[논문]고감도 범용성 콜리메이터를 이용한 소아 환자 99mTc-DMSA 신장 SPECT의 유용성

김진의; 김정수; 한재복; 최남길

doi:10.5392/jkca.2016.16.03.219

[국내논문] 고감도 범용성 콜리메이터를 이용한 소아 환자 99mTc-DMSA 신장 SPECT의 유용성
Clinical Usefulness of 99mTc-DMSA Renal SPECT Using High Sensitivity-All Purpose Collimator for Pediatric Patients 원문보기

한국콘텐츠학회논문지 = The Journal of the Korea Contents Association, v.16 no.3, 2016년, pp.219 - 231

김진의 (동신대학교 방사선학과) , 김정수 (동남보건대학교 방사선과) , 한재복 (동신대학교 방사선학과) , 최남길 (동신대학교 방사선학과)

초록
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신장의 기능을 정량분석 할 수 있는 $^{99m}Tc$-DMSA 평면 영상은 단층영상에 비해 병소의 위치 정보에 한계가 있다. 따라서 광자 신호에 민감한 범용성 collimator로 교체하여 SPECT 방식으로 임상실험을 시행한 후, 진단의 정확도와 검사 소요시간을 분석하여 임상적용 가능성을 평가하였다. 10명의 실험대상에게 방사성의약품(1.0-1.2 MBq/kg)을 정맥주사하고, 이중 검출기 감마카메라를 이용하여 planar scan (high resolution (HR)-mode, $256{\times}256$, 50 kcts/view, 4 image)과 SPECT (HR / high sensitive (HS)-mode, $128{\times}128$, step and shoot, $180^{\circ}$, variable sec/angle, total 64 frame, OSEM reconstruction)를 시행하였다. 획득한 데이터를 분석 프로그램을 이용하여 비교한 결과, 실험 방법에 따라서 total counts는 high sensitive-mode SPECT가 대략 1.8-5.6 배 정도 많았고, counts를 이용한 상대신장기능은 모든 실험에서 유의한 수준 범위에서 차이가 없었으며(p=0.96), 검사 소요시간은 39%정도 단축되었다. 그러므로 고감도 범용성 collimator를 이용한 $^{99m}Tc$-DMSA renal SPECT는 planar scan에 비하여 신장의 기능을 정량분석 할 수 있고, 병변의 위치에 대한 정보를 보다 정확하게 진단할 수 있으며, 동시에 검사 소요시간을 단축시킬 수 있으므로 임상적으로 유용하게 활용할 수 있을 것으로 사료된다.

Abstract ▼ AI-Helper

$^{99m}Tc$-DMSA planar scan that can analyze the functions of kidney quantitatively provides less information on a lesion than tomography scanning. Therefore, this study applied a high sensitivity all-purpose collimator that is sensitive to photonic signals to $^{99m}Tc$-DMSA and carried out a clinical scan with single photon emission computed tomography (SPECT). And diagnostic accuracy and time requirement of were analyzed to know the clinical usefulness of the applied scanning method. 10 subjects were intravenously injected with radiopharmaceutical product (1.0-1.2 MBq/kg) and scanned by a gamma camera with planar scanner (high resolution (HR)-mode, $256{\times}256$, 50 kcts/view, 4 image) and SPECT (HR / high sensitive (HS)-mode, $128{\times}128$, step and shoot, $180^{\circ}$, variable sec/angle, total 64 frame, OSEM reconstruction), respectively. The collected data was compared with an analysis program. The results showed that HS-mode SPECT detected total counts 1.8-5.6 times more than planar scan. Relative renal function evaluated based on the counts was not significantly different by two scanning methods (p=0.96) and it turned out that test time was shortened by 39% when HS-mode SPECT was used. Therefore, SPECT using HR, HS-mode collimator could analyze renal function more quantitatively than using planar scan and the former could diagnose the location information of a lesion more accurately than the latter as well as shortened test time requirement, which demonstrated the clinical usefulness of $^{99m}Tc$-DMSA renal SPECT using high sensitivity all purpose collimator.

주제어

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가설 설정

1. A; Voiding cystourethrography demonstrates bilateral grade V reflux. B; ^99mTc-DMSA renal cortical scan demonstrates multiple bilateral peripheral photopenic defects.

