• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.1
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• pp.27-32
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• 2008

Purpose: The evaluation of SUV (Standardized Uptake Values) for quantitative analysis in PET exam is the most significant. In PET exam, we make attenuation correction images by using $^{68}Ge$, $^{137}Cs$ or CT data. At this time, a distorted attenuation map affects quantitative analysis. After the exam using barium-sulfate and high density of barium contrast make attenuation map distorted. And then it brings bed influences on SUV. The aim of this study is to verify the relationship between high density barium-sulfate and SUV in PET exam. Materials and Methods By using $^{18}F$-FDG, we made barium-sulfate powder, density of 0, 1.5, 3, 5, 10 and 15% respectively and acquired PET and PET/CT images per each density. And we examined SUV variations from PET and PET/CT images according to differences of barium's density. Moreover, we finally calculated SUV causing variations in HU (Hounsfield Units) values to justify whether the differences of barium density bring any changes in PET/CT exam. Results: From PET images acquired from transmission scan with $^{68}Ge$, we got SUV figures from 6.46 to 6.8 in barium density between 0 to 15 percent. On the other hand, In PET images acquired from Tx scan that using CT, SUV was 6.77 to 23.73, derived from the same barium density. And CT HU values range from 29 to 2004. Conclusion: PET images from Tx data using $^{68}Ge$ weren't affected by barium density and had no differences in SUV. But in the PET/CT images using CT Tx data, there's considerable variations in HU and SUV values according to a difference of barium density in HU values. To perform a precise examination, barium sulfate should be removed from a human body before performing a PET exam.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.58-62
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• 2003

Purpose: To evaluate the efficacy of positron emission tomography with 2-[F-18] fluoro-2-deoxy-D-glucose in discrimination of response in the nasopharyngeal carcinoma patients who treated with radiotherapy. Methods and Materials: Twenty-four patients who underwent FDG-PET scan before and after radiotherapy for no disseminated head and neck carcinoma at the Asan Medical Center between August 2001 and September 2002 were evaluate by prospective analysis. First FDG-PET scan performed before radiotherapy within 1 month, and second FDG-PET scan performed 1 month after radiotherapy. FDG-PET images were analyzed by standard uptake value (SUV). Follow-up period was more than 6 months. Results: The pretreatment SUV was 3.4-14.0 (median: 6.0) and posttreatment SUV was ground level-7.7 (median: 2.0). The overall sensitivity and specicity of FDG-PET to evaluate residual tumors in the nasopharyngeal carcinoma patients were 94% and 94%. Conclusion: FDG-PET is effective in evaluation of radiation response in the nasopharyngeal carcinoma. We think that the timing of one month after finished radiotherapy FDG-PET scan was not too fast to evaluation of radiation response.

• Korean Journal of Digital Imaging in Medicine
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• v.15 no.1
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• pp.55-59
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• 2013

Patients who had claustrophobia tend to feel fear when they were scanned by an MRI, CT, PET-CT, or using a gamma camera scan. In this paper, claustrophobic patients were tested to find effective ways by changing patient's positions. For this paper, PET-CT scan in patients who had claustrophobia were used in the prone position. Prone position helped to maintain stable position and to get a h0igh quality of inspection without failure. Thus, as claustrophobic patients were requested taking prone position, they could feel comfortable. In a confined space, prone position for the claustrophobic patients who had a fear of the PET-CT examination would be expected to reduce the failure rate of inspection.

• Journal of Radiopharmaceuticals and Molecular Probes
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• v.1 no.2
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• pp.130-136
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• 2015

We evaluate the influence of MR contrast agent on positron emission tomography (PET) image using phantom, animal and human studies. Phantom consisted of 15 solutions with the mixture of various concentrations of Gd-based MR contrast agent and fixed activity of [$^{18}F$]FDG. Animal study was performed using rabbit and two kinds of MR contrast agents. After injecting contrast agent, CT or MRI scanning was performed at 1, 2, 5, 10, and 20 minutes. PET image was obtained using clinical PET/CT scan, and attenuation correction was performed using the all CT images. The values of HU, PET activity and MRI intensity were obtained from ROIs in each phantom and organ regions. In clinical study, patients (n=20) with breast cancer underwent sequential acquisitions of early [$^{18}F$]FDG PET/CT, MRI and delayed PET/CT. In phantom study, as the concentration increased, the CT attenuation and PET activity also increased. However, there was no relationship between the PET activity and the concentration in the clinical dose range of contrast agent. In animal study, change of PET activity was not significant at all time point of CT scan both MR contrast agents. There was no significant change of HU between early and delayed CT, except for kidney. Early and delayed SUV in tumor and liver showed significant increase and decrease, respectively (P<0.05). Under the condition of most clinical study (< 0.2 mM), MR contrast agent did not influence on PET image quantitation.

