• Nuclear Medicine and Molecular Imaging
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• v.43 no.6
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• pp.557-564
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• 2009

Purpose: To evaluate the relationship between F-18 FDG uptake of tumor in PET/CT scan and pathological or immunohistochemial parameters of colorectal cancer. Materials and Methods: 147 colorectal cancer patients who underwent both pre-operative F-18 FDG PET/CT scan and surgery were included. In cases with perceptible FDG uptake in primary tumor, the maximum standardized uptake value (SUVmax) was calculated. The pathologic results such as site, size, depth of invasion (T stage), growth pattern, differentiation of primary tumor, lymph node metastasis and Dukes-Astler & Coller stage and immunohistochemical markers such as expression of EGFR, MLH1, MSH2 and Ki-67 index were reviewed. Results: 146 out of 147 PET/CT scans with colorectal cancer showed perceptible focal FDG uptake. SUVmax showed mild positive linear correlation with size of primary tumor (r=0.277, p=0.001) and Ki-67 index (r=0.226, p=0.019). No significant difference in F-18 FDG uptake was found according to site, depth of invasion (T stage), growth pattern, differentiation of primary tumor, presence of lymph node metastasis, Dukes-Astler & Coller stage and expression of EGFR. Conclusion: The degree of F-18 FDG uptake in colorectal cancer was associated with the size and the degree of Ki-67 index of primary tumor. It could be thought that FDG uptake of primary tumor has a correlation with macroscopic and microscopic tumor growth.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.5
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• pp.411-420
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• 2009

Purpose: The aim of this study was to investigate the usefulness of $^{18}F$-FDG PET/CT with neck ultrasonography (neck US) in patients with recurrent, papillary thyroid cancer. Material and methods: This retrospective study (December 2006 to April 2008) enrolled sixty-one patients (ninety-one lesions) who underwent high-dose $^{131}I$-ablation therapy after total thyroidectomy, and evaluated recurred papillary thyroid cancer. All lesions were confirmed by histopathology and compared histopathologic findings to PET, PET/CT, and neck US findings. Results: In sixty-one patients (57 women, 4 men; age range, 24-81 years, mean 49 years; 61 papillary carcinomas), the sensitivity, specificity, accuracy of $^{18}F$-FDG PET/CT was 87.2%, 64.0%, 78.1% on a patient basis and 92.3%, 66.7%, 80.9% on a lesion basis, respectively. The sensitivity, specificity, accuracy of $^{18}F$-FDG PET was 71.8% (p=0.03), 59.0% (p=1.00), 67.2% (p=0.03) on a patient basis and 78.8% (p<0.01), 64.1% (p=1.00), 72.5% (p=0.02) on a lesion basis, respectively. The sensitivity, specificity, accuracy of neck US was 71.1% (p=0.07), 52.2% (p=0.75), 63.9% (p=0.05) on a patient basis and 71.2% (p<0.01), 61.5% (p=1.00), 67.0% (p=0.06) on a lesion basis, respectively. Combined $^{18}F$-FDG PET/CT with neck US improved the sensitivity, specificity, accuracy to 94.7% (p=0.50), 82.6% (p=0.13), 90.2% (p=0.03) on a patient basis and 96.2% (p=0.50), 89.7% (p<0.01), 93.4% (p<0.01) on a lesion basis, respectively. Conclusion: $^{18}F$-FDG PET/CT demonstrated significantly higher sensitivity than neck US for the detection of recurred papillary thyroid cancer lesions. Furthermore, combined $^{18}F$-FDG PET/CT with neck US showed more improved sensitivity, specificity, accuracy for diagnosis of recurrent papillary thyroid cancer.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.4
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• pp.287-293
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• 2009

