Official journal of Society of Nuclear Medicine, Bangladesh
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Correlation of Myocardial Ischemia Assessed by Myocardial Perfusion Imaging with High Sensitivity C - Reactive Protein in Patients with Stable Ischemic Heart Disease
Atherosclerosis and plaque formation are driven by inflammation, with high sensitivity C – reactive protein (hs-CRP) serving as a key biomarker of this process and a predictor of coronary heart disease risk. Ischemia occurs when atherosclerotic narrowing limits blood flow, and single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) plays a crucial role in detecting perfusion defects. MPI can distinguish viable from scarred tissue and link the functional impact of atherosclerosis to inflammatory activity in patients with stable ischemic heart disease (SIHD). The study was conducted at the National Institute of Nuclear Medicine & Allied Sciences (NINMAS) between February 2024 to July 2025 with the objective to analyze the correlation between hs-CRP levels and MPI in patients with SIHD. A total of 50 patients with SIHD were selected for SPECT MPI through a single-day stress–(pharmacological) rest protocol. Serum hs-CRP level was measured within one week of SPECT MPI by nephelometry method. The mean age of the participants was 55.2 ± 9.9 years, with a male predominance (76.0%). Hypertension (76.0%) and Diabetes Mellitus (62.0%) were the most common associated risk factors. The mean SSS, SRS, and SDS were 12.4 ± 8.1, 6.5 ± 6.0, and 6.4 ± 2.4, respectively, indicating moderate to severe ischemia. Elevated hs-CRP (>3 mg/L) was found in 38.0% of cases. hs-CRP showed strong positive correlations with SSS (r = 0.657, p < 0.001) and SDS (r = 0.528, p < 0.001), and a moderate positive correlation with SRS (r = 0.479, p < 0.001). These findings indicate that higher hs-CRP levels were closely linked to increased ischemic burden and reduced myocardial function. Therefore, combined assessment of hs-CRP and MPI may improve risk stratification in stable ischemic heart disease. Bangladesh J. Nuclear Med. 28(2): 233-240, July 2025
Copyright (c) 2025 Bangladesh Journal of Nuclear Medicine
Relative Perfusion and Glomerular Filtration Rate: Integrating Doppler and Scintigraphy Findings in Renal Evaluation
Various imaging tools are utilized for the quantitative assessment of renal function in clinical practice. Integration of Doppler ultrasonography and renal scintigraphy might be invaluable for different aspects of renal evaluation. However, the relationship between these modalities remains incompletely defined. In this prospective observational study, multiple linear regression analyses were performed to evaluate the predictive value of Doppler parameters and scintigraphy derived estimations in both kidneys. For the right kidney, glomerular filtration rate was significantly predicted by resistive index (β = –0.448, p = 0.036) and relative perfusion (β = 0.535, p = 0.001), with an overall model fit of R² = 0.533 (p = 0.001). For the left kidney, glomerular filtration rate was strongly predicted by relative perfusion (β = 0.787, p < 0.001), with an overall model fit of R² = 0.700 (p < 0.001). In conclusion, Doppler indices alone do not reliably predict renal perfusion, underscoring the complementary rather than interchangeable role of Doppler and scintigraphy. Integrated use of both modalities enhances renal functional assessment and may improve diagnostic accuracy in patients with suspected renal impairment. Bangladesh J. Nuclear Med. 28(2): 241-246, July 2025
Radiopharmaceutical Fractionation as a Crisis Management Strategy: Experience with 99mTc-DTPA
Imaging with ⁹⁹ᵐTc-DTPA is a standard technique for assessing renal function. A single vial of DTPA cold kit contains sufficient amount of ligand for multiple dose preparation. This study was conducted to optimize kit utilization during a nationwide supply shortage by adapting kit fractionation approach. In this study a full vial of DTPA kit was aseptically divided into three aliquots using 0.9% and preserved at 4°C. Then the fraction was used over multiple days, with each fraction radiolabeled using freshly eluted ⁹⁹ᵐTc. Radiochemical purity (RCP) was assessed by ITLC-SG and consistently remained ≥ 95% in all fractions. The average of % RCP of DTPA fractions 96.77%. All clinical studies produced satisfactory image quality without the need for repeat imaging. This approach of kit fractionation led to reduced kit consumption, minimized waste, and improved operational efficiency. Additionally, this method can be considered as annual cost reduction method. Bangladesh J. Nuclear Med. 28(2): 247-250, July 2025
A Skeletal Symmetry Index for Patient Derived Quantitative Quality Control in 99mTc-MDP Bone Scintigraphy
Introduction: This study utilizes the Skeletal Symmetry Index (SSI) to quantify bilateral uptake uniformity of 99mTc-MDP bone scintigraphy images, aiming to compare calculated values with previously published reference limits to differentiate physiological variation. Method: Bone scintigraphy data of 35 adult patients were analyzed retrospectively across five anatomical regions: skull, humerus, rib, iliac crest, and femur. Bilateral asymmetry was quantified using the mentioned SSI formula. Standard statistical analysis was performed to analyze and correlate the regional count data. Results: High degrees of bilateral symmetry were observed across all skeletal sites. The calculated SSI values (median) ranged from 2.12% (skull) to 7.28% (humerus). Spearman’s correlation showed exceptionally strong symmetry. Most of the regions showed random count variation, but the regional count of ribs exhibited a statistically significant right-sided prevalence in the Wilcoxon signed-ranks test, likely due to hepatic activity. All measured indices remain well below the 10% clinical threshold for pathological asymmetry. Conclusion: SSI confirms high skeletal symmetry that is well below previously published limits and serves as a practical tool for routine image quality control Bangladesh J. Nuclear Med. 28(2): 251-256, July 2025
