• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.179-186
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• 2016

Purpose : To figure out if the treatment plan for rectum, bladder and prostate that have a lot of interfraction errors satisfies dosimetric limits without adaptive plan by analyzing MR image. Materials and Methods : This study was based on 5 prostate cancer patients who had IMRT(total dose: 70Gy) Using ViewRay MRIdian System(ViewRay, ViewRay Inc., Cleveland, OH, USA) The treatment plans were made on the same CT images to compare with the plan quality according to adaptive plan, and the Eclipse(Ver 10.0.42, Varian, USA) was used. After registrate the 5 treatment MR images to the CT images for treatment plan to analyze the interfraction changes of organ, we measured the dose volume histogram and the changes of the absolute volume for each organ by appling the first treatment plan to each image. Over 5 fractions, the total dose for PTV was $V_{36.25}$ Gy $${\geq_-}$$ 95%. To confirm that the prescription dose satisfies the SBRT dose limit for prostate, we measured $V_{100%}$, $V_{95%}$, $V_{90%}$ for CTV and $V_{100%}$, $V_{90%}$, $V_{80%}$ $V_{50%}$ of rectum and bladder. Results : All dose average value of CTV, rectum and bladder satisfied dose limit, but there was a case that exceeded dose limit more than one after analyzing the each image of treatment. After measuring the changes of absolute volume comparing the MR image of the first treatment plan with the one of the interfraction treatment, the difference values were maximum 1.72 times at rectum and maximum 2.0 times at bladder. In case of rectum, the expected values were planned under the dose limit, on average, $V_{100%}=0.32%$, $V_{90%}=3.33%$, $V_{80%}=7.71%$, $V_{50%}=23.55%$ in the first treatment plan. In case of rectum, the average of absolute volume in first plan was 117.9 cc. However, the average of really treated volume was 79.2 cc. In case of CTV, the 100% prescription dose area didn't satisfy even though the margin for PTV was 5 mm because of the variation of rectal and bladder volume. Conclusion : There was no case that the value from average of five fractions is over the dosimetric limits. However, dosimetric errors of rectum and bladder in each fraction was significant. Therefore, the precise delivery is needed in case of prostate SBRT. The real-time tracking and adaptive plan is necessary to meet the precision delivery.

• Investigative Magnetic Resonance Imaging
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• v.10 no.1
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• pp.20-25
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• 2006

Purpose : To evaluate the NMR relaxation properties of newly developed high performance paramagnetic complexes. Materials and methods : 4-aminomethylcyclohexane carboxylic acid (0.63g, 4 mmol) was mixed with the suspension solution of DMF (15mL) and DTPA-bis-anhydride (0.71g, 2 mmol) to synthesize the ligand. The ligand was then mixed with Gd2O3 (0.18g, 0.5 mmol) to synthesize Gd-chelate. For the measurement of magnetic relaxivity of paramagnetic compounds, the compounds were diluted to 1mM and then the relaxation times were measured at 1.5T(64 MHz). Inversion-recovery pulse sequence was employed for T1 relaxation measurement and CPMG(Carr-Purcell-Meiboon-Gill) pulse sequence was employed for T2 relaxation measurement. Using MATLAB(Version 7.1) program, T1 magnetic relaxation map, R1 map, T2 magnetic relaxation map and R2 map were developed to represent magnetic relaxation time and magnetic relaxivity as image. Results : Compared to $R1=4.9mM^{-1}sec^{-1}$ and $R2=4.8mM^{-1}sec^{-1}$ of Omniscan (Gadodiamide), which is commercially available paramagnetic MR agent, R1 of SUK090(Gd-C32H74N5O24) was $12.46mM^{-1}sec^{-1}$ and R1 of SUK091(Gd-C34H78N5O24) was $12.77mM^{-1}sec^{-1}$. However, R1 of SUK092(Gd-C30H56N5O17) was decreased to $2.09mM^{-1}sec^{-1}$. In case of R2, SUK090(Gd-C32H74N5O24) was $8.76mM^{-1}sec^{-1}$ and SUK091(Gd-C34H78N5O24) was $7.60mM^{-}1sec^{-1}$ whereas SUK092(Gd-C30H56N5O17) was decreased to $1.82mM^{-1}sec^{-1}$. Conclusion : Among three new paramagnetic complexes, SUK090(Gd-C32H74N5O24) and SUK091(Gd-C34H78N5O24) showed higher T1, T2 magnetic relaxation rates than that of commercially available paramagnetic MR agent and thus expected to have more contrast enhancement effect.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.1
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• pp.10-18
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• 2009

