• Clinical and Experimental Pediatrics
• /
• v.49 no.7
• /
• pp.737-744
• /
• 2006

Purpose : To assess the usefulness of $^{99m}Tc-DISIDA$ scanning in the early evaluation of neonatal cholestasis and to verify the diagnostic value of this test in the differential diagnosis of biliary atresia. Methods : DISIDA scannings were performed and analyzed in 87 children(58 males and 29 females; age, 18-139 days, mean, 59.1 days) with neonatal cholestasis. Five groups according to the final diagnosis and the results of DISIDA scanning were analyzed by scatter plots using the parameters of age and the level of liver function tests(direct bilirubin, AST, ALT, ALP, GGT). The diagnostic sensitivity, specificity and accuracy of DISIDA scanning in the diagnosis of biliary atresia were compared between a higher bilirubin group and a lower bilirubin group(direct bilirubin level >5 mg/dL vs. <5 mg/dL) decided by the pattern of scatter plots. Results : DISIDA scannings in the diagnosis of biliary atresia were analyzed by high sensitivity(100 percent, 16/16) but lower specificity(70.4 percent, 50/71) and accuracy(75.9 percent, 66/87). False positivity(29.6 percent, 21/71) was higher in patients with a higher direct bilirubin level(42.5 percent for >5 mg/dL vs. 9.7 percent for <5 mg/dL, P<0.01). The age and the level of liver function tests(AST, ALT, ALP, GGT) analyzed by scatter plots revealed neither diagnostic value in predicting final diagnosis nor estimated the accuracy rate of DISIDA scanning in the evaluation of neonatal cholestasis. Conclusion : We suggest that DISIDA scannings should not be routinely used in evaluating neonatal cholestasis with elevated direct bilirubin level(>5 mg/dL), especially if it delays early diagnosis and surgical intervention.

• The Korean Journal of Nuclear Medicine
• /
• v.33 no.4
• /
• pp.352-361
• /
• 1999

Purpose: Carotid endarterectomy nay benefit patients with bilateral carotid stenosis by improving cerebro-vascular hemodynamics of ipsilateral as well as contralateral cerebral hemispheres. We investigated cerebro-vascular hemodynamics after carotid endarterectomy in patients with contralateral carotid occlusion by acetazolamide stress brain SPECT. Materials and Methods: Subjects were 14 symptomatic patients (all men, mean age 66 yrs) with carotid stenosis (>50%) with contralateral carotid occlusion. Acetazolamide stress Tc-99m ECD brain SPECTs were performed within 2 weeks before and after carotid endarterectomy using one day protocol. Cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were assessed visually. In 12 patients, correlation between the patency of proximal anterior cerebral or anterior communicating arteries (A1/A-comm) and the improvement of CBF or CVR after endarterectomy was assessed. Results: Preoperative SPECT showed reduced CBF in 2 ipsilateral and 10 contralateral hemispheres. CVR was reduced in 4 ipsilateral and 9 contralateral hemispheres. Of 12 hemispheres with reduced CBF, 2 hemispheres (16.7%) showed improvement of CBF after endarterectomy. However, reduced CVR was improved in all 4 ipsilateral and 7 of 9 (78%) of contralateral hemispheres after endarterectomy. Three of4 with stenotic Al/A-comm and 4 of 8 with patent A1/A-comm had reduced contralateral CVR. Reduced contralateral CVR improved in all 3 patients with stenotic A1/A-comm and 3 of 4 with patent A1/A-comm. Conclusion: Acetazolamide stress brain SPECT demonstrated improvement of compromised cerebrovascular reserve in not only ipsilateral but also contralateral hemispheres of patients with contralateral carotid occlusion after carotid endarterectomy, and may, therefore, be useful for evaluating cerebral blood flow and cerebrovascular reserve after carotid endarterectomy.

