• Title/Summary/Keyword: perfusion SPECT

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The Effect of Seizure-Related Variables on Interictal Psychiatric Symptoms in the Intractable Epileptic Patients (난치성 간질환자에서 간질관련요인이 발작간 정신증상에 미치는 영향)

  • Kim, Jong-Hoon;Han, Wou-Sang;Lee, Sang-Kun;Lyoo, In-Kyoon;Ha, Kyoo-Seob
    • Korean Journal of Psychosomatic Medicine
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    • v.5 no.2
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    • pp.205-213
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    • 1997
  • The aim of this study is to find the relationship between interictal psychiatric symptoms and seizure-related variables such as structural changes, regional interictal perfusion changes, the number of interictal epileptic discharges and the presence of accompanying generalized tonic clonic seizure(GTC). The subjects were 75 patients (47 males : mean age $28.3{\pm}7.7$) with intractable epilepsy, Interictal psychiatric symptoms were rated by Symptom Checklist-90-R(SCL-90-R). Each of 4 seizure variables was measured by MRI, $^{99m}TC-HMPAO$ SPECT and the prolonged EEG monitoring. The mean SCL-90-R subscale T-scores and the ratio of the patients with definite psychiatric symptoms(T-score > 65 at any one subscale of SCL-90-R) were compared among the groups with different seizure variables. Demographic variables and clinical variables were not statistically different among the groups with different seizure variables. The patients with right mesial temporal sclerosis had higher mean SCL-90-R scores for obsessive compulsive symptom, interpersonal sensitivity, depression, hostility and psychotic symptoms than the patients with left mesial temporal sclerosis, and they also showed higher ratio of definite psychiatric symptoms. The presence of interictal epileptic discharges was related with higher T-scores of paranoid subscale. The areas of hypoperfusion, the presence of the GTC, and other clinical seizure variables showed no significant influences on the mean SCL-90-R subscale T-scores. from these results, the authors speculated that interictal subictal epileptic dischrages may be related with psychiatric symptoms of the intractable epileptic patients, especially with right mesial temporal sclerosis.

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Evaluation of Cerebrovascular Reactivity According to Age Using Transcranial Doppler (Transcranial Doppler를 이용한 연령에 따른 뇌혈관 반응성 평가)

  • Lee, Gyu Taek;Kim, Jong Gyu
    • Korean Journal of Clinical Laboratory Science
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    • v.36 no.1
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    • pp.43-48
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    • 2004
  • Cerebral vasoreactivity is an index of autoregulation of cerebral perfusion, and can be measured using functional images such as Xe CT, SPECT and PET in reponse to hypercapneic stimulus. In order to measure cerebral $CO_2$ vasoreactivity in routine TCD study conveniently and reliably, we devised a method of rebreathing into closed volume of reservoir bag as a hypercapneic stimulus, and applied it to 44 healthy volunteers. As a hypercapneic stimulus, we applied fitting mask connected with closed reservoir bag for about 90 seconds, and mean blood flow velocity(MBFV) and pulsatility index(PI) were evaluated at proximal middle cerebral arteries(MCA) of 50-55 mm depth, before and after the hypercapneic stimulus. Age affected the MFV and PI value showed significant and the MFV was 56.45(SD=9.75)cm/sec, while PI was 0.406(SD=0.089). As age increases the flow velocity decreased significantly whereas PI value increased(P<0.05). The vasoreactvity significantly decreased with age(P<0.05). The decrease of cerebral blood flow quantity and cerebral blood flow velocity is not only because of increase of diameter of cerebrovascular resulting from aging, but the resistance increase of small blood vessel resulting from the increase of PI & RI value is regarded. We suppose that the rebreathing method is a reliable and convenient technique as a hypercapneic stimulus in determining cerebral $CO_2$ vasoreactivity. The rebreathing method could be non-invasive and useful methods in estimation of the cerebrovascular reactivity and could be applied to the basal and follow-up evaluation of the cerebrovascular reserve of the ischemic stroke patients.

