National Institute Of Nuclear Medicine And Allied Sciences Research Articles

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.

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

18F FDG PET/CT Scan in the Evaluation of Metabolic and Morphologic Change of Breast Cancer after Neoadjuvant Chemotherapy

Background: Breast cancer remains the most commonly occurring cancer among women across the world and accounts for 69% of cancer deaths. Neoadjuvant chemotherapy (NACT) has been effective in downstaging a primary tumor before surgery. In this study, a fluorine-18, 2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan was used to determine the metabolic and morphological changes of breast cancer after therapy. An 18F-FDG PET/CT scan was done before and after NACT. The change in maximum standard uptake value (SUVmax) ultimately reflects the metabolic status of tumor cells, and the change in tumor diameter represents the morphology of the tumor. Objective: To determine the therapeutic response by assessing metabolic and morphologic changes in breast cancer patients using an 18F-FDG PET/CT scan after NACT. Patients and methods: The study was conducted at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Bangabandhu Sheikh Mujib Medical University (BSMMU) campus, from March 2020 to June 2021, on biopsy-proven female patients diagnosed with breast cancer (stage II to stage IV as defined by the AJCC). A total of nine patients were enrolled in this study. Before and after NACT, a PET/CT scan was performed in accordance with the IAEA CRP guidelines (in a prone posture with breast hanging supported by a breast cushion) and following the NINMAS protocol. Morphological and metabolic data were recorded and analyzed to ascertain the tumor's metabolic and morphologic (as per RECIST 1.1) outcomes. A follow-up 18F-FDG PET/CT after NACT was done using the same dose and the same number of beds (1 minute per bed) as done before NACT. Results: About 89% of patients showed a reduction in tumor size following NACT. The mean tumor size reduction rate was 23.66±22.19 (%) and the difference was statistically significant between prior and after NACT (P < 0.05). Only 11% of patients developed higher SUVmax following NACT. According to RECIST 1.1 criteria, 11.11% of patients had progressive disease, 44.44% had a partial response, and 44.44% were stable. In PET/CT scans, approximately 66.67% of patients responded to NACT. Conclusion: 18F-FDG PET/CT can be used as a potential state-of-the art imaging approach in breast cancer patients before and after NACT. Following NACT, metabolic and morphological changes are visible in the 18F-FDG PET/CT scan, distinguishing responder and non-responder, which must be compared with pathologic response. Bangladesh J. Nuclear Med. 26(1): 13-18, 2023

Evaluation of Physiochemical and Microbiological Stability of 2-[18F] Fluoro-2-Deoxy-D-Glucose, [18F]FDG: Synthesized in the Cyclotron Facility of National Institute of Nuclear Medicine and Allied Sciences

2-[18F]Fluoro-2-Deoxy-D-Glucose ([18F]FDG) is very effective and the most successful radiotracer for the assessment of glucose metabolism in the brain, heart, and lungs. It has also been used for imaging different tumors in oncology. The purpose of this study was to evaluate the stability and quality of [18F]FDG synthesized by the newly installed 18MeV Cyclotron facility at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS). [18F]FDG was synthesized by nucleophilic fluorination of Mannose-triflate followed by basic hydrolysis with an IBA Synthera® auto synthesizer. [18F]FDG solution was collected in a sterilized vial after the filtration by a vented Millex®-GS 0.22µm syringe-driven hydrophilic filter. An aliquot of [18F]FDG solution was taken 0, 2, 4, 6, and 8 hours after the synthesis. All quality control parameters were measured in the first evaluated period, immediately (i.e., 0 hours) after synthesis. Radiochemical purity (RCP) was measured for all [18F]FDG samples and for all time points. The radiochemical and radionuclidic purity was more than 95% and 99.99% respectively. The [18F]FDG was physiochemically & microbiologically stable over 8 hours. Bangladesh J. Nuclear Med. 26(1): 44-50, 2023

Papillary Thyroid Carcinoma Arising in Thyroglossal Duct Cyst and Locally Infiltrated to Hyoid Bone: Issue of Individualized Management