• Journal of Chest Surgery
• /
• v.38 no.5 s.250
• /
• pp.323-334
• /
• 2005

Background: Gene therapy is a new and promising option for the treatment of severe myocardial ischemia by therapeutic angiogenesis. The goal of this study was to elucidate the efficacy of therapeutic angiogenesis by using VEGF165 in large animals. Material and Method: Twenty-one pigs that underwent ligation of the distal left anterior descending coronary artery were randomly allocated to one of two treatments: intramyocardial injection of pCK-VEGF (VEGF) or intramyocardial injection of pCK-Null (Control). Injections were administered 30 days after ligation. Seven pigs died during the trial, but eight pigs from VEGF and six from Control survived. Echo-cardiography was performed on day 0 (preoperative) and on days 30 and 60 following coronary ligation. Gated myocardial single photon emission computed tomography imaging (SPECT) with $^{99m}Tc-labeled$ sestamibi was performed on days 30 and 60. Myocardial perfusion was assessed from the uptake of $^{99m}Tc-labeled$ sestamibi at rest. Global and regional myocardial function as well as post-infarction left ventricular remodeling were assessed from segmental wall thickening; left ventricular ejection fraction (EF); end systolic volume (ESV); and end diastolic volume (EDV) using gated SPECT and echocardiography. Myocardium of the ischemic border zone into which pCK plasmid vector had been injected was also sampled to assess micro-capillary density. Result: Micro-capillary density was significantly higher in the VEGF than in Control ($386\pm110/mm^{2}\;vs.\;291\pm127/mm^{2};\;p<0.001$). Segmental perfusion increased significantly from day 30 to day 60 after intramyocardial injection of plasmid vector in VEGF ($48.4\pm15.2\%\;vs.\;53.8\pm19.6\%;\;p<0.001$), while no significant change was observed in the Control ($45.1\pm17.0\%\;vs.\;43.4\pm17.7\%;\;p=0.186$). This resulted in a significant difference in the percentage changes between the two groups ($11.4\pm27.0\%\;increase\;vs.\;2.7\pm19.0\%\;decrease;\;p=0.003$). Segmental wall thickening increased significantly from day 30 to day 60 in both groups; the increments did not differ between groups. ESV measured using echocardiography increased significantly from day 0 to day 30 in VEGF ($22.9\pm9.9\;mL\;vs.\;32.3\pm9.1\;mL;\; p=0.006$) and in Control ($26.3\pm12.0\;mL\;vs.\;36.8\pm9.7\;mL;\;p=0.046$). EF decreased significantly in VEGF ($52.0\pm7.7\%\;vs.\;46.5\pm7.4\%;\;p=0.004$) and in Control ($48.2\pm9.2\%\;vs.\;41.6\pm10.0\%;\;p=0.028$). There was no significant change in EDV. The interval changes (days $30\~60$) of EF, ESV, and EDV did not differ significantly between groups both by gated SPECT and by echocardiography. Conclusion: Intramyocardial injection of pCK-VEGF165 induced therapeutic angiogenesis and improved myocardial perfusion. However, post-infarction remodeling and global myocardial function were not improved.

• Journal of Acupuncture Research
• /
• v.18 no.4
• /
• pp.46-54
• /
• 2001

Objective : To study correlation of the brain areas with acupoints used in the treatment of cerebrovascular diseases to evaluate the hypothesis that selecting acupoints on the left side to treat disorders on the right side and vice versa is known as the crossing combination of acupoints. Materials and Methods: Rest/acupuncture-stimulation Tc-99m ECD brain SPECT using a same-dose subtraction method was performed on 5 normal male volunteers (age range from 27 to 30 years) using acupuncture at acupoint, LI4 located in the left hand. In the control study, needle location was chosen on a non-meridian focus 1cm posterior to the right fibular head. All images were spatially normalized and the differences between rest and acupuncture stimulation were statistically analyzed using SPM(R) for Windows(R). Results : Acupuncture applied at LI4 located in the left hand increased rCBF in the right hemisphere, that is, the right parietal lobe(angular gyrus) and a part of the right middle posterior temporal gyrus and the right inferior occipital lobe. In the control stimulation, no significant rCBF increase was observed. Conclusion : The results demonstrated a correlation between stimulation at acupoint with increase in rCBF to the controlateral hemisphere.

