허혈성 심장 질환의 One-stop Evaluation Protocol: Myocardial Fusion PET Study

김경목,이병욱,이동욱,김정수,장영도,방찬석,백종훈,이인수,Kim, Kyong-Mok,Lee, Byung-Wook,Lee, Dong-Wook,Kim, Jeong-Su,Jang, Yeong-Do,Bang, Chan-Seok,Baek, Jong-Hun,Lee, In-Su 대한핵의학기술학회 2010 핵의학 기술 Vol.14 No.2

Purpose: In the early stage of using PET/CT, it was used to damper revision but recently shows that CT with MDCT is commonly used and works well for an anatomical diagnosis. This hospital makes the accuracy and convenience more higher in the diagnosis and evaluate of coronary heart disease through concurrently running myocardial perfusion SPECT examination, myocardial PET examination with FDG, and CT coronary artery CT angiography(coronary CTA) used PET/CT with 64-slice. This report shows protocol and image based on results from about 400 coronary heart disease examinations since having 64 channels PET/CT in July 2007. Materials and Methods: An Equipment for this examination is 64-slice CT and Discovery VCT (DVCT) that is consisted of PET with BGO ($Bi_4Ge_3O_{12}$) scintillation crystal by GE health care. First myocardial perfusion SPECT with pharmacologic stress test to reduce waiting time of a patient and get a quick diagnosis and evaluation, and right after it, myocardial FDG PET examination and coronary CTA run without a break. One-stop evaluation protocol of ischemic heart disease is as follows. 1)Myocardial perfusion SPECT with pharmacologic stress: A patient is injected with $^{99m}Tc$-MIBI 10 mCi and does not have any fatty food for myocardial PET examination and drink natural water with ursodeoxcholic acid 100 mg and we get SPECT image in an hour. 2)Myocardial FDG PET: To reduce blood fatty content and to increase uptake of FDG, we used creative oral glucose load using insulin and Acipimox to according to blood acid content. A patient is injected with $^{18}F$-FDG 5 mCi for reduction of his radiation exposure and we get a gated image an hour later and get delay image when we need. 3) Coronary CTA: The most important point is to control heart rate and to get cooperation of patient's breath. In order to reduce a heart rate of him or her below 65 beats, let him or her take beta blocker 50 mg ~ 200 mg after a consultation with a doctor about it and have breath-practices then have the examination. Right before the examination, we spray isosorbide dinitrate 3 to 5 times to lower tension of bessel wall and to extension a blood wall of a patient. It makes to get better the shape of an anatomy. At filming, a patient is injected CT contrast with high pressure and have enough practices before the examination in order to have no problem. For reduction of his radiation exposure, we have to do ECG-triggered X-ray tube modulation exposure. Results: We evaluate coronary artery stenosis through coronary CTA and study correlation (culprit vessel check) of a decline between stenosis and perfusion from the myocardial perfusion SPECT with pharmacologic stress, coronary CTA, and can check viability of infarction or hibernating myocardium by FDG PET. Conclusion: The examination makes us to set up a direction of remedy (drug treatment, PCI, CABG) because we can estimate of effect from remedy, lesion site and severity. In addition, we have an advantage that it takes just 3 hours and one-stop in that all of process of examinations run in succession and at the same time. Therefore it shows that the method is useful in one stop evaluation of ischemic heart disease. 관상동맥질환의 진단 및 평가에 있어서 myocardial perfusion SPECT검사와 FDG를 이용한 myocardial PET검사 그리고 PET/CT에 장착된 64-slice CT를 이용한 coronary CT angiography를 동시에 실행함으로 검사의 신뢰도와 편의성을 한층 더 높이고자 한다. 먼저 약물부하 myocardial perfusion SPECT검사를 먼저 시행한다. 환자의 피폭경감을 위해서 $^{99m}Tc$-MIBI 10 mCi 로 주사하며 myocardial PET검사를 위해서 지방식을 먹지 않고 ursodeoxcholic acid 100 mg을 생수와 함께 복용하게 하여 1시간 후에 SPECT 영상을 얻는다. 이어서 myocardial FDG PET검사를 시행한다. 혈중의 지방산 농도를 낮추고 심장의 FDG섭취율을 증가시키기 위해 혈중 포도당 농도치에 따라 insulin과 Acipimox를 함께 사용하는 독창적인 경구 당 부하법을 사용하였으며, 환자의 피폭 경감을 위해서 $^{18}F$-FDG 5 mCi를 주사하고 1시간 후에 10분간 gated 영상을 얻으며 필요시 delay 영상을 얻는다. PET검사가 끝남과 동시에 환자는 동일한 position을 하고 연속해서 coronary CTA를 시행한다. 이 검사에서 가장 중요한 것은 심박동수 조절과 환자의 호흡협조이다. 심박동수를 65회 이하로 낮추기 위해 beta blocker 50 mg~200 mg을 의사와 상의하여 복용케 하고 호흡법을 충분히 연습을 시키다. 검사 직전에 isosorbide dinitrate를 3~5회 분무하여 혈관벽의 긴장을 낮추고 혈관을 확장시켜서 coronary artery의 해부학적 형태를 더욱 잘 나타낼 수 있게 한다. 촬영 시 CT 조영제를 4.0~5.0 mL/sec의 압력으로 주입하며 촬영을 한다. Coronary CTA를 이용하면 coronary artery stenosis가 잘 보이며, 약물부하 myocardial perfusion SPECT로 coronary CTA에서 보인 stenosis와 perfusion저하의 상관관계를 검토(culprit vessel 확인)할 수 있으며, FDG PET으로 hibernating myocardium 또는 infarction site의 viability를 확인할 수 있다. 한 가지 검사로 lesion site와 severity 및 치료에 대한 반응 예측이 가능함으로 약물치료, PCI, CABG 등 치료방향을 설정할 수 있다. 또한 모든 검사 과정들이 연속적으로 동시에 이루어지기 때문에 짧은 시간(3시간) 내에 one-stop으로 검사를 종료할 수 있는 큰 장점을 가지게 된다. 그러므로 이 검사법은 ischemic heart disease의 one-stop evaluation에 있어서 유용한 protocol로 보여진다.

