Experimental Study on 99mTc-MIBI Imaging Evaluating Multidrug Resistance of Mice Lewis Lung Cancer / 昆明医科大学学报

Objectives 99mTc-methoxyisobutylisonitrile (MIBI) SPECT imaging technology was used to observe the condition of tumor cell in-taking imaging agent in the C57BL/6J mice Lewis lung cancer model before and after using Ginsenoside Rg3 (short for Rg3).We aimd so as to discuss the feasibility of using this method to evaluate tumor multidrug resistance (MDR) status.Methods Mice Lewis lung cancer models were randomly divided into Rg3 group and the control group.After applying Rg3,semi-quantitative analysis was made on 99mTc-MIBI SPECT imaging and region of interest (ROI) to observe the multidrug resistance state of tumor and then the results were compared with the detection results of flow cytometry.Results The tumor intake ratio (T/N) difference between the control group and the Rg3 group in imaging,imaging before applying Rg3 and imaging after applying Rg3 were separately 15,60 and 120 min.The differences were statistical significant (P ＜ 0.01).The eliminate indexes (WR) of the control group and Rg3 group were positively related to P-gp protein expression positive cells detected by flow cytometry (P ＜ 0.05).Conclusions 99mTc-MIBI imaging is negatively related to P-glycoprotein (P-gp) expression in mice Lewis lung cancer cells,which can clearly show the multidrug resistance state of tumors and dynamically monitor the effect of Rg3 on multidrug resistance reversion of mice Lewis lung cancer.

Application of 18F-FDG/99mTc-MIBI dual-isotope SPECT and gated myocardial imaging in early diagnosis of diabetes-induced myocardial damage / 实用医学杂志

Objective To explore the diagnostic value of 18F-FDG/ 99mTc-MIBI dual-isotope SPECT and gated myocardial imaging in early diagnosis of diabetes-induced myocardial damage. Methods 32 patients with diabetes and 26 healthy volunteers received 18F-FDG/ 99mTc-MIBI dual-isotope SPECT and gated myocardial imaging for assessing myocardial ischemia, viability status, and cardiac function. Results Myocardial perfusion abnormalitieswere observed in 47 regions on myocardial perfusion imagingin 21 of 32 (65.6%)patients with diabetes, showing perfusion/metabolism mismatched and suggesting viable myocardium. All the volunteers were normal on DISA. As compared with the normal control group, the positive rate of DISA in diabetic patients was significantly higher (P < 0.01). Left ventricular ejection fraction (LVEF) was (54.3 ± 7.2%) and (67.3±4.9%) respectively, the difference was statistically significant (P < 0.05). Conclusions 18F-FDG/ 99mTc-MIBI dual-isotope SPECT and gated myocardial imaging can assess myocardial ischemia ,viability and cardiac function in diabetic patients, and it is helpful for the early diagnosis of cardiac damage in patients with diabetes mellitus.

Effects of Intracoronary Administration of Autologous Adipose Tissue-Derived Stem Cells on Acute Myocardial Infarction in a Porcine Model

PURPOSE: Adipose-derived stem cells (ADSCs) are known to be potentially effective in regeneration of damaged tissue. We aimed to assess the effectiveness of intracoronary administration of ADSCs in reducing the infarction area and improving function after acute transmural myocardial infarction (MI) in a porcine model. MATERIALS AND METHODS: ADSCs were obtained from each pig's abdominal subcutaneous fat tissue by simple liposuction. After 3 passages of 14-days culture, 2 million ADSCs were injected into the coronary artery 30 min after acute transmural MI. At baseline and 4 weeks after the ADSC injection, 99mTc methoxyisobutylisonitrile-single photon emission computed tomography (MIBISPECT) was performed to evaluate the left ventricular volume, left ventricular ejection fraction (LVEF; %), and perfusion defects as well as the myocardial salvage (%) and salvage index. At 4 weeks, each pig was sacrificed, and the heart was extracted and dissected. Gross and microscopic analyses with specific immunohistochemistry staining were then performed. RESULTS: Analysis showed improvement in the perfusion defect, but not in the LVEF in the ADSC group (n=14), compared with the control group (n=14) (perfusion defect, -13.0+/-10.0 vs. -2.6+/-12.0, p=0.019; LVEF, -8.0+/-15.4 vs. -15.9+/-14.8, p=0.181). There was a tendency of reducing left ventricular volume in ADSC group. The ADSCs identified by stromal cell-derived factor-1 (SDF-1) staining were well co-localized by von Willebrand factor and Troponin T staining. CONCLUSION: Intracoronary injection of cultured ADSCs improved myocardial perfusion in this porcine acute transmural MI model.

