Comparison Study between Myocardial Velocity obtained from Gated Myocardial SPECT and Myocardial Functional indices with a Focus on Myocardial Perfusion / 핵의학분자영상

PURPOSE: We aimed to assess the myocardial velocity on gated myocardial perfusion SPECT (gated MPS), to compare myocardial velocity between patients without coronary artery disease (CAD) and CAD patients and to assess the correlation of myocardial velocity and perfusion and wall thickening on CAD group. MATERIALS AND METHODS: Seventeen patients without CAD (M:F=9:8, mean age 61.8+/-11.1 yrs: group A) and thirty-nine patients with CAD (M:F=18:21, mean age 66.9+/-8.1 yrs: group B) had undergone one-day adenosine stress gated MPS. In twenty segment model, 12 segments (except apical and basal segments) of each patient were included. We obtained systolic and diastolic gate ratio in left ventricular volume curve by eight frames per cardiac cycle on gated MPS. Using the systolic and diastolic gate ratio and R-R time of each patient, we obtained systolic and diastolic time ratio. The myocardial velocity was defined as wall thickening over systolic or diastolic time. RESULTS: We presented normal range of myocardial velocities according segments and territories of coronary artery. The myocardial velocity of group B was significantly lower than group A (p=0.00). There was no significant difference between the myocardial velocity of group B with preserved EF and group A. The stress systolic velocity significantly correlated with regional myocardial perfusion in group B with preserved EF (p=0.00) as well as decreased EF (p=0.01). In group B, stress perfusion of segments which had decreased wall thickening and decreased myocardial velocity was significantly lower than segments which had decreased wall thickening and preserved myocardial velocity (p=0.01). CONCLUSION: The new functional index of velocity will be used as an useful of gated MPS

State of the Art of Imaging Equipment and Tools for Nuclear Cardiology / 핵의학분자영상

Nuclear cardiology in Korea is less active, compared to nuclear oncology, but it has been specialized and ramified. Lately, sophisticated nuclear cardiac imaging methods provide more convenience for patients. It is necessary to accurately estimate the recent progress in the imaging devices for nuclear cardiology. Myocardial perfusion imaging is a well established study to evaluate heart function. Myocardial perfusion SPECT and PET have been used for assessment of coronary artery disease with various radiopharmaceuticals. And of late, the development of advanced imaging devices - multi-pinhole technique and high definition imaging technique - and software made the scanning time shorter and expanded the application field. Therefore, it is required to review the nuclear cardiology hardware/software for the clinical practice and research. In this review, the characteristics about recently-developed SPECT/PET and software for nuclear cardiology are described. It is hoped that this information would contribute to improving the activity of nuclear cardiac research in Korea where the research for the fusion imaging combining CT and nuclear imaging is drawing more attention.

Radiopharmaceuticals Used in Cardiac Imaging / 핵의학분자영상

Many radiopharmaceuticals have been developed and wildy used in the imaging cardiac function. Myocardial perfusion imaging (MPI) is a well established noninvasive method of assessing coronary blood flow and has been widely used in patients diagnosed or suspected with coronary artery diseases. The innovation of radiopharmaceuticals used in the cardiac imaging is one of the most important contributors to the development of nuclear cardiology. Thallium-201 and various technetium-99m agents have been globally used for myocardial perfusion SPECT, and N-13 ammonia (13NH3), rubidium-82 (82Rb), O-15 water (H215O) for myocardial perfusion PET. As well as the cardiac perfusion studies, new radiopharmaceuticals that visualize fat metabolism or receptors of the sympathetic nervous system have successfully been applied to clinical practice. Useful information can be obtained for diagnosing coronary artery disease, evaluating patients' condition, or assessing therapeutic effects. In this review, we describe the characteristics and clinical usefulness of radiopharmaceuticals used for cardiac SPECT and PET.