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Long-Term Trend Analysis in Nuclear Medicine Examinations (핵의학 영상 검사의 중장기 추세 분석 - 서울 소재 일개 상급 종합병원을 중심으로 -)

  • Jung, Woo-Young;Shim, Dong-Oh;Choi, Jae-Min
    • The Korean Journal of Nuclear Medicine Technology
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    • v.23 no.1
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    • pp.15-28
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    • 2019
  • Purpose Nuclear medicine was initially introduced in Korea in 1969 and widely applied to treat hyperthyroidism with $^{131}I$. Also, gamma camera was adopted in 1969 in the first place and its application has been growing continually in many ways. We analyzed long-term trend in nuclear medicine examinations for the last 2 decades. The purpose of this paper is to make predictions and to set both plans and directions on the development of nuclear medicine. Materials and Methods We analyzed the performance of nuclear medicine examinations and therapies performed in Asan Medical Center from 1998 to 2017. Results Results from the last 20 years regarding Bone scan, Renal scan, MUGA scan and $^{18}F$-FPCIT, Bone Mineral Density were on a increase. And Myocardium perfusion SPECT, Thyroid scan, Lung scan were on a decrease while $^{18}F-FDG$ PET maintained on a steady course. Until 2010 there was a positive performance with the therapy but after the excessive medical care in thyroid examination performance is at status quo. Key events such as a medical strike(2000), Middle-East Respiratory Syndrome (2015) influenced the overall performance of the therapy. Conclusion In order to promote a long-term growth in nuclear medicine examination and therapy, it is inevitable to respond to the changes in current medical environment. Furthermore, it is strongly suggested to put efforts to maintain and develop new examinations and clinical indicators.

Effect of Repetitive Transcranial Magnetic Stimulation in Drug Resistant Depressed Patients (치료 저항성 우울증 환자에서 반복적 경두개 자기자극후 국소뇌혈류 변화)

  • Chung, Yong-An;Yoo, Ie-Ryung;Kang, Bong-Joo;Chae, Jeong-Ho;Lee, Hye-Won;Moon, Hyun-Jin;Kim, Sung-Hoon;Sohn, Hyung-Sun;Chung, Soo-Kyo
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.1
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    • pp.9-15
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    • 2007
  • Purpose: Repetitive transcranial magnetic stimulation (rTMS) has recently been clinically applied in the treatment of drug resistant depressed patients. There are mixed findings about the efficacy of rTMS on depression. Furthermore, the influence of rTMS on the physiology of the brain is not clear. We prospectively evaluated changes of regional cerebral blood flow (rCBF) between pre- and post-rTMS treatment in patients with drug resistant depression. Materials and Methods: Twelve patients with drug-resistant depression (7 male, 5 female; age range: $19{\sim}52$ years; mean age: $29.3{\pm}9.3$ years) were given rTMS on right prefrontal lobe with low frequency (1 Hz) and on left prefrontal lobe with high frequency (20 Hz), with 20-minute-duration each day for 3 weeks. Tc-99m ECD brain perfusion SPECT was obtained before and after rTMS treatment. The changes of cerebral perfusion were analyzed using statistical parametric mapping (SPM; t=3.14, uncorrected p<0.01, voxel=100). Results: Following areas showed significant increase in rCBF after 3 weeks rTMS treatment: the cingulate gyrus, fusiform gyrus of right temporal lobe, precuneus, and left lateral globus pallidus. Significant decrement was noted in: the precental and middle frontal gyrus of right frontal lobe, and fusiform gyrus of left occipital lobe. Conclusion: Low-frequency rTMS on the right prefrontal cortex and high-frequency rTMS on the left prefrontal cortex for 3 weeks as an add-on regimen have increased and decreased rCBF in the specific brain regions in drug-resistant depressed patients. Further analyses correlating clinical characteristics and treatment paradigm with functional imaging data may be helpful in clarifying the pathophysiology of drug-resistant depressed patients.

Tc-99m Labeling of Dione Bisoxime Compounds (Dione Bisoxime 계통의 화합물에 대한 테크네슘표지 원리에 관한 연구)