Thyroglossal duct cyst (TGDC) is the most common developmental anomaly of the thyroid gland, while TGDC carcinoma with local infiltration to the hyoid bone is extremely rare. The reported case of papillary thyroid carcinoma (PTC) was diagnosed in TGDC along with local infiltration to the hyoid bone and needed individualized management. A 70-year-old male patient presented with a history of PTC arising in TGDC and locally infiltrated to the hyoid bone followed by total thyroidectomy and radical sistrunk operations and was referred to National Institute of Nuclear Medicine and Allied Sciences (NINMAS) for radioactive iodine therapy (RAIT). His post-operative ultrasound of the neck revealed an irregular shaped, fungating, grossly non-homogenous mixed echogenic mass lesion invading the hyoid bone, measuring about 25 X 28 mm. Radioactive iodine(131I) of 150 mCi was administered because the residual hyoid bone mass was inoperable and he was on thyroxine suppression therapy. The post-therapy 131I scan (RxWBS) showed two intense foci of radiotracer concentration (RTC) in the upper area (above the thyroid bed) and an intense focal RTC in the fundal region of the stomach. The activity in the stomach region was evaluated by ultrasound imaging, which revealed a soft tissue mass or thickening of the mid-region of the posterior wall of the stomach (3.3 cm X 1.6 cm). A CT scan of the chest was also performed to rule out metastasis, and it revealed multiple nodular lesions in both lung fields (most likely secondary) as well as tiny subcentric lymphnodes in the lower pre- and right paratracheal regions after nearly one month of RAIT when the patient was stable for examination. EBRT is still under consideration as adjuvant therapy. Tyrosine kinase inhibitors (TKI) may be considered in cases of refractoriness to radioiodine and disease progression. Bangladesh J. Nuclear Med. 26(1): 67-70, 2023

Demography and Characteristics of Lung Cancer Patients Evaluated by 18F-FDG PET- CT imaging - Retrospective Analysis in NINMAS

Introduction: Carcinoma of the lung is one of the most common cancer in Bangladesh. Fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) plays an important role in staging and evaluating therapy response. Currently, limited data is available about the demography and characteristics of lung cancer patients in Bangladesh by 18F-FDG PET-CT scan. Objectives: To evaluate the demographic pattern and pattern of findings in lung cancer patients by 18F-FDG PET-CT scan in the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka. Materials and Methods: This retrospective study was conducted in the PET-CT division of NINMAS. A total of 53 patients out of 103 patients with lung cancer were enrolled who were referred to NINMAS from October 2020 to December 2021 for either baseline PET CT or for assessment of therapy response. Data were collected in a predesigned format from old documents and analyzed for demographic characteristics, histopathologic, morphologic and metabolic patterns as well as a comparison of the overall number of lung cancer patients with previous years. Results: Among the enrolled 53 lung cancer patients the majority (34%) are in the 6th to 7th decades with 56.6% male and 43.4 % female. Adenocarcinoma (62%) and squamous cell carcinoma (24%) were the most common lung cancer subtypes. The majority of patients (53%) came for a therapeutic response evaluation; among them, 32% had a good response following therapy, 25% with progressive disease and others had mixed response, partial response, and stable disease. Nine percent of the patients came for follow up and among them, recurrence is detected in 20%. Lung cancer patients who came for baseline study, (38%) were upstaged (80%) mainly with 20% remaining in the same stage. Conclusion: The demographic pattern of lung cancer patients observed in this study belonged to 6th & 7th decades having male predominance. Most of the patients were diagnosed with advanced stages of lung cancer. The use of 18FDG PET-CT is crucial for the staging and diagnosis of suspected lung cancer, as well as therapeutic response and follow-up. Bangladesh J. Nuclear Med. 25(1): 22-27, 2022

Installation of First Medium Energy Medical Cyclotron in Bangladesh at National Institute of Nuclear Medicine and Allied Sciences (NINMAS) for PET radiopharmaceuticals Production

PET-CT (positron emission tomography and computed tomography) is a gold-standard cancer imaging tool for diagnosis and management, as well as prognostic information based on treatment. Positron-emitting radionuclide 18F (Fluorine) is generated by accelerating particles to energies high enough to cause a certain nuclear reaction 18O(p,n)18F within the particle accelerator, the cyclotron. Mannose triflate is converted to 2-[18F] Fluoro-2-deox-D-yglucose ([18F]FDG) via nucleophilic reaction. Under the ownership of Bangladesh Atomic Energy Commission installed a medium energy (18/9 MeV, IBA) Cyclotron at National Institute of Nuclear Medicine and Allied Sciences (NINMAS). The facility was established in the oncology Building (Block F) of Bangabandhu Sheikh Mujib Medical University (BSMMU). Cyclotron vault and the Control room are located in the underground i.e. basement floor. Each wall of the cyclotron vault and ceiling is made of concrete with a density of 2.35 g/cm3 and a thickness sufficient to shield gamma and neutron radiation. On the ground floor, there are Synthesis room, Quality control laboratory, and the Decontamination room. PET-CT rooms are located on the first floor. Identification, Radionuclide purity (Gamma spectrum detection and half-life measurement), Radiochemical Purity, Chemical purity, Residual solvent measurement, pH measurement, Sterility, and bacterial endotoxins (LAL test) are performed to maintain the quality of the product. The current uses of the Cyclotron are mostly for the synthesis of 18F-FDG. Bangladesh J. Nuclear Med. 24(1&2): 48-50, 2021

