Although serum thyroglobulin (Tg) is a reliable differentiated thyroid carcinoma (DTC) prognostic marker, its cutoff values can be affected by TSH stimulation status. Serum Tg prognostic values measured at different time points before and after radioactive iodine (RAI) therapy prepared with recombinant human TSH (rhTSH) in DTC patients, were investigated. This study included 160 DTC patients who underwent surgery followed by rhTSH-aided RAI therapy. Their serum Tg levels were measured 7 days before (D-7Tg), on the day of (D0Tg), and 2 days after (D2Tg) the RAI therapy. For response evaluation, the patients were classified into 2 groups: acceptable response and non-acceptable response (non-AR). Optimal Tg level cutoff values measured at different time points were evaluated for persistent or recurrent disease (PRD) prediction, as well as therapeutic response. Multivariate analysis showed that D-7Tg, D0Tg, and D2Tg significantly predicted non-AR ( P < .05, for all). Optimal Tg level cutoff values for non-AR prediction were 0.6, 2.6, and 3.7 ng/mL for D-7Tg, D0Tg, and D2Tg, respectively. Cox regression analysis showed that Tg levels were significantly associated with PRD free survival with D-7Tg, D0Tg, and D2Tg cutoff values of 0.8, 4.0, and 6.0 ng/mL, respectively (D-7Tg, P = .010; D0Tg, P = .005; D2Tg, P = .011). Serum Tg levels measured at the different time points could predict PRD free survival as well as therapeutic response with different cutoff values in DTC patients who underwent rhTSH-aided RAI therapy.

Introduction: Carcinoma of the lung is one of the most common cancer in Bangladesh. Fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) plays an important role in staging and evaluating therapy response. Currently, limited data is available about the demography and characteristics of lung cancer patients in Bangladesh by 18F-FDG PET-CT scan. Objectives: To evaluate the demographic pattern and pattern of findings in lung cancer patients by 18F-FDG PET-CT scan in the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka. Materials and Methods: This retrospective study was conducted in the PET-CT division of NINMAS. A total of 53 patients out of 103 patients with lung cancer were enrolled who were referred to NINMAS from October 2020 to December 2021 for either baseline PET CT or for assessment of therapy response. Data were collected in a predesigned format from old documents and analyzed for demographic characteristics, histopathologic, morphologic and metabolic patterns as well as a comparison of the overall number of lung cancer patients with previous years. Results: Among the enrolled 53 lung cancer patients the majority (34%) are in the 6th to 7th decades with 56.6% male and 43.4 % female. Adenocarcinoma (62%) and squamous cell carcinoma (24%) were the most common lung cancer subtypes. The majority of patients (53%) came for a therapeutic response evaluation; among them, 32% had a good response following therapy, 25% with progressive disease and others had mixed response, partial response, and stable disease. Nine percent of the patients came for follow up and among them, recurrence is detected in 20%. Lung cancer patients who came for baseline study, (38%) were upstaged (80%) mainly with 20% remaining in the same stage. Conclusion: The demographic pattern of lung cancer patients observed in this study belonged to 6th & 7th decades having male predominance. Most of the patients were diagnosed with advanced stages of lung cancer. The use of 18FDG PET-CT is crucial for the staging and diagnosis of suspected lung cancer, as well as therapeutic response and follow-up. Bangladesh J. Nuclear Med. 25(1): 22-27, 2022

Abstract

Objective: Worldwide, osteoporosis in postmenopausal women is a common public health problem. The measurement of bone mineral density (BMD) of spine and hip using central dual energy X-ray absorptiometry (DXA) is the most standard technique to diagnose osteoporosis. But in many circumstances, measurement of spine or hip BMD is quite difficult to carry out where wrist BMD can be used as an alternative. Moreover, wrist BMD can be done with smaller, cheaper, portable peripheral devices for screening osteoporosis at primary health care level. The objective of the study was to explore the agreement of wrist BMD with spine and hip BMD in postmenopausal women. Patients and Methods: This observational, cross sectional study was carried out at National Institute of Nuclear Medicine & Allied Sciences (NINMAS), Bangabandhu Sheikh Mujib Medical University (BSMMU) campus, from July 2017 to June 2018. A total of 110 postmenopausal women referred to NINMAS for BMD measurement were enrolled in this study after fulfilling selection criteria.  BMD of spine, right and left hip and wrist of enrolled subjects were measured by dual energy X-ray absorptiometry (DXA) scan by Stratos DR Bone densitometer. Results:  Agreement analysis done by kappa statistics revealed kappa value of 0.930 (p<0.05), 0.782 (p<0.05) and 0.635 (p<0.05) between wrist and spine BMD, wrist and right hip BMD and wrist and left hip BMD, respectively. In Bland-Altman analysis, the mean difference of T-score measured by wrist and spine was -0.007 ± 1.361, wrist and right hip was -0.645 ± 1.271 and wrist and left hip was -0.450 ± 1.259 with 95% of differences were found in between -2.674 and 2.660, -3.136 and 1.846 and -2.917 and 2.017, respectively. Positive significant Pearson’s correlation was observed between wrist BMD and spine BMD (r=0.664; p=0.001), wrist BMD and right hip BMD (r=0.719; p=0.001) and wrist BMD and left hip BMD (r=0.727; p=0.001). Conclusion: This study results showed an excellent kappa agreement between wrist and spine BMD with good kappa agreement of wrist with right and left hip BMD as well as in Bland-Altman analysis, the mean differences of T-score between wrist andspine, wrist and right hip and wrist and left hip were small. The biases between the methods were considered not significant suggesting that these sites can be used interchangeably for measurement of BMD. Hence, wrist BMD can be used with regular skeletal sites (spine and hip) as an effective method of diagnosing osteopenia and osteoporosis by DXA where spine or hip BMD is difficult to carry out as well as it can be used for osteoporosis screening at primary health care level by portable peripheral DXA device to initiate early treatment to reduce fracture risks. Bangladesh J. Nuclear Med. 22(1): 41-46, Jan 2019

