Chonnam Med J.  2016 Sep;52(3):145-150. 10.4068/cmj.2016.52.3.145.

¹²³I-Meta-iodobenzylguanidine Sympathetic Imaging: Standardization and Application to Neurological Diseases

Affiliations
  • 1Department of Nuclear Medicine, Kanazawa University, Kanazawa, Japan. nakajima@med.kanazawa-u.ac.jp
  • 2Department of Neurology, Kanazawa University, Kanazawa, Japan.

Abstract

¹²³I-meta-iodobenzylguanidine (MIBG) has become widely applied in Japan since its introduction to clinical cardiology and neurology practice in the 1990s. Neurological studies found decreased cardiac uptake of ¹²³I-MIBG in Lewy-body diseases including Parkinson's disease and dementia with Lewy bodies. Thus, cardiac MIBG uptake is now considered a biomarker of Lewy body diseases. Although scintigraphic images of ¹²³I-MIBG can be visually interpreted, an average count ratio of heart-to-mediastinum (H/M) has commonly served as a semi-quantitative marker of sympathetic activity. Since H/M ratios significantly vary according to acquisition and processing conditions, quality control should be appropriate, and quantitation should be standardized. The threshold H/M ratio for differentiating Lewy-body disease is 2.0-2.1, and was based on standardized H/M ratios to comparable values of medium-energy collimators. Parkinson's disease can be separated from various types of parkinsonian syndromes using cardiac ¹²³I-MIBG, whereas activity is decreased on images of Lewy-body diseases using both ¹²³I-ioflupane for the striatum and ¹²³I-MIBG. Despite being a simple index, the H/M ratio of ¹²³I-MIBG uptake is reproducible and can serve as an effective tool to support a diagnosis of Lewy-body diseases in neurological practice.

Keyword

Lewy Body Disease; Parkinson Disease; Dementia; Nuclear Medicine; Quantitation

MeSH Terms

3-Iodobenzylguanidine
Cardiology
Dementia
Diagnosis
Japan
Lewy Bodies
Lewy Body Disease
Neurology
Nuclear Medicine
Parkinson Disease
Parkinsonian Disorders
Quality Control
3-Iodobenzylguanidine

Figure

  • FIG. 1 Semiautomatic method of setting ROI. Circular heart and rectangular mediastinal ROI (height, 30%; width, 10% of the mediastinum) are automatically determined after pointing towards the center of the heart.

  • FIG. 2 Typical calibration phantom images with low-energy high-resolution (LEHR) and medium-energy low-penetration (MELP) collimators. Contrast between heart and mediastinal counts is notable in both images. Regions of interest are automatically selected and positioned by smartMIBG software.

  • FIG. 3 123I-MIBG H/M ratio in control, Alzheimer's disease (AD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB), Parkinson's disease (PD), and pure autonomic failure (PAF). Regions of interest were positioned using smartMIBG software. H/M ratios are 2.9, 3.7, 3.0, 1.2, 1.7 and 1.2, respectively.

  • FIG. 4 Late H/M ratios in patients with probable Alzheimer's disease (AD), possible dementia with Lewy bodies (DLB), and probable DLB. Differences are significant among groups (p < 0.0001). Data are from Reference 26.

  • FIG. 5 Imaging with 123I-MIBG and 123I-ioflupane from a 72-year-old man with progressive supra-nuclear palsy (PSP). Uptake is normal on MIBG image (left) and obviously decreased on both sides of striatum on ioflupane image (right).


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