$^{99m}Tc$을 이용한 심근 관류 SPECT에서 Multiple Confocal SPECT System의 유용성

신채호,표성재,김봉수,조용귀,조진우,김창호,Shin, Chae-Ho,Pyo, Sung-Jai,Kim, Bong-Su,Cho, Yong-Gyi,Jo, Jin-Woo,Kim, Chang-Ho 대한핵의학기술학회 2011 핵의학 기술 Vol.15 No.2

근래의 심근 관류 SPECT를 위한 검사 장비는 진단의 정확도가 높아졌을 뿐만 아니라 검사 시간을 단축함으로써 환자의 편의성을 높이고 움직임에 대한 artifact를 줄이는 방향으로 발전되고 있다. 본 연구에서는 기존의 심근 관류 SPECT와 비교하여 IQ SPECT에 맞는 protocol을 design 하고 IQ SPECT의 특성과 유용성에 대하여 알아 보고자 하였다. Simens사의 Symbia T6 SPECT/CT를 이용하여 LEHR collimator와 Multiple confocal collimator에 대하여 acrylic dish에 $^{99m}Tc$ 37MBq을 넣고 5 cm, 10 cm, 20 cm, 30 cm, 40 cm 거리에서 각각 sensitivity ($cpm/{\mu}Ci$)를 측정 하였다. 그리고 Sensitivity 측정 결과를 바탕으로 기존의 일반적인 심근관류 SPECT를 기준으로 IQ SPECT protocol을 design 후 Anthropomorphic torso phantom을 사용하여 심근 관류 SPECT를 시행하여 비교하고, LEHR collimator의 영상 재구성에 따른 FWHM 비교를 위해 $^{99m}Tc$ Line source를 이용하여 기존의 심근 관류 SPECT의 재구성법인 FBP법과 IQ SPECT의 3D OSEM법에 대하여 알고리즘만 변화시켜 FWHM을 측정 비교하였다. Collimator senstivity 측정 결과 IQ SPECT의 multiple confocal collimator의 sensitivity가 LEHR collimator와 비교하여 30 cm 거리에서 sensitivity가 약 4배 정도 더 많아짐을 알 수 있었다. Sensitivity 결과를 바탕으로 IQ SPECT의 기하학적 특성에 맞게 심근 관류 SPECT protocol을 design 하여 phantom 실험을 시행한 결과 기존에 비해 검사시간을 1/4로 단축할 수 있었으며, LEHR collimator를 사용하여 SPECT 검사 후 FBP법과 3D OSEM 법의 재구성 알고리즘에 따른 FWHM 비교에서는 3D OSEM법에서 FWHM이 2배 정도 향상된 결과를 얻었다. 본 연구를 통해 IQ SPECT는 심근관류 SPECT에서 Multiple confocal collimator를 사용하여 감도를 향상시키고 심장에 특화된 기하학적인 영상 획득 방식과 영상 재구성 방법을 통하여 검사 시간을 단축하고 영상의 화질 개선에 도움을 준다. 이로 인해 환자는 전보다 더욱 편안하고 정확한 검사를 수행 할 수 있을 것이며, 추가적으로 더 많은 임상 자료를 통한 연구가 필요할 것이다. Purpose: The recently adopted multiple confocal SPECT SYSTEM (hereinafter called IQ SPECT$^{TM}$) has a high difference from the conventional myocardial perfusion SPECT in the collimator form, image capture method, and image reconstruction method. This study was conducted to compare this novice equipment with the conventional one to design a protocol meeting the IQ SPECT, and also determine the characteristics and usefulness of IQ SPECT. Materials and Methods: 1. For the objects of LEHR (Low energy high resolution) collimator and Multiple confocal collimator, $^{99m}Tc$ 37MBq was put in the acrylic dish then each sensitivity ($cpm/{\mu}Ci$) was measured at the distance of 5 cm, 10 cm, 20 cm, 30 cm, and 40 cm respectively. 2. Based on the sensitivity measure results, IQ SPECT Protocol was designed according to the conventional general myocardial SPECT, then respectively 278 kBq/mL, 7.4 kBq/mL, and 48 kBq/mL of $^{99m}Tc$ were injected into the myocardial and soft tissues and liver site by using the anthropomorphic torso phantom then the myocardial perfusion SPECT was run. 3. For the comparison of FWHMs (Full Width at Half Maximum) resulted from the image reconstruction of LEHR collimator, the FWHMs (mm) were measured with only algorithms changed, in the case of the FBP (Filtered Back projection) method- a reconstruction method of conventional myocardial perfusion SPECT, and the 3D OSEM (Ordered subsets expectation maximization) method of IQ SPECT, by using $^{99m}Tc$ Line source. Results: 1. The values of IQ SPECT collimator sensitivity ($cpm/{\mu}Ci$) were 302, 382, 655, 816, 1178, and those of LEHR collimator were measured as 204, 204, 202, 201, 198, both at the distance of 5 cm, 10 cm, 20 cm, 30 cm, and 40 cm respectively. It was found the difference of sensitivity increases up to 4 times at the distance of 30 cm in the cases of IQ SPECT and LEHR. 2. The myocardial perfusion SPECT Protocol was designed according to the geometric characteristics of IQ SPECT based on the sensitivity results, then the phantom test for the aforesaid protocol was conducted. As a result, it was found the examination time can be reduced 1/4 compared to the past. 3. In the comparison of FWHMs according to the reconstructed algorithm in the FBP method and 3D OSEM method followed after the SEPCT test using a LEHR collimator, the result was obtained that FWHM rose around twice in the 3D OSEM method. Conclusion : The IQ SPECT uses the Multiple confocal collimator for the myocardial perfusion SPECT to enhance the sensitivity and also reduces examination time and contributes to improvement of visual screen quality through the myocardial-specific geometric image capture method and image reconstruction method. Due to such benefits, it is expected patients will receive more comfortable and more accurate examinations and it is considered a further study is required using additional clinical materials.

