Comparison of the Usefulness of Brain Perfusion SPECT and MIBG Myocardial Scintigraphy for the Diagnosis of Dementia with Lewy Bodies

Abstract

Background: Supportive features in the diagnostic criteria for dementia with Lewy bodies (DLB) include occipital hypoperfusion and decreased cardiac uptake of ¹²³I-metaiodobenzylguanidine (MIBG). In this study, we performed both brain perfusion single photon emission computed tomography (SPECT) and MIBG myocardial scintigraphy in the same subjects and evaluated their sensitivity to detect the characteristic features of DLB. Methods: Twenty-five patients with probable DLB (76.8 ± 5.1 years old, 10 male) underwent ^99mTc-ethylcysteinate dimer brain perfusion SPECT and ¹²³I-MIBG myocardial scintigraphy. The results of SPECT were analyzed using a qualitative analysis program, easy Z score imaging system (eZIS), and an automated quantitative analysis program, 3DSRT. Results: Qualitative analysis using eZIS demonstrated occipital hypoperfusion in 17 subjects (68%). The quantified mean blood perfusion in the occipital segment on the 3DSRT template was 40.7 ± 5.03 ml/100 g/min (right) and 40.5 ± 5.38 ml/100 g/min (left), and in 19 DLB patients these values were below the normal limit. Twenty-four of 25 subjects (96%) had decreased cardiac MIBG uptake in the delayed image. Conclusion: MIBG myocardial scintigraphy was superior to brain perfusion SPECT in detecting a characteristic feature of DLB. Our results suggest that combining SPECT and MIBG scintigraphy could increase the accuracy of clinical diagnosis of DLB.

Two-Layer Appearance on Brain Perfusion SPECT in Idiopathic Normal Pressure Hydrocephalus: A Qualitative Analysis by Using Easy Z-Score Imaging System, eZIS

“…Brain Perfusion SPECT Brain perfusion SPECT was performed as previously reported [10][11][12][13] . Briefly, all subjects were resting in a supine position in quiet surroundings.…”

Diagnosis of dementia with Lewy bodies: can 123I-IMP and 123I-MIBG scintigraphy yield new core features?

“…[13][14][15][16][17] The value of 123 I-MIBG myocardial scintigraphy in the early diagnosis of DLB and in the differential diagnosis between DLB and other dementias has been studied; scintigraphic findings are reported to yield independent diagnostic predictors of DLB. [18][19][20][21] In their metaanalysis, Treglia and Cason 22 demonstrated that MIBG scintigraphy is an accurate diagnostic imaging method to differentiate DLB from other dementias; they reported a pooled sensitivity and specificity of 98% and 94%, respectively. In addition, 123 I-MIBG scintigraphy appears to be of higher sensitivity than brain perfusion SPECT for the diagnosis of DLB.…”

“…In addition, 123 I-MIBG scintigraphy appears to be of higher sensitivity than brain perfusion SPECT for the diagnosis of DLB. 19 Combining these methods may increase the accuracy of the clinical diagnosis of DLB. 23 However, according to the current guidelines, they yield supportive rather than diagnostic features because their diagnostic specificity has not been confirmed.…”

How to Distinguish Dementia with Lewy Bodies from Alzheimer Disease?

“…However, these abnormalities are seen in only approximately 50-70% of DLB cases (high specificity, but somewhat poor sensitivity). Of note, in two recent studies comparing brain perfusion SPECT and MIBG myocardial scintigraphy, the latter was significantly superior in the identification of DLB subjects [46,47]. …”