Optimal Protocol and Clinical Usefulness of 123I-MIBG Cardiac Scintigraphy for Differentiation of Parkinson¡¯s Disease and Dementia with Lewy Body from Non-Parkinson¡¯s Diseases
Nuclear Medicine and Molecular Imaging 2023³â 57±Ç 3È£ p.145 ~ p.154
Abstract
Purpose : 123I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy was a useful imaging modality for the diagnosis of Parkinson¡¯s disease, but its diagnostic performances were variably reported. This retrospective study compared the diagnostic performances and investigated the optimal imaging protocol of 123I-MIBG cardiac scintigraphy at various imaging time points in patients suspected of Parkinson¡¯s disease in clinical practice.
Methods : In patients suspected of Parkinson¡¯s disease, clinical records, autonomic function tests, and 123I-MIBG cardiac scintigraphy were retrospectively reviewed. Semi-quantitative parameters such as heart-to-mediastinum ratio (HMR) and washout rate (WR) were calculated and compared at 15 min, 1 h, 2 h, 3 h, and 4 h post-injection (p.i.). of 123I-MIBG cardiac scintigraphy. Group A consisted of Parkinson¡¯s disease (PD), Parkinson¡¯s disease dementia (PDD), and dementia with Lewy body (DLB), and group B consisted of non-Parkinson¡¯s diseases such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), drug-induced parkinsonism (DIP), essential tremor (ET), Parkinson-plus syndrome (PPS), and unspecified secondary parkinsonism (NA). The diagnostic performances of HMR and WR were compared for differentiation of group A from group B, and their clinical usefulness and optimal imaging time points were explored.
Results : Seventy-eight patients were included in group A (67 PD, 7 PDD, 4 DLB), and 18 patients were included in group B (5 MSA, 3 PSP, 2 DIP, 2 ET, 1 PPS, and 1 NA). Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value of HMR and WR were maximized at 4 h p.i., (82.1%, 85.7%, 82.6%, 97.0%, and 46.2%; cutoff threshold < 1.717; area under curve 0.8086) and at the time interval between 1 and 4 h p.i. (65.4%, 85.7%, 68.5%, 96.2%, and 30.8%; cutoff threshold > 24.1%; area under curve 0.8246), respectively, and PPVs of both HMR and WR persistently showed greater than 92.7% at earlier time points and shorter time intervals.
Conclusion : This study reassured that 4-h-delayed imaging is recommended for the best diagnostic performances in 123I-MIBG cardiac scintigraphy. Although it showed suboptimal diagnostic performances to differentiate PD, PDD, and DLB from non-Parkinson¡¯s diseases, it can be useful as an auxiliary measure for the differential diagnosis in usual clinical practice.
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123I-MIBG cardiac scintigraphy, Heart-to-mediastinum ratio, Washout rate, Parkinson¡¯s disease, Dementia with Lewy body, Atypical Parkinson syndrome
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This study reassured that 4-h-delayed imaging is recommended for the best diagnostic performances in 123I-MIBG cardiac scintigraphy. Although it showed suboptimal diagnostic performances to differentiate PD, PDD, and DLB from non-Parkinson¡¯s diseases, it can be useful as an auxiliary measure for the differential diagnosis in usual clinical practice.