• The Korean Journal of Nuclear Medicine Technology
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• v.19 no.2
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• pp.63-67
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• 2015

Purpose Among various causes that influence image quality degradation, various methods for decrease in Artifact occurred by respiration of patients are being used. Among them, this study intended to evaluate CTAC Shift correction method and additional scan compare to the Scan(Q static scan) using respiratory gated system. Materials and Methods This study was conducted on 10 patients, and used PET-CT Discovery 710 (GE Healthcare, MI, USA) and Varian's RPM system. 5.18 Mbq per kg of $^{18}F$-FDG was injected on patients, asked them to take a rest for 1 hour in the bed, and conducted test after urination. Images were visualized through Q static scan, CTAC Shift correction method, Additional scan based on the Whole body scan(WBS) with Artifact. Decrease in Artifact was compared in each image, conducted Gross Evalution, and measured changes of SUVmax. Results For image obtained through the CTAC Shift correction method through WBS with Artifact, 12~56%, Q static scan image showed 17~54% of change rate and Additional Scan showed -27~46% of change rate. In Blind Test, the CTAC Shift correction image showed the highest point with 4 points, Q static scan image showed 3.5 points, and Additional scan image showed 3.4 points. The standardized WBS scan through Oneway ANOVA and three types of Scan method showed significant difference(p<0.05), and did not show significant difference between the three Scan methods(p>0.05). However, the three Scan methods showed significant difference in Blind test. Conclusion Additional scan and Q static scan require more time than the CTAC Shift correction method, there is concern about excessive exposure to patients by CT rescan and Q static scan is difficult to apply on patients with inconsistent respiration or irregular respiration cycle due to pain. For CTAC Shift correction method, limited correction is possible and the range is limited as well. It is considered as a useful method of improving diagnostic value when hospitals use the system appropriately and develop various advantageous factors of each method.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.4
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• pp.361-362
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• 2009

We present a patient with high $^{18}$F-fluorodeoxyglucose (FDG) uptake detected in a neurofibroma that was confused with sarcomatous transformation on a positron emission tomography/computed tomography (PET/CT) scan. A 39-year-old male patient with a 20-year history of neurofibromatosis-1 (NF-1) performed FDG PET/CT scan for the evaluation of lesions with sarcomatous transformation. The FDG PET/CT images demonstrated varying degrees of increased FDG uptake in the multiple nodules throughout whole body. The left pelvic mass with the highest FDG uptake had a maximum standardized uptake values (maxSUV) 5.0 and surgical resection was performed. Histological analysis confirmed the presence of a benign neurofibroma infiltrated with inflammatory cells.

• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.2
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• pp.21-25
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• 2011

Purpose: $^{18}F$-FDG Fusion Whole Body PET scan is performed approximately 1 hour after injecting $^{18}F$-FDG. At this point in the injection procedure, as a tool of the criteria of time input, time of clocks or computers can be used and in the scan procedure, time of workstation can be used. In case that synchronized time input is not done in the injection and scan procedures for PET scan, time error from injection to scan can occur. This time error may affect Standard Uptake Value (SUV) being used as quantitative assessment. Therefore, in this study, we analyzed the change of SUV according to time input difference and necessity of time synchronization. Materials and Methods: The analysis was performed to 30 patients ($54.8{\pm}15.5$ years old) who examined $^{18}F$-FDG Fusion Whole Body PET scan in Department of nuclear medicine, Asan Medical Center from December 2009 to February 2010. To observe the change of SUV according to time input difference, the image was reconstructed and analyzed by artificially changing time difference of 1, 2, 3, 5, 10, 20 min against the same patients based on 60 minutes. Result: SUV of the image that reconstructed the images of 30 patients by giving intervals of 1, 2, 3, 5, 10, 20 min respectively and the image that entered original time was compared and analyzed through paired t-test. Based on 0 minute, mean SUV of aorta was changed by 0.3, 1.1, 1.4, 3.2, 4.7, 12.5% respectively and there was no statistically significant difference in 1, 2 minutes (p>0.05) but there was significant difference in 3, 5, 10, 20 min (p<0.05). The changes of $SUV_{avg}$ of liver were 1.6, 2.5, 3.0, 4.2, 6.6, 12.8% in 1, 2, 3, 5, 10, 20 min respectively and the changes of $SUV_{max}$ of primary lesion were 1.0, 1.5, 2.2, 3.5, 6.6, 12.8% respectively (p<0.05). Conclusion: Errors may occur in the process of measuring or recording variables affecting SUV such as height and weight of patients, $^{18}F$-FDG dose, Emission scan start time etc. and as these errors are more, the accurate assessment of SUV is interfered. Therefore, in order to assess SUV more accurately, it is thought that efforts to minimize these errors should be made. Of these efforts, time synchronization will be a cornerstone for accurate scanning.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.314-317
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• 2002

