• The Korean Journal of Nuclear Medicine
• /
• v.33 no.1
• /
• pp.65-75
• /
• 1999

Purpose: The aim of this study is to demonstrate the feasibility of 2-[fluorine-18] fluoro-2-deoxy-D-glucose (F-18-FDG) whole body scan (FDG W/B Scan) using dual-head gamma camera equipped with ultra high energy collimator in patients with various cancers, and compare the results with those of coincidence imaging. Materials and Methods: Phantom studies of planar imaging with ultra high energy and coincidence tomography (FDG CoDe PET) were performed. Fourteen patients with known or suspected malignancy were examined. F-18-FDG whole body scan was performed using dual-head gamma camera with high energy (511 keV) collimators and regional FDG CoDe PET immediately followed it Radiological, clinical follow up and histologic results were correlated with F-18-FDG findings. Results: Planar phantom study showed 13.1 mm spatial resolution at 10 cm with a sensitivity of 2638 cpm/MBq/ml. In coincidence PET, spatial resolution was 7.49 mm and sensitivity was 5351 cpm/MBq/ml. Eight out of 14 patients showed hypermetabolic sites in primary or metastatic tumors in FDG CoDe PET. The lesions showing no hypermetabolic uptake of FDG in both methods were all less than 1 cm except one lesion of 2 cm sized metastatic lymph node. The metastatic lymph nodes of positive FDG uptake were more than 1.5 cm in size or conglomerated lesions of lymph nodes less than 1cm in size. FDG W/B scan showed similar results but had additional false positive and false negative cases. FDG W/B scan could not visualize liver metastasis in one case that showed multiple metastatic sites in FDG CoDe PET. Conclusion: FDG W/B scan with specially designed collimators depicted some cancers and their metastatic sites, although it had a limitation in image quality compared to that of FDG CoDe PET. This study suggests that F-18-FDG positron imaging using dual-head gamma camera is feasible in oncology and helpful if it should be more available by regional distribution of FDG.

• Radiation Oncology Journal
• /
• v.21 no.2
• /
• pp.107-111
• /
• 2003

Purpose: To establish the role of stereoactic radiosurgery using a linear accelerator for the treatment of patients with cavernous angloma. Materials and Methods: Between February 1995 and May 1997, 11 patients with cavernous angioma were treated with stereotactic radiosurgery using a linear accelerator. Diagnoses were based on the magnetic resonance imaging in 8 patients, and the histological in 3. The vascular lesions were located on the brainstem (5 cases), cerebellum (2 cases) thalamus (1 case) and cerebrum (3 cases). The clinical presentation at onset included previous intracerebral hemorrhages (9 cases) and seizures (2 cases). All patients were treated with a a linac-based radiosurgery. The median dose of radiation delivered was 16 Gy ranging from 14 to 24 Gy, which was typically proscribed to the 80$\%$ isodose surface (range 50 $\~$ 80$\%$), corresponding to the periphery of the lesion with a single isocenter. Ten patients were followed-up. Results: The median follow-up was 49 months ranging from 8 to 73 months, during which time two patients developed an intracerebral hemorrhage, 1 at 8 months, with the other at 64 months post radiosurgery. One patient developed neurological deficit after radiosurgery, and two developed an edema on the T2 weighted images of the MRI surrounding the radiosurgical target. Conclusion: The use of stereotactic radiosurgery in the treatment of a cavernous angioma may be effective in the prevention of rebleedlng, and can be safely delivered. However, a longer follow-up period will be required.

• Journal of Chest Surgery
• /
• v.29 no.6
• /
• pp.639-645
• /
• 1996

A 14-year-old male patient with previous surgical repair of tetralogy of Fallot was admitted with hemodynamically significant ventricular tachycardia (VT). On preoperative electrophysiologic study (EPS), the morphology of documented VT was RBBB of vertical axis with 320 msec cycle length. The endocardial mapping during VT delineated the origin of VT at right ventricular outflow tract (RVOT), where the patch was attached. The clinical VT had a clockwise reentry circuit around the patch with the earliest activation at the same site seen during the preoperative EPS. The previously placed right ventricular outflow patch and fibrous tissue were removed. During a postoperative EPS, it was no longer possible to induce the VT. Ventricular tachycardia following repair of tetralogy of Fallot seen in this patient was caused by a macro-reentry around the right ventricular outflow patch. We were able to ablate the VT with the aid of a detailed mapping of its epicardial activation sequence.

