Sadia Sultana

Evaluation of Skeletal Hot Spots in Carcinoma Prostate Patients by Scintimetric Method

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. Sivas 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. Bangladesh J. Nuclear Med. 20(1): 9-13, January 2017

Efficacy of Cardiac Blood Pool Activity in Hepatobiliary Scintigraphy for Diagnosis of Neonatal Hepatitis in Patients with Suspected Biliary Atresia

Background : Biliary atresia (BA) is the commonest fatal liver disorder in children. It results from developmental anomaly due to fibrosis of extra hepatic bile ducts. The reported global incidence of biliary atresia varies from 5/100,000 to 32/100,000 live births. Accurate diagnosis is important before 8 weeks of age, since hepatoportoenterostomy (Kasai’s procedure) has a 90% success rate at this stage whereas success rate drops to 20% beyond 3 months. On the other hand, neonatal hepatitis (NH) which is other most common cause of neonatal cholestasis (NC) needs conservative treatment. So, differentiation of biliary atresia from neonatal hepatitis is very crucial. Hepatobiliary scintigraphy (HBSG) is most popular method to differentiate biliary atresia from neonatal hepatitis. But in severe neonatal hepatitis the diagnosis become inconclusive when excretion of radiotracer in bowel become absent along with prolonged cardiac activity. Prolonged cardiac blood pool activity in hepatobiliary scintigraphy is an indication of hepatocyte destruction in neonatal hepatitis. The aim of the study was to assess the efficacy of cardiac blood pool in hepatobiliary scintigraphy for diagnosis of neonatal hepatitis in suspected biliary atresia patient. Patients and methods: A total of 24 infants with history of conjugated hyperbilirubinaemia underwent HBSG showed prompt cardiac blood pool activity (9 infants) and also with prolonged cardiac blood pool (15 infants) with no excretion of radiotracer in bowel either in early or delayed images was included in the study. The findings of HBSG were compared with percutaneous liver biopsy findings and analyzed. Result: Among 24 infants prolonged cardiac blood pool activity in HBSG was observed in 11 (73.3%) BA infants and 4 (44.4%) of NH infants. Absent bowel activity with prompt clearance of cardiac blood pool activity was observed in 4 (26.7%) BA infants and 5 (55.6%) NH infants. The difference was not statistically significant ( p >0.05).The calculated sensitivity of cardiac blood pool activity in HBSG for evaluation of NH was 44.4%, specificity was 26.7%, accuracy was 33.3%, positive predictive value (PPV) was 26.7% and negative predictive value (NPV) was 44.4%. The sensitivity, specificity, PPV, NPV and accuracy were low due to large number of false positive infants which might be due to complete obstruction of bile duct or due to early hepatocyte destruction (within 3 months of age). Conclusion: Although prolonged cardiac blood pool activity was considered as diagnostic criteria for the diagnosis of NH in suspected BA patient but it could not be able to differentiate these two conditions. Bangladesh J. Nuclear Med. 20(2): 124-128, July 2017

Analysis of Lag Behind Thyrotropin State After Radioiodine Therapy in Hyperthyroid Patients

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