Purpose: We investigated quantification of dopaminergic transporter (DAT) and serotonergic transporter (SERT) on $^{123}I$-FP-CIT SPECT for differentiating between multiple systemic atrophy (MSA) and idiopathic Parkinson's disease (IPD). Materials and Methods: N-fluoropropyl-$2{\beta}$-carbomethoxy-$3{\beta}$-4-[$^{123}I$]-iodophenylnortropane SPECT ($^{123}I$-FP-CIT SPECT) was performed in 8 patients with MSA (mean age: $64.0{\pm}4.5yrs$, m:f=6:2), 13 with early IPD (mean age: $65.5{\pm}5.3yrs$, m:f=9:4), and 12 healthy controls (mean age: $63.3{\pm}5.7yrs$, m:f=8:4). Standard regions of interests (ROls) of striatum to evaluate DAT, and hypothalamus and midbrain for SERT were drawn on standard template images and applied to each image taken 4 hours after radiotracer injection. Striatal specific binding for DAT and hypothalamic and midbrain specific binding for SERT were calculated using region/reference ratio based on the transient equilibrium method. Group differences were tested using ANOVA with the postHoc analysis. Results: DAT in the whole striatum and striatal subregions were significantly decreased in both patient groups with MSA and early IPD, compared with healthy control (p<0.05 in all). In early IPD, a significant increase in the uptake ratio in anterior and posterior putamen and a trend of increase in caudate to putamen ratio was observed. In MSA, the decrease of DAT was accompanied with no difference in the striatal uptake pattern compared with healthy controls. Regarding the brain regions where $^{123}I$-FP-CIT binding was predominant by SERT, MSA patients showed a decrease in the binding of $^{123}I$-FP-CIT in the pons compared with controls as well as early IPD patients (MSA: $0.22{\pm}0.1$ healthy controls: $0.33{\pm}0.19$, IPD: $0.29{\pm}0.19$), however, it did not reach the statistical significance. Conclusion: In this study, the differential patterns in the reduction of DAT in the striatum and the reduction of pontine $^{123}I$-FP-CIT binding predominant by SERT could be observed in MSA patients on $^{123}I$-FP-CIT SPECT. We suggest that the quantification of SERT as well as DAT using $^{123}I$-FP-CIT SPECT is helpful to differentiate parkinsonian disorders in early stage.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.191-197
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• 2008

Purpose: To evaluate the postoperative magnetic resonance image (MRI) findings of anterior cruciate ligament (ACL) reconstructed with a tension load technique using auto-Achilles tendon, and to compare the results with knees with a native ACL. Materials and Methods: We evaluated 21 postoperative MRI scan of 21 patients (group A) who had undergone ACL reconstruction between January 1995 and November 1996. The control group (group B) consisted of 50 patients whose meniscus tear had been operated by arthroscopy and whose ACL was intact. We measured the orientation of the graft in the sagittal and coronal planes and compared it with that of the native ACL. Results: The mean sagittal angle of the ACL angle in group A ($55.7{\pm}5.6^{\circ}$, range $47.2{\sim}68.8^{\circ}$) was statistically lesser than group B ($58.7{\pm}3.8^{\circ}$, range $50.4{\sim}67.5^{\circ}$) (p=0.036). But there was no statistically significant difference between the two groups with regard to the mean ACL-Blumensaat line angle (group A: $8.1^{\circ}{\pm}4.9^{\circ}$, range $1.7^{\circ}{\sim}22.0^{\circ}$, group B: $8.6^{\circ}{\pm}3.6^{\circ}$, range $2.6^{\circ}-18.1^{\circ}$) and the mean coronal angle of the ACL (group A: $64.9^{\circ}{\pm}9.1^{\circ}$, range $46.9^{\circ}{\sim}76.4^{\circ}$, group B: $65.9^{\circ}{\pm}4.4^{\circ}$, range $57.7^{\circ}{\sim}75.2^{\circ}$)(p=0.88, p= 0.62). In the sagittal plane, the mean center of tibial insertion of the ACL graft in group A ($31.9{\pm}7.1%$, range 22.4-47.9%) was positioned more anteriorly than group B ($37.0{\pm}4.9%$, range $18.5{\sim}44.7%$)(p=0.005). But in the coronal plane, there was no statistically significant difference between the two groups(group A: $46.3{\pm}2.8%$, range $42.1{\sim}52.5%$, group B: $45.7{\pm}2.8%$, range $41.0{\sim}49.1%$)(p=0.392). Conclusion: We performed an ACL reconstruction with the tension load technique using auto-Achilles tendon and we found that the graft orientation in MRI was as good as that of the native ACL.