Added Value of 3D Cardiac SPECT/CTA Fusion Imaging in Patients with Reversible Perfusion Defect on Myocardial Perfusion SPECT / 핵의학분자영상

PURPOSE: Integration of the functional information of myocardial perfusion SPECT (MPS) and the morphoanatomical information of coronary CT angiography (CTA) may provide useful additional diagnostic information of the spatial relationship between perfusion defects and coronary stenosis. We studied to know the added value of three dimensional cardiac SPECT/CTA fusion imaging (fusion image) by comparing between fusion image and MPS. MATERIALS AND METHODS: Forty-eight patients (M:F=26:22, Age: 63.3+/-10.4 years) with a reversible perfusion defect on MPS (adenosine stress/rest SPECT with Tc-99m sestamibi or tetrofosmin) and CTA were included. Fusion images were molded and compared with the findings from the MPS. Invasive coronary angiography served as a reference standard for fusion image and MPS. RESULTS: Total 144 coronary arteries in 48 patients were analyzed; Fusion image yielded the sensitivity, specificity, negative and positive predictive value for the detection of hemodynamically significant stenosis per coronary artery 82.5%, 79.3%, 76.7% and 84.6%, respectively. Respective values for the MPS were 68.8%, 70.7%, 62.1% and 76.4%. And fusion image also could detect more multi-vessel disease. CONCLUSION: Fused three dimensional volume-rendered SPECT/CTA imaging provides intuitive convincing information about hemodynamic relevant lesion and could improved diagnostic accuracy.

Development of Optical Molecular Imaging System for the Acquisition of Bioluminescence Signals from Small Animals / 핵의학분자영상

PURPOSE: Optical imaging is providing great advance and improvement in genetic and molecular imaging of animals and humans. Optical imaging system consists of optical imaging devices, which carry out major function for monitoring, tracing, and imaging in most of molecular in-vivo researches. In bio-luminescent imaging, small animals containing luciferase gene locally irradiate light, and emitted photons transmitted through skin of the small animals are imaged by using a high sensitive charged coupled device (CCD) camera. In this paper, we introduced optical imaging system for the image acquisition of bio-luminescent signals emitted from small animals. MATERIALS AND METHODS: In the system, Nikon lens and four LED light sources were mounted at the inside of a dark box. A cooled CCD camera equipped with a control module was used. RESULTS: We tested the performance of the optical imaging system using effendorf tube and light emitting bacteria which injected intravenously into CT26 tumor bearing nude mouse. The performance of implemented optical imaging system for bio-luminescence imaging was demonstrated and the feasibility of the system in small animal imaging application was proved. CONCLUSION: We anticipate this system could be a useful tool for the molecular imaging of small animals adaptable for various experimental conditions in future.

Development of Quantification Method for Bioluminescence Imaging / 핵의학분자영상

PURPOSE: Optical molecular luminescence imaging is widely used for detection and imaging of bio-photons emitted by luminescent luciferase activation. The measured photons in this method provide the degree of molecular alteration or cell numbers with the advantage of high signal-to-noise ratio. To extract useful information from the measured results, the analysis based on a proper quantification method is necessary. In this research, we propose a quantification method presenting linear response of measured light signal to measurement time. MATERIALS AND METHODS: We detected the luminescence signal by using lab-made optical imaging equipment of animal light imaging system (ALIS) and different two kinds of light sources. One is three bacterial light-emitting sources containing different number of bacteria. The other is three different non-bacterial light sources emitting very weak light. By using the concept of the candela and the flux, we could derive simplified linear quantification formula. After experimentally measuring light intensity, the data was processed with the proposed quantification function. RESULTS: We could obtain linear response of photon counts to measurement time by applying the pre-determined quantification function. The ratio of the re-calculated photon counts and measurement time present a constant value although different light source was applied. CONCLUSION: The quantification function for linear response could be applicable to the standard quantification process. The proposed method could be used for the exact quantitative analysis in various light imaging equipments with presenting linear response behavior of constant light emitting sources to measurement time.

Quality Assurance and Performance Evaluation of PET/CT / 핵의학분자영상

Positron emission tomography-computed tomography (PET/CT) provides both functional and anatomical images of high quality non-invasively with better precision in localization than PET alone. Increase in the use of PET/CT, coupled with increasing concerns about the quality of medical services accrued the demands for accurate evaluation of system performance and quality assurance. Thus, well designed programs for performance evaluation and quality assurance are needed. Widely used protocols for performance evaluation of PET are the methods proposed by National Electrical Manufacturers Association (NEMA) in 1994 and 2001. In addition, in order to maintain high quality of PET/CT images, quality assurance programs including periodic (daily, monthly, and yearly). Therefore, in this article, the methods and present state of performance evaluation and quality assurance of PET/CT are reviewed.

