위장관 간질 종양(Gastrointestinal stromal tumor)에서 18F-fluorodeoxyglucose positron emission tomography의 역할

유이령 ( Ie Ryung Yoo ) 대한핵의학회 2008 핵의학 분자영상 Vol.42 No.-

후두 편평상피암종의 림프절 피막외 침범에 대한 FDG PET/CT 영상의 유용성

주영훈(Young-Hoon Joo)유이령(Ie-Ryung Yoo),조광재(Kwang-Jae Cho),송지남(Jee-Nam Song),유동준(Dong-Joon Yoo),이호석(Ho-Suk Lee),김민식(Min-Sik Kim) 대한두경부종양학회 2012 대한두경부 종양학회지 Vol.28 No.2

Backgrounds:To evaluated the use of FDG PET/CT for the identification of extracapsular spread(ECS) with histologic correlation in laryngeal cancer. Methods:We reviewed 79 medical records of patients who under-went of FDG PET/CT for laryngeal cancer before surgery. Results:ECS was present in 41.9%(18/43) dis-sected necks and in 34.5%(20/58) dissected cervical levels. There was a significant difference in the SUVmax between cervical lymph nodes with ECS and without ECS(6.39±4.53 vs. 1.19±1.64, p<0.001). The cut-off value for the SUVmax for differentiating with ECS from without ECS was 2.8 with the sensitivity of 85.7% and the specificity of 85.6%. Conclusion:The median SUVmax cut-off values of FDG PET/CT higher than 2.8 was associated with greater risk cervical lymph node metastasis with ECS in patients with laryngeal cancer.

Significance of Incidental Nasopharyngeal Uptake on 18F-FDG PET/CT: Patterns of Benign/Physiologic Uptake and Differentiation from Malignancy

이나래,유이령,박영주,윤혁진,이영주,오진경 대한핵의학회 2015 핵의학 분자영상 Vol.49 No.1

Purpose The purpose of this study was to assess the significanceof incidental nasopharyngeal uptake on 18F-FDG PET/CT andto identify image patterns useful in the differentiation betweenbenign or physiologic activity and nasopharyngeal carcinoma. Methods We retrospectively reviewed medical records of patientswith nasopharyngeal uptakes on 18F-FDG PET/CTscans taken between January 2010 and July 2011. Patientswith head and neck cancer, other metastatic head and necklesions, or lymphoma were excluded. Total 177 patients wereenrolled (Group A). PET images were reviewed for patterns ofnasopharyngeal FDG uptake, presence/absence of cervicallymph node uptake and pattern of cervical node uptake. Diagnostic confirmation was made by pathology or clinicaland radiological follow-up for 1 year or longer. Furthermore,initial PET/CT images of 48 patients with nasopharyngealcarcinoma (Group B) were reviewed for comparison withPET/CT images of Group A patients. Results All nasopharyngeal uptakes in Group A were confirmedto be benign. Group B showed significantly moreintense FDG uptake (SUVmax of Group A 3.9 ± 1.4 vs. Group B 10.4 ± 4.6, p<0.001). and asymmetric nasopharyngealuptake (asymmetric uptake of Group A 67.8% vs. GroupB 89.6%). When SUVmax of 6.0 was used as cut off fordetection of malignant nasopharyngeal uptake, the area underthe ROC curve was 0.93 (95% confidence interval, 0.88-0.98), with a sensitivity of 88.1% and a specificity of 91.7%. Metastatic nodes in Group B showed higher SUVmax (GroupA 2.3 ± 0.6 vs. Group B 7.1 ± 4.0, p<0.001) and larger size(short axis of Group A 5.3 ± 2.0 mm vs. Group B 13.1 ± 4.7mm, p<0.001) than benign nodes of Group A. The majority ofGroup B cases demonstrated retropharyngeal lymph nodeuptake (70.8%), compared to only 2 cases in Group A. Conclusions In patients without a history of underlying malignancyinvolving head and neck, incidental nasopharyngealuptake on PET/CT does not indicate malignancy. However, ifthe nasopharyngeal uptake is intense (SUVmax≥6.0) or concomitantretropharyngeal lymph node uptake is present, thepossibility of a malignant condition should be considered.