급성 심근경색증에 대한 일차 관상동맥 중재술 후 심근조직 재관류 평가에 있어 TIMI 화면계수법과 TIMI 심근관류등급법의 비교

김범준,정해억,고윤석,임상현,윤호중,강동헌,승기배,김재형,홍순조,최규보 대한순환기학회 2003 Korean Circulation Journal Vol.33 No.10

Recent Advances in Nuclear Cardiology

Lee, Won Woo The Korea Society of Nuclear Medicine 2016 핵의학 분자영상 Vol.50 No.3

Nuclear cardiology is one of the major fields of nuclear medicine practice. Myocardial perfusion studies using single-photon emission computed tomography (SPECT) have played a crucial role in the management of coronary artery diseases. Positron emission tomography (PET) has also been considered an important tool for the assessment of myocardial viability and perfusion. However, the recent development of computed tomography (CT)/magnetic resonance imaging (MRI) technologies and growing concerns about the radiation exposure of patients remain serious challenges for nuclear cardiology. In response to these challenges, remarkable achievements and improvements are currently in progress in the field of myocardial perfusion imaging regarding the applicable software and hardware. Additionally, myocardial perfusion positron emission tomography (PET) is receiving increasing attention owing to its unique capability of absolute myocardial blood flow estimation. An F-18-labeled perfusion agent for PET is under clinical trial with promising interim results. The applications of F-18 fluorodeoxyglucose (FDG) and F-18 sodium fluoride (NaF) to cardiovascular diseases have revealed details on the basic pathophysiology of ischemic heart diseases. PET/MRI seems to be particularly promising for nuclear cardiology in the future. Restrictive diseases, such as cardiac sarcoidosis and amyloidosis, are effectively evaluated using a variety of nuclear imaging tools. Considering these advances, the current challenges of nuclear cardiology will become opportunities if more collaborative efforts are devoted to this exciting field of nuclear medicine.

Clinical Utility of Coronary CT Angiography with Stress Perfusion CT in Preoperative Cardiac Risk Evaluation

장성아,김성목,최승혁,최연현,김영욱,김덕경 대한심장학회 2014 Korean Circulation Journal Vol.44 No.3

Background and Objectives: Vascular surgery carries high operative risk. Recently developed cardiac computed tomography (CT) provides excellent imaging of coronary artery disease (CAD), as well as myocardial perfusions. We investigated the role of stress perfusion CT with coronary computed tomography angiography (CCTA) using 128-slice dual source CT (DSCT) in preoperative cardiac risk evaluation. Subjects and Methods: Patients scheduled for vascular surgery were admitted and underwent the adenosine stress perfusion CT with CCTA using DSCT. Patients who presented with unstable angina, recent myocardial infarction, decompensated heart failure, or renal failure were excluded. Stress perfusion CT was first acquired using sequential mode during adenosine infusion, after which, scanning for CT angiography was followed by helical mode. Perioperative events were followed up for 1 month. Results: Ninety-one patients completed the study. Most patients (94.5%) had coronary atherosclerosis, with 36 (39.6%) patients had more than 50% coronary artery stenosis. Perfusion defects with significant stenosis were found in 12 cases (13.2%). Revascularization after DSCT was rarely performed. Four patients (4.4%) experienced cardiac events in the perioperative period: two experienced heart failure and two had non-fatal myocardial infarction. Conclusion: We cannot conclude that the stress perfusion CT, with CCTA using DSCT, plays a significant role in preoperative risk evaluation from this study. However, the coronary atherosclerosis and the significant CAD were commonly found. The perfusion defects with significant lesions were found in only small fraction of the patients, and did not contribute to perioperative myocardial infarction or heart failure.

