Institute Of Nuclear Medicine Research Articles

Estimation of the Effective Radiation Dose in Nuclear Medicine Workers from Dhaka by Measuring Radioactivity in Urine Sample Resulting from Internal Exposure

This study estimates the effective doses and activity concentration from 151 urine samples which are collected from 15 (Fifteen) occupational workers at National Institute of Nuclear Medicine and Allied Science (NINMAS) in Dhaka, Bangladesh. The radioactivity concentration in urine sample is due to intake of I-131, Tc-99m and F-18. The samples have been analyzed using High Purity Germanium (HPGe) detector. The radioactivity of I-131 and Tc-99m was found 0.91 ± 0.26 BqL-1 to 504.49 ± 6.03 BqL-1 and 0.15 ± 0.21 BqL-1 to 191.19 ± 6.98 BqL-1 respectively. Radioactivity of F-18 was found from 0.031 ± 0.022 BqL-1 to 0.282 ± 0.065 BqL-1. The effective doses of occupational workers have been also calculated using the radioactivity concentration and the dose coefficient according to ICRP publication 78. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 64−80

Role of Ultrasonography in the Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is still prevalent as a major surgical emergency. Due to the fast progress of the ailment, surgery is often the most sensible approach to manage it. But any surgery comes with its fair share of risk. If the diagnosis of the disease can be made more accurate prior to surgery, the error rate of negative appendectomy can be greatly reduced. Aim of the study: The aim of the study was to evaluate the role of ultrasonography in the diagnosing acute appendicitis. Methods: This prospective cross-sectional study was conducted at the Institute of Nuclear Medicine & Allied Sciences (INMAS), Rangpur with Department of Surgery & Department of Pathology of Rangpur Medical College Hospital, Rangpur, Bangladesh. The study duration was 02 years, from 01January 2022 to 31 December 2023. A total of 100 cases were selected from those patients were come for ultrasound examination, send from the hospital with pain in the right lower quadrant of the abdomen for the purpose of this study. Result: Among the 100 participants of the study, histopathological diagnosis showed that 86% were acute appendicitis cases and 14% had normal appendicitis. Gender or age had no significant association with histopathological diagnosis, but male prevalence was observed in the study, with a high prevalence of young adults. The original site of pain was periumbilical pain shifted to the right iliac fossa for half the participants. Pain duration was between 18-24 hours for 36% of the cases. All participants presented with pain, fever, anorexia, and nausea had a high prevalence among participants. The sensitivity and specificity of high-resolution ultra-sonogram were 84.9% and 85.7% respectively. Conclusion: Appendicitis is a disease of the young, and can occur in participants of both genders. Histopathological diagnosis has no significant association with patient age or gender. Ultra-sonogram has high sensitivity and specificity ratio in diagnosing acute appendicitis and also h

Outcomes of Low-Risk Differentiated Thyroid Cancer (DTC) without Radioactive Iodine (RAI) Ablation Therapy Post-Thyroidectomy: An Experience from a Tertiary Centre in Karachi.

To assess the outcomes of low-risk differentiated thyroid cancer (DTC) with tumour size 1 to 4 cm post-thyroidectomy in patients who never received radioactive iodine (RAI) ablation and to compare the outcomes with those who received RAI therapy. Observational study. Place and Duration of the Study: Department of Nuclear Medicine, Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) Hospital, Karachi, Pakistan, from January 2016 to December 2020. A total of 130 consecutive patients of low-risk DTC of both genders aged between 18-75 years were identified who underwent thyroidectomy. Patients were classified as either being treated or not treated with RAI, based on RAI data post-thyroidectomy. Patients were followed up for two to five years depending on their date of diagnosis from 2016 to 2020, using thyroglobulin (Tg), anti-thyroglobulin (anti-Tg), and thyrotropin (TSH) levels and ultrasound neck. Association betweenpatients who received RAI and who did not receive RAI was determined and a p-value<0.05 was considered as statistical significance. Patients had mean age of 34.5 ± 10.4 years with majority of females (75.4%). Majority of the patients (94.6%) had total thyroidectomy with no neck dissection (83.1%). RAI therapy was conducted among 70.8% participants, of which, 56.9% participants received a dose of 100 mci. Most of the patients had positive outcomes as there was no recurrence among 96.2% participants. There was a significant difference in RAI therapy with total thyroidectomy as compared to subtotal, RAI dose, tumour stage, neck dissection, and lymph node involvement (p ≤0.001). After complete tumour resection, a highly selected group of patients with low-risk local disease have shown low rate of recurrence when managed without RAI. Interestingly, the disease recurrence was also only seen in patients who received RAI therapy in comparison to those who did not receive RAI therapy. Outcomes, Differentiated thyroid cancer, Radioactive iodine, Ablation therapy, Post-surgery.