Correlation between Semiquantitative Myocardial Perfusion Score and Absolute Myocardial Blood Flow in 13N-Ammonia PET / 핵의학분자영상

PURPOSE: 13N-ammonia is a well known radiopharmaceutical for the measurement of a myocardial blood flow (MBF) non-invasively using PET-CT. In this study, we investigated a correlation between MBF obtained from dynamic imaging and myocardial perfusion score (MPS) obtained from static imaging for usefulness of cardiac PET study. METHODS: Twelve patients (11 males, 1 female, 57.9+/-8.6 years old) with suspicious coronary artery disease underwent PET-CT scan. Dynamic scans (6 min: 5 sec X 12, 10 sec X 6, 20 sec X 3, and 30 sec X 6) were initiated simultaneously with bolus injection of 11 MBq/kg 13N-ammonia to acquire rest and stress image. Gating image was acquired during 13 minutes continuously. Nine-segment model (4 basal walls, 4 mid walls, and apex) was used for a measurement of MBF. Time activity curve of input function and myocardium was extracted from ROI methods in 9 regions for quantification. The MPS were evaluated using quantitative analysis software. To compare between 20-segment model and 9-segment model, 6 basal segments were excluded and averaged segmental scores were used. RESULTS: There are weak correlation between MBF (rest, 0.18-2.38 ml/min/g; stress, 0.40-4.95 ml/min/g) and MPS (rest 22-91%, stress, 14-90%), however the correlation coefficient between corrected MBF and MPS in rest state was higher than stress state (rest r=0.59; stress r=0.80). As a thickening increased, correlation between MBF and MPS also showed good correlation at each segments. CONCLUSIONS: Corrected and translated MPS as its characteristics using 13N-ammonia showed good correlation with absolute MBF measured by dynamic image in this study. Therefore, we showed MPS is one of good indices which reflect MBF. We anticipate PET-CT could be used as useful tool for evaluation of myocardial function in nuclear cardiac study.

Diagnostic Performance of Combined Single Photon Emission Computed Tomographic Scintimammography and Ultrasonography Based on Computer-Aided Diagnosis for Breast Cancer / 핵의학분자영상

PURPOSE: We investigated whether the diagnostic performance of SPECT scintimammography (SMM) can be improved by adding computer-aided diagnosis (CAD) of ultrasonography (US). MATERIALS AND METHODS: We reviewed breast SPECT SMM images and corresponding US images from 40 patients with breast masses (21 malignant and 19 benign tumors). The quantitative data of SPECT SMM were obtained as the uptake ratio of lesion to contralateral normal breast. The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program. The diagnostic performance of SPECT SMM and CAD of US alone was determined using receiver operating characteristic (ROC) curve analysis. The best discriminating parameter (D-value) combining SPECT SMM and the CAD of US was created. The sensitivity, specificity and accuracy of combined two diagnostic modalities were compared to those of a single one. RESULTS: Both SPECT SMM and CAD of US showed a relatively good diagnostic performance (area under curve = 0.846 and 0.831, respectively). Combining the results of SPECT SMM and CAD of US resulted in improved diagnostic performance (area under curve =0.860), but there was no statistical differerence in sensitivity, specificity and accuracy between the combined method and a single modality. CONCLUSION: It seems that combining the results of SPECT SMM and CAD of breast US do not significantly improve the diagnostic performance for diagnosis of breast cancer, compared with that of SPECT SMM alone. However, SPECT SMM and CAD of US may complement each other in differential diagnosis of breast cancer.