Evaluation of the diagnostic value of 99mTc-MIBI SPECT positive tumor imaging and MRI in the recurrence or postoperative residual lesions of glioma / 实用医学杂志

Objective To evaluate the value of 99mTc-MIBI SPECT positive tumor imaging and MRI in the diagnosis of recurrence and postoperative residual of glioma. Methods Of 30 cases of glioma, 21 cases were residual or recurrent of glioma, while 9 cases were not, confirmed by pathology or follow-up. 99mTc-MIBI SPECT positive tumor imaging and MRI were performed on all patients. Results The sensitivity of 99mTc-MIBI SPECT positive tumor imaging (80.1%)was lower than that of MRI (90.5%) (χ2 = 0.006 4,P = 0.035), while the specificity of 99mTc-MIBI SPECT(88.9%) was much higher than that MRI(77.8%)(χ2= 3.827,P = 0.006). The accuracy in diagnosing residual or recurrent glioma between the two imaging has no significant difference. The sensitivity, specificity and accuracy were 95.2%, 100% and 93.3% when the two imaging methods were combined. Conclusions 99mTc-MIBI SPECT positive tumor imaging has higher specificity in the diagnosis of recurrence and postoperative residual of glioma. The combination of 99mTc-MIBI SPECT positive tumor imaging and MRI has great clinical significance.

Cirugía paratiroidea radioguiada: experiencia inicial / Initial experience in radio-guided parathyroid surgery

Introducción: la gammagrafía con 99mTc-MIBI permite la localización preoperatoria no invasiva y facilita el acceso mínimamente invasivo en pacientes con hiperparatiroidismo primario (HPTP). Objetivos: describir los resultados iniciales de la gammagrafía paratiroidea con 99mTc-MIBI en pacientes con HPTP. Métodos: entre mayo de 2007 y febrero de 2010 fueron operados 10 pacientes por HPTP. Se excluyó una paciente con un síndrome de neoplasia endocrina múltiple. La edad media fue 46,3 años (32-70 años). Predominó el sexo femenino (6). Los síntomas principales fueron dolores óseos, debilidad, cefalea y cólico nefrítico. Un paciente presentaba tumores pardos múltiples. La enfermedad asociada más frecuente fue la hipertensión arterial. Los pacientes fueron seguidos entre 25 y 58 meses (promedio 45,3 meses). Resultados: uno de dos enfermos reintervenidos por HPTP persistente presentó hipoparatiroidismo posoperatorio (ambos tenían enfermedad tiroidea multinodular). De un total de 12 glándulas enfermas, 11 eran inferiores (9 izquierdas y 2 derechas) y una superior izquierda. La sensibilidad para la gammagrafía fue del 83 por ciento y la especificidad del 100 por ciento y, para la ecografía, estos valores fueron del 34,6 por ciento y del 96 por ciento, respectivamente. No hubo complicaciones ni muertes. Con un seguimiento promedio de 45,3 meses (25-58 meses), todos los pacientes se encontraban eucalcémicos. Conclusiones: La sensibilidad de la gammagrafía preoperatoria con 99mTc-MIBI permite obtener resultados satisfactorios en pacientes con HPTP tratados mediante técnicas de mínima invasión. Los pacientes con enfermedad nodular tiroidea deben ser evaluados cuidadosamente por el riesgo de falsos positivos(AU)

Introduction: 99mTc-MIBI scanning allows the non-invasive preoperative location and facilitates the minimally invasive access to patients with primary hyperparathyroidism. Objectives: to describe the initial results of 99mTc-MIBI parathyroid scanning in patients suffering primary hyperparathyroidism. Methods: from May 2007 through February 2010, ten patients with hyperparathyroidism were operated on. A female patient with multiple endocrine neoplasia syndrome was excluded from the study. The mean age was 46.3 years (32-70 years). Females predominated (6). The main symptoms were bone aches, weakness, headache and nephric colic. One patient presented with multiple brown tumors. The most common associated disease was blood hypertension. These patients were followed-up for 25 to 28 months (average 45.3 months). Results: one of the two patients undergoing resurgery for persistent hyperparathyroidism presented with hypoparathyroidsm posoperatively (both suffered multinodular thyroid disease). Of a total of 12 sick glands, 11 were lower glands (9 left and 2 right) and one upper left gland. The scanning sensitivity was 83percent and the specificity was 100 percent whereas the echography values were 34.6 percent and 96 percent, respectively. Neither complications nor deaths were observed. With the average follow-up of 45.3 months (25-28 months), all the patients were eucalcemic. Conclusions: preoperative 99mTc-MIBI scanning sensitivity allows achieving satisfactory results in patients with hyperparathyroidism and treated with minimally invasive techniques. The patients with nodular thyroid disease should be carefully evaluated due to positive false risk(AU)