The Role of F-18 FDG PET/CT in Intrahepatic Cholangiocarcinoma

이영주,유이령,부선하,김형우,박혜림,오주현 대한핵의학회 2017 핵의학 분자영상 Vol.51 No.1

Purpose The aim of this study was to evaluate the diagnostic and prognostic role of metabolic parameters of FDG PET/CT in patients with intrahepatic cholangiocarcinoma (ICC). Methods From December 2008 to December 2013, 76 FDG PET/CT scans performed for initial staging of ICC in a single institution (57 male and 19 female; mean age 68 ± 9 years) were retrospectively reviewed. Patients with history of other known malignancy were excluded. Detection rates of regional lymph node and distant metastasis by FDG PET/CT were analyzed in comparison with conventional imaging modalities such as CT or MRI. Metabolic parameters including maximum, peak and mean standardized uptake values (SUVmax, SUVpeak, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), glucose corrected SUV (SUVgluc), and glucose corrected TLG (TLGgluc) were measured for the primary tumor. Cut-off values for the metabolic parameters were calculated by ROC curve analysis, and used to dichotomize the patient groups. The overall survival time (OS) was calculated and compared using the Cox proportional hazard regression analysis. Results The median duration of follow-up period was 5.4 months (interquartile range: 1.45∼15.45). FDG PET/CT showed higher sensitivity than conventional imagingmodalities in detection of regional node involvement (74.5 % vs. 61.8 %, p = 0.013). In six patients, distant metastasis was identified only by FDG PET/CT. The mean SUVmax, SUVpeak, SUVmean, MTV, and TLG for the primary tumor were 8.2 ± 3.1, 6.8 ± 2.5, 4.0 ± 0.8, 192.7 ± 360.5 cm3, and 823.7 ± 1615.4, respectively. Patients with higher (≥7.3, HR: 4.280, p = 0.001), higher SUVpeak (≥6.5, HR: 2.333, p = 0.020), higher SUVmean (≥3.9, HR: 2.799, p = 0.004), higher SUVgluc (≥8.1, HR: 2.648, p = 0.012), and higher TLGgluc (≥431.6, HR: 2.186, p = 0.030) showed significantly shorter survival time. By multivariate study, operability was an independent prognostic factor for longer survival (HR: 4.113, p= 0.005). Conclusion FDG PET/CT is an important diagnostic imaging tool in the nodal staging and detection of distant metastasis in ICC patients. Metabolic parameters may have a significant role as prognostic factors in patients with ICC.

Giant Cell Tumor of the Rib: Two Cases of F-18 FDG PET/CT Findings

박혜림,유이령,이영주,Sonya Youngju Park,정찬권 대한핵의학회 2017 핵의학 분자영상 Vol.51 No.2

We report two cases of giant cell tumor arising fromthe rib and their F-18 FDG PET/CT findings. The two patientscomplained of chest wall pain, and large lobulated soft tissuemasses with intense FDG uptake were seen on F-18 FDGPET/CT. A malignant tumor such as osteosarcoma orchondrosarcoma was suspected due to the large size of themass, bony destruction, and intense FDG uptake. En blocresection was performed and final pathologic results revealedgiant cell tumor of the rib. Giant cell tumor of the rib is veryrare, and larger lesions with high FDG uptake can bemisdiagnosed as an intrathoracic malignancy arising fromthe rib, pleura, or chest wall.

