[en] Slow coronary flow (SCF) is a phenomenon characterized by delayed opacification of coronary arteries in the absence of epicardial occlusive disease. SCF in normal coronary angiogram may result in hemodynamic disturbance of myocardial perfusion related with endothelial dysfunction. Thus, we investigated the findings of myocardial perfusion SPECT in patients with SCF. We prospectively studied 26 patients (mean age 56±11 yrs, 10 females) undergone coronary angiogram, of which finding was normal except for SCF. The SCF was determined using the frame count method. Normal frame counts in control(N=26, mean age 57±8 yrs, 6 females) were 27±4 in LAD, 26±4 in LCx and 24±5 in RCA. After coronary angiogram, adenosine gated Tc-99m Sestamibi myocardial perfusion SPECT was performed in all patients. The MPD was expressed as defect area (%) of all myocardial area and summed stress/rest score (SSS/SRS). The mean coronary frame counts of all patients were 44±11 in LAD, 40±13 in LCx, and 41±15 in RCA. Eighteen patients were normal and 8 patients had MPD on SPECT. The mean extent of MPD of 8 patients was 8.8±3.3% during stress and 4.1±3.2% at rest. The mean SSS of 8 patients was 6.5±2.1 and the mean SRS 2.8±2.1. The mean extent of MPD of other 18 patients was 1.1±1.7% during stress and 1.3±2.2% at rest. The mean SSS of 8 patients was 0.7±1.1 and the mean SRS 0.2±0.5. The mean coronary frame counts of 3 coronary arteries in patients with MPD were more than those in patients without MPD (47±13 vs 39±13, p=0.02). We have shown that the SPECT findings of most patients with normal coronary angiogram but SCF were normal, however some patients had abnormal perfusion pattern same as myocardial infarction and/or ischemia. Therefore SCF should be considered as a cause of abnormal myocardial perfusion on interpretation of SPECT imaging

[en] Absolute value of the functional data of gated myocardial perfusion SPECT is necessary to determine that individual patient is normal or not. Tc-99m MIBI gated myocardial perfusion SPECT was performed using emory cardiac tool box program. All patients (M:F=15:36, age 64±10 yrs) showed normal myocardial perfusion. The patients with following characteristics were excluded; previous angina or MI, ECG change with Q wave or ST-T change, diabetes mellitus, hypercholesterolemia, typical chest pain and hypertension. In all patients, myocardial mass is 117±23 g in stress gated SPECT, 106±22 g in stress ungated SPECT and 102±21 g in rest ungated SPECT. EDV is 90±28 ml, ESV 26±20 ml, SV 66±21 ml, EF 73±10 % and TID 1.06±0.14. Myocardial mass in rest ungated SPECT is significantly different between men and women (p=0.025). Myocardial mass is significantly different between stress gated SPECT and stress ungated SPECT (p=0.000), and between stress ungated SPECT and rest ungated SPECT (p=0.003). We provide normal value of functional parameters to determine the abnormality of individual patients in patients with low risk of coronary artery disease

[en] We evaluated the distribution pattern and uptake ratio of bone marrow using anti-NCA-95 monoclonal antibody in patients with various hematologic malignancy. Bone marrow immunoscintigraphy was performed on 50 patients; 11 with acute myelogenous leukemia (AML), 12 with acute lymphocytic leukemia (ALL), 15 with lymphoma (LYM) and 2 myelogenous syndrome (MDS). The bone marrow activity was categorized into four groups (G): I, II, III, IV. The degree of bone marrow extension was 0 in Gl, 7 in GII, 3 in GIII, 1 in GIV of AML patients; 0 in GI, 5 in GII, 6 in GIII, 1 in GIV of ALL patients; 3 in GI, 11 in GII, I in GIII, 0 in GIV of LYM patients; 1 in G1, 4 in GII, 5 in GIII, 2 in GIV of MDS patients. Bone marrow extension was marked in MDS patients (58% in GIII, GIV), mil in LYM patients (93% in GI, GII) and heterogenous in leukemic (AML, ALL) patients. UR was 5.9±3.6 in AML patients, 7.9±4.6 in ALL patients, 6.3±2.8 in LYM patients and 8.5±4.0 in MDS patients (p=NS). UR of whole patients was 5.4 ±2.6 in GI, 7.1±3.7 in GII, 9.3±3.4 in GIII and 2.1±0.4 in GIV (p=0.003). The pattern of bone marrow extension was different among the disease entities. Activity of central hemopoietic marrow was related to the degree of bone marrow extension, but not to the disease entities. Compensatory response of bone marrow developed at both peripheral and central skeleton in patients with hematologic malignancy