The role of 99mTc-MIBI SPECT/CT in predicting response to neoadjuvant chemotherapy with docetaxel-based regimen for locoregionally advanced nasopharyngeal carcinoma / 中国癌症杂志

Background and purpose:Neoadjuvant chemotherapy with docetaxel was gaining more attention in the treatment for locoregionally advanced nasopharyngeal carcinoma (NPC). The prediction of the sensitivity to neoadjuvant chemotherapy with docetaxel could enable clinicians to individualize treatment protocols for NPC. Recently we found that 99mTc-MIBI imaging in NPC could predict tumor response to chemotherapy with cisplatin plus 5-FU. However, there was no study to support similar findings in NPC patients receiving chemotherapy containing docetaxel. This study was to evaluate the value of double-phase 99mTc-MIBI SPECT/CT in predicting response to neoadjuvant chemotherapy with docetaxel-based regimen for nasopharyngeal carcinoma. Methods:Thirty-one nasopharyngeal carcinoma patients participated in this prospective study. Before treatment, early and delayed single-photon emission computed tomography/compute tomography (SPECT/CT) images were obtained instantly and 2 hours after an intravenous injection of 25-30 mCi 99mTc-MIBI. All patients received neoadjuvant chemotherapy consisting of docetaxel, cisplatin plus 5-FU for two cycles. The relationships between efficacy of neoadjuvant chemotherapy and the early uptake ratio, late uptake ratio and washout rate of 99mTc-MIBI were evaluated.Results:According to the MRI, the early uptake of 99mTc-MIBI (2.67±0.83) in the lesions which were sensitive to chemotherapy was significantly higher compared with that (1.69±0.46) in the insensitive lesions(P=0.003). The difference of the late uptake between the sensitive(1.46±0.39) and the insensitive (1.06±0.62) was also statistically significant (P=0.026). However, the washout rate of 99mTc-MIBI was not significantly different between the two groups (P=0.23). Through ROC curve analysis, the AUC for early uptake of 99mTc-MIBI and late uptake were 0.84. The sensitivity, specificity, positive predictive value and negative predictive value were 74.2%, 87.5%, 95.8%and 46.7%for early uptake when the cut off value of 1.97 was used. Conclusion:The uptake of 99mTc-MIBI in both early phase and late phase could predict the efficacy of neoadjuvant chemotherapy with docetaxel-based regimen.

Diagnóstico y seguimiento de cáncer de piel no-melanoma utilizando 99mTc-MIBI: estudios en un modelo animal / Usefulness of 99mTc-MIBI for the diagnosis and follow up of non-melanoma skin cancer: study in an animal model

El objetivo consistió en evaluar la utilidad del 99mTc-MIBI como marcador para diagnóstico y seguimiento de la progresión tumoral del NMSC en un modelo de carcinogénesis completa en ratones. Los animales en estudio fueron inyectados con 99mTc-MIBI a diferentes tiempos y eutanasiados. Se disecaron muestras de tumor y piel sana para evaluar la captación del radiofármaco y realizar el diagnóstico histológico. En animales con 22 semanas de progresión tumoral se observó una diferencia significativa en la captación del 99mTc-MIBI entre piel sana y NMSC. El protocolo que mejor se adapta al uso del 99mTc-MIBI como marcador para el diagnóstico y seguimiento de la progresión tumoral en ratones portadores de NMSC inducidos es la administración i.v de 1 mCi de 99mTc-MIBI con adquisición de datos a los 30 minutos post inyección. Se observó que a medida que los tumores progresan, la captación de 99mTc-MIBI disminuye respecto a la piel normal.