Significant Association of Epidemiological Factors with Hypothyroid Patients in Khulna Region: A Cross Sectional Study

Background and Objectives: Thyroid disorder is one of the most common endocrine disorders worldwide. A community‑based investigations showed that; overall occurrence of thyroid disease was 20.43%, highest incidence of diffuse goiter (7.35%), followed by sub-clinical hypothyroidism (6.59%), hypothyroidism (4.97%), hyperthyroidism (0.86%) and sub-clinical hyperthyroidism (0.65%) in Khulna, Bangladesh. High prevalence of hypothyroidism with autoimmunity are also observed in Khulna Region. The aim of this study was to conduct epidemiological survey of hypothyroid patients in Khulna region. Methods: This cross‑sectional study was done on Hypothyroid patients of Khulna Medical College Hospital and Institute of Nuclear Medicine and Allied Science (INMAS), Khulna, from July 2023 to December 2023. After having informed written consent of adult sixty hypothyroid patients, was interviewed and examined the blood sample for relevant information; data recorded in a preformed, semi-structured data collection sheet (Patient particulars form) and analyzed. Results: Out of the sixty hypothyroid patients about fifty percent was obese, eighty percent was female of 30-60 years age group. Ninety percent of them belongs to poor socioeconomic conditions and came from rural area of Khulna district. About 20 percent had positive family history of hypothyroidism, 27 percent patient was associated with other autoimmune diseases and about 80 percent was associated with anti-thyroid antibody. Conclusions: Most of the patients were rural female of low socioeconomic back ground of reproductive age groups. They also associated with other autoimmune diseases. Chronic autoimmune diseases, poverty, anti-thyroid antibody and salinity of environment may play an important role for the causation of hypothyroidism in Khulna region. Keywords: Thyroid disorder, hypothyroidism, dyslipidemia, thyroiditis.

Improving Hepatitis B diagnosis by implementing statistical quality controls

Hepatitis B is a viral infection that causes major health problems worldwide. The hepatitis B virus (HBV) and 1.2 million deaths per year globally infect more than two billion people. Hepatitis B mainly affects the liver and causes liver cirrhosis and hypocellularity carcinoma. This study investigates diagnostic quality parameters of quantitative polymerase Chain Reaction (qPCR) and enzyme-linked Immunosorbent Assay (ELISA) called enzyme immunoassay (EIA) for HBV Diagnosis. The research was conducted at the Molecular Biochemistry Laboratory (MBL) in the Department of Biochemistry at the University of Agriculture, Faisalabad, Pakistan. The samples for the randomized study containing 977 male and female samples who had pre-diagnosis HBV infection were selected for this comparative study and collected from the Punjab Institute of Nuclear Medicine (PINUM) Hospital and Allied Hospital Faisalabad, Pakistan. This study compared the sensitivity and specificity of the ELISA assay with the HBV qPCR assay to diagnose HBV infection. The cut-off value &lt; 1.00 was considered non-reactive, whereas ≥ 1.00 was reactive patients for ELISA. Similarly, HBV viral load was measured on qPCR &lt; 101 IU/mL was considered a negative result, and &gt; 101 IU/mL showed positive results. Statistical data analysis was conducted using Statistical Package for Social Sciences (SPSS 22) software. These tests were used to diagnose HBV infection on a large scale to calculate the percentage value of sensitivity, specificity, and other parameters. With a 95% confidence interval, the qPCR's positive predictive value (PPV) was 46%, whereas 52% for ELISA. The negative predictive value (NPV) for qPCR was 98%, but it was the same for ELISA. The specificity for qPCR was 91% and 92% for ELISA. The sensitivity value for qPCR was 83%, and 87% for ELISA was observed from the samples. Accuracy for both methods varied, which showed their proficiency and size. The results obtained from qPCR were more accurate and authentic than those obtained from ELISA.