The purpose of this study was to evaluate the clinical application of Patlak tool on GE PET workstation for quantitative analysis of dynamic PET images in cardiac patients. Three patients including coronary artery disease (CAD), myocardial infarction (MI), and angina were studied. All subjects underwent dynamic cardiac PET scan using a GE Advance scanner. After 10 min transmission scan for attenuation correction using two rotating $\^$68/Ge rod sources, three patients with cardiac disease were performed dynamic cardiac PET scan after the administration of approximately 370 MBq of FDG. The dynamic scan consisted of 36 frames with variable frame length (12${\times}$10s, 6${\times}$20s, 6${\times}$60s, 12${\times}$300s) for a total time of 70 min. Blood samples were obtained to determine the plasma substrate concentration. Region of interest of circular and rectangular shape to acquire input functions and tissue data were placed on left ventricle and myocardium. A value of 0.67 was used for lumped constant. Mean plasma substrate concentrations for three patients were 100 mg/dl (CAD), 100 mg/dl (MI), 132 mg/dl (angina), respectively. Regional MMRGlc values (mean${\pm}$SD) at lateral myocardium area for CAD, MI, and angina were 8.43${\pm}$0.24, 4.08${\pm}$0.16, and 6.15${\pm}$0.23 mg/min/100ml, respectively. Patlak tool on GE PET workstation appeared to be useful for quantitative analysis of dynamic PET images in cardiac patients, although further studies may be required for absolute quantitation.

• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.3
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• pp.184-191
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• 2008

Purpose: To evaluate the degree of malignancy of incident thyroid lesion found in $^{18}F$-FDG PET/CT findings and the usefulness of the method suggested in this study, we applicate the Delay Scan Method that differentiate a false positive benign tumor, inflammation and malignancy, as well as make the criteria of SUV. Materials and Methods: A retrograde study was conducted of 800 patients who were admitted in E hospital to receive $^{18}F$-FDG PET/CT examination. One patient who was diagnosed as primary thyroid cancer and received $^{18}F$-FDG PET/CT examination was excluded. The number of final patients of this study was 799, the reasons of $^{18}F$-FDG PET/CT examination of these patients were follow-up of old cancer or suspicious tumorous lesion in 696 and disease screening in 103. $^{18}F$-FDG PET/CT image photographing was taken in Biograph-Duo made by SIEMENS, after taking normal $^{18}F$-FDG PET/CT image (1 hr) and then 1 hr later we took the thyroid 1 bed-delayed image for the patients who showed abnormal thyroid $^{18}F$-FDG uptake and above 2.0 SUV for 2 minutes every 1 bed. For the patients who showed abnormal thyroid uptake and above 2.0 SUV, 1 hr later, we took a 1 bed-delayed image and then made a comparative study between measured $SUV_{max}$ of 1 hr-abnormal uptake image and that of 2 hr-delayed image. Results and Conclusion: In this $^{18}F$-FDG PET/CT study among the patients who showed incidental $^{18}F$-FDG thyroidal uptake the number of thyroid incidentaloma was 5 (0.63%), all of then showed benign findings. And in the case of incidental $^{18}F$-FDG uptake in thyroid, $SUV_{max}$ variance obtained from 2 hr delayed image can be a indirect criteria in differentiating benign tumor from malignancy and decrease finding error. In the cases found thyroid incidentaloma when 1) $SUV_{max}$ of focal thyroid lesion is above 5.0 and 2) $SUV_{max}$ variance between normal $^{18}F$-FDG PET/CT exam and 2 hr delayed is $1.0{\pm}0.5$, they are suspected as malignancy and confirming biopsy is to be followed. Otherwise, I also think that distinct follow-up PET or CT image study is a reasonable diagnostic method.

• The Korean Journal of Nuclear Medicine
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• v.33 no.5
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• pp.439-451
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• 1999

Purpose : It is important to differentiate malignant from benign lesions of intraocular masses in choosing therapeutic plan. Biopsy of intraocular tumor is not recommended due to the risk of visual damage. We evaluated the usefulness of F-18-FDG PET imaging in diagnosing intraocular neoplasms. Materials and Methods: F-18-FDG PET scan was performed in 13 patients (15 lesions) suspected to have malignant intraocular tumors. There were 3 benign lesions (retinal detachment, choroidal effusion and hemorrhage) and 10 patients with 12 malignant lesions (3 melanomas, 7 retinoblastomas and 2 metastatic cancers). Regional eye images ($256{\times}256$ and $128{\times}128$ matrices) were obtained with or without attenuation correction. Whole body scan was also performed in eight patients (3 benign and 6 malignant lesions). Results: All malignant lesions were visualized while all benign lesions were not visualized. The mean peak standardized uptake value (SUV) of malignant lesions was $2.64{\pm}0.57g/ml$. There was no correlations between peak SUV and tumor volume. Two large malignant lesions ($> 1000 mm^3$) showed hot uptake on whole body scan. But two medium-sized lesions ($100-1000mm^3$) looked faint and two small ($<100mm^3$) lesions were not visualized. The images reconstructed with $256{\times}256$ matrix showed lesions more clearly than those with $128{\times}128$ matrix Conclusion: F-18-FDG PET scan is highly sensitivity in detecting malignant intraocular tumor For the evaluation of small-sized intraocular lesions, whole body scan is not appropriate because of low sensitivity. A regional scan with sufficient acquisition time is recommended for that purpose. Image reconstruction in matrix size of $256{\times}256$ produced clearer images than the ones in $128{\times}128$, but it does not affect the diagnostic sensitivity.