• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.2
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• pp.35-43
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• 2012

Purpose : PET/CT performed CT-based attenuation correction generates the beam hardening artifact by metallic implant. The attenuation correction causes over or underestimate of the area adjacent to metallic hip prosthetic material and change of $^{18}F$-FDG uptake. Also, the image quality and the diagnosability on genitourinary disease are reduced. Therefore, this study will evaluate the usefulness of MAR (Metal Artifact Reduction) algorithm method to improve the image quality on PET/CT. Materials and Methods : PET/CT was performed by fixing hip prosthesis in SPECT/PET phantom. In PET images with and Without MAR algorithm, the Bright streak, Dark streak, Metal region and Background area that appeared on CT were confirmed, and the change of each SUV (standardized uptake value) was analyzed. Also, in 15 patients who underwent total hip arthroplasty, each MAR algorithm and Without MAR algorithm and non attenuation correction was evaluated. Results : In PET image Without MAR algorithm, SUV of Bright streak region was $0.98{\pm}0.48$ g/ml; Dark streak region was $0.88{\pm}0.02$ g/ml; Metal region was $0.24{\pm}0.16$ g/ml, Background area was $0.91{\pm}0.18$ g/ml. In SUV of PET image with MAR algorithm, Bright streak region was $0.88{\pm}0.49$ g/ml, Dark streak region was $0.63{\pm}0.21$ g/ml, Metal region was $0.06{\pm}0.07$ g/ml, Background was $0.90{\pm}0.02$ g/ml. SUV generally decreased when applying MAR algorithm. In PET image Without MAR algorithm, SUVs of Bright region were higher than those measured in the Background, and it was false positive uptake. But, in PET image with MAR algorithm, SUVs of Bright region were similar to the Background, and false positive uptake disappeared. Conclusion : MAR algorithm could reduce an increase of $^{18}F$-FDG uptake due to attenuation correction in the hip surrounding tissue. However, decrease of SUV in Dark streak region should be considered in the future. Therefore, this study propose that the diagnostic accuracy can be improved in genitourinary diseases adjacent to metallic hip prosthesis, if provided PET images with and Without MAR algorithm, and non attenuation correction images at the same time.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.127-132
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• 2010

Purpose: Because of limitation of image acquisition method and acquisition time, scatter correction cannot perform easily in SPECT study. But in our hospital, could provide to clinic doctor of scatter corrected images, through introduction of new generation gamma camera has function of simple scatter correction. Taking this opportunity, we will compare scatter corrected and non-scatter corrected image from image quality of point of view. Materials and Methods: We acquisite the 'Hoffman brain phantom' SPECT image and '1mm line phantom' SPECT image, each 18 times, with GE Infinia Hawkeye 4, SPECT-CT gamma camera. At first, we calculated each contrast from axial slice of scatter corrected and non-scatter corrected SPECT image of 'Hoffman brain phantom'. and next, calculated each FWHM of horizontal and vertical from axial slice of scatter corrected and non-scatter corrected SPECT image of '1mm line phantom'. After then, we attempted T test analysis with SAS program on data, contrast and resolution value of scatter corrected and non-scatter corrected image. Results: The contrast of scatter corrected image, elevated from 0.3979 to 0.3509. And the resolution of scatter corrected image, elevated from 3.4822 to 3.6375. p value were 0.0097 in contrast and <0.0001 in resolution. We knew the fact that do improve of contrast and resolution through scatter correction. Conclusion: We got the improved SPECT image through simple and easy way, scatter correct. We will expect to provide improved images, from contrast and resolution point of view. to our clinic doctor.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.24-27
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• 2010

Purpose: Early diagnosis of breast is of the utmost importance to improve prognosis. We have a limitation for mammography and sonography detecting small cancer. Clinical importance of Breast Specific Gamma Imaging (BSGI) has improved for that reason. So We studied performance evaluation test of count rate and resolution with high sensitivity to the low dose of BSGI. Materials and Methods: BSGI of Dilon 6800, point source of $^{99m}Tc$ from 1.85~148 MBq (0.05~4 mCi) at the intervals of 1.85~37 MBq (0.05~1 mCi) was used for the test. Performance evaluation method was performed for measuring deadtime for choosing at the 5 different point in the useful field of view (UFOV), acquired image for 60 seconds. Compared with reference of clinical uptake distribution of breast, activity increased according to the distance change 10, 20, 30, 40, 50 mm in the useful field of view. Results: Counting curve increased according to the activity from 1.85 MBq (0.05 mCi) to the 74 MBq (2 mCi), and it change flat shape over 74 MBq (2 mCi). The variation of the full width of half maximum (FWHM) to the distance is 4.05, 4.73, 5.77, 6.90, 8.00, 9.32 mm in 1.85 MBq (0.05 mCi), 4.30, 4.80, 5.90, 7.00, 8.10, 9.07 mm in 3.7 MBq (0.1 mCi), 4.90, 5.60, 6.20, 7.20, 8.20, 9.10 mm in 5.55 MBq (0.15 mCi), 5.30, 6.10, 6.60, 7.00, 7.90, 8.70 mm in 7.40 MBq (0.2 mCi). Conclusion: Distortions of image would be acquired because of the deadtime in BSGI. We found out the fact that specification of $^{99m}Tc$ reaction under 74 MBq (2 mCi) for BSGI. Second, FWHM distribution change from varied distance from the detector, clearly distinguished the location of the lesion.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.18-23
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• 2010

