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Optimal Protocol and Clinical Usefulness of 123I-MIBG Cardiac Scintigraphy for Differentiation of Parkinson’s Disease and Dementia with Lewy Body from Non-Parkinson’s Diseases

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Abstract

Purpose

123I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy was a useful imaging modality for the diagnosis of Parkinson’s disease, but its diagnostic performances were variably reported. This retrospective study compared the diagnostic performances and investigated the optimal imaging protocol of 123I-MIBG cardiac scintigraphy at various imaging time points in patients suspected of Parkinson’s disease in clinical practice.

Methods

In patients suspected of Parkinson’s disease, clinical records, autonomic function tests, and 123I-MIBG cardiac scintigraphy were retrospectively reviewed. Semi-quantitative parameters such as heart-to-mediastinum ratio (HMR) and washout rate (WR) were calculated and compared at 15 min, 1 h, 2 h, 3 h, and 4 h post-injection (p.i.). of 123I-MIBG cardiac scintigraphy. Group A consisted of Parkinson’s disease (PD), Parkinson’s disease dementia (PDD), and dementia with Lewy body (DLB), and group B consisted of non-Parkinson’s diseases such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), drug-induced parkinsonism (DIP), essential tremor (ET), Parkinson-plus syndrome (PPS), and unspecified secondary parkinsonism (NA). The diagnostic performances of HMR and WR were compared for differentiation of group A from group B, and their clinical usefulness and optimal imaging time points were explored.

Results

Seventy-eight patients were included in group A (67 PD, 7 PDD, 4 DLB), and 18 patients were included in group B (5 MSA, 3 PSP, 2 DIP, 2 ET, 1 PPS, and 1 NA). Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value of HMR and WR were maximized at 4 h p.i., (82.1%, 85.7%, 82.6%, 97.0%, and 46.2%; cutoff threshold < 1.717; area under curve 0.8086) and at the time interval between 1 and 4 h p.i. (65.4%, 85.7%, 68.5%, 96.2%, and 30.8%; cutoff threshold > 24.1%; area under curve 0.8246), respectively, and PPVs of both HMR and WR persistently showed greater than 92.7% at earlier time points and shorter time intervals.

Conclusion

This study reassured that 4-h-delayed imaging is recommended for the best diagnostic performances in 123I-MIBG cardiac scintigraphy. Although it showed suboptimal diagnostic performances to differentiate PD, PDD, and DLB from non-Parkinson’s diseases, it can be useful as an auxiliary measure for the differential diagnosis in usual clinical practice.

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Data Availability

All data and materials are only permitted to be temporarily stored in the secured storage and any sharing of them is not permitted by an institutional review board of Kangwon National University Hospital.

Funding

This study was supported by a 2020 Research Grant from Kangwon National University.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine and School of Medicine, 1 Kangwondaehak-gil, Chuncheon, Gangwon-do, 24341, Republic of Korea

    In Kook Chun

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All the study processes including study design, material preparation, data collection, manuscript writing, and revision were performed by the only author In Kook Chun.

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Correspondence to In Kook Chun.

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This article is an original article made from the retrospective study approved by an institutional review board of Kangwon National University Hospital (reference number: KNUH-2022-09-010) and this study was performed in accordance with the ethical standards as laid down in the Helsinki Declaration as revised in 2013.

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Supplementary Information

Supplementary file 1

Supplement Fig. S1 Examples of Differentiation of DLB from PD and PDD by Washout Rate (WR) (a) and K-MMSE (b). Statistical significance was displayed by asterisks; * for p < 0.05 and ** for p < 0.01.

Supplementary file 2

Supplement Table S1 Temporal Comparisons of Heart-to-Mediastinum Ratio and Washout Rate between Two Different Time Points or Intervals in either Group A or Group B

Supplementary file 3

Supplement Table S2 Intergroup Comparisons of Heart-to-Mediastinum Ratio and Washout Rate between Two Different Time Points or Intervals between Group A and Group B

Supplementary file 4

Supplement Table S3 Improved Diagnostic Performances for Differentiation of Group A from Group B by Adding Autonomic Function Tests

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Chun, I.K. Optimal Protocol and Clinical Usefulness of 123I-MIBG Cardiac Scintigraphy for Differentiation of Parkinson’s Disease and Dementia with Lewy Body from Non-Parkinson’s Diseases. Nucl Med Mol Imaging 57, 145–154 (2023). https://doi.org/10.1007/s13139-023-00790-w

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