Purpose: This study is to evaluate rib fractures on bone scan in breast cancer patients treated with breast cancer surgery and radiation therapy and to evaluate its relation with radiation therapy and operation modality. Materials and Methods: Two hundred seventy cases that underwent serial bone scan after breast cancer surgery and radiation therapy were enrolled. Bone scan and chest a findings of rib fracture were analyzed. Results: The rib uptake was seen in 74 of 270 cases (27.4%) on bone scan and 50 cases (18.5%) were confirmed to have rib fracture by chest CT. The rate of modified radical mastectomy in patients with rib fracture was significantly higher than that in patients without rib fracture (66.0% vs. 27.0%, p = 0.000). The rate of additional radiation therapy to axillar or supraclavicular regions in patients with rib fracture was significantly higher than that in patients without rib fracture (62.0% vs. 28.6%, p =0.000). Rib fracture was seen most frequently at 1-2 years after radiation therapy (51.9%) and single rib fracture was seen most frequently (55.2%). Of total 106 rib fractures, focal rib uptake was seen in 94 ribs (88.7%) and diffuse rib uptake was seen in 12 ribs (11.3%). On one year follow-up bone scan, complete resolution of rib uptake was seen in 15 ribs (14.2%). On chest a, the rate of fracture line in ribs with intense uptake was significantly higher than that in ribs with mild or moderate uptake (p = 0.000). The rate of presence of fracture line in ribs with focal uptake was significantly higher than that in ribs with diffuse uptake (p = 0.001). Conclusion: Rib fracture in breast cancer patients after radiation therapy was related to radiation portal and operation modality. It should be interpreted carefully as a differential diagnosis of bone metastasis.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.1
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• pp.30-41
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• 2007

Purpose: Bone metastasis in breast cancer patients are usually assessed by conventional Tc-99m methylene diphosphonate whole-body bone scan, which has a high sensitivity but a poor specificity. However, positron emission tomography with $^{18}F-2-deoxyglucose$ (FDG-PET) can offer superior spatial resolution and improved specificity. FDG-PET/CT can offer more information to assess bone metastasis than PET alone, by giving a anatomical information of non-enhanced CT image. We attempted to evaluate the usefulness of FDG-PET/CT for detecting bone metastasis in breast cancer and to compare FDG-PET/CT results with bone scan findings. Materials and Methods: The study group comprised 157 women patients (range: $28{\sim}78$ years old, $mean{\pm}SD=49.5{\pm}8.5$) with biopsy-proven breast cancer who underwent bone scan and FDG-PET/CT within 1 week interval. The final diagnosis of bone metastasis was established by histopathological findings, radiological correlation, or clinical follow-up. Bone scan was acquired over 4 hours after administration of 740 MBq Tc-99m MDP. Bone scan image was interpreted as normal, low, intermediate or high probability for osseous metastasis. FDG PET/CT was performed after 6 hours fasting. 370 MBq F-18 FDG was administered intravenously 1 hour before imaging. PET data was obtained by 3D mode and CT data, used as transmission correction database, was acquired during shallow respiration. PET images were evaluated by visual interpretation, and quantification of FDG accumulation in bone lesion was performed by maximal SUV(SUVmax) and relative SUV(SUVrel). Results: Six patients(4.4%) showed metastatic bone lesions. Four(66.6%) of 6 patients with osseous metastasis was detected by bone scan and all 6 patients(100%) were detected by PET/CT. A total of 135 bone lesions found on either FDG-PET or bone scan were consist of 108 osseous metastatic lesion and 27 benign bone lesions. Osseous metastatic lesion had higher SUVmax and SUVrel compared to benign bone lesion($4.79{\pm}3.32$ vs $1.45{\pm}0.44$, p=0.000, $3.08{\pm}2.85$ vs $0.30{\pm}0.43$, p=0.000). Among 108 osseous metastatic lesions, 76 lesions showed as abnormal uptake on bone scan, and 76 lesions also showed as increased FDG uptake on PET/CT scan. There was good agreement between FDG uptake and abnormal bone scan finding (Kendall tau-b : 0.689, p=0.000). Lesion showed increased bone tracer uptake had higher SUVmax and SUVrel compared to lesion showed no abnormal bone scan finding ($6.03{\pm}3.12$ vs $1.09{\pm}1.49$, p=0.000, $4.76{\pm}3.31$ vs $1.29{\pm}0.92$, p=0.000). The order of frequency of osseous metastatic site was vertebra, pelvis, rib, skull, sternum, scapula, femur, clavicle, and humerus. Metastatic lesion on skull had highest SUVmax and metastatic lesion on rib had highest SUVrel. Osteosclerotic metastatic lesion had lowest SUVmax and SUVrel. Conclusion: These results suggest that FDG-PET/CT is more sensitive to detect breast cancer patients with osseous metastasis. CT scan must be reviewed cautiously skeleton with bone window, because osteosclerotic metastatic lesion did not showed abnormal FDG accumulation frequently.