[en] Eight-interval gating is commonly used in Tc-99m MIBI SPECT. The differences in regional myocardial tracer uptake were not fully evaluated between 8 and 16-interval gated SPECT. The purpose of this study was to compare regional myocardial perfusion and LV functional parameters between 8 and 16-interval gated SPECT in the same subject. 38 patients (mean age 55 years, male:female=23:15) with suspected coronary artery disease underwent rest-gated SPECT twice by 8 frames and 16 frames a cardiac cycle. LV end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were obtained and we analyzed regional myocardial uptake of end-diastolic images using a 18-segment, 4-point scale of perfusion (0=normal to 3=severe hypoperfusion). The agreement of regional myocardial perfusion between 8 and 16-interval gated SPECT was fairly good (agreement: 87.0%, tau-b: 0.750, p<0.001). The differences in EDV and EF between 8 and 16-interval gated SPECT were small, although statistically significant. The agreement of regional myocardial perfusion between 8 and 16-interval gated SPECT was fairly good and the differences in LV functional parameters were small

[en] In western country, 3 systems of brachytherapy using commercial radioactive source has been established. However, brachytherapy using holmium-166 liquid balloon system (HLBS) for the patient with stent restenosis has not been studied enough. 30 patients (male 23, mean age 58.9 7.7) were enrolled. Target dose was 15 Gy at 1 mm distance from the intimal surface. Clinical diagnoses of the study patients included stable angina 10 and unstable angina 20 patients. Target lesion included LAD 19, LCx 5 and RCA 6 arteries. Pre-brachytherapy treatment included cutting balloon angioplasty in 25, rotational atherectomy in 5 patients. Fractionation and stepping was done in 6 patients each. Follow-up angiography was done in 19 patients. Of them, 4 cases developed angiographic restenosis (21%) including 3 cases of total occlusion. 6 month MACE (major adverse cardiac event) occurred in 5 patients including one sudden cardiac death in a patient with 80 year-old, triple-vessel diseased patient. Vascular brachytherapy using HLBS is a safe and effective treatment modality for in-stent restenosis showing acceptable angiographic and clinical result

[en] Segmental parenchymal excretion delay on Tc-99m DISIDA scan in caused by intrahepatic bile duct obstruction. However, the diagnostic value for intrahepatic bile duct obstruction is unknown. We conducted this study to assess the positive predictive value of segmental excretion delay for the diagnosis of intrahepatic bile duct obstruction, and additional benefit over other noninvasive radiologic studies. The study population consisted of 43 patients (48 scans) who showed segmental parenchymal excretion delay on Tc-99m DISIDA scan. The results of abdominal CT or ultrasonography, which was done within 1 month of Tc-99m DISIDA scan, were compared with scintigraphic findings. The etiology of segmental parenchymal excretion delay was determined by ERC or PTC in 31 scans, and follow-up studies in 13 scans. No causes were identified in 4 scans. The positive predictive value of segmental parenchymal excretion delay for intrahepatic bile duct obstruction was 92% (44/48). On the other hand, 13% (5/38) of CT and 28% (5/18) of ultrasonography were normal. In 18% *7/38) of CT and 17% (3/18) of ultrasonography, only intrahepatic bile duct dilatation was noted without any diagnostic findings of intrahepatic bile duct obstruction. Segmental parenchymal excretion delay on Tc-99m DISIDA scan had a high positive predictive value for the diagnosis of intrahepatic bile duct obstruction. Tc-99m DISIDA scan may be useful for the diagnosis of intrahepatic bile duct obstruction, especially in patients with nondiagnostic CT or ultrasonography. The diagnostic usefulness need to be confirmed by further prospective studies