  • Jeong, Jae-Min;Cho, Jung-Hyuk;Oh, Seung-Joon;Lee, Myung-Chul;Chung, Soo-Wook;Chung, June-Key;Lee, Dong-Soo;Kwark, Cheol-Eun;Lee, Kyung-Han;Koh, Chang-Soon
    • The Korean Journal of Nuclear Medicine
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    • v.29 no.1
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    • pp.110-117
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    • 1995
  • Tc-99m Labeled hexamethylenepropyleneamineoxime ([$^{99m}Tc$]-HMPAO) is a famous amino-oxime compound and is widely used to construct SPECT images of cerebral blood flow. To investigate the relationship between chemical structure and radiolabeling in these kind of diamine-oxime compounds, we synthesized seven compounds by Schiff's base formation and successive reduction with sodium borohydride. They were (RR/SS )-4,8-diaza-3,6,6,9-tetramethylundecane-2,10-dione bisoxime (2), (RR/SS/meso)-4,8-diaza-3,9-dimethy-lundecane-2,10-dione bisoxime (4), (RR/SS/meso)-4,8-diaza-3,10-dimethyldodecane-2,11-dione bisoxime (5), (RR/SS/meso)-4,7-diaza-3,6,6,8-tetramethyldecane-2,9-dione bisoxime (8), (RR/SS/meso)-4,7-diaza-5,6-cyclohexyl-3,8-dimethyldecane-2,9-dione bisoxime (10), (RR/SS/meso)-3,4-bis(1-aza-2-methyl-3-oxime-1-butyl)-benzoic acid (12), and (RR/SS/ meso)-2,3-bis(1-aza-2-methyl-3-oxime-1-butyl) benzophenone (14). Chemical structures of all the synthesized compounds were identified by taking $^1H$ spectrum. Among them, 2 and 4 are propyleneamine oxime (PnAO), 6 is butyleneamine oxime (BnAO) and 8, 10, 12 and 14 are ethyleneamine oxime (EnAO). Each compound (0.5 mg) was incubated with stannous chloride (0.5 g - 8 g), carbonate-bicarbonate buffer (final concentration = 0.1 M, pH 7 - pH 10) and Tc-99m-pertechenate (1 ml). Tc-99m labeling of these compounds were checked by ITLC (acetone), ITLC (normal saline), reverse phase TLC (50 % acetonitrile) and ITLC (ethyl acetate). According to the results, EnAO's were not labeled by Tc-99m in any of above condition. About 11 % of maximum labeling efficiency was obtained with BnAO. However, 4 (PnAO) was labeled with Tc-99m to 85 % which is similar to the labeling efficiency of 2 (HMPAO). Hydrophilic impurity (9 % ) was the most significant problem with the labeling of 4, however, pertechnetate (3 % ) and colloid (3 %) were minor problem. In conclusion, we synthesized seven diamine blsoxlme compounds. Among them, four EnAO compounds were not labeled by Tc-99m. A BnAO was labeled poorly and two PnAO's were labeled well. These labeling can be explained by tertiary structure of their Tc-99m chelate.

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Determination of Brain Death by $^{99m}Tc$ DTPA and $^{99m}Tc$ HMPAO Images ($^{99m}Tc$ DTPA와 $^{99m}Tc$ HMPAO를 이용한 뇌사결정)

  • Kim, Jong-Kyu;Sohn, Hyung-Sun;Kim, Sung-Hoon;Yang, Woo-Jin;Lee, Sung-Yong;Chung, Soo-Kyo;Park, Seog-Hee;Kim, Choon-Yul;Bahk, Yong-Whee;Shinn, Kyung-Sub
    • The Korean Journal of Nuclear Medicine
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    • v.29 no.1
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    • pp.15-21
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    • 1995
  • To evaluate availability of cerebral radionuclide imaging for diagnosis of brain death, we examined 25 patients with a suspected clinical diagnosis of brain death. 8 patients were studied by $^{99m}Tc$ DTPA and 15 patients were studied by $^{99m}Tc$ HMPAO (Hexamethyl propyleneamine oxime). Seven patients with $^{99m}Tc$ DTPA studies revealed absence of cerebral blood flow and sagittal sinus activity. All of 15 patients with $^{99m}Tc$ HMPAO studies revealed complete absence of cerebral perfusion. The results of the cerebral radionuclide studies of brain death correlated with other clinical conditions, such as intracranial pressure(ICP), EEG, transcranial doppler sonography(TCDS), and neurologic examination. The ICP of 8 patients, who are confirmed by brain death with $^{99m}Tc$ HMPAO study are elevated in all cases. In conclusion, cerebral radionuclide imaging for diagnosis of brain death is available. $^{99m}Tc$ HMPAO imaging is unequivocal, easily interpreted, well reflect the physiologic state of increased ICP, and provides adequate assessment of posterior fossa activity. In addition, the SPECT imaging with $^{99m}Tc$ HMPAO produces more accurate results due to it's superiority of image contrast and proper localization of radiopharmaceutical distribution than conventional planar imaging.

