총담관낭종의 99mTc - DISIDA 간담도 스캔

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),정병천(Byung Cheon Chung),최정일(Chung Il Choi),곽동석(Dong Suk Kwak),전석길(Seok Kil Zeon),김정균(Jeong Gyun Kim),배선근(Sun Kun Bae),이형우(Hyung Woo Lee) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.1

N/A In order to evaluate the scintigraphic features of choledochal cyst and these diagnostic value, authors investigated the findings of fourteen patients with choledochal cyst undergone hepatobiliary scan with Tc-99m-DISIDA before surgery. Five cases demonstrated the decreased hepatic uptake at 5-minute image of which four cases revealed severe jaundice. Seven cases demonstrated visualization of the cystic dilated common bile duct within 1 hour after injection. Two cases showed the cyst activity between 1 and 12 hour, but the cyst activity was not visible in five cases. Nonvisualization of the gall bladder was noted in ten cases, while four cases demonstrated visualization of the gall bladder within 1 hour. The time of visualization of gut activity was variably delayed. The intestinal activity was found in three cases within 1 hour and appeared in three cases between 1 and 2 hours and eight cases showed no visible gut activity. In four cases, intrahepatic ductal prominence was visible on the scintigram. Seven cases showed early and persistent accumulation of tracer in the common bile duct. Three cases showed persistent photon-deficient area in the gall bladder region. Two cases showed early photon-deficient area around gall bladder region with progressive accumulation of tracer in the same region. Two cases showed no evidence of activity in the biliary tract but noted late excretion into the sma11 intestine. We concluded that hepatobiliary scan using Tc-99m-DISIDA is a noninvasive test useful in the eva1uation and the diagnosis of choledochal cyst.

관상동맥 질환에서의 Adenosine 부하 99mTc - MIBI 심근 스캔의 진단적 가치 : 운동 부하 99mTc - MIBI 심근 스캔과의 비교

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),박의현(Wee Hyun Park),정병천(Byung Cheon Chung),최정일(Chung Il Choi),전재은(Jae Eun Jun),채성철(Sung Chull Chae),강승완(Seung Wan Kang),우언조(Eon Jo Woo) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A Pharmacologic coronary vasodilation in conjunction with myocardial scintigraphy has become an accepted alternative to dynamic exercise testing for the diagnosis of coronary artery disease. Although dipyridamole has traditionally been used for this purpose, it causes frequent side effect, which at times can be life-threatening. Moreover, dipyridamole dose not elicit maximal coronary vasodilation in a substantial number of patients receiving the usual i.v. dose. Adenosine is an endogenously produced compound that has significant effects as a coronary vasodilator and rapid onset action and extremely short half-life ((10 seconds). The diagnostic accuracy and safety profile of adenosine Tc-99m-MIBI myocardial scintigraphy were evaluated and comparison with exercise Tc-99m-MIBI was performed. Twenty-eight subjects underwent Tc-99m-MIBI imaging after adenosine infusion and exercise Tc-99m-MIBI imaging. Adenosine was infused intravenously at a dose of 0.14 mg/kg/body weight per minute for 6 min and MIBI was injected at 3 minute. Adenosine caused an incerease in heart rate (64±12 at baseline versus 74±16 beats/min at peak effect, p〈0.001), a mild decrease in systolic and diastolic blood pressure and a slightly increase in PR interval(p; NS). Side effects were reported in 92% of patients and were mostly mild in nature and promptly resolved within 1 or 2 minutes of termination of adenosine infusion. Facial flushing (53%), chest pain (36%), mild dyspnea (39%), headache (21%), throat discomfort (21%) were frequent symptoms. ST segment depression(〉1mm) and second degree AV block in electrocardiography occured in 11% of thepatients, respectively. The overall sensitivity and specificity for individual coronary stenoses in 16 patients underwent coronary angiography were 88% and 95%, respectively. The agreement ratio of segmental perfusion between adenosine and exercise images was 92% (Kappa index=0.82). In conclusion, Tc-99m-MIBI myocardial perfusion scintigraphy with intravenous adenosine is a feasible, safe and highly accurate noninvasive technique for the detection of coronary artery disease and results are at least comparable with those of exercise Tc-99m-MIBI scintigraphy.

