<p>Skeletal scintigraphy is a highly sensitive tool in the detection of metastatic disease from prostate cancer, but its specificity is relatively low. Various quantitative parameters have been introduced to improve the bone scan specificity. Scintimetric method based Dr. V. Siva’s retention ratio is one such parameter proposed to help in predicting malignant or metastatic nature of the skeletal hot spots in a bone scan non-invasively. This study was performed to evaluate the V. Siva’s ratio in a small sample of prostate cancer patients in Bangladeshi population. This prospective observational study was carried out at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) from July 2015 to June 2016. A total of 32 patients with diagnosed prostate cancer were enrolled. Each patient underwent two bone scans at 4 hours and 24 hours respectively after radiopharmaceutical injection. Focal hot spots reported by expert Nuclear Medicine specialists were identified in both scans and maximum counts were taken by drawing region of interest over the spots. Dr. V. Siva’s retention ratio was calculated by dividing the 4-hour count with 24-hour count. Finally statistical analysis was done. The mean V. Siva's ratio of metastatic group was 9.3 ± 2.2 (95% CI 8.5-10.1) and that of degenerative group was 8.2 ± 2.0 (95% CI 7.5-8.9). Statistically significant difference was observed between the two groups. So it can be said that V. Siva’s retention ratio might be useful as a quantitative parameter in adjunct to conventional bone scintigraphy for the skeletal survey of carcinoma prostate patients.</p><p>Bangladesh J. Nuclear Med. 20(1): 9-13, January 2017</p>

<p><strong>Objectives:</strong> Bone is one of the most common organ for metastasis. Bone scintigraphy is widely used for staging of cancer patients before initiation of chemotherapy and adjuvant therapy and it can detect both symptomatic and asymptomatic bone metastases. The purpose of this study was to determine the frequency and site of metastatic bone lesion detected by bone scintigraphy in newly diagnosed asymptomatic cancer patients who werwe referred to National Institute of Nuclear Medicine &amp; Allied Sciences (NINMAS) for bone scintigraphy.</p><p><strong>Patients and Methods:</strong> This cross sectional observational type of study was carried out in NINMAS from July 2015 to June 2016. A total of 116 newly diagnosed asymptomatic cancer patients referred for the first time bone scintigraphy were included in this study.</p><p><strong>Results:</strong> Of the total 116 patients (57 male and 59 female; mean age: 54.8 ± 14.0 years), 46 (39.7%) patients had carcinoma breast, 30 (25.9%) patients had carcinoma prostate, 12(10.3%) patients had carcinoma lung, 8(6.9%) patients had carcinoma urinary bladder, 4(3.4%) patients had renal cell carcinoma and 16(13.8%) patients had other cancer. Bone scan was found positive for metastatic disease in 44.8% patients. Most common sites of bone metastases in different types of cancer in newly diagnosed asymptomatic cancer patients were rib, then hip bone, vertebral column (lumbar vertebra, thoracic vertebra respectively), sternum and skull.</p><p><strong>Conclusion:</strong> In this study, it was revealed that newly diagnosed asymptomatic cancer patients are frequently associated with metastatic bone disease, those can be detected by bone scintigraphy.</p><p>Bangladesh J. Nuclear Med. 20(1): 14-18, January 2017</p>

Ectopic thyroid gland is uncommon in our routine clinical practice and among them dual ectopic thyroid appears to be rarer. We report an unusual case of two different locations of ectopic thyroid tissues in the lingual and left submandibular regions of a 12 years old girl who presented with painless, nodular left upper neck swelling. Provisionally, the patient was diagnosed by high resolution ultrasound (HRUS) of neck and confirmed by radionuclide thyroid scan. Thyroid scintigraphy with 99mTc-pertechnetate is highly sensitive but minimally invasive procedure to detect and image the ectopic thyroid tissue with fairly good specificity and negligible radiation exposure. Bangladesh J. Nuclear Med. 23(1&2): 67-69, 2020