제안 방법

After measuring and analyzing the ingestion rate of radiopharmaceutical product – that is, the counts of photon emitted from both kidneys-, this study used the data to analyze relative renal function ratio, which indicates renal function.
With the region of interest (ROI) of left and right kidney and background set equal on ANT and POST kidney data acquired from renal planar scan, each count of them was measured. Because it has been reported that when planar scan is used, it is better to use geometric mean in case that there is difference in depth such as ectopic kidney and deformed chest wall than arithmetic mean, this study used the coefficients of ANT and POST to calculate geometric mean, which was to maintain the accuracy of measuring relative function by difference in death[Fig. 6][18].
Additionally and in clinical tests, dosage of radiopharmaceutical should be applied according to the each sites, because the functions of SPECT equipments and collimators are different according to the manufacturers and dosage of tracer that patients injected has the differences in individual institutions. Objective of this study was to identify the significance of renal static planar scan results according to the characteristic of collimator and the correlations with time reduction, in the process of finding hardware methods in order to reduce examination times of renal SPECT. If the software like image processing and half time methods (Onco.
As specified in the existing test protocol, planar scan equipped with HR collimator produced 4 images (ANT, POST, LPO and RPO). Of them, ROI was set on both kidneys in ANT and POST image data and each count were measured to calculate geometric mean. And then the counts of LT, RT kidney were compared.
96). That is, it indicates that those scanning methods attempted in this study can produce reliable scanning outcomes while maintaining image quality because they had detected no less than or more counts of photon, by which renal functions can be evaluated, than existing test methods. Therefore, it can be considered that they are suitable for clinical use because their diagnostic value was intact or better than existing ones[Fig.
Without waiting time, the test subjects still lying on the table were scanned for SPECT at 128×128 matrix, step and shoot mode, non-circular orbit, 180° rotation, counterclockwise direction, body contour and 7 kcounts/angle, total 64 frame acquisition mode. The collected SPECT data were recomposed in OSEM (ordered-subsets expectation maximization), setting a number of iteration to 6 and maximum number of subset to 8. At this time, frequency was set to 0.
This study examined the applicability of SPECT to clinical setting by analyzing and comparing the accuracy of renal planar scan and SPECT by collimator mode. In case that normal test is not allowed by the conditions of a patient such as young child patient, emergency patient and/or patient in serious condition and test should be done in a short time period, SPECT with high resolution, high sensitivity collimator can make up for the low count rate caused by radiopharmaceutical product ingestion rate of kidney; detect more total counts of raw data; identify the location of a lesion more accurately; analyze the collected data from kidney more quantitatively at due significance level; and shorten testing time than planar scan.
To objectify the correlation between the experimental data, descriptive statistic analysis was carried out using arithmetic, geometric mean and standard deviation. Parametric ANOVA (analysis of variance) test, which is one of inferential statistics, was applied and significant difference was confirmed (α=0.
Because ^99mTc-DMSA reacts with oxygen and its original property changes, which results in decreasing ingestion in kidney but increasing ingestion in liver, measurement had to be taken within 30 minutes after the injection[16]. While keeping constant the distance between the gamma camera detector and the test table for accurate quantitative analysis on kidney ingestion rate and functions, this study measured the radiation in the injector of the radiopharmaceutical product before and after injection and calculated accurate dose.
8. Workstation was used to quantitatively analyze the entire counts acquired from all the experiments of this study.

대상 데이터

Moreover, when the diagnostic value of planar scan and two type-mode SPECT scanning were evaluated, all SPECT scanning could more easily detect a lesion on 6 test subjects who showed abnormal ingestion out of 10 participants than planar scan. Judging from bare-eye evaluation, the image quality of HR-mode SPECT was the best, but HS-mode SPECT was not also significantly different from HR-mode SPECT in terms of sensitivity, accuracy and specificity, which determine the diagnosis of a lesion.
Using 10 normal pediatric patients who volunteered for the study (6 males, 4 females), the study was conducted from March to April, 2015. Average age was 6.

데이터처리

Parametric ANOVA (analysis of variance) test, which is one of inferential statistics, was applied and significant difference was confirmed (α=0.05; significance level of 95%, p > 0.05).

성능/효과

In addition, all the test results from the quantitative analyses in this study did not yield statistically significant difference in on renal functions by scanning method (p=0.96). That is, it indicates that those scanning methods attempted in this study can produce reliable scanning outcomes while maintaining image quality because they had detected no less than or more counts of photon, by which renal functions can be evaluated, than existing test methods.
Therefore, it can reduce the chance of wrong diagnosis on patient’s conditions due to patient’s artifact and motion blurring by long test and even provide more accurate medical information on the area where existing planar scan can’t reach. In conclusion, ^99mTc-DMSA renal SPECT is more useful scanning method than planar scan in diagnosing, identifying, and determine the initial kidney lesion of young child. By detecting cortex ingestion defect at early stage, it can prevent kidney damage and help decide tracking check.
Moreover, when the diagnostic value of planar scan and two type-mode SPECT scanning were evaluated, all SPECT scanning could more easily detect a lesion on 6 test subjects who showed abnormal ingestion out of 10 participants than planar scan. Judging from bare-eye evaluation, the image quality of HR-mode SPECT was the best, but HS-mode SPECT was not also significantly different from HR-mode SPECT in terms of sensitivity, accuracy and specificity, which determine the diagnosis of a lesion. Therefore, HS-mode SPECT was considered as most suitable for clinical use because it had shorter testing time than planar scan, detected enough counts of photon, was significantly similar in relative renal function ratio, and was better in locating a lesion[Fig.
And then the counts of LT, RT kidney were compared. The comparison showed that planar scan had the mean of total counts of left kidney (139.7 kcounts) and right kidney (147.3 kcounts), HR-mode SPECT had the mean of total counts of LT kidney (409.3 kcounts) and RT kidney (436.3 kcounts) and HS-mode SPECT had the mean of total counts of LT kidney (748.6 kcounts) and RT kidney (787.9 kcounts)[Table 1]. In addition, both scanning methods didn’t show significant difference in background counts measured after setting ROI around both kidneys (P=0.
Therefore, the testing time of HR-mode SPECT was 1.19 times shorter and HS-mode SPECT, which is the main research object, 1.94 times shorter than planar scan. As explained before, SPECT scanning methods (HR-mode and HS mode) used high resolution collimator to obtain photon signals for 4 images in every direction, so could shorten testing time more than planar scan that acquired the signals only in one direction.

후속연구

Objective of this study was to identify the significance of renal static planar scan results according to the characteristic of collimator and the correlations with time reduction, in the process of finding hardware methods in order to reduce examination times of renal SPECT. If the software like image processing and half time methods (Onco. Flash, Astonish, evolution) can be provided by the manufacturer and additional tests are performed, interesting results are expected and therefore additional studies are considered to be performed in the future. Additionally, recent technologies which enable consecutive capturing SPECT and CT images and subsequent fusion or registration provide the methods to compare and read the images more accurately and conveniently which are the current trends, and therefore, additional studies will be required

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용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

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