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Saeda S, Sumi Y, Fujiwara K, Kadotani H. Blunted tachycardia and cardiac sympathetic denervation in isolated rapid eye movement sleep behavior disorder. BMC Neurol 2024; 24:317. [PMID: 39232705 PMCID: PMC11373284 DOI: 10.1186/s12883-024-03822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Isolated rapid eye movement sleep behavior disorder (iRBD) serves as a prodromal phase of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Blunted tachycardia (BT) during postural changes indicates neurogenic orthostatic hypotension, a marker of autonomic dysfunction. We aimed to investigate whether BT is associated with cardiac sympathetic neurogenic denervation. Additionally, we conducted a preliminary short-term follow-up to examine the potential prognostic significance of BT regarding phenoconversion and mortality. METHODS Forty-three patients with iRBD at Shiga University of Medical Science Hospital underwent active standing tests to identify BT, defined by a specific ratio of decrease in systolic blood pressure to inadequate increase in heart rate after standing, and orthostatic hypotension. 123I-metaiodobenzylguanidine myocardial scintigraphy (123I-MIBG) and dopamine transporter single-photon emission computed tomography (DAT-SPECT) were performed. Participants were followed up for 3.4 ± 2.4 years for phenoconversion and 4.0 ± 2.3 years for mortality assessment, and the risk of events was analyzed using log-rank tests. RESULTS Among the 43 participants (mean age, 72.3 ± 7.9 years; 8 female), 17 met the BT criteria. We found no significant comorbidity-related differences in hypertension or diabetes between the BT(+) and BT(-) groups. Orthostatic hypotension was more prevalent in the BT(+) group than in the BT(-) group (47.1% vs 7.7%, p = 0.003). BT(+) patients were older with a lower early and delayed MIBG uptake; however, no significant differences were observed in DAT accumulation. Phenoconversion was observed in seven (41.2%) BT(+) and seven (26.9%) BT(-) patients. Three deaths were recorded in the BT(+) group (17.6%) and three in the BT(-) group (11.5%). No significant differences were observed in the risk of phenoconversion or mortality between the groups. CONCLUSIONS We have identified the possibility that BT reflects cardiac sympathetic neurogenic denervation in patients with iRBD. Future research is needed to elucidate the potential prognostic value of BT.
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Affiliation(s)
- Shota Saeda
- Department of Materials Process Engineering, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, Aichi, 464-8601, Japan
| | - Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Koichi Fujiwara
- Department of Materials Process Engineering, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, Aichi, 464-8601, Japan.
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
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Tang Z, Hirano S, Koizumi Y, Izumi M, Kitayama Y, Yamagishi K, Tamura M, Ishikawa A, Kashiwado K, Iimori T, Mukai H, Yokota H, Horikoshi T, Uno T, Kuwabara S. Diagnostic Sensitivity and Symptomatic Relevance of Dopamine Transporter Imaging and Myocardial Sympathetic Scintigraphy in Patients with Dementia with Lewy Bodies. J Alzheimers Dis 2024; 100:127-137. [PMID: 38848178 PMCID: PMC11307094 DOI: 10.3233/jad-231395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/09/2024]
Abstract
Background Dementia with Lewy bodies (DLB) presents with various symptoms, posing challenges for early diagnosis challenging. Dopamine transporter (123I-FP-CIT) single-photon emission tomography (SPECT) and 123I-meta-iodobenzylguanidine (123I-MIBG) imaging are crucial diagnostic biomarkers. Hypothesis about body- and brain-first subtypes of DLB indicate that some DLB may show normal 123I-FP-CIT or 123I-MIBG results; but the characteristic expression of these two subtypes remains unclear. Objective This study aimed to evaluate the diagnostic sensitivity of 123I-FP-CIT and 123I-MIBG imaging alone, combined in patients with DLB and explore symptoms associated with the abnormal imaging results. Methods Demographic data, clinical status, and imaging results were retrospectively collected from patients diagnosed with possible DLB. Both images were quantified using semi-automated software, and the sensitivity of each imaging modality and their combination was calculated. Demographic data, cognition, and motor and non-motor symptoms were compared among the subgroups based on the imaging results. Symptoms related to each imaging abnormality were examined using binomial logistic regression analyses. Results Among 114 patients with DLB, 80 underwent 123I-FP-CIT SPECT (sensitivity: 80.3%), 83 underwent 123I-MIBG imaging (68.2%), and 66 both (sensitivity of either abnormal result: 93.9%). Visual hallucinations differed among the four subgroups based on imaging results. Additionally, nocturia and orthostatic hypotension differed between abnormal and normal 123I-MIBG images. Conclusions Overall, 123I-FP-CIT SPECT was slightly higher sensitivity than 123I-MIBG imaging, with combined imaging increasing diagnostic sensitivity. Normal results of a single imaging test may not refute DLB. Autonomic symptoms may lead to abnormal 123I-MIBG scintigraphy findings indicating body-first subtype of patients with DLB.