Hypothyroid Patients Show Significant Association with Antithyroid Antibodies: A Cross Sectional Study in Khulna

Background and Objectives: A high prevalence of thyroid disorder is found worldwide and it is a serious public health problem. A community‑based investigations showed that; overall occurrence of thyroid disease was 20.43%, highest incidence of diffuse goiter (7.35%), followed by sub-clinical hypothyroidism (6.59%), hypothyroidism (4.97%), hyperthyroidism (0.86%) and sub-clinical hyperthyroidism (0.65%) in Khulna, Bangladesh. Antithyroid autoantibodies are one of the most important causes of thyroiditis resulting hypothyroidism. The aim of this study was to investigate the prevalence of antithyroid antibody to hypothyroid patients in Khulna region. Methods: This cross‑sectional study was done on Hypothyroid patients of Khulna Medical College Hospital and Institute of Nuclear Medicine and Allied Science (INMAS), Khulna, from July 2023 to December 2023. After having informed written consent of adult sixty hypothyroid patients, was interviewed and examined the blood sample for relevant information; data recorded in a preformed, semi-structured data collection sheet (Patient particulars form) and analyzed. Results: About 20 percent had positive family history of hypothyroidism, 27 percent patient was associated with other autoimmune diseases and about 80 percent was associated with anti-thyroid antibody. Out of the sixty hypothyroid patients about fifty percent was obese, eighty percent was female of 30-60 years age group. Ninety percent of them belongs to poor socioeconomic conditions and came from rural area of Khulna district. Conclusions: Most of the patients were rural female of low socioeconomic back ground of reproductive age groups. There was very significant association of anti-thyroid antibody with these patients. They also associated with chronic autoimmune diseases and poverty.

Radiosynthesis and Quality Control of [18F] PSMA-1007 at the Cyclotron Facility of National Institute of Nuclear Medicine and Allied Sciences (NINMAS) for Diagnosis of Prostate Cancer

Radiosynthesis and Quality Control of [18F] PSMA-1007 at the Cyclotron Facility of National Institute of Nuclear Medicine and Allied Sciences (NINMAS) for Diagnosis of Prostate Cancer

Prevalence and Determinants of Vitamin D Deficiency: A Comprehensive Analysis from the measured vitamin D level at Chemiluminescence Immunoassay (CLIA) laboratory of National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka

Prevalence and Determinants of Vitamin D Deficiency: A Comprehensive Analysis from the measured vitamin D level at Chemiluminescence Immunoassay (CLIA) laboratory of National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka

Preoperative Serum Thyroglobulin Levels Predict Radioiodine Therapy Outcome in Papillary Thyroid Microcarcinoma Patients.