Effect of Hyperglycemia on Myocardial Perfusion in Diabetic Porcine Models and Humans

박진주,김선화,김명아,차인호,최동주,윤창환 대한의학회 2019 Journal of Korean medical science Vol.34 No.29

Background: Diabetes mellitus (DM) causes macro- and microvasculopathy, but data on cardiac microvascular changes in large animals are scarce. We sought to determine the effect of DM on macro- and microvascular changes in diabetic pigs and humans. Methods: Eight domestic pigs (4 with type I diabetes and 4 controls) underwent coronary angiography with optical coherence tomography (OCT; at baseline and 1 and 2 months), coronary computed tomography angiography, cardiac magnet resonance (CMR) imaging, and histologic examination. Results: The diabetic pigs had more irregular capillaries with acellular capillaries and a smaller capillary diameter (11.7 ± 0.33 μm vs. 13.5 ± 0.53 μm; P < 0.001) than those of the control pigs. The OCT showed no significant epicardial stenosis in either group; however diabetic pigs had a greater intima-media thickness. CMR results showed that diabetic pigs had a lower relative upslope at rest (31.3 ± 5.9 vs. 37.9 ± 8.1; P = 0.011) and during stress (18.0 ± 3.0 vs. 21.6 ± 2.8; P = 0.007) than the control pigs, implying decreased myocardial perfusion. Among the 79 patients with ST elevation myocardial infarction, 25 had diabetes and they had lower myocardial perfusion on CMR as well. Conclusion: DM causes microvascular remodeling and a decrease in myocardial perfusion in large animals at a very early stage of the disease course. Early and effective interventions are necessary to interrupt the progression of vascular complications in diabetic patients.

Comparative study of ⁸²Sr separation/purification methods used at Brookhaven National Laboratory and ARRONAX

Ha, Yeong Su,Yoon, Sang-Pil,Kim, Han-Sung,Kim, Kye-Ryung 대한방사성의약품학회 2019 Journal of radiopharmaceuticals and molecular prob Vol.5 No.2

Nuclear imaging is one of the most powerful measures for non-invasive diagnosis of myocardial vascular disease. Radionuclide such as ¹³N, ¹⁵O, ²⁰¹Tl and ⁸²Rb is used for the measurement of cardiac blood flow. ¹³N, ¹⁵O and ²⁰¹Tl are produced in cyclotrons while ⁸²Rb is obtained from generator. Rubidium (Rb), an alkali ion, behaves biologically like potassium, and accumulates in myocardial tissue. Rb has rapid blood clearance profile which allows the use of ⁸²Rb with a short physical half-life of 75 s for non-invasive evaluation of regional myocardial perfusion. There are several advantages of ⁸²Rb over other radioisotopes. An ultra-short half-life significantly reduces the exposure of patients to radiation and allows to repeat injections for studying the effects of medical intervention. As a positron emitter, ⁸²Rb allows positron emission tomography (PET) imaging which have shown superior diagnostic performances. ⁸²Rb can be produced from generator by decay of its parent ⁸²Sr. However, the preparation of ⁸²Sr is difficult, because appropriate purity is required to meet the specification of the product. Recently reported procedure from ARRONAX research institute showed that a Chelex-100 resin is sufficient for this purpose and additional column is not necessary. Whereas Brookhaven National Laboratory (BNL) procedure contains three ion exchange resin separation, including Chelex-100 resin. Currently, since ⁸²Sr production site is non-existent in Korea, Korea Atomic Energy Research Institute (KAERI) has plan to produce ⁸²Sr within specifications. We compared ⁸²Sr purification procedures reported from ARRONAX and BNL to investigate the most suitable procedure for our conditions.

Comparative study of 82Sr separation/purification methods used at Brookhaven National Laboratory and ARRONAX Laboratory and ARRONAX

Yeong Su Ha,Sang-Pil Yoon,,Han-Sung Kim,Kye-Ryung Kim 대한방사성의약품학회 2019 Journal of radiopharmaceuticals and molecular prob Vol.5 No.2

