• Tuberculosis and Respiratory Diseases
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• 제41권2호
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• pp.111-119
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• 1994

배경 및 목적: 폐암 환자의 다수가 흡연력이 있고 만성 폐쇄성 폐질환이 병발되어 있으므로 수술후 폐기능의 변화를 정확히 예측하는 것은 수술후 합병증을 예방하는데 중요하다. 폐 절제술 후 잔여 폐기능을 예측함에 있어 현재까지 99mTc-MAA를 이용한 폐관류 스캔이 많이 이용되어 왔지만 이론적으로 폐환기와 폐관류의 불일치가 있는 경우 오차가 있을 수 있어 $^{99m}Tc$-DTPA 연무흡입 환기 스캔을 이용해 잔류 폐기능을 예측하여 관류 스캔을 비교하여 보았다. 방법: 수술전 연무 흡입스캔과 관류 스캔을 시행하고 수술전에 폐기능을 실시하여 잔여 폐기능을 예측하고 수술후 2개월 뒤에 폐기능을 실시하여 상관관계를 비교하여 보았다. 전 폐절제술인 경우: 수술전 폐기능$\times$전체 폐에 대한 잔류폐의 비 폐엽 절제술인 경우: 수술전 폐기능$\times$(1-침범된 폐의 전체폐에 대한 비$\times$절제될 폐의 분절 수/침범된 폐의 총 분절 수) 결과: 1) $FEV_1$에서 연무 흡입스캔을 이용하여 예측한 값과 실측치 간의 상관 계수는 0.94(p<0.0001), 폐관류 스캔을 이용한 경우는 0.86(p<0.0001)이었으며 두 군간에 통계학적으로 유의한 차이는 없었다. 2) FVC에 흡입스캔을 이용한 경우 상관 계수가 0.91(p<0.0001)이었고 폐관류 스캔에서는 0.72(p=0.0005)로 연무 흡입스캔으로 예측한 군에서 상관 관계가 좋았다. 3) $FEF_{25-75%}$에서의 결과는 연무 흡입스캔을 이용한 경우 상관 계수가 0.87(p=0.0001), 폐관류 스캔에서는 상관 계수가 0.87(p<0.0001)로 두 군간에 유의한 차이는 없었다. 4) 두 스캔을 동시에 시행한 군에서 비교한 결과를 보면 연무 흡입 스캔에서 상관 계수는 $FEV_1$ 0.97(p<0.0001), FVC 0.95(p<0.0001), $FEF_{25-75%}$ 0.85(p<0.001)이었고 폐관류 스캔에서는 $FEV_1$ 0.97(p<0.0001), FVC 0.96(p<0.0001), $FEF_{25-75%}$ 0.83(p<0.002)로 두 군간에 유의한 차이는 없었다. 결론: 수술후 잔여 폐기능을 예측함에 있어 연무 흡입스캔 및 관류 스캔사이에 큰 차이가 없었으며 비교적 정확했고 폐기능중에서는 $FEV_1$이 가장 상관 관계가 좋았다.

• Nuclear Medicine and Molecular Imaging
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• 제40권1호
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• pp.28-32
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• 2006

목적: 현재로는 각종 유독가스 흡입으로 인한 기도 손상시 기관지 내시경 검사가 가장 정확하나, 시행이 어렵고 환자에게 불편감을 주는 검사법이다. 반면, 폐환기/관류스캔은 비침습적이며 유용한 검사법으로서, 연구자들은 흡입에 의한 기도손상환자에서 조기 검사 및 추적검사를 실시하여 이들 스캔의 유용성을 평가하고자 하였다. 방법: 지하철 화재사고로 인한 기도손상이 의심되는 19명의 환자(남자: 9, 여자: 10, 평균연령 : 31.6세)를 대상으로 하였다. 사고 2일 후 $^{99m}Tc$-technegas 를 이용한 환기스캔을 실시하고, 4일 후 $^{99m}Tc$-MAA 를 이용한 폐관류스캔을 실시하였다. 비슷한 시기에 실시한 기관지 내시경 검사 소견과 스캔소견을 비교하고 환자의 증상이 호전된 후 추적검사(환기스캔은 16일 후, 관류스캔은 18일 후)를 실시하였다. 결과: 19명의 환자 중 14명은 정상스캔 소견을 보였고, 4명은 환기와 관류스캔 모두에서 결손의 소견을 보였으며, 나머지 1명은 환기스캔에서만 결손의 소견을 보였다. 비정상 소견을 보인 5명의 환자들은 스캔소견의 비정상부위와 기관지 내시경 검사에서 이상소견을 보인 부위가 유사하였고, 심한 호흡기 증상이 있었다. 흉부 X선 검사에서 이들 중 2명은 결핵을 앓은 흔적이 관찰되었다. 추적검사에서는 이상소견을 보인 모든 환자에서 스캔소견의 호전과 함께 임상소견도 호전되었다. 결론: 환기/관류 스캔은 화재에 의한 기도손상시 조기에 이를 진단할 수 있을 뿐만 아니라 추적관찰에도 유용할 것으로 생각된다.

