Bangladesh Journal of Nuclear Medicine

Evaluation of Surgical Outcome of Pelviureteric Junction Obstructive Patients by 99mTc-DTPA Renography

Sun, 23 Jun 2024 00:00:00 +0000

Objectives: Pelviureteric junction (PUJ) obstruction is the most common congenital abnormality of urinary tract and accounts for about 80% cases. 99mTc-DTPA renography with diuretic challenge helps to distinguish obstructive hydronephrosis from non-obstructive calyceal dilatation and also allows the surgeons to select cases for surgical intervention. This study aims to compare and evaluate the surgical outcomes of PUJ obstructive patients by 99mTc-DTPA renography. Patients and Methods: This prospective, longitudinal study was carried out at the Institute of Nuclear Medicine & Allied Sciences (INMAS), Dhaka, during July 2016 to June 2017 and 99mTc-DTPA renography was done in diagnosed cases of PUJ obstruction (diagnosed by ultrasonography and intravenous urography) before and 3 months after Anderson Hynes (A-H) pyeloplasty. Static renal imaging was also done after 1 and 2 hours after the dynamic acquisition to compare the pre and postoperative anatomical findings. The study included a total of 70 patients with PUJ obstruction before and after A-H pyeloplasty. Patients with GFR < 10 ml/min, serum creatinine level > 3 mg/dl and pregnancy were excluded. Result: In this study, 70 (100%) of the preoperative patients had obstructive uropathy. Following surgery, 31 patients (44.3%) had obstructive uropathy, 22 patients (31.4%) had partial obstruction, and 17 patients (24.3%) had functional obstruction. Before surgery, the individuals’ mean differential renal function (%) was 38.7 ± 8.2, and after surgery, it was 41 ± 9.8. In preoperative subjects, the mean glomerular filtration rate (ml/min) was 42.1 ± 9.1, while in postoperative ones, it was 46.2 ± 10.8. In preoperative subjects, the mean total glomerular filtration rate (ml/min) was 92.1 + 8.9, while in postoperative ones, it was 95.5 ± 10.4. The pre- and postoperative DTPA renography results differed in a statistically significant way (p < 0.05). Before surgery, the patients had a mean serum creatinine (mg/dl) of 1.3 ± 0.4, and after surgery, it was 1.2 ± 0.4. The pre- and postoperative differences were not statistically significant (p > 0.05). Static images of the DTPA renogram acquired one and two hours in post pyeloplasty patients revealed the characteristics of obstruction. Three months after the pyeloplasty, 23 (32.9%) of the participants had stable renal function, 36 (51.4%) had improved renal function, and the remaining 11 (15.7%) had worsened renal function in 99mTc-DTPA renogram. Conclusion: Most of the study subjects showed improved renal parenchymal function and glomerular filtration rate (GFR) in post pyeloplasty 99mTc-DTPA renograms at 3 months. Routine 99mTc-DTPA renogram of all the patients with PUJ obstruction before and after the pyeloplasty might be beneficial for further management as it is a simple, non-invasive, cost-effective technique with low radiation exposure.

Bangladesh J. Nuclear Med. 27(1): 16-20 , 2024

Homsy’s sign in DTPA renogram- initial experience at NINMAS

Sun, 23 Jun 2024 00:00:00 +0000

Introduction: Renogram findings in intermittent hydronephrosis may occur as a delayed double peak curve and can be considered as a possible fourth drainage pattern. It usually occurs 10.15 min post-diuretic injection and presents with an initially rapid tracer elimination followed by a sudden cessation of the effect or reversion to a rising curve resulting from self-obstruction of the pelviureteric junction (PUJ) by forced diuretics. This type of response is known as Homsy.s sign and is an indicator of an intermittent PUJ obstruction (PUJO). Objective: Patients with Homsy.s syndrome may easily be mistaken, and eventually an obstructive pattern is missed if the proper duration of the study is not carried out. The purpose of this study is to find out whether these are true obstructive patterns, with particular emphasis on the characteristic clinical and imaging findings in intermittent PUJO. Patients and methods: A retrospective study was conducted at NINMAS from October 2023 to January 2024 at the scintigraphy division of the National Institute of Nuclear Medicine and Allied Sciences. A total of eight patients with Homsy.s sign characteristics in a DTPA renogram with diuretic challenge were included in this study. Clinical H/O and other interventions were evaluated. Results: Among 8 patients, 6 (75%) were children and 2 (25%) were adults. There was an equal male-female distribution. Serum creatinine level was within the normal limit in six patients (75%), and elevated in two patients (25%). USG of renal system revealed mild HDN with PUJO in 03 (37.5%) patients, moderate HDN with PUJO in 02 (25%), gross HDN with PUJO in 1 (12.5%), extra renal pelvis in 01 (12.5%), and normal findings in 01 (12.5%) patients. Baseline diuretic DTPA renograms showed bilateral Homsy.s sign in 1 and unilateral in 7 patients. Among 7 patients, 6 positive Homsy.s signs were in the right kidney and 01 in the left kidney. Normal parenchymal function was found in 07, and mild parenchymal impairment was found in 02 affected patients. Conclusion: Surgical treatment is recommended for intermittent types of PUJO, as eventually it leads to frank obstruction and impairment of renal function. To confirm diagnosis, the F-15 diuretic protocol is recommended, where the maximum diuretic effect can result in either an obstructive or non-obstructive pattern of the curve.

