Evaluation of Probable or Possible Dementia with Lewy Bodies Using 123I-IMP Brain Perfusion SPECT, 123I-MIBG, and 99mTc-MIBI Myocardial SPECT

Abstract

We evaluated the diagnostic usefulness of combination studies with a statistical mapping method in N-isopropyl-p-123 Iiodoamphetamine ( 123 I-IMP) brain perfusion SPECT, cardiac sympathetic nerve function by 123 I-metaiodobenzylguanidine ( 123 I-MIBG), and myocardial function by electrocardiographically gated 99m Tc-sestamibi ( 99m Tc-MIBI) SPECT for patients with probable or possible dementia with Lewy bodies (DLB). Methods: Twelve patients with probable DLB (7 male, 5 female; mean age 6 SD, 72.3 6 5.63 y; range, 65-82 y) and 9 patients with possible DLB (3 male, 6 female; mean age 6 SD, 73.1 6 9.23 y; range, 59-88 y) were enrolled in this study. 123 I-IMP SPECT images were analyzed with 3-dimensional stereotactic surface projections (3D-SSP) and the severity of ischemia was classified objectively using quantitatively analytic and display software; stereotactic extraction estimation (SEE) methods were compared with a normal database. In addition, we evaluated 123 I-MIBG heart-to-mediastinum (H/M) uptake ratios. Moreover, we performed 99m Tc-MIBI SPECT to evaluate myocardial perfusion and the left ventricular ejection fraction (LVEF) compared with a normal database. Results: 3D-SSP images of group comparison with healthy control subjects showed significantly decreased perfusion in the parietotemporal, occipital cortex, posterior cingulated, and precuneus regions in the probable DLB group but no significant reduction in the possible DLB group. Mean H/M ratios in the probable DLB group were significantly lower than those of the possible DLB group and the control group, respectively. Ten of 12 patients (83.3%) with probable DLB and 1 of 9 patients (11.1%) with possible DLB showed severe reduction in the bilateral occipital lobe and also a low 123 I-MIBG uptake. One patient (8.3%) with probable DLB and 2 patients (22.2%) with possible DLB showed no bilateral occipital hypoperfusion but showed low 123 I-MIBG uptake. One patient (8.3%) with probable DLB and 6 patients (66.7%) with possible DLB showed no occipital hypoperfusion and normal 123 I-MIBG uptake. 99m Tc-MIBI gated SPECT did not indicate any wall motion abnormality in any subjects. Conclusion: These results suggest that combined examination of cerebral blood flow with 3D-SSP and SEE analysis, and cardiac sympathetic nerve function with 123 I-MIBG, would be a useful supporting diagnostic method in patients with DLB-particularly, in possible DLB and when cerebral blood flow does not indicate occipital hypoperfusion.

Diagnostic Performance of Myocardial Innervation Imaging Using MIBG Scintigraphy in Differential Diagnosis between Dementia with Lewy Bodies and Other Dementias: A Systematic Review and a Meta‐Analysis

“…The comprehensive computer literature search from the PubMed/MEDLINE and Embase databases revealed 71 articles (Fig 1). Reviewing titles and abstracts, 41 articles were excluded because they did not present any diagnostic information; 30 articles were selected 12–41 . These 30 studies were retrieved in full‐text version; an additional study was found screening the references of these articles 42 .…”

“…These 30 studies were retrieved in full‐text version; an additional study was found screening the references of these articles 42 . From these 31 articles potentially eligible for inclusion, after reviewing the full‐text article, one study was excluded as case report; 23 one article was excluded because sensitivity and specificity of MIBG scintigraphy in the subset of DLB population could not be calculated for insufficient data; 12 seven articles were excluded because there was an overlap of patient data in other studies; 20,24,26,29,31,34,40 12 articles were excluded because MIBG scintigraphy was not performed in patients with other dementia than LBD; 13–16,19,21,25,28,32,35,36,38 two articles were excluded because less than 6 patients with DLB were included 37,42 …”

Neuroimaging Findings in Dementia with Lewy Body: A Review

“…Interestingly, SPECT imaging was also used in combination with other measures to better detect changes in DLB. Several studies (Hanyu et al, 2006b;Inui et al, 2007;Novellino et al, 2010;Tateno et al, 2008b) which combined SPECT and (1,2,3)I-metaiodobenzylguanidine myocardial (MIBG) scintigraphy reported that the accuracy power in the diagnostic process of DLB resulted increased. Furthermore, Goto and colleagues (Goto et al, 2010) proposed to combine the computation of ratios on perfusion SPECT with MRI volumetric data (hippocampal, occipital, and striatal structures) to discriminate between DLB and AD.…”

Onset Patterns and Initial Symptoms of Dementia with Lewy Bodies: Possible Pathophysiological Diversities Deduced from a SPECT Study

“…In extreme cases, typical DLB patients without apparent uptake decreases in the occipital regions tend to be branded as ‘DLB unlikely’ only because of negative SPECT findings. It should be kept in mind that low uptake in the occipital areas is a feature distinguishing DLB from Alzheimer's disease (AD) [4,5,6,7,8,9,10,11], and that it is not a ubiquitous finding among patients with DLB [9,12,13]. Compared with normal controls, DLB patients may rather show lowered uptake in the frontal, parietal, temporal and thalamic regions [14].…”