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Background: Left ventricular function, volumes and regional wall motion provide valuable diagnostic information and are of long-term prognostic importance in patients with dilated cardiomyopathy (DCM). This study was designed to assess the agreement between the 2D-echocardiography and gated single-photon emission tomography (SPECT) for evaluation of these parameters in patients with DCM. Patients and methods: Gated SPECT and 2D-echocardiography were performed in 60 patients having DCM. Gated SPECT data, including left ventricular volumes and left ventricular ejection fraction (LVEF), were processed using an automated algorithm. Standard technique was used for 2D-echocardiography. Regional wall motion was evaluated using both modalities and was scored by two independent observers using a 4-point scoring system for 5 specific walls. Results: The overall agreement between the two imaging modalities for the assessment of regional wall motion was 95% (286/300 walls). With gated SPECT left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV) were 27.38±6.71%, 214.73±75.35 ml, and 158.33±63.22 ml, respectively, and 31.25±5.09%, 185.05±55.63 ml, and 123.47±46.00 ml, respectively, with echocardiography. The correlation between gated SPECT and 2D-echocardiography was moderate (r = 0.59, P

Papillary and follicular thyroid carcinomas, together known as differentiated thyroid carcinomas (DTC), are among the most curable of cancers. Distant metastases are rare events at the onset of DTC. Sites of metastases from follicular thyroid cancer (FTC) are usually osseous, and those from papillary thyroid cancer (PTC) metastasize to regional nodal basins and the lungs. Visceral metastases are rare, but the involvement of multiple sites has been reported so far. Liver metastases from differentiated thyroid carcinoma (LMDTC) are rare.We present the case of a patient with follicular variant of papillary thyroid carcinoma (FVPTC) unusually involving the liver. Bangladesh J. Nuclear Med. 22(2): 146-149, Jul 2019

Objective: It is well established that citrus stimulation has a definite role in preventing salivary gland damage after radioiodine therapy. The aim of this study was to observe how effectively this stimulation can be used to prevent salivary gland damage and whether the timing of sucking citrus substances play any role in preventing this damage more effectively. Patients and Methods: A total of 128 differentiated thyroid cancer (DTC) patients who received radioiodine treatment for thyroid carcinoma were divided into two groups- group-A and group-B. Group-A patients started citrus stimulation 1 hour after radioiodine ingestion and group-B patients started 24 hours after RAIT. Patients were followed-up at 5th day, 3rd month, and 6th month after RAIT. Follow up procedure consisted of physical examination and history of pain and swelling in salivary gland regions, taste dysfunction and dryness of mouth. Result: The incidence of different types of salivary glands side effects and abnormal scan findings were significantly high in the group of patients who were advised to start citrus stimulation 1 h after radioiodine ingestion. On the other hand, patients who started citrus stimulation 24 h after RAIT suffered less from salivary gland side effects. Conclusion: This study showed that delayed initiation of citrus stimulation was more effective in reducing salivary gland damage after RAIT. Bangladesh J. Nuclear Med. 21(2): 92-96, July 2018

Introduction: Bone scan with 99m Tc-MDP is a commonly used procedure for evaluation of bone metastases because of its high sensitivity, availability, and relatively low cost. The predilection sites for bone metastasis in patients particularly with lung cancers were investigated in this study.Methods: The study was done at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) between January 2013 and June 2014. A total of 123 patients with lung cancers who had whole body scintigraphy with 99mTc-MDP were studied. The bone scans were interpreted by experienced Nuclear Medicine physicians and the predilection sites with pattern of skeletal metastasis were analyzed.Results: Among the 123 (m/f: 104/19) cases studied, 99 (80.5%) patients had bone metastasis. Solitary metastatic lesion was detected in 18.2% cases, multiple lesions in 59.6% cases and extensive metastases were noted in 18.2% cases. Features of hypertrophic pulmonary osteoarthopathy were present in 4% cases. The predilection sites for metastases from lung cancer appear to be in the ribs (75% cases) followed by spines (54% cases) and pelvis (23% cases). In total 595 metastatic lesions were detected, among them 469(78.8%) were distributed in axial skeleton and 126 (21.2%) were in appendicular skeleton. Metastatic involvement was higher in axial skeleton comparing to the appendicular skeleton and the difference was statistically significant (Z=13.99, P

