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Fedorova TD, Knudsen K, Rasmussen TK, Horsager J, Nahimi A, Skjærbæk C, Schaeffer E, Berg D, Terkelsen AJ, Borghammer P. Thyroid [123I]MIBG uptake in Parkinson’s disease and diabetes mellitus. IBRO Neurosci Rep 2023; 14:342-345. [PMID: 37006721 PMCID: PMC10063394 DOI: 10.1016/j.ibneur.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Thyroid [123I]MIBG uptake is proposed as a tool for differentiating between Parkinson's disease (PD) and diabetes mellitus (DM) on [123I]MIBG scintigraphies since both patient groups show decreased cardiac uptake. One study compared thyroid [123I]MIBG uptake in DM and PD patients and reported reduced [123I]MIBG uptake only in the PD group. Here, we investigated thyroid [123I]MIBG uptake in patients with PD and DM and found severely reduced thyroid [123I]MIBG uptake in DM. Larger studies are needed to substantiate whether DM patients are more or less likely to exhibit decreased thyroid MIBG uptake compared to controls and PD patients.
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Affiliation(s)
- Tatyana D. Fedorova
- Aarhus University Hospital, Department of Nuclear Medicine and PET Centre, Aarhus, Denmark
- Aarhus University, Dept. of Clinical Medicine, Aarhus, Denmark
- Correspondence to: Dept. of Nuclear Medicine and PET Centre, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
| | - Karoline Knudsen
- Aarhus University Hospital, Department of Nuclear Medicine and PET Centre, Aarhus, Denmark
- Aarhus University, Dept. of Clinical Medicine, Aarhus, Denmark
| | - Thorsten K. Rasmussen
- Aarhus University, Dept. of Clinical Medicine, Aarhus, Denmark
- Aarhus University Hospital, Department of Neurology and Danish Pain Research Center, Aarhus, Denmark
| | - Jacob Horsager
- Aarhus University Hospital, Department of Nuclear Medicine and PET Centre, Aarhus, Denmark
| | - Adjmal Nahimi
- Aarhus University Hospital, Department of Nuclear Medicine and PET Centre, Aarhus, Denmark
| | - Casper Skjærbæk
- Aarhus University Hospital, Department of Nuclear Medicine and PET Centre, Aarhus, Denmark
- Aarhus University Hospital, Department of Neurology and Danish Pain Research Center, Aarhus, Denmark
| | - Eva Schaeffer
- Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Astrid J. Terkelsen
- Aarhus University Hospital, Department of Neurology and Danish Pain Research Center, Aarhus, Denmark
| | - Per Borghammer
- Aarhus University Hospital, Department of Nuclear Medicine and PET Centre, Aarhus, Denmark
- Aarhus University, Dept. of Clinical Medicine, Aarhus, Denmark
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Miyamoto K, Saiki S, Matsumoto H, Suzuki A, Yamashita Y, Iseki T, Ueno SI, Shiina K, Kataura T, Kamagata K, Imamichi Y, Sasazawa Y, Fujimaki M, Akamatsu W, Hattori N. Systemic Metabolic Alteration Dependent on the Thyroid-Liver Axis in Early PD. Ann Neurol 2023; 93:303-316. [PMID: 36128871 PMCID: PMC10092289 DOI: 10.1002/ana.26510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) is a common neurodegenerative disease characterized by initial involvement of the olfactory bulb/amygdala or autonomic nerves followed by nigral degeneration. Although autonomic innervation strictly regulates multiorgan systems, including endocrine functions, circulation, and digestion, how dysautonomia in PD affects systemic metabolism has not been identified. In this study, we tried to estimate the pathogenic linkage of PD by nuclear medicine techniques, trans-omic analysis of blood samples, and cultured cell experiments. METHODS Thyroid mediastinum ratio of 123 I-metaiodobenzylguanidine (MIBG) scintigraphy was measured in 1,158 patients with PD. Furthermore, serum exosome miRNA transcriptome analysis and plasma metabolome analysis followed by trans-omic analysis were performed in patients with de novo PD and age-matched healthy control persons. Additionally, thyroid hormone was administered to skeletal muscle and liver derived cells to evaluate the effect of hypothyroidism for these organs. RESULTS Sympathetic denervation of thyroid correlating with its cardiac denervation was confirmed in 1,158 patients with PD by MIBG scintigraphy. Among patients with drug-naïve PD, comprehensive metabolome analysis revealed decreased levels of thyroxine and insufficient fatty acid β-oxidation, which positively correlate with one another. Likewise, both plasma metabolome data and transcriptome data of circulating exosomal miRNAs, revealed specific enrichment of the peroxisome proliferator-activated receptor (PPARα) axis. Finally, association of thyroid hormone with PPARα-dependent β-oxidation regulation was confirmed by in vitro experiments. INTERPRETATION Our findings suggest that interorgan communications between the thyroid and liver are disorganized in the early stage of PD, which would be a sensitive diagnostic biomarker for PD. ANN NEUROL 2023;93:303-316.