Evaluation of Therapeutic Effects of Cognitive-Behavioral Therapy in Patients with Panic Disorder using Serial (99m)Tc-ECD Brain Perfusion / 핵의학분자영상

PURPOSE: Although several neuroanatomical models of panic disorder have been proposed, little is known regarding the neurological mechanisms underlying cognitive-behavioral therapy (CBT) in patients with panic disorder. This study was performed to identify the brain structures that show changes of regnioal cerebral blood flow (rCBF) after CBT in patients with panic disorder. MATERIALS AND METHODS: Seven patients who were diagnosed as panic disorder by DSM-IV were treated with CBT for 8 weeks and twelve healthy volunteers joined in this study. Serial (99m)Tc-ECD brain perfusion SPECT images were acquisited and PDSS-SR (Self-Report version of Panic Disorder Severity Scale) and ACQ (Agoraphobic Cognitive Question) scores were measured just before and after CBT in all patients. Data were analyzed using SPM2. RESULTS: Subjective symptoms were improved, and PDSS-SR and ACQ scores were significantly reduced (14.9+/-3.9 vs. 7.0+/-1.8, p<0.05; 30.3+/-8.5 vs. 21.6+/-3.4, p<0.05, respectively) after CBT in panic patients. Before CBT, a significant increase of rCBF was found in the cingulate gylus, thalamus, midbrain, both medial frontal and temporal lobes of the panic patients compared to the normal volunteers. After CBT, we observed a significant rCBF decrease in the left parahippocamus, right insula and cingulate gyrus, both frontal and temporal lobes, and a significant rCBF increase in both the occipital lobes, left insula, both frontal and left parietal lobes. CONCLUSION: These data suggested that CBT is effective for panic disorder and diminish the activity of the brain areas associated with fear in panic disorder.

Effects of Attenuation and Scatter Corrections in Cat Brain PET Images Using microPET R4 Scanner / 핵의학분자영상

PURPOSE: The aim of this study was to examine the effects of attenuation correction (AC) and scatter correction (SC) on the quantification of PET count rates. MATERIALS AND METHODS: To assess the effects of AC and SC, 18F-FDG PET images of phantom and cat brain were acquired using microPET R4 scanner. Thirty-minute transmission images using 68Ge source and emission images after injection of FDG were acquired. PET images were reconstructed using 2D OSEM. AC and SC were applied. Regional count rates were measured using ROIs drawn on cerebral cortex including frontal, parietal, and latral temporal lobes and deep gray matter including head of caudate nucleus, putamen and thalamus for pre- and post-AC and SC images. The count rates were then normalized with the injected dose per body weight. To assess the effects of AC, count ratio of "deep gray matter/cerebral cortex" was calculated. To assess the effects of SC, ROIs were also drawn on the gray matter (GM) and white matter (WM), and contrast between them ((GM-WM)/GM) was measured. RESULTS: After the AC, count ratio of "deep gray matter/cerebral cortex" was increased by 17+/-7%. After the SC, contrast was also increased by 12+/-3%. CONCLUSION: Relative count of deep gray matter and contrast between gray and white matters were increased after AC and SC, suggesting that the AC would be critical for the quantitative analysis of cat brain PET data.

Development and Performance Evaluation of an Animal SPECT System Using Philips ARGUS Gamma Camera and Pinhole Collimator / 대한핵의학회잡지

PURPOSE: We developed an animal SPECT system using clinical Philips ARGUS scintillation camera and pinhole collimator with specially manufactured small apertures. In this study, we evaluated the physical characteristics of this system and biological feasibility for animal experiments. MATERIALS AND METHODS: Rotating station for small animals using a step motor and operating software were developed. Pinhole inserts with small apertures (diameter of 0.5, 1.0, and 2.0 mm) were manufactured and physical parameters including planar spatial resolution and sensitivity and reconstructed resolution were measured for some apertures. In order to measure the size of the usable field of view according to the distance from the focal point, manufactured multiple line sources separated with the same distance were scanned and numbers of lines within the field of view were counted. Using a Tc-99m line source with 0.5 mm diameter and 12 mm length placed in the exact center of field of view, planar spatial resolution according to the distance was measured. Calibration factor to obtain FWHM values in 'mm' unit was calculated from the planar image of two separated line sources. Tc-99m point source with 1 mm diameter was used for the measurement of system sensitivity. In addition, SPECT data of micro phantom with cold and hot line inserts and rat brain after intravenous injection of [I-123]FP-CIT were acquired and reconstructed using filtered back projection reconstruction algorithm for pinhole collimator. RESULTS: Size of usable field of view was proportional to the distance from the focal point and their relationship could be fitted into a linear equation (y=1.4x+0.5, x: distance). System sensitivity and planar spatial resolution at 3 cm measured using 1.0 mm aperture was 71 cps/MBq and 1.24 mm, respectively. In the SPECT image of rat brain with [I-123]FP-CIT acquired using 1.0 mm aperture, the distribution of dopamine transporter in the striatum was well identified in each hemisphere. CONCLUSION: We verified that this new animal SPECT system with the Philips ARGUS scanner and small apertures had sufficient performance for small animal imaging.