• The Korean Journal of Nuclear Medicine
• /
• v.29 no.4
• /
• pp.504-510
• /
• 1995

Avascular necrosis(AVN) of bone can be resulted from various causes that distrub vascular supply to bone tissue, including steroid therapy after renal transplantation. In this study, we determine the prevalence of the avascular necrosis of bone after renal transplantation and compare the role of the bone scan, SPECT and MRI. In 301 patients with transplanted kidney, the prevalence of avascular necrosis was deter-mined clinically. Site of bone necrosis was evaluated by clinical symptom, bone scan, SPECT and MRI. Bone scan was done in all patients with AVN. Bone SPECT and MRI were done in six cases; and MRI was done in two cases. The prevalence of AVN was 3.3% (10/301), and the site of AVN was 16 femoral heads in 10 patients (bilateral: 60%) and bilateral calcaneal tuberosity in one patient. Bone scan showed typical AVN (cold area with surrounding hot uptake) in 13 lesions, only hot uptake in three lesions (including two calcaneal tuberosities), decreased uptake in one lesion, and normal in one lesion. Decreased uptake and normal lesion showed an equivacal cold area without surrounding hot uptake on SPECT. A symptomatic patient with positive bone SPECT showed normal finding on MRI. The prevalence of AVN of bone after renal transplantation was 3.3%, and whole body bone scan showed multiple bone involvement. Two symptomatic hip Joints without definite lesion on whole body bone scan or MRI showed cold defect on SPECT. Therefore, we conclude that bone SPECT should be perfomed in a symptomatic patient with negative bone scan or MRI in case with high risk of AVN after renal transplantation.

• The Korean Journal of Nuclear Medicine
• /
• v.30 no.4
• /
• pp.476-483
• /
• 1996

Following radiation therapy for brain tumors, patients often have clinical deterioration due to either radiation necrosis or recurrent tumor progression in the treatment field. The distinction between these entities is important but difficult clinically or even with CT or MRI. T1-201 has been known to accumulate in various tumors and be useful to grade, predict prognosis or detect recurrence of glioma. The aim of this study was to evaluate the usefulness of T1-201 SPECT in the differentiation of recurrent tumor from radiation necrosis. Of 67 patients who did T1-201 brain SPECT imaging with clinically suspected recurrent tumor or radiation necrosis, 20 patients underwent histopathological examination and constituted the study population. T1-201 uptake indices on T1-201 brain SPECT imaging rrere calculated and correlated with histopathological diagnosis. Of 20 patients, 15 were histopathologically confirmed as recurrent original tumor or malignant transformation of benign tumor and 5 were diagnosed as radiation necrosis. On T1-201 SPECT, 18 of 20 had T1-201 index above 2.5 which was regarded as positive indicator for the presence of tumor. Seventeen cases showed concordance, which consisted of 15 true positive and 2 true negative. Discordant 3 cases were all false positive. There was no case of false negative. The sensitivity, specificity, positive and negative predictive value of T1-201 SPECT were 100%, 40%, 83% and 100%. In conclusion, T1-201 brain SPECT is a sensitive diagnostic test in the detection of recurrent tumor following radiation therapy and is useful in the differentiation of recurrent tumor from radiation necrosis. Relatively low specificity should be evaluated further in larger number of patients in consideration of sampling error and referral bias for pathologic examination.

• The Korean Journal of Nuclear Medicine
• /
• v.31 no.3
• /
• pp.330-338
• /
• 1997

