Official journal of Society of Nuclear Medicine, Bangladesh
All rights reserved to Editor-in-Chief, Bangladesh Journal of Nuclear Medicine, Society of Nuclear Medicine, Bangladesh
Abstract not available Bangladesh J. Nuclear Med. 28(1): 178-224, 2025
Copyright (c) 2025 Bangladesh Journal of Nuclear Medicine
Current Applications and Advancements of State-of-the-Art technology of PET-CT
Positron Emission Tomography-Computed Tomography (PET-CT) is an innovative hybrid imaging technique that effectively combines functional and anatomical imaging. This integration enhances the diagnosis and treatment of a wide range of diseases, proving to be particularly valuable in fields such as oncology, neurology, cardiology, and infectious disease management. By offering detailed insights into disease mechanisms, progression, and responses to therapy, PET-CT plays a crucial role in advancing patient care. The continued development of PET-CT incorporates cutting-edge techniques, including the use of novel radiotracers, hybrid imaging modalities, and artificial intelligence (AI)-based image analysis. This review aims to spotlight the technological advancements, emerging trends, application in research, clinical applications, and challenges associated with PET-CT while emphasizing its potential in personalized medicine and the ongoing integration of novel radiotracers and AI technologies. Despite certain limitations, PET-CT is a vital component of modern medical imaging, significantly contributing to the evolution of precision healthcare. Bangladesh J. Nuclear Med. 28(1): 149-155, 2025
Roadmap to Clinical Leadership in Nuclear Medicine: Potential Advantages and Theoretical Viewpoints
Abstract not available Bangladesh J. Nuclear Med. 28(1): 11-13, 2025
Breast Metastasis from Follicular Variant of Thyroid Carcinoma: A Delayed and Rare Complication
Thyroid carcinoma is typically indolent and has a favorable prognosis when compared to other types of cancer. In advanced stages of thyroid cancer, distant metastases are typically appearing in the lungs, bones, and lymph nodes. Thyroid cancer breast metastasis is extremely rare. A case of follicular variant of papillary thyroid carcinoma (FVPTC) has been reported in this context, which was manifested as low FDG avid soft tissue density lesions in breast in a whole body PET-CT scan 4 years after thyroidectomy for papillary thyroid carcinoma (PTC) in a 46-year-old woman. The lesions were suspected as metastatic, which were confirmed through histopathology. Bangladesh J. Nuclear Med. 28(1): 156-158, 2025
A Rare Case of Autoimmune Polyglandular Syndrome (APS) Type 3
Background: Autoimmune Polyglandular Syndrome Type 3 is a rare condition where patients are diagnosed with more than one autoimmune disease having similarity in pathogenesis. Antibody detection with various imaging modalities, including nuclear medicine techniques, is crucial to confirm the diseases. Case Report: A 61-year-old elderly postmenopausal woman presented with vitiligo, features of hypothyroidism and systemic lupus erythematosus (SLE). After proper clinical evaluation, the anti-TPO antibody report came out positive, and a cold nodule was found in thyroid scintigraphy, thus confirming the diagnosis of autoimmune thyroiditis. Conclusion: Autoimmune thyroiditis associated with vitiligo is more common in female individuals under APS Type 3, so screening is recommended for clinically manifested pathology. Bangladesh J. Nuclear Med. 28(1): 159-163, 2025
Advancing the Management of Anaplastic Thyroid Carcinoma: A Case Study of Multimodal Therapy and the Role of Emerging Nuclear Medicine Infrastructure in Bangladesh
Anaplastic thyroid carcinoma (ATC) is an aggressive and rare form of thyroid cancer, representing 1-2% of thyroid malignancies but accounting for the majority of thyroid cancer-related deaths due to its rapid progression, invasiveness, and resistance to standard therapies. This report highlights the case of a 60-year-old male histopathologically diagnosed with ATC stage IV as there were lymph node metastases. The patient was managed with a multidisciplinary team approach and had total thyroidectomy followed by systemic chemotherapy and three-dimensional conformal radiotherapy. The reported case highlights the importance of aggressive, integrated therapeutic approaches in managing ATC, emphasizing personalized, multidisciplinary care, advanced radiotherapy techniques, and molecular-targeted therapies for improved outcomes. Bangladesh J. Nuclear Med. 28(1): 164-169, 2025
Rare Report of a Familial Case of Lingual Ectopic Thyroid
Thyroid developmental defects lead to 85% cases of congenital hypothyroidism (CH). Among those, few (about 2%) cases are familial, having dominant genetic predisposition with low penetrance. A case of ectopic positioned lingual thyroid gland are reported in a little girl and her father, where a routine and simple nuclear medicine scintigraphy of thyroid gland using 99mTc-pertechnetate played a vital role. In vitro analysis of thyroid hormones and high resolution ultrasound of neck aided the diagnosis. Screening of the family members and relatives in such cases appear to be essential. Bangladesh J. Nuclear Med. 28(1): 170-173, 2025
18F PSMA-1007 and 18F FDG PET/CT in an Advanced Prostate Cancer Patient - A Case Report
Positron Emission Tomography (PET) is currently playing a crucial role in the assessment of prostate cancer. 68Ga/18F prostate-specific membrane antigen (PSMA), 11C Choline, and 18F Fluciclovine are the most commonly used non-FDG PET tracers. F-18 FDG PET is not routinely recommended in prostate cancer due to the low glycolytic nature of the prostate tumor cells. However, in advanced and aggressive cases, 18F FDG PET can detect lesions. Till September 2023, 18F-FDG was the only available PET tracer in our country to detect recurrence and non-osseous metastases. We reported a case of a 53-year-old male who underwent an 18F PSMA-1007 PET-CT scan for restaging in October 2023. The patient had a previous 18F FDG PET-CT scan in January 2023. FDG PET showed hypermetabolic cervical, mediastinal, and abdominal lymph nodes as well as multiple skeletal lesions. Patient received chemotherapy and anti-androgen therapy. However, after 10 months, patients PSA raised from 225 ng/ml to 616.5 ng/ml. In the PSMA scan, we found extensive nodal and skeletal involvements with progression of disease. In this case, an FDG-positive scan reflects the aggressiveness of the disease; however, extensive PSMA-avid lesions, including the positive lesions in FDG, indicate the patient could benefit from PSMA-based therapy. Bangladesh J. Nuclear Med. 28(1): 174-177, 2025
