Development of an 123I-metaiodobenzylguanidine Myocardial Three-Dimensional Quantification Method for the Diagnosis of Lewy Body Disease

Document Type : Original Article

Authors

1 Graduate School of Health Sciences, Kumamoto University

2 Graduate School of Health Sciences, Kumamoto University,

3 Graduate School of Health Sciences, KChuo-ku, kumamoto 862-0976, Japan

4 Faculty of Fukuoka Medical Technology Teikyo University, 6-22, Misaki-Machi, Omuta-shi, Fukuoka 836-8505, Japan

5 Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University, Kuhonji 4-24-1, Kumamoto 862-0796, Japan

Abstract

Objective(s): We recently developed a new uptake index method for 123I-metaiodobenzylguanidine (123I-MIBG) heart uptake measurements by using planar images (radioisotope angiography and planar image) for the diagnosis of Lewy body disease (LBD), including Parkinson’s disease (PD) and dementia with Lewy bodies
(DLB). However, the diagnostic accuracy of the uptake index was approximately equal to that of the heart-to-mediastinum ratio (H/M) for the discrimination of the LBD and non-LBD patients. A simple and pain-free uptake index method using 123I-MIBG SPECT images by modifying the uptake index method may show better diagnostic accuracy than the planar uptake index method. We hypothesized that the development of a new uptake index method for the determination of 123I-MIBG using single-photon emission computed tomography (SPECT) imaging would provide a reliable and reproducible diagnostic tool for clinical application. Regarding this, the purpose of this study was to develop a new uptake index method with a simple protocol to determine 123I-MIBG uptake on SPECT.
Methods: The 123I-MIBG input function was determined from the input counts of the pulmonary artery, assessed by analyzing the pulmonary artery time-activity curves. The 123I-MIBG output function was obtained from 123I-MIBG SPECT counts on the polar map. The uptake index was calculated through dividing the output function by the input function (SPECT uptake method). For the purpose of the study, 77 patients underwent 123I-MIBG SPECT, with an average of 31.5 min after clinical assessment and injection of the tracer. The H/M values, as well as planar and SPECT uptake indices were calculated, and then correlated with clinical features.
Results: According to the results, values obtained for LBD were significantly lower than those for non-LBD in all analyses (P<0.01). The overlap of the H/M values between the LBD and non-LBD cases ranged from 2.06 to 2.50. Furthermore, the overlap in uptake index values between LBD and non-LBD cases in planar image analysis was 1.05-1.29.
The SPECT uptake index method showed the least overlap of 1.23-1.25, with the highest value for LBD patients clearly distinguished from the lowest value for the non-LBD patients.
Conclusion: The new 123I-MIBG SPECT quantification method, developed by the input counts of the pulmonary artery, clearly distinguished LBD from non-LBD. Therefore, this method may be appropriate for routine clinical study.

Keywords

Main Subjects


  1. Taki J, Yoshita M, Yamada M, Tonami N. Significance of 123I-MIBG scintigraphy as a pathophysiological indicator in the assessment of Parkinson’s disease and related disorders: it can be a specific marker for Lewy body disease. Ann Nucl Med. 2004;18(6):453-61.
  2. Nakajima K, Yoshita M, Matsuo S, Taki J, Kinuya S. Iodine-123-MIBG sympathetic imaging in Lewy-body diseases and related movement disorders. Q J Nucl Med Mol Imaging. 2008;52(4):378-87.
  3. King AE, Mintz J, Royall DR. Meta-analysis of 123I-MIBG cardiac scintigraphy for the diagnosis of Lewy body-related disorders. Mov Disord. 2011;26(7):1218-24.
  4. Merlet P, Valette H, Dubois-Randé JL, Moyse D, Duboc D, Dove P, et al. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure. J Nucl Med. 1992;33(4):471-7.
  5. Okuda K, Nakajima K, Hosoya T, Ishikawa T, Konishi T, Matsubara K, et al. Semi-automated algorithm for calculating heart-to-mediastinum ratio in cardiac Iodine-123 MIBG imaging. J Nucl Cardiol. 2011;18(1):82-9.
  6. Nakajima K, Okuda K, Yoshimura M, Matsuo S, Wakabayashi H, Imanishi Y, et al. Multicenter cross-calibration of I-123 metaiodobenzylguanidine heart-to-mediastinum ratios to overcome camera-collimator variations. J Nucl Cardiol. 2014;21(5):970-8.
  7. Kamiya Y, Ota S, Okumiya S, Yamashita K, Takaki A, Ito S. Uptake index of 123I-metaiodobenzylguanidine myocardial scintigraphy for diagnosing Lewy body disease. Asia Ocean J Nucl Med Biol. 2017;5(1):37-43.
  8. Chen J, Folks RD, Verdes L, Manatunga DN, Jacobson AF, Garcia EV. Quantitative I-123 mIBG SPECT in differentiating abnormal and normal mIBG myocardial uptake. J Nucl Cardiol. 2012;19(1):92-9.
  9. Van der Veen BJ, Al Younis I, de Roos A, Stokkel MP. Assessment of global cardiac I-123 MIBG uptake and washout using volumetric quantification of SPECT acquisitions. J Nucl Cardiol. 2012;19(4):752-62.

