planar GBP) is declining. Measurement of left ventricular ejection fraction using gated blood pool SPECT (GBPS) is known as relatively correspond with echocardiography. We compared EF derived from plnar GBP, GBPS and echocadiography using modified simpson method to determine the accuracy. Materials and Methods: From January 2007 to June 2010, planar GBP and GBPS were performed on 34 patients who admitted to Pusan National University Hospital (men 23, women 11, mean age $52.6{\pm}27.2$). Each patient was injected with $^{99m}{TcO_4}^-$ of 20 mCi after pyrophosphate injection and then scanned using both planar GBP and GBPS techniques. For image analysis, we use ADAC Laboratories, Ver. 4.20 software. The result analyzed was processed by SPSS 17.0 Win statistic program and statistical method applied in data analysis is one-way anova, Tukey's post hoc test, pearson correlation test. Results: One-way anova test show no significant difference (planar GBP $56.3{\pm}13.9%$; GBPS $60.4{\pm}16.0%$; echocardiography $59.1{\pm}14.4%$, p=0.486, p>0.05). Tukey's post hoc test show no significant difference (planar GBP-echocardiography p=0.697; GBPS-echocardiography p=0.928; planar GBP-GBPS p=0.469, p>0.05). Values for EF obtained with planar GBP and GBPS correlated well with those obtained with echocardiography (planar-echocardiography r=0.697; GBPS-echocardiography r=0.928; planar GBP-GBPS r=0.469). Conclusion: The problems of accuracy and reproducibility for planar GBP still remain. But planar GBP is a safe and non-invasive method. In addition, planar GBP is useful to evaluate patient with low resolution echocardiography images. GBPS is not appicated clinically. but GBPS can be obtain various left ventricular functional parameters. planar GBP, GBPS and echocardiography show a good correlation between each other. Therefore, planar GBP and GBPS are useful for evaluating left ventricular ejection fraction.

• The Korean Journal of Nuclear Medicine
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• v.24 no.2
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• pp.244-253
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• 1990

Sixty-four patients with paradoxical ventricular wall motion noticed both in angiocardiography or 2-dimensional echocardiography were assessed by ECG gated blood pool scan (GBPS). Endless cine loop image, phase and amplitude images and paradox image obtained by visual inspection of each cardiac beat or Fourier transformation of acquired raw data were investigated to determine the incremental value of GBPS with these processing methods for identification of paradoxical ventricular wall motion. The results were as follows: 1) Paradoxical wall motions were observed on interventricular septum in 34 cases, left ventricular free wall in 26 and right ventricular wall in 24. Underlying heart diseases were ischemic (23 cases) valvular(9), congenital heart disease (12), cardiomyopathy (5). pericardial effusion(5), post cardiac surgery(3), col pulmonale (2), endocarditis(1) and right ventricular tumor(1). 2) Left ventricular ejection fractions of patients with paradoxical left ventricular wall motion were significantly lower than those with paradoxical septal motion(p<0.005). 3) The sensitivity of each processing methods for detecting paradoxical wall motion was 76.9% by phase analysis, 74.6% by endless cine loop mapping and 68.4% by paradox image manipultion respectively. Paradoxial motions visualized only in phase, paradox or both images were appeared as hypokinesia or akinesia in cine loop image. 4) All events could be identified by at least one of above three processing methods, however only 34 cases (48.4%) showed the paradoxical molies in all of the three images. By these findings, we concluded that simultaneous inspection of all above three processing methods-endless cine loop, phase analysis and paradox image-is necessary for accurate identification and assessment of paradoxical ventricular wall motion when performing GBPS.

• The Korean Journal of Nuclear Medicine
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• v.28 no.1
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• pp.52-61
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• 1994