Nuclear imaging is one of the most powerful measures for non-invasive diagnosis of myocardial vasculardisease. Radionuclide such as 13N, 15O, 201Tl and 82Rb is used for the measurement of cardiac blood flow. 13N, 15O and 201Tl are produced in cyclotrons while 82Rb is obtained from generator. Rubidium (Rb), an alkaliion, behaves biologically like potassium, and accumulates in myocardial tissue. Rb has rapid blood clearanceprofile which allows the use of 82Rb with a short physical half-life of 75 s for non-invasive evaluation of regionalmyocardial perfusion. There are several advantages of 82Rb over other radioisotopes. An ultra-short half-lifesignificantly reduces the exposure of patients to radiation and allows to repeat injections for studying the effectsof medical intervention. As a positron emitter, 82Rb allows positron emission tomography (PET) imaging whichhave shown superior diagnostic performances. 82Rb can be produced from generator by decay of its parent82Sr. However, the preparation of 82Sr is difficult, because appropriate purity is required to meet the specificationof the product. Recently reported procedure from ARRONAX research institute showed that a Chelex-100 resinis sufficient for this purpose and additional column is not necessary. Whereas Brookhaven National Laboratory(BNL) procedure contains three ion exchange resin separation, including Chelex-100 resin. Currently, since82Sr production site is non-existent in Korea, Korea Atomic Energy Research Institute (KAERI) has plan toproduce 82Sr within specifications. We compared 82Sr purification procedures reported from ARRONAX andBNL to investigate the most suitable procedure for our conditions.

Respiratory Motion Detection and Correction in ECG-Gated SPECT: a New Approach

Ahmad Bitarafan,Hossein Rajabi,Bernhard Gruy,Feridoon Rustgou,Hasan Firoozabady,Nahid Yaghoobi,Hadi Malek,Christian Pirich,Werner Langesteger,Mohsen Beheshti 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.6

Objective: Gated myocardial perfusion single-photon emission computed tomography (GSPECT) has been established as an accurate and reproducible diagnostic and prognostic technique for the assessment of myocardial perfusion and function. Respiratory motion is among the major factors that may affect the quality of myocardial perfusion imaging (MPI) and consequently the accuracy of the examination. In this study, we have proposed a new approach for the tracking of respiratory motion and the correction of unwanted respiratory motion by the use of respiratory-cardiac gated-SPECT (RC-GSPECT). In addition, we have evaluated the use of RC-GSPECT for quantitative and visual assessment of myocardial perfusion and function. Materials and Methods: Twenty-six patients with known or suspected coronary artery disease (CAD)-underwent two-day stress and rest 99mTc-Tetrofosmin myocardial scintigraphy using both conventional GSPECT and RC-GSPECT methods. The respiratory signals were induced by use of a CT real-time position management (RPM) respiratory gating interface. A PIO-D144 card, which is transistor-transistor logic (TTL) compatible, was used as the input interface for simultaneous detection of both ECG and respiration signals. Results: A total of 26 patients with known or suspected CAD were examined in this study. Stress and rest myocardial respiratory motion in the vertical direction was 8.8-16.6 mm (mean, 12.4 ± 2.9 mm) and 7.8-11.8 mm (mean, 9.5 ± 1.6 mm), respectively. The percentages of tracer intensity in the inferior, inferoseptal and septal walls as well as the inferior to lateral (I/L) uptake ratio was significantly higher with the use of RC-GSPECT as compared to the use of GSPECT (p < 0.01). In