Our previous study showed that elevated preoperative thyroglobulin (pre-Tg) level predicted the risk of developing radioiodine refractory in PTC patients. In the present study, we aimed to evaluate the prognostic value of pre-Tg in papillary thyroid microcarcinoma (PTMC). After a specific inclusion and exclusion criteria were applied, a total of 788 PTMCs were enrolled from Jiangyuan Hospital affiliated to Jiangsu Institute of Nuclear Medicine between Jan 2015 and Dec 2019. Among them, 107 PTMCs were treated with radioiodine therapy (RAIT) and the response to therapy was grouped as excellent response (ER), and non-excellent response (NER: indeterminate response, IDR and biochemical incomplete response, BIR). Multivariable logistic regression was used to identify predictors for the response of RAIT in PTMCs. Higher pre-Tg levels were detected in PTMCs with RAIT as compared with PTMCs without RAIT (p=0.0018). Higher levels of pre-Tg were also found in patients with repeated RAIT as compared with patients with single RAIT (p<0.0001). Furthermore, pre-Tg level was higher in PTMC with IDR (n=16) and much higher in BIR (n=9) as compared with patients with ER (n=82, p=0.0003) after RAIT. Multivariate analysis showed that pre-Tg level over 16.79 ng/ml [OR: 6.55 (2.10-20.39), p=0.001] was the only independent predictor for NER in PTMC with RAIT. We found that high level of pre-Tg predicted a poor RAIT outcome in PTMC. Our finding explores a prospective way in identifying high-risk PTMCs with poor response to RAIT.

SUV max as Predictor of Metastatic Disease on 18 F-FDG PET-CT in Hepatocellular Carcinoma.

To ascertain the utility ofmaximum standardised uptake value (SUVmax) in 18F-FDG PET-CT in predicting metastatic disease burden in hepatocellular carcinoma (HCC) patients. Descriptive study. Place and Duration of the Study: Department of Nuclear Medicine and PET-CT Imaging, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan, from April to October 2022. 18F-FDG PET-CT data of 87 patients were analysed prospectively. Patients were considered regardless of resection status. The SUVmax measurements were performed, and their association with metastases was determined. Molecular docking studies were conducted to determine a mechanism behind the higher SUVmax at the metastatic sites. A higher number of patients (49) was found to have metastasis (1 to 5 in numbers) and demonstrated higher SUVmax, especially in cases of pre-surgery and post-transplant state. A positive correlation existed between SUVmax of pre-surgery (r = 0.419, p = 0.001) and post-transplant patients (r = 0.779, p = 0.001). Molecular docking studies revealed a strong binding affinity (-5.18± 0.25 kcal/mol) between the hexokinase (HK-II) and 18F-FDG. SUVmax positively correlated with metastatic tumour burden. The strong binding affinity between the HK-II and 18F-FDG may be the reason. 18F-FDG PET-CT appeared beneficial in providing prognostic information for HCC in a selected group. Hepatocellular carcinoma, 18F-FDG, Positron emission tomography, Maximum standardised uptake value, SUVmax, HK-II binding, PET-CT, Metastases.

Acetylcholinesterase enzyme among cancer patients a potential diagnostic and prognostic indicator a multicenter case–control study

Acetylcholinesterase enzyme (AChE) activity is impaired by a variety of inhibitors including organophosphorus pesticides, leading to the accumulation of acetylcholine. In this study, we aimed to determine the association between cancer and the blood level of the (AChE). This is a multicenter hospital-based case–control study conducted in the Radiation and Isotopes Center Khartoum, and Institute of Nuclear Medicine and Molecular Biology and Oncology Gezira. One hundred and fifty participants, half of them cancer patients and half cancer free were recruited. All participants were screened for demographic, environmental, occupational, and clinical characteristics. Blood for the (AChE) activity test was drawn from participants in the two groups. The mean age of the participants was 40.6 ± 14.8 years. Geographical distribution showed the Central Region of Sudan had the highest rate of cancer, followed by North State, Khartoum State, West State, and East State. The most common tumor subtype was breast cancer, followed by leukemia, colon, esophageal, and prostate cancer. Inferential analysis revealed significantly impaired (AChE) activity among cancer patients compared to controls (53.4 ± 20.3% vs. 93.8 ± 8.8, p-value 0.001). There was a significant statistical association between impaired (AChE) activity and cancer. (AChE) activity might be applied in the future as a diagnostic biomarker and therapeutic target. Further large sample and molecular studies are recommended.