• Investigative Magnetic Resonance Imaging
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• v.12 no.1
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• pp.8-19
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• 2008

Purpose : To investigate the 3-bond and spatial connectivity of human brain metabolites by scalar coupling and dipolar nuclear Overhauser effect/enhancement (NOE) interaction through 2D- correlation spectroscopy (COSY) and 2D- NOE spectroscopy (NOESY) techniques. Materials and Methods : All 2D experiments were performed on Bruker Avance 500 (11.8 T) with the zshield gradient triple resonance cryoprobe at 298 K. Human brain metabolites were prepared with 10% $D_2O$. Two-dimensional spectra with 2048 data points contains 320 free induction decay (FID) averaging. Repetition delay was 2 sec. The Top Spin 2.0 software was used for post-processing. Total 7 metabolites such as N-acetyl aspartate (NAA), creatine (Cr), choline (Cho), lutamine (Gln), glutamate (Glu), myo-inositol (Ins), and lactate (Lac) were included for major target metabolites. Results : Symmetrical 2D-COSY and 2D-NOESY pectra were successfully acquired: COSY cross peaks were observed in the only 1.0-4.5 ppm, however, NOESY cross peaks were observed in the 1.0-4.5 ppm and 7.9 ppm. From the result of the 2-D COSY data, cross peaks between the methyl protons ($CH_3$(3)) at 1.33 ppm and methine proton (CH(2)) at 4.11 ppm were observed in Lac. Cross peaks between the methylene protons (CH2(3,$H{\alpha}$)) at 2.50ppm and methylene protons ($CH_2$,(3,$H_B$)) at 2.70 ppm were observed in NAA. Cross peaks between the methine proton (CH(5)) at 3.27 ppm and the methine proton (CH(4,6)) at 3.59 ppm, between the methine proton (CH(1,3)) at 3.53 ppm and methine proton (CH(4,6)) at 3.59 ppm, and between the methine proton (CH(1,3)) at 3.53 ppm and methine proton (CH(2)) at 4.05 ppm were observed in Ins. From the result of 2-D NOESY data, cross peaks between the NH proton at 8.00 ppm and methyl protons ($CH_3$) were observed in NAA. Cross peaks between the methyl protons ($CH_3$(3)) at 1.33 ppm and methine proton (CH(2)) at 4.11 ppm were observed in Lac. Cross peaks between the methyl protons (CH3) at 3.03 ppm and methylene protons (CH2) at 3.93 ppm were observed in Cr. Cross peaks between the methylene protons ($CH_2$(3)) at 2.11 ppm and methylene protons ($CH_2$(4)) at 2.35 ppm, and between the methylene protons($CH_2$ (3)) at 2.11 ppm and methine proton (CH(2)) at 3.76 ppm were observed in Glu. Cross peaks between the methylene protons (CH2 (3)) at 2.14 ppm and methine proton (CH(2)) at 3.79 ppm were observed in Gln. Cross peaks between the methine proton (CH(5)) at 3.27 ppm and the methine proton (CH(4,6)) at 3.59 ppm, and between the methine proton (CH(1,3)) at 3.53 ppm and methine proton (CH(2)) at 4.05 ppm were observed in Ins. Conclusion : The present study demonstrated that in vitro 2D-COSY and NOESY represented the 3-bond and spatial connectivity of human brain metabolites by scalar coupling and dipolar NOE interaction. This study could aid in better understanding the interactions between human brain metabolites in vivo 2DCOSY study.

