Nosheen Fatima
Aga Khan University, Radiology, Faculty Member
Meckel\u27s diverticulum (MD) is the most common gastrointestinal anomaly with heterotopic mucosa in 60% of cases. 99m technetium-pertechnetate scintigraphy is a sensitive tool for detection of MD containing heterotopic gastric mucosa. It... more
Meckel\u27s diverticulum (MD) is the most common gastrointestinal anomaly with heterotopic mucosa in 60% of cases. 99m technetium-pertechnetate scintigraphy is a sensitive tool for detection of MD containing heterotopic gastric mucosa. It is usually located in the right lower quadrant or umbilical region and less frequently in other quadrants. A mobile or wandering MD is a rare clinical presentation and may pose a diagnostic dilemma. However, presence of temporal correlation with gastric activity and compactness of focus during wandering period could make this riddle easy
Research Interests:
Tumor thrombosis is a relatively uncommon complication of renal cell carcinoma (RCC), and its diagnosis has therapeutic and prognostic implication. Computerized tomography (CT) is the primary imaging modality for staging RCC, but it has... more
Tumor thrombosis is a relatively uncommon complication of renal cell carcinoma (RCC), and its diagnosis has therapeutic and prognostic implication. Computerized tomography (CT) is the primary imaging modality for staging RCC, but it has low sensitivity to differentiate between tumor thrombus and bland or benign thrombus. 18-fluorodeoxyglucose positron emission tomography/CT (PET/CT) has a limited role in diagnosis and staging of RCC, but its diagnostic accuracy is considerably high for detection of metabolically active tumor thrombus. We are presenting a case of metastatic left-sided RCC with massive hypermetabolic tumor thrombus extending from left kidney to left renal vein and inferior vena cava giving an interesting Suspension Bridge appearance on PET/CT images
Research Interests:
Objective The purpose fo this prospective study was to find the impact of primary tumor size (Ts), standardized uptake values (SUVmax) of primary tumor, and the most avid neck node on disease recurrence in patients with head and neck... more
Objective The purpose fo this prospective study was to find the impact of primary tumor size (Ts), standardized uptake values (SUVmax) of primary tumor, and the most avid neck node on disease recurrence in patients with head and neck oropharyngeal squamous cell carcinoma (HNOP-SCC). Material and methods We included patients with HNOP-SCC (without distant metastasis—M0 disease) who had pre- and post-treatment F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT) using strict standardized imaging protocol from 2017 to 2019. Based on follow-up (18FDG PET/CT) findings, patients were categorized as disease free (no or minimal 18FDG uptake ≤ background over surgical bed and no distant metastasis) and disease recurrence (18FDG uptake > background over surgical bed with or without nodal and/or distant metastasis). Ts and SUVmax of primary tumor and the most avid neck node were compared and impact of these was studied upon disease recurrence. Results Tota...
Research Interests:
In re ce nt days , iodinate d contras t age nts are one of th e m os t com m onl y pre s cribe d drugs and h ave contribute d s ignificantl y in th e ph e nom e nal grow th of radiol ogy in th e pre s e nt e ra.Al l curre ntl y avail abl... more
In re ce nt days , iodinate d contras t age nts are one of th e m os t com m onl y pre s cribe d drugs and h ave contribute d s ignificantl y in th e ph e nom e nal grow th of radiol ogy in th e pre s e nt e ra.Al l curre ntl y avail abl e contras t m e dia are ch e m ical m odifications of a 2,4,6-tri-iodinate d be nz e ne ring and com m onl y cl as s ifie d on th e bas is of os m ol al ity into h igh os m ol al ity age nts (diatriz oate anion as Re nografin® , H ypaq ue ® , Conray®) and l ow os m ol al ity age nts w h ich are s ub-cl as s ifie d into non-ionic m onom e rs (Om nipaq ue ® , Ul travis t® , Opt iray®), ionic dim e rs (H e xabrix®) and non-ionic dim e rs (V is ipaq ue ®). Th e s e contras t age nts are us ual l y s af e , and adve rs e re actions are ge ne ral l y m il d and s e l f-l im iting. None th e l e s s , s e ve re or l if e-th re ate ning re actions can occur. Th e s e adve rs e re actions are cl as s ifie d as im m e diate (occurring w ith in 01 h our of inj...