Bangladesh J. Nuclear Med. 27(1): 21-33, 2024

First Five Years Performance of FDG PET-CT in Institute of Nuclear Medical Physics, SavarAbstract to be submitted Bangladesh J. Nuclear Med. 27(1): page, 2024

Sun, 23 Jun 2024 00:00:00 +0000

Background: In an effort to improve Bangladesh’s molecular imaging capabilities, the Institute of Nuclear Medical Physics (INMP), Savar, which is governed by the Bangladesh Atomic Energy Commission (BAEC), inaugurated its first FDG PET CT scan in September 2018. We will take a look at the first five years of FDG PET CT services provided to cancer patients at INMP in this article. Patients and Methods: The patients were advised to fast overnight before the day of the scan. A whole-body PET-CT scan was acquired with Philips 128-slice Ingenuity TF, one hour after intravenous injection of 18F FDG. Patients who had undergone FDG PET CT scans at INMP, Savar, from September 2018 to December 2023 were retrospectively included, and INMP report databases were reviewed for demographic analyses. Results: A total of 2879 patients underwent FDG PET CT scans for various clinical oncological and non-oncological indications from September 2018 to December 2023. In 2018, a total of 27 patients were scanned in the first year of the inauguration of FDG PET CT at INMP, Savar. Thereafter, 332 in 2019, 469 in 2020, 399 in 2021, 716 in 2022, and 936 in 2023 were scanned subsequently. A total of 12 patients underwent PET-CT scans for non-oncological indications; among them, tuberculosis was 75%. The top five most common primary malignancies were lymphoma (26.4%), carcinoma breast (21%), gastrointestinal carcinoma (9.6%), carcinoma lung (8.8%), and carcinoma ovary (4.6%). Among 762 lymphoma patients, non-Hodgkin’s lymphoma was 58.5%. The majority of patients were more than 61 years of age, with male predominance (52%). The percentage of DM was 34.0%, and dyslipidemia was 27%. Among 980 diabetic cancer patients, 78 had fasting hyperglycemia and required insulin injections before a PET-CT scan. Conclusions: Despite the COVID-19 pandemic and initial uncertainty about FDG availability, there has been a notable increase in FDG PET-CT scanning in INMP from 2018 to 2023. This considerable upsurge is extremely rewarding and plays a critical role in cancer management nationally.

Bangladesh J. Nuclear Med. 27(1): 27-33, 2024

A Comparison Study of the Solid Phantom and Water Phantom Using 6 MV and 15 MV Photon Energies, Depending on the Depth

Sun, 23 Jun 2024 00:00:00 +0000

Water is such an environmental element that is considered the best human body tissue equivalent. In the field of dosimetry studies, water is frequently used. This comparison study is conducted by a solid phantom and a water phantom with 6 MV and 15 MV photon energies, respectively. A cylindrical-type ionization chamber is used to collect charge when beams are on. The distance between the ray source and the surface of the phantom was fixed at 100 cm i.e. to SSD (Source to Surface Distance) of during the experiment. Chamber travels 1 cm to 20 cm in both phantoms and an electrometer is attached in the experimental set-up to measure the charge. The field size was 10x10 cm2. The relative deviation ratio of the solid phantom to the water phantom was calculated. In the result, the maximum deviation was 0.64%, while the minimum deviation was 0%, corresponding to the depths of 1 cm and 2.5 cm, respectively, for 6 MV and at 15 MV, maximum deviation and minimum deviation were 1.90% and 0.167% respectively, corresponding to the depths of 1.5 cm and 13 cm. Therefore, it can be said that the solid phantom can overcome the disadvantages of installation time required for the water phantom and problems while water level changing for depth measurement, simultaneously can used to measure the radiological dose precisely.