Metastatic Pattern in Triple Negative versus Triple Positive Invasive Ductal Carcinoma of Breast: Single Center Experience
Background: Breast carcinoma presents with various subtypes based on expression of hormone receptors for estrogen (ER) and progesterone (PR) and human epidermal growth factor receptor 2 (HER2) gene amplification. This study was planned to gain insight into metastatic behavior of two such immunohistochemical subcategories, namely triple negative and triple positive breast carcinoma. Material & methods: A group of patients with known triple negative breast carcinoma (TNBC) and triple positive breast carcinoma (TPBC) in immunohistochemical analysis were enrolled in the study. Detail history was documented and Technitium-99m MDP skeletal scintigraphy was done. Findings were recorded and finally statistical tests were done using Microsoft Excel and SPSS. Result: About 53.3% of the patients presented with lymph node metastasis, 68.8% of them were triple negative and 31.2% were triple positive. Skeletal and hepatic metastases were found in 25% cases of TPBC group, while history of lung metastasis was documented in 5% cases of TNBC group. Bone scintigraphy revealed positive scan in about 25% subjects of the triple positive group but none of the triple negative group (p value 0.025). Conclusion: TNBC shows propensity for lymph node metastasis, while TPBC tends to metastasize skeletal system. Bangladesh J. Nuclear Med. 28(1): 14-17, 2025
18F-FDG PET-CT in Re-staging Post-operative Renal Cell Carcinoma: A Five-year Experience in INMAS Dhaka
Background: Renal cell carcinoma (RCC) includes a wide variety of histopathologic subtypes. About 25–30% patients present with metastatic disease initially and 20%-40% patients later develop distant metastases. Accurate re-staging of disease as early as possible is crucial for optimum therapeutic decision and alters outcome of patients. F-18 FDG PET-CT plays a vital role in effective postoperative surveillance and restaging with high sensitivity, specificity, and accuracy. Materials & Methods: This prospective observational study included 67post-operative patients with renal cell carcinoma who were referred to Institute of Nuclear Medicine and allied sciences, Dhaka for an 18F FDG PET scan during the period of July, 2019 to July, 2024. PET-CT was performed with ‘Philips 128 slice ingenuity TF PET CT’ machine 60 minutes after intravenous administration of radiopharmaceutical. Semi-quantitative estimation of FDG uptake was performed by calculating SUVmax value, corrected for dose administered and body weight (g/ml). Results: 16 out of 22 patients with suspected metastases in other imaging modalities were positive in 18F FDG PET-scan. 22 new metabolically active distant metastatic foci without previous evidence were detected. 8 new locoregional recurrences were found. In total,35 patients had distant metastases in 114 foci among which lymph node (41 foci, comprising of 34 %) & lung (27 foci, comprising of 22.5 %) were the commonest sites. The other metastatic foci were present in adrenal glands (12 foci), peritoneum (7 foci), pleura (4 foci), bones (12 foci), soft tissue (8 foci), muscle (4 foci), liver (3 foci), brain (1 foci) & opposite kidney (1 foci). Conclusion: Our study was done to find the impact of 18F FDG PET-CT in restaging of post-operative cases due to RCC. Bangladesh J. Nuclear Med. 28(1): 18-21, 2025
Role of 18F-FDG PET/CT scan and MRI for Predicting Pathological Response to Neoadjuvant Chemotherapy in Breast Cancer Management
Background: Neoadjuvant chemotherapy is used in breast cancer patients to reduce tumor size and prevent micrometastasis, with accurate assessment through 18F-FDG PET-CT and DCE-MRI providing operation guidelines. Objective: To establish the diagnostic accuracy of 18F-FDG PET-CT scans and MRI compared to pathological response for NAC assessment in BC management. Patients and Methods: This cross-sectional comparative study was conducted at NINMAS, Shahbag, Dhaka, under a Coordinated Research Project (CRP)-E1.30.44 of IAEA. The study spanned from September 2022 to February 2024, examining 17 stage II and stage III BC patients who had received NAC before surgery and had prior 18F-FDG PET-CT and DCE-MRI studies. For therapy response of NAC, 18F-FDG PET-CT and MRI were performed after completion of NAC. Parameters of 18F-FDG PET-CT and MRI were obtained and evaluated by using PET Response Criteria in solid tumors (PERCIST) 1.0 based on SUV normalized by lean body mass (SULpeak) in PET-CT and Response Evaluation Criteria in solid tumors (RECIST) 1.1 based on the longest diameter in MRI of primary tumors and axillary lymph nodes, respectively. Descriptive and analytical analyses were performed to examine 18F-FDG PET-CT and MRI to compare pathological response after surgery, and diagnostic accuracies were compared. Result: The study patients were divided into responder 12 (70.5%) and non-responder five (29.4%) groups according to overall pathological response to NAC after surgery. Both RECIST 1.1 and PERCIST 1.0 with post-surgical pathological response to NAC of BC patients were compared. The sensitivity of PET-CT with pathological response to NAC of the study population was 80%, followed by specificity 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 92.31%. The sensitivity of MRI with pathological response to NAC of study patients was 100%, followed by specificity at 83.33%, PPV at 71.43%, and NPV at 100%. The accuracy levels of PET-CT and MRI were 94.12% and 88.24%, respectively. PPV and accuracy compared to RECIST 1.1.; PERCIST 1.0 was more accurate in predicting pathological response to NAC of BC patients. Conclusion: PET-CT accurately predicts pathological response in breast cancer patients following NAC, reducing surgical intervention and chemo radiation burden, thereby reducing the need for chemo radiation. Bangladesh J. Nuclear Med. 28(1): 22-30, 2025