[en] Parkinsons disease (PD) is a neurodegenerative disorder that represents cognitive impairment as well as motor symptoms. Even in the early stages of PD, cognitive alterations can be demonstrated by careful neuropsychological test. The purposes of this study are to investigate the pattern of cognitive impairment and the regional cerebral blood flow (rCBF) using Tc-99m HMPAO SPECT in patients with PD. One hundred and twenty two patients with PD and 35 control subjects participated in this study. Patients with PD who had dementia clinically or K-MMSE score below 25 points or with severe motor dysfunction to interfere with the tests were also excluded. They were all matched for age (61±10 vs 61±8), education periods (8.8±4.9 vs 8.8±4.5), and K-MMSE score (27±1.6 vs 27±1.5). All subjects were evaluated using the Seoul Neuropsychological Screening Battery (SNSB) and Tc-99m HMPAO SPECT with SPM software to measure rCBF. Patients with PD performed worse in digit span backward, Rey Complex Figure Test, visual memory, semantic fluency, stroop test, and alternating hand movement test(p<0.05) compared with control group. On SNSB test, 100 patients (82.0%) showed some abnormalities. Eighty-six patients (70.5%) showed frontal dysfunction, 47 (38.5%) memory impairment, 33 (27.0%) language dysfunction, 25 (20.5%) attention deficit and 22 (18.3%) visuospatial dysfunction in the order of frequency. Eight patients with PD showed single memory domain MCI and 28 single non-memory domain MCI (20 frontal dysfunction). Multiple domain MCI was found in 64 patients with PD. SPM analysis of the SPECT image revealed multiple perfusion deficit in the both frontal, temporal, both limbic lobes, Lt. parietal and Lt. Putamen. It is concluded that abnormalities of cognitive function be detected very commonly in patients with PD. MCI in PD patients is most frequently involved in the item of frontal lobe function. SPECT image might be helpful to explain cognitive impairment in some PD patients

[en] Full text: Until the Fukushima disaster of March 2011, the recent history of nuclear power has been relatively uneventful. About 440 power reactors in 30 countries have been operating for almost 25 years without a catastrophic accident, and this relative uneventfulness and encouraging safety record led many to believe in the viability of a large-scale global nuclear expansion or renaissance. Post-Fukushima, the relative economics of nuclear power compared with other generating technologies may deteriorate. Finance providers may demand tougher financing conditions, driving up the cost of capital, and some may decide to discontinue investing in nuclear projects altogether. More stringent safety regulations may lengthen lead times for construction and increase construction and operating costs, as could more vigorous action by opponents of nuclear power. In view of these uncertainties, we examine the potential of fusion power by assuming that no more reactors are built beyond those already under construction and government confirmed plants in the TIMES (The Integrated MARKAL EFOM System) model. The TIMES model maps the Korean electricity energy system from 2010 to 2050 in five year time steps, modeling in detail the primary energy supply and electricity generation sectors. To examine the potential of fusion power, three scenarios (base, no more nuke and high carbon) are adopted to estimate the longterm role of fusion power. In the “no more nuke” scenario, fusion power takes a substantial share of the market in 2040 and 2050 compared to the “base” case. The goals of carbon mitigation have a critical role in the degree of penetration by fusion power. Higher carbon constraints, lead to more fusion power to generate electricity. (author)

[en] To establish an optimal imaging protocol of I-123 MIBG scintigraphy, we compared early 4 hour(hr) planar, 4 hr SPECT, and delayed 18-24 hr planar images. The study subjects were 19 patients with adrenal or perirenal mass lesions suspected of pheochromocytomas or paragangliomas on CT or MRI. Two patients had bilateral adrenal masses. After injection of 370 MBq of I-123 MIBG, 4 hr whole body planar, 4 hr abdomen and pelvis SPECT, and 18-24 hr planar images were obtained by dual or triple head gamma camera. Three reviewers evaluated the intensity of the uptake in each lesion with a grading scale of 0-3 by using the activity in the liver as a reference; grades 1-3 were considered as positive. Final diagnoses were made by surgery (15 lesions) and clinical follow-up (6 lesions). Among the 21 lesions, 11 lesions were confirmed as pheochromocytoma or paraganglioma. Sensitivities for 4 hr planar, SPECT and 18-24 hr planar images were 82%(9/11), 91%(10/11), and 91%(10/11), respectively, and specificities for all three images were 100%(10/10). On 4 hr whole body image, one unsuspected thyroid lesion was detected. A 12 cm sized lesion was false negative in all three images. A 2.5 cm lesion showed no visible uptake in 4 hr planar image, whereas there were grade 1 uptake in SPECT and grade 2 uptake in 18 hr planar image. Nine out of 10 positive lesions showed higher grade uptake in delayed planar images than 4 hr planar images. SPECT image provided clearer anatomical correlation with CT or MRI than 4 hr planar image and also higher grade uptake in 6 our of 10 positive lesions. In conclusion, the optimal imaging protocol of I-123 MIBG scintigraphy for diagnosis of pheochromocytoma may be 4 hr whole body imaging with SPECT. Additional delayed 18-24 hr image can be reserved for equivocal lesions with low grade uptake in 4 hr images