Purpose: Horseshoe kidney is a congenital malformation that is found incidentally in many of the asymptomatic patients undergoing 99mTc- DTPA renography and 99mTc-dimercaptosuccinic acid (DMSA) renal scans in the nuclear nephrology division of National Institute of Nuclear Medicine & Allied Sciences (NINMAS). Scan findings of year 2012 and 2013 are demonstrated in this study. Methods: Few of the patients had known ultrasound reports of ectopic positioned or non-visualized kidney and mostly referred to our institute for 99mTc-DTPA renogram. Each diuretic renogram consisted of dynamic renal scan images obtained with camera in both anterior and posterior positions and15% window centered at 140 keV using 64 X 64matrix. Acquisition started with bolus injection of 99mTc-DTPA and dynamic images were acquired at 16-seconds/ frame for 75 frames. Intravenous injection of furosemide (1 mg / kg body weight) was given between 10-15 minutes of the study. They each underwent a 99mTc-DMSA renal cortical scan to confirm the horseshoe kidney. Results: In a 2-year period, 14 patients (5 children and 9 adults) with horseshoe kidney were found with age ranging from 6 to 43 yrs (mean + SD,23.93 ± 9.19) and a male to female ratio of 9:5.Nearly one third of patients (35.8%) were asymptomatic. Urinary tract infections or infection like symptoms were present in five (35.8 %), whereas few showed vague symptoms like flank pain (7.1 %), abdominal pain (7.1 %), gastrointestinal symptoms such as nausea (7.1 %), abdominal distension and fullness (7.1 %). Three kidneys (21.42 %) showed stasis of radioactive urine in the renal pelvic region prior to diuretic injection, suggesting functional obstruction. Only one kidney (7.17 %) showed frank unilateral hydronephrosis and 2(14.28%) showed obstructive nephropathy. There was no incidence of bilateral hydronephrosis. Gross parenchymal disease was seen in 2 (14.28%) and mild parenchymal insufficiency in 4 (28.57%). In 2 (14.28%) cases normal renal function with low GFR were observed. 35.71% patients show horseshoe kidneys with normal function and GFR with variation of sizes of two distinct kidneys. Of the 14 patients, asymmetrical renal cortical function between the two kidneys was found in10 (71.4%). Conclusion: 99mTc-DMSA renal scan and diuretic renogram with 99mTc-DTPA are the simple techniques for the assessment of the patency of horseshoe shaped kidneys, because they can evaluate functional anatomy and urodynamics. DOI: http://dx.doi.org/10.3329/bjnm.v17i1.22488 Bangladesh J. Nuclear Med. 17(1): 25-29, January 2014

Hemangioma is one of the most common benign liver tumors. They are mostly asymptomatic. Differentiating hemangiomas from malignant tumoral lesions and metastases by a non invasive method is very important. We report a asymptomatic case with incidental finding of a large massive hemangioma occupying almost whole of the right lobe of liver and emphasized its detection by Tc-99m red blood cell (RBC) three phase imaging and localization of the tumor.Bangladesh J. Nuclear Med. 17(2): 153-155, July 2014