Metastatic Pattern of Breast Carcinoma Observed in PET-CT Imaging at INMAS Suhrawardy
Introduction: Metastasis from breast carcinoma accounts for the majority of the death from this disease. Hybrid imaging like PET-CT is an integral part of staging breast carcinoma, selection of therapy, and detection of metastases. Patients and methods: Histopathologically proven breast carcinoma patients before or after surgery, chemotherapy and radiotherapy who had undergone whole body 18F-FDG PET-CT at Institute of Nuclear Medicine & Allied Sciences, (INMAS) Suhrawardy, between May, 2024 to December, 2024 were retrospectively studied to assess the pattern of metastases. Results: A total of 33 breast carcinoma patients with a mean age of 51.4 ± 12 years were studied. Among them infiltrating ductal cell carcinoma (IDC) was found in 22 (66.7%), lobular carcinoma in 5 (15.1%), mucinous carcinoma in 2 (6.1%), triple negative breast carcinoma in 2 (6.1%), ductal cell carcinoma in situ in 1(3.03%) and metaplastic carcinoma in 1(3.03%). Out of 22 IDC cases, 15 (68%) were diagnosed with lung metastasis and 3 (60%) out of 5 cases of lobular breast carcinoma metastasized to bones. Other than axillary lymph nodes, breast carcinoma often metastasizes to mediastinal lymph nodes. Two patients presented with rare metastasis in the ovary and adrenal gland. Conclusions: 18F-FDG PET-CT findings of breast carcinoma have a substantial impact on therapeutic strategies, and stage migration may require a significant change in the management protocol to provide proper treatment. Bangladesh J. Nuclear Med. 28(1): 31-38, 2025
Navigating the Unknown: Evaluating the Role of FDG PET-CT in Detecting Primary Tumors in Cancer of Unknown Primary- A Five Years Institutional Perspectives in Bangladesh
Objective: To evaluate the clinical usefulness of 18F FDG PET-CT whole body imaging for identifying primary tumors in patients with cancer of unknown primary (CUP). Methods: A total of 108 patients with an unidentified primary etiology were referred for whole body FDG PET-CT scan from 2019 to 2023 at the Institute of Nuclear Medical Physics, Savar. Visual examination and semi-quantitative analysis (standardized uptake value, SUV) were used to analyze PET-CT images. The utility of FDG PET-CT was evaluated based on formal clinical follow-up findings and histopathological data. Result: The study analyzed 108 cancer patients with CUP aged 19–80 years (mean age: 56.70 ± 13.42 years; males: 65.7%, females: 34.3%). Comorbidities included diabetes (22.2%), hypertension (24.1%), and others. Metastases were frequently detected in cervical lymph nodes (33%), bones (19.4%), and liver (13.9%). Whole-body FDG PET-CT scans identified the primary site in 25% of cases, primarily in the lungs (13.9%), with histopathological confirmation. Histopathology revealed adenocarcinoma (55.6%), squamous cell carcinoma (22.2%), and poorly differentiated carcinoma (11.1%). Pre-scan treatment varied, with 59.3% receiving no prior treatment, while others underwent chemotherapy, radiotherapy, or surgery. The mean SUV was 9.43 ± 11.61. Conclusion: The FDG PET-CT whole-body scan, a non-invasive and sensitive imaging modality, achieved a 25% success rate in identifying primary tumors, enhancing tumor staging, treatment planning, and prognostic accuracy. Bangladesh J. Nuclear Med. 28(1): 39-49, 2025
Initial Experience with 18FDG PET-CT at INMAS, Mohakhali: Transforming Cancer Diagnosis in Bangladesh
Background: The Institute of Nuclear Medicine and Allied Sciences (INMAS), Mohakhali, Dhaka, under the Bangladesh Atomic Energy Commission (BAEC), launched its first FDG PET-CT scanner in February 2024, marking a significant milestone in enhancing molecular imaging capabilities in Bangladesh. This study examines the initial experience of FDG PET-CT services for cancer patients at INMAS, Mohakhali. Patients and Methods: Patients were instructed to fast overnight before undergoing a whole-body PET-CT scan, which was performed one hour after intravenous administration of 18F-FDG. Data from February 2024 to November 2024 were retrospectively reviewed from the INMAS report database to analyze patient demographics and scan indications. Results: A total of 369 patients underwent FDG PET-CT scans during the study period, with 365 scans performed for oncological and 4 for non-oncological indications. The most common primary malignancies included breast carcinoma (38.2%), lymphoma (20.5%), lung carcinoma (9.4%), gastrointestinal carcinoma (8.9%) and head, neck, thyroid malignancy (4.6%). Among lymphoma cases, non-Hodgkin's lymphoma accounted for 55%. Most patients were aged between 41 to 60 years, with a female predominance (63%). Conclusions: Initial experiences with FDG PET-CT at INMAS, Mohakhali, demonstrate its transformative role in cancer care in Bangladesh. The study reveals diverse malignancies and comorbidities, highlighting the modality's effectiveness in diagnostic accuracy and treatment planning. These findings pave the way for broader applications in non-oncological conditions. Bangladesh J. Nuclear Med. 28(1): 50-54, 2025
18F FDG PET-CT in Evaluation of Prostate Cancer – Experience at NINMAS