Comprehensive Radiation Dose Monitoring and Shielding Effectiveness Assessment in the Nuclear Medicine Hot Lab of INMAS, Pabna: Six Months Observation
Background: Radiation protection in nuclear medicine hot lab is essential to minimize occupational exposure during handling of radiopharmaceuticals. Continuous monitoring of dose rates and evaluation of shielding effectiveness are necessary to maintain safe working environments. Methods: A six-month observational study was conducted in the nuclear medicine hot lab at Institute of Nuclear Medicine and Allied Sciences (INMAS) Pabna. Monthly average dose rate measurements over six months and day-wise measurements during generator elution were recorded using a calibrated survey meter at 24-hour intervals across multiple locations including the fume hood (FH) surface, radial distances from the hood (0.15 m–1 m), inner and outer door surfaces of FH, post-dose handling area and corridor outside the hot lab. Dose attenuation and shielding effectiveness were analysed. Each location was selected to assess both high-risk zones and peripheral areas. Data were recorded in micro-Sieverts per hour (μSv/h). Results: The highest monthly mean dose rate was observed at the fume hood surface (37.85 ± 1.29 μSv/h), while the lowest value was recorded in the corridor (0.29 ± 0.01 μSv/h). Dose rate decreased progressively with increasing distance from the source and a strong negative correlation (r = -0.96) was observed between distance and dose rate. The shielding was corrected using a consistent half-value layer (HVL) approach for 99mTc gamma photons. Based on the measured fume hood surface dose rates, approximately 1.27 mm lead is required to reduce the monthly mean dose rate to 2.0 μSv/h and about 1.34 mm lead is required to reduce the peak elution dose rate to the same target. Conclusions: The results demonstrate effective radiation attenuation with distance and confirm that existing shielding and operational protocols maintain radiation exposure within acceptable safety limits. However, localized shielding enhancements near the fume hood may further improve radiation protection. Bangladesh J. Nuclear Med. 28(2): 257-262, July 2025
Impact of Reagent Lot-to-Lot Variation on Internal Quality Control Results in Thyroid Hormone Analysis: A Retrospective Laboratory Study
Background: Reagent lot-to-lot variation is a recognized source of analytical variability in immunoassays. The magnitude and clinical relevance of this phenomenon are underexplored in routine laboratory practice. Methods: This retrospective study analyzed internal quality control data for FT3, FT4, and TSH over a period of 12 months. Bias resulting from reagent lot shift was calculated by comparing mean QC values between shifting reagent lots. Both directional and absolute bias were calculated. Results: The mean bias was 1.05% for FT3, 1.20% for FT4, and 0.83% for TSH. Despite low mean bias, substantial variability was observed, with mean absolute bias ranging from 5.08% to 6.01%. TSH demonstrated the highest maximum bias (15.06%). No consistent concentration-dependent pattern was observed across QC levels. Conclusion: Reagent lot transitions introduced non-directional random variability in thyroid hormone analysis. The variability was often large enough to be clinically significant. These findings highlight the need for robust lot verification protocols to ensure analytical consistency and accurate clinical interpretation. Bangladesh J. Nuclear Med. 28(2): 263-269, July 2025
Copyright (c) 2026 Bangladesh Journal of Nuclear Medicine
Evaluation of Beam Profiles between Physical and Enhanced Dynamic Wedges
Background: The purpose of the work is to find out the beam profiles using physical and enhanced wedges of different angles, different field sizes, and different energies and to compare them. Materials and Methods: The study was conducted using the Varian Clinac iX LINAC with different photon energies—6 MV and 15 MV. The slab phantom is arranged at a fixed depth (10 cm depth) above the IBA MatriXX device, which consists of 1020 vented ion chamber 2D array detectors arranged in a 32 × 32 grid. The physical and enhanced dynamic wedges at different angles (15°, 30°, 45°, and 60°) were examined for the field sizes 5x5 cm², 10x10 cm², 10x115×15 cm² by delivering 50 monitoring units (MU). Result: In comparison of beam profiles (without rescaling) of PW and DW obtained from 2D array measurement, it was found that there was a difference, but the gradient of curves is almost the same except for some points in the toe, heel, and penumbral region, which is negligible. From the beam profiles, it was understood that a. The difference between PW and DW increased with the increase of wedge angle while field size and energy were fixed. b. The difference between PW and DW increased with increasing field sizes while energy and wedge angle were fixed. c. The difference between PW and DW increased with increasing energy while field size and wedge angle were fixed. Conclusion: Based on the results of our study, it can be concluded that the Universal detector 2D array (matrix) can be used effectively to obtain the dosimetric characteristics of both EDW and physical wedges. Bangladesh J. Nuclear Med. 28(2): 270-274, July 2025
Association Between Vitamin D Status and Peripheral Thyroid Hormone Activation: Insights from FT3/FT4 Ratio Analysis