Evaluating internal exposure due to intake of 131I at a nuclear medicine centre of Dhaka using bioassay methods

Handling of radioisotopes may cause external and internal contamination to occupational workers while using radiation for medical purposes. This research aims to monitor the internal hazard of occupational workers who handle 131I. Two methods are used: in vivo or direct method and in vitro or indirect method. The in vivo or direct method was performed by assessing thyroid intake with a thyroid uptake monitoring machine. The in vitro or indirect method was performed by assessing urine samples with the help of a gamma-ray spectroscopy practice using a High-Purity Germanium (HPGe) Detector. In this study, fifty-nine thyroid counts and fifty-nine urine samples were collected from seven occupational workers who were in charge of 131I at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka. The result showed that the average annual effective dose of seven workforces from thyroid counts were 0.0208 mSv/y, 0.0180 mSv/y, 0.0135 mSv/y, 0.0169 m Sv/y, 0.0072 mSv/y, 0.0181 mSv/y, 0.0164 mSv/y and in urine samples 0.0832 mSv/y, 0.0770 mSv/y, 0.0732 mSv/y, 0.0693 mSv/y, 0.0715 mSv/y, 0.0662 mSv/y, 0.0708 mSv/y.The total annual effective dose (in vivo and in vitro method) was found among seven workers in average 0.1039 mSv/y, 0.0950 mSv/y, 0.0868 mSv/y, 0.0862 mSv/y, 0.0787 mSv/y, 0.0843 mSv/y, 0.0872 mSv/y. Following the rules of the International Commission on Radiological Protection (ICRP), the annual limit of effective dose for occupational exposure is 20 mSv per year and the finding values from this research work are lesser than this safety boundary.

Risk-stratified Distant Metastatic Thyroid Cancer with Clinicopathological Factors and BRAF/TERT Promoter Mutations.

To assess the prognostic value of clinicopathological factors as well as BRAF and TERT promoter mutations in predicting distant metastasis in patients with papillary thyroid cancer. The status of BRAF and TERTp mutations were available in 1,208 thyroid cancer patients who received thyroidectomy at Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine from January 2008 to December 2021. Based on inclusion criteria, 99 distant metastasis thyroid cancers (DM-TCs) and 1055 patients without DM (Non-DM-TCs) were retrospectively reviewed. After univariate and multivariate analyses, a risk model was established for DM prediction based on factors: T3/T4 stage, lymph node metastasis (LNM) number over 5, and BRAF/TERT mutations (TLBT). It was defined based on the number of TLBT factors: low risk (no risk factor, n=896), intermediate risk (1 risk factor, n=199), and high risk (≥2 risk factors, n=59). Notably, compared with patients with low and intermediate risks, patients assigned to high TLBT risk have a shorter time of DM disease-free survival. Except for gene mutation, other factors were also included in the 2015 American Thyroid Association (ATA) risk guideline. Comparing with the ATA risk category, this risk model showed a better performance in predicting DM-TCs. This study proposes a TLBT risk classifier consisting of T3/T4 stages, LNM (n>5), and BRAF+TERTp mutations for predicting DM-TCs. TLBT risk stratification may help clinicians make personalized treatment management and follow-up strategies.

Oxidative stress a potent risk factor for thyroid diseases in young pregnant females.