심근관류 스캔중에 나타난 Thallium - 201의 심장외 국소적 섭취

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),정병천(Byung Cheon Chung),최정일(Chung Il Choi),곽동석(Dong Suk Kwak),박무근(Moo Keun Park) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A Myocardial perfusion imaging with 201T1-chloride following exercise or vasodilator-induced hyperemia has been effective in detecting the presence of coronary artery disease. An increased lung uptake of thallium has been reported as a sensitive marker of severe and extensive coronary artery disease and associated with poor prognosis. Thallium has also been noted to concentrate in a variety of malignant lesions. We report 5 cases of extracardiac uptake of thallium during myocardial perfusion scan with pharmacologic vasodilation. Accumulation of thallium was found in the lesions of a breast cancer, a lung cancer, a Castleman's disease and 2 cases of thymoma. We believe that the presence of focal extracardiac uptake of thallium during myocardial perfusion scan should suggest the need for further clinical evaluation to detect the tumor and must differentiate the increased lung uptake of thallium due to left ventricular dysfunction in coronary artery disease.

Adenosine 부하 99mTc-MIBI 심근 관류스캔도중 나타나는 ST 절 하강과 관상동맥 질환의 중증도와의 관계

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),손상균,채성철,전재은,박의현,정병천(Byung Cheon Chung),최정일(Chung Il Choi),곽동석(Dong Suk Kwak),강승완(Seung Wan Kang),우언조(Eon Jo Woo),김정균(Jeong Gyun Kim),배선근(Sun Kun Bae),조정아(Jung Ah Cho) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.2

N/A Pharmacologic coronary vasodilation in conjunct.ion with myocardial perfusion scintigraphy has become an alternative to dynamic exercise test for the diagnosis and risk stratification of coronary arter y disease, especially in patients who are unable to perform adequate exercise. Dipyridamole and adenosine have been used for pharmacologic stress t,esting with myocardial perfusion imaging. Adenosine is a potent, coronary vasodilator with rapid onset of action, short half Iife, near maximal coronary vasodilation and less serious side effects. ST segment depression has been reported in about 7-15% of patients with coronary artery disease receiving dipyridamole in conjunction with myocar dial perfusion imaging. The exact cause and clinical significance are not known. In order to evaluate ihe relationship between adenosine-induced ST segment depression dur- ing Tc-MIBI myocardial perfusion scin(igraphy and the severity of coronary artery disease, we performed 99mTc-MIBI imaging after int#ravenous infusion of adenosine in 120 patients with susper,t.ed coronary artery disease. Of t.he 120 patients, 28 also performed coronary angiography. There were 24 patients with ST segment depression during 99mTc-5/IIBI scintigraphy and 96 patients without ST segment depression. Adenosine was infused intravenously at. a dose of 0.14mg/kg per minute for 6minutes and 99mTc-MIB1 was injected at 3 miinute. We then compared the hemodynamic changes, side effects, scintigraphic and angiographic findings. Heart, rate increased 90 +- 19 beats/minute in t.he group with ST depression compared with 80+16 beats/rninute in the group without ST depression(p<0.05). Baseline systolic blood pressure was significantly higher in the group with ST depression(152 +- 27 mmHg) than in the group without ST depression(140 +- 21mmHg, p<0.05). Double product, at baseline(10.90 +- 2.77 versus 9.55 +- 2.34beats/minutexmmHg) and during adenosine infusion(12.72 +- 3.89 versus 10.83+2.98 beats/minutexmrnHg) were significant,ly higher in t.he group with ST de pression(p<0.05). The incidenoe of anginal chest pain was also significantly higher in the group with ST depression(75 versus 29%, p<0.0001). The 99mTc-MIBI images were abnormal in 23(96%) patients wit.h ST segment depression and 66(69%) patients without ST segment depression(p<0.05). In patients with ST segment depression, there were more reversible per- fusion defects than in patients without ST segment depression(83 versus 55%, p<0.05). The number of abnormal segments were significantly higher in the group with ST depression(3.05 +- 2.01 versus 1.51 +- 1.45, p<0.005). In patients with ST segment depression, there were more segments of reversible perfusion defects than in patients without segment depression(2.15 +- 2. 11 versus 0.89 +- 1.24, p<0.05). There were no differences in the angiographic severity by ves sel(p, NS). We concluded that ST segment depression during 99mTc-MIBI myocardial perfusion scintigraphy with intravenous adenosine is related to the severity of coronary artery disease.