• The Korean Journal of Nuclear Medicine
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• v.38 no.4
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• pp.294-299
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• 2004

Purpose: Both human NIS and mutant $D_2R$ transgenes are proposed as reporting system in transplanted cell tracking. Using hepatoma cell lines, we constructed a dual reporter system containing human sodium-iodide symporter (hNIS) and dopamine 2 receptor ($D_2R$) and compared its characteristics. Materials and Methods: The recombinant plasmid ($pIRES-hNIS/D_2R$) was constructed with IRES (internal ribosome entry site) under control of the CMV promoter $pIRES-hNIS/D_2R$ was transfected to human hepatoma SK-Hep1 cell line with lipofectamine. HEP-ND ($SK-Hep1-hNIS/D_2R$) cells stably expressing hNIS and $D_2R$ was established by selection with G418 for two weeks. RT-PCR was performed to investigate the expression of both hNIS and $D_2R$ genes. The expressions of hNIS and $D_2R$ were measured by $^{125}I$ uptake assays and receptor binding assays. Specific binding of $D_2R$ to $[^3H]spiperone$ was verified by Scatchard plot with (+) butaclamol as a specific inhibitor. $K_d\;and\;B_{max}$ values were estimated. The correlation between hNIS and $D_2R$ expression was compared by using each clone. Results: Similar quantities of hNIS and $D_2R$ genes were expressed on HEP-ND as RT-PCR assays. HEP-ND cells showed 30 to 40 fold higher radioiodine uptakes than those of parental SK-Hep1 cells. $^{125}I$ uptake in HEP-ND cells was completely inhibited by $KClO_4$, a NIS inhibitor Specific binding to HEP-ND cells was saturable and the $K_d\;and\;B_{max}$ values for HEP-ND cells were 2.92 nM, 745.25 fmol/mg protein and 2.91nM, 1323 fmole/mg protein in two clones, respectively. The radioiodine uptake by hNIS activity and $D_2R$ binding was highly correlated. Conclusion: We developed a dual positron and gamma imaging reporter system of hNIS and $D_2R$ in a stably transfected cell line. We expect that $D_2R$ and hNIS genes can complement mutually as a nuclear reporting system or that $D_2R$ can be used as reporter gene when hNIS gene were used as a treatment gene.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.127-135
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• 2014

Purpose : By taking advantage of each imaging modality, the use of fused CT/MRI image has increased in prostate cancer radiation therapy. However, fusion uncertainty may cause partial target miss or normal organ overdose. In order to complement such limitation, our hospital acquired MRI image (Planning MRI) by setting up patients with the same fixing tool and posture as CT simulation. This study aims to evaluate the usefulness of the Planning MRI through comparing and analyzing the diagnostic MRI image and Planning MRI image. Materials and Methods : This study targeted 10 patients who had been diagnosed with prostate cancer and prescribed nonhormone and definitive RT 70 Gy/28 fx from August 2011 to July 2013. Each patient had both CT and MRI simulations. The MRI images were acquired within one half hour after the CT simulation. The acquired CT/MRI images were fused primarily based on bony structure matching. This study measured the volume of prostate in the images of Planning MRI and diagnostic MRI. The diameters at the craniocaudal, anteroposterior and left-to-right directions from the center of prostate were measured in order to compare changes in the shape of prostate. Results : As a result of comparing the volume of prostate in the images of Planning MRI and diagnostic MRI, they were found to be $25.01cm^3$(range $15.84-34.75cm^3$) and $25.05cm^3$(range $15.28-35.88cm^3$) on average respectively. The diagnostic MRI had an increase of 0.12 % as compared with the Planning MRI. On the planning MRI, there was an increase in the volume by $7.46cm^3$(29 %) at the transition zone directions, and there was a decrease in the volume by $8.52cm^3$(34 %) in the peripheral zone direction. As a result of measuring the diameters at the craniocaudal, anteroposterior and left-to-right directions in the prostate, the Planning MRI was found to have on average 3.82cm, 2.38cm and 4.59cm respectively and the diagnostic MRI was found to have on average 3.37cm, 2.76cm and 4.51cm respectively. All three prostate diameters changed and the change was significant in the Planning MRI. On average, the anteroposterior prostate diameter decrease by 0.38cm(13 %). The mean right-to-left and craniocaudal diameter increased by 0.08cm(1.6 %) and 0.45cm(13 %), respectively. Conclusion : Based on the results of this study, it was found that the total volumes of prostate in the Planning MRI and the diagnostic MRI were not significantly different. However, there was a change in the shape and partial volume of prostate due to the insertion of prostate balloon tube to the rectum. Thus, if the Planning MRI images were used when conducting the fusion of CT/MRI images, it would be possible to include the target in the CTV without a loss as much as the increased volume in the transition zone. Also, it would be possible to reduce the radiation dose delivered to the rectum through separating more clearly the reduction of peripheral zone volume. Therefore, the author of this study believes that acquisition of Planning MRI image should be made to ensure target delineation and localization accuracy.