Bangladesh J. Nuclear Med. 27(1): 34-38, 2024

Workplace Radiation Monitoring and Analysis: A Single Institution Based Study

Sun, 23 Jun 2024 00:00:00 +0000

Purpose: The primary objectives of this study were threefold: first, to comprehensively assess radiation exposure levels within the Nuclear Medicine (NM) institution; second, to identify and address potential risks associated with diagnostic and therapeutic procedures; and third, to establish strong control measures and emergency response plans. These goals collectively aim to contribute to the creation of a personalized radiation protection program that addresses the unique issues provided by NM applications. Materials and Methods: Radiation doses were computed over a six-month period using survey meter data gathered three times each day. Measurements were carried out in ionization chambers using radiation's ionizing properties. Continuous radiation surveys used digital survey meters in designated regions, which were classified according to dose rates, with a focus on monitoring doses from radiopharmaceuticals such as 131I and 99mTc. Results: Continuous radiation surveys over six months identified maximum values in specific areas within the institution, such as the SPECT room and therapy patient room, all below the allowable limit. This ensured the safety of personnel and patients while maintaining ambient radiation levels outside the institution consistently below the permissible limit. Conclusion: This study provided essential data for establishing a dose reduction strategy in a clinical NM facility, confirming INMAS Bogura as free from radiation-induced risks and emphasizing the importance of continuous evaluation, adherence to regulations, and long-term monitoring to ensure safe radiological working conditions.

Bangladesh J. Nuclear Med. 27(1): 39-43, 2024

The Outcomes and Success Rates of Kasai Operation for Biliary Atresia Cases Using Presurgical Hepatobiliary Scan: Observations at NINMAS

Sun, 23 Jun 2024 00:00:00 +0000

Abstract not avaiable

Bangladesh J. Nuclear Med. 27(1): 44-48, 2024

Association between Carotid Intima-Media Thickness (CIMT) and Alzheimers Disease Detected by 99mTc- ECD SPECT of Brain

Ashrafi Anar, Sheikh Md Adnan, Nasreen Sultana — Sun, 23 Jun 2024 00:00:00 +0000

Background: Single-photon emission computed tomography (SPECT) imaging of brain has emerged as a well-established and non-invasive technique for diagnosing dementia, specifically its primary subtype, Alzheimer’s disease (AD). Recent research suggested a potential correlation between the increased intima-media thickness of the carotid artery and the onset of AD. The primary objective of this study is to assess the association between carotid intima-media thickness (CIMT) measured by 2D ultrasound of the carotid artery and AD, detected by Brain SPECT imaging with 99m Technetium-Ethyl Cysteinate Dimer (99m Tc ECD). Patients and Methods: This cross-sectional study was conducted at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) between March 2021 to June 2022. Ethical approval was obtained from Medical Research Ethics Committee (MREC). The study included 65 patients with suspected or confirmed dementia. Data collection included Mini Mental State Examination (MMSE) score of neurology and associated laboratory reports. All the participants underwent 2D ultrasonography of carotid artery to measure carotid intima-media thickness (CIMT) and a brain SPECT with 99mTc-ECD followed by image interpretations using the easy Z score imaging system (eZIS). Result: The mean age of the study population was 63.8 ± 9.5 years, with a male predominance (69.2%). The most prevalent comorbidities were hypertension and dyslipidemia (24.6%) and diabetes mellitus (13.8%). The majority of patients scored in the 25.27 range on the MMSE. Regarding CIMT, 40% of patients had moderate CIMT, 35.4% had normal CIMT, and 24.6% had mildly increased CIMT. Brain SPECT results indicated that 69.2% of patients had Alzheimer’s disease (AD), while 30.8% had dementia other than AD. Among AD patients, 71.1% had mild AD, 20.0% had moderate AD, and 8.9% had severe AD. An unpaired t-test revealed a slightly higher mean CIMT value in AD patients (1.28±0.58 mm vs. 1.25 ± 0.60 mm, p = 0.873), though this difference was not statistically significant. Conversely, ANOVA and Pearson’s correlation tests demonstrated a statistically significant association between CIMT and the severity of AD, as represented by the Z-score (r = +0.693, p<0.001). Conclusion: The study highlights the significance of carotid intima-media thickness (CIMT) in Alzheimer’s disease (AD) and non-AD patients, suggesting its use in initial assessment and follow-up measures.