The aim of the work was to evaluate the usefulness of 99mTc-MIBI as a tracer for the tumor diagnosis and progression of NMSC in a chemically induced model in mice. After administration of 99mTc-MIBI animals were sacrificed at different times. Samples of tumor and healthy skin were dissected in order to perform histological analysis and to evaluate 99mTc-MIBI uptake. Animals under 22 weeks of tumor evolution showed a statistically difference in 99mTc-MIBI uptake between healthy skin and NMSC. Our results showed that the better protocol for the study of the tumor diagnosis and progression of NMSC in mice is the administration of 1 mCi of 99mTc-MIBI and acquisition of images 30 minutes post injection. Results showed that, as tumor progresses, the uptake of 99mTc-MIBI is significantly lower than healthy skin.

99mTc-MIBI myocardial perfusion image in predicting therapeutic effect of percutaneous coronary intervention / 第二军医大学学报

Objective: To observe the 99mTc-MIBI myocardial perfusion images in patients with myocardial infarction before/after percutaneous coronary intervention (PCI), so as to screen for the reliable predictors for the therapeutic effect of PCI. Methods: Forty-eight patients with myocardial infarction receiving PCI were included in this study. The rest, stress and nitroglycerin myocardial perfusion imaging tests were performed before PCI. The stress and rest myocardial perfusion imaging tests were repeated 1-2 weeks after PCI. The value of (rest 99mTc-MIBI imaging in myocardial perfusion scores after PCI-stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI)/stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI was taken as the curative effect of PCI; the value of(rest 99mTc-MIBI imaging in myocardial perfusion scores before PCI-stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI)/stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI was taken as the functional viable myocardium; the value of (stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI-nitroglycer 99mTc-MIBI imaging in myocardial perfusion scores before PCI)/stress 99mTc-MIBI imaging in myocardial perfusion scores before PCI was taken as potential functional viable myocardium; and the value of(rest 99mTc-MIBI imaging in myocardial perfusion scores before PCI-nitroglycer 99mTc-MIBI imaging in myocardial perfusion scores before PCI)/rest 99mTc-MIBI imaging in myocardial perfusion scores before PCI was taken as drug relative viable myocardium. To screen the proper predictors for therapeutic effects, linear correlation analysis was performed between the curative effect of PCI and the latter 3 factors. Results: Stress and rest myocardial perfusion defects were significantly improved after PCI (P<0.01). Correlation analysis showed that the curative effect of PCI was correlated with the latter 3 factors, with the correlation coefficients being r1=0.63, P<0.01, r2=0.94, P<0.000 1,and r3=0.92, P<0.000 1, respectively,indicating that the potential functional viable myocardium had the best correlationship with PCI. Conclusion: It is necessary to perform the rest, stress and nitroglycerin myocardial perfusion imaging tests in patients with cardiac infarction. The functional viable myocardium is a reliable index in screening the patients suitable for PCI and in predication of the therapeutic effect.

Diffuse Bone Marrow Uptake of 99mTc-MIBI in A Case of Intravascular Large B-cell Lymphoma / 핵의학분자영상

Intravascular large B-cell lymphoma (IVLBCL) is a subtype of diffuse large cell lymphoma, characterized by proliferation of lymphoid cells in the intravascular space of various organs without causing a mass effect. Although 18F-FDG PET is a powerful imaging tool in lymphoma, the usefulness of 18F-FDG PET in the assessment of IVLBCL is still controversial. 99mTc-MIBI, a tumor imaging radiopharmaceutical with a different mechanism from that of 18F-FDG, has been reported to be also effective in lymphoma. However, there is nearly no report on the efficacy of 99mTc-MIBI in the assessment of IVLBCL. We present one case of IVLBCL that showed 99mTc-MIBI accumulation in the involved bone marrow as an incidental finding, which was discrepant from that of 18F-FDG PET.

The Multidrug Resistance-related Protein and P-glycoprotein Expressions, and the Washout Rates of 99mTc-MIBI in Infiltrating Ductal Carcinoma of Breast, Correlation with the Response After Neoadjuvant Chemotherapy / 한국유방암학회지