• The Korean Journal of Nuclear Medicine
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• v.38 no.6
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• pp.492-497
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• 2004

Purpose: it is very important to differentiate breast cancer from benign mass. There are many reports to evaluate the differential diagnosis under the several diagnostic tools. We evaluated the usefulness of mammography and Tc-99m MIBI scintimammography in the differential diagnosis of breast mass and correlated with pathologic findings. Materials and Methods: This study included 80 patients (a8e: 24-72, mean: 48.4) who underwent mammography and Tc-99m MIBI scintimammography for breast masses. Scintimammographies (anterior-posterior and lateral projections) were acquired in 10 minutes and 2 hours after intravenous injection of Tc-99m MIBI. four specialists in diagnostic radioloay and nuclear medicine evaluated the findings of breast masses under the mammography and Tc-99m MIBI scintimammography, and calculated the tumor to background (T/B) ratio. The pathologic results were obtained and we statistically analyzed the correlations between pathologic results and imaging findings under the mammography and Tc-99m MIBI scintimammography by chi-square and correlation test. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of mammography for detection of breast cancer were 87.5%, 56.3%, 75.0%), and 75.0% respectively. 45 cases of 80 patients were suspicious for breast cancer under the Tc-99m MIBI scintimammography. 41 cases of 45 patients were confirmed as breast cancer and the remaining 4 cases were confirmed as benign masses. The sensitivity, specificity, positive predictive value and negative predictive value of Tc-99m MIBI scintimammography for detection of breast cancer were 85.4%, 87.5%, 91.1%, and 80.8% respectively. The sensitivity of scintimammography was lower than that of mammography for detection of breast cancer, however the specificity, positive predictive value, and negative predictive value were higher. In the benign mass, the mean T/B ratio in 10 minutes was $1.409{\pm}0.30$, and that in 2 hours was $1.267{\pm}0.42$. The maximal T/B ratio of benign mass in 10 minutes was $1.604{\pm}0.42$, and that in 2 hours was $1.476{\pm}0.50$. In the malignant mass, the mean T/B ratio in 10 minutes was $2.220{\pm}1.07$, and that in 2 hours was $1.842{\pm}0.75$. The maximal T/B ratio of malignant mass was $2.993{\pm}1.94$, and that in 2 hours was $2.480{\pm}1.34$. And the T/B ratio under the early and delayed images were meaningful. Conclusion: The scintimammography is useful diagnostic tool to differentiate breast cancer from benign mass, although the sensitivity of mammography for detection of breast mass is high. Especially, the use of the T/B ratio is helpful to diagnose breast cancer.

