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Neuroimaging in Nuclear Medicine: Drug Addicted Brain.

Nuclear Medicine and Molecular Imaging.2006;40(1):1-8.

Addiction to illicit drugs is one of today's most important social issues. Most addictive drugs lead to irreversible parenchymal changes in the human brain. Neuroimaging data bring to light the pharmacodynamics and pharmacokinetics of the abused drugs, and demonstrate that addiction is a disease of the brain. Continuous researches better illustrate the neurochemical alterations in brain function, and attempt to discover the links to consequent behavioral changes. Newer hypotheses and theories follow the numerous results, and more rational methods of approaching therapy are being developed. Substance abuse is on the rise in Korea, and social interest in the matter as well. On the other hand, diagnosis and treatment of drug addiction is still very difficult, because how the abused substance acts in the brain, or how it leads to behavioral problems is not widely known. Therefore, understanding the mechanism of drug addiction can improve the process of diagnosing addict patients, planning therapy, and predicting the prognosis. Neuroimaging approaches by nuclear medicine methods are expected to objectively judge behavioral and neurochemical changes, and response to treatment. In addition, as genes associated with addictive behavior are discovered, functional nuclear medicine images will aid in the assessment of individuals. Reviewing published literature on neuroimaging regarding nuclear medicine is expected to be of assistance to the management of drug addict patients. What's more, means of applying nuclear medicine to the care of drug addict patients should be investigated further.
Behavior, Addictive ; Brain* ; Diagnosis ; Hand ; Humans ; Korea ; Neuroimaging* ; Nuclear Medicine* ; Pharmacokinetics ; Prognosis ; Street Drugs ; Substance-Related Disorders ; Tomography, Emission-Computed, Single-Photon

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Analysis of Myocardial Function Using Gated Myocardial SPECT : Comparison of QGS, 4D-MSPECT Software and Echocardiography.

Seok Mo LEE ; Sang Kyun BAE

Nuclear Medicine and Molecular Imaging.2008;42(6):435-443.

PURPOSE: Gated myocardial perfusion SPECT provides not only myocardial perfusion status but also various functional parameters of left ventricle. We compared left ventricular ejection fraction, end-diastolic volume, LV mass by cardiac SPECT using Quantitative Gated SPECT (QGS), 4D-MSPECT software and standard 2D-echocardiography. MATERIALS AND METHODS: One hundred fourteen patients (male 51, female 63; 29-85 years old, mean 61.3+/-13.3 years old) with normal perfusion status on Tc-99m tetrofosmin gated myocardial perfusion SPECT were analyzed retrospectively. Ejection fraction (LVEF), End-diastolic volume (LVED), LV mass (LVM) were calculated using QGS, 4D-MSPECT, and LVEF, LVM using 2D-echocardiography. Statistical analysis including Bland-Altman plot was performed using MedCalc(R) (MedCalc software, Mariakerke, Belgium). RESULTS: The correlation of LVEF between methods was good: 0.95/0.96 (stress/rest) between QGS and 4D-MSPECT, 0.79 between QGS and echocardiography, 0.79 between 4D-MSPECT and echocardiography (p<0.001). Using Bland-Altman plot, the 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -12.7% to 7.3% / from -12.2% to 6.5% (stress/rest). The agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -17.4% to 24.0%, and -14.8% to 27.0% respectively. The correlation of LVM between methods was also good: 0.95 between QGS and 4D-MSPECT, 0.76 between QGS and echocardiography, 0.73 between 4D-MSPECT and echocardiography (p<0.001). The 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -33.8 g to 14.1 g (stress/rest). The 95% confidence interval of agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -148.7 g to 21.8. g, and -142.8 g to 35.5 g, respectively. CONCLUSION: There was a good correlation for LVEF, LVED, LVM among methods (QGS, 4D-MSPECT, echocardiography), but the variance between methods was big. Therefore, the functional parameters by each method cannot be used interchangeably.
Echocardiography ; Female ; Heart Ventricles ; Humans ; Perfusion ; Retrospective Studies ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon

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Practical Approach for the Clinical Use of Dopamine Transporter Imaging.

Jae Seung KIM

Nuclear Medicine and Molecular Imaging.2008;42(6):425-434.

