• 대한핵의학회:학술대회논문집
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• 1991.05a
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• pp.141.2-142
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• 1991

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.175-181
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• 1998

Objectives: The authors tried to analyze the results of carotid artery sacrifice with or without preoperative carotid evaluation. Materials and Methods: Thirteen patients undergone carotid sacrifice were evaluated. Carotid balloon occlusion test (BOT) and single-photon emission computed tomography (SPECT) with technetium-99m-labeled hexamethylpropyleneamineoxime ($^{99m}Tc-HMPAO$) were used for preoperative carotid evaluation. Results: The causes of carotid artery sacrifice consisted of the neck mass involving the carotid artery, spontaneous aneurysmal rupture, and traumatic pseudoaneurysm. Five patient had postoperative neurologic complications and two of them had permanent neurologic deficits. Conclusion: The authors stress that the preoperative evaluation in carotid artery sacrifice is imperable, and the BOT with SPECT can be used in selecting the method of treatment. But since these tests cannot predict the postoperative outcome perfectly, careful perioperative care of the patients should be exercised regardless of the results of the preoperative evaluation.

• The Korean Journal of Nuclear Medicine
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• v.27 no.1
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• pp.22-27
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• 1993

Drug abuse is widespread in worldwide and has been associated with neurologic complication. Zipeprol is one of the drugs which been abused for psychological satisfaction in some adolescents. This agent is non-opioid antitussive agent, which is not legally considered as being capable of creating dependence or abuse liability at therapeutic serum levels. But it has been reported that acute or chronic overdose create neurologic complication such as convulsion as well as dependence. Recently we experienced six zipeprol abusers who admitted due to convulsion and variable neurologic symptoms. The aim of our study was to determine the role of $^{99m}Tc$-HMPAO brain SPECT in those patients. EEG and brain CT showed no abnormal finding, but brain SPECT showed focal or multiple perfusion abnormalities in frontal, parietal, occipital cortex, basal ganglia, thalamus and especially at temporal cortex. These results suggest that brain SPECT may be a useful diagnostic tool to evaluate the cerebral dysfunction infused by zipeprol abuse.

• The Korean Journal of Nuclear Medicine
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• v.25 no.1
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• pp.6-16
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• 1991

Regional cerebral blood flow (rCBF) was evaluated in 12 children ranging in age from 2.7 to 10.0 yr using $^{99m}Tc-HMPAO$ SPECT. For quantitative analysis, 13 pairs of homologous regions of interest (ROIs) were created on three attenuation-corrected 18.8 mm thick transverse slices matching the cerebral cortical regions, deep gray matter, cerebellar hemisphere, and vascular territories, and the semiquantitative indices including "right to left ratio" [(mean count/voxel of homologous right ROI) / (mean count/voxel of homologous left ROI)] and "regional index"(RI) [(mean count/voxel of a ROI)/ (mean count/voxel of all ROIs of each hemisphere)] were calculated. Mean values of right to left ratios of homologous regions ranged from 0.984 to 1.028 in children under 5 yr (group 1) and from 0.982 to 1.012 in children between 5 and 10 yr (group 2), and the mean $value{\pm}2S.D.$ for each region did not exceed 11% and 12% in group 1 and group 2, respectively. There were no statistically significant differences between the RIs of the homologous right and left regions. Significant differences of RIs were found both between vascular regions (p<0.0005 for goup 1, and p=0.0001 for goup 2) and between regions of cerebral cortices (p<0.0005 for group 1, and p<0.005 for group 2) with a relatively high value in the occipital cortex and the lower values in the cerebellum and deep gray matter among the regions of cerebral cortices in both groups. There were no significant differences between the RIs of corresponding regions of group 1 and group 2, except a significantly higher value of right deep gray matter in group 2 than in group 1(p=0.0301). The RIs of the superior frontal cortex and deep gray matter showed to be positively correlated with age (superior frontal cortex; right: rs=0.5254, p=0.0814, left : rs=0.5919, p=0.0496/deep gray matter; right: rs=0.8246, p=0.0062, left: rs=0.6266, p=0.0377). The results suggest that the rCBF pattern of children approaches that of adults in an accipito-rostral direction. This time course of rCBF changes is in agreement with behavioral, neurophysiological, and anatomical alterations known to occur in the developing brain.