F-18 FDG PET Findings for Vogt-Koyanagi-Harada Disease

박혜림,유이령,Sonya Youngju Park 대한핵의학회 2017 핵의학 분자영상 Vol.51 No.2

Vogt-Koyanagi-Harada disease is a raremultisystemic granulomatous autoimmune disorder affectingpigmented tissues such as the choroid, meninges,inner ear, and the skin. Neurologic symptoms are usuallymild. Clinical manifestations include generalizedmuscle weakness, headache, meningismus, vertigo, decreasedvisual acuity, hearing loss and mental changesranging from mild confusion to psychosis, hemiparesis,dysarthria, and aphasia. Seizures are very rare. Wedescribe a case of 18F-fluorodeoxyglucose (F-18 FDG)positron emission tomography (PET) and software-fusedPET-magnetic resonance imaging (MRI) in Vogt-Koyanagi-Harada disease with seizure.

양전자 방출 단층촬영 검사에서의 흉곽내 비악성 FDG 집적

박현진,유이령,천호종,송선화,임수아,박석희,김성훈,이교영 대한영상의학회 2007 대한영상의학회지 Vol.57 No.1

Fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) has been used exclusively to diagnose malignancies. However, increased FDG uptake is not always limited to malignant tissue. Many false positive findings for PET have been reported. Moreover, the use of PET/CT may allow the reassessment of previously recognized patterns of physiological bio-distribution of a tracer. In this report we demonstrate the physiological FDG uptake of normal structures in the thorax using PET/CT imaging and illustrate many benign pathological conditions with standardized uptake values greater than 2.5. 지금까지 악성 질환의 진단에 18FDG-양전자 방출 단층촬영 검사(PET)가 널리 쓰이고 있다. 그러나 PET에서 FDG 집적이 반드시 악성 조직에서만 이루어지는 것이 아니며 이는 지금까지의 여러 연구결과를 통해 알려졌다. 이후 PET/CT의 개발 덕분에 FDG의 생체 내 생리학적 분포에 대해서 알려지게 되었고, 따라서 이전에 PET만으로 설명할 수 없었던 FDG 집적에 관한 재분석이 이루어졌다. 이에 저자들은 PET/CT를 통하여 흉곽 내에의 정상구조물에 의한 정상적인 FDG 집적과 정상구조물의 생리학적 변화로 인한 FDG 집적 그리고 마지막으로 양성질환에 의한 FDG 집적의 예들을 열거하고자 한다.

The Value of F-18 FDG PET for Planning Treatment and Detecting Recurrence in Malignant Salivary Gland Tumors: Comparison with Conventional Imaging Studies

박혜림,유이령,이나래,윤혁진,최은경,김성훈,최현수 대한핵의학회 2013 핵의학 분자영상 Vol.47 No.4

Purpose To assess the value of F-18 FDG PET/CT for detecting cervical lymph node (LN) metastasis and recurrence,as well as planning treatment, and to compare the accuracy of PET/CT with conventional imaging studies (CIS) in patients with malignant salivary gland tumor (SGT). Methods Staging and follow-up PET/CT for SGTwere retrospectively reviewed. Enhanced CT and/or MRI of the neck were performed within 1 month of PET/CT. Final diagnosis was based on histology from cervical LN dissection and biopsy or a minimum 6 months of clinical and imaging follow-up.We compared the performance of PET/CT in initial cervical LN staging and recurrence detection with that of CIS. Results A total of 184 PET/CT exams of 66 patients were included, and 34 initial staging and 150 surveillance PET/CT exams were performed. The initial cervical LN detection sensitivity, specificity, accuracy, positive predictive value,and negative predictive value were 60.9 %, 89.2 %, 84.0 %,56.0 %, and 91.0 % for visual analysis on PET/CT, 39.1 %,95.0 %, 84.8 %, 64.3 %, and 87.4 % for semiquantitative analysis on PET/CT, and and 43.5%, 94.1%, 84.8%, 62.5%,and 88.1% for CIS. The sensitivity of visual analysis on PET/CT was significantly higher than that of semiquantitative analysis on PET/CT and CIS (p =0.0009 and 0.0086). In 5of 34 initial staging patients (14.7 %), the treatment plan was changed from curative surgery to palliative therapy. The performance of follow-up PET/CT showed no significant difference compared with CIS. Conclusion PET/CT showed comparable performance with CIS for cervical LNs staging. Initial PET/CT changed treatment plans in 14.7 % of patients. However, PET/CT offered no additional advantage for detecting locoregional recurrence.