Background: Renovascular hypertension is a secondary form of hypertension which occurs due to renal artery stenosis and is potentially curable. The gold standard for diagnosis of this condition is renal angiography which is rather invasive. Captopril renography on the other hand is an established technique used for more than three decades for accurate and non-invasive diagnosis of significant renovascular hypertension. At NINMAS captopril renography is also used to screen renovascular hypertension and has been a routine procedure since the mid-nineties. Aim: The aim of the present study is to reassess the value of captopril renography test after two decades of its use at NINMAS.

<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>

<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>

Background: Cirrhosis is characterized by diffused hepatic fibrosis and nodule formation that can occur at any age. It has significant morbidity and mortality. Worldwide common causes of cirrhosis are viral hepatitis (hepatitis B virus and hepatitis C virus), prolonged excessive alcohol intake and nonalcoholic fatty liver disease (NAFLD). Progression of chronic liver disease (CLD) and deterioration of liver function are associated with various hepatic complications. Hepatic osteodystrophy is an important extrahepatic manifestation of advanced liver disease with features of classical osteoporosis and an increased risk for fractures. The objective of the study to assess the bone mineral density (BMD) by duel energy x-ray absorptiometry (DEXA) in patients with nonalcoholic steatohepatitis (NASH) cirrhosis of liver.  Patients and Methods: A cross sectional observational study was carried out at National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Bangabandhu Sheikh Mujib Medical University (BSMMU) campus, Dhaka, from July, 2016 to June, 2017. This study included the diagnosed cases of NASH cirrhosis patients presented at outpatient or inpatient department of Hepatology of BSMMU. For measurement of the BMD dual energy x-ray absorptiometry (DEXA) scan was performed by DMS Strator DR Bone densitometer at NINMAS.  BMD were measured at lumbar vertebrae L1-L4 and both the femoral neck. Analysis of data from DEXA was computerized and completely automated (software 3DXA, Medix DR.)   Results: A total of 54 participants was included and among them 27 were cirrhotic patients (cirrhotic group) & 27 were non-cirrhotic patients with healthy liver (non-cirrhotic group). The age range of the patients was 40-70 years in both groups. Male to female ratio was 1:1.45.  The mean age was 56.3 ± 6.7 years in cirrhotic group and 55.0 ± 6.3 years in non cirrhotic group. In cirrhotic group, 22 (66.7%) patients had low BMD and five (23.8%) patients had normal BMD. In non-cirrhotic group, 11 (33.3%) patients had low BMD and 16 (76.2%) patients had normal BMD. The difference was statistically significant (p < 0.05) between two groups. Multivariate logistic regression analysis was done to see the effect of multiple independent variables (age, menopause and cirrhosis) on dependent variable (low BMD). In cirrhotic patients odds ratio (OR) was 1.961 (95% CI 0.110 to 25.893) which implies cirrhotic patients had 1.961 times greater chance to develop low BMD than non cirrhotic patients keeping all other factors in fixed level.  Conclusion: Hepatic osteodystrophy is an important extrahepatic complication of cirrhosis. NASH cirrhosis is found among elderly people and female. Osteoporosis is common in aged people and menopausal female. But in this study it was observed that a NASH cirrhosis patient is highly significant risk factor for low BMD (osteopenia and osteoporosis) other than aged persons and menopausal females. So, special measures and monitoring should be taken regarding osteoporosis in NASH cirrhotic patient to reduce subsequent morbidity. Bangladesh J. Nuclear Med. 21(1): 16-20, January 2018