Improvement in Regional Contractility of Myocardium after CABG / 대한핵의학회잡지

PURPOSE: The maximal elastance (E (max) ) of myocardium has been established as a reliable load-independent contractility index. Recently, we developed a noninvasive method to measure the regional contractility using gated myocardial SPECT and arterial tonometry data. In this study, we measured regional E (max) (rE (max) ) in the patients who underwent coronary artery bypass graft surgery (CABG), and assessed its relationship with other variables. MATERIALS AND METHODS: 21 patients (M: F=17: 4, 58+/-12 y) who underwent CABG were enrolled. (201) Tl rest/ dipyridamole stress (99m) Tc-sestamibi gated SPECT were performed before and 3 months after CABG. For 15 myocardial regions, regional time-elastance curve was obtained using the pressure data of tonometry and the volume data of gated SPECT. To investigate the coupling with myocardial function, preoperative regional E (max) was compared with regional perfusion and systolic thickening. In addition, the correlation between E (max) and viability was assessed in dysfunctional segments (thickening or=60%), E (max) was 2.65+/-1.67, while it was 1.30+/-1.24 in the segments of decreased perfusion. With regard to thickening, E (max) was 3.01+/-1.92 mmHg/mL for normal regions (thickening > or=40%), 2.40+/-1.19 mmHg/mL for mildly dysfunctional regions ( or=20%), and 1.13+/-0.89 mmHg/mL for severely dysfunctional regions (< 20%). E (max) was improved after CABG in both the viable (from 1.27+/-1.07 to 1.79+/-1.48 mmHg/mL) and non-viable segments (from 0.97+/-0.59 to 1.22+/-0.71 mmHg/mL), but there was no correlation between E (max) and thickening improvements (r=0.007). CONCLUSIONS: Preoperative regional E (max) was relatively concordant with regional perfusion and systolic thickening on gated myocardial SPECT. In dysfunctional but viable segments, E (max) was improved after CABG, but showed no correlation with thickening improvement. As a load-independent contractility index of dysfunctional myocardial segments, we suggest that the regional E (max) could be an independent parameter in the assessment of myocardial function.

Reducing the Scan Time in Gastric Emptying Scintigraphy by Using Mathematical Models / 대한핵의학회잡지

PURPOSE: Gastric emptying scan (GES) is usually acquired up to 2 hours. Our study investigated whether a fraction of meal-retention in the stomach at 120 minutes (FR120) was predicted from the data measured for 90 minutes by using non-linear curve fitting. We aimed at saving the delayed imaging by utilizing mathematical models. MATERIALS AND METHODS: Ninety-six patients underwent GES immediately after taking a boiled egg with 74 MBq (2 mCi) Tc-99m DTPA. The patients were divided into Group I (T1/2 < or=90 min) and Group II (90 min< T1/2< or=120 min). Group I (n=51) had 21 men and 30 women, and Group II (n=45) 15 men and 30 women. There was no significant difference in age and sex between the two groups. Simple exponential, power exponential, and modified power exponential curves were acquired from the measured fraction of meal-retention at each time (0, 15, 30, 45, 60, 75, and 90 min) by non-linear curve fitting (MATLAB (R) 5.3) and another simple exponential fitting was performed on the fractions at late times (60, 75, and 90 min). A predicted FR120 was calculated from the acquired functional formulas. A correlation coefficient between the measured FR120 and the predicted FR120 was computed (MedCalc (R) 6.0). RESULTS: Correlation coefficients (r) between the measured FR120 and the predicted FR120 of each mathematical functions were as follows: simple exponential function (Group I: 0.8858, Group II: 0.5982, p< 0.0001), power exponential function (Group I: 0.8755, Group II: 0.6008, p< 0.0001), modified power exponential function (Group I: 0.8892, Group II: 0.5882, p< 0.0001), and simple exponential function at the late times (Group I: 0.9085, Group II: 0.6832, p< 0.0001). In all the fitting models, the predicted FR120 were significantly correlated with the measured FR120 in Group I but not in Group II. There was no statistically significant difference in correlation among the 4 mathematical models. CONCLUSION: In the cases with T1/2 < or=90 min, the predicted FR120 is significantly correlated with the measured FR120. Therefore, FR120 can be predicted from the data measured for 90 minutes by using non-linear curve fitting, saving the delayed imaging after 90 minutes when T1/2 < or=90 min is ascertained.