Background: Vitamin D deficiency has been increasingly recognized as a potential factor influencing endocrine regulation beyond calcium metabolism. However, its relationship with peripheral thyroid hormone activation remains insufficiently clarified, particularly in populations with high rates of thyroid dysfunction. Objective: This study aimed to evaluate the association between serum 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), and the FT3/FT4 ratio as an indicator of peripheral thyroid hormone conversion. Methods: A retrospective cross-sectional study was conducted at the in-vitro division of Institute of Nuclear Medicine and Allied Sciences (INMAS), Mohakhali, Dhaka. A total of 138 participants were included. Serum levels of TSH, Free triiodothyronine (FT3), Free thyroxine (FT4), 25(OH)D, PTH, and calcium were measured using chemiluminescence immunoassay (CLIA). Due to non-normal distribution, TSH values were log-transformed prior to analysis. Correlations were assessed using Pearson’s coefficient, and linear regression was performed to determine explanatory power. Results: The study population demonstrated marked thyroid dysfunction and widespread vitamin D deficiency. Serum 25(OH)D levels showed a strong positive correlation with the FT3/FT4 ratio (r = +0.69, p < 0.001). Log-transformed TSH exhibited a significant inverse correlation with the FT3/FT4 ratio (r = −0.64, p < 0.001), explaining 40.5% of its variability. Intact PTH showed a weaker but statistically significant inverse association with the FT3/FT4 ratio (r = −0.23, p = 0.027), accounting for 5.5% of the variation. Conclusion: Higher vitamin D levels are linked to enhanced peripheral thyroid hormone conversion, while greater stimulation of the thyroid axis correlates with a decreased FT3/FT4 ratio. Vitamin D status shows a stronger relationship with thyroid hormone activation compared to PTH. These results suggest the importance of vitamin D in thyroid hormone metabolism and its potential role in endocrine evaluation, indicating the need for further prospective studies to explore the mechanisms involved. Bangladesh J. Nuclear Med. 28(2): 275-281, July 2025
Data Archiving of Genome Sequencing and Medical Records of Radioiodine-Treated Differentiated Thyroid Carcinoma Patients at NINMAS since 1980: A Continuing Initiative
Differentiated thyroid carcinoma (DTC) is among the most prevalent endocrine malignancies, with a rising global incidence. Since 1980, the Thyroid Division of the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Bangladesh Atomic Energy Commission (BAEC), has been treating DTC patients with Radioactive Iodine Therapy (RAIT) following thyroidectomy and maintaining lifelong follow-up. To date, over 9,000 patients have received RAIT, generating a vast volume of medical records that have been preserved exclusively as hardcopies, creating significant space and retrieval challenges. This project aims to digitally archive both medical records and BRAF mutation genomic sequencing data of all radioiodine-treated DTC patients, encompassing records from 1980 to the present. Approximately 4,000 patient records have been digitized so far, using dedicated software, specialized hardware, and individual patient ID systems. Among them, 15 high-risk patients underwent BRAF gene sequencing, of which 10 tested positive. Digital archiving has demonstrably improved clinical efficiency, enabling faster data retrieval, better longitudinal patient management, and a robust foundation for future oncological research. Continuation of this initiative will ensure comprehensive registration of all remaining DTC patients. Bangladesh J. Nuclear Med. 28(2): 241-246, July 2025
Five years of Institutional Experience in the Evaluation and Management of Papillary Thyroid Microcarcinoma: Insights from the NINMAS
Papillary thyroid microcarcinoma (PTMC) is defined by the World Health Organization as a papillary thyroid carcinoma (PTC) with the greatest dimensions ≤1.0 cm. Its incidence is increasing along with the rise of PTC. The purpose of this study was to observe the five-year clinical outcome of PTMC patients who were referred to the Thyroid Division, National Institute of Nuclear Medicine & Allied Sciences (NINMAS) after total thyroidectomy and followed up without radioactive iodine ablation therapy (RAIT). The record files of registered PTMC patients between January 2017 and December 2020 were retrospectively analyzed, and the overall outcome was evaluated. A total of 95 patients (M: F = 3:16), with a mean age of 43 ± 14.14 years, were included in the study. Initial mean thyroglobulin (Tg) was 12.3±0.57 ng/dl, while mean Tg in the last follow-up was 1.72±0.23 ng/dl. Most of the patients (96.84%) had an uneventful follow-up period. But three (3.16%) patients had shown recurrence and underwent revision neck surgery followed by radioiodine ablation. In these patients with recurrence, initial average Tg was 35.02 ng/dl, and last follow-up Tg was 0.20 ng/dl after RAIT. Histopathology of recurrent tissue in the thyroid bed and lymph nodes confirmed PTC. The results of this study reaffirm that papillary microcarcinoma has an excellent prognosis if managed initially by total thyroidectomy. However, appropriate counselling and patient awareness are required considering the small recurrence rate evaluated by this study. Bangladesh J. Nuclear Med. 28(2): 289-292, July 2025
Geographic distribution of thyroid carcinoma in different districts of Bangladesh- Single Center Experience