Dipyridamole 부하 심장 풀 스캔을 이용한 관동맥질환의 평가

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),김광원(Gwang Weon Kim),박의현(Wee Hyun Park),정병천(Byung Cheon Chung),최정일(Chung Il Choi),채성철(Shung Chull Chae),전재은(Jae Eun Jun),박희명(Hee Myung Park) 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.1

N/A Thirty-one patients with coronary artery disease and twenty-six normal subjects underwent 99mTc-GBPS before and aft.er coronary vasodilatation was induced by dipyridamIe 0.54 mg/kg given IV over 4 min. LVKF, EF and regional wall motion by phase analysis were measured during rest and dipyridamole infusion. The results were as follows: 1) Mean LVEF of normal subjects was significantly higher than that of MI group (p=0.001), but similar to that of angina group during rest. Among Ml group, mean LVEF of anterior MI group was significantly lower than that of inferior MI group during rest (p=0,024). 2) The normal subjects had a significnat increase in mean LVEF during dipyridamole infusion (+ 12 +- 3,8), while the CAD group had no increase (+ 2=5.0) (p<0.001). If an increase of LVEF during stress is less than 5%., it suggests an abnormality. The sensitivity and specificity of LUEF changes aft:er dipyridamole infusion were 81%, 96%, respectively. 3) With phase analysis, LV mean phase angle af normal subjects and CAD patients was 143+20, 5, 132 +- 20.6 rc.spectively, durign rest (p=0.049). But an ncrease of LV mean phase angle during dipyridamole infusion in t.hese two groups was not signifieantly different. Dipyridarnole infusion did not affect standard deviation and FWHM of phase angle. 4) Regional wall motion was abnormal in 5 patients (16%) during dipyridamole infusion. 5) Side effects with dipyridamole infusion include; headache, angina pain, chest discomfirt, nausea, weakness sense. In conclusion, dipyridamole GBPS might be useful in detection and follow up of CAD.

관해된 급성 골수성 백혈병 환자에서 발생한 과립성 육종의 67Ga - citrate Scan 소견

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),황기석(Kee Suk Whang),김광원(Gwang Weon Kim),정병천(Byung Cheon Chung) 대한핵의학회 1990 핵의학 분자영상 Vol.24 No.2

N/A A case of a 39-year-old man with granulocytic sarcoma documented by positive Ga-67 scan is described and brief review of literature was performed. He was diagnosed as acute myelogenous leukemia and got complete remission with antileukemic chemotherapy for 7 months. On admission, picture of his bone marrow and peripheral blood showed remission state of leukemia. Radiologic examinations were performed for evaluation of lesions in head and chest, and findings of granulocytic sarcoma were suspected. So we got 67Ga-citrate scan and pleural biopsy for identification of causes of intractable pleural effusion and skin lesion. Myeloblastomas (or granular sarcomas) proved by pleural biopsy were correctly identified by 67Ga-citratre scan, and disease extent was clearly delineated. We believe that 67Ga-scintigraphy is very helpful in localizing and follow-up evaluation of granulocytic sarcoma.

방사성핵종 복막촬영술을 이용한 복수에 동반된 수흉의 감별진단

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),황기석(Kee Suk Whang),조동규(Dong Kyu Cho),김광원(Gwang Weon Kim),정병천(Byung Cheon Chung),정준모(Joon Mo Chung) 대한핵의학회 1990 핵의학 분자영상 Vol.24 No.2

N/A Simultaneous presence of ascites and pleural effusion has been documented in patients with cirrhosisof the liver, renal disease, Meigs' syndrome and in patients undergoing peritoneal dialysis. Mechanisms proposed in the formation of pleural effusion in most of the above diseases are lymphatic drainage and diaphragmatic defect. But sometimes, hepatic hydrothoraxes in the absence of clinical ascites and pleural effusion secondary to pulmonary or cardiac disease are noted. It is not always possible to differentiate between pleural effusion caused by transdiaphragmatic migration of ascites and by other causes based soly on biochemical analysis. Authors performed radionuclide scintigraphy after intraperitoneal administration of Tc-99m-labeled colloid in 23 patients with both ascites and pleural effusion in order to discriminate causative mechanisms responsible for pleural effusion. Scintigraphy demonstrated the transdiaphtagmatic flow of fluid from the peritoneum to pleural cavities in 13 patients correctly. In contrast, in 5 patients with pleural effusion secondary to pulmonary, pleural and cardiac diseases, radiotracers fail to traverse the diaphragm and localize in the pleural space. Ascites draining to mediastinal lymph nodes and blocked passage of lymphatic drainage were also clarified, additionaly. Conclusively, radionuclide peritoneal scintigraphy is an accurate, rapid and easy diagnostic tool in patients with both ascites and pleural effusion. It enables the causes of pleural effusion to be elucidated, as well as providing valuable information required when determining the appropriate therapy.