Gated SPECT Myocardial Perfusion Imaging at status-post Thrombolysis with Streptokinase

Background: Adequate reperfusion by thrombolysis (TL) with streptokinase (STK) after an ST elevation myocardial infarction (STEMI) is associated with better patient outcome. This study described theattributes of patients who at status-post TL underwent gated SPECT myocardial perfusion imaging (GSMPI). Patients and methods: This cross sectional retrospective study was conducted in 2017 on a group of patients who were referred to Nuclear Cardiology Division of National Institute of Nuclear Medicine and Allied Sciences (NINMAS) from February 2005 to October 2016 for GSMPI. Archive was reviewed to include those who received STK with diagnoses of an acute MI, then underwent coronary angiogram (CAG) and then underwent GSMPI. Findings from status-post TL CAG reports were compared with that from GSMPI. Results: Among 1347 patients, 59 (4.4%) were eligible for analysis with mean age of 51.2 ± 9.5 years. GSMPI revealed normal perfusion in 16 (27%), abnormal perfusion in 43 patients with mean LV infarct size at rest of 48.6 ± 17.2% and ischemia in 13 patients with mean ischemic LV of 12.1 ± 9.6%. Mean LVEF in normally perfused LV and in those with perfusion defects were 50.0 ± 18.7% and 39.5 ±14.9%respectively (p = 0.04). CAG was normal in one among 43 patients with abnormal myocardial perfusion. CAG was abnormal in 75% (12 of 16)of patients with normal perfusion. Six (10% of 59) among that 12 with abnormal CAG and normal perfusion had further coronary revascularization (CR). Conclusions: In this series, 27% (16/59) patients who had received STK had normal perfusion and at least in 10% (6/59) the normal perfusion despite an abnormal CAG and without further CR may indicate adequacy of TL using STK. Bangladesh J. Nuclear Med. 23(1&2): 29-36, 2020

Role of Gated SPECT MPI in Follow-up of Patients afterCoronary Revascularization

Objective: Gated SPECT myocardial perfusion imaging (GSMPI) is a preferred modality for non invasive assessment following coronary revascularization (CR) of both symptomatic and asymptomatic patients. This study was conducted to observe the impact of GSMPI results on further management of patients who after CR had underwent GSMPI at National Institute of Nuclear Medicine and Allied Sciences (NINMAS).
 Patients and methods: Record files of GSMPI of all patients who underwent GSMPI over a period of 31 months from June 2011 to December 2013 at NINMAS for assessment of perfusion after CR were selected from the Nuclear Cardiology Divisional archive of patient studies in order to retrieve their clinical and demographic data including the contact numbers. The results of GSMPI scan were categorized as normal scan (NS) and perfusion defect (PD) which included reversible and/or fixed PD. All the contact numbers were called up by a nuclear medicine physician who conducted a semi-structured telephonic interview either with the patients or with a concerned family member. Management strategies adopted after GSMPI were categorized as conservative (CM) and interventional (IM).Cramer’s V (φc) test were done to find strength of relation among patients’ symptoms, scan findings and management strategies.
 Results: Follow up data of 55 patients (54M, 1F) among 68 (66M, 2F) were available who underwent MPI for the purpose of post CR assessment. MPI was performed in between six months to 13 years after CR (mean 43.8 ± 48.2 months). Categorically 33 patients had percutaneous transluminal coronary angioplasty (PTCA) with stent, 16 patients had coronary artery by-pass grafting (CABG) and 6 patients had both CABG & PTCA. There were 38PD (27symptomatic) and 17NS(12 symptomatic).Since all patients (n=12) who had fixed PD were symptomatic, a strong relation was found between being symptomatic and fixed perfusion defect (φc> 0.3). Symptoms were found to be weakly related with reversible PD i.e. ischemia (φc< 0.2). Management strategies were conservative in 44 (30 symptomatic and 28 PD) and interventional in 11 (nine symptomatic and 10 PD). Management strategies were found to be weakly related with symptoms (φc< 0.2) but moderately related with perfusion status (φc = 0.24).
 Conclusions: While symptoms were observed to be poorly related with perfusion status following CR, GSMPI guided to choose further interventional management strategies with rationality in lower proportion of patients.
 Bangladesh J. Nuclear Med. 22(1): 30-35, Jan 2019

Assessment of Agreement Between Peak Systolic Velocity of Inferior Thyroid Artery And Thyroid Scan In Differentiating Diffuse Toxic Goiter And Subacute Thyroiditis.