• 대한핵의학회지
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• 제35권4호
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• pp.288-290
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• 2001

A 61 year-old woman underwent perfusion and inhalation lung scan for the evaluation of pulmonary thromboembolism. Tc-99m MAA perfusion lung scan showed multiple round hot spots in both lung fields. Tc-99m DTPA aerosol inhalation lung scan and chest radiography taken at the same time showed normal findings (Fig. 1, 2). A repeated perfusion lung scan taken 24 hours later demonstrated no abnormalities (Fig. 3). Hot spots on perfusion lung scan can be caused by microsphere clumping due to faulty injection technique or by radioactive embolization from upper extremity thrombophlebitis after injection. Focal hot spots can signify zones of atelectasis, where the hot spots probably represent a failure of hypoxic vasoconstriction. Artifactual hot spots due to microsphere clumping usually appear to be round and in peripheral location, and the lesions due to a loss of hypoxic vasoconstriction usually appear to be hot uptakes having linear $borders^{1-3)}$. Although these artifactual hot spots have been well-known, we rarely encounter them. This report presents a case with artifactual hot spots due to microsphere clumping on Tc-99m MAA perfusion lung scan.

• 대한핵의학회지
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• 제1권2호
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• pp.1-25
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• 1967

In 20 normal cases and 39 pulmonary tuberculosis cases, regional pulmonary arterial blood flow measurements and lung perfusion scans by $^{131}I$-Macroaggregated albumin, lung inhalation scans by colloidal $^{198}Au$ and spirometries by respirometer were done at the Radiological Research Institute. The measured lung function tests were compared and the results were as the following: 1. The normal distribution of pulmonary blood flow was found to be $54.5{\pm}2.82%$ to the right lung and $45.5{\pm}2.39%$ to the left lung. The difference between the right and left pulmonary arterial blood flow was significant statistically (p<0.01). In the minimal pulmonary tuberculosis, the average distribution of pulmonary arterial blood flow was found to be $52.5{\pm}5.3%$ to the right lung and $47.5{\pm}1.0%$ to the left lung when the tuberculous lesion was in the right lung, and $56.2{\pm}4.4%$ to the right lung and $43.8{\pm}3.1%$ to the left lung when the tuberculous lesion was in the left lung. The difference of pulmonary arterial blood flow between the right and left lung was statistically not significant compared with the normal distribution. In the moderately advanced pulmonary tuberculosis, the average distripution of pulmonary arterial blood flow was found to be $26.9{\pm}13.9%$ to the right lung and $73.1{\pm}13.9%$ to the left lung when the tuberculous lesion was more severe in the right lung, and $79.6{\pm}12.8%$ to the right lung and $20.4{\pm}13.0%$ to the left lung when the tuberculous lesion was more severe in the left lung. These were found to be highly significant statistically compared with the normal distribution of pulmonary arterial blood flow (p<0.01). When both lungs were evenly involved, the average distribution of pulmonary arterial blood flow was found to be $49.5{\pm}8.01%$ to the right lung and $50.5{\pm}8.01%$ to the left lung. In the far advanced pulmonary tuberculosis, the average distribution of pulmonary arterial blood flow was found to be $18.5{\pm}11.6%$ to the right lung and $81.5{\pm}9.9%$ to the left lung when the tuberculous lesion was more severe in the right lung, and $78.2{\pm}8.9%$ to the right lung and $21.8{\pm}10.5%$ to the left lung when the tuberculous lesion was more severe in the left lung. These were found to be highly significant statistically compared with the normal distribution of pulmonary arterial blood flow (p<0.01). When both lungs were evenly involved the average distribution of pulmonary arterial