Bangladesh J. Nuclear Med. 27(1): 49-55, 2024

Bone Scintigraphic Pattern and Correlation with Serum Prostate Specific Antigen Levels in Prostate Cancer Patients at NINMAS

Sun, 23 Jun 2024 00:00:00 +0000

Abstract not available

Bangladesh J. Nuclear Med. 27(1): 56-61, 2024

Correlation of B-mode and Doppler Ultrasound Parameters of Kidney with Serum Creatinine Level in Chronic Kidney Disease Patients

Sun, 23 Jun 2024 00:00:00 +0000

Abstract not available

Bangladesh J. Nuclear Med. 27(1): 62-68, 2024

Definitive Diagnosis of Hepatic Hemangioma by 99mTc Labeled Red Blood Cell SPECT and Comparative Analysis with Ultrasound

Sun, 23 Jun 2024 00:00:00 +0000

Introduction: Hemangiomas are the most common benign tumors of the liver. Accurate diagnosis is crucial for differentiating hemangioma from other space-occupying lesions (SOLs) as management strategies differ significantly. Though FNAC is the gold standard investigative tool for the diagnosis of hepatic hemangioma, newer modalities like 99mTc labeled RBC liver SPECT now is being emerging diagnostic tool for tailoring the treatment of the patient with hepatic hemangioma. Objective: This study aims to evaluate the diagnostic performance of 99mTc labeled RBC liver SPECT over ultrasound in the definitive diagnosis of hepatic hemangiomas. Patients and Methods: A retrospective observational study of 52 patients was conducted who underwent both 99mTc labeled RBC liver SPECT scan and USG for hepatic lesion evaluation at NINMAS Dhaka from the period of 2022 to 2023. High-resolution ultrasonography was performed. Diagnostic measures, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy, were calculated for 99mTc labeled RBC SPECT and compared with USG. Imaging protocols, demographic data, and clinical characteristics were systematically analyzed. Results: Among 52 patients females were predominant. Representative images highlighted the enhanced blood pool activity in hepatic hemangiomas detected by RBC liver SPECT, which demonstrated superior sensitivity (92.3%) compared to ultrasound (76.9%). The specificity, positive predictive value (PPV), and overall accuracy were also higher for 99mTc labeled RBC SPECT and demonstrated significantly higher sensitivity (92.3%) compared to ultrasound (76.9%), with superior specificity, PPV, and overall accuracy. Conclusion: 99mTc labeled red blood cell liver SPECT holds a superior sensitivity and overall accuracy compared to ultrasound. It contributes to the evolving landscape of hepatic imaging and emphasizes the potential clinical utility of nuclear medicine techniques in the definitive diagnosis of hepatic lesions and also affects the clinical outcomes.

Bangladesh J. Nuclear Med. 27(1): 69-74, 2024

A Comprehensive Analysis of Lymphoscintigraphy Results for Lower Limb Edema in Pediatric Group of Patients at NINMAS

Sun, 23 Jun 2024 00:00:00 +0000

Background: The diagnosis and treatment of pediatric lymphedema provide particular challenges. The defining feature of lymphedema is aberrant interstitial fluid collection, which can be caused by a variety of factors, including acquired illnesses and congenital defects. This study used lymphoscintigraphy to determine the source of lymphedema in children of various ages. Patients and Methods: In this retrospective analysis, 53 children were included, who were referred to National Institute of Nuclear Medicine and Allied Sciences (NINMAS) for lower limb lymphoscintigraphy in the years 2022.2023. All pertinent facts and data were taken from the medical records. An average dosage of 1+1 mCi of 99m Technetium- (99m Tc) labeled nanocolloid was injected into the web spaces of the first and second toes of each foot. Spot views and delayed whole-body sweep images were acquired on time. Dual head gamma camera images were collected anterior and posteriorly. The assessment of the injection site, primary lymphatic channels, collateral vessels, dermal backflow, and quantity and strength of radiotracer absorption of the lymph nodes were all included in the qualitative image interpretation process. Result: The mean age was 10.14 years ± 5.37 with age ranging from 0-17 years. In 48/53 cases (90.6%) of clinically positive leg swelling were found to be positive for lymphedema on lymphoscintigraphy, where 16 patients had unilateral and 33 patients had bilateral. Remaining 05/53 (9.4%) were scintigraphically normal. Among the positive patients, 48 cases (98%) were primary lymphedema and only one (2%) had secondary cause, who was a case of bilateral lymphedema, Grade-I in left lower limb (LLL) and Grade-III in right lower limb (RLL). Conclusion: Lymphoscintigraphy, a non-invasive, straightforward imaging modality, is very helpful in precisely documenting and grading lymphedema for finding the etiology and subsequent treatment plans in patients with leg swelling. It also serves as a means of functional evaluation of lymphatic channels. Additionally, it can be crucial for individuals undergoing surgical procedures to relieve clinical symptoms early on in their recovery.