Objective:To analyze agreement between Peak Systolic Velocity (PSV) of inferior thyroid artery (ITA) and Tc99m Thyroid Scan for evaluation of thyrotoxicosis(diffuse toxic goiter and sub-acute thyroiditis)
 Patients and Methods: This prospective cross sectional study was conducted in National Institute of Nuclear medicine and Allied sciences (NINMAS)From July 2016 to June 2017.Total sixty four patients with thyrotoxicosis were included in the study. History, clinical examination and thyroid function tests were done for all patients. The thyroid glands of all patients wereevaluated by gray scale ultrasonography for size, shapeand echotexture. Color-flow Doppler ultrasonographyof the thyroid tissue was performed and spectral flowanalysis of both inferior thyroid arteries were assessed. Tc99m Thyroid scan was done for all patients. The patients were divided into two groups. Group A- Diffuse toxic goiter(DTG) and Group B- Subacute thyroiditis(SAT).The diagnosis of diffuse toxic goiter and subacute thyroiditis was supported by the clinical picture, RAIU uptake and Thyroid Scan.
 Results:All patients had suppressed thyrotropin.Thyroid blood flow, measured by PSV of ITA (CFDS) was highthan normal in DTG patients, while low PSV ofITA than normal was found in SAT.According to Thyroid Scan,Radiotracer concentration (RTC)was diffusely increased with low BKG (background) and almost absent RTC with high BKG was noted in DTG and SAT respectively.In our study Tc99m Thyroid Scan shows agreement with Peak Systolic Velocity of ITA.Here Kappa value was 0.818 and 0.871 in DTG and SAT respectively with P value <0.05 which was statistically significant with almost perfect agreement.
 Conclusion:An Almost perfect agreement between the two modality (PSV of ITA and Tc99m Thyroid Scan) establishes that they are useful alternativein the differential diagnosis of thyrotoxicosis (Diffuse toxic goiter and Subacute thyroiditis)
 Bangladesh J. Nuclear Med. 21(2): 97-101, July 2018

Theranostics in Bangladesh: Current Status, Challenges, and Future Perspective.

Therapeutic nuclear medicine (NM) in Bangladesh began in the early 1980s with the application of radioactive iodine for treatment of thyroid cancer and primary hyperthyroidism. Since then, NM practice has remarkably developed in the country with the advancement of instrumentation, radiopharmacy, and information technology. The government took the initiative to establish four PET-CT centers at different NM centers, including one at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS). A further development is the installation of a cyclotron center (18-MeV cyclotron) at NINMAS by the government's fund. Currently, NM is providing good health services to oncology patients throughout the country. More than 20 NM centers are functioning in different parts of the country, and therapeutic NM has an important place. However, conventional radioactive iodine still remains the major theranostic application. The expansion and development of therapeutic NM for other cancers have been limited due to a number of challenging factors. A brief overview of the history and current status of NM in Bangladesh is presented here with an examination of factors that pose as obstacles to the introduction and development of new therapeutic technologies. Finally, future perspectives are discussed with ways to mitigate existing problems and challenges.