Renal scintigraphy using 99m Tc MAG-3 and 99m Tc DMSA are the most commonly prescribed functional imaging for patients with various renal diseases. Visualization of bone marrow on renal imaging is an unusual finding. We present a case of... more
Renal scintigraphy using 99m Tc MAG-3 and 99m Tc DMSA are the most commonly prescribed functional imaging for patients with various renal diseases. Visualization of bone marrow on renal imaging is an unusual finding. We present a case of chronic renal failure whose renal scans with 99m Tc MAG-3 revealed enhanced marrow perfusion and 99m Tc DMSA study showed uptake of tracer in axial and appendicular skeleton
Research Interests:
Osteopetrosis is a rare and inherited skeletal disorder characterized by severe osteosclerosis due to a defect in osteoclast differentiation (osteoclast deficient) or its dysfunction (osteoclast rich). Three types of osteopetrosis have... more
Osteopetrosis is a rare and inherited skeletal disorder characterized by severe osteosclerosis due to a defect in osteoclast differentiation (osteoclast deficient) or its dysfunction (osteoclast rich). Three types of osteopetrosis have been described like congenital (autosomal recessive), intermediate or marble bone disease (autosomal recessive) and tarda (autosomal dominant). Prognosis is worst for osteopetrosis congenital, better for marble bone disease and best for osteopetrosis tarda. Treatment is primarily symptomatic with stem cell marrow transplantation for the most severe cases (autosomal recessive types) with bone marrow failure and currently offers best chance of longer survival. Key words : Osteopetrosis; marble bone disease; Albers-Schonberg disease; bone marrow failure; bone mineral density; Erlenmeyer flask" deformity
Research Interests:
Objective: Obesity is generally considered as a risk factor for coronary artery disease (CAD) and cardiac deaths but some reports suggest better survival in obese with CAD. The objective of this study was to find out predictive value of... more
Objective: Obesity is generally considered as a risk factor for coronary artery disease (CAD) and cardiac deaths but some reports suggest better survival in obese with CAD. The objective of this study was to find out predictive value of body mass index (BMI) and waist circumference (WC) for CAD and its outcome using gated myocardial perfusion imaging (GMPI). Material and Methods: This was a prospective study conducted at Nuclear Cardiology Department of Karachi Institute of Heart Diseases (KIHD), Karachi, Pakistan from August 2011 till May 2013. 400 patients who qualified study criteria were included and were divided in (a) to Obese (BMI ≥ 30 Kg/m 2 ) and Non-obese (BMI < 30 30 Kg/m 2 ) and (b) Low-WC group (male <90cm and female <80 cm) and High-WC group (male≥90 cm and female ≥80cm). Rest and stress GMPI using Tc-99m MIBI was performed in all patients and abnormal GMPI was followed by coronary angiogram. These patients were followed for 12-18 months regarding fatal and no...
Research Interests:
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy comprised of papillary (80%) and follicular (10%) types and is associated with high 10-year survival rate (90 to 95%) (Sawka et al., 2004; Zaman et al., 2013).... more
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy comprised of papillary (80%) and follicular (10%) types and is associated with high 10-year survival rate (90 to 95%) (Sawka et al., 2004; Zaman et al., 2013). Adjuvant ablation of residual functioning thyroid tissue using radioiodine-131 (RAI) is considered a mainstay of managing these cancers (Cooper et al., 2006) due to advantages of eradication of occult cancer and improved sensitivity of sTg and post-operative whole body iodine scan (WBIS) as a marker for disease recurrence (Sherman 2003). Successful ablation is defined as undetectable sTg and a negative WBIS (Pacini et al., 2006). However,
Meaningful change in bone mineral density (BMD) should be equal or higher than institutional least significant change (LSC). But some facilities use vendor's LSC which is discouraged by International Society for Clinical Densitometry... more
Meaningful change in bone mineral density (BMD) should be equal or higher than institutional least significant change (LSC). But some facilities use vendor's LSC which is discouraged by International Society for Clinical Densitometry (ISCD). The aim of this study was to find the impact of scan interpretation upon interval BMD changes using vendors and institutional LSCs. This prospective study was conducted at Joint Commission International-accredited facility of Pakistan from April-June 2017 using Hologic Discovery-A scanner. As per ISCD recommendations, precision error and LSC of two technologists were measured. Serial BMD changes such as deterioration or improvement interpreted based on vendor's and institutional LSCs were compared. Serial BMD changes in 102 patients were included, having a mean age, male:female ratio, and mean body mass index of 63 years, 94%:06%, and 29.274 kg/m, respectively. Mean menopausal age was 47 years and mean duration between two dual X-ray abs...