10. Giorgetti A, Burchielli S, Positano V, Kovalski G, Quaranta A, Genovesi D, et al. Dynamic 3D analysis of myocardial sympathetic innervation: an experimental study using 123I-MIBG and a CZT camera. J Nucl Med. 2015;56(3):464-9.

11. Mu X, Hasegawa S, Yoshioka J, Maruyama A, Maruyama K, Paul AK, et al. Clinical value of lung uptake of iodine-123 metaiodobenzylguanidine (MIBG), a myocardial sympathetic nerve imaging agent, in patients with chronic heart failure. Ann Nucl Med. 2001;15(5):411-6.

12. Ofuji A, Mimura H, Yamashita K, Takaki A, Sone T, Ito S. Development of a simple non-invasive microsphere quantification method for cerebral blood flow using I-123-IMP. Ann Nucl Med. 2016;30(3):242-9.

13. Ofuji A, Nagaoka R, Yamashita K, Takaki A, Ito S. A simple non-invasive I-123-IMP autoradiography method developed by modifying the simple non-invasive I-123-IMP microsphere method. Asia Ocean J Nucl Med Biol. 2018;6(1):50-6.

14. Yamashita K, Uchiyama Y, Ofuji A, Mimura H, Okumiya S, Takaki A, et al. Fully automatic input function determination program for simple noninvasive (123)I-IMP microsphere cerebral blood flow quantification method. Phys Med. 2016;32(9):1180-5.

15. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. 1967. Neurology. 2001;57(10 Suppl 3):S11-26.

16. Okuda K, Nakajima K, Hosoya T, Ishikawa T, Konishi T, Matsubara K, et al. Semi-automated algorithm for calculating heart-to-mediastinum ratio in cardiac Iodine-123 MIBG imaging. J Nucl Cardiol. 2011;18(1):82-9.

17. Metz CE, Herman BA, Shen JH. Maximum-likelihood estimation of receiver operating (ROC) curves from continuously distributed data. Stat Med. 1998;17(9):1033-53.

18. Dorfman DD, Berbaum KS, Metz CE. ROC rating analysis: generalization to the population of readers and cases with the jackknife method. Invest Radiol. 1992;27(12):1099.

19. Masunaga S, Uchiyama Y, Ofuji A, Nagaoka R, Tomimatsu T, Iwata A, et al. Development of an automatic ROI setting program for input function determination in 99mTc-ECD non-invasive cerebral blood flow quantification. Phys Med. 2014;30(4):513-20.

20. Garcia EV, Van Train K, Maddahi J, Prigent F, Friedman J, Areeda J, et al. Quantification of rotational thallium-201 myocardial tomography. J Nucl Med. 1985;26(1):17-26.

21. El Fakhri G, Buvat I, Benali H, Todd-Pokropek A, Di Paola R. Relative impact of scatter, collimator response, attenuation, and finite spatial resolution corrections in cardiac SPECT. J Nucl Med. 2000;41(8):1400-8.

22. Patil HR, Bateman TM, McGhie AI, Burgett EV, Courter SA, Case JA, et al. Diagnostic accuracy of high-resolution attenuation-corrected Anger-camera SPECT in the detection of coronary artery disease. J Nucl Cardiol. 2014;21(1):127-34.

23. Nakajima K, Matsumoto N, Kasai T, Matsuo S, Kiso K, Okuda K. Normal values and standardization of parameters in nuclear cardiology: Japanese Society of Nuclear Medicine working group database. Ann Nucl Med. 2016;30(3):188-99.