<p><strong>Objective: </strong>Lung carcinoma is the most common cancer worldwide with high potentiality of being metastasized to bone. Technetium-99m methylene diphosphonate (99mTc MDP) bone scintigraphy is a sensitive nuclear medicine imaging study to detect the skeletal metastases. The utilization of bone scan upon diagnosis of lung cancer appears to help in accurate staging of patients and planning treatment.  The aim of the present study was to see the role of baseline bone scintigraphy in the newly diagnosed lung carcinoma patients and also to see the number, pattern and sites of involvement of bone as well as to evaluate the skeletal metastases according to the different histological types of lung carcinoma.</p><p><strong>Patients and Methods:</strong> This observational study was carried out at the Institute of Nuclear Medicine &amp; Allied Sciences (INMAS), Sylhet during the period of July 2014 to June 2015. A total number of 59 lung carcinoma patients who attended at the scintigraphy division of INMAS, Sylhet within three months of their histopathological diagnosis were included in this study. Clinical staging was done from clinical evaluation (history and physical examination) and also form available investigation reports. Skeletal scintigraphy was performed by dual-head gamma camera using low-energy all purpose collimator, 2-3 hours after IV administration of 20-30 mCi of 99mTc MDP. Interpretation was done by recording the distribution of radiotracer within the skeleton along with correlation of history, physical examination, FNAC or biopsy reports and other relevant investigation findings.</p><p><strong>Results:</strong> Out of 59 patients, 43 (72.9%) were male and 16 (27.1%) were female. The age range of the patients was from 37 to 85 years with a mean (± SD) of 59.10 ± 10.43 years. The rate of lung carcinoma was highest in the age group of 55-64 years (45.7%), followed by 45-54 years (27.1%) and 65-74 years (11.9%). Incidence was lowest in patients below 45 years (6.8%) and above 75 years (8.5%). Skeletal metastases were detected in 52.54% of lung carcinoma patients where multiple lesions were seen in 87.1% of cases and solitary lesion in 12.9%. Among the metastatic lesions, 82.9% lesions were distributed in axial skeleton and 17.1% lesions were distributed in appendicular skeleton. Spine was the most frequent site of metastatic involvement in the present study which was 37.8% followed by ribs 28.0%, sternum 9.7% and pelvic bones 7.3%. Thoracic spine was found to be involved more (58.1%). Regarding patterns of metastatic lesions, 23 patients (74.1%) showed hot lesions, two patients (6.5%) showed cold lesions, four patients (12.9%) showed superscan and two patients (6.5%) showed pattern of hypertrophic osteoarthropathy. Bone metastasis was found in 75% cases of small cell lung carcinoma (SCLC) and 49.2% cases of non-small cell lung carcinoma (NSCLC). Among NSCLC, adenocarcinoma showed 62.9% metastases followed by 36.8% squamous cell carcinomas and 20.0% large cell carcinomas. In this series, clinical staging was done  and  11 patients ( 18.6% ) were found in stage I, 21 patients ( 35.6% )  in stage II,  23  patients  ( 39.0% ) in stage III  and  04 patients ( 6.8 % )   in stage IV.  Skeletal scintigraphy detected metastatic lesions in six of 11 cases (54.5 %) in clinical stage I, five of 21 cases (23.8 %) in clinical stage II, 16 of 23 cases (69.6 %) in clinical stage III and in all patients (100%) with clinical stages IV showing higher rate of bone metastases with advanced clinical stages.</p><p><strong>Conclusion</strong>: In this study, skeletal scintigraphy changed clinical staging of 27 patients. Early diagnosis of lung carcinoma, followed by bone scanning without delay helps to diagnose skeletal metastases, the presence of which is a major determinant in subsequent pathological staging and treatment planning.</p><p>Bangladesh J. Nuclear Med. 19(2): 111-115, July 2016</p>

Thyroid tissue may be found in an abnormal location along the thyroglossal duct tract or other sites due to abnormal embryologic development and migration. Thyroid ectopia is an uncommon but well-documented clinical entity. In the event of any neck swelling, it should be kept as a differential diagnosis. Thyroid scintigraphy plays a very important role in diagnosing ectopic thyroid, with the complementary primary role of high-resolution neck ultrasonography (HRUS). Reported case of an 18-year-old male referred to INMAS for evaluation of a slowly enlarging submental swelling with no history of dysphagia or dyspnea was biochemically hypothyroid. Patient had a history of submental swelling that was misdiagnosed as an abscess, creating a diagnostic dilemma, as he was found to have glandular tuberculosis after surgical drainage of the lesion. Bangladesh J. Nuclear Med. 25(2): 125-127, 2022

Thyroid disorders are among the most common endocrinopathies, and a wide array of patients are referred to Nuclear Medicine (NM) institutes for different thyroid-related investigations. In this study, we analyzed the findings of thyroid scintigraphy, high-resolution thyroid gland ultrasound, and thyroid hormone assays of 279 referred patients in the thyroid division of the Institute of Nuclear Medicine and Allied Sciences (INMAS), Mitford. The complementary role of the aforementioned investigations not only helped portray the pattern of thyroid disease in the historic southern part of Dhaka but also once again emphasized the importance of multidisciplinary diagnostic tools in disease management. Bangladesh J. Nuclear Med. 26(1): 31-33, 2023