Background : The demand for refinement in noninvasive and quantitative assessment of left ventricular (LV) function is increasing. Purpose : To assess normal values of left ventricular functional parameters during both systole and diastole by scintigraphic method using computerized triple-head gamma camera and to evaluate correlations between these parameters. Methods : ECG gated blood pool scan with $^{99m}Tc$-Human serum albumin was performed in 94 normal Korean subjects. Ejection fraction (EF), systolic parameters [peak emptying rate (PER), average emptying rate (AER), time to peak emptying rate (TPER)], and diastolic parameters [peak filling rate (PFR), average filling rate (AFR), time to peak filling rate (TPFR)] were obtained by analysis of LV time-activity curve, the correlation of these parameters to the age and sex, and the correlation between these parameters were evaluated. Results : 1) Mean value of ejection fraction in study subjects was $59.6{\pm}5.25%$ and showed no significant correlation to age (r=-0.08) and sex but showed most pronounced correlation to PFR (r=0.46, p<0.001), PER (r=0.41, p<0.001), AFR (r=0.34, p<0.001) and AER (r=0.28, p<0.01). 2) Mean values of systolic parameters were as follows: $PER=3.22{\pm}0.50$ end-diastolic volume/sec, $AER=2.22{\pm}0.45$ end-diastolic volume/sec, $TPER=103.5{\pm}29.30$ msec. They showed no significant correlation to age and sex. 3) Mean values of diastolic parameters were as follows: $PFR=2.71{\pm}0.51$ end-diastolic volume/sec, $AFR=1.83{\pm}0.44$ end-diastolic volume/sec, $TPFR=132.1{\pm}33.45$ msec. They showed strong correlation to age (r=0.70, -0.64, 0.37, p<0.001). Conclusions : Left ventricular functional parameters in normal Korean subjects were obtained reliably by computerized scintigraphic method and may be applied to the evaluation of cardiac function in diseased patients.

• The Korean Journal of Nuclear Medicine
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• v.25 no.2
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• pp.186-191
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• 1991

Radionuclide cardiac studies lend themselves exceptionally well to functional imaging. This is especially true for gated blood pool scan (GBP). Making functional images is also possible in radionuclide angiocardiography (RNAC). In this study we tried to validate the functional images obtained from RNAC by comparing it with GBP. Twenty three patients (16 patients with coronary artery diseases, 5 with hypertensive heart diseases, and 2 with nonspecific chest pains) underwent simultaneous RNAC and GBP at the same position (LAO $45^{\circ}$). From both studies, global ejection fraction, regional ejection fraction, phase image, amplitude image, stroke image, paradox image, maximum ejection and maximum filling rates were obtained. Global ejection fraction are almost same in both studies. Regional ejection fractions of apex and inferior portion of left ventricle calculated from RNAC are well correlated with those of GBP. Phase and paradox image, maximum ejection and maximum filling rates were obtained. Global ejection fraction are almost same in both studies. Regional ejection fractions of apex and inferior portion of left ventricle calculated from RNAC are well correlated with those of GBP. Phase and paradox images of RNAC are very similar to those of GBP. However, amplitude and stroke images are different. Regional ejection fractions of the left ventricular base, maximum ejection and maximum filling rates obtained from RNAC are significantly different from those of GBP. In conclusion, albeit all of functional images of RNAC is not same as GBP, regional walt motions and global left ventricular function are expected to be successfully analyzed by phase and paradox image and ejection fraction.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.91-95
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• 2012

Purpose: In this study, we evaluated the ejection fraction (EF) according to the difference of patient position in Gated Blood Pool (GBP) scan. Material and Methods: The analysis was performed to 80 patients ($51.2{\pm}17.4$ years old) who examined GBP scan in Department of nuclear medicine, National Cancer Center from March 2011 to August 2011. We divided the patients into two groups; one group received conventional position (raise left arm up supine) and supine position (group 1) and the other group received conventional position and left arm back down supine position (group 2). To observe the change EF according to patient position difference, the image was reconstructed and analyzed by Xeleris (GE, USA). We measured body mass index (BMI) of patients. Result: In group 1, EF error less than 3% occurred at a rate of 72.5% (29 of the 40 patients). In group 2, EF error less than 3% occurred at a rate of 79% (32 of the 40 patients). The patient's BMI did not affect ejection fraction. Conclusion: The EF error of left arm back down supine position closer to conventional position than in supine position shows the results.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.57-61
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• 2012