Introduction: Thyroid carcinoma is one of the predominant endocrine malignancies. There are limited studies worldwide regarding the distribution of thyroid carcinoma in different areas of a country. Objective: The study was aimed at evaluating the distribution of thyroid carcinoma in different districts of Bangladesh. Materials and Methods: This was a retrospective observational study that included 100 thyroid carcinoma patients who came to INMAS, Dhaka, for radioiodine ablation after total thyroidectomy. The study period was from January 2022 to May 2022. Patients were selected according to the inclusion and exclusion criteria. Results: Out of a total of 100 patients, 72 patients were female and 28 patients were male. The age range was 15-63 years, with the mean age being 37 ± 8.4 years. There are a total of 8 divisions in Bangladesh: Dhaka, Chattogram, Barisal, Khulna, Rajshahi, Rangpur, Mymensingh, and Sylhet. Out of a total of 100 patients, Chattogram division had 42 patients, Dhaka division had 26 patients, Barisal division had 10 patients, Khulna division had 9 patients, Rajshahi division had 3 patients, Rangpur division had 3 patients, Mymensingh division had 5 patients, and Sylhet division had 2 patients. Out of a total of 42 patients in the Chattogram division, Brahmanbaria had 16 patients (the highest among all districts of Bangladesh); Comilla had 12 patients; Noakhali had 6 patients; Chadpur, Feni, and Lakshmipur each had 2 patients; and Chattogram & Cox’s Bazar each had 1 patient. Conclusion: Thyroid carcinoma was predominant in the Chattogram division, and among all districts of Bangladesh, Brahmanbaria was highest and next highest was the Comilla district. However, further large-scale and multicenter studies are needed to find out more specific distribution and Bangladesh J. Nuclear Med. 28(2): 293-297, July 2025
Unseen Battles: Pre-Treatment Anxiety Among Patients with Thyroid Carcinoma
Background: When diagnosed with cancer, patients often experience significant psychological stress and fear of death. Thyroid carcinoma, although more treatable, carries similar stigma, leading to acute mental stress for those affected. Patients scheduled for therapy frequently endure considerable pre-treatment anxiety about prognosis and treatment outcomes. This study aims to assess anxiety disorders in thyroid carcinoma patients before they undergo radioiodine therapy. Materials and Methods: This observational study was conducted at the Institute of Nuclear Medicine and Allied Sciences-INMAS, Mitford between January 2024 and June 2025 on 150 patients referred for radioiodine therapy (M= 56, F= 94). Participants received doses of 100 mCi, 150 mCi, or 200 mCi based on clinical indications. Anxiety levels were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) scale, with data analyzed using SPSS and significance determined via Chi-square test. Results: The 64 patients receiving radioiodine therapy indicated varying levels of anxiety: 76.6% at 100 mCi showed minimal anxiety, while 17.2% had mild anxiety, 4.7% moderate, and 1.6% severe. For those at 150 mCi, 74.2% had minimal anxiety, 14.5% mild, 8.1% moderate, and 3.2% marked anxiety. Among 24 patients receiving 200 mCi, 62.5% exhibited minimal anxiety, 16.7% mild, 8.3% moderate, and 12.5% severe. Chi-square test results were insignificant (P > 0.05). Conclusion: Pre-treatment anxiety is common in thyroid carcinoma patients, regardless of gender. It underscores the necessity of regular psychological evaluations and psychosocial support prior to radioiodine therapy, suggesting that addressing mental health alongside physical treatment can enhance patient outcomes and quality of life. Bangladesh J. Nuclear Med. 28(2): 298-302, July 2025
Outcome of Differentiated Thyroid Carcinoma Patients After 5 Years of Radioiodine Ablation at INMAS, Rajshahi
Introduction: Radioactive iodine (RAI) ablation is a well-established treatment modality for differentiated thyroid carcinoma (DTC). The Institute of Nuclear Medicine and Allied Sciences (INMAS), Rajshahi, has been providing RAI therapy for several years, and its management protocol was upgraded in 2015 by the Society of Nuclear Medicine Bangladesh. The objectives of this study were to assess the long-term outcome of RAI ablation in patients with DTC, evaluate therapeutic response in iodine-avid metastases, and determine the disease-free status of patients after treatment. Materials and Methods: This retrospective study included 257 patients diagnosed with DTC who received RAI ablation between January 2015 and December 2017 at INMAS, Rajshahi. All patients had previous surgical treatment. Based on risk stratification, low-risk patients received 30–100 mCi of iodine-131, while intermediate and high-risk patients received doses greater than 100–200 mCi. Follow-up assessment included diagnostic whole-body scintigraphy, serum thyroglobulin (Tg), anti-thyroglobulin antibody (anti-Tg Ab), and high-resolution ultrasound (HRUS) of the neck. Treatment response was categorized as complete response (CR) or persistent disease (PD). Results: Among the 257 patients, 89 (34.63%) were male and 168 (65.37%) were female. Five patients were lost to follow-up. Papillary carcinoma accounted for 235 cases (93.25%) while follicular carcinoma accounted for 17 cases (6.74%). After one year, 231 patients (89.68%) were disease-free based on negative imaging and biochemical markers. Twenty-one patients required additional evaluation or therapy due to residual tissue or metastases. After an average follow-up of five years, complete response was observed in 239 patients (94.84%) while persistent disease or recurrence occurred in 13 patients (5.16%). Conclusion: RAI ablation is highly effective for achieving disease control in patients with DTC, particularly in iodine-avid locoregional disease. However, patients with iodine non-avid metastases show limited response and require alternative therapeutic strategies. Bangladesh J. Nuclear Med. 28(2): 303-308, July 2025