Background: Fluorine-18 Fluorodeoxyglucose positron emission tomography-computed tomography (18F FDG PET-CT) is the most widely used oncologic imaging tool. However, due to some limitations and with the advent of newer disease-specific tracers 18F FDG is not routinely recommended in prostate cancer. However, in a developing country like Bangladesh with a growing cancer burden and where 18F FDG is an available tracer, we have tried to describe our experience in detecting the extent of disease in PCa. Methods: Retrospectively reviewed data of 18F FDG PET-CT of total 25 prostate cancer patients referred to National Institute of Nuclear Medicine and Allied Sciences (NINMAS) from February, 2021 to August, 2023 were included. Each patient’s PET-CT findings were reviewed in relation with histologic grade, Gleason’s score and serum PSA level. Results: Among the 25 patients with two patients came for baseline scan. 23 patients came for follow up evaluation with mean time for follow up from diagnosis being 26.8 months and all of them received treatment according to stage and standard guideline. In thirteen patients (52%) 18F FDG PET scan was negative with mean PSA 4.2 ng/ml and most of them (85%) were in grade group 2 and 3 with low Gleason’s score (6 to 7). 18F FDG PET was positive in 12 patients (48%) including the two patients who came for baseline staging with mean PSA 145.46 ng/ml. Those two patients had isolated focal hypermetabolic lesion in prostate. Rest of the 10 patients with positive PET scan found high serum PSA level (mean PSA 167.67 ng/ml) with Gleason’s score 8 to 10 and histologically all patients had poorly differentiated adenocarcinoma. Conclusion: 18F FDG PET-CT can detect presence of disease in prostate cancer in follow up cases with raised PSA level and with high grade group or Gleason’s score at the time of diagnosis. 18F FDG PET-CT can be a valuable tool for diagnosis of recurrence/metastases and follow up of prostate cancer in a cost-effective way in a developing country like Bangladesh. 18F FDG PET-CT effectively detects prostate cancer in high-grade cases, providing a cost-effective method for recurrence and metastatic diagnosis in developing countries like Bangladesh. Bangladesh J. Nuclear Med. 28(1): 55-61, 2025
PET-CT Evaluation, Scoring and Response Assessment of Hodgkin’s and Non-Hodgkin’s Lymphoma: Observation of a Single Institute
Introduction: 18F-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET-CT) is a non-invasive imaging technique that combines PET and CT in a single instrument. It detects and measures metabolic activity in cancer cells, providing both anatomical and metabolic information. Whole body 18F-FDG PET-CT plays a vital role in staging, evaluating therapeutic response, excluding relapse, and various stages of management of lymphoma and constitutes a step towards the pursuit of personalized therapies. Patients and methods: This observational study was done in the PET-CT division of the Institute of Nuclear Medicine & Allied Sciences (INMAS), Suhrawardy, between May 2024 and December 2024. A total of 42 patients diagnosed with Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) who requested whole-body 18F-FDG PET-CT scans were enrolled in this study. Image findings were analyzed and properly documented in a predesigned format to evaluate the results. Results: A total of 42 lymphoma patients with an average age of 41.11 ± 17.50 years were studied. Histologically diagnosed NHL was seen in 26 patients, and among them, B-cell lymphoma was the most common (84.6%), diffuse large B-cell lymphoma (DLBCL) (42.3%) was the most aggressive, and follicular lymphoma (15.4%) was the most indolent subtypes. HL was diagnosed in 16 patients. Male predominance (78.6%) was observed in both types with relatively early onset in NHL. Cervical lymph nodes appear to be the most commonly affected (78.5%) lymph nodes. Higher Deauville scores among the 42 study subjects reflected the severity of disease. Conclusion: PET-CT is most effective when clinicians, reporting nuclear medicine physicians, and radiologists understand the uses and limitations and participate as a multidisciplinary team for accurate interpretation of baseline and post-treatment scans. Bangladesh J. Nuclear Med. 28(1): 62-67, 2025
Survey of Radiation Exposure During Cyclotron Operation for PET Radiopharmaceutical Production at NINMAS
Regular monitoring, proper shielding, and attention to safety procedures are all necessary for radiation safety in cyclotron facilities to reduce exposure and ensure regulatory compliance. This study investigates the radiation safety precautions taken at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) of Bangladesh Atomic Energy Commission (BAEC), during the operation of 18/9 MeV IBA Cyclone and synthesis of 18F-2-fluoro-2-deoxyglucose (18F-FDG). Portable survey meters and fixed Geiger-Muller (GM) counters were used to measure exposed dose of radiation in highly hazardous locations such as the cyclotron control room close to the vault and hot cell close to the synthesizers. Measurements were thoroughly carried out before, during, and following cyclotron operations. The findings showed that the hot cell room experienced radiation levels of 2.3 μSv/h during the synthesis of 18F-FDG, and the corridor vault experienced peak radiation levels of 2.0 μSv/h during the production of 18F. There was still activity present since post-operation values were higher than the baseline. When handling 18F-FDG, additional measurements at L-bench positions demonstrated the value of shielding and distance, with unshielded dose rates rising to 1.58 mSv/h. Safety precautions including radiation workers distance guidelines, ALARA (As Low As Reasonably Achievable) principles, and real-time monitoring were implemented to provide radiation protection. The results highlight the necessity of constant radiation monitoring, sufficient shielding, and rigorous adherence to radiation safety procedures to reduce occupational exposure and preserve regulatory compliance in medical cyclotron facilities. Bangladesh J. Nuclear Med. 28(1): 68-74, 2025
Challenges in Accessing and Operating PET-CT: Patient Experiences and Institutional Hurdles in a Newly Established Nuclear Medicine Institute in Bangladesh