Objective: To evaluate the potent role of oxidative stress in thyroid disease development and progression in young pregnant females during 1st and second trimesters compared with matched healthy pregnant females of the same gestational age. Study Design: Cross-sectional Comparative study. Setting: Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Pakistan. Samples were collected at the Punjab Institute of Nuclear Medicine (PINUM), Faisalabad, and the Department of Obstetrics at DHQ Hospital, Chiniot. Period: July 2019 to July 2021. Material &amp; Methods: Thyroid disease- comorbid pregnant women and euthyroid pregnant women were compared for serum levels of oxidative stress markers and antioxidants. The markers were evaluated between 68 healthy subjects in Group A and 43 subjects in Group B known for having thyroid diseases. Blood samples were taken under highly sterile conditions after gaining written consent from all subjects and stored at –8°c to –30°c. A spectrophotometer at 532nm was used to measure serum concentrations of oxidative stress markers. ELISA kits were used to determine serum levels of triiodothyronine, thyroxin, and thyroid-stimulating hormone. Data was analyzed using independent student t-test, multiple logistic regression, and receiver operating characteristic curve (ROC) analysis using SPSS version 25. Results: Group A and Group B had a mean age of 26.07±4.88 and 29.19±4.17 years, respectively. Pregnant women having thyroid dysfunction had decreased superoxide dismutase levels (0.05±0.01 nmol/ml) than group A (0.06±0.01). Other indicators of lipid peroxidation showed a non-significant mean difference compared between both groups (p&gt;0.05). Multiple linear regression studies revealed healthy pregnant women with a positive thyroid medication history had higher SOD levels among group B than those without antithyroid medicine, with a Beta coefficient of +0.26 and p=0.04. According to ROC curve analysis, the Superoxide Dismutase biomarker area under ROC was 67.25% at p=0.002. Thus, it may be used as a diagnostic and predictive biomarker. A cutoff value of 51.5pg/ml was proposed, at which sensitivity is 79% and specificity is 69%. It can be a diagnostic and predictive biomarker. Conclusion: The results of the current study concluded that oxidative stress can be considered a potent risk factor for the development and progression of thyroid disease in young pregnant females.

Psychological Burden of Breast Cancer Predicted Quality of Life: A Case Study of Multan Institute of Nuclear Medicine and Radiology

Breast cancer is a highly prevalent cancer in females worldwide, with new cases around one million every year. The study was aimed to investigate psychological burden and quality of among women with breast cancer. The nature of study was quantitative that was completed through correlational research design. Questionnaires were administered with breast cancer patients by conducting a survey as method of data collection. Sample of 139 breast cancer patients were recruited from Multan Institute of Nuclear Medicine and Radiology through purposive sampling technique. Findings of study reveal that depression, anxiety and stress are the most frequent psychological disorders in BC patients. In addition, psychological burden due to BC among women is a significant negative predictor of quality of life. Moreover, results suggest that young breast cancer patients reported propounding level of psychological problems. Several psychotherapeutic and supportive approaches have proven effective in managing psychological disorders in BC patients.

Assessment of Acute Side Effects Among 3D-Concurrent Radiotherapy With Cisplatin-Treated Head and Neck Cancer Patients.

Three-dimensional conformal radiation therapy has become one of the basic components of multidisciplinary treatment for head and neck cancer. Generally, patients with squamous-cell carcinoma of the head and neck receive cisplatin-based chemoradiation. In the current project, the goal was to assess 3D-CRT with cisplatin-induced acute side effects (dermatitis plus xerostomia) among head and neck cancer patients. This descriptive case series was held at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, with an enrollment of 106 head and neck cancer patients following the hospital's ethical approval. All patients received 3D-CRT with concurrent cisplatin chemotherapy according to the oncology treatment protocol at the Institute of Nuclear Medicine and Oncology. The evaluation of enrolled patients was done during treatment at a weekly interval and at one-month post-radiation. Stage 3 patients (17.9%) received chemo-radiation therapy with 40 mg/m2 cisplatin once weekly for seven weeks. All patients received 70 grays in 35 fractions with two grays per fraction over the course of seven weeks following a standard protocol. All enrolled cases had biopsy-proven squamous cell carcinoma of the head and neck. IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. analyzed the data. Chi-square and Fisher's exact tests were applied, while a p-value ≤ 0.05 was taken as statistically significant. All patients developed acute skin changes (dermatitis plus xerostomia) as a side effect of radiation therapy, with cisplatin having different grades during treatment until seven weeks. However, these changes improved and became less severe in terms of grade after one month of post-treatment among all patients. It was concluded that 3D-CRT was associated with dermatitis and xerostomia during and immediately after follow-up, even though the treatment response was good. However, clinical signs and symptoms improved, indicating that radiation therapy is a relatively safe treatment modality among cancer patients. Moreover, 40 mg/m2 cisplatin once weekly for seven weeks resulted in better loco-regional control and survival among advanced-stage head and neck cancer patients as a part of treatment. Although, higher doses of cisplatin (100 mg/m2 ) every three weeks have more harmful acute side effects and delay treatment for patients due to poor compliance.

