Diagnostic Accuracy of 123I-Meta-Iodobenzylguanidine Myocardial Scintigraphy in Dementia with Lewy Bodies: A Multicenter Study

Abstract

Background and PurposeDementia with Lewy bodies (DLB) needs to be distinguished from Alzheimer’s disease (AD) because of important differences in patient management and outcome. Severe cardiac sympathetic degeneration occurs in DLB, but not in AD, offering a potential system for a biological diagnostic marker. The primary aim of this study was to investigate the diagnostic accuracy, in the ante-mortem differentiation of probable DLB from probable AD, of cardiac imaging with the ligand 123I-meta-iodobenzylguanidine (MIBG) which binds to the noradrenaline reuptake site, in the first multicenter study.MethodsWe performed a multicenter study in which we used 123I-MIBG scans to assess 133 patients with clinical diagnoses of probable (n = 61) or possible (n = 26) DLB or probable AD (n = 46) established by a consensus panel. Three readers, unaware of the clinical diagnosis, classified the images as either normal or abnormal by visual inspection. The heart-to-mediastinum ratios of 123I-MIBG uptake were also calculated using an automated region-of-interest based system.ResultsUsing the heart-to-mediastinum ratio calculated with the automated system, the sensitivity was 68.9% and the specificity was 89.1% to differentiate probable DLB from probable AD in both early and delayed images. By visual assessment, the sensitivity and specificity were 68.9% and 87.0%, respectively. In a subpopulation of patients with mild dementia (MMSE ≥ 22, n = 47), the sensitivity and specificity were 77.4% and 93.8%, respectively, with the delayed heart-to-mediastinum ratio.ConclusionsOur first multicenter study confirmed the high correlation between abnormal cardiac sympathetic activity evaluated with 123I-MIBG myocardial scintigraphy and a clinical diagnosis of probable DLB. The diagnostic accuracy is sufficiently high for this technique to be clinically useful in distinguishing DLB from AD, especially in patients with mild dementia.

123I-MIBG myocardial scintigraphy for the diagnosis of DLB: a multicentre 3-year follow-up study

“…We undertook a 3-year follow-up assessment of participants enrolled to our previous multicentre study 11. The detailed inclusion criteria were described elsewhere 11.…”

“…We previously carried out the first multicentre study to establish diagnostic accuracy of 123 I-MIBG SPECT imaging,11 in which 133 patients with clinical diagnoses of probable (n=61), possible (n=26) DLB and probable AD (n=46) were enrolled. When we used a heart-to-mediastinum (H/M) ratio of 123 I-MIBG as an indicator of myocardiac sympathetic function, sensitivity and specificity were 0.69 and 0.89 using a threshold H/M ratio of 2.1, respectively, to differentiate probable DLB from probable AD, and 123 I-MIBG contributed significantly to increase diagnostic accuracy of DLB 11.…”

“…When we used a heart-to-mediastinum (H/M) ratio of 123 I-MIBG as an indicator of myocardiac sympathetic function, sensitivity and specificity were 0.69 and 0.89 using a threshold H/M ratio of 2.1, respectively, to differentiate probable DLB from probable AD, and 123 I-MIBG contributed significantly to increase diagnostic accuracy of DLB 11. In the 2017 consensus criteria for DLB, the increased diagnostic weight was given to 123 I-MIBG scintigraphy, and reduced uptake on 123 I-MIBG scintigraphy was classified to indicative biomarkers for DLB as with reduced dopamine transporter uptake in basal ganglia and polysomnographic confirmation of rapid eye movement (REM) sleep without atonia 12…”

Cerebrospinal fluid Alzheimer biomarkers can be useful for discriminating dementia with Lewy bodies from Alzheimer’s disease at the prodromal stage

“…MIBG scintigraphy quantifies postganglionic sympathetic cardiac innervation, which postmortem studies show as reduced in Lewy body disease. Early studies suggesting very high diagnostic accuracy were followed by lower, but still useful, sensitivity (69%) and specificity (87%) values for discriminating probable DLB from probable AD in multicentres settings, rising to 77% and 94% in milder cases with Mini-Mental State Examination (MMSE) >21 17. Nevertheless, it is essential to discover new biomarkers that are able to discriminate DLB from AD to increase differential diagnosis.…”

Orthostatic hypotension in dementia with Lewy bodies

“…В 2001 г. в Японии были впервые представлены результаты сцинтиграфии миокарда со 123-МИБГ при ДТЛ, отражающей состояние симпатической иннерваци миокарда [58]. 123-МИБГ -аналог нор-адреналина, связывается с адренергическими нерв-ными окончаниями постганглионарных симпатиче-ских нейронов, иннервирующих сердечную мышцу.…”