1. 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

2. 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.

3. 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

4. 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

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

6. Target
Feb ~ Aug. 2009
Raynaud’s syndrome Hx patients (male : 8, female : 21)
Isotope Tl 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

7. 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)

8. 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

9. Method
Flow
Blood pool
Delay

10. Method
Flow
Composite
Blood pool
Delay

11. 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

12. 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

13. 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 & p = p < 0.05
Group 1 & p = p < 0.05
Group 1 & p = p < 0.05

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

15. Question And Answer
Q&A