Dopamine transporter imaging is useful in the diagnosis of Parkinson's disease and the most successful technique in the clinical use of neuroreceptor imaging. Recently, several radiopharmaceuticals including I-123 FP-CIT, Tc-99m TRODAT, and F-18 FP-CIT for dopamine transporter imaging have been approved for the routine clinical use in several European countries, Taiwan and Korea, respectively. This review summarized the practical issue for the routine clinical examination of dopamine transporter imaging.
Dopamine ; Dopamine Plasma Membrane Transport Proteins ; Korea ; Parkinson Disease ; Positron-Emission Tomography ; Radiopharmaceuticals ; Sensory Receptor Cells ; Taiwan ; Tomography, Emission-Computed, Single-Photon ; Tropanes

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Recent Advances in Radioiodine Therapy for Thyroid Cancer.

Sang Kyun BAE

Nuclear Medicine and Molecular Imaging.2006;40(2):132-140.

Well-differentiated thyroid cancer is the most common endocrine malignancy with an increasing incidence. Most patients with well-differentiated thyroid caner have a favorable prognosis with high survival rate. While surgery and radioiodine therapy is sufficient treatment for the majority of patients with differentiated thyroid cancer, a minority of these patients experiences progressive, life-threatening growth and metastatic spread of the disease. Because there is no prospective controlled study to evaluate the differences of management of thyroid cancer, it is hard to choose the best treatment option. And there are still lots of controversies about the management of this disease, such as surgical extent, proper use of radioiodine for remnant ablation and therapy, use of rhTSH instead of withdrawal of thyroid hormone, long-term follow-up strategy, thyroglobulin as a tumor marker, etc. In this review, recent data related to these conflicting issues and recent advances in diagnosis, radioiodine therapy and long-term monitoring of well-differentiated thyroid cancer are summarized.
Carcinoma, Papillary ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Prognosis ; Survival Rate ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyrotropin Alfa

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Radiosynovectomy.

Deog Yoon KIM

Nuclear Medicine and Molecular Imaging.2006;40(2):127-131.

Radiosynovectomy has been used as an effective treatment in patients with resistant synovitis after failure of long-term medication and intraarticular steroid injection. Although 90Y silicate/citrate, 186Re sulfide, and 169Er citrate were approved in Europe for the appropriate radiopharmaceuticals for radiosynovectomy, other radionuclides such as 32P-chromic phosphate, 165Dy-ferric hydroxide macroaggregate, 188Rh-microspheres, 153Sm-particulate, and 166Ho-ferric hydroxide macroaggregate have been used in many countries. Reported success rates range from 40% to 90% for the different joints and underlying disease. In Korea, 188Re-tin-colloid and 166Ho-chitosan complex are now using as the major radionuclides in radiosynovectomy with good clinical results. A study on radiation synovectomy using 188Re-tin-colloid for patients with Korean rheumatoid arthritis shows the treatment resulted in the improvement of arthritis and well tolerated. In our study, the radiosynovectomy with 166Ho-chitosan complex in 53 hemophilic patients markedly decreased intra-articular bleeding frequency and need for coagulation factor. This review inculdes general priciples in the application of radiosynovectomy and the clinical experience in Korea.
Arthritis ; Arthritis, Rheumatoid ; Blood Coagulation Factors ; Citric Acid ; Europe ; Hemophilia A ; Hemorrhage ; Humans ; Joints ; Korea ; Radioisotopes ; Radiopharmaceuticals ; Synovitis

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Internal Radiation Dosimetry in Radionuclide Therapy.

Kyeong Min KIM ; Sang Moo LIM

Nuclear Medicine and Molecular Imaging.2006;40(2):120-126.

Radionuclide therapy has been continued for treatment of incurable diseases for past decades. Relevant evaluation of absorbed dose in radionuclide therapy is important to predict treatment output and essential for making treatment planning to prevent unexpected radiation toxicity. Many scientists in the field related with nuclear medicine have made effort to evolve concept and technique for internal radiation dosimetry. In this review, basic concept of internal radiation dosimetry is described and recent progress in method for dosimetry is introduced.
Nuclear Medicine ; Radiometry*

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Brachytherapy in Coronary Artery Disease.

Ho Chun SONG

Nuclear Medicine and Molecular Imaging.2006;40(2):113-119.