Positron Emission Tomography-Computed Tomography (PET-CT) is one of the latest state-of-the-art hybrid imaging techniques of nuclear medicine that has various applications in oncology, neurology, cardiology, and infectious disease evaluation. However, accessing this facility in Bangladesh and other 3rd world countries remains limited mostly due to financial barriers. Limited infrastructure, radiopharmaceutical unavailability, and lack of skilled and trained personnel are also some major obstacles of accessing PET-CT in this country. The difficulties patients and nuclear medicine staff encounter while trying to obtain and use 18FFDG PET-CT services in a newly established institute like Institute of Nuclear Medicine and Allied Sciences (INMAS), Suhrawardy along with some scenario-based operational challenges have been highlighted in this context. Bangladesh J. Nuclear Med. 28(1): 75-80, 2025
Patient Trends of Stress Myocardial Perfusion Imaging: Experience in a Tertiary Center of Bangladesh
Objectives: This retrospective study was performed to show population trends of gated stress myocardial perfusion imaging (MPI) using single photon emission computed tomography (SPECT) describing sociodemographic and clinical variables of the patients in a tertiary center, the National Institute of Cardiovascular Disease (NICVD). Patients and Methods: This retrospective study recruited a total of 1236 patients who underwent stress-gated SPECT MPI scans from October 2019 to October 2024 in the department of Nuclear Cardiology, NICVD, Bangladesh. Results: A total of 1236 patients were studied, with the majority of them being male (85.4%). Mean age in both genders is 52.2 years. The highest number of patients was found in the year 2023. Either pharmacological or exercise stress was given. The main indication of referral was risk stratification after old myocardial infarction (OMI) (65.2%). Major MPI findings in studied patients were fixed defect (68.7%); SVD (41.7%); DVD (32%); TVD (17.4%); high SSS in 77.3%. High-risk features found after ECG gating were a dilated left ventricular cavity (54.9%) and high TID (38.2%). Involved vascular territory in both coronary angiogram and MPI matched in 70% of cases. Conclusion: Gated stress SPECT MPI is a powerful tool for risk stratification and management of CAD patients, and the Nuclear Cardiology department of NICVD is serving the Bangladeshi population on a wide scale in this regard. Bangladesh J. Nuclear Med. 28(1): 81-86, 2025
The Significance of TID in Subendocardial Ischemia or Balanced Ischemia in the Setting of an Otherwise Normal SPECT Myocardial Perfusion Imaging Study
Objectives: The term "transient ischemic dilation" (TID) refers to the apparent significant enlargement of left ventricle (LV) on post-stress images as compared to rest images on SPECT radionuclide myocardial perfusion imaging (MPI). In presence of abnormal SPECT MPI, transient ischemic dilatation (TID) is regarded as a sign of severe and widespread coronary artery disease (CAD) with poor prognosis. However, high TID is also observed with normal MPI. The possible explanations are balanced epicardial CAD, diffuse microvascular disease or widespread subendocardial ischemia which would be associated with adverse outcomes. TID has been identified as a significant indication of severe and widespread CAD and predictive of a high risk of cardiac events. However, the clinical relevance of TID and its relationship with CAD in individuals with an otherwise normal MPI exam is unknown. Patients & Methods: This observational study was conducted in Nuclear Cardiology division of National Institute of Nuclear Medicine & Allied Sciences (NINMAS), BSMMU campus, Dhaka from January 2023 to December 2023. Out of a total of 178 patients who underwent stress-rest SPECT-MPI in the nuclear cardiology division, ten patients were identified with normal perfusion scans but exhibited high TID values. The TID index was calculated based on published threshold values with >1.12 denoting high TID. Almost all the patients went through coronary angiogram (CAG) within six months and had positive findings. This study aimed to investigate the relationship between TID and the presence or severity of coronary artery disease (CAD) in angiography. Results: Among the ten patients having normal perfusion but high TID, there is male predominance. Age ranges from 34 to 74 years. Nine out of ten patients had undergone previous coronary angiography (CAG) within a six-month timeframe, revealing triple vessel disease (TVD) in five patients (50%), double vessel disease (DVD) in three patients (30%), and single vessel disease (SVD) in one patient (10%). One patient did not have any CAG. The patients with TVD and two DVDs on CAG were obstructive CAD which was defined as diameter stenosis of 50% or more in the left main coronary artery or stenosis of 70% or more in a major epicardial vessel. The remaining patients were diagnosed with nonobstructive CAD based on angiogram findings. Conclusions: In this observational study, the clinical relevance of obstructive CAD is highlighted by the presence of high TID accompanied with otherwise normal SPECT MPI, which reveals the existence of CAD and predicts a significant risk of cardiac events. Bangladesh J. Nuclear Med. 28(1): 87-90, 2025
Correlation of Age, Weight and Body Mass Index with Bone Mineral Density using Dual–Energy X-ray Absorptiometry–Initial Experience in INMAS, Bogura