Bangladesh J. Nuclear Med. 27(1): 75-80, 2024

Newborn Screening for the Early Detection of Congenital Hypothyroidism: A Countrywide Comprehensive Program of Bangladesh Atomic Energy Commission

Sun, 23 Jun 2024 00:00:00 +0000

The crucial practice of newborn screening allows for the early identification of curable medical issues in infants. Congenital hypothyroidism (CH), a disorder brought on by insufficient thyroid hormone production, is the subject of this study. Worldwide variations exist in CH prevalence, and early identification is essential for the best results. A thorough screening program was launched in Bangladesh from July 2018 to June 2022, gathering over 500,000 samples from infants throughout the nation. This program’s goal was to recognize CH cases and offer prompt intervention in collaboration with 839 hospitals. TSH levels were found above the cut-off values in 274 of the samples, which corresponds to an incidence rate of about 1 in 1,825 births. TSH levels ranged from 20 to 75 mIU/L in the majority of positive cases, with the highest value reaching 506.05 mIU/L. The study discovered that infant girls were more likely than infant boys to have CH. The greater Mymensingh region showed a higher prevalence than other places, and regional variations in CH incidence were also noted. It was determined that iodine deficiency, which affects 38% of the population, may have an impact on the prevalence of CH. Low public knowledge and the unwillingness of the uneducated population to offer samples are obstacles to newborn screening in Bangladesh. To get beyond these obstacles and underline the value of early screening, public awareness campaigns and educational initiatives are required. The study emphasizes the necessity for focused interventions, especially for female newborns in areas where the prevalence of CH is higher. To effectively address iodine deficiency, access to comprehensive iodine supplementation programs should be ensured. In conclusion, Bangladesh can successfully treat congenital hypothyroidism and enhance the health and wellbeing of babies across the country by addressing these issues, putting in place targeted interventions, and increasing access to screening programs. To improve outcomes for newborns with CH, the study underlines the relevance of early detection, timely intervention, and increasing public awareness.

Bangladesh J. Nuclear Med. 27(1): 81-88, 2024

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

Sun, 23 Jun 2024 00:00:00 +0000

Vitamin D deficiency has emerged as a global health concern, affecting populations across various geographical and socioeconomic spectrums. This study, conducted at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) in Shahbag, Dhaka, investigates the prevalence and determinants of Vitamin D deficiency among 1,819 individuals who have visited for their regular health check-up. Utilizing retrospective data from the Laboratory Information System of the Chemiluminescence Immunoassay (CLIA) laboratory of In-vitro and Radiochemistry Division of NINMAS, we analyzed Vitamin D levels alongside demographic variables and seasonal fluctuations to elucidate patterns of deficiency within this cohort. Our findings reveal a widespread Vitamin D deficiency, with 62.1% of the studied population exhibiting levels below 20 ng/mL, indicative of deficiency. A gender disparity was evident, with females comprising 74.7% of those deficient, compared to 25.3% of males. The overall mean Vitamin D level was recorded at 19.73 ± 11.94 ng/mL, with a slight male predominance in Vitamin D concentrations (20.80 ± 11.48 ng/mL for males vs. 19.33 ± 12.11 ng/mL for females). Seasonal analysis further underscored higher Vitamin D levels during the summer months, pointing towards the impact of sun exposure on Vitamin D synthesis. Conclusively, the substantial prevalence of Vitamin D deficiency underscores an urgent need for comprehensive public health strategies aimed at addressing this issue within the Bangladeshi population. Strategies may include promoting dietary sources of Vitamin D, enhancing public awareness about the importance of sun exposure, and considering food fortification programs.

