Usefullness of flow composite image in Raynaud scan(201Tl) Department of Nuclear Medicine, East-West Neo Medical Center , KyungHee University Dae Yeon Kim, Gyoo Seol Shin, Eun Jeong Oh, Kun Jae Kim

Raynaud syndrome Report : Maurice Raynaud of France, 1862 Rates : 10 % of population : Female > Male [9 times] 1862년 불란서의 Maurice Raynaud 가 처음 보고한 현상으로서 서늘하거나 추운곳, 찬물에 손,발등을 담글때나 감정이 자극되었을 때 발작적으로 손가락, 발가락, 코나 귀, 유두나 무릎 등의 끝부분이 혈관 수축을 일으키고 혈액 순환 장애를 일으키는 것을 레이노 현상(Raynaud phenomenon)이라고 한다.

Raynaud syndrome Primary Raynaud’s phenomenon (Raynaud’s disease) - cannot look up the cause - bilateral - about 15~30 min Secondary Raynaud’s phenomenon Raynaud’s phenomenon Raynaud’s disease 95% 5% - to neurologic disorder. - May be unilateral - more severe and rapid progression

Triphasic color change Raynaud syndrome Pallor Cyanosis Rubber Triphasic color change Triphasic color changes Precipitate by cold emotional stress Triphasic color change : pallor  cyanosis  rubber

Differential diagnosis Raynaud scan - 201 Tl Nailfold capillaroscopy (NFC) Angiography Power doppler ultrasonography (PDU) Antinuclear antibody or rheumatoid arthritis factor blood test General blood test Biochemistry test

Target Feb. 2008 ~ Aug. 2009 Raynaud’s syndrome Hx. - 29 patients (male : 8, female : 21) Isotope - 201Tl 111 MBq (3 mCi) we are probably walking each other on the other side of the Earth IV - Diagonal and each other on the other side of the region

Acquisition Machine - Philips Gamma Camera Forte A - Z Collimator - LEHR Zoom fator – 1.00 x (Full Field) Matrix size – 64 x 64, 128 x 128, 256 x 256 we are probably walking each other on the other side of the Earth Dynamic(155 f / 2 sec) → Blood pool(300 sec) → Delay(300 sec)

Method Philips PEGASYS processing system Dynamic composition : 155 frame  1 slice composite image Composite - blood pool image ROI comparison & analysis Composite - delay image ROI comparison & analysis

Method Flow Blood pool Delay

Method Flow Composite Blood pool Delay

Method Comparison with composite image and delay image in raynaud scan Flow Blood pool Delay Blood pool Delay Flow flow  composite + Composite Blood pool Delay

Lt hand count/ Rt hand count Rate Result Lt hand count/ Rt hand count Rate rate 3 2 1 patient composite count rate Blood pool count rate Delay count rate

Result Comparison Section Group 1 Group 2 Group 3 Part Composite Blood pool Delay Count ratio (Rt. / Lt.) mean 1.25 ± 0.39 1.20 ± 0.33 1.11 ± 0.17 Comparison Group 2 & 3 p = 0.029 p < 0.05 Group 1 & 2 p = 0.038 p < 0.05 Group 1 & 3 p = 0.016 p < 0.05

Conclusion Flow Blood pool Delay Visual Comparison Classification Composite we are probably walking each other on the other side of the Earth Useful Diagnosis

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