a left ventricular ejection fraction (LVEF) correlation analysis between the use of rest GSPECT and RC-GSPECT with echocardiography, better correlation was noted between RC-GSPECT and echocardiography as compared with the use of GSPECT (y = 0.9654x + 1.6514; r = 0.93, p < 0.001 versus y = 0.8046x + 5.1704; r = 0.89, p < 0.001). Nineteen (19/26) patients (73.1%) showed abnormal myocardial perfusion scans with reversible regional myocardial defects; of the 19 patients, 14 (14/26) patients underwent coronary angiography. Conclusion: Respiratory induced motion can be successfully corrected simultaneously with the use of ECG-gated SPECT in MPI studies using this proposed technique. Moreover, the use of ECG-gated SPECT improved image quality, especially in the inferior and septal regions that are mostly affected by diaphragmatic attenuation. However, the effect of respiratory correction depends mainly on the patient respiratory pattern and may be clinically relevant in certain cases. Objective: Gated myocardial perfusion single-photon emission computed tomography (GSPECT) has been established as an accurate and reproducible diagnostic and prognostic technique for the assessment of myocardial perfusion and function. Respiratory motion is among the major factors that may affect the quality of myocardial perfusion imaging (MPI) and consequently the accuracy of the examination. In this study, we have proposed a new approach for the tracking of respiratory motion and the correction of unwanted respiratory motion by the use of respiratory-cardiac gated-SPECT (RC-GSPECT). In addition, we have evaluated the use of RC-GSPECT for quantitative and visual assessment of myocardial perfusion and function. Materials and Methods: Twenty-six patients with known or suspected coronary artery disease (CAD)-underwent two-day stress and rest 99mTc-Tetrofosmin myocardial scintigraphy using both conventional GSPECT and RC-GSPECT methods. The respiratory signals were induced by use of a CT real-time position management (RPM) respiratory gating interface. A PIO-D144 card, which is transistor-transistor logic (TTL) compatible, was used as the input interface for simultaneous detection of both ECG and respiration signals. Results: A total of 26 patients with known or suspected CAD were examined in this study. Stress and rest myocardial respiratory motion in the vertical direction was 8.8-16.6 mm (mean, 12.4 ± 2.9 mm) and 7.8-11.8 mm (mean, 9.5 ± 1.6 mm), respectively. The percentages of tracer intensity in the inferior, inferoseptal and septal walls as well as the inferior to lateral (I/L) uptake ratio was significantly higher with the use of RC-GSPECT as compared to the use of GSPECT (p < 0.01). In a left ventricular ejection fraction (LVEF) correlation analysis between the use of rest GSPECT and RC-GSPECT with echocardiography, better correlation was noted between RC-GSPECT and echocardiography as compared with the use of GSPECT (y = 0.9654x + 1.6514; r = 0.93, p < 0.001 versus y = 0.8046x + 5.1704; r = 0.89, p < 0.001). Nineteen (19/26) patients (73.1%) showed abnormal myocardial perfusion scans with reversible regional myocardial defects; of the 19 patients, 14 (14/26) patients underwent coronary angiography. Conclusion: Respiratory induced motion can be successfully corrected simultaneously with the use of ECG-gated SPECT in MPI studies using this proposed technique. Moreover, the use of ECG-gated SPECT improved image quality, especially in the inferior and septal regions that are mostly affected by diaphragmatic attenuation. However, the effect of respiratory correction depends mainly on the patient respiratory pattern and may be clinically relevant in certain cases.