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Quantitative Assessment Technology of Small Animal Myocardial Infarction PET Image Using Gaussian Mixture Model (다중가우시안혼합모델을 이용한 소동물 심근경색 PET 영상의 정량적 평가 기술)

  • Woo, Sang-Keun;Lee, Yong-Jin;Lee, Won-Ho;Kim, Min-Hwan;Park, Ji-Ae;Kim, Jin-Su;Kim, Jong-Guk;Kang, Joo-Hyun;Ji, Young-Hoon;Choi, Chang-Woon;Lim, Sang-Moo;Kim, Kyeong-Min
    • Progress in Medical Physics
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    • v.22 no.1
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    • pp.42-51
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    • 2011
  • Nuclear medicine images (SPECT, PET) were widely used tool for assessment of myocardial viability and perfusion. However it had difficult to define accurate myocardial infarct region. The purpose of this study was to investigate methodological approach for automatic measurement of rat myocardial infarct size using polar map with adaptive threshold. Rat myocardial infarction model was induced by ligation of the left circumflex artery. PET images were obtained after intravenous injection of 37 MBq $^{18}F$-FDG. After 60 min uptake, each animal was scanned for 20 min with ECG gating. PET data were reconstructed using ordered subset expectation maximization (OSEM) 2D. To automatically make the myocardial contour and generate polar map, we used QGS software (Cedars-Sinai Medical Center). The reference infarct size was defined by infarction area percentage of the total left myocardium using TTC staining. We used three threshold methods (predefined threshold, Otsu and Multi Gaussian mixture model; MGMM). Predefined threshold method was commonly used in other studies. We applied threshold value form 10% to 90% in step of 10%. Otsu algorithm calculated threshold with the maximum between class variance. MGMM method estimated the distribution of image intensity using multiple Gaussian mixture models (MGMM2, ${\cdots}$ MGMM5) and calculated adaptive threshold. The infarct size in polar map was calculated as the percentage of lower threshold area in polar map from the total polar map area. The measured infarct size using different threshold methods was evaluated by comparison with reference infarct size. The mean difference between with polar map defect size by predefined thresholds (20%, 30%, and 40%) and reference infarct size were $7.04{\pm}3.44%$, $3.87{\pm}2.09%$ and $2.15{\pm}2.07%$, respectively. Otsu verse reference infarct size was $3.56{\pm}4.16%$. MGMM methods verse reference infarct size was $2.29{\pm}1.94%$. The predefined threshold (30%) showed the smallest mean difference with reference infarct size. However, MGMM was more accurate than predefined threshold in under 10% reference infarct size case (MGMM: 0.006%, predefined threshold: 0.59%). In this study, we was to evaluate myocardial infarct size in polar map using multiple Gaussian mixture model. MGMM method was provide adaptive threshold in each subject and will be a useful for automatic measurement of infarct size.

Usefulness of Three-phasic Bone Scan in Young Male Patients Suspected of Post-traumatic Reflex Sympathetic Dystrophy Syndrome (외상후 교감신경 이영양증이 의심되는 젊은 남자 환자들에서 삼상 골스캔의 유용성)

  • Lee, Won-Woo;Kim, Tae-Uk;Kim, Tae-Hoon;Jung, Cheoul-Yun;Moon, Jin-Ho
    • The Korean Journal of Nuclear Medicine
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    • v.35 no.1
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    • pp.52-60
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    • 2001
  • Purpose: In young male patients who suffered several kinds of trauma with subsequent suspicious reflex sympathetic dystrophy syndrome, we performed three-phasic bone scan in order to investigate its usefulness. Materials and Methods: Patients with narrow range of age (21-25. mean $22.8{\pm}1.3$, all male) were included with suspicious reflex sympathetic dystrophy syndrome of 12 feet and 5 hands. Only one was bilateral feet case and 16 were ipsilateral (Rt:13, Lt:3). The etiologic traumas were 4 fractures, 4 sprains, 3 blunt trauma, 2 cellulitis, 1 tendon tear, 1 crush injury, 1 overexercise, and 1 unknown. Radiologically 3 showed osteoporotic changes. Three-phasic bone scans were performed $21.2{\pm}7.3wks$ after trauma. Results: According to symptom complex, confirmatory reflex sympathetic dystrophy syndrome 4 cases and suspicious 13 were analyzed. All confirmatory cases (100%) showed increased uptake at delay phase with periarticular accentuation. Of confirmatory 4 cases, 2 showed increased uptake in all three phases (perfusion: P, blood pool: B, and delay: D), and other 2 revealed decreased P but, both increased B and D. Of suspicious 13 cases, 9(69.2%) had increased D (4 periarticular and 5 focal), 2 decreased D, and 2 symmetric D. In 12 foot cases, so-called weight hearing patterns - increased contralateral sole at P and B - were revealed in 7(58.3%). Conclusion: Diffuse periarticular increased uptake at delay phase of three-phasic bone scan was a compatible finding to reflex sympathetic dystrophy syndrome in young male patients whose symptom complex strongly designated post traumatic reflex sympathetic dystrophy syndrome.