Assessment of Bone Mineral Density in Nonalcoholic Steatohepatitis Cirrhosis

Background: Cirrhosis is characterized by diffused hepatic fibrosis and nodule formation that can occur at any age. It has significant morbidity and mortality. Worldwide common causes of cirrhosis are viral hepatitis (hepatitis B virus and hepatitis C virus), prolonged excessive alcohol intake and nonalcoholic fatty liver disease (NAFLD). Progression of chronic liver disease (CLD) and deterioration of liver function are associated with various hepatic complications. Hepatic osteodystrophy is an important extrahepatic manifestation of advanced liver disease with features of classical osteoporosis and an increased risk for fractures. The objective of the study to assess the bone mineral density (BMD) by duel energy x-ray absorptiometry (DEXA) in patients with nonalcoholic steatohepatitis (NASH) cirrhosis of liver.
 Patients and Methods: A cross sectional observational study was carried out at National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Bangabandhu Sheikh Mujib Medical University (BSMMU) campus, Dhaka, from July, 2016 to June, 2017. This study included the diagnosed cases of NASH cirrhosis patients presented at outpatient or inpatient department of Hepatology of BSMMU. For measurement of the BMD dual energy x-ray absorptiometry (DEXA) scan was performed by DMS Strator DR Bone densitometer at NINMAS. BMD were measured at lumbar vertebrae L1-L4 and both the femoral neck. Analysis of data from DEXA was computerized and completely automated (software 3DXA, Medix DR.) 
 Results: A total of 54 participants was included and among them 27 were cirrhotic patients (cirrhotic group) & 27 were non-cirrhotic patients with healthy liver (non-cirrhotic group). The age range of the patients was 40-70 years in both groups. Male to female ratio was 1:1.45. The mean age was 56.3 ± 6.7 years in cirrhotic group and 55.0 ± 6.3 years in non cirrhotic group. In cirrhotic group, 22 (66.7%) patients had low BMD and five (23.8%) patients had normal BMD. In non-cirrhotic group, 11 (33.3%) patients had low BMD and 16 (76.2%) patients had normal BMD. The difference was statistically significant (p < 0.05) between two groups. Multivariate logistic regression analysis was done to see the effect of multiple independent variables (age, menopause and cirrhosis) on dependent variable (low BMD). In cirrhotic patients odds ratio (OR) was 1.961 (95% CI 0.110 to 25.893) which implies cirrhotic patients had 1.961 times greater chance to develop low BMD than non cirrhotic patients keeping all other factors in fixed level.
 Conclusion: Hepatic osteodystrophy is an important extrahepatic complication of cirrhosis. NASH cirrhosis is found among elderly people and female. Osteoporosis is common in aged people and menopausal female. But in this study it was observed that a NASH cirrhosis patient is highly significant risk factor for low BMD (osteopenia and osteoporosis) other than aged persons and menopausal females. So, special measures and monitoring should be taken regarding osteoporosis in NASH cirrhotic patient to reduce subsequent morbidity.
 Bangladesh J. Nuclear Med. 21(1): 16-20, January 2018

Evaluation of Bone Mineral Density in Subjects with Primary Hyperparathyroidism by Dual Energy X-Ray Absorptiometry

<p><strong><em>Objective:</em></strong><strong> </strong>Bone loss is a major complication of primary hyperparathyroidism (PHPT), and the extent of bone loss is an important factor for parathyroidectomy. Studies focused on this issue of bone loss in subjects with PHPT are quite rare in our country. This study will help the physicians to take proper action by giving an exact reflection of bone condition in subjects with PHPT. The purpose of this study was to evaluate the bone condition by measuring Bone Mineral Density (BMD), in subjects with PHPT using Dual Energy X-ray Absorptiometry (DEXA) and compare these findings with individuals without PHPT.</p><p><strong><em>Patients and Methods:</em></strong><strong> </strong>It was an analytic cross sectional study (group comparison) carried out at National Institute of Nuclear Medicine and Allied Sciences (NINMAS) BSMMU campus, Dhaka from July 2015-December 2016. Subjects of PHPT diagnosed by biochemical evaluation (increased serum calcium and parathyroid hormone concentrations), between age ranges 15-45 years were selected as group-A. Individuals without biochemical evidence of PHPT or other major illness causing bone loss were selected as comparison group or as group-B. The subjects underwent BMD test by DEXA at lumbar spines from L1-L4 vertebra and the left femoral neck using Norland XR-46 densitometer. BMD was classified according to WHO criteria. Data presented on categorical form were analyzed using chi-squared test. While the data presented on continuous scale were analyzed using student’s t-test. In each analysis, level of significance was 5% and P value <0.05 was considered significant. Data were processed and analyzed with the help of computer software SPSS, version 20.</p><p><strong><em>Results:</em></strong><strong> </strong>Total number of 90 subjects were selected for this study, 45 subjects with PHPT were in group-A and equal number of subjects without PHPT were in group-B. The findings derived from data analysis showed, a significantly more male participants in group-A. The mean age of group-A and group-B was 37.24 ± 8.03 years and 38.20 ± 5.74 years respectively. Mean BMI of group-A was 25.10 ± 4.35 kg/m<sup>2 </sup>in compare to 29.43 ± 5.17 kg/m<sup>2</sup> in group-B. Higher BMI was noted in both groups. PHPT subjects with high BMI had low BMD. BMD expressed in absolute value (gm/cm<sup>2</sup>) and T score. BMD was significantly low in group-A (with PHPT) than in group-B (without PHPT), (p<0.0001). In group-A, prevalence of low BMD was 62.2% (osteopenia 37.8% and osteoporosis 24.4%) at lumbar spine and 84.5% (osteopenia 35.6% and osteoporosis 48.9%) at femoral neck. PHPT subjects had significant difference in both T score and BMD between lumbar spine and femoral neck.</p><p><strong><em>Conclusion:</em></strong><strong> </strong>Primary hyperparathyroidism (PHPT) is shown to be associated with significantly reduced BMD especially at femoral neck. Thus, an increased fracture risk should consider if it is left untreated.</p><p>Bangladesh J. Nuclear Med. 20(2): 129-135, July 2017</p>