TIRADS Score and Strain Ratio in Elastography to Predict Malignant Thyroid Nodule and Correlation with Histopathology
Thyroid nodules are a common clinical finding, and accurate differentiation between benign and malignant nodules is essential for appropriate clinical management. This study aimed to evaluate the diagnostic value of the Thyroid Imaging Reporting and Data System (TIRADS) and elastography strain ratio in predicting malignant thyroid nodules and to correlate the findings with histopathology. This study was conducted from 2023 to 2024 and included 30 patients with thyroid nodules referred for ultrasound TIRADS assessment and elastography. Nodules were categorized according to the TIRADS classification system (TIRADS 1–5), and real-time strain ratio (SR) was measured using elastography to assess tissue stiffness. The final diagnosis was confirmed by histopathology following near-total thyroidectomy. The mean age of the patients was 34.1 ± 9.54 years (range 18–55 years), with 80% females. TIRADS demonstrated a sensitivity of 33.33%, a specificity of 93.33%, and an overall accuracy of 63.33%. Elastography strain ratio showed higher diagnostic performance with a sensitivity of 80.00%, a specificity of 93.33%, and an accuracy of 86.67%. Elastography strain ratio appears to be a more reliable method than TIRADS alone for detecting malignant thyroid nodules and may improve diagnostic accuracy in clinical practice. Bangladesh J. Nuclear Med. 28(2): 309-313, July 2025
Spine–Hip BMD Discordance and Age-Dependent Divergence Between T-Scores and Z-Scores at DXA: A Cross-Sectional Study
Background: Spine–hip bone mineral density (BMD) discordance complicates dual-energy X-ray absorptiometry (DXA) interpretation and may affect osteoporosis classification. This study assessed the prevalence of spine–hip discordance and the age-dependent divergence between T-scores and Z-scores. Methods: This cross-sectional study included 292 apparently healthy individuals who underwent DXA. BMD, T-scores, and Z-scores were analyzed at the lumbar spine, left femur, and right femur. Spine–hip discordance was defined as an absolute difference of at least 1.0 SD between the lumbar spine T-score and either femoral T-score and was categorized as minor (1.0 to <2.0 SD) or major (≥2.0 SD). The T–Z gap was defined as T-score minus Z-score. Inter-site differences were assessed using repeated-measures ANOVA, and associations between age and T–Z gap were evaluated using Pearson correlation. Results: Participants were predominantly female (84.9%). The lumbar spine showed the lowest score profile, with mean T-scores of −1.36 ± 1.64 at the lumbar spine, −0.08 ± 1.16 at the left femur, and −0.17 ± 1.27 at the right femur. Corresponding mean Z-scores were −0.19 ± 1.62, 0.57 ± 1.10, and 0.48 ± 1.20, respectively (all inter-site comparisons, p < 0.001). Overall, 73.3% of subjects demonstrated spine–hip discordance, including 41.1% with minor and 32.2% with major discordance. Age was strongly negatively correlated with the T–Z gap at all sites (r = −0.892, −0.886, and −0.888; all p < 0.001). Osteoporosis prevalence increased from 3.1% by hip-only classification to 29.1% by worst-site classification. Conclusion: Spine–hip discordance is highly prevalent, predominantly spine-driven, and associated with substantial age-related T/Z divergence and diagnostic reclassification. Bangladesh J. Nuclear Med. 28(2): 314-320, July 2025
Assessment of Serum Vitamin D, Serum Calcium and Bone Mineral Density in Juvenile Idiopathic Arthritis Patients of Bangladesh
Objective: To assess the serum concentrations of vitamin D and calcium and bone mineral density (BMD) in patients with juvenile idiopathic arthritis (JIA) and to compare them with those of healthy children. Patients & Methods: A total of 75 JIA children were evaluated and compared to healthy individuals matched for age and sex in this cross-sectional case-control study. Laboratory evaluations included serum calcium and 25-hydroxyvitamin D. The normal range of serum calcium was 9-11 mg/dl; vitamin D was classified as normal (>32 ng/ml), insufficient (20-32 ng/ml), and deficient (<20 ng/ml). BMD was assessed by dual-energy X-ray absorptiometry (DXA) of the lumbar spine and both femur necks. BMD (in g/cm²) was expressed in Z score, the number of standard deviations above or below the mean value of an age- and sex-matched reference population. In children, low bone mass was defined as a Z-score equal or less than minus 2 (-2). Results: The mean vitamin D level in both cases and controls was low, which was 18.66 ± 10.22 and 21.3 ± 4.07, respectively. Vitamin D deficiency and insufficiency in JIA patients were 69.3% and 21.3%, respectively. The mean concentration of serum calcium of cases was 9.46±0.46 mg/dl. Low bone mass in JIA patients’ lumbar, right femur, and left femur was found in 97.3%, 69.3%, and 70.7%, respectively (p < 0.001, 0.023, 0.016). All types of JIA had low bone mass in lumbar vertebrae. BMD Z-scores in the right and left femoral necks showed a significant correlation with types of JIA (p=0.007 and 0.035, respectively). There was no significant association between disease duration and vitamin D or BMD at any sites in our study. Conclusion: The study indicated that hypovitaminosis D and low bone mass are common in JIA patients and healthy controls in Bangladesh. It highlights the need to enhance dietary intake of calcium and vitamin D, along with promoting physical activities and sunlight exposure for JIA patients. Bangladesh J. Nuclear Med. 28(2): 321-328, July 2025