PURPOSE: Numerous non-invasive imaging methods for evaluating the chemotherapy response of breast cancer patients are currently being explored. The aim of present study was to investigate whether the washout rates (WRs) of 99mTc-MIBI could predict the response to chemotherapy in patients suffering with infiltrating ductal carcinoma using the expressions of multidrug resistance-related protein (MRP) and P-glycoprotein (Pgp). METHODS: From May 2002 and March 2004, the patients were randomly and consecutively selected according to the results of immunohistochemical analyses of breast carcinoma specimens before the administration of neoadjuvant chemotherapy. A total 45 infiltrating ductal carcinomas in 45 female patients were selected and they were separated into three groups: group A consisted of tumors with both negative Pgp and MRP expressions (n=15); group B consisted of the tumors that were positive for either a Pgp expression or a MRP expression (n=15); group C consisted of the tumors that were positive for both Pgp and MRP expressions (n=15). All the patients were referred for double phase 99mTc-MIBI mammoscintigraphy after the injection of 925 MBq of 99mTc-MIBI to calculate the WR. The tumor response was evaluated after completion of neoadjuvant chemotherapy. The tumor response was classified as a complete or partial response (the responder group) and stable or progression (the non-responder group). All the patients underwent surgery. RESULTS: The response rate of group C was lower than that of the other groups, but the difference was not statistically significant (p=0.283). The WR of non-responder group was lower than that of the responder group, although the difference was not statistically significant (p=0.674). The washout rates of group C was the highest than other groups and the difference was statistically significant (p=0.001). CONCLUSION: In conclusion, the WR of 99mTc-MIBI is helpful for in vivo determination of both the Pgp and MRP expressions for infiltrating ductal carcinoma of the breast.

The Clinical Usefulness of 99mTc-MIBI Scintimammography in Diagnosis of Breast Cancer / 한국유방암학회지

PURPOSE: Imaging studies for the diagnosis of breast cancer such as ultrasonography or mammography, play an essential role; however, it is well known that they have some limitations; the low specificity of ultrasonography and the low sensitivity of mammography, especially in the dense breasts of Korean women. Recently, 99mTc-MIBI scintimammography was introduced for the detection of breast cancer, and showed acceptable results in its diagnostic accuracy. In this study, the clinical usefulness of 99mTc-MIBI scintimammography was evaluated for the determination of a better imaging study for the diagnosis of breast cancer. METHODS: This study included 75 patients with breast masses, and 3 imaging studies were performed; mammography, ultrasonography and 99mTc-MIBI scintimammography and the results compared on the basis of the pathological reports from core needle or excisional biopsies of the patients. RESULTS: From the pathological reports of 75 patients, 45 cases were confirmed as malignant and 30 as benign diseases. Based on the pathological reports, the sensitivities of mammography, ultrasonography and 99mTc-MIBI scintimammiography were 62.2, 88.9, and 86.7%, and the specificites of 3 imaging studies were 90.0, 76.7, and 90.3% respectively. The positive predictive values were 90.3, 85.1, and 92.9% and the negative predictive values were 61.4, 82.1, and 81.8%, respectively. 99mTc-MIBI mammoscintigraphy showed a comparable sensitivity to ultra-sonography, and a similar specificity to mammography, in the diagnosis of breast cancer. CONCLUSION: Clinically, as a primary imaging tool, 99mTc-MIBI mammoscintigraphy showed acceptable results in the diagnosis of breast cancer. Considering the weak points of ultrasonography and mammography, 99mTc-MIBI mammoscintigraphy would be a very useful tool in the diagnosis of breast cancer.

A Modified Protocol for Myocardial Perfusion SPECT Using Natural Plant Extracts for Enbancement of Biliorg Excretion / 대한핵의학회잡지

PURPOSE: For good quality of myocardial perfusion images, an approximately 30 min to 1 hour of waiting time after radiopharmaceutical injection and ingestion of fatty meal are asked of the patients. The aim of this study was to investigate the shortening of waiting time after radiopharmaceutical injection and improvement of image quality using natural plant extracts that promote bile excretion. MATERIALS AND METHODS: Ten volunteers participated in protocol 1 (7 men, 3 women; mean age, 24.1+/-2.4 years) and protocol 2 (8 men, 2 women; mean age, 26.1+/-2.9 years), respectively. For the modified method of both protocols, subjects took natural plant extracts 15 minutes before the first injection of 99mTc MIBI without taking fatty meals. Control (Conventional) methods were performed with intake of a fatty meal 20 to 30 minutes after 99mTc MIBI injection. RESULTS: As the results of protocol 1 and 2, the ratio of myocardial to lung ratio were not different between modified and conventional method. Liver to lung ratio of modified method showed significantly lower value than that of conventional method. In modified method, myocardial to liver ratio was higher persistently. In protocol 2, natural plant extracts took before the first injection of 99mTc MIBI exerted accelerating effect of excretion of bile juice into intestine until the end of examination. CONCLUSION: These results represent that natural plant extracts for facilitation of bile excretion before injection of 99mTc MIBI may provide better quality of myocardial perfusion images without the need for preparations such as ingestion of fatty meal within the 2 hours compared with conventional method.