• Progress in Medical Physics
• /
• v.10 no.2
• /
• pp.73-81
• /
• 1999

Scatter correction for single photon emission computed tomography (SPECT) plays an important role to improve image quality and quantitation. The purpose of this study was to investigate three scatter correction methods using Monte Carlo simulation. Point source and Jaszack phantom filled with Tc-99m were simulated by Monte Carlo code, SIMIND. For scatter correction, we applied three methods, Compton window (CW) method, triple window (TW) method, and dual photopeak window (DPW) method. Point sources located at various depths along the center line within a 20-cm phantom were simulated to calculate the window ratios and corresponding scatter fractions by evaluating the polynomial coefficients for DPW method. Energy windows were located in W$_1$=92-125 keV, W$_2$=124-126 keV, W$_3$=136-140 keV, W$_4$=140-141 keV, and W$_{5}$=154-156 keV. The results showed that in Jaszack phantom with cold sphere and hot sphere, the TW gave the closest contrast and percentage recovery to the ideal image, respectively, while CW overestimated and DPW underestimated the contrast of ideal one. All three scatter correction methods showed an improved image contrast. In conclusion, scatter correction is essential for improving image contrast and accurate quantification. The choice of scatter correction method should be made on the basis of accuracies and ease of implementation.

• Journal of the Korean Society of Radiology
• /
• v.12 no.5
• /
• pp.593-601
• /
• 2018

Recently in nuclear medicine, to improve diagnostic value, SUV, semi-quantitative indicator used in PET-CT, is adopted in SPECT-CT. Therefore, this research analyzed correlation of $SUV_{max}$ of two scanners through phantom test, and evaluated possibility of clinical application. Radiopharmaceuticals ($^{18}F$, $^{99m}Tc$) were injected with the ratios of 8:1 and 4:1, considering background radioactivity, into the phantom manufactured with 6 globes of different sizes, and, based on clinical protocol, positive phases were acquired with PET-CT and SPECT-CT scanners, and interesting areas were divided into ROI and VOI, and $SUV_{max}$ of them were measured, and analyzed. Tests found out no statistically significant difference in $SUV_{max}$ measured with two scanners (P>0.05). Thus, $SUV_{max}$ of PET-CT and SPECT-CT had a certain correlation within significant levels, and were evaluated as the same. Accordingly, it seems that $SUV_{max}$ quantitative analysis using SPECT-CT can provide significant diagnostic information as the case of PET-CT.

• Progress in Medical Physics
• /
• v.19 no.4
• /
• pp.291-297
• /
• 2008

The purpose of this study is to optimize a parallel-hole collimator for small gamma camera having the pixellated crystal array and evaluate the effect of crystal-collimator misalignment on the image quality using a simulation tool GATE (Geant4 Application for Tomographic Emission). The spatial resolution and sensitivity were measured for the various size of hexagonal-hole and matched square-hole collimators with a Tc-99m point source and the uniformity of flood image was estimated as a function of the angle between crystal array and collimator by misalignment. The results showed that the spatial resolution and sensitivity were greatly improved by using the matched collimator and the uniformity was reduced by crystal-collimator misalignment.