This study investigated the method to adjust acquisition time(a) and injection dose (i) to make the best basal and subtraction images in consecutive SPECT. Image quality was assumed to be mainly affected by signal to noise ratio(S/N). Basal image was subtracted from the second image consecutively acquired at the same position. We calculated S/N ratio in basal SPECT images($S_1/N_1$) and subtraction SPECT images(Ss/Ns) to find a(time) and i(dose) to maximize S/N of both images at the same time. From phantom images, we drew the relation of image counts and a(time) and i(dose) in our system using fanbeam-high-resolution collimated triple head SPECT. Noise by imaging process depended on Poisson distribution. We took maximum tolerable duration of consecutive acquisition as 30 minutes and maximum injectible dose as 1,850MBq(50 mCi)(sum of two injections) per study. Counts of second-acquired image($S_2$), counts($S_s$) and noise($N_s$) of subtraction SPECT were as follows. $C_1$ was the coefficient of measurement with our system. $$S_2=S_1{\cdot}(\frac{30-a}{a})+background{\cdot}(1-\frac{30-a}{a})+C_1{\cdot}(30-a){\cdot}{\epsilon}{\cdot}(50-i)$$ $$Ss=S_2-\{S_1{\cdot}(\frac{30-a}{a})+background{\cdot}(1-\frac{(30-a)}{a})\}$$ $$Ns={\sqrt{N_2^2+N_1^2{\cdot}\frac{(30-a)^2}{a^2}}={\sqrt{S_2+S_1{\cdot}\frac{(30-a)^2}{a^2}}$$ In case of rest/acetazolamide study, effect(${\epsilon}$) of acetazolamide to increase global brain uptake of Tc-99m-HMPAO could be 1.5 or less. Varying ${\epsilon}$ from 1 to 1.5, a(time) and i(dose) pair to maximize both $S_1/N_l$ and Ss/Ns was determined. 15 mCi/17 min and 35mCi/13min was the best a(time) and i(dose) pair for rest/acetazolamide study(when ${\epsilon}$ were 1.2) and came to be used for our clinical routine after this study. We developed simple method to maximize S/N ratios of basal and subtraction SPECT from consecutive acquisition. This method could be applied to ECD/HMPAO and brain activation studies as well as rest/acetazolamide studies.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.18 no.1
• /
• pp.94-97
• /
• 2014

Purpose: Standardized uptake value (SUV) is a simple semi-quantitative method that can measure the ratio of the tissue radioactivity between the tumor and normal. SUV is commonly used in PET/CT, however, SUV is affected by various factor. The purpose of this study was to evaluate the impact of the residual activity on SUV depending on the location of catheter insertion device post injection. Materials and Methods: NEMA IEC Body Phantom was imaged using a Discovery 600 PET scanner. In 22 mm diameter sphere, the different activity of $^{18}F-FDG$ (7.4, 14.8, 22.2, 29.6, 37, 55.5 MBq) was filled and background was filled with $^{18}F-FDG$ (5.7 kBq/mL). We scaned the phantom on the assumption that the radioactivity in sphere was residual activity in insertion device. Simulation of PET was divided into three groups based on the location of sphere in Scan FOV (SFOV); inclusion, 1/2 inclusion and exclusion group. Results: Among three groups, the group of excluded sphere showed the highest SUV regardless of the amount of $^{18}F-FDG$ activity. In case of 7.4 MBq, average SUV of inclusion group, 1/2 inclusion and exclusion group was 0.780, 0.840 and 0.896 respectively. However, average SUV of 55.5 MBq showed 0.372, 0.460 and 0.508 with same order. Depend on residual radioactivity in the sphere and position of sphere, the SUV was different minimum of 10.4%, maximum of 62.8%. Conclusion: This study showed that SUV is underestimated as the residual radio-activity is increased. In addition, SUV was a changed according to the position of residual radio-activity. And among the position, exclusion group showed the difference of SUV was lowest. If we measure the residual radio-activity of inserting devices and radio-activity from extra-vasation in the patients, it seems to be more useful in clinical field.