blood flow was found to be $56.0{\pm}3.6%$ to the right lung and $44.0{\pm}3.2%$ to the left lung. 2. Lung perfusion scan by $^{131}I$-MAA in patients with pulmonary tuberculosis was as follows: a) In the pretreated minimal pulmonary tuberculosis, the decreased area of pulmonary arterial blood flow was corresponding to the chest roentgenogram, but the decrease of pulmonary arterial blood flow was more extensive than had been expected from the chest roentgenogram in the apparently healed minimal pulmonary tuberculosis. b) In the pretreated moderately advanced pulmonary tuberculosis, the decrease of pulmonary arterial blood flow to the diseased area was corresponding to the chest roentgenogram, but the decrease of pulmonary arterial blood flow was more extensive in the treated moderately advanced pulmonary tuberculosis as in the treated minimal pulmonary tuberculosis. c) Pulmonary arterial blood flow in the patients with far advanced pulmonary tuberculosis both before and after chemotherapy were almost similar to the chest roentgenogram. Especially the decrease of pulmonary arterial blood flow to the cavity was usually greater than had been expected from the chest roentgenogram. 3. Lung inhalation scan by colloidal $^{198}Au$ in patients with pulmonary tuberculosis was as follows: a) In the minimal pulmonary tuberculosis, lung inhalation scan showed almost similar decrease of radioactivity corresponding to the chest roentgenogram. b) In the moderately advanced pulmonary tuberculosis the decrease of radioactivity in the diseased area was partly corresponding to the chest roentgenogram in one hand and on the other hand the radioactivity was found to be normally distributed in stead of tuberculous lesion in the chest roentgenogram. c) In the far advanced pulmonary tuberculosis, lung inhalation scan showed almost similar decrease of radioactivity corresponding to the chest roentgenogram as in the minimal pulmonary tuberculosis. 4. From all these results, it was found that the characteristic finding in pulmonary tuberculosis was a decrease in pulmonary arterial blood flow to the diseased area and in general decrease of pulmonary arterial blood flow to the diseased area was more extensive than had been expected from the chest roentgenogram, especially in the treated group. Lung inhalation scan showed almost similar distribution of radioactivity corresponding to the chest roentgenogram in minimal and far advanced pulmonary tuberculosis, but there was a variability in the moderately advanced pulmonary tuberculosis. The measured values obtained from spirometry were parallel to the tuberculous lesion in chest roentgenogram.

• 대한핵의학회:학술대회논문집
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• 대한핵의학회 1985년도 제24차 춘계학술대회
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• pp.172.2-173
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• 1985

• Investigative Magnetic Resonance Imaging
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• 제4권2호
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• pp.113-119
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• 2000

목적 : 산소호흡을 이용한 뇌의 관류 자기공명영상의 임상적용 가능성을 알고자 하였다. 대상 및 방법 정상 성인 지원자 2명과 3명의 환자, 각각 모야모야병 환자 1명, 뇌경색환자 1명, 뇌수막종 환자 1명을 대상으로 하였으며, 1.5 Tesla의 자기공명영상 장치를 이용하여 뇌의 자화율 대조 (susceptibility contrast) echo planar image (EPI) 방법으로 뇌영역을 10 slice씩 25회(검사시간은 검사당 1.6초) 영상을 얻었다. 검사자는 안면마스크를 착용한 상태로 스캔 시작 8초 후부터 35초가지 산소 15 liter/min를 실내 공기와 혼합되어 흡입되도록 하였다. 획득된 영상을 Magnetom Vision (Siemens Medical Systems, Erlangen, Germany)의 VB31C 프로그램을 이용하여 산소투여전(3골 번째 검사)과, 산소투여 후의 초기 (12-18 번째 검사)와 후기(19-25 번째 검사) 군으로 나누었다. 초기 및 후기 군과 산소투여전 군의 신호차이는 Z-score 0.7 내지 1.0으로 하여 여러번 영상후 처리를 반복하여 difference map을 얻어서, T1 강조영상에 중첩시켜 관류 영상을 얻었다. 모야모야병 환자는 추가로 Gd-DTPA를 0.1 mmol/kg급속주사 후 동일한 방법으로 관류 영상을 얻어 산소호흡에 의한 관류 영상과 비교하였다. 결과 : 산소 공급 후에 시행한 자화율 대조 EPI 방법으로 2명의 지원자와 각각 1예의 모야모야병, 뇌경색, 뇌수막종 증례에서 혈류 분포를 반영하는 관류 영상을 얻을 수 있었다. 모야모야병 1예의 산소 호흡에 의한 관류 영상은 Gd-DTPA투여후의 관류 영상과 유사한 양상을 보였다. 결론 : 산소호흡을 이용한 자화율 대조 EPI 방법은 향후 뇌의 관류 자기공명영상 방법으로 적용이 가능하리라고 생각된다.