• The Korean Journal of Nuclear Medicine
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• v.34 no.5
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• pp.403-409
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• 2000

Objectives: Due to the heterogeneous receptor distribution and changes of receptor status over time, the biochemical measurement of estrogen receptor status of biopsy specimens is not sufficient to diagnose breast cancer. As a result, I-123 labeled estradiols have been applied for the diagnosis. The purpose of this study was to develop a suitable radioligand for imaging estrogen receptor-positive human breast tumors. Methods: Among the various estradiol derivatives, $17{\alpha}-[^{123}I]$iodovinyl estradiol ($[^{123}I]$IVE) has been prepared from $17{\alpha}$-ethynyl estradiol. Labeling of $E-17{\alpha}-[^{123}I]$iodovinyl estradiol (E-$[^{123}I]$IVE) was carried out using peracetic acid with $[^{123}I]NaI\;and\;Z-[^{123}I]IVE$ labelling was archived using chloamine-T/HCl solution with $[^{123}I]$NaI. Labeling yield was determined by silica thin-layer chromatography (TLC) and radiochemical purity was measured by high performance liquid chromatography (HPLC). The biodistribution of E-$[^{123}I]$IVE was measured in immature female rats at 60 min, 120 min and 300 min after injection. Results: The labeling yield of two isomers was 92% and 94% ($E-[^{123}I]IVE\;and\;Z-[^{123}I]IVE$, respectively). The radiochemical purity was more than 98% after purification. The highest uptake was observed at 120 min in uterus (3.11% ID/g for E-$[^{123}I]$IVE). Conclusion: These results suggest the possibility of using E-$[^{123}I]$IVE as an imaging agent for the evaluation of the evaluation of the presence of estrogen receptor in patients with breast cancer.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.5
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• pp.364-372
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• 2007

Purpose: This study was designed to investigate the cellular uptake of various tumor imaging radiopharmaceuticals in human breast cancer cells before and after paclitaxel exposure considering viable cell number. Materials and Methods: F-18-fluorodeoxyglucose, C-11-methionine, Tl-201, Tc-99m-MIBI, and Tc-99m-tetrofosmin were used to evaluate the cellular uptake in MCF-7 cells. MCF-7 cells were cultured in multi-well plates. Wells were divided into DMSO exposure control group, and paclitaxel exposure group. The exposure durations of paclitaxel with 10 nM or 100 nM were 2 h, 6 h, 12 h, 24 h, and 48 h. Results: Viable cell fraction was reduced as the concentration and exposure time of paclitaxel increased. After 10 nM paclitaxel exposure, the cellular uptake of all 5 radiopharmaceuticals was not reduced significantly, irrespective of exposure time and viable cell fraction. After 100 nM paclitaxel exposure, the cellular uptake of all 5 radiopharmaceuticals was enhanced significantly irrespective of viable cell fraction. The peak uptake was observed in experimental groups with paclitaxel exposure for 6 to 48 h according the type of radiopharmaceutical. When the cellular uptake was adjusted for the viable cell fraction and cell count, the peak cellular uptake was observed in experimental groups with paclitaxel exposure for 48 h, irrespective of the type of radiopharmaceutical. Conclusion: The cellular uptake of F-18-fluorodeoxyglucose, C-11-methionine, Tl-201, Tc-99m-MIBI, and Tc-99m-tetrofosmin did not reflect viable cell number in MCF-7 cells after paclitaxel exposure for up to 48 h.

• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.1
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• pp.49-56
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• 2008

Purpose: Whole body imaging with radioiodine can detect functioning metastases. Non-physiologic I-131 uptake detected on images usually is interpreted as suggesting functioning thyroid metastases. However, extra-thyroidal I-131 accumulation does not always imply thyroid cancer metastases and has been reported in many circumstances. In order to avoid unnecessary therapeutic interventions it is important to distinguish false-positive sites of I-131 localization. We study here to remove false-positive sites around esophagus region on I-131 whole body imaging in patients who were administrated thyroidectomy. Materials and Methods: From April to August in 2007, we had the patients who had visited our department after they received thyroidectomy due to thyroid cancer. They were given I-131, and performed radioiodine body scan after 41 to 50 hours. Patients were whole-body-scanned for the speed of 8 cm per minute. After that, we took anterior and posterior static images around the patients' neck measured by 300 thousand counts per image. We selected 44 patients who had hot spots around neck region, we divided the patients into two groups. One group was given 0.5 L of water and the other group was given 0.5 L of water with 1 g of Vitamin C dissolved. The patients were asked to drink the fluid for one minute in sitting position and after that, we measured 300 kilo counts per image again. We compared prior anterior, posterior static images with anterior, posterior images after the patients had water or water that Vitamin C resolved. Results: In using water, both observer 1 and 2 interpreted 6 patients were washed out. In the water with Vitamin C resolved, observer 1 and 2 interpreted 9 and 8 patients were washed out. Observer 1 and 2 interpreted 6 and 5 patients had 'indeterminate' when they used water. Both observer 1 and 2 interpreted 6 patients had 'indeterminate' when they used water with Vitamin C resolved. When they used water, observer 1 interpreted 10 patients had 'unchanged' and observer 2 interpreted 11 patients had 'unchanged'. Differently, when they used water with vitamin C resolved, observer1 had 8 patients having 'unchanged'and observer 2 had 9. Conclusion: As a result, by making patients drink 0.5 liter of water which has vitamin C resolved helped getting rid of false-positive sites in esophagus. Therefore, based on this study, we believe that drinking water with vitamin C dissolved is very in terms of reducing false-positive hot spot around the esophagus for the iodine-131 whole body scan.

• The Korean Journal of Nuclear Medicine
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• v.32 no.4
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• pp.374-381
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• 1998

Purpose: I-131 labeled (2'-deoxy-2'-iodo-${\beta}$-D-arabinofuranosyl) adenine (IAD) may be involved in DNA synthesis during active proliferation of tumor cells. We conducted this study to find out the biodistribution of IAD and it's feasibility for scintigraphic tumor imaging. Materials and Methods: Tosyl acetyl-adenosine was dissolved in acetonitrile, and I-131-NaI was added and heated to synthesize IAD. Female Fisher 344 rats innoculated with breast tumor cells were injected with 0.27 MBq of IAD. Rats were sacrificed at 0.5, 1, 2, 4, 24h and the % of injected dose per gram of tissue (%ID/g) was determined. For scintigraphy, rats bearing breast cancer were administered with 1.11 MBq of IAD and imaging was performed after 2 and 24h. Then, rat body was fixed and microtomized slice was placed on radiographic film for autoradiography. Results: %ID/g of tumor was 0.74 (0.5h),0.73 (1h), 0.55 (2h), 0.38 (4h), and 0.05 (24h), respectively. At 1h after injection, %ID/g of tumor was higher than that of heart (0.34), liver (0.42), spleen (0.47), kidney (0.69), muscle (0.14), bone (0.33) and intestine (0.51). However, %ID/g of tumor was lower than blood (1.06), lung (0.77), and thyroid (177.71). At 4h, %ID/g of tumor in comparison with other tissue did not change. Tumor contrast expressed by tumor to blood ratio was 0.69 and tumor to muscle ratio was 5.11 at 1h. However, these ratios did not improve through 24h. On autoradiogram and scintigraphy at 2 and 24 hour, the tumor was well visualized. Conclusion: This results suggest that IAD may have a potential for tumor scintigraphy. However, further work is needed to improve localization in tumor tissue.