• Childhood Kidney Diseases
• /
• v.10 no.2
• /
• pp.201-212
• /
• 2006

Purpose : Vesicoureteral reflux(VUR) is the major risk factor of urinary tract infection(UTI) in children and may result in serious complications such as renal scarring and chronic renal failure. The purpose of this study was to evaluate the relationship between VUR and renal scar formation, the usefulness and correlation of various imaging studies in reflux nephropathy, and the spontaneous resolution of VUR. Methods : We retrospectively reviewed 106 patients with VUR with no accompanying urogenital anomalies in the Department of Pediatrics, Bundang CHA Hospital during the period from Jan. 1996 to Mar. 2005. Ultrasonography and $^{99m}Tc$-dimercaptosuccinic acid(DMSA) scan were performed in the acute period of UTI. Voiding cystourethrography(VCUG) was performed 1 to 3 weeks after treatment with UTI. Follow-up DMSA scan was performed 4 to 6 months after treatment and a follow-up VCUG was performed every 12 months. Results : The mean age at detection of VUR was $13.8{\pm}22.2$ months and the male to female ratio was 2:1. The incidence of renal scarring showed a tendency of direct correlation between severity of VUR(P<0.001) and abnormal findings of renal ultrasonography(P<0.01). 63.2%(24 of 38 renal units) of renal parenchymal defects present in the first DMSA scan disappeared on follow-up DMSA scans. Follow-up DMSA scans detected renal scars in 7(14%) of 50 renal units with ultrasonographically normal kidneys. Meanwhile, ultrasonography did not show parenchymal defects in 7(36.8%) of 19 renal units where renal scarring was demonstrated on a follow-up DMSA scan. The spontaneous resolution rate of VUR was higher(75%) in cases with low grade(I to III) VUR(P<0.01). Conclusions : The presence and severity of VUR and abnormal findings of renal ultrasonography significantly correlated with renal scar formation. DMSA scan was useful in the diagnosis of renal defects. Meanwhile renal ultrasonography was an inadequate method for evaluating renal parenchymal damage. Therefore, follow-up DMSA scans should be performed to detect renal scars even in children with low-grade VUR and normal renal ultrasonography.

• Journal of radiological science and technology
• /
• v.26 no.2
• /
• pp.63-69
• /
• 2003

Filtering is necessary to reduce statistical noise and to increase image quality in SPECT images. Noises controled by low-pass filter designed to suppress high spatial frequency in SPECT image. Most SPECT filter function control the degree of high frequency supression by chosing a cut of frequency. The location of cut off frequency determines the affect image noise and spatial resolution. If select the low cut off frequency, its provide good noise suppression but insufficient image quantity and high cut off frequencies increase the image resolution but insufficient noise suppression. The purpose of this study was to determines the optimam cut off level with comparison of FWHM according to cut off level in each kiters-Band-limited, Sheep-logan, Sheep-logan Hanning, Generalized Hamming, Low pass cosine, Parazen and Butterworth filter in SPECT camera. We recorded image along the X, Y, Z-axis with $^{99m}TcO_4$ point source and measured FWHM by use profile curve. We find averaged length is $9.16\;mm{\sim}18.14\;mm$ of FWHM in X, Y, and Z-axis, and Band-limited and Generalized Hamming filters measures 9.16 mm at 0.7 cycle/pixel cut off frequency.

• Journal of Acupuncture Research
• /
• v.21 no.1
• /
• pp.111-118
• /
• 2004

Background and purpose: Opposing-needling technique involves selecting acupoints at unaffected limb. The aim of this study was to evaluate the effect of LI4-LI11 electrical acupuncture at unaffected limb on the cerebral blood flow in ischemic stroke patients using SPECT Methods: We selected 9 ischemic stroke patients. Baseline brain SPECT was done with triple head gamma camera(MultiSPECT3, Siemens, USA) after intravenous administration of 925 MBq of Tc-99m ECD). Fifteen-minute electro-acupuncture at Hapgok(LI 4) and Gokji(LI 11) were applied on unaffected upper limb of subjects. The same dose of Tc-99m ECD was injected during the electro-acupuncture, and the second SPECT images were obtained. Using the computer software(ICON 7.1, Siemens, USA), 3 SPECT slices(upper, middle, lower) surrounding the brain lesion were selected and each slice was divided by 10-16 brain regions. Asymmetry indexes were analyzed in each brain region. We regarded$\geq$10% changes of asymmetry index between before and after electro-acupuncture as significance. Results: Seven Patients(77.8%) had significantly increased perfusion and 2(22.2%) didn't show increased perfusion in post-acupuncture scans compared to pre-acupuncture scans(baseline). The regions of CBF improvement were mostly frontal lobes and anterior temporal lobes. Conclusions: This study demonstrated that LI4-LI11 electro-acupuncture at unaffected limb increased regional cerebral blood perfusion to the corresponding brain areas in ischemic stroke patients.