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Affiliation(s)
- Kengo Miyamoto
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinji Saiki
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Matsumoto
- School of Information and Data Sciences, Nagasaki University, Nagasaki, Japan.,Laboratory for Bioinformatics Research, RIKEN Center for Biosystems Dynamics Research, Saitama, Japan
| | - Ayami Suzuki
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuri Yamashita
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Aging Biology in Health and Disease, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tatou Iseki
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shin-Ichi Ueno
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenta Shiina
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsushi Kataura
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoko Imamichi
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yukiko Sasazawa
- Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Motoki Fujimaki
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Wado Akamatsu
- Center for Genomic and Regenerative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Clement SC, Tytgat GAM, van Trotsenburg ASP, Kremer LCM, van Santen HM. Thyroid function after diagnostic 123I-metaiodobenzylguanidine in children with neuroblastic tumors. Ann Nucl Med 2022; 36:579-585. [PMID: 35499668 PMCID: PMC9132835 DOI: 10.1007/s12149-022-01743-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Metaiodobenzylguanidine (MIBG) labeled with radioisotopes can be used for diagnostics 123I-) and treatment (131I-) in patients with neuroblastic tumors. Thyroid dysfunction has been reported in 52% of neuroblastoma (NBL) survivors after 131I-MIBG, despite thyroid protection. Diagnostic 123I-MIBG is not considered to be hazardous for thyroid function; however, this has never been investigated. Therefore, the aim of this study was to evaluate the prevalence of thyroid dysfunction in survivors of a neuroblastic tumor who received diagnostic 123I-MIBG only. METHODS Thyroid function and uptake of 123I- in the thyroid gland after 123I-MIBG administrations were evaluated in 48 neuroblastic tumor survivors who had not been treated with 131I-MIBG. All patients had received thyroid prophylaxis consisting of potassium iodide or a combination of potassium iodide, thiamazole and thyroxine during exposure to 123I-MIBG. RESULTS After a median follow-up of 6.6 years, thyroid function was normal in 46 of 48 survivors (95.8%). Two survivors [prevalence 4.2% (95% CI 1.2-14.0)] had mild thyroid dysfunction. In 29.2% of the patients and 11.1% of images 123I- uptake was visible in the thyroid. In 1 patient with thyroid dysfunction, weak uptake of 123I- was seen on 1 of 10 images. CONCLUSIONS The prevalence of thyroid dysfunction does not seem to be increased in patients with neuroblastic tumors who received 123I-MIBG combined with thyroid protection. Randomized controlled trials are required to investigate whether administration of 123I-MIBG without thyroid protection is harmful to the thyroid gland.