Background: Staging of multiple myeloma (MM) requires quantification of lesions and serum biomarkers. Sestamibi (MIBI) scan can detect medullary and extra-medullary lesions whereas pathological fracture of MM when associated with osteoblastic activity which can be imaged by methyl diphosphonate (MDP). Patients and methods: This case report is of a biopsy proven case of MM with serum biomarkers inconclusive for staging. With evidence of multiple pathological rib fractures on conventional radiography, the patient was sent for MDP scan as she was unable to afford any other modality for whole body survey. A complimentary MIBI scan was therefore done. Results: MDP scan revealed multiple osteoblastic lesions in spine and ribs. The MIBI scan was conclusive for stage II active disease. Conclusions: MIBI scan added to diagnostic information and aided an inexpensive staging. MIBI scan can be an affordable work-up tool for MM. Bangladesh J. Nuclear Med. 22(2): 150-154, Jul 2019

Background: Breast carcinoma is a common type of malignancy in women worldwide. Radionuclide bone scintigraphy is recognized choice of investigation for the detection of bone metastases both in asymptomatic and symptomatic patients. Biomarkers like Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal growth factor -2 (HER-2) also play important role in the management and prognosis of breast cancer. The study was aimed to find out the relationship between the MDP bone scan findingsand hormone receptor and HER-2 status of breast carcinoma patients referred to the Institute of Nuclear Medicine and Allied Sciences (INMAS), Mitford, Dhaka. Patients and Methods: This cross sectional study was conducted among 301 breast carcinoma patients between January 2018 and December 2019. Planar bone scan and SPECT (if needed) was done to all the patients after intravenous injection of 99mTc-MDP. Receptor status (ER, PR and HER-2) were documented from the patient’s medical records. Breast tumors were classified as (a) Triple positive- HER2-, ER-, and PR-positive) (b) Triple negative- HER2-, ER-, and PR-negative (c) Hormonereceptor (HR) positive (ER+/PR+) with HER-2 negative and d) HR negative (ER-/PR-) with HER-2 positive.Patients were broadly grouped according to age as A. less than 50 years (n = 59) and B. more than 50 (n = 260 ) years. Results: The mean age of the patients enrolled for this study was 59.02±9.3 with range of 32 to 81 years. Out of the 301 patients, positive bone scans were found in 105 (34.8%) and negative bone scan were found 196 (66.2%). Patients of group A (<50years) with triple negative and HR+/HER-status had no bone or bone with visceral metastases. Triple positive subtype had 2 bone metastases, and HR-/HER-2+ subtype had 2 bone metastases and 1 had bone with visceral metastases. Group B (> 50years) patients having HR+/HER2- receptor status showed 16% solitary metastases, 53.2% multiple metastases, 33.3% extensive bony metastases, 13.6% bone with visceral metastases. Triple negative subtype showed 36.0 % solitary metastases, 19.1% bone with visceral metastases. Triple positive subtype group had 40.0% solitary metastases, 34.0 % multiple metastases, 66.7% extensive bony metastases, and 13.6% bone with visceral metastases. HR-/HER-2+ subtype group had 8% solitary metastases, 12.8% multiple metastases, and 18.2 % bone metastases with visceral involvement Overall relationship between bone scan and hormone receptor subtype, showed that most of the patients had HR+/ HER-2-(35.2%) subtype and 25.6% patient had triple positive, 23.3% patient had triple negative and 15.9% patient had HR-/HER-2 – receptor subtype. This study showed the visceral involvement with bone metastases (13 % in HR+/HER-2- 52.2 % in triple negative, 13 % in triple positive, 21.7 % in HR-/HER-2+subtype). Highest bone only metastases (35) in triple positive and HR+/HER-2-(31) subtype. Most of the patiens who had bone metastases with visceral involvement belong to triple negative (52.2%) and HER-2 subtypes -HR-/HER-2+ (21.7%). The result was significant (P<0.001). Conclusion: It is observed from this study that triple positive and HR+/HER-2- were more likely to develop bone metastases than triple negative and HR-/HER-2-. Patients with bone scan negative and HR-/HER-2- or triple negative receptor status most likely develop visceral metastases Bangladesh J. Nuclear Med. 22(2): 114-118, Jul 2019