Objectives: Worldwide osteoporosis is the major public health concern among the aging population. Body weight & Body Mass Index (BMI) are inversely related with the risk of the osteoporotic fractures. Low bone mineral density (BMD) is also a major risk factor for osteoporosis & its related fractures. Osteoporosis is becoming a burning issue within the elderly group of Bangladesh. There are several studies that have shown the significant relationship of age, body weight and BMI with BMD. Therefore, the objective of the recent study is to establish the relationship of age, weight and BMI with BMD, in patients attending for DEXA scan at INMAS Bogura. Patients and methods: The cross-sectional observational study was carried out at INMAS Bogura from August 2023 to February 2024. A total of 64 patients referred for BMD estimation by DEXA scan, were included in this study. Result: In this study among 64 patients about 31.25% were male and 68.75% were female. About 20.31% were underweight, 40.62% were normal, 23.07% were overweight and 14.00% were obese. Less than 60 years of age were 48.43% and ≥60 years of age were 51.56%. In the right femur 40.62% were normal BMD, whereas 59.37% were low BMD. In the case of the left femur 46.87% were normal and 53.12% were low BMD. In spine BMD 23.47% were normal and 76.56% were low BMD. Moderate positive Pearson’s correlation is found in between BMI with right femur T score (r= 0.43; p=<0.001), left femur T-score (r= 0.633; p=< 0.001) and lumbar spine T score (r= 0.475, p=< 0.001). Conclusion: Statistically significant association and moderate positive correlation was found in between BMI with right femur BMD, left femur BMD and lumbar spine BMD. Non-significant small negative correlation is found in between age with right femur BMD, left femur BMD and lumbar spine BMD. Statistically significant association and moderate positive correlation was also found in between weight with right femur BMD, left femur BMD and lumbar spine BMD. Bangladesh J. Nuclear Med. 28(1): 91-97, 2025
Assessment of Effective Dose of Levothyroxine in Treatment of Congenital Hypothyroid Babies: A Pilot Study
Introduction: Congenital hypothyroidism (CH) is when newborns and infants have a low-functioning thyroid gland, leading to insufficient thyroid hormone production. Although affected babies may look normal at first, they can start to show symptoms within weeks or months after birth. The main treatment for congenital hypothyroidism is hormone replacement therapy, usually with levothyroxine (LT4). The American Academy of Pediatrics (AAP) and the European Society for Pediatrics Endocrinology (ESPE) recommend starting with a dose of 10 to 15 mcg/kg/day of levothyroxine. However, some studies suggest that using lower doses might still be effective while lowering the chance of an overdose on thyroxine. Objective: The aim of this study was to evaluate the optimal dose of levothyroxine in the treatment of congenital hypothyroidism in Bangladeshi infants. Materials and Methods: This study took place at the National Institute of Nuclear Medicine & Allied Sciences (NINMAS) from September 2022 to February 2024. A total of 29 newborns with diagnosed congenital hypothyroidism were enrolled. The infants received levothyroxine, prescribed mostly by physicians of Thyroid Division of NINMAS, though few of them were initially treated by outside physicians. Their thyroid hormone levels were regularly monitored with serum thyroid-stimulating hormone (TSH) test. The starting dose of levothyroxine and how long it took for the infants to reach a normal thyroid state were recorded. Results: Among 29 subjects, male to female ratio was 15:14. It was observed that 14% of the infants started with a dose of levothyroxine less than 6 mcg/kg/day, 31% received 6-7.9 mcg/kg/day, 27% got 8-9.9 mcg/kg/day, and 28% were given 10-14 mcg/kg/day. Infants who received lower initial doses (less than 10 mcg/kg/day) reached a normal thyroid state more quickly than those who started with higher doses (10-14 mcg/kg/day). Importantly, 21 out of the 29 infants received lower doses than the usual starting amount but still showed normal thyroid function without signs of overtreatment. Conclusion: Proper treatment of congenital hypothyroid babies is essential for appropriate growth and neurodevelopment. This study provided an important observation regarding effective dose of levothyroxine that will be helpful for adequate treatment planning of Bangladeshi congenital hypothyroid babies. Bangladesh J. Nuclear Med. 28(1): 98-104, 2025
Comparison of Pre- Pyeloplasty and Post- Pyeloplasty Renal status by 99mTC-DTPA Renogram: A New Experience in a New Institute
Background: Radionuclide scanning for the functional assessment of kidney is a very helpful procedure. 99mTc DTPA renogram with diuretic challenge can evaluate the improvement or decline of individual renal function and GFR at pre operative and postoperative period in case of pelviureteric junction obstruction (PUJO). Patients and methods: This prospective, longitudinal study was carried out among 25 patients with age ranging from 4 to 57 years at Institute of Nuclear Medicine and Allied Sciences (INMAS), Mohakhali who were referred for the estimation of pre and post pyeloplasty renal status. Results: Mean age of study subjects were 24.54±17.96 years with male predominance (56 %). Left kidney was mostly affected (68%). The pre and post pyeloplasty parenchymal and excretory functions were compared and found to be improved about 56% parenchymal and 64 % in excretory functions respectively. Pre-operative mean glomerular filtration rate (GFR) was 33.49 ± 22.40 ml/min which improved to 44.81 ±25.99 ml / min (33.80%) postoperatively. Conclusion: Comparison of pre pyeloplasty and post pyeloplasty renal status by 99mTc DTPA renogram with diuretic challenge appears to be an authentic and beneficial work up that causes very little radiation exposure to patients but provides important clinical clues for further management and follow up. Bangladesh J. Nuclear Med. 28(1): 105-108, 2025
Sterility Testing and Contamination Analysis of the 99mTc Eluates from RIPDTEC Mo-99/Tc-99m Chromatographic Column Generator