Purpose: The multi-gated cardiac blood pool scan is to evaluate the function of left ventricle (LV) and usefully observe a value of ejection fraction (EF) for a patient who is receiving chemotherapy. To calculate LVEF, we should adjust an angle of left anterior oblique (LAO) view to separate both ventricles. And by overlapped ventricles, it is possible to affect LVEF. The purpose of this study is to investigate and compare quantitative indices by changing an angle of LAO view. Materials and methods: We analyzed the 49 patients who were examined by multi-gated cardiac blood pool scan in department of nuclear medicine at Asan Medical Center from June to September 2011. Firstly, we acquired "Best septal" view. And then, we got images by addition and subtraction of angle for LAO view to anterior and lateral. We compared three LAO views for 20 people by 5 degrees and 39 people by 10 degrees. And we analyzed quantitative indices, EF, end diastole and end systole counts, by automated and manual region of interest (ROI) modes. Results: Firstly, we analyzed quantitative indices by automated ROI mode. In case of 5 degrees, the averages of EF are $61.0{\pm}7.5$, $62.1{\pm}7.1$, $60.9{\pm}6.7%$ ($p$=0.841) in LAO, LAO $-5^{\circ}$ and LAO $+5^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). In case of 10 degrees, the averages of EF are $62.4{\pm}9.5$, $62.3{\pm}10.8$, $61.6{\pm}.9.3%$ ($p$=0.938) in LAO, LAO $-10^{\circ}$ and LAO $+10^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). Secondly, we analyzed quantitative indices by manual ROI mode. In case of 5 degrees, the averages of EF are $62.8{\pm}7.1$, $63.6{\pm}7.5$, $62.7{\pm}7.3%$ ($p$=0.903) in LAO, LAO $-5^{\circ}$ and LAO $+5^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). In case of 10 degrees, the averages of EF are $65.5{\pm}9.0$, $66.3{\pm}8.7$, $63.5{\pm}.9.3%$ (p=0.473) in LAO, LAO $-10^{\circ}$ and LAO $+10^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). Conclusion: When an image is nearly "Best septal" view, the difference of LAO angle would not affect to change LVEF. Although there was no difference in quantitative analysis, deviations could happen when to interpret wall motion qualitatively by reading physicians.

• The Korean Journal of Nuclear Medicine
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• v.39 no.2
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• pp.94-99
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• 2005

Electrocardiogram-gated single photon omission computed tomography (SPECT) provides valuable information in the assessment of both myocardial perfusion and ventricular function. Tl-201 is a suboptimal isotope for gating. Tl-201 images are more blurred compared with Tc-99m tracers due to the increased amount of scattered photons and use of a smooth filter. The average myocardial count densities are approximately one-half those of conventional technetium tracers. However, Tl-201 is still widely used because of its well-established utility for assessing myocardial perfusion, viability and risk stratification. Gated SPECT with Tl-201 enables us to assess both post-stress and rest left ventricular volume and function. Previous studies with gated Tl-201 SPECT measurements of ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV) have shown high correlation with first-pass radionuclide angiography, gated blood pool scan, Tc-99m-MIBI gated SPECT, contrast ventriculography, echocardiography, and 3-dimensional magnetic resonance imaging. However, problems related to these studies include few agreement data of EDV and ESV, use of a reference method that is likely to have the same systemic errors (gated Tc-99m-MIBI SPECT), and other technical factors related to the count density of gated SPECT. With optimization of gated imaging protocols and more validation studies, gated Tl-201 SPECT would be an accurate method to provide perfusion and function information in patients with coronary artery disease.

• The Korean Journal of Nuclear Medicine
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• v.34 no.3
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• pp.222-227
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• 2000

Purpose: We compared estimates of ejection fraction (EF) determined by gated Tl-201 perfusion SPECT (g-Tl-SPECT) with those by gated blood pool (GBP) scan. Materials and Methods: Eighteen subjects underwent g-Tl-SPECT and GBP scan. After reconstruction of g-Tl-SPECT, we measured EF with Cedars software. The comparison of the EF with g-Tl-SPECT and GBP scan was assessed by correlation analysis and Bland Altman plot. Results: The estimates of EF were significantly different (p<0.05) with g-Tl-SPECT ($40%{\pm}14%$) and GBP scan ($43%{\pm}14%$). There was an excellent correlation of EF between g-Tl-SPECT and GBP scan (r=0.94, p<0.001). The mean difference of EF between GBP scan and g-Tl-SPECT was +3.2% Ninety-five percent limits of agreement were ${\pm}9.8%$. EF between g-Tl-SPECT and GBP scan were in poor agreement. Conclusion: The estimates of EF by g-Tl-SPECT was well correlated with those by GBP scan. However, EF of g-Tl-SPECT doesn't agree with EF of GBP scan. EF of g-Tl-SPECT can't be used interchangeably with EF of GBP scan.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.1
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• pp.13-19
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• 2016