Role of MRI and Plain Radiograph to Diagnose Fibrous Dysplasia Mimicking Metastasis on PET/CT in a Patient with Breast Cancer

조송미,지원희,유이령,이아원,정양국,Cho, Song-Mee,Jee, Won-Hee,Yoo, Ie-Ryung,Lee, Ah-Won,Chung, Yang-Guk The Korean Musculoskeletal Tumor Society 2010 대한골관절종양학회지 Vol.16 No.1

Fibrous dysplasia is a common benign disorder of bone in which normal bone marrow is replaced with fibro-osseous tissue. As PET/CT is increasingly used for the staging of different malignant disease, incidentally found fibrous dysplasia with increased FDG uptake may mimic metastasis. We report on a 46-year-old woman with fibrous dysplasia who underwent PET/CT because of suspected recurrence of breast cancer and was misdiagnosed as a bony metastasis with a focal FDG uptake on left proximal femur. This lesion was interpreted as fibrous dysplasia based on MRI in addition to the plain radiographs. We conclude that MRI in addition to radiography may help to differentiate fibrous dysplasia mimicking metastasis on PET/CT in the patients with malignancy. 섬유형성이상은 골수가 섬유-골성 조직으로 치환되는 흔한 양성 골 질환이다. 암환자에서 병기의 결정과 추적 검사 시 암 전이의 발견에 PET/CT의 역할이 증가됨에 따라 우연히 발견된 FDG 섭취 증가를 보이는 섬유형성이상에서 암 전이와의 감별이 중요하다. PET/CT를 시행한 46세의 유방암 환자에서 좌측 대퇴골에 국소 FDG 섭취를 보여 암 전이로 의심되었으나 단순촬영과 자기공명 영상 소견에서 섬유형성이상으로 진단한 환자의 증례를 보고하고자 한다. 이 환자에서 단순활영과 자기공명영상 소견은 PET/CT에서 유방암 전이로 오인된 섬유형성이상의 감별에 도움이 되었다.

One Versus Up-to-5 Lesion Measurements for Response Assessment by PERCIST in Patients with Lung Cancer

권수진,오주현,유이령 대한핵의학회 2021 핵의학 분자영상 Vol.55 No.3

Purpose The optimal number of lesions to measure for response assessment from fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) is not validated for lung cancer. We compared 1 lesion and up-to-5 lesion measurements for response assessment in lung cancer per PET Response Criteria in Solid Tumors (PERCIST). Methods Patients with lung cancer with pre- and post-treatment PET/CT images were included. The standard uptake value corrected for lean body mass ( SULpeak) of up-to-5 hottest target lesions was measured at each time point. The percent changes of SULpeak of the single hottest lesion and the sum of up-to-5 hottest lesions were computed. Pearson correlation coefficient evaluated the strength of association between the percent changes of SULpeak values from the 1 lesion and up-to-5 lesion analyses. Response categories were complete metabolic response (CMR) with no perceptible lesion; partial metabolic response (PMR), stable metabolic disease (SMD), or progressive metabolic disease (PMD) using the threshold of 30% and 0.8 unit change in SULpeak; and unequivocal new lesion meant PMD. The concordance for response categorization was assessed by kappa statistics. Results A total of 40 patients (25 non-small cell lung cancer; 15 small cell lung cancer) were analyzed, all with 18F-FDGavid lung cancer. Average of 3 target lesions were measured for up-to-5 lesion analysis. Pearson’s r was 0.74 (P < 0.001) and increased to 0.96 (P < 0.001) when two outliers were excluded. Response categorization with 1 lesion and up-to-5 lesion analyses was concordant in 37 patients (92.5%, weighted kappa = 0.89). Conclusion Analyzing 1 lesion and up-to-5 lesions for response assessment by PERCIST showed high concordance in patients with lung cancer.