Differentiation of idiopathic Parkinson's disease from striatonigral degeneration and progressive supranuclear palsy using iodine-123 meta-iodobenzylguanidine myocardial scintigraphy

Yoshita, Mitsuhiro

doi:10.1016/s0022-510x(97)00278-5

Cited by 225 publications

(166 citation statements)

References 30 publications

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“…However, patients of PD-2, 3, 4 and 5 showed a significant decrease in 123 I-MIBG compared with PSP group. Although a previous report showed that there was no significant difference in the early and delayed H/M ratio among PD patients with a different severity according to the H & Y scale (20), there was no significant decrease in PD-1 patients in this study, probably due to the small number of pa-tients in PD-1. In agreement with another previous studies (21,22), the present results also support the usefulness of 123 I-MIBG myocardial scintigraphy for distinguishing PD-2, 3, 4 and 5 groups from the other 4 groups ( Table 2).…”

Section: Discussioncontrasting

confidence: 87%

PSP as Distinguished from CBD, MSA-P and PD by Clinical and Imaging Differences at an Early Stage

et al. 2011

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Objective Because it is often difficult to precisely diagnose and distinguish progressive supranuclear palsy (PSP) from corticobasal degeneration (CBD), multiple system atrophy-parkinsonism (MSA-P) and Parkinson's disease (PD) at the onset of the disease, we compared the patients and clarified the features of these diseases. Methods We compared 77 PSP, 26 CBD, 26 MSA-P and 166 PD patients from clinical and imaging points of view including cerebral blood flow (CBF) in the frontal eye field. Results The clinical characteristics of PSP were supranuclear gaze disturbance, optokinetic nystagmus (OKN) impairment and falls at the first visit. On head MRI, midbrain tegmentum atrophy was much more frequently detected in PSP than in all of the other groups. Heart-to-mediastinum average count ratio (H/M) in iodine-123 meta-iodobenzyl guanidine ( 123 I-MIBG) myocardial scintigraphy was not decreased in PSP, CBD, MSA-P and PD-Yahr 1 (-1), but patients of PD-2, 3, 4 and 5 showed a significant decrease compared with the PSP group. The CBF in the left frontal eye field of PD-3 group and that in right frontal eye field of PD-3 and PD-4 groups were lower than that of PSP group, although other groups showed a tendency without a significant decrease compared with PSP group. Conclusion PSP is distinguishable from CBD, MSA-P and PD even at the early stage with extra-ocular movement (EOM) disturbance, falls, atrophy of the midbrain tegmentum, and H/M in 123 I-MIBG myocardial scintigraphy, and the reduction of CBF in area 8 could serve as a supplemental diagnostic method for distinguishing PSP from PD-3 or PD-4.

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Section: Discussioncontrasting

confidence: 87%

PSP as Distinguished from CBD, MSA-P and PD by Clinical and Imaging Differences at an Early Stage

et al. 2011

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“…For MIBG scintigraphy, the overall H/M ratio (1.34) of the PD patients in the present study confirms previous results reporting H/M ratios between 1.19 and 1.57 depending on disease duration, PD subtype, and (probably) also on the exact method of quantification such as size, shape, and positioning of ROIs and the use of maximum compared with mean count values (15,28,(37)(38)(39). Nevertheless, in any case considerable overlap exists for the PD-APD differentiation, suggesting also that MIBG scintigraphy alone is not sufficient to distinguish these entities and that low MIBG uptake alone does not necessarily indicate PD (40).…”

Section: Cardiac Mibg Uptakesupporting

confidence: 90%

Diagnostic Accuracy of Combined FP-CIT, IBZM, and MIBG Scintigraphy in the Differential Diagnosis of Degenerative Parkinsonism: A Multidimensional Statistical Approach

Südmeyer

Antke²,

Zizek³

et al. 2011

J Nucl Med

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In vivo molecular imaging of pre-and postsynaptic nigrostriatal neuronal degeneration and sympathetic cardiac innervation with SPECT is used to distinguish idiopathic Parkinson disease (PD) from atypical parkinsonian disorder (APD). However, the diagnostic accuracy of these imaging approaches as standalone procedures is often unsatisfying. The aim of this study was therefore to evaluate to which extent diagnostic accuracy can be increased by their combined use together with a multidimensional statistical algorithm. Methods: The SPECT radiotracers 123 , and meta-123 I-iodobenzylguanidine (MIBG) were used to assess striatal postsynaptic D 2 receptor binding, striatal presynaptic dopamine transporter binding, and myocardial adrenergic innervation, respectively. Thirty-one PD and 17 APD patients were prospectively investigated. PD and APD diagnoses were established using consensus criteria and reevaluated after 37.4 6 12.4 and 26 6 11.6 mo in PD and APD, respectively. Test accuracy (TA) for PD-APD differentiation was computed for all logical (Boolean) combinations of imaging modalities by receiver-operating-characteristic analysis-that is, after multidimensional optimization of cutoff values. Results: Analysis showed moderate TA for PD-APD differentiation using each molecular approach alone (IBZM, 79%; MIBG, 73%; and FP-CIT, 73%). For combined use, the highest TA resulted under the assumption that at least 2 of the 3 biologic markers had to be positive for APD using the following cutoff values: 1.46 or less for IBZM, less than 2.10 for FP-CIT, and greater than 1.43 for MIBG. This algorithm distinguished APD from PD with a sensitivity of 94%, specificity of 94% (TA, 94%), positive predictive value of 89%, and negative predictive value of 97%. Conclusion: Results suggest that the multidimensional combination of FP-CIT, IBZM, and MIBG scintigraphy is likely to significantly increase TA in differentiating PD from APD. The differential diagnosis of degenerative parkinsonism may thus be facilitated.

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“…These findings suggested that degeneration of the cardiac sympathetic nerve begins even in the presymptomatic stage of PD, when neuronal loss in the dorsal vagal nucleus is not yet evident. The present study also revealed relatively preserved cardiac 123 I-MIBG uptake in MSA, consistent with previous studies (Yoshita et al, 1998;Nagayama et al, 2005 (Yoshita et al, 1998;Braune et al, 1999;Orimo et al, 1999;Druschky et al, 2000;Takatsu et al;2000a, 2000b. Postmortem studies demonstrated that postganglionic cardiac sympathetic nerve fibers are markedly decreased in all PD patients, but not necessarily in those with MSA, providing substantial evidence of discrepant 123 I-MIBG uptake between PD and MSA (Orimo et al, 2001(Orimo et al, , 2002.…”

Section: Discussionsupporting

confidence: 93%

Role of 123I-Metaiodobenzylguanidine Myocardial Scintigraphy in Parkinsonian Disorders

Suzuki¹

2012

Mechanisms in Parkinson's Disease - Models and Treatments

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Differentiation of idiopathic Parkinson's disease from striatonigral degeneration and progressive supranuclear palsy using iodine-123 meta-iodobenzylguanidine myocardial scintigraphy

Cited by 225 publications

References 30 publications

PSP as Distinguished from CBD, MSA-P and PD by Clinical and Imaging Differences at an Early Stage

PSP as Distinguished from CBD, MSA-P and PD by Clinical and Imaging Differences at an Early Stage

Diagnostic Accuracy of Combined FP-CIT, IBZM, and MIBG Scintigraphy in the Differential Diagnosis of Degenerative Parkinsonism: A Multidimensional Statistical Approach

Role of 123I-Metaiodobenzylguanidine Myocardial Scintigraphy in Parkinsonian Disorders

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