Metastable Technetium-99 is a widely used radioisotope in nuclear medicine that is administered to patients intravenously for imaging, functional studies of cells, and diagnosis of tumor cells of different body organs. Tc-99m is instantly available from the Mo-99/Tc-99m generator, accounts for more than 80% of all nuclear medicine procedures used for imaging, and is in growing demand worldwide every year. Hence, bulk manufacturing of this generator is carried out under strict aseptic conditions to ensure the sterility of Tc-99m. However, at the production stages of Tc-99m, there is still the possibility of getting contaminated with microbes and their endotoxin, which has a pyrogenic effect. The objective of this study is to assess and analyze the microbial and endotoxin contamination of the 3634 Tc-99m eluate samples collected from RIPDTEC Mo-99/Tc-99m chromatographic column generators. In the case of sterility testing, only 2 samples out of 3634 (0.05% of the total samples) exhibited bacterial growth after 14-day incubation in the media used to detect aerobic bacteria. In contrast, no fungal and anaerobic bacterial growth was observed during the 14-day incubation. In this study, 9 samples out of 3634 (0.25% of the total samples) showed gel clot formation in Tachypleus Amebocytes Lysate (TAL) kits used to detect endotoxin, which indicated the presence of endotoxin in those samples, and the amount was found 0.25-0.50 EU/ml. However, abnormal temperature rise was not observed in the case of any mice injected with eluate samples. Bangladesh J. Nuclear Med. 28(1): 109-113, 2025
Prevalence and Seasonal Variations of Vitamin D Deficiency in the Southeastern Region of Bangladesh
Background: Vitamin D deficiency due to varying sunlight exposure in adult population is one of the prevalent medical conditions worldwide. Objectives: To investigate the prevalence of and the seasonal influence on vitamin D deficiency among the people residing in the Chattogram division of Bangladesh. Methods: The serum 25-hydroxy vitamin D (25-OHD) was assessed by the chemiluminescence method. To investigate the seasonal impact three distinct seasons were broadly categorized winter, summer, and rainy seasons. Results: This observational study analyzed serum 25-OHD data from 969 participants, comprising 777 adults (80%) and 192 children (20%). Among the adults, 77% were female and 23% male, while in the child group, 53% were female and 47% male. A significant positive correlation was found between age and serum 25-OHD (p=.001**). Comparison based on gender, adult males showed relatively higher mean serum 25-OHD levels (18.79 ± 11.02 ng/mL) than females (16.69 ± 10.16 ng/mL). The varying degrees of vitamin D deficiency (mild, moderate, severe) were significantly associated with the gender of the adult participants (Χ2 (2, N = 712) =5.994, p = 0.05*) as well. Seasonal comparison in women showed a better status of vitamin D3 (significantly higher, mean difference: 2.16, p = 0.047*) in the rainy season than winter. Conclusion: The highest average serum vitamin D3 levels were observed during the rainy season, while the lowest occurred in winter, with significant seasonal variation in 25-OHD levels found only in females. This suggests that seasons may influence vitamin D deficiency status. Bangladesh J. Nuclear Med. 28(1): 114-118, 2025
Operational Challenges and Achievements in 18F-Fluorodeoxyglucose Production during the Pre-automation Phase of Cyclotron at NINMAS
An important step forward for nuclear medicine in Bangladesh was the establishment of the 18/9 MeV Cyclotron (Model: Cyclone 18/9, IBA) at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) under the Bangladesh Atomic Energy Commission (BAEC). This cyclotron, capable of operating at 18 MeV for protons and 9 MeV for deuterons, has been pivotal in producing 18F, a crucial radioisotope for PET imaging. During the pre-automation phase, the cyclotron supported limited 18F production, addressing the initial demand for 18F-FDG and significantly reducing patient waiting times for PET scans in Dhaka. Initially, 18F production was performed with a low beam current of 10–12 μA, yielding a modest amount of radioisotope transferred for synthesis. Despite the limitations of manual operations, nearly 10 batches of 18F-FDG were successfully produced during this phase. The transition to automation allowed the cyclotron to operate at its full capacity, with beam currents increased to 40–50 μA. This enhancement enabled the production of 18F within a 60-120 minute bombardment period, meeting the growing demand for PET imaging. This paper highlights the operational challenges encountered during the pre-automation period, including low production efficiency and manual handling constraints. Key factors influencing 18F production, such as beam current, irradiation time, enriched 18O water quantity, Dee voltage, vacuum levels, and other parameters, were carefully studied to optimize yield. The pre-automation phase provided valuable insights into cyclotron operation, laying the groundwork for current automated processes that have greatly enhanced production efficiency and reduced operational costs. This study is a testament to the innovative efforts that bridged the gap between manual and automated 18F production, ensuring the availability of radiopharmaceuticals in Bangladesh. Bangladesh J. Nuclear Med. 28(1): 119-124, 2025
Distribution of Skeletal Metastases in Common Malignant Tumors: Observational Study at INMAS, Mohakhali
Background: Bone scan is a sensitive method for detecting bone metastases but not very specific. This means it can identify most cases of bone metastases but may also show false positives due to other conditions like arthritis or healing fractures (1). However, combining clinical data with bone scan results helps doctors narrow down the possible causes. The study aims to investigate how common cancers spread to bones using 99m Technetium-Methyl Diphosphonate ( 99m Tc-MDP). Study design: Single-center-based retrospective study Patients and Methods: 181 consecutive patients with malignancy (prostate cancer: 39, breast cancer: 108, lung cancer: 25, gastrointestinal cancers: 03, and others: 06) underwent bone scans. Results: Total 111 (61.32%) out of 181 patients had abnormal bone scans attributable to metastatic tumors. Bone metastases were found in 58.3%, 30.7%, 66.6%, 64%, and 80% of patients with breast, prostate, GI, and lung cancers and others, respectively. The most frequently involved area was the spine, followed by the ribs and pelvic bones. The spine was the most frequent site of bone metastases in breast and lung cancers. Except for the spine, common locations of bone metastases from breast cancer were ribs and sternum. In prostate cancer, the most frequent sites were the spine and pelvis, with similar incidences. In lung cancer, ribs, followed by the spine, were the most frequent sites of bone metastases. 