Bangladesh J. Nuclear Med. 27(1): 89-94, 2024

SPECT Myocardial Perfusion Imaging in the Diagnosis of Apical Hypertrophic Cardiomyopathy- Case Series and Literature Review

Sun, 23 Jun 2024 00:00:00 +0000

Apical hypertrophic cardiomyopathy (AHCM) is a subtype of hypertrophic cardiomyopathy (HCM) in which hypertrophy mostly affects the apex of the left ventricle, resulting in mid-ventricular obstruction. The diagnosis is usually made when the LV apex has an apical wall thickness of ≥ 15 mm in echocardiography, though sometimes it is missed due to the poor acoustic window in two-dimensional echocardiography. Single Photon Emission Computed Tomography-Myocardial Perfusion Imaging (SPECT-MPI) can often detect apical hypertrophy. The apical hypertrophy was identified by SPECT-MPI in the reported three cases, which were not previously diagnosed by echocardiography.

Bangladesh J. Nuclear Med. 27(1): 100-106, 2024

18F FDG PET/CT Findings in a Patient with Sarcoidosis: A Case Report

Sun, 23 Jun 2024 00:00:00 +0000

Sarcoidosis is a multisystem disease characterized by the formation of noncaseating granulomas that can affect any site in the body with extremely variable clinical course. Fluorine -18 Fluorodeoxyglucose positron emission computed tomography (18F FDG PET/CT) is a useful technique for detecting active inflammatory sites in patients with sarcoidosis thus diagnosis, monitoring response and predicting prognosis. Here we present the case of a 44-year-old lady with sarcoidosis having hepatic involvement detected by 18F FDG PET/CT scan. This patient was presented with increasing complaints of low-grade fever, weight loss and generalized weakness for two years who was found to have a hilar lymphadenopathy in chest X-ray and chest CT scan. 18F FDG PET/CT scan performed to see the extent of disease and revealed multiple hypermetabolic mediastinal and abdominal lymph nodes. There was also heterogenous intense FDG uptake (SUVmax:9.6) in liver without definite change on CT likely due to sarcoidosis involvement in the liver. Later on, hepatic biopsy confirmed the diagnosis of hepatic sarcoidosis.

Bangladesh J. Nuclear Med. 27(1): 107-111, 2024

Baseline PET-CT evaluation of Bone Marrow-Liver-Spleen Type of Diffuse Large B-Cell Lymphoma: A Rare Aggressive Extranodal Lymphoma

Sun, 23 Jun 2024 00:00:00 +0000

Bone marrow-liver-spleen (BLS) type lymphoma is a rare subgroup of diffuse large B-cell lymphoma, characterized by bone marrow involvement without lymph nodes. Symptoms include fever, anemia, and hemophagocytic lymphohistiocytosis. Early diagnosis and treatment are crucial for proper management and prevention. We report a case of a 59-year-old male with diffuse large B-cell lymphoma (DLBCL) involving bone marrow. He was diagnosed with a bone marrow-liver-spleen (BLS) subtype of lymphoma with the help of F-18 FDG PET-CT. BLS is an unusual subgroup of extra-nodal DLBCL. Very few cases have been reported to date. The disease showed unique clinico-pathological features of involvement of bone marrow with or without liver and/or spleen, but no lymph node or other extra-nodal sites are involved, hence the name BLS.

Bangladesh J. Nuclear Med. 27(1): 112-116, 2024

Paradoxical Myocardial Perfusion Imaging Pattern in Cardiac Patient: Two Case Reports

Sirajum Munira, Tapati Mandal, Sadia Sultana — Sun, 23 Jun 2024 00:00:00 +0000

To evaluate myocardial blood flow and identify regions of ischemia or infarction, Myocardial Perfusion Imaging (MPI) is a useful diagnostic technique. It relies on the identification of perfusion anomalies, which are related to underlying coronary artery disease and usually appear as regions of reduced blood flow. However, the appearance of paradoxical perfusion patterns in MPI raises doubt on the accepted interpretation of these imaging findings. Unexpected results in MPI are known as "paradoxical perfusion patterns," where regions of increased perfusion are found in places where decreased blood flow would be expected based on clinical presentation and conventional risk factors. Clinicians are faced with a diagnostic dilemma as a result of the unusual phenomena that have been documented in only a small number of cases. We are presenting two case reports that describe a paradoxical perfusion pattern seen during MPI. These cases raise questions about the traditional interpretation of MPI data and emphasize how crucial it is to take anatomical variations and collateral circulation into consideration when interpreting the results of perfusion imaging. Understanding the causes behind paradoxical patterns of perfusion is essential for proper diagnosis and appropriate therapeutic management, as it may affect treatment methods and prognosis. The reported cases conclude by emphasizing the need for careful interpretation of MPI findings to point out possible paradoxical perfusion patterns, which could be a symptom of particular anatomical differences. Keywords: Myocardial perfusion, paradoxical pattern, coronary artery disease, myocardial infarction, myocardial viability, stress tests.