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Current Status and Future Perspective of PET (PET 이용 현황 및 전망)

  • Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.1
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    • pp.1-7
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    • 2002
  • Positron Emission Tomography (PET) is a nuclear medicine imaging modality that consists of systemic administration to a subject of a radiopharmaceutical labeled with a positron-emitting radionuclide. Following administration, its distribution in the organ or structure under study can be assessed as a function of time and space by (1) defecting the annihilation radiation resulting from the interaction of the positrons with matter, and (2) reconstructing the distribution of the radioactivity from a series of that used in computed tomography (CT). The nuclides most generally exhibit chemical properties that render them particularly desirable in physiological studies. The radionuclides most widely used in PET are F-18, C-11, O-15 and N-13. Regarding to the number of the current PET Centers worldwide (based on ICP data), more than 300 PET Centers were in operation in 2000. The use of PET technology grew rapidly compared to that in 1992 and 1996, particularly in the USA, which demonstrates a three-fold rise in PET installations. In 2001, 194 PET Centers were operating in the USA. In 1994, two clinical and research-oriented PET Centers at Seoul National University Hospital and Samsung Medical Center, was established as the first dedicated PET and Cyclotron machines in Korea, followed by two more PET facilities at the Korea Cancer Center Hospital, Ajou Medical Center, Yonsei University Medical Center, National Cancer Center and established their PET Center. Catholic Medical School and Pusan National University Hospital have finalized a plan to install PET machine in 2002, which results in total of nine PET Centers in Korea. Considering annual trends of PET application in four major PET centers in Korea in Asan Medical Center recent six years (from 1995 to 2000), a total of 11,564 patients have been studied every year and the number of PET studies has shown steep growth year upon year. We had 1,020 PET patients in 1995. This number increased to 1,196, 1,756, 2,379, 3,015 and 4,414 in 1996,1997,1998,1999 and 2000, respectively. The application in cardiac disorders is minimal, and among various neuropsychiatric diseases, patients with epilepsy or dementia can benefit from PET studios. Recently, we investigated brain mapping and neuroreceptor works. PET is not a key application for evaluation of the cardiac patients in Korea because of the relatively low incidence of cardiac disease and less costly procedures such as SPECT can now be performed. The changes in the application of PET studios indicate that, initially, brain PET occupied almost 60% in 1995, followed by a gradual decrease in brain application. However, overall PET use in the diagnosis and management of patients with cancer was up to 63% in 2000. The current medicare coverage policy in the USA is very important because reimbursement policy is critical for the promotion of PET. In May 1995, the Health Care Financing Administration (HCFA) began covering the PET perfusion study using Rubidium-82, evaluation of a solitary pulmonary nodule and pathologically proven non-small cell lung cancer. As of July 1999, Medicare's coverage policy expanded to include additional indications: evaluation of recurrent colorectal cancer with a rising CEA level, staging of lymphoma and detection of recurrent or metastatic melanoma. In December of 2001, National Coverage decided to expand Medicare reimbursement for broad use in 6 cancers: lung, colorecctal, lymphoma, melanoma, head and neck, and esophageal cancers; for determining revascularization in heart diseases; and for identifying epilepsy patients. In addition, PET coverage is expected to further expand to diseases affecting women, such as breast, ovarian, uterine and vaginal cancers as well as diseases like prostate cancer and Alzheimer's disease.