Evaluation of Skeletal Hot Spots in Carcinoma Prostate Patients by Scintimetric Method

<p>Skeletal scintigraphy is a highly sensitive tool in the detection of metastatic disease from prostate cancer, but its specificity is relatively low. Various quantitative parameters have been introduced to improve the bone scan specificity. Scintimetric method based Dr. V. Siva’s retention ratio is one such parameter proposed to help in predicting malignant or metastatic nature of the skeletal hot spots in a bone scan non-invasively. This study was performed to evaluate the V. Siva’s ratio in a small sample of prostate cancer patients in Bangladeshi population. This prospective observational study was carried out at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) from July 2015 to June 2016. A total of 32 patients with diagnosed prostate cancer were enrolled. Each patient underwent two bone scans at 4 hours and 24 hours respectively after radiopharmaceutical injection. Focal hot spots reported by expert Nuclear Medicine specialists were identified in both scans and maximum counts were taken by drawing region of interest over the spots. Dr. V. Siva’s retention ratio was calculated by dividing the 4-hour count with 24-hour count. Finally statistical analysis was done. The mean V. Siva's ratio of metastatic group was 9.3 ± 2.2 (95% CI 8.5-10.1) and that of degenerative group was 8.2 ± 2.0 (95% CI 7.5-8.9). Statistically significant difference was observed between the two groups. So it can be said that V. Siva’s retention ratio might be useful as a quantitative parameter in adjunct to conventional bone scintigraphy for the skeletal survey of carcinoma prostate patients.</p><p>Bangladesh J. Nuclear Med. 20(1): 9-13, January 2017</p>

Renal Manifestation in Patients with Primary Hyperparathyroidism: a Retrospective Analysis in a Tertiary Institute

<p><strong>Objectives:</strong> The classical renal manifestations of primary hyperparathyroidism (PHPT) are nephrolithiasis and nephrocalcinosis. The presence of renal stone categorizes PHPT as symptomatic variant. The clinical profile of PHPT has changed in past few decades with decreased prevalence of renal stone disease with the introduction of widespread routine biochemical screening in normal subjects. In developing countries, PHPT is still a late diagnosed disorder and most of the patients are symptomatic at presentation. Presence of renal stone in PHPT patients is an absolute indication of parathyroidectomy, hence it is important to identify renal involvement in PHPT. The objective of the study is to determine the rate of renal manifestations in patients of biochemically primary hyperparathyroidism and compared to control group. This retrospective review was performed to determine whether the rate of nephrolithiasis and nephrocalcinosis is still high in the patients who underwent dual phase 99mTc sestamibi scan for PHPT at National Institute of Nuclear Medicine and Allied Sciences (NINMAS) compared to those not affected by the disorder.</p><p><strong>Patients and Methods:</strong> A total 149 patients (male 72 and female 77) and mean age 41 ± 14.73 years with PHPT were included in this study. All patients underwent dual phase 99mTc sestamibi parathyroid scan. Result of 99mTc sestamibi scan were divided into two groups. Group I represented positive scan and group II indicated negative scan respectively.Relevant clinical history, biochemical values including serum calcium level, serum parathormone (PTH) level and data on renal manifestations were recorded. The control group comprised of 650 subjects who had abdominal ultrasonography for various clinical conditions without any history of PHPT. Renal manifestations were compared between PHPT patients and the control group.</p><p><strong>Results:</strong> Among 149 patients, scan was positive in 54(36.2%) cases (group I) and scan was negative in 95(63.8%) cases (group II). In group I, renal manifestations were present in 20 cases and absent in 34 cases. In group II, renal manifestations were present in 32 cases and were absent in 63 cases. Nephrolithiasis and nephrocalcinosis were present in 45(30.2%) and 7(4.7%) cases respectively in study population compared to 8(1.23%) persons of control group of 650 subjects. Pearson’s chi-square analysis showed that the difference in the rate of renal manifestations was significant (p < 0.001) between study population and control group. However, with in the study population the rate of renal manifestations between group I and group II was not significantly different (p = 0.137).</p><p><strong>Conclusion:</strong> This study showed eighteen fold increased renal manifestations in the patients with PHPT imaged for parathyroid gland compared to the subjects not affected by the disorder. Symptomatic variant of PHPT with renal manifestation was higher in this study compared to western countries. During parathyroid scanning in PHPT routine ultrasonographic evaluation of kidneys is necessary to exclude renal manifestation, even with negative parathyroid scan.</p><p>Bangladesh J. Nuclear Med. 20(1): 32-36, January 2017</p>