91 (50.2%) of the cancer patients studied had symptoms of bone pain. The highest incidence was associated with metastatic lesions in bone scans. Significant correlation between the location of bone pain and evidence of bone metastasis in the same region was noticed in the pelvis, skull, sternum, spine, and femur. Conclusion: The spine, pelvis, breast, lung, and sternum are most frequently invaded in prostate, breast, and lung cancers, with bone pain in these areas being more significant for metastatic bone involvement. Bangladesh J. Nuclear Med. 28(1): 125-129, 2025
Radiation Dose Assessment Around Patients in Single Photon Emission Computed Tomography Units During Bone scintigraphy and DTPA Renogram
Introduction: During imaging with Single Photon Emission Computed Tomography (SPECT) units, ionizing radiation is emitted by a patient's body after being injected with radiopharmaceuticals (Rph). Radiation protection as well as knowledge of safe regions around the working environment is essential for nuclear medicine (NM) occupational workers. The present study measured the dose rate at different points around the Rph-injected patients with different activities of 99m Tc-DTPA for renograms and 99mTc-HDP for bone scans, the two most common imaging procedures in the SPECT units of NM establishments. Patients and Methods: This study was carried out in the scintigraphy division of the Institute of Nuclear Medicine and Allied Sciences (INMAS), Kushtia, where 52 male patients were included. Out of the 52 patients, DTPA renogram was done in 26, aging between 1 and 69 (mean = 30.8) years, and bone scan was done in 26, aging between 29 and 71 (mean = 38.8) years. Patients received a dose of 2-5 mCi for the DTPA renogram and 20 mCi for the bone scan with the Mediso SPECT-CT gamma camera unit. The dose rates were measured pragmatically by using a ranger survey meter around radioactive patients in different locations in SPECT-CT units. Result: During contact with radioactive patients, the occupational exposure increases but significantly decreases by increasing distance, as well as the dose rate reduces greatly with respect to time. This study observed that radiation dose was very low at 1 m distance from the radioactive patient. Conclusion: The SPECT/CT occupational worker should remain at a distance of more than 1 m from the radioactive patients and carry TLD batches and wear lead shield aprons for their safety. Bangladesh J. Nuclear Med. 28(1): 130-134, 2024
Photon Contamination Analysis (Bremsstrahlung tail) of Electron Beams in Small Fields
Intensity-modulated radiotherapy, volumetric arc radiotherapy, and stereotactic radiosurgery are three modern radiotherapy applications that commonly use dosimetry of small fields. Field sizes ranging from 1 × 1 cm² to 5 × 5 cm² are taken for analysis. Varian Clinac IX SN6298 was utilized for both 6 and 12 MeV electron beams, using the TRS-398 and IAEA Technical Reports Series No. 483 procedure as the standard. The beam profile and the percentage of depth dosage (PDD) were finally ascertained in a water phantom. Various percent dosages and Bremsstrahlung tail regions were experimentally measured from the PDD curves. With an increase in field size (s), R100, R90, R80, R50, and Rp all rose for the medical linear accelerators. In the CC13 chamber, this held true for both 6 MeV and 12 MeV electron beams. The area of the bremsstrahlung tail grows as energy increases. This may result in modifications to the penumbra region's dosage distribution. Beam profiles revealed that dose was scattered more in small fields than in intermediate sizes. The interactions between the radiation beam, detector, and surrounding materials make small-field dosimetry difficult. Additionally, none of the beam symmetries exceed 2%. Bangladesh J. Nuclear Med. 28(1): 135-141, 2025
A Comprehensive Analysis of Vitamin D Levels Based on Demographic Data at INMAS, Mohakhali
Background: Sunshine Gold, a crucial element, namely vitamin D, is essential for maintaining calcium homeostasis and promoting bone mineralization. Its deficiency has become a global health issue, particularly concerning in our country, affecting people from all socioeconomic and geographic backgrounds, especially females and children. Methods: 111 blood samples were investigated in the In-vitro Division of the Institute of Nuclear Medicine and Allied Sciences (INMAS) in Mohakhali, Dhaka from January to December 2024. Demographic and socio-economic impacts on vitamin D levels and their probable reasons are investigated through several statistical and mathematical analytics. Results: About 75.67% of people are deficient in vitamin D (<20 ng/mL). Deficiency was noted in 61.90% of females (mean ± S.D.) 11.21 ± 4.50 ng/mL and 11.98 ± 3.43 ng/mL in males, indicating higher levels of vitamin D in males. Approximately 60.00% of participants aged 19-40 years had a deficiency with 11.29 ± 3.80 ng/mL. Seasonal studies showed higher vitamin D levels in summer due to increased sun exposure. Housewives exhibited notable deficiencies with an average level of 9.38 ± 4.50 ng/mL, comprising 19.05% of the deficient group. People from lower socioeconomic classes had longer sun exposure, resulting in higher vitamin D concentrations. Conclusion: It is a pressing need for comprehensive public health interventions to address the significant prevalence of vitamin D deficiency among Bangladeshis. Increasing public awareness about the levels of vitamin D and its interrelations to sun exposure, boosting dietary sources of vitamin D, and considering food fortification initiatives are some possible strategies. Bangladesh J. Nuclear Med. 28(1): 142-148, 2025