• The Korean Journal of Nuclear Medicine
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• v.32 no.1
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• pp.20-31
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• 1998

A robust algorithm to disclose and display the difference of ictal and interictal perfusion may facilitate the detection of ictal hyperfusion foci. Diagnostic performance of localizing epileptogenic zones with subtracted SPECT images was compared with the visual diagnosis using ictal and interictal SPECT, MR, or PET. Ietal and interictal Tc-99m-HMPAO cerebral perfusion SPECT images of 48 patients(pts) were processed to get parametric subtracted images. Epileptogenic foci of all pts were diagnosed by seizure free state after resection of epileptogenic zones. In subtraction SPECT, we used normalized difference ratio of pixel counts(ictal-interictal)/interictal ${\times}100%$) after correcting coordinates of ictal and interictal SPECT in semi-automatized 3-dimensional fashion. We found epileptogenic zones in subtraction SPECT and compared the performance with visual diagnosis of ictal and interictal SPECT, MR and PET using post-surgical diagnosis as gold standard. The concordance of subtraction SPECT and ictal-interictal SPECT was moderately good(kappa=0.49). The sensitivity of ictal-interictal SPECT was 73% and that of subtraction SPECT 58%. Positive predictive value of ictal-interictal SPECT was 76% and that of subtraction SPECT was 64%. There was no statistical difference between sensitivity or positive predictive values of subtraction SPECT and ictal-interictal SPECT, MR or PET. Such was also the case when we divided patients into temporal lobe epilepsy and neocortical epilepsy. We conclude that subtraction SPECT we produced had equivalent diagnostic performance compared with ictal-interictal SPECT in localizing epileptogenic zones. Additional value of these subtraction SPECT in clinical interpretation of ictal and interictal SPECT should be further evaluated.

• The Korean Journal of Nuclear Medicine
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• v.23 no.2
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• pp.155-163
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• 1989

Regional cerebral perfusion was evaluated in 15 normal controls by single photon emission computed tomography using $^{99m}Tc$ HM-PAO. For quantitative analysis, 13 pairs of homologous region of interest (ROI) were drawn on three transverse slices matching the vascular territories and cerebral cortices, and normal values of 3 semiqunatitative indices including 'Right to left ratio'(R/L ratio), 'Regional index'(RI), and 'Region to cerebellum ratio'(R/cbll ratio) were calculated. Mean values of R/L ratios of homotogous regions were ranged from 0.985 to 1.023, and mean ${\pm}2$ s.d. of all regions did not exceed 11% of mean. Significant difference of RIs (mean count per voxel of a ROI/mean count per voxel of total ROIs) between regions were found (p<0.001) with highest values in occipital cortex and cerebellum. After attenuation correction, RIs in deep gray, cranial portion of anterior cerebral artery and vascular territories in the 2nd slice increased significantly (p < 0.05-0.001), but vise versa in other ROIs. Region to cerebellum ratios also showed regional difference similar to RIs.

• The Korean Journal of Nuclear Medicine
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• v.31 no.3
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• pp.330-338
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• 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
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• v.28 no.3
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• pp.307-312
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• 1994

Interictal single photon emission computed tomography of regional cerebral blood flow (rCBF SPECT) in 18 intractable temporal lobe epilepsy patients(8 male and 10 female patients: average 23.5 years old) were compared with 2.0 T magnetic resonance imaging (MRI). And surgical outcome was analysed with the findings, symptom duration and lateralization of temporal lobe. Preoperatively rCBF SPECT was done in all 18 patients with intravenous injection of 740 MBq 99mTc-HMPAO. MRI was also done preoperatively in 13 patients. Surgical outcome was classified by Engel's outcome classification(four-part classification recommended at the first Palm Desert conference). rCBF SPECT detected correctly lateralising abnormality of temporal lobe hypoperfusion in 13/18(72.2%), contralateral temporal lobe hypoperfusion in 2/18(11.1%) and showed no def-inite abnormality in 3/18(16.7%). The positive predictive value of unilateral temporal lobe hypoperfusion was 87%. MRI detected correct localising abnormality in 8/13(61.5%), such as hippocampal atrophy(7/13), asymmetric temporal horn(6/13), anterior temporal lobe atrophy(1/13), increased signal intensity from hippocampus(1/13) and calcific density(1/13), and no abnormal finding was noted in 5/13(38.5%). There was no false positive findings and the positive predictive value of MRI was 100%. Only 2 cases showed same lateralization findings in rCBF SPECT and MRI. There was no significant correlation between symptom duration and no abnormal findings on SPECT or MRI. Surgical outcome showed class I in 15/18(83.3%), and class II in 2/18(11.1%). One case of no abnormal finding in both SPECT and MRI showed class III surgical outcome. No class IV surgical outcome was noted. Surgical outcome, lateralization of epileptic focus in temporal lobe and abnormal findings in rCBR SPECT or MRI were not significantly correlated.