Objective: The modified fixed doses of radioactive iodine (RAI) in different types of hyperthyroidism had been practiced at National Institute of Nuclear Medicine & Allied Science (NINMAS) according to Society of Nuclear Medicine Bangladesh (SNMB) protocol since 2002 which was upgraded in 2015. The objective of the study was to observe the treatment outcome in modified fixed dose on previous protocol. Patients and Methods: In the present study the outcome of radioiodine therapy of hyperthyroid patients was retrospectively evaluated in 1349 consecutive primary hyperthyroid patients treated from January 2010 to December 2014 at NINMAS. Diagnosis of hyperthyroidism was done by thyroid function test; thyroid stimulating hormone (TSH), free triiodothyronine (FT3) & free thyroxine (FT4), 99m Technetium scan, thyroid radioiodine uptake and ultrasound imaging of thyroid gland. All patients received a fixed dose (8-29 m Ci) of radioactive iodine (RAI) depending on types of hyperthyroidism, visual assessment of gland size and severity of disease at diagnosis. They were followed up at 2 months of therapy, then every three months intervals for first year and thereafter 6 monthly up to 5 years or as needed during fluctuation of thyroid function.Results: Among the study population, 832 patients had diffuse toxic goiter (Graves’ disease), 369 patients were diagnosed as toxic multinodular goiter and 148 patients with single toxic nodule. At one year follow-up, permanent hypothyroidism occurred in 61.62% of patients and the cumulative incidence of hypothyroidism progressively increased up to 79.25% after 5 years. Cure or success of RAI therapy was considered as attainment of euthyroid state or hypothyroid state. About 11.26 % patients received more than single dose.Conclusion: Fixed dose RAI therapy is very much cost effective mode of treatment for primary hyperthyroidism with ~89% success by giving single dose.Bangladesh J. Nuclear Med. 20(1): 37-40, January 2017

Objective: The aim of this study was to compare the B mode ultrasonography findings of thyroid gland and peak systolic velocity of inferior thyroid artery by color Doppler application, in patients with diffuse toxic goiter at the time of diagnosis and 6-8 months after radioiodine 131-I therapy.Patients and Methods: This was a prospective observational study conducted in National Institute of Nuclear Medicine & Allied Sciences (NINMAS) between June 2015 and October 2016. Forty consecutive diagnosed diffuse toxic goiter patients were selected at the time of diagnosis prior to radioiodine therapy. An ultrasonography evaluation of thyroid gland (measurement of anterior posterior diameter for convenience) and measurement of peak systolic velocity of inferior thyroid artery in both sides of thyroid gland were performed before and after 131-I therapy (6-8 months). The examination was performed in thyroid division of NINMAS by advanced ultrasound machine with a linear transducer (5-12 MHz). The patients were divided into two groups. Group A-diffuse toxic goiter prior to radioiodine therapy and group B- same patients 6-8 months after radioiodine therapy.Results: A reduction in the anterior –posterior diameter of the thyroid gland was observed from pre to post treatment evaluation, performed at 6 and or 8 months after radioiodine therapy. Color Doppler showed increased parenchymal vascularity at the time of diagnosis which gradually declined after radioiodine therapy. Thyroid blood flow, as assessed by PSV of ITA, was significantly higher in Group A than in Group B respectively (70.5 ± 15.5 cm/ sec versus 22.2 ± 12.9 cm/sec). PSV was measured in 10 healthy euthyroid adults & their PSV ranged 13-20 cm/Sec. Parenchymal vascularity of the thyroid gland was higher in hyperthyroid patients than in euthyroid patients.Conclusion: Assessment of thyroid gland by B-mode ultrasound and blood flow by color Doppler study (CDS) is an effective marker in the initial diagnosis of diffuse toxic goiter.Bangladesh J. Nuclear Med. 20(1): 41-44, January 2017

Asymmetrical uptake of 99m Tc MDP (methylene diphosphonate) in skeletal scintigraphy in extremity may lead to confusion in the diagnosis of metastasis or complex regional pain syndrome. After the exclusion of possible contamination in this report a case was presented with asymmetrical uptake of MDP in the upper extremity from accidental intra-arterial injection.Bangladesh J. Nuclear Med. 19(2): 152-154, July 2016