Diagnostic Accuracy of [99mTc] Pertechnetate Scintigraphy Among Patients with Suspected Meckel's Diverticulum – One-Year Experience in NINMAS
Background: The reported accuracy of pertechnetate scintigraphy (Meckel scan) for evaluating children with Meckel's diverticulum has steadily increased since its introduction into clinical practice in 1970. In our study, we retrospectively analyze the accuracy of Tc-99 m pertechnetate scintigraphy in NINMAS over 01 year. Objective: This study aimed to evaluate the accuracy of pertechnetate scintigraphy performed at the National Institute of Nuclear Medicine & Allied Sciences (NINMAS) in pediatric patients with suspected Meckel's Diverticulum. Methods: A retrospective study was conducted of 60 pediatric patients who presented with symptoms suggestive of MD and underwent 99mTc-pertechnetate scintigraphy at NINMAS over a 1-year period. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated by comparing scintigraphic results with surgical and histopathological findings. Result: Six patients were diagnosed with MD on 99mTc-pertechnetate scintigraphy, all confirmed histopathologically as true positives. Among 54 patients with negative scans, one was a false negative, and 53 were confirmed as true negatives through clinical, imaging, endoscopic, and laparoscopic evaluation. Accordingly, 99mTc-pertechnetate scintigraphy showed a sensitivity of 85.7% (6/7), specificity of 100.0% (53/53), positive predictive value of 100.0% (6/6), negative predictive value of 98.1% (53/54), and overall diagnostic accuracy of 98.3% (59/60) for MD. Receiver operating characteristic analysis revealed an area under the curve of 0.929 (standard error, 0.079; p < 0.001; 95% confidence interval, 0.775–1.082), indicating excellent diagnostic performance. Conclusion: We find that Meckel scanning is a non-invasive procedure with low radiation exposure. It is a highly specific and accurate method for diagnosing MD in pediatric patients. Bangladesh J. Nuclear Med. 28(2): 329-335, July 2025
Abnormal Brain Perfusion in Autism Spectrum Disorder: Evidence from Radionuclide SPECT Imaging
Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with increasing prevalence worldwide. Identifying cerebral perfusion abnormalities may provide objective biomarkers for diagnosis and therapeutic monitoring. Objective: To evaluate regional cerebral blood flow (rCBF) abnormalities in children with ASD using Tc-99m ECD Brain SPECT and assess their correlation with clinical severity. Methods: A cross-sectional study was conducted at the National Institute of Nuclear Medicine & Allied Sciences (NINMAS), Dhaka. A total of 34 children (3–12 years) with clinically confirmed ASD were included. Participants underwent 99m Tc- ECD Brain SPECT, and perfusion abnormalities were analyzed using Z-scores. Severity was classified according to Autism Diagnostic Checklist (ADCL) scores. Statistical analysis was performed using SPSS v26, with p ≤ 0.05 considered significant. Results: Hypoperfusion was observed across multiple cortical regions. In mild ASD, hypoperfusion occurred in the frontal (100%), temporal (80%), and parietal (70%) cortices. Low-moderate ASD demonstrated widespread perfusion deficits, particularly in frontal (100%) and temporal (90%) regions. High-moderate ASD cases exhibited marked hypoperfusion in parietal (100%) and frontal (85%) regions. Symptom analysis revealed strong associations: speech delay (93%) correlated with frontal (98%) and temporal (88%) hypoperfusion; hyperactivity (68%) with frontal (100%) and temporal (85%) hypoperfusion; and cognitive dysfunction with frontal and parietal hypoperfusion. ADCL scores positively correlated with Z-scores (ρ = 0.609, p = 0.002). High-moderate ASD cases showed significantly elevated Z-scores compared to mild and low-moderate groups (p < 0.05). Conclusion: Abnormal cerebral perfusion, particularly hypoperfusion in the frontal, temporal, and parietal cortices, is strongly associated with ASD severity and core clinical symptoms. Tc-99m ECD Brain SPECT may serve as a valuable adjunctive tool for early diagnosis, severity stratification, and therapeutic monitoring in ASD. Bangladesh J. Nuclear Med. 28(2): 336-343, July 2025
Enhanced Localization of Recurrent Parathyroid Carcinoma Using 99mTc-MIBI SPECT/CT: A Case Report
Parathyroid carcinoma (PC) is a rare endocrine malignancy, representing less than 1% of primary hyperparathyroidism cases. Its management is particularly challenging due to the high incidence of local recurrence. Detailed mapping of tumor location requires imaging modalities. Hybrid imaging SPECT/CT is widely regarded as the preferred imaging technique for localizing both primary and recurrent parathyroid tumors prior to surgical intervention. Here, we report the case of a 24 year old male with hyperparathyroidism due to recurrent parathyroid carcinoma. Patient had history of radical neck surgery four times. Each time, preoperative localization of the recurrent mass was successfully achieved using 99mTc-MIBI SPECT/CT. Bangladesh J. Nuclear Med. 28(2): 359-363, July 2025
Incidental Meningioma Identified on Tc-99m Sestamibi Parathyroid Imaging: A Case Report
Meningiomas are the most common intracranial tumors and frequently observed in older adults with a high prevalence in females. This report presents the case of a 71-year-old woman with known diabetes mellitus, hypertension, ischemic heart disease and history of tuberculosis, who was under evaluation for mildly raised parathyroid hormone level. She was eventually referred for a 99m Tc- Sestamibi SPECT parathyroid scan—in which a meningioma was incidentally detected. Bangladesh J. Nuclear Med. 28(2): 364-367, July 2025
Autoimmune Switch of Hashimoto’s thyroiditis to Graves’ Disease: A Rare Case Report