Research Interests:
This prospective study was carried out to find the negative predictive value of various Duke Treadmill Scores (DTSs) in patients with normal myocardial perfusion imaging (MPI). This study was conducted from August 2012 to July 2015, and... more
This prospective study was carried out to find the negative predictive value of various Duke Treadmill Scores (DTSs) in patients with normal myocardial perfusion imaging (MPI). This study was conducted from August 2012 to July 2015, and 603 patients having normal exercise MPIs were included. Patients were followed for 2 years for fatal myocardial infarction (FMI) and nonfatal myocardial infarction (NFMI). Follow-up was not available in 23 patients, leaving a cohort of 583 participants. DTS was low risk (≥5) in 286, intermediate risk (between 4 and - 10) in 211, and high risk (≤-11) in 86 patients. Patients with high- and intermediate-risk DTS were significantly elder than low-risk DTS cohort. Patients with high-risk DTS had significantly higher body mass index with male preponderance compared to other groups. No significant difference was found among three groups regarding modifiable or nonmodifiable risk factors and left ventricular ejection fraction. On follow-up, single FMI was o...
Research Interests:
Prostate cancer (PC) is the most frequent solid tumor in men and the third most common cause of cancer mortality among men in developed countries. Current imaging modalities like ultrasound (US), computerized tomography (CT), magnetic... more
Prostate cancer (PC) is the most frequent solid tumor in men and the third most common cause of cancer mortality among men in developed countries. Current imaging modalities like ultrasound (US), computerized tomography (CT), magnetic resonance imaging (MRI) and choline based positron emission (PET) tracing have disappointing sensitivity for detection of nodal metastasis and small tumor recurrence. This poses a diagnostic challenge in staging of intermediate to high risk PC and restaging of patients with biochemical recurrence (PSA >0.2 ng/ml). Gallium-68 labeled prostate specific membrane antigen (68Ga-PSMA) PET imaging has now emerged with a higher diagnostic yield. 68Ga-PSMA PET/CT or PET/MRI can be expected to offer a one-stop-shop for staging and restaging of PC. PSMA ligands labeled with alpha and beta emitters have also shown promising therapeutic efficacy for nodal, bone and visceral metastasis. Therefore a PSMA based theranostics approach for detection, staging, treatmen...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The negative predictive value of a normal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is very high. However, prognostic implication of a normal SPECT MPI in patients with known coronary artery... more
The negative predictive value of a normal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is very high. However, prognostic implication of a normal SPECT MPI in patients with known coronary artery disease (CAD) is not clear. Objective of this study was to evaluate the cardiac event rate in patients with known CAD who had a normal stress SPECT MPI. This prospective study accrued 428 consecutive patients with a history of CAD [revascularization or previous myocardial infarction (MI)] who had a normal stress (dynamic exercise or dipyridamole intervention) and rest Tc-99m-MIBI SPECT MPI. These patients were followed for 2-5 years (median: 3.1 years) for all-cause and cardiac mortality and non-fatal MI. Univariate and multivariate analyses were performed to identify predictors of outcome. During a follow-up period, all-cause mortality was found in 60 patients (14%) and 41 (10%) died of cardiac reasons. Non-fatal MI was found in 77 (18%) patients. Ann...
Research Interests:
Amiodarone is an effective anti-arrhythmic agent for control of various life threatening ventricular tachyarrhythmias but may give Various side effects. Clinically relevant thyroid dysfunction is not uncommon during amiodarone therapy and... more
Amiodarone is an effective anti-arrhythmic agent for control of various life threatening ventricular tachyarrhythmias but may give Various side effects. Clinically relevant thyroid dysfunction is not uncommon during amiodarone therapy and is caused by iodide excess and inhibition of deiodinase activity. Amiodarone induced thyroid dysfunction varies from asymptomatic variation in thyroid function to clinically overt hypothyroidism and thyrotoxicosis. Prolonged elimination and half life and associated complications warrant for rational prescribing and long term follow up.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
99mTc is the work horse of every nuclear medicine department. It is obtained by the elution of a 99Molybdenum-99mTechnetium (99Mo-99mTc) generator. Molybdenum-99 (t1/2 = 66 h) decays by beta emission to 99mTc (87%) and 99Tc (13%),... more
99mTc is the work horse of every nuclear medicine department. It is obtained by the elution of a 99Molybdenum-99mTechnetium (99Mo-99mTc) generator. Molybdenum-99 (t1/2 = 66 h) decays by beta emission to 99mTc (87%) and 99Tc (13%), emitting photons of 740 and 778 ...