Evaluation of Myocardial Blood Flow and Coronary Flow Reserve Using Positron Emission Tomography / 대한핵의학회잡지

Positron emission tomography (PET) serves as a gold standard for noninvasive in vivo measurement of myocardial blood flow (MBF) and coronary flow reserve (CFR). CFR can be defined as the ratio of maximally vasodilated MBF over its basal flow. It is an important parameter for the evaluation of functional severity of coronary stenosis and prognositification in various diseases such as dilated cardiomyopathy. 13NH3, H215O, 82Rb are widely used radiopharmaceuticals for measuring MBF and CFR, This review introduces imaging techniques and its clinical utility. Cardiac application of PET and PET/CT is expected to be increased in near future.

Performance Characteristics of MicroPET R4 Scanner for Small Animal Imaging / 대한핵의학회잡지

PURPOSE: Dedicated animal PET is useful equipment for the study of new PET tracer. Recently, microPET R4 was installed in the Korea institute of radiology and medical science. In this study, we measured the characteristics of scanner. MATERIALS AND METHODS: Resolution was measured using a line source (F-18: 65 micro Ci, inner diameter: 0.5 mm). The line source was put in the axial direction and was moved from the center of field of view to outside with 1 mm interval. PET images were reconstructed using a filtered back-projection and ordered subset expectation maximization. Line source (16.5 micro Ci, 78 mm) was put on the center of axial direction to measure the sensitivity when the deadtime was under 1%. Images were acquired during 4 minutes respectively from center to 39 mm outward. Delayed count was subtracted from total count and then decay was corrected for the calculation of sensitivity. Noise equivalent count ratio and scatter fraction were calculated using cylindrical phantom. RESULTS: Spatial resolution of reconstructed image using filtered back-projection was 1.86 mm (radial), 1.95 mm (tangential), 1.95 mm (axial) in the center of field of view, and 2.54 mm, 2.8 mm, 1.61 mm in 2 cm away from the center respectively. Sensitivity was 2.36% at the center of transaxial field of view. Scatter fraction was 20%. Maximal noise equivalent count ratio was 66.4 kcps at 242 kBq/mL. Small animal images were acquired for confirmation of performance. CONCLUSION: Performance characteristics of microPET R4 were similar with reported value. So this will be a useful tool for small animal imaging.

Development of Quantification Methods for the Myocardial Blood Flow Using Ensemble Independent Component Analysis for Dynamic H215O PET / 대한핵의학회잡지