• 대한핵의학회지
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• 제24권2호
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• pp.229-236
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• 1990

Perfusion and ventilaion imagings of the lung are well established procedure for diagnosing pulmonary embolism, differentiation it from chronic obstructive lung disease, and making an early detection of chronic obstructive lung disease. To evaluate the usefulness of radioaerosol inhalation imaging (RII) in chronic obstructive lung disease, especially pulmonary emphysema, we analyzed RIIs of five normal adult non-smokers, five asymptomatic smokers (age 25-42 years with the mean 36), and 21 patients with pulmonry emphysema (age 59-78 years with the mean 67). Scintigrams were obtained with radioaerosol produced by a BARC nebulizer with 15 mCi of Tc-99m-phytate. Scanning was performed in the anterior, posterior, and lateral projections after five to 10-minute inhalation of the radioaerosol on sitting position. The scans were analyzed and correlated with the results of pulmonary function studies and chest radiographs. Also lung perfusion scan with $^{99m}Tc-MAA$ was performed in 12 patients. In five patients, we performed follow-up scans for the evaluation of the effects of a bronchodilator. Based on the X-ray findings and clinical symptoms, pulmonary emphysema was classified into four types: centrilobular (3 patients), panlobular (4 patients), intermediate (10 patients), and combined (4 patients). RII findings were patternized according to the type, extent, and intensity of the aerosol deposition in the central bronchial and bronchopulmonary system and lung parenchyma. 10 controls, normal five non-smokers and three asymptomatic smokers revealed homogeneous parenchymal deposition in the entire lung fields without central bronchial deposition. The remaining two of asymptomatic smokers revealed mild central airway deposition. The great majority of the patients showed either central (9/21) or combined type (10/21) of bronchopulmonary deposition and the remaining two patients peripheral bronchopulmonary deposition. Parenchymal aerosol deposition in pulmonary emphysema was diffuse (6/21), discrete(6/21), intermediate (3/21), or combined (6/21). In 12 patients studied also with perfusion scans, perfusion defects matched closely with ventilation defects in location and configuration. But the size of the ventilation defects was generally larger than the perfusion defects. In all four patients treated with bronchodilators, the follow-up study demonstrated decrease in abnormal of radioaerosol deposition in the central airway with improvement of ventilation defects. RII was useful technique for the evaluation of regional ventilatory abnormality and the effects of treatment with bronchodilators in pulmonary emphysema.

• 대한임상독성학회지
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• 제4권2호
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• pp.161-165
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• 2006

Organophosphate insecticides, commonly used in agriculture, are a gradually increasing cause of accidental and suicidal poisoning. Intoxication can occur by ingestion, inhalation or dermal contact. Exposure to organophosphorus agents causes a sequentially triphasic illness consisting of the cholinergic phase, the intermediate syndrome, and organophosphate-induced delayed polyneuropathy. Acute pancreatitis as a rare complication of organophosphate intoxication has also been infrequently observed. We report a case of intoxication with organophosphate (phos-phamidon) by parenteral exposure (inhalation and/or dermal contact). A 34-year-old male patient was transferred to our Emergency Medical Center and was intubated due to a progressive respiratory failure. He presented with meiotic pupils, cranial nerve palsies, weak respiration, and proximal limb motor weaknesses without sensory changes. He had been employed in filling syringes with phosphamidon during the previous month. Because the patient's history and symptoms suggested organophosphate intoxication with intermediate syndrome, he was mechanically ventilated for 18 days with continuous infusion of atropine and pralidoxime (total amounts of 159 mg and 216 g, respectively). During his admission, hyperamylasemia and hyperli-pasemia were detected, and his abdominal CT scan showed a finding compatible with acute pancreatitis. He was administered a conservative treatment with NPO and nasogastric drainage. The patient was discharged and showed neither gastrointestinal nor neurologic sequelae upon follow up at one week and three months.