Research Interests:
Research Interests:
Research Interests: Magnetic Resonance Imaging, Medical Physics, Positron Emission Tomography, Medicine, Modalities, and 10 moreHumans, Medical Oncology, Functional Imaging, Multimodal imaging, Public health systems and services research, Neoplasms, Radiopharmaceuticals, X ray Computed Tomography, Contrast Media, and Neoplasm staging
Research Interests:
Research Interests:
The primary purpose of this brief review is to discuss the basic facts about Meckel’s diverticulum, its complications like bleeding and role of radiological and nuclear medicine imaging in the detection of Meckel’s diverticulum and... more
The primary purpose of this brief review is to discuss the basic facts about Meckel’s diverticulum, its complications like bleeding and role of radiological and nuclear medicine imaging in the detection of Meckel’s diverticulum and heterotopic gastric mucosa. Key words : Meckel’s diverticulum; bleeding; ultrasound; scintigraphy; computerized tomography
Research Interests:
The primary purpose of this brief review is to discuss the basic facts about Meckel’s diverticulum, its complications like bleeding and role of radiological and nuclear medicine imaging in the detection of Meckel’s diverticulum and... more
The primary purpose of this brief review is to discuss the basic facts about Meckel’s diverticulum, its complications like bleeding and role of radiological and nuclear medicine imaging in the detection of Meckel’s diverticulum and heterotopic gastric mucosa. Key words : Meckel’s diverticulum; bleeding; ultrasound; scintigraphy; computerized tomography
Research Interests:
Background : Time, distance and shielding are the 3 effective methods to keep radiation dose to radiation workers. However, in small but busy nuclear medicine department, efficacy of distance from injected patients staying in hot waiting... more
Background : Time, distance and shielding are the 3 effective methods to keep radiation dose to radiation workers. However, in small but busy nuclear medicine department, efficacy of distance from injected patients staying in hot waiting area is questioned. The aim of this study was to find out the exposure rate in hot waiting area of a busy nuclear medicine department and measuring of radiation dose to NM technologists them during study period. Material and Methods : This was a prospective study conducted from 1 st November 2015 till 31 st December 2015 at Nuclear Medicine Department of Dr Ziauddin Hospital Karachi, Pakistan, having an area of 240 square meters and equipped with 01 gamma camera. Exposure rate was measured on all patients at 1 meter distance from anterior mid trunk in sitting position using digital rate meter (Radiation Alert Inspector, S.E. international, INC). Observed measurements of exposure rate were carried out first at 1 meter distance from sitting patients i...
Research Interests:
Background : Time, distance and shielding are the 3 effective methods to keep radiation dose to radiation workers. However, in small but busy nuclear medicine department, efficacy of distance from injected patients staying in hot waiting... more
Background : Time, distance and shielding are the 3 effective methods to keep radiation dose to radiation workers. However, in small but busy nuclear medicine department, efficacy of distance from injected patients staying in hot waiting area is questioned. The aim of this study was to find out the exposure rate in hot waiting area of a busy nuclear medicine department and measuring of radiation dose to NM technologists them during study period. Material and Methods : This was a prospective study conducted from 1 st November 2015 till 31 st December 2015 at Nuclear Medicine Department of Dr Ziauddin Hospital Karachi, Pakistan, having an area of 240 square meters and equipped with 01 gamma camera. Exposure rate was measured on all patients at 1 meter distance from anterior mid trunk in sitting position using digital rate meter (Radiation Alert Inspector, S.E. international, INC). Observed measurements of exposure rate were carried out first at 1 meter distance from sitting patients i...