Reproducibility of Gated Myocardial Perfusion SPECT for the Assessment of Myocardial Function : Comparison with Thallium-201 and Technetium-99m-MIBI / 대한핵의학회잡지

PURPOSE: We compared the reproducibility of 201Tl and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. MATERIALS AND METHODS: Gated SPECT acquisition was repeated in the same position in 30 patients who received 201Tl and in 26 who received 99mTc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201Tl and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201Tl gated SPECT was compared with that of 99mTc-MIBI gated SPECT. RESULTS: Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201Tl (r=0.928 to 0.986; p<0.05) and 99mTc-MIBI (r=0.979 to 0.997; p<0.05). However, Bland Altman analysis revealed the 95% limits of agreement (2 SD) for volumes and EF were tighter by repeated 99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5%) than by repeated 201Tl gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by repeated 201Tl gated SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). CONCLUSION: 99mTc-MIBI provides more reproducible volumes and EF than 201Tl on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function.

Measurement of Myocardial Perfusion with Electron Beam Tomography: Comparison with 99m Tc-MIBI Scan

PURPOSE: To compare the accuracy with which electron beam tomography (EBT) and 99m Tc-MIBI scanning measure myocardial perfusion valve. MATERIALS AND METHODS: Twenty-two subjects [normal volunteers (n = 6), patients in whom ischemic heart disease was diagnosed (n = 5), and those in whom ischemic heart disease was suspected but who were found to be normal (n = 11)] were involved in this study. EBT was performed after bolus injection of contrast media (50 ml of Iopamiro 370 or Optiray 350, 3 ml/sec). The myocardium was divided into 16 segments according to the classification devised by the American Society of Echocardiography, and each myocardial perfusion value was calculated by post-image processing. A pharmacologic stress test was performed in all subjects except four patients with acute myocardial infarction, and myocardial perfusion reserve ratios were assessed. Single photon emission computed tomography (SPECT) was performed after the injection of 20 mCi of 99m Tc-MIBI. Any segments with moderate to severe photon defect on visual analysis of SPECT were identified and perfusion values determined by EBT in normal and ischemic segments were compared. RESULTS: No difference in myocardial perfusion was found between volunteers and the suspected group. Their perfusion values were 0.71 +/-0.14 ml/g/min in the resting state and 1.16 +/-0.24 ml/g/min on the stress test and the myocardial perfusion reserve ratio was, therefore, 1:1.68 +/-0.38. In ischemic patients, 99m Tc-MIBI scanning revealed a perfusion defect in 28 segments, and on EBT the measurement obtained was 0.54 +/-0.19 ml/g/min. The remaining 324 perfusion segments shown by SPECT to be normal showed a perfusion value of 0.79 +/-0.22 ml/g/min on EBT. CONCLUSION: Compared with 99mTc-MIBI scanning, the measurement of myocardial perfusion by EBT provides absolute quantification of perfusion value and more detailed anatomic information.

201Tl SPECT and 99mTc MIBI SPECT: A Comparative Study with Pathologic Grading of Meningioma

Early and delayed 201Tl SPECT studies were performed on 20 patients with intracranial meningioma who were classified into 4 groups according to Helsinki Grading System: Grade I: benign(n=15), Grade II: atypical(n=5), Grade III: anaplastic(n=0) and Grade IV: sarcomatous(n=0). The early uptake indices(eTl, ratios of average counts/pixel in the lesion to those of contralateral area on early image) were relatively high in all types: Grade I, 3.05+/-1.44(mean+/-standard deviation): Grade II, 2.66+/-1.29. There was no statistical difference in relation to pathological grade. The delay uptake indices were 2.64+/-1.34 and 2.67+/-1.31 respectively, there was no statistical difference in relation to pathological grade. The retention indices(RI, ratios of delay to early uptake indices) were 0.92+/-0.35, 1.04+/-0.36 respectively. there was no statistical differences in relation to pathological grade. In ten cases presenting mitosis, RI was 1.11+/-0.30. But other cases not presenting mitosis RI was 0.80+/-0.34. There was significant difference between two groups p<0.05. The 99mTc-MIBI SPECT study was performed in 14 patients who classified into 4 group: Grade I(n=10) and Grade II(n=4). The uptake ratios were high in all types: Grade I, 6.70+/-3.63 and Grade II, 5.40+/-0.92. There were no statistical difference. In this study, there was no malignant case(Grade III, IV). In summary, if the further study including malignant cases, this study would aid in overcoming to overcome the limitation of CT, MRI about tumor differentiation, with regards to possible detection of presence of residual tumor and viability of tumor after treatment.