Purpose: PET/CT combines functional and morphologic data and increases diagnostic accuracy in a variety of malignancies. Especially reconstructed Fusion PET/CT images or MIP (Maximum Intensity Projection) images from a 2-dimensional image to a 3-dimensional one are useful in visualization of the lesion. But in Fusion & MIP 3D reconstruction image, due to hot uptake by urine or urostomy bag, lesion is overlapped so it is difficult that we can distinguish the lesion with the naked eye. This research tries to improve a distinction by removing parts of hot uptake. Materials and Methods: This research has been conducted the object of patients who have went to our hospital from September 2008 to March 2009 and have a lot of urine of remaining volume as disease of uterus, bladder, rectum in the result of PET/CT examination. We used GE Company's Advantage Workstation AW4.3 05 Version Volume Viewer program. As an analysis method, set up ROI in region of removal in axial volume image, select Cut Outside and apply same method in coronal volume image. Next, adjust minimum value in Threshold of 3D Tools, select subtraction in Advanced Processing. It makes Fusion & MIP images and compares them with the image no using Region Cut Definition. Results: In Fusion & MIP 3D reconstruction image, it makes Fusion & MIP images and compares them by using Advantage Workstation AW4.3 05's Region Cut Subtraction, parts of hot uptake according to patient's urine can be removed. Distinction of lesion was clearly reconstructed in image using Region Cut Definition. Conclusion: After examining the patients showing hot uptake on account of volume of urine intake in bladder, in process of reconstruction image, if parts of hot uptake would be removed, it could contribute to offering much better diagnostic information than image subtraction of conventional method. Especially in case of disease of uterus, bladder and rectum, it will be helpful for qualitative improvement of image.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.1
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• pp.104-111
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• 2009

Purpose: Osteocalcin is also known as the bone gamma-carboxyglutamic acid (Gla) protein (BGP), is noncollagenous bone protein synthesized by osteoblasts. Serum concentrations of Osteocalcin have been used as a biochemical marker of bone turnover. The reference intervals of Osteocalcin is categorized by kit corporation according to the age. However, each laboratory should establish its own reference intervals. In this study, the variation in the serum Osteocalcin level were used to find actual standard age-specific Osteocalcin reference intervals. Materials and Methods: We have selected 864 healthy females aged 20~80 years who visited a health promotion center between Aug. 2007 and Sep. 2008. The Osteocalcin IRMA Kit (OSTEO-RIACT, CIS Bio international, Gif-sur-Yvette, France) was used for the quantification. Each results were analyzed with the SPSS 12.0 statistical software. Results: The analyzed reference intervals of Osteocalcin by using Hoffmann method are from 8.8~39.4 ng/mL to 6.3~28.8 ng/mL for the case of the age from 20 to 30, from 7.7~31.9 ng/mL to 5.9~17.4 ng/mL for the case of the age from 31 to 40, and from 8.0~36.0 ng/mL to 5.5~20.1 ng/mL for the case of the age from 41 to 50, and from 8.0~50.5 ng/mL to 6.7~27.0 ng/mL for the case of the age from 51 to 60, and from 12.9~55.9 ng/mL to 7.5~27.5 ng/mL for the case of the age from 61 to 80. Reference intervals of Osteocalcin were not in agreement with those recommended by the manufacturers. Conclusions: Osteocalcin is used as an indication of metabolic bone diseases. So in our study we wanted to provide reference intervals of Osteocalcin that can be useful to a clinical decisions. Also, previous reference intervals should not be re-used and new intervals should be set by continuous analyzing.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.13-17
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• 2010