• The Korean Journal of Nuclear Medicine
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• v.30 no.4
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• pp.463-468
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• 1996

본 연구는 간질 병소의 국소화에 있어 발작기 및 발작간 뇌스캔의 정확도를 알아보고 발작기 뇌 스캔에서 나타나는 간질 확산이 정확한 간질 병소를 국소화 하는데 어떠한 영향을 미치는가에 대하여 알아보고자 하였다. 15명의 복잡 부분 발작 환자를 대상으로 하였으며, 간질 병소의 최종적인 국소화는 두피 및 발작 뇌파, 피질 뇌파, 자기 공명 영상, 임상양상 및 병리 소견을 종합한 근거로 하였다. 발작기 뇌스캔은 뇌파상 발작 중 또는 환자가 aura를 호소할 때 Tc-99m HMPAO 20mCi(740 MBq)를 정맥주입후 시행하였으며 발작간 뇌스캔은 발작기 뇌스캔 후 3일 이내 임상적으로 발작 증상이 없는 기간에 시행하였다. 간질 병소는 우측 측두엽이 8예, 좌측 측두엽이 6예, 측두엽 이외의 기원이 1예 였다. 발작기 뇌스캔상, 모두 11예(73.3 %)에서 단발성 또는 다발성 섭취 증가가 간질 병소 및 간질확산 부위에서 관찰되었으며, 간질 병소에만 국한된 섭취 증가는 4예(26.7%)에 불과 하였다. 발작간 뇌스캔에는 모두 11예(73.3 %)에서 간질 병소에만 섭취가 감소되었다. 자기 공명 영상에서는 8예(53.3 %)에서 hippocampal sclerosis를 포함한 간질 병소가 확인되었다. 본 연구로 복잡 부분 발작 환자에서, 간질 확산이 발작기 뇌 스캔 중 자주 관찰됨을 알 수 있었으며, 이러한 간질 확산에 따른 다발성 방사능 섭취가 발작기 뇌스캔상, 간질 병소의 국소화에있어 한계가 있음을 결론 내릴 수 있었다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.20 no.3
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• pp.122-128
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• 2009

Objectives : Autism is a well-known psychiatric disorder that is presumed to have a neural basis. To investigate the underlying neurofunctional abnormalities of autism, the authors performed single photon emission computed tomography (SPECT) on children with autism. Methods : Fifty-five children with untreated autism (47 boys and 8 girls, mean age=$50.6{\pm}20.28$ months) were selected from among the patients visiting the child and adolescent psychiatric clinic of Seoul National University Hospital. Psychiatrists had diagnosed the participants according to the DSM-IV criteria for autistic disorder and the Childhood Autism Rating Scale (CARS) criteria for a diagnosis of autism. All participants were examined using 99mTC-HMPAO Brain SPECT. Using statistical parametric mapping (SPM) analysis, we compared the participants' SPECT images to standardized SPECT images of normal children, which had been retrospectively selected by the authors, on a voxel by voxel basis. Voxels with a p-value less than .001 were considered to be significantly different. Results : The autistic group showed significant hypoperfusion in the right medial frontal gyrus, right precentral gyrus, and left precuneus gyrus. In addition, they showed no significant hyperperfusion areas when compared to the control group. Conclusion : The findings of hypoperfusion in the medial-frontal lobe and precuneus are accord with hemodynamic abnormalities that have been already reported. Therefore, these findings are compatible with the recently suggested "theory of mind" hypothesis and the disturbances in attention shifting that have been observed in autistic children.