Hashimoto’s thyroiditis and Graves’ disease (GD) represent two ends of the autoimmune thyroid disease spectrum. While progression from GD to Hashimoto’s thyroiditis is relatively common, the reverse transition is rare. We report a case of a 47-year-old woman with long-standing Hashimoto’s thyroiditis and positive anti-thyroid peroxidase antibodies who remained euthyroid on levothyroxine for 10 years. Later, she developed symptoms of thyrotoxicosis, including palpitations, exertional dyspnea, and rapid, unintentional significant weight loss. The reported case demonstrated that the formation of thyroid-stimulating autoantibodies can cause an immunological transition from hypothyroidism to hyperthyroidism, however this is rare. Bangladesh J. Nuclear Med. 28(2): 368-370, 2025
Hepatic Metastasis as an Unusual Manifestation of Papillary Thyroid Carcinoma: A Rare Case Report
Papillary thyroid carcinoma (PTC) is typically an indolent malignancy with a favorable prognosis, and distant metastases are uncommon, most frequently involving the lungs and bones. Hepatic metastasis from PTC is exceedingly rare and may present diagnostic and therapeutic challenges. We report a case of papillary thyroid carcinoma with hepatic and lymph node metastasis (LNM), highlighting its unusual presentation, diagnostic workup, and management approach in a 68-year-old woman with PTC with LNM further developed hepatic metastasis that was of thyroid origin, which was proven cytologically. Bangladesh J. Nuclear Med. 28(2): 371-373, 2025
Thyroid Dyshormonogenesis Presenting with Clinical Hypothyroidism Despite Biochemical Euthyroidism: A Case Report
Thyroid dyshormonogenesis is an uncommon cause of congenital hypothyroidism resulting from inherited defects in thyroid hormone synthesis. Although most patients present with biochemical hypothyroidism, atypical presentations may occur. This report describes a case of thyroid dyshormonogenesis presenting clinical features of hypothyroidism despite normal thyroid function tests, emphasizing the need for further investigations. A 15-year-old boy presented with neck swelling and clinical features suggestive of hypothyroidism, but biochemical euthyroidism. Ultrasonography showed an enlarged heterogeneous thyroid gland with cystic nodules in both lobes. A 99mTc-pertechnetate thyroid scan demonstrated nonhomogeneous tracer concentration with diffuse thyroid enlargement. Radioiodine uptake testing followed by a perchlorate discharge test confirmed a defect in iodide organification consistent with thyroid dyshormonogenesis. The patient was subsequently referred to levothyroxine therapy and follow up. This case highlights an unusual clinicobiochemical discordance in thyroid dyshormonogenesis, where clinical manifestations of hypothyroidism may occur despite biochemical euthyroidism. Bangladesh J. Nuclear Med. 28(2): 374-378, 2025
The Thyroglobulin paradox; An enigmatic case report of thyroid carcinoma with skeletal metastasis
Thyroglobulin (Tg) is frequently measured in follow-up of patients with differentiated thyroid carcinoma after total thyroidectomy and radioiodine therapy. A low stimulated Tg level (<1 ng/ml) associated with normal neck ultrasonography is considered as the most reliable criteria for complete remission in low-risk patients. We are reporting a case of middle-aged man with thyroid cancer and diffuse skeletal metastasis associated with low serum Tg level bringing a point of caution in evaluation of patients with low Thyroglobulin. Bangladesh J. Nuclear Med. 28(2): 379-384, 2025
Improving Specificity of Bone Scintigraphy: SPECT/CT Evaluation of Degenerative Spinal Uptake in 99mTc-MDP Bone Scintigraphy Mimicking Metastases
Bone scintigraphy is highly sensitive for detecting skeletal lesions. However, it is still difficult to differentiate metastases from degenerative bone disease, especially in older cancer patients. Here, two cases are presented with chronic back pain in the background of history of cancer in which whole-body bone scans showed focal “hot spots” suspicious for metastasis. Hybrid SPECT/CT imaging clarified that these findings consistent with degenerative disease. This distinction significantly altered clinical management, avoiding unnecessary investigations and further oncologic treatment. These cases highlight the critical role of SPECT/CT in enhancing diagnostic specificity and guiding appropriate patient care. Bangladesh J. Nuclear Med. 28(2): 385-389, 2025
Utility of Bone Scintigraphy for Detection of Primary Malignant Mesenchymal Tumor: A Case Report
Primary malignant mesenchymal tumors are heterogenous group of tumors arising from bone, cartilage and other connective tissues. The aggressive nature of these tumors requires prompt diagnosis and multidisciplinary approach for best possible outcome for the patients. Bone scintigraphy being an excellent modality to detect osteoblastic bone activity can help in early detection of primary bone tumors as well as staging, localizing of lesion and aiding in multidisciplinary management alongside other imaging facilities. The reported case demonstrates a 22-year-old male patient with pain and swelling in left hip and upper thigh for four months. Initial radiograph revealed a large expansile mixed lytic and sclerotic lesion of femur. However, bone scintigraphy precisely localized the lesion involving femoral head and proximal part, excluding any distant skeletal metastasis. Finally, histopathological findings confirmed the tumor to be a malignant one with mesenchymal origin, likely an Osteosarcoma. This case once again proves that nuclear medicine techniques including 99mTc -MDP Bone Scintigraphy has now become an integral part for diagnosing and staging of primary malignant mesenchymal tumors alongside conventional radiographs. Bangladesh J. Nuclear Med. 28(2): 390-393, 2025