Coronary artery disease is a leading cause of morbidity and mortality across the world. Percutaneous coronary intervention has become the major technique of revascularization. However, restenosis remains a major limitation of this procedure. Recently the need for repeat intervention due to restenosis, the most vexing long-term failure of percutaneous coronary intervention, has been significantly reduced owing to the introduction of two major advances, intracoronary brachytherapy and the drug-eluting stents. Intracoronary brachytherapy has been employed in recent years to prevent restenosis lesions with effective results, principally in in-stent restenosis. Restenosis is generally considered as an excessive form of normal wound healing divided up in processes: elastic recoil, neointimal hyperplasia, and negative vascular remodeling. Restenosis has previously been regarded as a proliferative process in which neointimal thickening, mediated by a cascade of inflammatory mediators and other factors, is the key factor. Ionizing radiation has been shown to decrease the proliferative response to injury in animal models of restenosis. Subsequently, several randomized, double-blind trials have demonstrated that intracoronary brachytherapy can reduce the rates of both angiographic restenosis and clinical event rates in patients undergoing percutaneous coronary intervention for in-stent restenosis. Some problems, such as late thrombosis and edge restenosis, have been identified as limiting factors of this technique. Brachytherapy is a promising method of preventing and treating coronary artery restenosis.
Brachytherapy* ; Coronary Artery Disease* ; Coronary Vessels* ; Drug-Eluting Stents ; Humans ; Hyperplasia ; Models, Animal ; Mortality ; Percutaneous Coronary Intervention ; Radiation, Ionizing ; Thrombosis ; Wound Healing

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Radioisotope Treatment for Benign Strictures of Non-vascular Luminal Organs.

Ji Hoon SHIN

Nuclear Medicine and Molecular Imaging.2006;40(2):106-112.

Tissue hyperplasia is one of the most frequently encountered complications when self-expanding metallic stents are placed in benign non-vascular luminal organ strictures, thus causing restenosis of the lumen. The investigators postulated that ionizing irradiation could be applied to prevent restenosis caused by tissue hyperplasia in non-vascular luminal organs as it reduced coronary or peripheral arterial narrowing successfully. The authors combined beta-irradiation using 188Re-MAG3 solution with balloon dilation for animal and clinical studies because this new treatment approach had the advantages such as low penetration depth of beta-ray, self-centering irradiation, and mechanical effect of balloon dilation over using gamma-irradiation with afterloading devices. In this article, the concept and mechanism of radioisotope balloon dilation, and animal and clinical studies using radioisotope balloon dilation are reviewed.
Animals ; Constriction, Pathologic* ; Humans ; Hyperplasia ; Phenobarbital* ; Research Personnel ; Stents

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Monitoring Gene Therapy by Radionuclide Approaches.

Jung Joon MIN

Nuclear Medicine and Molecular Imaging.2006;40(2):96-105.

Molecular imaging has its root in nuclear medicine and gene therapy monitoring. Therefore, recent progress in the development of non-invasive imaging technologies, particularly nuclear medicine, should allow molecular imaging to play a major role in the field of gene therapy. These tools have recently been validated in gene therapy models for continuous quantitative monitoring of the location, magnitude, and time-variation of gene delivery and/or expression. This article reviews the use of radionuclide imaging technologies as they have been used in imaging gene delivery and gene expression for gene therapy applications. The studies published to date lend support that noninvasive imaging tools will help to accelerate pre-clinical model validation as well as allow for clinical monitoring of human gene therapy.
Gene Expression ; Genetic Therapy* ; Humans ; Molecular Imaging ; Nuclear Medicine ; Radionuclide Imaging

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Review of Radionuclide Treatment for Neuroendocrine Tumors.

Hwan Jeong JEONG

Nuclear Medicine and Molecular Imaging.2006;40(2):90-95.

Neuroendocrine tumors (NETs) consist of a heterogeneous group of tumors that are able to uptake neuroamine and/or specific receptors, such as somatostatin receptors, which can play important roles of the localization and treatment of these tumors. When considering therapy with radionuclides, the best radioligand should be carefully investigated. 131I-MIBG and beta-particle emitter labeled somatostatin analogs are well established radionuclide therapy modalities for NETs. 111In, 90Y and 177Lu radiolabeled somatostatin analogues have been used for treatment of NETs. Further, radionuclide therapy modalities, for example, radioimmunotherapy, radiolabeled peptides such as minigastrin are currently under development and in different phases of clinical investigation. For all radionuclides used for therapy, long-term and survival statistics are not yet available and only partial tumour responses have been obtained using 131I-MIBG and 111In-octreotide. Experimental results using 90Y-DOTA-lanreotide as well as 90Y-DOTA-D-Phe1-Tyr3-octreotide and/or 177Lu-DOTA-Tyr3-octreotate have indicated the possible clinical potential of radionuclides receptor-targeted radiotherapy. It may be hoped that the efficacy of radionuclide therapy will be improved by co-administration of chemotherapeutic drugs whose antitumoral properties may be synergistic with that of irradiation.
3-Iodobenzylguanidine ; Hope ; Neuroendocrine Tumors* ; Peptides ; Radioimmunotherapy ; Radioisotopes ; Radiotherapy ; Receptors, Somatostatin ; Somatostatin

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