Bangladesh J. Nuclear Med. 27(1): 117-120, 2024

The Intricate Diagnostic Journey of a Breast Cancer Patient, Revealing Extensive Hepatic Metastasis Through Extraosseous Uptake in Planar Bone Scintigraphy and SPECT-CT Precision Mapping

Sun, 23 Jun 2024 00:00:00 +0000

In breast cancer patients, planar bone scintigraphy is commonly used for detecting osseous metastasis. This case report emphasizes the importance of recognizing unusual extraosseous uptake in bone scintigraphy, even when negative for osteoblastic lesions. A 35-year-old post-treatment breast carcinoma patient exhibited unexpected radiotracer uptake in the upper abdomen. Subsequent SPECT/CT revealed radiotracer-avid calcified hepatic lesions and extensive non-avid metastatic lesions, however no osteoblastic metastasis. Ultrasound-guided core biopsy confirmed extensive hepatic metastases secondary to ductal carcinoma of the breast. This highlights the critical role of SPECT/CT in precisely identifying and characterizing lesions, aiding in advanced breast cancer diagnosis and management planning.

Bangladesh J. Nuclear Med. 27(1): 121-126, 2024

Incidental Finding of Mesenteric Cyst by 18F FDG PET- CT: Case Report

Sun, 23 Jun 2024 00:00:00 +0000

Mesenteric cysts are rare intra-abdominal lesions, and they have a wide range of clinical signs and symptoms that make pre-operative diagnosis difficult. Diagnosis is often incidental. Although the exact cause of mesenteric cysts is unknown, obstruction of the lymphatic system due to trauma, infection, or tumors is thought to play a role. The optimal treatment is surgical excision of the cyst with laparotomy or laparoscopy. We report a case of a 65-year-old female with ovarian cancer who had an incidental finding of a mesenteric cyst during an 18F FDG PET-CT scan.

Bangladesh J. Nuclear Med. 27(1): 127-129, 2024

Assessment of Perfusion Abnormalities in a Case of Autism Spectrum Disorders Using 99mTc ECD Brain SPECT: A Landmark case in Bangladesh

Sheikh Mohammad Adnan, Jannat Ara Shefa, Mohammad Badrul Alam, Nasreen Sultana — Sun, 23 Jun 2024 00:00:00 +0000

The prevalence of Autism Spectrum Disorders (ASD) has witnessed a rapid increase globally, necessitating effective diagnostic tools for comprehensive assessment. This case report presents a three-year-old male child clinically identified with ASD, undergoing a brain perfusion scan using single-photon emission computed tomography (SPECT). Hypoperfusion, characterized by multiple focal areas of decreased radiotracer concentration, was observed in frontal lobes, left temporal lobe, right parietal, right precuneus, and both hypothalami. The application of the e-ZIS system indicated a severity of rCBF decrease in specific voxels. This case underscores the utility of radionuclide brain SPECT imaging in unveiling abnormal rCBF patterns in ASD patients. Establishing a correlation between these abnormalities and symptom profiles could enhance treatment strategies, incorporating innovative interventions and specific medications tailored to the observed abnormalities.

Bangladesh J. Nuclear Med. 27(1): 130-133, 2024

Avascular Necrosis of Femoral Head in Bone Scintigraphy with Concurrent Parathyroid Adenoma Diagnosed by Parathyroid SPECT/CT- A Case Report

Sun, 23 Jun 2024 00:00:00 +0000

Avascular necrosis is a degenerative bone condition that occurs due to an interruption of the subchondral blood vessel. It is categorized as traumatic or non-traumatic based on risk factors, with a hypercoagulable state being one of them. Several studies indicate that hypercoagulability may be linked to hypercalcemia, a significant feature of hyperparathyroidism. Although it is an irreversible condition, early diagnosis can mitigate disability rates. Diagnosis of avascular necrosis and finding out its cause are clinical challenges. Investigative strategies are essential for the diagnosis of diseases and to the etiology behind this. But imaging tests, including nuclear imaging tests, have made it even easier. In this case report, bone scintigraphy played a crucial role in aiding the diagnosis of avascular necrosis, while a parathyroid scan proved instrumental in identifying associated risk factors.