• 한국임상수의학회지
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• 제33권1호
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• pp.6-9
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• 2016

Bronchoarterial (BA) ratio is a commonly used criterion to define airway dilatation despite the lack of normative human and animals. The objective of our study was to compare the range of normal bronchial to accompanying arterial diameter ratio with previous reports on CT scan of the thorax in dogs and assess influence anesthetics on BA ratio in dogs. Dogs undergoing multidetector CT scan of the chest for nonpulmonary conditions at a single center were prospectively identified. High-resolution reconstruction was performed on those included and both airway lumen and vessel diameters were measured in the lobar bronchi of the left cranial (cranial and caudal parts), right cranial, right middle, left caudal, and right caudal lung lobes. Eight dog were included; Mean of the mean BA ratios was $1.43{\pm}0.24$ (95% CI = 1.36 - 1.50) in inhalation anesthetic group. In propofol group, the mean of the mean BA ratios was $1.13{\pm}0.29$ (95% CI = 1.04 - 1.22). In medetomidine group, the mean of the mean BA ratios was $0.89{\pm}0.19$ (95% CI = 0.83 - 0.95). Comparing individual lobes within anesthetic category, there was no signicant difference in mean BA ratio between lung lobes or between dog according to inhalation, propofol, and medetomidine group (P = 0.630, P = 0.878, and P = 0.508, respectively). The BA ratio in these clinically normal dogs was consistent and may be a useful tool in evaluating for bronchiectasis on CT images. However, some different criteria for bronchiectasis were applied by the anesthetic methods.

• 한국의학물리학회지:의학물리
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• 제24권4호
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• pp.220-229
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• 2013

Respiratory-induced dynamic tumors render free-breathing cone-beam computed tomography (FBCBCT) images with motion artifacts complicating the task of quantifying the internal target volume (ITV). The purpose of this paper is to study the visibility of the revealed ITV when the imaging dose parameters, such as the kVp and mAs, are varied. The $Trilogy^{TM}$ linear accelerator with an On-Board Imaging ($OBI^{TM}$) system was used to acquire low-imaging-dose-mode (LIDM: 110 kVp, 20 mA, 20 ms/frame) and high-imaging-dose-mode (HIDM: 125 kVp, 80 mA, 25 ms/frame) FBCBCT images of a 3-cm diameter sphere (density=0.855 $g/cm^3$) moving in accordance to various sinusoidal breathing patterns, each with an unique inhalation-to-exhalation (I/E) ratio, amplitude, and period. In terms of image ITV contrast, there was a small overall average change of the ITV contrast when going from HIDM to LIDM of $6.5{\pm}5.1%$ for all breathing patterns. As for the ITV visible volume measurements, there was an insignificant difference between the ITV of both the LIDM- and HIDM-FBCBCT images with an average difference of $0.5{\pm}0.5%$, for all cases, despite the large difference in the imaging dose (approximately five-fold difference of ~0.8 and 4 cGy/scan). That indicates that the ITV visibility is not very sensitive to changes in imaging dose. However, both of the FBCBCT consistently underestimated the true ITV dimensions by up to 34.8% irrespective of the imaging dose mode due to significant motion artifacts, and thus, this imaging technique is not adequate to accurately visualize the ITV for image guidance. Due to the insignificant impact of imaging dose on ITV visibility, a plausible, alternative strategy would be to acquire more X-ray projections at the LIDM setting to allow 4DCBCT imaging to better define the ITV, and at the same time, maintain a reasonable imaging dose, i.e., comparable to a single HIDM-FBCBCT scan.