J Clin Neurol.  2006 Mar;2(1):51-57. 10.3988/jcn.2006.2.1.51.

Clinical Implications of Cardiac-MIBG SPECT in the Differentiation of Parkinsonian Syndromes

• Shin DH
• Lee PH
• Bang OY
• Joo IS
• Huh K

• KMID: 2287703
• DOI: http://doi.org/10.3988/jcn.2006.2.1.51

Abstract

BACKGROUND AND PURPOSE
123I cardiac meta-iodobenzylguanidine (MIBG), an analogue of norepinephrine, has been used to estimate myocardial sympathetic nerve function. We investigate whether cardiac-MIBG SPECT is clinically applicable in the differentiation of Parkinson's disease (PD) from parkinsonian syndromes.
METHODS
Cardiac-MIBG scintigraphy was performed in 27 controls, in 40 patients with PD and in 52 patients with other parkinsonian syndromes comprising 23 with multiple system atrophy (MSA), 26 with drug-induced parkinsonism (DIP), and 3 with corticobasal degeneration (CBD). The heart to mediastinum (H/M) uptake ratio was calculated for each subjects. Patients who either had medical conditions that confused the MIBG SPECT results or who took medications that interfere with MIBG accumulation were excluded from the study.
RESULTS
Both early and delayed H/M ratios were in patients with PD significantly lower than in controls (early, 1.34+/-0.15 vs 1.79+/-0.19; delayed, 1.29+/-0.15 vs 2.06+/-0.29, p<0.001). In patients with PD, both early and delayed H/M ratios were significantly lower than those in patients with MSA (early, 1.68+/-0.23; delayed, 1.80+/-0.34, p<0.001), DIP (early, 1.83+/-0.24; delayed, 2.07+/-0.4, p<0.001), or CBD (early, 1.85+/-0.01; delayed, 1.99+/-0.19, p<0.001). Two patients with DIP, who were within the range of patients with PD, showed clinically similar courses of PD.
CONCLUSIONS
This study demonstrates that cardiac-MIBG is a clinically powerful tools to differentiate PD from other parkinsonian syndromes.

Keyword

123I-MIBG SPECT; Parkinson's disease; Multiple system atrophy; Drug-induced parkinsonism

MeSH Terms

3-Iodobenzylguanidine
Heart
Humans
Mediastinum
Multiple System Atrophy
Norepinephrine
Parkinson Disease
Parkinsonian Disorders*
Radionuclide Imaging
Tomography, Emission-Computed, Single-Photon*
3-Iodobenzylguanidine
Norepinephrine

Figure

• 

  Figure 1 Definition of regions of interest (ROI) on an anterior planar image of a control subject. Rectangular ROIs are drawn on the heart (1) and mediastinum (2) for early (A) and delayed (B) images. Cardiac meta-iodobenzylguanidine (MIBG) uptake is assessed using the heart-to-mediastinum (H/M) activity ratio that determines the average count per pixel in the ROI.

• 

  Figure 2 Scatter diagram of an individual H/M ratio of 123I-MIBG uptake in patients with Parkinson's disease (PD), multiple system atrophy (MSA), drug-induced parkinsonism (DIP), and corticobasal degeneration (CBD), compared with controls (Con). The thick line indicates the mean value of the H/M ratio. Panels 2A and 2B indicate early and delayed MIBG images, respectively.

• 

  Figure 3 Cutoff values to discriminate between patients with PD and controls (left) in an early MIBG image, and between patients with PD and MSA (right) in a delayed MIBG image.

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