Skeletal Metastatic Mimicry in Ovarian Cancer: A Case Report on the Diagnostic Challenges of Osteopetrosis and Metabolic Bone Disease
Ovarian carcinoma is a significant malignancy in women, frequently requiring comprehensive follow-up to detect metastasis. Skeletal involvement is often assessed via anatomical imaging like CT and MRI; however, these modalities can occasionally encounter "metastatic mimics." Reported case entails a 43-year-old woman with a history of ovarian cancer whose follow-up contrast enhanced CT (CECT) and magnetic resonance imaging (MRI) suggested widespread osteoblastic metastases. Subsequent functional imaging (bone scintigraphy) and laboratory investigations inclined toward metabolic bone disease rather than malignancy. A CT-guided core needle biopsy of the rib ultimately confirmed the absence of malignant cells, identifying the dense skeletal lesions as a combination of osteopetrosis and severe vitamin D deficiency (osteomalacia). This case highlights the necessity of multimodality imaging and histological confirmation to prevent the misdiagnosis of metastatic disease. Bangladesh J. Nuclear Med. 28(2): 394-398, 2025
Renographic Evaluation with 99mTc-DTPA in Bilateral Nephrolithiasis with Cystinuria: A Rare Case Report
Cystinuria is a rare inherited disorder leading to recurrent nephrolithiasis and potential renal impairment. This report presents the case of a 9-year-old female with elevated urinary cystine, with normal serum biochemical parameters. Ultrasound showed mild hydronephrosis due to bilateral staghorn calculi while intravenous urography demonstrated preserved excretory function. A 99mTc DTPA renogram revealed pelvicalyceal dilatation without obstruction and mild functional impairment of the left kidney, with normal right renal function. The patient underwent left open pyelolithotomy with DJ stent placement. This case highlights the importance of DTPA renogram in detecting early renal dysfunction, differentiating obstruction, and guiding management in pediatric cystinuria to preserve renal function. Bangladesh J. Nuclear Med. 28(2): 399-402, 2025
Capacity Enhancement of Nuclear Medicine Facilities: Renovation of Institute of Nuclear Medicine and Allied Sciences (INMAS), Rangpur
The increasing demand for diagnostic and therapeutic nuclear medicine services in northern Bangladesh necessitated the capacity enhancement and modernization of the Institute of Nuclear Medicine and Allied Sciences (INMAS), Rangpur. This technical case study presents a comprehensive overview of the renovation project aimed at upgrading infrastructure, improving workflow efficiency, and expanding clinical service capabilities. The renovation involved strategic redesign of facility layout, installation of advanced imaging equipment, enhancement of radiation safety measures, and optimization of patient management systems. Key interventions included the modernization of gamma camera and SPECT systems, the establishment of dedicated hot labs and radiopharmacy units, and improvements in shielding, ventilation, and waste management systems in compliance with international safety standards. A systematic methodology involving needs assessment, planning, implementation, and evaluation was adopted for the project, which highlighted human resource development through training for medical physicists and technologists. The upgraded facility allowed for advanced NM procedures and better patient accessibility, alongside improved radiation protection. This case study underscores the significance of integrated planning and regulatory adherence in facility upgrades, positioning INMAS Rangpur as a model for similar initiatives in resource-constrained environments. Bangladesh J. Nuclear Med. 28(2): 356-358, July 2025
The Utility of 18F-Fluorodeoxyglucose PET (FDG PET) in Epilepsy
Abstract not available Bangladesh J. Nuclear Med. 28(2): 349-355, July 2025
Genetic Landscape of Congenital Hypothyroidism in Bangladesh: Implications for Personalized Therapeutics
Congenital hypothyroidism (CH) is the most common neonatal endocrine disorder and a leading preventable cause of intellectual disability if not diagnosed and treated early. In Bangladesh, neonatal screening for CH was initiated in 1999 with support from the International Atomic Energy Agency using radioimmunoassay-based thyroid-stimulating hormone (TSH) measurement. Recent national data indicate an increasing incidence, highlighting the growing public health importance of CH in the country. This review explores the genetic landscape of CH in Bangladesh and its implications for diagnosis and personalized therapeutics. CH is genetically heterogeneous, broadly classified into thyroid dysgenesis and dyshormonogenesis. Mutations in genes such as TSHR, PAX8, NKX2-1, and FOXE1 are associated with thyroid dysgenesis, while defects in TPO, TG, DUOX2, and SLC5A5 underlie dyshormonogenesis. Available studies from Bangladesh, though limited, reveal a predominance of TPO gene mutations, indicating dyshormonogenesis as a significant contributor. Additional mutations in TSHR and NKX2.5 genes further highlight genetic diversity and complexity. Integrating genetic screening into neonatal CH programs in Bangladesh is essential for improving etiological diagnosis, enabling personalized treatment, and reducing healthcare burden. Strengthening national genomic research and screening strategies will be critical to advancing precision medicine in CH management. Bangladesh J. Nuclear Med. 28(2): 344-348, July 2025
Caring Thyroid Eyes: Preventing Blindness
Abstract not available Bangladesh J. Nuclear Med. 28(2): 231-232, July 2025