Gender Difference of Accuracy in Detecting Coronary Artery Disease by Myocardial Perfusion SPECT / 대한핵의학회잡지

PURPOSE: Myocardial SPECT is an effective test for detecting coronary artery disease in the general population. But the diagnostic accuracy between sexes is not defined. The purpose of this study is to compare the diagnostic accuracy between males and females. MATERIALS AND METHODS: One hundred and seventy seven male and 98 female patients who underwent myocardial SPECT within 1 month of coronary angiography were studied. Myocardial SPECTs were considered abnormal if fixed or reversible perfusion defects were detected. Stenosis severity of > or = 50% luminal diameter reduction of any artery defined coronary artery disease (CAD). RESULTS: Overall sensitivity for detection of CAD was 98% in men and 97% in women (p=not significant). However, specificities, accuracies, and positive predictive values (PPV) in men and women were 49% vs 31% (p<0.05), 81% vs 57% (p<0.01), 78% vs 48% (P<0.01), respectively Diagnostic accuracies for detection of right coronary artery disease were not different in both sexes, however, accuracies for detection of left anterior descending artery disease and left circumflex artery disease were significantly lower in female (p<0.05). CONCLUSION: A significant difference of diagnostic accuracy between sexes, especially in LAD and LCx disease, was noted. Artifacts from breast attenuation might be a cause for the lower diagnostic accuracy in female.

Usefulness of 99mTx Methoxyisobutylisonitrile Lung SPECT in Benign andMalignant Lesion of the Lungs / 결핵

BACKGROUND: 99mTc MIBI(Methoxyisobutylisonitrile complex), a member of the isonitrile class of coordination compounds, is a lipophilic cation presently under investigation for clinical use as myocardial perfusion imaging agent and is widely used to detect myocardial infarction. Preliminary reports indicate that T1-201 accumulate in human neoplasm and several authors reported 99mTc MIBI may also localized in primary malignant tumor and metastatic deposits from lung cancer. We evaluated the uptake of 99mTc MIBI in lung cancer and localization of mediastinal and other site metastasis, and compared the benign lesion of the lung. METHOD: Thirty four patients of lung cancer and ten patients of benign lung lesion were studied with chest CT and 99mTc MIBI Lung SPECT. 99mTc MIBI uptake ratio was assessed by TR/NL(Lung lesion/ Normal area), HT/NL (Heart/ Normal area) and HT/TR(Heart/Lung lesion). RESULTS: 1) All lung cancer patients showed increased uptakes of 99mTc MIBI in malignant lung lesion and Tc-99m MIBI uptake was also increased in mediastinal and lymph node metastasis except two cases. 2) There was significant different ratio of TR/NL between malignant and benign lesion, 3.79 +/- 1.82 and 1.67+/-0.63 on planar images, respectively(p <0.001). 3) There was no significant difference of 99mTc MIBI uptake ratio between squamous cell carcinoma, small cell carcinoma and adeno carcinoma(3.64+/- 1.66, 3.57+/-0.72, 4.31 +/-2.28 respectively). CONCLUSION: 99mTc MIBI lung SPECT was useful in the localization of tumor and mediastinal or other site metastatic lesion in lung cancer and also in the differential diagnosis between benign and malignant lesion.

The Diagnostic Value of Dipyriddamole99mTc-MIBI SPECT in the Diagnosis of Coronary Artery Disease : Comparison with Coronary Angiography