Bangladesh J. Nuclear Med. 27(1): 134-139, 2024

18F FDG PET Cardiac Imaging for Myocardial Viability Assessment in NINMAS

Sun, 23 Jun 2024 00:00:00 +0000

Abstract not available

Bangladesh J. Nuclear Med. 27(1): 95-99, 2024

Radiotheranostics: A Potent Nuclear Medicine Tool for Combating Cancer - Exploring Prospects and Obstacles in Developing Countries

Akram Al Ibrahim — Sun, 23 Jun 2024 00:00:00 +0000

Abstract not available

Bangladesh J. Nuclear Med. 27(1): 12-15, 2024

Abstracts

Editor in Cheif — Sun, 23 Jun 2024 00:00:00 +0000

Abstract not available

Bangladesh J. Nuclear Med. 27(1): 140-152, 2024

Bangladesh Journal of Nuclear Medicine

Evaluation of Surgical Outcome of Pelviureteric Junction Obstructive Patients by 99mTc-DTPA Renography

Homsy’s sign in DTPA renogram- initial experience at NINMAS

First Five Years Performance of FDG PET-CT in Institute of Nuclear Medical Physics, SavarAbstract to be submitted Bangladesh J. Nuclear Med. 27(1): page, 2024

A Comparison Study of the Solid Phantom and Water Phantom Using 6 MV and 15 MV Photon Energies, Depending on the Depth

Workplace Radiation Monitoring and Analysis: A Single Institution Based Study

The Outcomes and Success Rates of Kasai Operation for Biliary Atresia Cases Using Presurgical Hepatobiliary Scan: Observations at NINMAS

Association between Carotid Intima-Media Thickness (CIMT) and Alzheimers Disease Detected by 99mTc- ECD SPECT of Brain

Bone Scintigraphic Pattern and Correlation with Serum Prostate Specific Antigen Levels in Prostate Cancer Patients at NINMAS

Correlation of B-mode and Doppler Ultrasound Parameters of Kidney with Serum Creatinine Level in Chronic Kidney Disease Patients

Definitive Diagnosis of Hepatic Hemangioma by 99mTc Labeled Red Blood Cell SPECT and Comparative Analysis with Ultrasound

A Comprehensive Analysis of Lymphoscintigraphy Results for Lower Limb Edema in Pediatric Group of Patients at NINMAS

Newborn Screening for the Early Detection of Congenital Hypothyroidism: A Countrywide Comprehensive Program of Bangladesh Atomic Energy Commission

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

SPECT Myocardial Perfusion Imaging in the Diagnosis of Apical Hypertrophic Cardiomyopathy- Case Series and Literature Review

18F FDG PET/CT Findings in a Patient with Sarcoidosis: A Case Report

Baseline PET-CT evaluation of Bone Marrow-Liver-Spleen Type of Diffuse Large B-Cell Lymphoma: A Rare Aggressive Extranodal Lymphoma

Paradoxical Myocardial Perfusion Imaging Pattern in Cardiac Patient: Two Case Reports

The Intricate Diagnostic Journey of a Breast Cancer Patient, Revealing Extensive Hepatic Metastasis Through Extraosseous Uptake in Planar Bone Scintigraphy and SPECT-CT Precision Mapping

Incidental Finding of Mesenteric Cyst by 18F FDG PET- CT: Case Report

Assessment of Perfusion Abnormalities in a Case of Autism Spectrum Disorders Using 99mTc ECD Brain SPECT: A Landmark case in Bangladesh

Avascular Necrosis of Femoral Head in Bone Scintigraphy with Concurrent Parathyroid Adenoma Diagnosed by Parathyroid SPECT/CT- A Case Report

18F FDG PET Cardiac Imaging for Myocardial Viability Assessment in NINMAS

Radiotheranostics: A Potent Nuclear Medicine Tool for Combating Cancer - Exploring Prospects and Obstacles in Developing Countries

Abstracts

Association between Carotid Intima-Media Thickness (CIMT) and Alzheimers Disease Detected by 99mTc- ECD SPECT of Brain