Purpose: Partial volume effect (PVE) is the phenomenon to lower the accuracy of image due to low estimate, which is to occur from PET/CT 3D image acquisition. The more resolution is declined and the lesion is small, the more it causes a big error. So that it can influence the test result. Studied the optimum image reconstruction method by using variation of parameter, which can influence the PVE. Materials and Methods: It acquires the image in each size spheres which is injected $^{18}F$-FDG to hot site and background in the ratio 4:1 for 10 minutes by using NEMA 2001 IEC phantom in GE Discovey STE 16. The iterative reconstruction is used and gives variety to iteration 2-50 times, subset number 1-56. The analysis's fixed region of interest in detail part of image and compute % difference and signal to noise ratio (SNR) using $SUV_{max}$. Results: It's measured that $SUV_{max}$ of 10 mm spheres, which is changed subset number to 2, 5, 8, 20, 56 in fixed iteration to times, SNR is indicated 0.19, 0.30, 0.40, 0.48, 0.45. As well as each sphere's of total SNR is measured 2.73, 3.38, 3.64, 3.63, 3.38. Conclusion: In iteration 6th to 20th, it indicates similar value in % difference and SNR ($3.47{\pm}0.09$). Over 20th, it increases the phenomenon, which is placed low value on $SUV_{max}$ through the influence of noise. In addition, the identical iteration, it indicates that SNR is high value in 8th to 20th in variation of subset number. Therefore, to reduce partial volume effect of small lesion, it can be declined the partial volume effect in iteration 6 times, subset number 8~20 times, considering reconstruction time.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.3-7
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• 2010

Purpose: The usefulness of Positron Emission Tomography (PET) images in diagnosis, staging, recurrent and treatment response evaluation has already been known. However, tumors which are small size, located in lower lobe of lung or upper lobe of liver are shown misalignment, distortion and different Standard Uptake Value (SUV) by respiration in PET images. Therefore, if radiotherapy based on normal respiration, it may cause low treatment response or more side effects because targets which had to treat, out of treat range or over dose to normal tissue. The purpose of this study is to evaluate attenuation-correction with Average CT (ACT) for more accuracy SUV measurement and minimize artifact by respiration. Materials and Methods: 13 patients, who had tumors which are around the diaphragm, underwent ACT scan after Helical CT (HCT) scan with PET/CT (Discovery DSTE 8; GE Healthcare). We quantified the differences between attenuation corrected image with HCT and attenuation corrected image with ACT in artifact size and maximum SUV ($SUV_{max}$). Artifacts were evaluated by measurement of the curved photogenic area in the lower thorax of the PET images for all patients. $SUV_{max}$ was measured separately at the primary tumors. Analysis program was Advantage Workstation v4.3 (GE Healthcare). Patients were injected with 7.4 MBq (0.2 $mC_i$) per kg of $^{18}F$-FDG and scanned 1 hour after injection. The PET acquisition was 3 minute per bed. Results: Significantly lower artifact were observed in PET/ACT images than in PET/HCT images (below-thoracic artifacts caused by under corrected $1.5{\pm}3.5$ cm vs. $13.4{\pm}4.2$ cm). Significantly higher $SUV_{max}$ were noted in PET/ACT images than in PET/HCT images in the primary tumor. Compared with PET/HCT images, $SUV_{max}$ in PET/ACT images were higher by $5.3{\pm}3.9%$ (mean value) tumor. The highest difference was observed in Lower lobe of lung (7.7 to 8.7; 13%). Conclusion: Due to its significantly reduced artifacts in lower thoracic, attenuation corrected image with ACT images provided more reliable $SUV_{max}$ and may be helpful in monitoring treatment response. Moreover, ACT can separate upper lobe of liver and lower lobe of lung, it may be helpful in interpretation. ACT will be clinically useful, considering increased dose caused by ACT scan and adapt.

• The Korean Journal of Nuclear Medicine Technology
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• v.21 no.2
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• pp.31-36
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• 2017

Purpose Recently, the performance of PET/CT scanner has been improved and various techniques have been developed to increase the image quality such as Sensitivity and Resolution. The purpose of this study is to evaluate the usefulness of Q.Clear (a fully convergent iterative reconstruction) technique of GE Discovery IQ equipment to enhance the image quality. Materials and Methods All scans were acquired by Discovery IQ (GE Healthcare, MI, USA). In NEMA IEC Body Phantom test, Background to Hot-sphere (10 mm, 13 mm, 17 mm, 22 mm) ratio was 1:4 and scan time was 3 minutes. The images were reconstructed by VPHDs (VUE Point High-Definition + SharpIR) and Q.Clear to evaluate each Contrast. We injected 18F-FDG 187 M㏃ to PET/SPECT Performance Phantom. And then it was scanned for 4 minutes to evaluate Resolution and Uniformity. T-test statistical analysis was performed on SUVmax of small lesions less than 2 cm in 100 clinical patients regardless of disease type. Results In the NEMA IEC Body Phantom, the Contrast was $63.6{\pm}5.7%$ (VPHDs) and $75{\pm}4.8%$ (Q.Clear). In the PET/SPECT Performance Phantom, the Resolution was 9.2 mm (VPHDs) and 7.3 mm (Q.Clear). Uniformity of Q.Clear was 10.8% better than VPHDs. T-test statistic of the clinical patients showed a significant difference of p value of 0.021. Conclusion Both the phantom test and the clinical results showed that the quality of the image was improved in Q.Clear was applied. The SUVmax was highly measured in Q.Clear and the lesions were clearly distinguished visually. Therefore Q.Clear can be useful in various aspects such as dose-reduction, patients evaluation and image analysis.

• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.299-306
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• 1992

Gastic emptying scan in diabetic patients is widely used to assess the degree of motility disturbance and the symtoms such as nausea, vomiting, bloating, abdominal pain and early gastric fullness which we can't find anatomic lesion by fiberoscopic or barium study In order to determine the relationship among diabetic gastropathy, neropathy, retinopathy and disease duration, gastric emptying scan using $^{99m}Tc-tin$ colloid labeled scramble egg in hamburger was performed in 10 healty male controls and 50 diabetic patients which were subdivided to no neuropathy, peripheral neuropathy and autonomic neuropathy groups according to the degree of diabetic neuropathy and no retinopathy, background retinopathy and proliferative retinopathy groups according to the degree of diabetic retinopathy. After medication of cisapride for 2 weeks, we observed the presence of improvement of gastric motility in diabetics. The results were as following: 1) In controls, gastric emptying time (GET1/2) was $75{\pm}13.6$ min and 2 hour gastric retension rate (GRR2) was $32{\pm}11.1%$. 2) In diabetics, GET/2 was prolonged more than 2 hours and GRR2 was $58{\pm}23.1%$. According to degree of neuropathy, GET1/2 was prolonged more than 2 hours in all three groups and GRR2 was $54{\pm}24.1%$ in no neuropathy group, $57{\pm}24.3%$ in peripheral neuropathy group and $69{\pm}24.6%$ in autonomic neuropathy group. According to degree of retinopathy, GET1/2 was $110{\pm}23.4$ min in no retinopathy group and prolonged more than 2 hours in other two groups and GRR2 was $45{\pm}21.6%$ in no retinopathy group, $71{\pm}19.7%$ in background retinopathy group and $73{\pm}21.5%$ in proliferative retinopathy group. 3) After cisapride medication for 2 weeks, GET1/2 and GRR2 were improved as $90{\pm}14.6$ min and $40{\pm}13.8%$ (initial GET1/2 and GRR2 were above 2 hours and $61{\pm}15.4%$). We can conclude from above findings that gastropathy in diabetic neuropathy suggesting main underlying factor in motility disorder The degree of retinopathy and disease duration were correlated with severity of gastropathy in diabetics. From the results of gastric emptying scan, we can conclude that cisapride was useful drug for improving diabetic gastropathy and gastric emptying scan was valuable for assessing severity of diabetic gastropathy as non-invasive method.

• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.1
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• pp.58-64
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• 2011

Objective: The 3-dimensional reconstruction method with resolution recovery modeling has advantages of high spatial resolution and contrast because of its precise modeling of spatial blurring according to the distance from detector plane. The aim of this study was to evaluate one of the resolution recovery reconstruction methods (Astonish, Philips Medical), compare it to other iterative reconstructions, and verify its clinical usefulness. Materials and Methods: NEMA IEC PET body phantom and Flanges Jaszczak ECT phantom (Data Spectrum Corp., USA) studies were performed using Skylight SPECT (Philips) system under four different conditions; short or long (2 times of short) radius, and half or full (40 kcts/frame) acquisition counts. Astonish reconstruction method was compared with two other iterative reconstructions; MLEM and 3D-OSEM which vendor supplied. For quantitative analysis, the contrast ratios obtained from IEC phantom test were compared. Reconstruction parameters were determined by optimization study using graph of contrast ratio versus background variability. The qualitative comparison was performed with Jaszczak ECT phantom and human myocardial data. Results: The overall contrast ratio was higher with Astonish than the others. For the largest hot sphere of 37 mm diameter, Astonish showed about 27.1% and 17.4% higher contrast ratio than MLEM and 3D-OSEM, in short radius study. For long radius, Astonish showed about 40.5% and 32.6% higher contrast ratio than MLEM and 3D-OSEM. The effect of acquired counts was insignificant. In the qualitative studies with Jaszczak phantom and human myocardial data, Astonish showed the best image quality. Conclusion: In this study, we have found out that Astonish can provide more reliable clinical results by better image quality compared to other iterative reconstruction methods. Although further clinical studies are required, Astonish would be used in clinics with confidence for enhancement of images.