BACKGROUND: The purpose of this study is to assess the ability of dipyridamole99mTc-MIBI SPECT to identify and localize coronary artery disease(CAD). METHODS: The study population consists of 60 patients(37 males, 23 females : mean age 57+/-10 years) including 30 with prior myocardial infarction who underwent both dipyridamole99mTc-MIBI SPECT and coronary angiography for the evaluation of chest pain. RESULTS: The sensitivities for detection of CAD(> or =50% and > or =70% coronary stenosis by angiography) by dipyridamole99mTc-MIBI SPECT are 96% and 98% respectively, and specifities are 71% and 73% respectively. The sensitivities for detection of individual diseased vessels(> or =50% and > or =70%) are 79% and 90% for left anterior descending artery(LAD), 53% and 59% for left circumflex artery(LCX), 45% and 53% for right coronary artery(RCA), 64% and 77% for LCX/RCA, 63% and 72% for total. The specificities for detection of individual diseased vessels(> or =50% and > or =70%) are 62% for LAD, 98% and 98% for LCX, 92% and 89% for RCA, 91% and 89% for LCX/RCA, 87% and 86% for total. The concordances for ditection of individual didseased vessels beteen coronary angiography and dipyridamole99mTc-MIBI SPECT are all fair for SAD(Kappa=0.4 in > or =50% stenosis, 0.54 in > or =70% stenosis)LCX(Kappa=0.56,0.63),RCA(Kappa=0.4,0.44) and LCX/RCA(Kappa=0.56,0.67). CONCLUSION: Dipyriddamole99mTc-MIBI SPECT appers to be an useful noninvasive test for both identification and localization of coronary artery disease.

Peripheral Hemodynamic Responses Induced during Dipyridamole Infusion and the Relationships to the Coronary Artery Disease

BACKGROUND: Perfusion scintigraphy with dipyridamole have been reported to be useful for diagnosis of coronary artery disease and the assessment of the presence and extent of myocardium at ischemic risk, especially in patients who can not undergo dynamic exercise testing. Dipyridamole, pharmacologic coronary vasodilator, also induces fall in blood pressure and rise in heart rate. The purpose of this study was to answer the question if dipyridamole induced peripheral hemodynamic responses were related to chest pain, ST changes on EKG, scintigraphic defect or extent of coronary stenosis. METHODS: Dipyridamole 99mTc-MIBI myocardial scintigraphy and coronary angiography on 43 subjects who were suspected to have coronary artery disease. The peripheral hemodynamic response was graded as absent(group 0) if there was a 10 but 10 but 20mm fall in SBP and/or >20 beats/min rise in HR. RESULTS: The overall diagnostic sensitivity and specificity for coronary artery disease of dipyridamole perfusion scintigraphy were 68%, 83% while per vessel sensitivity and specificity for coronary artery disease were 66%, 97%. The numbers of induced chest pain and ischemic ST changes among hemodynamic subgroups, were 40%, 40% in group 0, 33%, 27% in group 1 and 50%, 40% in group 2 without significant difference in each hemodynamic subgroups. Either the numbers of diseased coronary arteries or the numbers of patients demonstrationg reversible scintigraphic defects were not statically different among each subgroups. CONCLUSION: Although the peripheral hemodynamic response dose not always correlate with its central coronary effect but dipyridamlole 99mTc-MIBI myocardial perfusion scintigraphy is an useful test for diagnosis of coronary artery disease.

The Usefulness of Dipyridamole 99mTc-MIBI Myocardial Scintigraphy in the Detection of Coronary Artery Disease

Though exercise T1-201 myocardial perfusion-scintigraphy is an important test in the diagnosis and evaluation of coronary artery disease, this test is limited in cases with poor physical conditions and unstable angina and the physical characteristics of thallium are not ideal for nuclear imaging of the myocardium. Recently, technetium-99m-labelled agent(99mTc-MIBI) has been developed to improved the quality of imaging and for easy usage in myocardial perfusion scan. Therefore, we performed dipyridamole 99mTc-MIBI myocardial scintigraphy and coronary angiography on 25 subjects who were suspeced to have coronary artery disease and the results obtanined were as follows ; 1) The overall diagnostic sensitivity of dipyridamole 99mTc-MIBI perfusion scintigraphy was 73.4%, while specificity was 66.7%. 2) Per vessel sensitivity for coronary artery disease diagnosis by the test was 71.4% and a per vessel specificity for coronary artery disease was 95.7%. 3) In all 75 coronary arteries, LAD had a sensitivity of 66.7%(10/15) and a specificity of 100%(10/10); RCA had a sensitivity of 75%(6/8) and a specificity of 82.4%(14/17); LCX had a sensitivity of 60%(3/5) and a specificity of 100%(20/20). 4) After infusion of dipyridamole, the most frequent adverse effect was chest pain which was seen in 8 cases(32%). The headache was seen in 7 cases(28%). Most of the symptoms were mild in severity and subsided spontaneously but 3 subjects were severe enough to require intravenous administration of aminophylline. In conclusion, dipyridamole 99m2011-06-17Tc-MIBI myocardial perfusion scintigraphy is a useful and safe test for diagnosis of coronary artery disease.