Research Interests:
Research Interests:
Research Interests:
Aim: Aga Khan University Hospital has recently embarked into PET/CT imaging and we have tailored standard operating procedures (SOP) as per recent guidelines. This clinical audit was done to ensure good clinical practice as per defined... more
Aim: Aga Khan University Hospital has recently embarked into PET/CT imaging and we have tailored standard operating procedures (SOP) as per recent guidelines. This clinical audit was done to ensure good clinical practice as per defined bench marks. Material Methods: This clinical audit was conducted from 1 st July till 5 th August 2016 and we did audit of 11 parameters related to demographics, patient preparation, acquisition protocol, qualitative and semiquantitative parameters, reporting and radiation dose from PET/CT study. The compliance of these parameters was checked against predefined benchmarks. Results: 100% compliance was found for demographic, height and weight entries, fasting blood glucose level, pregnancy, intravenous contrast and low dose CT scan. Non-compliance was found for dose of 18 FDG (71% for 3 MBq/kg benchmark), uptake time (25% against 55-75 minute benchmark), mean hepatic uptake (19% against 1.3-3% benchmark) and addenda in reporting (4% against 0.5% benchm...
Research Interests:
Aim: Aga Khan University Hospital has recently embarked into PET/CT imaging and we have tailored standard operating procedures (SOP) as per recent guidelines. This clinical audit was done to ensure good clinical practice as per defined... more
Aim: Aga Khan University Hospital has recently embarked into PET/CT imaging and we have tailored standard operating procedures (SOP) as per recent guidelines. This clinical audit was done to ensure good clinical practice as per defined bench marks. Material Methods: This clinical audit was conducted from 1 st July till 5 th August 2016 and we did audit of 11 parameters related to demographics, patient preparation, acquisition protocol, qualitative and semiquantitative parameters, reporting and radiation dose from PET/CT study. The compliance of these parameters was checked against predefined benchmarks. Results: 100% compliance was found for demographic, height and weight entries, fasting blood glucose level, pregnancy, intravenous contrast and low dose CT scan. Non-compliance was found for dose of 18 FDG (71% for 3 MBq/kg benchmark), uptake time (25% against 55-75 minute benchmark), mean hepatic uptake (19% against 1.3-3% benchmark) and addenda in reporting (4% against 0.5% benchm...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The purpose of this prospective study was to determine metabolic response predictor(s) in propensity-matched patients having lymphomas who had baseline and interim 18fluorodeoxyglucose (FDG) positron-emission tomography/computed... more
The purpose of this prospective study was to determine metabolic response predictor(s) in propensity-matched patients having lymphomas who had baseline and interim 18fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) using strict standardized imaging and reporting protocols. This prospective study was conducted at PET/CT section of a JCI-accredited healthcare facility from April 2017 to February 2018. Patients with baseline and interim 18FDG PET/CT scans using standardized protocol were selected. Interim scans were performed not earlier than 2nd or later than 4th chemotherapy. During the study period, 97 of 112 consecutive patients with lymphomas (Hodgkin-HL: 32/97 and Non-Hodgkin-NHL: 65/97) were included in the study. Mean age of cohort was 45 ± 19 years (71% male and 29% female) having a mean body mass index (BMI) of 25.57 ± 5.54 Kg/m2 having Stage I (21%), Stage II (18%), Stage III (16%), and Stage IV (45%) disease. Bulky disease was found in 14% ...
Research Interests:
The purpose of this prospective study was to determine metabolic response predictor(s) in propensity-matched patients having lymphomas who had baseline and interim 18fluorodeoxyglucose (FDG) positron-emission tomography/computed... more
The purpose of this prospective study was to determine metabolic response predictor(s) in propensity-matched patients having lymphomas who had baseline and interim 18fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) using strict standardized imaging and reporting protocols. This prospective study was conducted at PET/CT section of a JCI-accredited healthcare facility from April 2017 to February 2018. Patients with baseline and interim 18FDG PET/CT scans using standardized protocol were selected. Interim scans were performed not earlier than 2nd or later than 4th chemotherapy. During the study period, 97 of 112 consecutive patients with lymphomas (Hodgkin-HL: 32/97 and Non-Hodgkin-NHL: 65/97) were included in the study. Mean age of cohort was 45 ± 19 years (71% male and 29% female) having a mean body mass index (BMI) of 25.57 ± 5.54 Kg/m2 having Stage I (21%), Stage II (18%), Stage III (16%), and Stage IV (45%) disease. Bulky disease was found in 14% ...