The Role of &lt;sup&gt;123&lt;/sup&gt;I-Metaiodobenzylguanidine Myocardial Scintigraphy in the Diagnosis of Lewy Body Disease in Patients with Dementia in a Memory Clinic

Hanyu, Haruo; Shimizu, Soichiro; Hirao, Kentaro; Sakurai, Hirofumi; Iwamoto, Toshihiko; Chikamori, Taishiro; Hida, Satoshi; Yamashina, Akira; Koizumi, Kiyoshi; Abe, Kimihiko

doi:10.1159/000095641

Cited by 52 publications

(40 citation statements)

References 70 publications

(40 reference statements)

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“…[13][14][15][16][17] The value of 123 I-MIBG myocardial scintigraphy in the early diagnosis of DLB and in the differential diagnosis between DLB and other dementias has been studied; scintigraphic findings are reported to yield independent diagnostic predictors of DLB. [18][19][20][21] In their metaanalysis, Treglia and Cason 22 demonstrated that MIBG scintigraphy is an accurate diagnostic imaging method to differentiate DLB from other dementias; they reported a pooled sensitivity and specificity of 98% and 94%, respectively. In addition, 123 I-MIBG scintigraphy appears to be of higher sensitivity than brain perfusion SPECT for the diagnosis of DLB.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis of dementia with Lewy bodies: can 123I-IMP and 123I-MIBG scintigraphy yield new core features?

Sakamoto

Shiraishi

Tsuda

et al. 2017

The British Journal of Radiology

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Objective: Since the clinical symptoms of different types of dementia frequently overlap, especially in the earlier stages at onset, it is difficult to distinguish dementia with Lewy bodies (DLB) from other neurodegenerative dementias based on their clinical manifestations alone. Nuclear medicine imaging has been reported as a high-value index for the objective evaluation and diagnosis of DLB. The aim of this study was to evaluate whether nuclear medicine imaging findings may yield core features to be added to the diagnosis of DLB. Methods: We enrolled 332 patients with suspected DLB. All were evaluated by both 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy and 123I-labelled N-isopropyl-p-iodoamphetamine (123I-IMP). brain perfusion single-photon emission CT. The final clinical diagnosis indicated probable DLB in 92 patients (40 males, 52 females; mean age ± standard deviation, 77.4 ± 6.4 years; range, 56–89 years); 240 patients (98 males, 142 females; mean age, 75.5 ± 9.0 years; range, 70–87 years) were recorded as being without DLB. The accepted core features used for clinical evaluations were fluctuating cognition, visual hallucinations and Parkinsonism. The nuclear medicine evaluation indices were the severity score of cerebral blood flow on 123I-IMP scintigraphs of the posterior cingulate and praecuneus and a reduction in the blood flow in the occipital lobe. For 123I-MIBG evaluation, we recorded the early and delayed heart-to-mediastinum (H/M) ratios and the washout rate. Results: Univariate and multivariate analyses of fluctuating cognition, visual hallucinations, Parkinsonism and early H/M ratio in patients with probable and without DLB revealed significant differences. Parameters based on 123I-IMP studies did not show any significant differences by multivariate analysis. The area under the curve for the early H/M ratio was 0.918; for fluctuating cognition, visual hallucinations and Parkinsonism, it was 0.693, 0.760 and 0.611, respectively, by receiver-operating characteristic analysis. The early H/M ratio of <2.0 on 123I-MIBG scintigraphs was of the highest diagnostic accuracy. The sensitivity, specificity and accuracy for the diagnosis of probable DLB were 82.4%, 96.3% and 92.5%, respectively. Conclusion: The early H/M ratio obtained by 123I-MIBG myocardial scintigraphy can serve as a reliable diagnostic index for the core clinical features of DLB. It can be used for the early diagnosis and treatment of DLB. Advances in knowledge: 123I-MIBG myocardial scintigraphy performed at the initial clinical examination can facilitate the early identification or exclusion of DLB and the early H/M ratio may be a diagnostic biomarker for DLB.

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Section: Resultsmentioning

confidence: 99%

Diagnosis of dementia with Lewy bodies: can 123I-IMP and 123I-MIBG scintigraphy yield new core features?

Sakamoto

Shiraishi

Tsuda

et al. 2017

The British Journal of Radiology

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“…Previous research has shown promising results for the use of MIBG cardiac scintigraphy as a diagnostic tool to distinguish DLB from AD (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003, Hanyu et al, 2006, Wada-Isoe et al, 2007 with sensitivity and specificity values of 100% (Yoshita et al, 2006). However, most studies included limited study populations, and studies in Caucasian populations are sparse.…”

Section: Discussionmentioning

confidence: 99%

“…The decreased cardiac uptake of MIBG in DLB reflects the postganglionic cardiac sympathetic denervation (Orimo et al, 2005). Promising results have been published, but these studies have been conducted under very strict exclusion criteria (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003, Hanyu et al, 2006, Wada-Isoe et al, 2007. Indeed, patients with ischemic heart disease, heart failure, thyroid disease, or diabetes mellitus were excluded (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003.…”

