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Avascular necrosis (AVN) may be defined as cellular death of bone components due to the lack of blood supply resulting in joint damage and loss of joint function. This condition may arise from a number of causes i.e. both traumatic and non-traumatic. Diagnosis of the disease at an early stage and deliberate management can prevent the unwanted complications like femoral head collapse and severe arthritis and may save the bone. Although diagnosis of AVN is primarily dependent on radiological investigations, the incremental value and vital role of 99mTc-methylene diphosphonate (99mTc-MDP) single-photon emission computed tomography (SPECT) over planar bone scintigraphy permits more accurate localization of lesions and provide pertinent information to recognize the disease at initial stage for better management. We present a case of unexplained low back pain in a young woman who was diagnosed as having avascular necrosis of both femoral heads by 99mTc-MDP bone scan incorporated with SPECT Bangladesh J. Nuclear Med. 23(1&2): 55-58, 2020

Liver scintigraphy is a specialized nuclear medicine imaging technique used to diagnose hepatic pathological conditions as well as to assess the function of the liver. Itis also used to follow the progress of treatment of certain diseases. This procedure may be referred as liver-spleen scan because the spleen is alsoevaluateddue to its proximity and close functional relationship to liver.SPECT-CT correlation along with planar images increases the specificity of the test and can guide the physicians to rule outdiagnostic dilemma regarding certain hepatic & splenic diseases. Here, we present a case where the patient was initially suspected tohave splenomegaly with splenic hematomabut finally confirmedas unusuallyenlarged left lobe of liverand normal sized spleen with SPECT-CT of liver-spleen scan. Bangladesh J. Nuclear Med. 22(2): 161-165, Jul 2019

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

Lesion at the superior orbital margin is infrequently seen on MDP bone scintigraphy, however the exactetiology cannot always be clearly explained. Here, acase is presented showing focal uptakeof MDP tracer in right supra-orbital region. Single photon emission computed tomography/computed tomography (SPECT/CT) was done to localize and characterize this undetermined lesion. Bangladesh J. Nuclear Med. 22(1): 73-75, Jan 2019

Introduction: A good number of hyperthyroid patients may show delayed recovery of Thyroid Stimulating Hormone (TSH) level in clinically evident euthyroid condition after radioiodine therapy. This group of patients need to be addressed in therapeutic decision making. The purpose of the study was to evaluate the duration and pattern of lag in TSH recovery after I - 131 therapy and the relationship between clinical parameters with stable thyroid function status.Materials and Methods: Total 192 hyperthyroid patients treated with I-131 were included in this study. These patients were followed up clinically and biochemically at three month, six month and one year after radioiodine therapy. Patients having suppressed TSH with normal Free Triiodothyronine (FT3) / Free Thyroxin (FT4) level and clinically euthyroid condition were followed-up for one year without giving antithyroid drug.Results: At three months follow-up 42/192 (22%) had suppressed TSH with normal FT3/FT4 level. Duration of lagging behind state of TSH was three months for 42 patients (22 %), six months for 13 patients (7%) and One year in three patients (2 %). Twelve patients were lost from follow-up. Among 30 patients with lag behind TSH level, 16 (53%) became hypothyroid, 8 (27%) became euthyroid and 6 (20%) became hyperthyroid at one year follow-up. Lagging behind patient with high serum FT4 level at diagnosis and high Radio Active Iodine Uptake (RAIU) showed increased rate of relapse of hyperthyroidism.Conclusion: Lagging state of TSH may be unexpectedly prolonged in some hyperthyroid patients treated with I-131. These patients should be followed up with both TSH and thyroid hormone levels. Most of them do not require further therapy with short period of time.Bangladesh J. Nuclear Med. 17(2): 103-107, July 2014

Ectopic gall bladder is a rare entity. It can often be misdiagnosed causing diagnostic dilemma leading to various complications. Ultrasonography is the most common investigation for evaluating gall bladder pathologies. However, the confirmation of ectopic gallbladder is not easily possible by this method. On the other hand, hepatobiliary scan (HIDA scan) plays an important role in evaluating the presence and position of ectopic gallbladder. Here we present a case of sonographically suspected ectopic gallbladder confirmed by hepatobiliary scan highlighting the importance of HIDA scan in ectopic gallbladder.Bangladesh J. Nuclear Med. 17(2): 156-158, 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