• Journal of the Korean Society of Radiology
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• v.12 no.6
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• pp.755-762
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• 2018

The purpose of this study was to compare the FA(faractional anisotropy) and ADC(apparent diffusion coefficient) values, which were derived from diffusion tensor imaging in breast cancer patients. The diffusion gradient used in this study was derived from quantitative diffusion indices using 20 directions(b-value, 0 and $1,000s/mm^2$). Quantitative analysis was analyzed using Pearson's correction and qualitative analysis using for correction coefficients. As a result, $FA_{min}$, $FA_{mean}$ and $FA_{max}$ were $0.098{\pm}0.065$, $0.302{\pm}0.142$ and $0.634{\pm}0.236$, respectively(p > 0.05). The $ADC_{min}$, $ADC_{mean}$ and $ADC_{max}$ were $0.741{\pm}0.403$, $1.095{\pm}0.394$ and $1.530{\pm}0.447$, respectively(p > 0.05). The $FA_{min}$, $FA_{mean}$, and $FA_{max}$ mean values were $0.132{\pm}0.050$, $0.418{\pm}0.094$, and $0.770{\pm}0.164$ for Category 6 and Kinetic Curve Pattern III, respectively. $ADC_{min}$, $ADC_{mean}$, and $ADC_{max}$ were $0.753{\pm}0.189$, $1.120{\pm}0.236$, and $1.615{\pm}0.372$, respectively. Quantitative analysis showed negative correlation between $ADC_{mean}-FA_{mean}$ and $ADC_{max}-FA_{max}$(p = 0.001, 0.003). The qalitative analysis showed ADC 0.628(p = 0.001), FA 0.620(p = 0.001) in the internal evaluations, ADC 0.677(p = 0.001), FA 0.695(p = 0.001) in external evaluations. In conclusion, based on the morphological examination, time to signal intensity graph is the form of wash-out(pattern III) in the dynamic contrast enhance examination, As a result, the $ADC_{mean}$ $1.120{\pm}0.236$ and $FA_{mean}$ values were $0.032{\pm}0.142$ with a negative correlation (Y=1.44-1.12X). Therefore, If we understand the shape of time to signal intensity graph and the relationship between ADC and FA, It will be a criterion for distinguishing malignant diseases in breast cancer.

• Journal of the Korean Society of Radiology
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• v.82 no.2
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• pp.406-416
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• 2021

Purpose To evaluate the association between magnetic resonance imaging (MRI)-based texture parameters and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation in patients with non-mucinous rectal cancer. Materials and Methods Seventy-nine patients who had pathologically confirmed rectal non-mucinous adenocarcinoma with or without KRAS-mutation and had undergone rectal MRI were divided into a training (n = 46) and validation dataset (n = 33). A texture analysis was performed on the axial T2-weighted images. The association was statistically analyzed using the Mann-Whitney U test. To extract an optimal cut-off value for the prediction of KRAS mutation, a receiver operating characteristic curve analysis was performed. The cut-off value was verified using the validation dataset. Results In the training dataset, skewness in the mutant group (n = 22) was significantly higher than in the wild-type group (n = 24) (0.221 ± 0.283; -0.006 ± 0.178, respectively, p = 0.003). The area under the curve of the skewness was 0.757 (95% confidence interval, 0.606 to 0.872) with a maximum accuracy of 71%, a sensitivity of 64%, and a specificity of 78%. None of the other texture parameters were associated with KRAS mutation (p > 0.05). When a cut-off value of 0.078 was applied to the validation dataset, this had an accuracy of 76%, a sensitivity of 86%, and a specificity of 68%. Conclusion Skewness was associated with KRAS mutation in patients with non-mucinous rectal cancer.