Uptake index of 123I-metaiodobenzylguanidine myocardial scintigraphy for diagnosing Lewy body disease

Document Type : Original Article

Authors

1 Graduate School of Health Sciences, Kumamoto University, Kuhonji 4-24-1, Chuo-ku, Kumamoto 862-0796, Japan

2 Graduate School of Health Sciences, Kumamoto University

3 Fujifilm RI Pharma Co.,Ltd.

4 Faculty of Life Sciences, Kumamoto University,

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

Abstract

Objective(s): Iodine-123 metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy has been used to evaluate cardiac sympathetic denervation in Lewy body disease (LBD), including Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). The heart-tomediastinum ratio (H/M) in PD and DLB is significantly lower than that in Parkinson’s plus syndromes and Alzheimer’s disease. Although this ratio is useful for distinguishing LBD from non-LBD, it fluctuates depending on the system performance of the gamma cameras. Therefore, a new, simple quantification method using 123I-MIBG uptake analysis is required for clinical study. The purpose of this study was to develop a new uptake index with a simple protocol to determine 123I-MIBG uptake on planar images.
Methods: The 123I-MIBG input function was obtained from the input counts of the pulmonary artery (PA), which were assessed by analyzing the PA time-activity curves. The heart region of interest used for determining the H/M was used for calculating the uptake index, which was obtained by dividing the heart count by the input count.
Results: Forty-eight patients underwent 123I-MIBG chest angiography and planar imaging, after clinical feature assessment and tracer injection. The H/M and 123I-MIBG uptake index were calculated and correlated with clinical features. Values for LBD were significantly lower than those for non-LBD in all analyses (P<0.001). The overlapping ranges between non-LBD and LBD were 2.15 to 2.49 in the H/M method, and 1.04 to 1.22% in the uptake index method. The diagnostic accuracy of the uptake index (area under the curve (AUC), 0.98; sensitivity, 96%; specificity, 91%; positive predictive value (PPV), 90%; negative predictive value (NPV), 93%; and accuracy, 92%) was approximately equal to that of the H/M (AUC, 0.95; sensitivity, 93%; specificity, 91%; PPV, 90%; NPV, 93%; and accuracy, 92%) for discriminating patients with LBD and non-LBD.
Conclusion: A simple uptake index method was developed using 123I-MIBG planar imaging and the input counts determined by analyzing chest radioisotope angiography images of the PA. The diagnostic accuracy of the uptake index was approximately equal to that of the H/M for discriminating patients with LBD and non-LBD.

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References

1. Glowniak JV, Turner FE, Gray LL, Palac RT,Lagunas-Solar MC, Woodward WR. Iodine-123 metaiodobenzylguanidine imaging of the heart in idiopathic congestive cardiomyopathy and cardiac
transplants. J Nucl Med. 1989;30(7):1182-91.
2. 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.
3. Imamura Y, Fukuyama T. Prognostic value of myocardial MIBG scintigraphy findings in patients with cardiomyopathy--importance of background correction for quantification of MIBG activity. Ann Nucl Med. 2002;16(6):387-93.
4. Oliveira SM, Martins E, Oliveira A, Pinho T, Gavina C, Faria T, et al. Cardiac 123I-MIBG scintigraphy and arrhythmic risk in left ventricular noncompaction. Rev Port Cardiol. 2012;31(3):247-50.
5. Nakajima K, Yoshita M, Matsuo S, Taki J, Kinuya S. Iodine- 123- MIBG sympathetic imaging in Lewybody diseases and related movement disorders. Q J Nucl Med Mol Imaging. 2008;52(4):378-87.
6. 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.
7. 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.
8. Treglia G, Cason E, Stefanelli A, Cocciolillo F, Di Giuda D, Fagioli G, et al. MIBG scintigraphy in differential diagnosis of Parkinsonism: a meta-analysis. Clin Auton Res. 2012;22(1):43-55.
9. Inoue Y, Suzuki A, Shirouzu I, Machida T, Yoshizawa Y, Akita F. Effect of collimator choice on quantitative assessment of cardiac iodine 123 MIBG uptake. J Nucl Cardiol. 2003;10(6):623-32.
10. Verberne HJ, Feenstra C, de Jong WM, Somsen GA, van Eck-Smit BL, Busemann Sokole E. Influence of collimator choice and simulated clinical conditions on 123I-MIBG heart/mediastinum ratio: a phantom study.Eur J Nucl Med Mol Imaging. 2005;32(9):1100-7.
11. Nakajima K, Okuda K, Matsuo S, Yoshita M, Taki J, Yamada M, et al. Standardization of metaiodobenzylguanidine heart to mediastinum ratio using a calibration phantom: effects of correction on normal databases and a multicentre study. Eur J Nucl Med Mol Imaging. 2012;39(1):113-9.
12. Nakajima K, Okuda K, Yoshimura M, Matsuo S, Wakabayashi H, Imanishi Y, et al. Multicenter crosscalibration of I-123 metaiodobenzylguanidine heart-to-mediastinum ratios to overcome
camera-collimator variations. J Nucl Cardiol.2014;21(5):970-8.
13. Slomka PJ, Mehta PK, Germano G, Berman DS. Quantification of I-123-meta-iodobenzylguanidine heart-to-mediastinum ratios: not so simple after all. J Nucl Cardiol. 2014;21(5):979-83.
14. 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.
15. van der Veen BJ, Al Younis I, de Roos A, Stokkel MP. Assessment of global cardiac I-123 MIBG uptake andwashout using volumetric quantification of SPECT acquisitions. J Nucl Cardiol.2012;19(4):752-62.
16. Raffel DM, Corbett JR, Schwaiger M, Wieland DM. Mechanism- based strategies for mapping heart sympathetic nerve function. Nucl Med Biol.1995;22(8):1019-26.
17. Raffel DM, Wieland DM. Assessment of cardiac sympathetic nerve integrity with positron emission tomography. Nucl Med Biol. 2001; 28(5):541-59.
18. 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.
19. 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.
20. 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.
21. Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, et al. Movement Disorder Society UPDRS-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008; 23(15): 2129-70.
22. McKeith IG, Dickson DW, Lowe J, Emre M, O’Brien JT, Feldman H, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005;65(12):1863-72.
23. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the  NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease.
Neurology. 1984;34(7):939-44.
24. 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.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 5, Issue 1
January 2017
Pages 37-43

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