Section: Introductionmentioning

confidence: 99%

P2‐198: The Diagnostic Value of Mibg Cardiac Scintigraphy for Differential Dementia Diagnosis

Engelborghs

Slaets

Acker

et al. 2014

Alzheimer's & Dementia

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Objective: Iodine-123 metaiodobenzylguanidine (MIBG) cardiac scintigraphy has shown the potential to discriminate dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). However, these studies did not reflect clinical practice, as patients with ischemic heart disease, heart failure, diabetes mellitus, arterial hypertension, and hyperlipidemia and patients treated with antidepressants like trazodone were excluded. Methods: This study aimed to evaluate the use of MIBG cardiac scintigraphy to diagnose DLB in clinical practice. Moreover, the potential diagnostic value of MIBG cardiac scintigraphy in patients with clinically ambiguous dementia diagnosis (DLB versus AD) was tested. Eighty-five patients with a possible clinical diagnosis of DLB entered the study. MIBG uptake was determined by calculating the heartto-mediastinum-uptake ratio (H/M). Results: The average H/M ratio was 1.42 ± 0.35. The number of core features for DLB and the H/M ratio were negatively correlated (p = 0.001; r = À0.360). With an H/M ratio cutoff of 1.68 in 20 patients with clinically ambiguous dementia diagnoses (DLB versus AD) at the moment of MIBG cardiac scintigraphy, 95% (19/20) of the patients were correctly classified as compared with clinical or definite diagnosis at follow-up, with sensitivity and specificity values for diagnosing DLB of 100% (16/16) and 75% (3/4), respectively. The H/M ratio was influenced only by age (p = 0.046; r = À0.217) and gender (p = 0.024) and not by any other variable studied. Conclusions: The MIBG cardiac scintigraphy H/M ratio is a possible diagnostic biomarker for DLB in routine clinical practice and might have an added diagnostic value in case of doubt between DLB and AD.

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“…This investigation has excellent sensitivity (95-100%) and specificity (87-100%), [48][49][50] is superior to perfusion SPECT in differentiating DLB from AD 34 and has been shown to be useful in combination with IMP SPECT in possible DLB cases. 51 The main drawback is that abnormal scans are difficult to interpret in the elderly as diseases common in this age group -such as diabetes, myocardial infarction, ischaemic heart disease and cardiomyopathy -can all lead to abnormal scans, thus increasing the risk of a false-positive diagnosis.…”

Section: Myocardial Scintigraphymentioning

confidence: 99%

Efficacy of Single Photon Emission Computed Tomography in Differentiating Dementia with Lewy Bodies - A Review of Neurotransmitter and Perfusion Imaging

Morgan¹,

Walker²

2009

European Neurological Review

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The accuracy of the clinical diagnosis of dementia with Lewy bodies continues to be relatively poor. Several neuroimaging techniques have been used to facilitate a more accurate diagnosis. Thus far, functional neuroimaging has provided the most help. This article concentrates on the use of single photon emission computed tomography (SPECT) and reports on the efficacy data available from studies investigating cerebral perfusion, cardiac scintigraphy and dopaminergic neurotransmission. The results from perfusion studies are inconsistent. Cardiac scintigraphy shows more promise, but it is not yet known whether co-morbid cardiac conditions, which are common in the elderly, will limit the clinical use of this method. The radioligand 123 I-FP-CIT binds to dopamine transporters in nigrostriatal nerve terminals and provides a way of assessing the neurodegeneration caused by Lewy body pathology. Abnormal 123 I-FP-CIT has been shown to have high sensitivity and specificity in an autopsy study and a large multicentre trial. This article aims to give an overview of the topic. KeywordsDementia with Lewy bodies, single photon emission computed tomography (SPECT), functional imaging, perfusion imaging, neurotransmitter imaging, dopamine transporter Disclosure: Shirlony Morgan has received radiopharmaceuticals free of charge for a research project from GE Healthcare. Zuzana Walker has received consultancy payments from GE Healthcare and Bayer Schering Pharma AG and reimbursement for travel expenses for a conference from GE Healthcare. Table 1. Dopamine Transporter ImagingDecreased concentrations of dopamine and dopamine transporters in DLB were first described in histopathological studies.

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The Role of <sup>123</sup>I-Metaiodobenzylguanidine Myocardial Scintigraphy in the Diagnosis of Lewy Body Disease in Patients with Dementia in a Memory Clinic

Cited by 52 publications

References 70 publications

Diagnosis of dementia with Lewy bodies: can 123I-IMP and 123I-MIBG scintigraphy yield new core features?

Diagnosis of dementia with Lewy bodies: can 123I-IMP and 123I-MIBG scintigraphy yield new core features?

P2‐198: The Diagnostic Value of Mibg Cardiac Scintigraphy for Differential Dementia Diagnosis

Efficacy of Single Photon Emission Computed Tomography in Differentiating Dementia with Lewy Bodies - A Review of Neurotransmitter and Perfusion Imaging

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