Interrelationship between Skeletal and Visceral Metastases in Invasive Ductal Carcinoma of Breast- Observational Study at INMAS, Mitford, Dhaka

Background: Invasive Ductal Carcinoma (IDC) is the most common of all diagnosed breast cancers, and it frequently presents with metastatic spread to the bone as well as other viscera. Bone scintigraphy is the primary tool for detecting bone metastases, while different imaging modalities can be useful in detecting visceral metastases. The purpose of this study was to determine the relationship between skeletal and visceral metastases in female patients with IDC referred to INMAS, Mitford, for bone scintigraphy. Patients and Methods: This observational study was conducted at the Institute of Nuclear Medicine and Allied Sciences (INMAS), Mitford, Dhaka, from July 2020 to July 2021. Bone scintigraphy was done with a Siemens dual-head gamma camera after an intravenous injection of 20 mCi of 99mTc-MDP. Both anterior and posterior views were obtained, with additional SPECT images when needed. Images were interpreted and analysed by Nuclear Medicine (NM) physicians of this institute. Data about visceral metastases were collected from patients’ record files. Results: The patients were divided into two groups based on the presence of visceral metastases. Group-A had 95 patients with no known metastases to the viscera, and in Group-B, there were 50 patients who had documented visceral metastases. The majority of the patients in the first group (53.7%) showed no bone metastasis, while a small portion (5.3%) revealed a solitary skeletal metastatic lesion and the rest (41.1%) presented with multiple skeletal metastases. Sixty-six percent of patients in Group B had solitary visceral metastases, with the remaining 34% having metastases to multiple viscera. All the patients in this group were affected at various levels by secondary skeletal deposits. Conclusion: The findings of the study revealed that the presentation of visceral metastases was related to the extent and severity of bone metastases in patients with carcinoma of the breast. Bangladesh J. Nuclear Med. 25(2): 117-120, 2022

Follicular Thyroid Carcinoma Metastasis to the Skull and Brain: Case Series with Literature Review

Distant metastasis is more common in follicular thyroid carcinomas (FTC) than papillary thyroid carcinomas (PTC), as vascular invasion is often characteristic of FTC. Lung, bone, brain, liver, bladder, and skin are potential sites of distant metastases. On the other hand, lymph node involvement is much less common (8–10%) in cases of FTC compared to PTC. The therapy of patients may be significantly impacted by learning more about the epidemiological features of thyroid metastases at uncommon sites. In our experience, metastases in uncommon sites do not always indicate a poor prognosis for differentiated thyroid carcinoma (DTC), which might be due to the disease patterns. Every year, around 5% new FTC patients are registered, treated with radioiodine, and followed up in the thyroid division of National Institute of Nuclear Medicine and Allied Sciences (NINMAS). Four FTC patients (F=3, M=1) with skull bone and brain metastases are discussed in this case series. All of them were post thyroidectomized and were referred to NINMAS for radioiodine ablation therapy (RAIT). Two of them had skull and brain metastases, third patient had extensive skull, facial bone and pubic bone invasion, whereas, fourth patient had multiple skull metastases. Bangladesh J. Nuclear Med. 25(2): 128-137, 2022

Role of F-18 FDG PET-CT in Follow up Patients with Rectal Carcinoma: Single Institute Based Study