Purpose In order to calculate the left ventricular ejection fraction (LVEF) accurately, it is important to acquire the best septal view of left ventricle in the multi-gated cardiac blood pool scan (GBP). This study aims to acquire the best septal view by measuring angle of ventricular septal wall (${\theta}$) using enhanced CT scan and compare with conventional method using left anterior oblique (LAO) 45 view. Materials and Methods From March to July in 2015, we analyzed the 253 patients who underwent both enhanced chest CT and GBP scan in the department of nuclear medicine at National Cancer Center. Angle (${\theta}$) between ventricular septum and imaginary midline was measured in transverse image of enhanced chest CT scan, and the patients whose difference between the angle of ${\theta}$ and 45 degree was more than 10 degrees were included. GBP scan was acquired using both LAO 45 and LAO ${\theta}$ views, and LVEFs measured by automated and manual region of interest (Auto-ROI and Manual-ROI) modes respectively were analyzed. Results $Mean{\pm}SD$ of ${\theta}$ on total 253 patients was $37.0{\pm}8.5^{\circ}$. Among them, the patients whose difference between 45 and ${\theta}$ degrees were more than ${\pm}10$ degrees were 88 patients ($29.3{\pm}6.1^{\circ}$). In Auto-ROI mode, there was statistically significant difference between LAO 45 and LAO ${\theta}$ (LVEF $45=62.0{\pm}6.6%$ vs. LVEF ${\theta}=64.0{\pm}5.6%$; P = 0.001). In Manual-ROI mode, there was also statistically significant difference between LAO 45 and LAO ${\theta}$ (LVEF $45=66.7{\pm}7.2%$ vs. LVEF ${\theta}=69.0{\pm}6.4%$; P < 0.001). Intraclass correlation coefficients of both methods were more than 95%. In case of comparison between Auto-ROI and Manual ROI of each LAO 45 and LAO ${\theta}$, there was no significant difference statistically. Conclusion We could measure the angle of ventricular septal wall accurately by using transverse image of enhanced chest CT and applied to LAO acquisition in the GBP scan. It might be the alternative method to acquire the best septal view of LAO effectively. We could notify significant difference between conventional LAO 45 and LAO ${\theta}$ view.

• The Korean Journal of Nuclear Medicine
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• v.28 no.1
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• pp.44-51
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• 1994

It is known that the normal His-Purkinje system provides for nearly synchronous activation of right (RV) and left (LV) ventricles. When His-Purkinje conduction is abnormal, the resulting sequence of ventricular contraction must be correspondingly abnormal. These abnormal mechanical consequences were difficult to demonstrate because of the complexity and the rapidity of it's events. To determine the relationship of the phase changes and the abnormalities of ventricular conduction, we performed phase image analysis of $^{99m}Tc$-RBC gated blood pool scintigrams in patients with intraventricular conduction disturbances (24 complete left bundle branch block (C-LBBB), 15 complete right bundle branch block (C-RBBB), 13 Wolff-Parkinson-White syndrome (WPW), 10 controls). The results were as follows; 1) The ejection fraction (EF), peak ejection rate (PER), and peak filling rate (PFR) of LV in gated blood pool scintigraphy (GBPS) were significantly lower in patients with C-LBBB than in controls ($44.4{\pm}13.9%$ vs $69.9{\pm}4.2%,\;2.48{\pm}0.98$ vs $3.51{\pm}0.62,\;1.76{\pm}0.71$ vs $3.38{\pm}0.92$, respectively, p<0.05). 2) In the phase angle analysis of LV, Standard deviation (SD), width of half maximum of phase angle (FWHM), and range of phase angle were significantly increased in patients with C-LBBB than in controls ($20.6{\pm}18.1$ vs $8.6{\pm}1.8,\;22.5{\pm}9.2$ vs $16.0{\pm}3.9,\;95.7{\pm}31.7$ vs $51.3{\pm}5.4$, respectively, p<0.05). 3) There was no significant difference in EF, PER, PFR between patients with the Wolff-parkinson-White syndrome and controls. 4) Standard deviation and range of phase angle were significantly higher in patients with WPW syndrome than in controls ($10.6{\pm}2.6$ vs $8.6{\pm}1.8$, p<0.05, $69.8{\pm}11.7$ vs $51.3{\pm}5.4$, p<0.001, respectively), however, there was no difference between the two groups in full width of half maximum. 5) Phase image analysis revealed relatively uniform phase across the both ventricles in patients with normal conduction, but markedly delayed phase in the left ventricle of patients with LBBB. 6) In 13 cases of WPW syndrome, the site of preexcitation could be localized in 10 cases (77%) by phase image analysis. Therefore, it can be concluded that phase image analysis can provide an accurate noninvasive method to detect the mechanical consequences of a wide variety of abnormal electrical activation in ventricles.