• Clinics in Shoulder and Elbow
• /
• v.16 no.2
• /
• pp.73-83
• /
• 2013

Purpose: The goal of this study is to evaluate the minimum three-year follow-up results of reverse total shoulder arthroplasty (RTSA) for glenohumeral (GH) arthritic and pseudoparalytic patients with severe rotator cuff deficiency. Materials and Methods: We evaluated 13 patients (three males and 10 females) who underwent RTSA from July 2007 to July 2010. The average follow-up duration was 54.2 months (range, 37~74 months). Clinical results were evaluated using the Visual Analog Scale (VAS) for pain, active Range of Motion (ROM): active forward flexion (aFF); active external rotation at the side (aERs); active internal rotation to the back (aIRb), American Shoulder and Elbow Surgeons (ASES) score, Korean Shoulder Score (KSS), and intraoperative and postoperative complications. Results: VAS score improved from 7.5(6~10) points to 1.5(0~4), and ROM of active forward elevation improved from $42.7(10{\sim}100)^{\circ}$ to $129.1(110{\sim}180)^{\circ}$. In addition, ASES score improved from preoperative 32.9 (11.7~46.7) points to 80.2(58.3~95.0) postoperatively, and KSS score improved from 36.8(24~47) points to 78.4 (61~92). Twelve out of 13 cases showed various degrees of scapular notching at the last follow-up. There was one case of intraoperative anterior glenoid fracture and two cases of temporary nerve injury. Revision surgery was performed in two cases for treatment of delayed postoperative deep infection. Conclusion: According to minimum three-year follow-up results, RTSA may be an effective treatment option for glenohumeral (GH) arthritic and pseudoparalytic patients. However, considering the possibility of complications related to delayed deep infection or surgeon's technique, RTSA should be judiciously and carefully indicated by expert surgeons.

• Journal of The Korean Society of Inherited Metabolic disease
• /
• v.15 no.1
• /
• pp.29-34
• /
• 2015

Citrullinemia type1 is an autosomal recessive disorder of the urea cycle characterized by neonatal or late onset of hyperammonemia caused by a deficiency of the enzyme argininosuccinate synthetase (ASS). An ASS1 deficiency demonstrates fatal clinical manifestations that are characterized by the neonatal metabolic coma and early death when untreated. It causes a broad spectrum of effects, ranging from a mild disorder to a severe mental retardation, epilepsy, neurologic deficits. An acute neonatal form is the most common. Infants are normal at birth followed by an acute illness characterized by vomiting, lethargy, seizures and coma. These medical problems are life-threatening in many cases. A later onset form is less frequent and may be milder than the neonatal form. This later-onset form is associated with severe headaches, visual dysfunction, motor dysfunction, and lack of energy. Citrullinemia type1 is caused by mutations in the ASS1 gene located on chromosome 9q34.1 that encodes argininosuccinate synthetase, the third enzyme of the urea cycle catalyzing the formation of argininosuccinic acid from citrulline and aspartic acid. The enzyme is distributed in tissues including liver and fibroblasts. This mutation leads to hyperammonemia, arginine deficiency and elevated citrulline level. In the urea cycle, argininosuccinate synthetase catalyses the conversion of citrulline and aspartate to argininosuccinate.. Here, we describe a female newborn patient with lethargy, rigidity and hyperammonemia who was diagnosed as citrullinemia type1 with a c.[421-2A>G], c.[1128-6_1188dup] mutation.

• Journal of Food Hygiene and Safety
• /
• v.25 no.4
• /
• pp.410-417
• /
• 2010

Various functional foods, marketing health and functional effects, have been distributed in the market. These products, being in forms of foods, tablets, and capsules, are likely to be mistaken as drugs. In addition, non-experts may sell these as foods, or use these for therapy. Efforts for creating health food regulations or building regulatory system for improving the current status of functional foods have been made, but these have not been communicated to consumers yet. As a result, problems of circulating functional foods for therapy or adding illegal medical to such products have persisted, which has become worse by internet media. The cause of this problem can be categorized into (1) product itself and (2) its use, but in either case, one possible cause is lack of communications with consumers. Potential problems that can be caused by functional foods include illegal substances, hazardous substances, allergic reactions, considerations when administered to patients, drug interactions, ingredients with purity or concentrations too low to be detected, products with metabolic activations, health risks from over- or under-dose of vitamin and minerals, and products with alkaloids. (Journal of Health Science, 56, Supplement (2010)). The reason why side effects related to functional foods have been increasing is that under-qualified functional food companies are exaggerating the functionality for marketing purposes. KFDA has been informing consumers, through its web pages, to address the above mentioned issues related to functional foods, but there still is room for improvement, to promote proper use of functional foods and avoid drug interactions. Specifically, to address these issues, institutionalizing to collect information on approved products and their side effects, settling reevaluation systems, and standardizing preclinical tests and clinical tests are becoming urgent. Also to provide crucial information, unified database systems, seamlessly aggregating heterogeneous data in different domains, with user interfaces enabling effective one-stop search, are crucial.