Spectrum of MDP Bone Scan in Paediatric Patients - Experience at NINMAS

Objective: To assess the clinical indications and spectrum of MDP bone scan findings in paediatric patients referred to the National Institute of Nuclear Medicine and Allied Sciences (NINMAS).Materials and Methods: Paediatric patients, age ranged from 2-18 years referred to NINMAS from January 2014 to November 2015 for bone scintigraphy were included in this study. All patients had 99mTc MDP bone scan for various clinical indications. The spectrum of clinical indications and bone scan findings were recorded and analyzed.Results: Total 2323 bone scans with 99mTc MDP were done in NINMAS in the above mentioned period. Among them 91 (3.917%) cases were in paediatric age group. Of which 82 (90.11%) patients with known malignancy were referred for radionuclide skeletal survey. The most common clinical indications were osteosarcoma 30 (32.96%) cases and Ewing’s sarcoma 25 (27.47%) cases followed by five neuroblastoma (5.49%), four (4.39%) rhabdomyosarcoma, three (3.29%) Langerhans cell histocytosis and rest others. Bone scan was positive in 58 (63.7%) cases and normal in 33 (36.3%) cases. Out of 58 cases 38 had features of primary bony lesion, 10 cases had multiple metastases, four cases had primary bone tumour of Ewing’s sarcoma as well as metastases.Conclusion: Bone scan is a popular imaging modality for skeletal survey of paediatric patients in malignancy, both primary and metastatic bone diseases. Bone scanning in paediatric patients contributes a major role in detecting the cause and localizing the pathology of bone. High quality imaging, interpreted by physicians familiar with paediatric diseases, correlation with clinical records and other imaging are mandatory to maximize the benefit.Bangladesh J. Nuclear Med. 19(1): 28-31, January 2016

Overall External Surface Dose Rate Measurement of 131I Package and 99mTc Generator at the National Institute of Nuclear Medicine and Allied Sciences

Measuring the external surface dose rate of the radioisotope I-131in order to reduce the radiation hazard during the transportation of this is to perform at National Institute of Nuclear Medicine and Allied Sciences (NINMAS) to the hospitals and clinics is a very basic but important requirement. Measured the external surface dose rate of I-131 after receiving the isotope send to NINMAS in shielded packages by Monrol N.P. Company, Turkey and Radioisotope Production Division (RIPD). The authors also measured the external surface dose rate of Tc-99m generator supplied by RIPD, AERE, Saver, Dhaka, Bangladesh, to check whether the radioisotopes package shielding are within the dose rate limit. From this study, the dose rate was found relatively higher for I-131 transportation by the smaller vehicle than large vehicle, although dose rate in both categories of vehicles are within the permissible limit. The external surface dose rates for Tc-99m generator were also found to be within the permissible limit.Bangladesh J. Nuclear Med. 19(1): 9-14, January 2016

Survival Outcome in Patients with Bilateral Gross Renal Parenchymal Impairment detected by Tc-99m DTPA Renogram

Introduction: Bilateral gross renal parenchymal impairment (GPI) is a term often used in nuclear imaging to describe severe diffuse glomerular dysfunction obtained with renal scan using Tc-99m diethylene triamine penta-acteic acid (Tc99m DTPA renogram). Whether bilateral GPI found on Tc99m DTPA renogram has any significance on the survival outcome of the patients has not been studied in Bangladesh.Purpose: The study was carried out with the purpose of obtaining a sketch of short-term survival outcome in patients diagnosed with bilateral GPI at National Institute of Nuclear Medicine and Allied Sciences (NINMAS), a tertiary level institute.Method: Nuclear imaging data of patients who had Tc-99m DTPA renogram from January 2013 to June 2013 at NINMAS were obtained from the divisional archive. Total number of patient who underwent the procedure within this period were examined and only those patients with definite diagnosis of bilateral GPI on renal scan were selected for final analysis. Telephone interview was conducted in the year 2015 to obtain the clinical follow-up data of patients with bilateral GPI.Results: In the six months period from January 2013 to June 2013, there were 576 patients who had Tc-99m DTPA renogram. Out of these, 21 patients (M/F=15/6) with mean age 45 ± 20.9 (3 months to 71 years) were diagnosed to have bilateral GPI. Follow up data of 16 (M/F=12/4) patients with mean age 41.2 ± 22.3 (3 months to 65 years) were available. Eleven (68.8%) patients were alive at the time of follow up and five (31.2%) patients were found deceased. Deaths in all were reported to be associated with renal failure and occurred during hospital management. In this patient group, one and two year survival was estimated to be 93.8 and 68.8%.Conclusions: This study is expected to initiate in-depth assessment of survival pattern in kidney diseases in Bangladesh through future research.Bangladesh J. Nuclear Med. 18(2): 135-140, July 2015

