• Tuberculosis and Respiratory Diseases
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• v.71 no.6
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• pp.425-430
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• 2011

Background: High 2-[$^{18}F$] fluoro-2-deoxy-D-glucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT) is a prognostic factor for poor survival in non-small cell lung cancer (NSCLC), especially in Stage I. We determined whether the high FDG uptake value of a primary tumor was associated with recurrence and death in patients with resected Stage I and Stage II NSCLC. Methods: We identified consecutive patients who underwent complete surgical resection for Stage I and II NSCLC between 2006 and 2009, who had preoperative PET-CT, and reviewed clinical records retrospectively. FDG uptake was measured as the maximal standardized uptake value (SUVmax) for body weight. Patients were divided into two groups based on SUVmax: (i) above or (ii) below the cut-off value (SUVmax=5.9) determined by a receiver operating characteristic (ROC) curve. Results: Of 57 patients who were enrolled consecutively, 32 (56%) had Stage I NSCLC and 25 (44%) had Stage II. The 5-year recurrence-free survival (RFS) for patients with high (${\geq}5.9$) and low (<5.9) SUVmax were 31% and 57%, respectively (p=0.014). The 5-year overall survival (OS) rates were 39% and 60%, respectively (p=0.029). In univariate analyses, SUVmax (p=0.014), T staging (p=0.025), and differentiation of tumor tissue (p=0.034) were significantly associated with RFS. But, multivariate analyses did not show that SUVmax was an independently significant factor for RFS (p=0.180). Conclusion: High FDG uptake on PET-CT is not an independent prognostic factor for poor outcomes (disease recurrence in patients with resected Stage I and II NSCLC).

• Tuberculosis and Respiratory Diseases
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• v.43 no.5
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• pp.720-727
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• 1996

Objectives: $^{201}TI$ - chloride, $^{99m}Tc$ - MIBI, $^{99m}Tc$(V) - DMSA SPECT has been used in distinguishing lung cancer from benign lesion. To compare the diagnostic efficacy of SPECT with these tumor - seeking agents, we perfonned three consecutive SPECT using $^{201}TI$, $^{99m}Tc$ - MIBI, $^{99m}Tc$(V) - DMSA in same subjects with a solitary pulmonary lesion. Methods: SPECT was carried out at 10min and 3hr for $^{201}TI$ after injection of 20mCi, and 2hr for $^{99m}Tc$ - MIBI and $^{99m}Tc$(V) - DMSA after injection of 20mCi, respectively, in 37 patients with a solitary pulmonary lesion(27 lung cancer and 10 benign diseases). In patients showing visual uptake on lesion site, we obtained the lesion - to - background(target lesion/contralateral normal lung) uptake ratio from transverse slice for each radionuclide and also calculated the retention index for $^{201}TI$. Results: The diagnostic sensitivity of $^{201}TI$, $^{99m}Tc$ - MIBI and $^{99m}Tc$(V) - DMSA SPECT to lung cancer was 100%, 96% and 73%, and the specificity was 40%, 70% and 70%, respectively. The low specificities for these agents were mainly due to high positive uptake in patients with active pulmonary tuberculosis. There were no significant differences in uptake ratios and retention index between malignant and benign lesions, and among the histologic types of lung cancer. Conclusion : $^{201}TI$ and $^{99m}Tc$ - MIBI showed higher sensitivity than $^{99m}Tc$(V) - DMSA for detecting lung cancer, but was of limited usefulness in distinguishing lung cancer from benign lesion due to low specificity, especially in area with a high prevalence of active pulmonary tuberculosis.

• Journal of Chest Surgery
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• v.2 no.1
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• pp.25-40
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• 1969

Lung homotransplantation was performed in 15 pairs of dog. Methotrexate and R.E.S. blocking were used to prolong the survival time. Details of handling the transplant, operative technique and management of the recipient were discussed and following results were obtained: 1]. 7 dogs out of 15 dogs of homotransplantation of lung were survived beyond 3 days. In the group of dogs treated with methotrexate, the average survival was 8.5 days, and in the group of dogs treated with R.E.S. blocking, the average survial was 9.7 days with longest survival of 17 days. 2]. The causes of immediate postoperative death in homotransplantation of dogs were lung edema and disruption of bronchial anastomosis. 3]. The main causes of death in successful homotransplantation dogs which were survived beyond 3 days were infection of lung parenchyma and bronchial necrosis rather than the occurence of graft rejection. 4]. Graft rejection was not revealed even after 7 days of operation in the group treated with methotrexate as well as in the group treated with R. E.S. blocking. This finding made it suggest that the R. E.S. blocking may be effective to control the rejection reaction. 5]. Even though the pulmonary function of transplanted lung was revealed the evidence of severe impairment immediate after operation by bronchospirometry, it was increased gradually and 10 days after operation the minute ventilation and oxygen uptake were decreased 8%, 13% respectively less than pre-operative one.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.115-121
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• 2010