• Sleep Medicine and Psychophysiology
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• v.5 no.1
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• pp.54-70
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• 1998

Objectives : The purpose of this study is to evaluate the role of structural and functional changes of the brain in the pathophysiology of schizophrenia. Methods : The authors measured the regions of interest on the magnetic resonance imaging of the brain in 20 patients with paranoid schizophrenia(15 men and 5 women) and 23 control subjects(15 men and 8 women). We also assessed the neurocognitive functions with the Wisconsin Card Sorting Test, the Benton Neuropsychological Assessment, and the Weschler IQ test-Korean version, soft neurologic signs, and psychiatric symptoms in the patient group. Results : In the patient group, all ventricles and basal ganglia including caudate nucleus and globus pallidus were significantly enlarged. Although there were no significant differences between the two groups in the values of right frontal lobe and left temporal lobe, there was a tendency of decrease in the values of right frontal lobe and left temporal lobe. There were significant positive correlations between the values of ventricles and the frequency of previous hospitalization. However, there were no significant correlations between other values of regions of interest and clinical data. The value of the right frontal lobe was significantly correlated with the score of soft neurologic signs, which is suggestive of the neurodevelopmental abnormalities. There were significant correlations between the value of frontal lobe and the scores of the various subscales of Benton Neuropsychiatric Inventory. In contrast, the value of left amygdala and putamen showed significant correlation with the score of verbal IQ on the Weschler IQ test. Structural changes of the temporal lobe areas were related with the positive and general symptom scores on PANSS, while those of the basal ganglia were related with the negative symptom scores. Conclusions : These results suggest that the structural changes of the brain in the patients with schizophrenia show the dual process, which is suggestive that the enlarged ventricle show the neurodegenerative process, while enlarged basal ganglia, and shrinked right frontal and left temporal lobe show the neurodevelopmental abnormalities. Among these changes, structural changes of the frontal lobe related with various neuropsychological deficits, while those of left temporal lobe related with language abnormality. Relative to the relation between structural changes and psychiatric symptoms, structural changes of the temporal lobe areas were related with the positive and general symptoms, while those of the basal ganglia were related with the negative symptoms.

• The Korean Journal of Nuclear Medicine
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• v.39 no.1
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• pp.34-43
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• 2005

Purpose: $^{99m}Tc$-sestamibi(MIBI) and $^{99m}Tc$-tetrofosmin have been used as substrates for P-glycoprotein (Pgp) and multidrug resistance associated protein (MRP), which are closely associated with multidrug resistance of the tumors. To understand different handling of radiotracers in cancer cell lines expressing Pgp and MRP, we compared cellular uptakes of $^{99m}Tc$-MIBI and $^{99m}Tc$-tetrofosmin. The effects of cyclosporin A (CsA), well-known multidrug resistant reversing agent, on the uptake of both tracers were also compared. Materials and Methods: HCT15/CL02 human colorectal cancer cells for Pgp expressing cells, and human non-small cell lung cancer A549 cells for MRP expressing cells, were used for in vitro and in vivo studies. RT-PCR, western blot analysis and immunohistochemistry were used for detection of Pgp and MRP. MDR-reversal effect with CsA was evaluated at different drug concentrations after incubation with MIBI or tetrofosmin. Radioactivities of supernatant and pellet were measured with gamma well counter. Tumoral uptake of the tracers were measured from tumor bearing nude mice treated with or without CsA. Results: RT-PCR, western blot analysis of the cells and irnrnunochemical staining revealed selective expression of Pgp and MRP for HCY15/CL02 and A549 cells, respectively. There were no significant difference in cellular uptakes of both tracers in HCT15/CL02 cells, but MIBI uptake was slightly higher than that of tetrofosmin in A549 cells. Co-incubation with CsA resulted in a increase in cellular uptakes of MIBI and tetrofosmin. Uptake of MIBI or tetrofosmin in HCT15/CL02 cells was increased by 10- and 2.4-fold, and by 7.5 and 6.3-fold in A549 cells, respectively. Percentage increase of MIBI was higher than that of tetrofosmin with CsA for both cells (p<0.05). In vivo biodistribution study showed that MIBI (114% at 10 min, 257% at 60 min, 396% at 240 min) and tetrofosmin uptake (110% at 10 min, 205% at 60 min, 410% at 240 min) were progressively increased by the time, up to 240 min with CsA. But increases in tumoral uptake were not significantly different between MIBI and tetrofosmin for both tumors. Conclusion: MIBI seems to be a better tracer than tetrofosmin for evaluating MDR reversal effect of the modulators in vitro, but these differences were not evident in vivo tumoral uptake. Both MIBI and tetrofosmin seem to be suitable tracers for imaging Pgp- and MRP-mediated drug resistance in tumors.