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Affiliation(s)
- Sarah C Clement
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | | | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands. .,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
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Schmidt M, Decarolis B, Franzius C, Hero B, Pfluger T, Rogasch JMM, Simon T. Durchführung und Befundung der 123I-mIBG-Szintigraphie bei Kindern und Jugendlichen mit Neuroblastom (Version 3) – DGN-Handlungsempfehlung (S1-Leitlinie), Stand: 2/2020 – AWMF-Registernummer: 031-040. Nuklearmedizin 2022; 61:96-110. [PMID: 35421899 DOI: 10.1055/a-1778-3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfasssungDie aktualisierte 3. Fassung der 123I-mIBG-Szintigrafie bei Kindern und Jugendlichen berücksichtigt folgende aktuelle Entwicklungen: Die Leitlinie fokussiert auf die diagnostische Anwendung von 123I-mIBG beim Neuroblastom. 131I-mIBG kommt bei der Radionuklidtherapie zum Einsatz. An wenigen Stellen wird auf Besonderheiten des 131I-mIBG bei der Befundung von Posttherapie-Szintigrammen eingegangen. Es werden aktuelle Entwicklungen in der Patientenvorbereitung bei den Medikamenteninterferenzen und Empfehlungen zur Schilddrüsenblockade berücksichtigt. Neue Empfehlungen der zu applizierenden Aktivität werden genannt und die damit assoziierten Probleme diskutiert. Die Bildakquisition unter Berücksichtigung von SPECT bzw. SPECT/CT des Körperstammes inkl. des Kopfes wird berücksichtigt. Die Befundung unter Verwendung des SIOPEN-Scores wird neu aufgenommen. Auf PET bzw. PET/CT mit 18F-DOPA bzw. 68Ga-DotaTATE wird verwiesen.
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Affiliation(s)
- Matthias Schmidt
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Köln (Cologne), Germany
| | - Boris Decarolis
- Klinik und Poliklinik für Kinderheilkunde, Abteilung Kinderonkologie und -Hämatologie, Universitätsklinikum Köln, Köln (Cologne), Germany
| | - Christiane Franzius
- Zentrum für moderne Diagnostik (ZeMoDi), MR- und MR/PET, Schwachhauser Heerstraße 63 A, 28211 Bremen, ZeMoDi, Bremen, Germany
| | - Barbara Hero
- Klinik und Poliklinik für Kinderheilkunde, Abteilung Kinderonkologie und -Hämatologie, Universitätsklinikum Köln, Köln (Cologne), Germany
| | - Thomas Pfluger
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany
| | | | - Thorsten Simon
- Klinik und Poliklinik für Kinderheilkunde, Abteilung Kinderonkologie und -Hämatologie, Universitätsklinikum Köln, Köln (Cologne), Germany
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Chen Cardenas SM, Duan D, Rooper LM, Santhanam P, Cooper DS, Ladenson PW. Misdiagnosis of Paraganglioma by 123I-mIBG Without Stable Iodine Blockade of Thyroidal Radioiodine Uptake. J Endocr Soc 2020; 4:bvaa099. [PMID: 32793847 PMCID: PMC7414919 DOI: 10.1210/jendso/bvaa099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/13/2020] [Indexed: 01/02/2023] Open
Abstract
Iodine-123/iodine-131 (123I/131I)-metaiodobenzylguanidine (mIBG) scan is an established tool for the localization and treatment of neuroendocrine tumors such as paragangliomas (PGL). To minimize thyroid irradiation by the radioactive iodine in the mIBG preparation, blockade of thyroidal iodine uptake with high doses of stable iodine used to be given routinely as part of all mIBG protocols. As 123I is now more frequently utilized than 131I, concern about thyroid radiation has lessened and thyroid blockade is often considered unnecessary. However, in certain situations, the lack of thyroid blockade can significantly impact treatment decisions. This report describes 2 patients who had mediastinal masses incidentally discovered on CT scans, and on further evaluation were found to have symptoms suggesting catecholamine excess with mildly elevated plasma normetanephrine levels. 123I-mIBG scans were performed without thyroid blockade, which demonstrated accumulation of tracer in the masses that were therefore deemed positive for PGL. Both patients underwent surgical resection of the masses with their surgical pathology revealing ectopic thyroid tissue (ETT). These cases illustrate that if appropriate thyroid blockade is not performed, ETT concentrating radioiodine from mIBG can lead to falsely positive mIBG scans and unnecessary surgical procedures. We conclude that in the setting of a mass suspicious for PGL in a location potentially representing ETT, such as the mediastinum, thyroid blockade should be employed for mIBG protocols to avoid false positive scans caused by ETT.