급성심근경색증 환자에서 응급으로 시행한 Tc - 99m Sestamibi 심근관류 SPECT와 심전도의 비교

원규장(Kyu Chang Won),이형우(Hyoung Woo Lee),심봉섭(Bong Sup Shim),이현우(Hyun Woo Lee),조인호(Ihn Ho Cho),박종선(Jong Sun Park),도준영(Jun Young Do),신동구(Dong Gu Sin),윤경우(Kyung Woo Yoon),김영조(Young Jo Kim) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1

N/A We did Tc-99m sestamibi myocardial perfusion SPECT in 36 patients with acute myocardial infarction when they arrived at the emergency room. And we compared myocardial perfusion images with ECG findings. Then we obtained the follows. The myocardial infarction by the obstruction of left coronary descending artery and right coronary artery showed a good concordance in the diagnosis and infarction site between myocardial perfusion images and ECG findings. The 7 patients with myocardial infarction by a left circumflex coronary artery showed a perfusion defect in the lateral wall in myocardial perfusion SPECT images. But 4 patients of them showed ST segment elevation, 2 patients showed ST depression and 1 patient showed normal ECG findings. The diagnostic sensitivity of Tc-99m sestamibi myocardial perfusion SPECT was 100% by a qualified analysis. The perfusion defect site in the myocardial perfusion SPECT were con-responded with the infarct related coronary artery in 31 patients which was diagnosed by coronary angiograpy. The size of perfusion defect in the polar map was 31±18%(M±SD), in the myocardial infarction with left anterior descending coronary arery obstruction, 31±13% (M±SD) in the myocardial infarction with right coronary artery obstruction and 25±5.9%(M±SD) in the myocardial infarction on with left circumflex coronary artery obstruction. We concluded that emergency myocardial perfusion SPECT images are useful in the diagnose of myocardial infarction and it's very useful when we are difficult to diagnose with ECG like as lateral wall infarction or left bundle branch block.