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Journal of Neurology

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01-11-2020 | Parkinson's Disease | Original Communication

Appropriate assessment method of ¹²³I-MIBG myocardial scintigraphy for the diagnosis of Lewy body diseases and idiopathic REM sleep behavior disorder

Authors: Kazuto Tsukita, Naoko Tachibana, Toshiaki Hamano

Published in: Journal of Neurology | Issue 11/2020

Abstract

Background

In ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) myocardial scintigraphy, the early heart-to-mediastinum (H/M) ratio is considered to reflect the density of the cardiac sympathetic nerve endings, washout rate (WR) is an indicator of the cardiac sympathetic tone, and the delayed H/M ratio reflects both. The Delayed H/M ratio is usually used to support the diagnosis of Lewy body diseases (LBDs) and idiopathic REM sleep behavior disorder (iRBD); however, which values should be used have not been specified. Here, we hypothesized that the combination of these values is appropriate for the diagnostic purpose.

Methods

In this single-center retrospective cohort study, we recruited 106 patients with LBDs or iRBD and 33 patients without those diseases, of whom we reviewed the ¹²³I-MIBG myocardial scintigraphy results.

Results

Sensitivity/specificity to diagnose LBDs and iRBD were 0.77/0.94 for the early H/M ratio (≤ 2.0), 0.82/0.94 for the delayed H/M ratio (≤ 2.0), and 0.89/0.91 for WR (≥ 23.0). When patients were considered positive if at least either the early H/M ratio or WR was abnormal, the sensitivity significantly increased to 0.97, whereas the specificity remained similar at 0.91. Furthermore, our subgroup analyses revealed that WR enhancement preceded H/M ratio reduction, but, in patients with a severely reduced early H/M ratio, paradoxically normal WR could be observed.

Conclusion

We propose the highly sensitive, combined early H/M ratio and WR assessments for ¹²³I-MIBG myocardial scintigraphy. The temporal precedence of cardiac sympathetic dysfunction over denervation and the floor effect in ¹²³I-MIBG uptake may underlie the sensitivity improvement.

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Title: Appropriate assessment method of 123I-MIBG myocardial scintigraphy for the diagnosis of Lewy body diseases and idiopathic REM sleep behavior disorder
Authors: Kazuto Tsukita
Naoko Tachibana
Toshiaki Hamano
Publication date: 01-11-2020
Publisher: Springer Berlin Heidelberg
Keywords: Parkinson's Disease
Scintigraphy
Progressive Supranuclear Palsy
Published in: Journal of Neurology / Issue 11/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-020-09992-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Appropriate assessment method of ¹²³I-MIBG myocardial scintigraphy for the diagnosis of Lewy body diseases and idiopathic REM sleep behavior disorder

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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