Chemiluminescence Immunoassay: Basic Mechanism and Applications

Chemiluminescence immunoassay (CLIA) has been widely applied in different fields including environmental monitoring, liquid chromatography, clinical diagnosis; food safety, pharmaceutical analysis, immuno- and gene probe assays, as a promising approach for selective, sensitive, rapid and simple analysis. It is often necessary to detect a large number of complicated or low-abundance samples. However, traditional methods need great consumption of time, reagents and labor, which limit their clinical applications. As a result, rapid, high-throughput, sensitive and low-cost detection methods have become the development trend of CLIA. A new chemiluminescence immunoassay analyzer with advanced acridinium ester (AE) technology will be installed at the radioimmunoassy laboratory of National Institute of Nuclear Medicine and Allied Sciences (NINMAS) shortly. In conjunction with the existing Radioimmunoassay (RIA), Immunoradiometric assay (IRMA) and DissociationEnhanced Lanthanide Fluorescent Immunoassay (DELFIA), introduction of chemiluminescence immunoassay (CLIA) technology will expand the activities of in vitro immunoassay. It will also improve the research and development activities of in vitro division of NINMAS. In this review article, we have summarized the basic principle of chemiluminescence immunoassay and its applications. A comparison of RIA, CLIA and enzyme-linked immunosorbent assay (ELISA) was also briefly described in the article.Bangladesh J. Nuclear Med. 18(2): 171-178, July 2015

DTPA Captopril Renogram: Still an Invaluable Tool for Probability Assessment in Suspected Cases of Renovascular Hypertension

Background: Renovascular hypertension is a secondary form of hypertension which occurs due to renal artery stenosis and is potentially curable. The gold standard for diagnosis of this condition is renal angiography which is rather invasive. Captopril renography on the other hand is an established technique used for more than three decades for accurate and non-invasive diagnosis of significant renovascular hypertension. At NINMAS captopril renography is also used to screen renovascular hypertension and has been a routine procedure since the mid- nineties. Aim: The aim of the present study is to reassess the value of captopril renography test after two decades of its use at NINMAS.Materials and Methods: This is a retrospective study of patients who underwent DTPA Captopril renography for evaluation of renovascular hypertension at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS). Divisional archive was searched and patient’s clinical record files were screened from January 2014- September 2015. In total thirty patients who had both baseline and post Captopril renography test during this period were selected and analyzed for the study.Results: Total 30 patients (male 21 and female 09, mean age 24± 5.5 years); were analyzed who completed both post Captopril and base line studies in two different days. The records showed that a baseline renal scintigraphy was performed with 370-444 MBq Tc-99m diethylene triamine pentaacetic acid (Tc-99m DTPA renogram). Scintigraphy was repeated within a week with 25-50 mg of oral Captopril given 60 min prior to the test. Among the 30 patients studied, normal post-captopril renogram was revealed in 08(26%) cases, abnormal findings in 12(40%) , the study was not sensitive in 06 (20%) due to gross parenchyma impairment (GPI) and no change was found in 04(14%) cases. On the basis of diagnostic criteria for gradation for renal arterial stenosis in 12 abnormal finding of Captopril study, the findings were, grade-1 in 06(20%), grade-2 in 05(17%) and grade -3 in 01(3%) cases. After assessing time activity curve, glomerular filtration and renal split function the probability assessment of renal arterial stenosis (RAS) among the abnormal Captopril studies (n=12) were determined and the high probability for RAS was found in 05 (42%), indeterminate in 03(25%) and low probability in 04(33%) cases.Conclusion: Captopril renography is a sensitive test for detection of RVH in patients in whom the renal function is as yet unimpaired. Even though our study is severely limited by the lack of confirmatory renal angiogram data, yet we can conclude that captopril renogram by itself is of considerable value since it can predict the functional significance of the stenosis. Therefore we conclude that captopril renography can add value to the diagnosis of RVH and should remain a method of choice even in this era of Doppler Ultrasound.Bangladesh J. Nuclear Med. 18(2): 131-134, July 2015