PURPOSE: Factor analysis and independent component analysis (ICA) has been used for handling dynamic image sequences. Theoretical advantages of a newly suggested ICA method, ensemble ICA, leaded us to consider applying this method to the analysis of dynamic myocardial H215O PET data. In this study, we quantified patients' blood flow using the ensemble ICA method. MATERIALS AND METHODS: Twenty subjects underwent H215O PET scans using ECAT EXACT 47 scanner and myocardial perfusion SPECT using Vertex scanner. After transmission scanning, dynamic emission scans were initiated simultaneously with the injection of 555~740 MBq H215O. Hidden independent components can be extracted from the observed mixed data (PET image) by means of ICA algorithms. Ensemble learning is a variational Bayesian method that provides an analytical approximation to the parameter posterior using a tractable distribution. Variational approximation forms a lower bound on the ensemble likelihood and the maximization of the lower bound is achieved through minimizing the Kullback-Leibler divergence between the true posterior and the variational posterior. In this study, posterior pdf was approximated by a rectified Gaussian distribution to incorporate non-negativity constraint, which is suitable to dynamic images in nuclear medicine. Blood flow was measured in 9 regions - apex, four areas in mid wall, and four areas in base wall. Myocardial perfusion SPECT score and angiography results were compared with the regional blood flow. RESULTS: Major cardiac components were separated successfully by the ensemble ICA method and blood flow could be estimated in 15 among 20 patients. Mean myocardial blood flow was 1.2 +/- 0.40 ml/min/g in rest, 1.85 +/- 1.12 ml/min/g in stress state. Blood flow values obtained by an operator in two different occasion were highly correlated (r=0.99). In myocardium component image, the image contrast between left ventricle and myocardium was 1: 2.7 in average. Perfusion reserve was significantly different between the regions with and without stenosis detected by the coronary angiography (P< 0.01). In 66 segment with stenosis confirmed by angiography, the segments with reversible perfusion decrease in perfusion SPECT showed lower perfusion reserve values in H215O PET. CONCLUSIONS: Myocardial blood flow could be estimated using an ICA method with ensemble learning. We suggest that the ensemble ICA incorporating non-negative constraint is a feasible method to handle dynamic image sequence obtained by the nuclear medicine techniques.

Performance Characteristics of 3D GSO PET/CT Scanner (Philips GEMINI PET/CT) / 대한핵의학회잡지

PURPOSE: Philips GEMINI is a newly introduced whole-body GSO PET/CT scanner. In this study, performance of the scanner including spatial resolution, sensitivity, scatter fraction, noise equivalent count ratio (NECR) was measured utilizing NEMA NU2-2001 standard protocol and compared with performance of LSO, BGO crystal scanner. METHODS: GEMINI is composed of the Philips ALLEGRO PET and MX8000 D multi-slice CT scanners. The PET scanner has 28 detector segments which have an array of 29 by 22 GSO crystals (4x6x20 mm), covering axial FOV of 18 cm. PET data to measure spatial resolution, sensitivity, scatter fraction, and NECR were acquired in 3D mode according to the NEMA NU2 protocols (coincidence window: 8 ns, energy window: 409~664 keV). For the measurement of spatial resolution, images were reconstructed with FBP using ramp filter and an iterative reconstruction algorithm, 3D RAMLA. Data for sensitivity measurement were acquired using NEMA sensitivity phantom filled with F-18 solution and surrounded by 1~5 aluminum sleeves after we confirmed that dead time loss did not exceed 1%. To measure NECR and scatter fraction, 1110 MBq of F-18 solution was injected into a NEMA scatter phantom with a length of 70 cm and dynamic scan with 20-min frame duration was acquired for 7 half-lives. Oblique sinograms were collapsed into transaxial slices using single slice rebinning method, and true to background (scatter + random) ratio for each slice and frame was estimated. Scatter fraction was determined by averaging the true to background ratio of last 3 frames in which the dead time loss was below 1%. RESULTS: Transverse and axial resolutions at 1cm radius were (1) 5.3 and 6.5 mm (FBP), (2) 5.1 and 5.9 mm (3D RAMLA). Transverse radial, transverse tangential, and axial resolution at 10 cm were (1) 5.7, 5.7, and 7.0 mm (FBP), (2) 5.4, 5.4, and 6.4 mm (3D RAMLA). Attenuation free values of sensitivity were 3, 620 counts/sec/MBq at the center of transaxial FOV and 4, 324 counts/sec/MBq at 10 cm offset from the center. Scatter fraction was 40.6%, and peak true count rate and NECR were 88.9 kcps @ 12.9 kBq/mL and 34.3 kcps @ 8.84 kBq/mL. These characteristics are better than that of ECAT EXACT PET scanner with BGO crystal. CONCLUSION: The results of this field test demonstrate high resolution, sensitivity and count rate performance of the 3D PET/CT scanner with GSO crystal. The data provided here will be useful for the comparative study with other 3D PET/CT scanners using BGO or LSO crystals.