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Affiliation(s)
- Zhihui Tang
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yume Koizumi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michiko Izumi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihisa Kitayama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kosuke Yamagishi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mitsuyoshi Tamura
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ai Ishikawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kouichi Kashiwado
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Iimori
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Hiroki Mukai
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuro Horikoshi
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Nuvoli S, Palumbo B, Marongiu A, Bianconi F, Spanu A. 123I-MIBG Cardiac Scintigraphy and Heart/Mediastinum Ratio in Neurodegenerative Disorders: Is Delayed Scan Really Necessary? Curr Radiopharm 2022; 15:257-258. [PMID: 35619294 DOI: 10.2174/1874471015666220520090630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/24/2021] [Accepted: 01/17/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Susanna Nuvoli
- Department of Medical, Surgical and Experimental Sciences, Unit of Nuclear Medicine, Università degli Studi di Sassari, Sassari, Italy
| | - Barbara Palumbo
- Department of Medicine and Surgery, Section of Nuclear Medicine and Health Physics, Università degli Studi di Perugia, Perugia, Italy
| | - Andrea Marongiu
- Department of Medical, Surgical and Experimental Sciences, Unit of Nuclear Medicine, Università degli Studi di Sassari, Sassari, Italy
| | - Francesco Bianconi
- Department of Engineering, Università degli Studi di Perugia, Perugia, Italy
| | - Angela Spanu
- Department of Medical, Surgical and Experimental Sciences, Unit of Nuclear Medicine, Università degli Studi di Sassari, Sassari, Italy
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Roberts G, Kane JP, Lloyd J, Firbank M, Donaghy PC, Petrides GS, Taylor JP, O’Brien J, Thomas AJ. Can early phase cardiac [123I]mIBG images be used to diagnose Lewy body disease? Nucl Med Commun 2022; 43:770-777. [PMID: 35603421 PMCID: PMC9177152 DOI: 10.1097/mnm.0000000000001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Some studies have suggested that cardiac [123I]metaiodobenzylguanidine images obtained 15-20 min after tracer administration are as accurate for dementia with Lewy bodies (DLB) diagnosis as standard images acquired after a delay of 3-4 h; some suggest delayed imaging is preferable. We compare early and delayed heart-to-mediastinum ratios (HMR) in a well-characterised research dataset and make recommendations for clinical practice. METHODS Images were acquired using a Siemens gamma camera with medium energy collimators. Early images were obtained at 20 min and delayed at 4 h (± 30) min. In total 167 pairs of images were reviewed: 30 controls, 39 people with dementia and 98 with mild cognitive impairment. HMR normal cutoff values derived from control data were ≥2.10 for early imaging and ≥1.85 for delayed. RESULTS HMR tended to drop between early and delayed for abnormal images, but increase for normal images. Histograms of early and delayed HMR showed a slightly better separation of results into two groups for delayed imaging. Accuracy results were slightly higher for delayed imaging than early imaging (73 vs. 77%), sensitivity 63 vs. 65% and specificity 82 vs. 88%. However, this was not statistically significant - in total only 8/167 (5%) of scans changed designation between early and delayed imaging. CONCLUSION We suggest that a delayed image could be acquired only if the early result is borderline. This removes the need for delayed imaging in about 70% of patients. Adopting this protocol in clinical practice would reduce the time most patients have to wait and could free up scanner time.