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Affiliation(s)
- Stanley M Chen Cardenas
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daisy Duan
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa M Rooper
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul W Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bonacina M, Albano D, Steimberg N, Bosio G, Camoni L, Bertagna F, Giubbini R, Mazzoleni G. Different uptake of 123I-MIBG in the two main liver lobes: A persistant unsolved mistery. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Different uptake of 123I-MIBG in the two main liver lobes: A persistant unsolved mistery. Rev Esp Med Nucl Imagen Mol 2018; 37:285-289. [PMID: 29754941 DOI: 10.1016/j.remn.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE After radiopharmaceutical injection, a heightened 123I-MIBG concentration is frequently observed in the left hepatic lobe compared to the right one, but the reason of this finding remains unknown. Our aim was to retrospectively analyze the different 123I-MIBG uptake pattern between the two hepatic lobes and correlate our results with some epidemiological/clinical features. MATERIAL AND METHODS Ninety-four 123I-MIBG scintigraphies from 71 patients were selected. Regions of interest were drawn in the right and left lobes using transverse tomographic sections and left to right activity ratios (L/R ratio) were calculated at 6 and 24h after radiotracer administration. RESULTS Twenty-seven examinations were positive for hypermetabolic lesions while the remaining 67 were negative. In all cases mean early and delayed L/R ratios were greater than 1.00; average early L/R ratio was 1.37 and delayed L/R ratio 1.52. The delayed L/R ratio was significantly higher than the early one. There was no difference in the L/R ratios with regard to age, gender, primary disease and result of scintigraphy. CONCLUSIONS 123I-MIBG uptake was higher in left hepatic lobe compared to right and this ratio did not correlate with any epidemiological or clinical feature. The reason of this metabolic is not yet explained and some biomolecular hypotheses could be tested in 3D dynamic in vitro models.
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Borghammer P, Knudsen K, Fedorova TD, Brooks DJ. Imaging Parkinson's disease below the neck. NPJ Parkinsons Dis 2017; 3:15. [PMID: 28649615 PMCID: PMC5460119 DOI: 10.1038/s41531-017-0017-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/21/2016] [Accepted: 03/21/2017] [Indexed: 01/18/2023] Open
Abstract
Parkinson's disease is a systemic disorder with widespread and early α-synuclein pathology in the autonomic and enteric nervous systems, which is present throughout the gastrointestinal canal prior to diagnosis. Gastrointestinal and genitourinary autonomic symptoms often predate clinical diagnosis by several years. It has been hypothesized that progressive α-synuclein aggregation is initiated in hyperbranched, non-myelinated neuron terminals, and may subsequently spread via retrograde axonal transport. This would explain why autonomic nerves are so prone to formation of α-synuclein pathology. However, the hypothesis remains unproven and in vivo imaging methods of peripheral organs may be essential to study this important research field. The loss of sympathetic and parasympathetic nerve terminal function in Parkinson's disease has been demonstrated using radiotracers such as 123I-meta-iodobenzylguanidin, 18F-dopamine, and 11C-donepezil. Other radiotracer and radiological imaging methods have shown highly prevalent dysfunction of pharyngeal and esophageal motility, gastric emptying, colonic transit time, and anorectal function. Here, we summarize the methodology and main findings of radio-isotope and radiological modalities for imaging peripheral pathology in Parkinson's disease.
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Affiliation(s)
- Per Borghammer
- Department of Nuclear Medicine & PET Centre, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine & PET Centre, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tatyana D. Fedorova
- Department of Nuclear Medicine & PET Centre, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David J. Brooks
- Department of Nuclear Medicine & PET Centre, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Division of Neuroscience, Department of Medicine, Imperial College London, London, UK
- Division of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Jacobson AF. Thyroid blockade in 123I-mIBG cardiac imaging: A common sense approach. J Nucl Cardiol 2016; 23:1340-1342. [PMID: 25971988 DOI: 10.1007/s12350-015-0168-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
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Pellegrino T, Piscopo V, Petretta M, Cuocolo A. 123I-Metaiodobenzylguanidine cardiac innervation imaging: methods and interpretation. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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