Introduction: F-18 Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET/CT) is a hybrid non-invasive imaging tool that integrates PET and CT into a single imaging device. It is used to detect and measure metabolic activity in a cancer cell and, hence, can provide anatomic and metabolic information. 18F-FDG PET/CT is useful for the detection of loco-regional recurrence, distant metastases, and monitoring therapy response in patients with rectal carcinoma. This study was done to see the usefulness of 18F-FDG PET/CT in the follow-up evaluation of patients with rectal carcinoma. Materials and Methods: This retrospective study was done in the PET/CT division of the National Institute of Nuclear Medicine &amp; Allied Sciences (NINMAS) between January 2021 and December 2022. A total of 26 patients with rectal carcinoma, requested for an F-18 FDG PET-CT scan were enrolled in this study. Image findings were analyzed and properly documented in a predesigned format to evaluate the results. Results: Total 26 patients with an average age of 47.69 and a follow up period of 6 months to 5 years were enrolled in this study. Histologically adenocarcinoma was seen in 21 patients, four patients were mucinous, two were papillary, and carcinoid tumor was found in one patient. On PET/CT imaging, no metastases were found in 17 (65.4%) out of 26 patients and metastases was seen in 9 (34.6%) patients. Among them four (44.5%) had lung, two (22.2%) had lymph nodes, one (11.1%) had liver and lymph node metastases, one (%11.1) had skeletal metastases, and one (11.1%) had peritoneal metastases. No significant association was observed with histopathology or treatment protocol. CEA was higher in patients with metastases and lower in those without. Conclusion: 18F-FDG PET/CT is an effective tool in follow up patients with rectal carcinoma as it can accurately detect locoregional recurrence or distant metastases. Bangladesh J. Nuclear Med. 25(2): 105-109, 2022

Abstract #1386026: Outcome of Radioactive Iodine Treatment and its Association with Various Parameters in People Presenting with Hyperthyroidism at Tertiary Care Hospital of Karachi, Pakistan

Hyperthyroidism is a common disorder of thyroid gland with multiple etiologies and radioactive iodine (RAI) is one of the important modalities to treat it. The outcome after RAI treatment is unpredictable as it is influenced by many factors. Successful treatment is determined by development of euthyroidism and / or Hypothyroidism within 6 months of radioactive iodine treatment. The aim of this study was to find out the outcome of RAI treatment and its association with factors like age, gender various etiologies of hyperthyroidism, and baseline TSH, FT4 in our population. This retrospective case series study was conducted at Karachi institute of Radiology and Nuclear Medicine” (KIRAN) from January 2018 to June 2020. Among 537 who were given RAI for hyperthyroidism a total of 199 participants with complete data were recruited in study after IRB approval. Demographic details, age, gender, underlying cause of hyperthyroidism (graves disease, toxic multinodular goitre, solitary toxic nodule etc,) were obtained from medical records along with baseline FT4 & TSH. A fixed dose of 15mci of radioactive iodine was given to all patients and TSH and FT4 were measured at 6 weeks 3, 6, and 12 months to evaluate the outcome of RAI treatment. The data was analyzed by SPSS version 20 to compute mean standard deviation and percentages. A total of 199 participant’s data was analyzed, 77.9% were females and 22.1% males with mean age of 41.32±0.99 years. Seventy-four 74.4% participants had diffuse toxic goiter (Graves’ disease) and 15% had solitary toxic nodule or toxic multinodular goiter. Post RAI TSH target (either normal or high) was achieved earlier at 6 weeks in comparison to FT4 (normal or low) that attained at 3months. Outcome of RAI treatment in patients with Graves’ disease and toxic nodule revealed statistically significant and early result by normalization and or increased TSH at 6 weeks 3, 6 and 12 months (p-value <0.05), and FT4 normalization was only seen in patients with graves’ disease in each measurement compared to other etiologies. Females revealed statistically significant and early improvement in both biochemical markers i-e TSH and FT4 at all point of time (normalization of TSH at 6 weeks, increased TSH / and normalization of FT4 at 3, 6 and 12 months) in comparison to males who showed statistically significant improvement in TSH in all points of measurement. Patients with aged greater than 40 years observed early response after RAI by normalization of FT4 at 6 weeks compared to those aged < 40 years. The treatment failure rate was 24.5% at 6 and 12months whereas successful treatment was noticed in 35%, 56%, 75.6%, 75.6% at 6 weeks, 3,6,12 months respectively. Female Participants with Graves’ disease of age greater than 40 years responds better and early to RAI treatment by achieving successful treatment goals compared to elderly males with underlying diagnosis other than graves for hyperthyroidism.