Purpose: The purpose of this study is to measure F-18 FDG with two different types of dose calibrator measuring radionuclide and radioactivity and investigate the effect of F-18 FDG on SUV (Standard Uptake Value) in human body. Materials and Methods: Two different dose calibrators used in this study are CRC-15 Dual PET (Capintec) and CRC-15R (Capintec). Inject 1 mL, 2 mL, 3 mL of F-18 FDG into three 2 mL syringes, respectively, and measure initial radioactivity from each dose calibrator. Then measure and record radioactivity at 30 minute interval for 270 minutes. According to the initial radioactivity, linearity between decay factor driven from radioactive decay formula and the values measured by dose calibrator have been analyzed by simple linear regression. Fine linear regression line optimizing values measured with CRC-15 through regression analysis on the basis of the volume of which the measured value is close to the most ideal one in CRC-15 Dual PET. Create ROI on lung, liver, and region part of 50 persons who has taken PET/CT test, applying values from linear regression equation, and find SUV. We have also performed paired t-test to examine statistically significant difference in the radioactivity measured with CRC-15 Dual PET, CRC-15R and its SUV. Results: Regression analysis of radioactivity measured with CRC-15 Dual PET and CRC-15R shows results as follows: in the case 1 mL, the r statistic representing correlation was 0.9999 and linear regression equation was y=1.0345x+0.2601; in 2 mL case, r=0.9999, linear regression equation y=1.0226x+0.1669; in 3 mL case, r=0.9999, linear regression equation y=1.0094x+0.1577. Based on the linear regression equation from each volume, t-test results show significant difference in SUV of ROI in lung, liver, region part in all three case. P-values in each case are as follows: in 1 mL case, lung, liver and region (p<0.0001); in 2 mL case, lung (p<0.002), liver and region (p<0.0001); in 3 mL case, lung (p<0.044), liver and region (p<0.0001). Conclusion: Radioactivity measured with CRC-15 Dual PET, CRC-15R, dose calibrator for F-18 FDG test, do not show difference correlation, while these values infer that SUV has significant differences in the aspect of uptake in human body. Therefore, it is necessary to consider the difference of SUV in human body when using these dose calibrator.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.1
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• pp.82-85
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• 2009

Purpose: The purpose of this study was to evaluate the effect of extended CT field of view (FOV) on PET/CT of Standardized uptake value (SUV) when imaging extends beyond the CT FOV. Materials and Methods: CT images were reconstructed at different FOV sizes (500 and 700 mm). Two sets of CT images were reconstructed from the CT projection data by using two FOV sizes. Twenty patients were used in this study. PET images were reconstructed using attenuation maps with 500 mm CT FOV and 700 mm extended CT FOV images. Region of interests (ROIs) drawn on the PET images. In addition, twenty patients' PET images reconstructed by 500 mm CT FOV and 700 mm extended CT FOV were compared with $SUV_{max}$. Results: When using attenuation maps with 700 mm extended CT FOV, the $SUV_{max}$ analysis of liver (p=0.000), lung (p=0.007), mediastinum (p=0.001) were statistically significant. Conclusions: 700 mm extended CT FOV helps to recover the true activity distribution in the PET emission data. In addition, 700 mm extended CT FOV has affected SUV measurement of liver, lung, mediastinum.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.4
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• pp.366-367
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• 2009

Ga-67 scintigraphy demonstrated increased uptake in the lungs and stomach in a 26-year-old man with hypercalcemia. A primitive neuroectodermal tumor was confirmed by bone marrow examination. Tc-99m MDP uptake in the same locations as Ga-67 revealed by bone scintigraphy was consistent with metastatic calcification. Although the mechanism of Ga-67 uptake in metastatic calcification is not understood, the presence of an inflammatory process is suggested.

• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.218-222
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• 1993

Lung/heart uptake ratio (L/H R) in $^{201}Tl$ myocardial perfusion scan is a reliable marker for long-term prognosis in patients with coronary artery disease. However, the value of L/H R in $^{99m}Tc-MIBI$ myocardial perfusion scan is controversial in determining the prognosis and severity of the coronary artery disease. The purpose of this study was to determine the clinical implications of L/H R in $^{99m}Tc-MIBI$ myocardial perfusion scan. Forty five patients who received $^{99m}Tc-MIBI$ myocardial perfusion scan were divided into control group and coronary artery disease (CAD) group by their clinical findings, EKGs, and $^{99m}Tc-MIBI$ myocardial perfusion scans. Twenty five patients in CAD group were divided into ischemic group and infarct group according to their results from $^{99m}Tc-MIBI$ myocardial perfusion scan. L/H R was calculated on the anterior planar view, 60 minutes after infusion of dipyridamole. Two regions of interest (ROI) were placed on the left lung area 8 pixel above the left ventricle and on the myocardial area which had the highest radioactivity. In the control group, there were no significant differences of L/H R according to sex and age. No significant difference of L/H R was found between the control and CAD group ($0.26{\pm}0.06,\;0.29{\pm}0.05$, p>0.05). In the CAD group, there was also no significant difference of L/H R between the ischemic group and infarct group ($0.29{\pm}0.07,\;0.30{\pm}0.04$, p>0.05). L/H R in CAD group did not show correlations with the defect area of stress polar map (r=0.18, p >0.05) and with the sum of severity weighted extent score or reversibility score which represent severity and extent of myocardial perfusion defect area in stress (r=0.18, p>0.05). We conclude that it is difficult to use L/H R as a marker for severity of CAD in dipyridamole $^{99m}Tc-MIBI$ myocardial perfusion scan.

• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.315-318
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• 1993

We experienced 7 cases of patients who were performed $^{99m}Tc$-methylene diphosphonate bone scintigraphy for the evaluation of diseases they had. Their bone scintigrams showed incidental radionuclide uptake in the gastrointestinal tracts and they had no special symptom or sign attributable to the findings. Case 1 showed radionuclide uptake in the stomach and both lung and the patient had suffered from hypercalcemia and azotemia. Case 3 and case 6 showed diffuse radionuclide uptake in the stomach and intestinal tract. Others showed diffuse or regional radionuclide uptake in the intestinal tracts. Radionuclide uptake in the gastrointestinal tract by $^{99m}Tc$-methylene diphosphonate is caused by a certain pathologic lesion but also can be seen in the normal gastrointestinal tract. So, one who reads bone scintigrams should be alert for the pathologic lesion in the gastrointestinal tract although one must interpretate with the concept of this normal variations.

• Radiation Oncology Journal
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• v.31 no.3
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• pp.111-117
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• 2013

Purpose: To determine whether the maximum standardized uptake value (SUV) of [$^{18}F$] fluorodeoxyglucose uptake by positron emission tomography (FDG PET) ratio of lymph node to primary tumor (mSUVR) could be a prognostic factor for node positive non-small cell lung cancer (NSCLC) patients treated with definitive radiotherapy (RT). Materials and Methods: A total of 68 NSCLC T1-4, N1-3, M0 patients underwent FDG PET before RT. Optimal cutoff values of mSUVR were chosen based on overall survival (OS). Independent prognosticators were identified by Cox regression analysis. Results: The most significant cutoff value for mSUVR was 0.9 with respect to OS. Two-year OS was 17% for patients with mSUVR > 0.9 and 49% for those with mSUVR ${\leq}0.9$ (p = 0.01). In a multivariate analysis, including age, performance status, stage, use of chemotherapy, and mSUVR, only performance status (p = 0.05) and mSUVR > 0.9 (p = 0.05) were significant predictors of OS. Two-year OS for patients with both good performance (Eastern Cooperative Oncology Group [ECOG] ${\leq}1$) and mSUVR ${\leq}0.9$ was significantly better than that for patients with either poor performance (ECOG > 1) or mSUVR > 0.9, 23% (71% vs. 23%, p = 0.04). Conclusion: Our results suggested that the mSUVR was a strong prognostic factor among patients with lymph node positive NSCLC following RT. Addition of mSUVR to performance status identifies a subgroup at highest risk for death after RT.

• Korean Journal of Radiology
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• v.23 no.1
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• pp.112-123
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• 2022

Objective: To investigate the relationship between ¹⁸F-FDG PET/CT semi-quantitative parameters and the International Association for the Study of Lung Cancer, American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histopathologic classification, including histological subtypes, proliferation activity, and somatic mutations. Materials and Methods: This retrospective study included 419 patients (150 males, 269 females; median age, 59.0 years; age range, 23.0-84.0 years) who had undergone surgical removal of stage IA-IIIA lung adenocarcinoma and had preoperative PET/CT data of lung tumors. The maximum standardized uptake values (SUVmax), background-subtracted volume (BSV), and background-subtracted lesion activity (BSL) derived from PET/CT were measured. The IASLC/ATS/ERS subtypes, Ki67 score, and epidermal growth factor/anaplastic lymphoma kinase (EGFR/ALK) mutation status were evaluated. The PET/CT semi-quantitative parameters were compared between the tumor subtypes using the Mann-Whitney U test or the Kruskal-Wallis test. The optimum cutoff values of the PET/CT semi-quantitative parameters for distinguishing the IASLC/ATS/ERS subtypes were calculated using receiver operating characteristic curve analysis. The correlation between the PET/CT semi-quantitative parameters and pathological parameters was analyzed using Spearman's correlation. Statistical significance was set at p < 0.05. Results: SUVmax, BSV, and BSL values were significantly higher in invasive adenocarcinoma (IA) than in minimally IA (MIA), and the values were higher in MIA than in adenocarcinoma in situ (AIS) (all p < 0.05). Remarkably, an SUVmax of 0.90 and a BSL of 3.62 were shown to be the optimal cutoff values for differentiating MIA from AIS, manifesting as pure ground-glass nodules with 100% sensitivity and specificity. Metabolic-volumetric parameters (BSV and BSL) were better potential independent factors than metabolic parameters (SUVmax) in differentiating growth patterns. SUVmax and BSL, rather than BSV, were strongly or moderately correlated with Ki67 in most subtypes, except for the micropapillary and solid predominant groups. PET/CT parameters were not correlated with EGFR/ALK mutation status. Conclusion: As noninvasive surrogates, preoperative PET/CT semi-quantitative parameters could imply IASLC/ATS/ERS subtypes and Ki67 index and thus may contribute to improved management of precise surgery and postoperative adjuvant therapy.