Comparison of I-123 MIBG planar imaging and SPECT for the detection of decreased heart uptake in Parkinson disease

Abstract

Decreased myocardial uptake of I-123 metaiodobenzylguanidine (MIBG) is an important finding for diagnosis of Parkinson's disease (PD). This study compared I-123 MIBG SPECT and planar imaging with regard to their diagnostic yield for PD. 52 clinically diagnosed PD patients who also had decreased striatal uptake on FP-CIT PET/CT were enrolled. 16 normal controls were also included. All underwent cardiac MIBG planar scintigraphy and SPECT separately. Myocardial I-123 MIBG uptake was interpreted on planar and SPECT/CT images separately by visual and quantitative analysis. The final diagnosis was made by consensus between two readers. Kappa analyses were performed to determine inter-observer agreement for both methods. Sensitivity, specificity, and accuracy were compared with McNemar's test. The sensitivity, specificity, and accuracy were 84.6, 100, and 88.2% for planar images and 96.2, 100 and 97.1% for SPECT, respectively, with a significant difference between the two imaging methods (p < 0.031). All inter-observer agreements were almost perfect (planar scintigraphy: κ = 0.82; SPECT: κ = 0.93). Heart-to-mediastinum ratios from PD patients with negative planar and positive SPECT scans (group A) and patients with positive planar and positive SPECT scans (group B) were 1.69 ± 0.16 (1.59-1.85) and 1.41 ± 0.15 (1.20-1.53), respectively, and showed significant difference (p = 0.023). Lung-to-mediastinum ratios for groups A and B were 2.16 ± 0.20 (1.96-2.37) and 1.6 ± 0.19 (1.3-1.78), respectively, and were significantly higher in the former (p = 0.001). I-123 MIBG SPECT has a significantly higher diagnostic performance for PD than planar images. Increased lung uptake may cause false-negative results on planar imaging.

Parkinson’s Disease: Biomarkers, Treatment, and Risk Factors

“…The heart-to-mediastinum ration of 123 I-MIBG uptake is impaired in idiopathic PD patients, but not in patients with MSA. PET/CT scanning of these PD patients illustrated also decreased FP-CIT striatal uptake (Oh et al, 2015). MIBG scintigraphy allows to distinguish not only between PD versus MSA, but also between PD and DLB (Goldstein, 2001, 2013).…”

Cardiac 123I-MIBG scintigraphy: A window into the brain in Parkinsonism?

“…We share the authors' point of view that further knowledge of the genetic makeup of PD will allow better understanding of the pathophysiology and help design specific treatments that alter the course of the disease. Future studies using cardiac 123 I-MIBG SPECT imaging will provide valuable information to evaluate myocardial function and detect cardiac neuronal architecture with higher diagnostic performance than planar images 13,14 according to the recommendations of the European Cardiovascular Committee. 15 Further prospective studies in a larger group of patients with parkin mutations and other genetic forms of PD are required to confirm the findings of De Rosa et al…”

The Current Status of SPECT or SPECT/CT in South Korea

“…In a previous study that evaluated 52 PD patients and 16 healthy controls, higher diagnostic value in PD was found on I-123 MIBG SPECT than on planar imaging [14]. The sensitivity, specificity, and accuracy for the diagnosis of PD were 84.6 %, 100 %, and 88.2 %, respectively, on planar imaging, and 96.2 %, 100 %, and 97.1 % on SPECT, respectively.…”

“…I-123 MIBG myocardial imaging has also been applied to differentiate Parkinson's disease (PD) from non Parkinson's tremor [13,14]. In a previous study that evaluated 52 PD patients and 16 healthy controls, higher diagnostic value in PD was found on I-123 MIBG SPECT than on planar imaging [14].…”