Evaluation of Endothelium-dependent Myocardial Perfusion Reserve in Healthy Smokers: Cold Pressor Test using H2 (15) O PET / 대한핵의학회잡지

PURPOSE: Much evidence suggests long-term cigarette smoking alters coronary vascular endothelial response. In this study, we applied nonnegative matrix factorization (NMF), an unsupervised learning algorithm, to CO-less H2 (15) O-PET to investigate coronary endothelial dysfunction caused by smoking noninvasively. MATERIALS AND METHODS: This study enrolled eighteen young male volunteers consisting of 9 smokers (23.8 +/- 1.1 yr; 6.6 +/- 2.5 pack-years) and 9 nonsmokers (23.8 +/- 2.9 yr). They do not have any cardiovascular risk factor or disease history. Myocardial H2 (15) O-PET was performed at rest, during cold (5degrees C) pressor stimulation and during adenosine infusion. Left ventricular blood pool and myocardium were segmented on dynamic PET data by NMF method. Myocardial blood flow (MBF) was calculated from input and tissue functions by a single compartmental model with correction of partial volume and spillover effects. RESULTS: There were no significant difference in resting MBF between the two groups (Smokers: 1.43 0.41 ml/g/min and non-smokers: 1.37 +/- 0.41 ml/g/min; p = NS). during cold pressor stimulation, MBF in smokers was significantly lower than that in non-smokers (1.25 +/- 0.34 ml/g/min vs 1.59 +/- 0.29 ml/g/min ; p=0.019). The difference in the ratio of cold pressor MBF to resting MBF between the two groups was also significant (p=0.024; 90 +/- 24% in smokers and 122 +/- 28% in non-smokers.). During adenosine infusion, however, hyperemic MBF did not differ significantly between smokers and non-smokers (5.81 +/- 1.99 ml/g/min vs 5.11 +/- 1.31 ml/g/min ; p=NS). CONCLUSION: In smokers, MBF during cold pressor stimulation was significantly lower compared with nonsmokers, reflecting smoking-induced endothelial dysfunction. However, there was no significant difference in MBF during adenosine-induced hyperemia between the two groups.

Development of Evaluation Method of Regional Contractility of Left Ventricle Using Gated Myocardial SPECT and Assessment of Reproducibility / 대한핵의학회잡지

PURPOSE: Regional contractility can be calculated using the regional volume change of left ventricle measured by gated myocardial SPECT image and curve of central artery pressure obtained from radial artery pressure data. In this study, a program to obtain the regional contractility was developed, and reproducibility of regional contractility measurement was assessed. MATERIALS AND METHODS: Seven patients (male: female=5: 2, 58+/-11.9 years) with coronary artery diseases underwent gated Tc-99m MIBI myocardial SPECT twice without delay between two scans. Regional volume change of left ventricle was estimated using CSA (Cardiac SPECT Analyzer) software developed in this study. Regional contractility was iteratively estimated from the time-elastance curve obtained using the time-pressure curve and regional time-volume curve. Reproducibility of regional contractility measurement assessed by comparing the contractility values measured twice from the same SPECT data and by comparing those measured from the pair of SPECT data obtained from a same patient. RESULTS: Measured regional contractility was 3.36 +/- 3.38 mmHg/mL using 15-segment model, 3.16 +/- 2.25 mmHg/mL using 7-segment model, and 3.11 +/- 2.57 mmHg/mL using 5-segment model. The harmonic average of regional contractility value was almost identical to the global contractility. Correlation coefficient of regional contractility values measured twice from the same data was greater than 0.97 for all models, and two standard deviations of contractility difference on Bland Altman plot were 1.5%, 1.0%, and 0.9% for 15-, 7-, and 5-segment models, respectively. Correlation coefficient of regional contractility values measured from the pair of SPECT data obtained from a same patient was greater than 0.95 for all models, and two standard deviations on Bland Altman plot were 2.2%, 1.0%, and 1.2%. CONCLUSION: Regional contractility of left ventricle measured using developed software in this study was reproducible. Regional contractility of left ventricle will be a new useful index for myocardial function after analysis of the clinical data.