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Affiliation(s)
- Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne
| | - Joseph P.M. Kane
- Translational and Clinical Research Institute, Newcastle University
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne
| | - Jim Lloyd
- Translational and Clinical Research Institute, Newcastle University
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University
| | | | - George S. Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University
| | - John O’Brien
- Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Belfast and Department of Psychiatry, University of Cambridge School of Clinical Medicine, UK
| | - Alan J. Thomas
- Translational and Clinical Research Institute, Newcastle University
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Frantellizzi V, Lavelli V, Ferrari C, Sardaro A, Farcomeni A, Pacilio M, Borrazzo C, Pani R, Rubini G, Vincentis GD. Diagnostic Value of the Early Heart-to-Mediastinum Count Ratio in Cardiac 123I-mIBG Imaging for Parkinson's Disease. Curr Radiopharm 2021; 14:64-69. [PMID: 32720610 DOI: 10.2174/1874471013999200727211633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/10/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Early diagnosis of Parkinson's disease (PD) is of primary importance. The delayed (3-4 h after injection) Iodine-123-Metaiodobenzylguanidine (123I-mIBG) scintigraphy has been proven to be effective in early differential diagnosis for Lewy body disease. But early imaging (15-30 min after injection) has only been marginally studied for its possible diagnostic role. In this prospective study, a threshold for the early Heart-to-Mediastinum (H/M) count ratio has been investigated, obtaining a diagnostic accuracy analogous to conventional, delayed imaging. METHODS One hundred and eight patients with suspected Parkinson's disease (PD) were acquired after 15 and 240 minutes from the injection of 150-185 MBq of 123I-mIBG. The early and late H/M (He/Me and Hl/Ml) were evaluated by drawing Region-of-Interests on the heart and the upper half of the mediastinum. Optimal threshold (Youden index) and overall predictive performance were determined by receiver operating characteristic curve, classifying tentatively patients having an Hl/Ml lower than 1.6 as suffering from PD. RESULTS He/Me was not significantly different from Hl/Ml (p-value=0.835). The Area-under-curve was 0.935 (95%CI: 0.845-1.000). The He/Me optimal threshold was 1.66, with sensitivity, specificity, and diagnostic accuracy of 95.5%, 85.7 and 90.7% respectively. CONCLUSION The He/Me Ratio is almost as accurate as the widely used delayed 123I-mIBG imaging, reducing the burden of delayed imaging but preserving the diagnostic accuracy of the method. Moreover the differential diagnosis in Parkinson's disease can be made in just 25 minutes against the 4 hours currently needed, lowering costs of the healthcare system and improving patients compliance.
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Affiliation(s)
- Viviana Frantellizzi
- Department of Molecular Medicine, Sapienza, "Sapienza" University of Rome, viale Regina Elena,324, 00161Rome, Italy
| | - Valentina Lavelli
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine - University of Bari "Aldo Moro", Bari, Italy
| | - Cristina Ferrari
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine - University of Bari "Aldo Moro", Bari, Italy
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Alessio Farcomeni
- Department of Economic and Finance, "Tor Vergata" University of Rome, via Columbia, 2, 00133Rome, Italy
| | - Massimiliano Pacilio
- Department of Medical Physics, Azienda Ospedaliera Universitaria Policlinico Umberto I, viale del Policlinico 155, 00161Rome, Italy
| | - Cristian Borrazzo
- Department of Medical Physics, Azienda Ospedaliera Universitaria Policlinico Umberto I, viale del Policlinico 155, 00161Rome, Italy
| | - Roberto Pani
- Department of Sciences and Medico-Surgical Biotechnologies, "Sapienza" University of Rome, viale Regina Elena,324, 00161Rome, Italy
| | - Giuseppe Rubini
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine - University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, viale Regina Elena,324, 00161Rome, Italy
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Terao Y, Honma M, Asahara Y, Tokushige SI, Furubayashi T, Miyazaki T, Inomata-Terada S, Uchibori A, Miyagawa S, Ichikawa Y, Chiba A, Ugawa Y, Suzuki M. Time Distortion in Parkinsonism. Front Neurosci 2021; 15:648814. [PMID: 33815049 PMCID: PMC8017233 DOI: 10.3389/fnins.2021.648814] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/24/2021] [Indexed: 11/13/2022] Open
Abstract
Although animal studies and studies on Parkinson’s disease (PD) suggest that dopamine deficiency slows the pace of the internal clock, which is corrected by dopaminergic medication, timing deficits in parkinsonism remain to be characterized with diverse findings. Here we studied patients with PD and progressive supranuclear palsy (PSP), 3–4 h after drug intake, and normal age-matched subjects. We contrasted perceptual (temporal bisection, duration comparison) and motor timing tasks (time production/reproduction) in supra- and sub-second time domains, and automatic versus cognitive/short-term memory–related tasks. Subjects were allowed to count during supra-second production and reproduction tasks. In the time production task, linearly correlating the produced time with the instructed time showed that the “subjective sense” of 1 s is slightly longer in PD and shorter in PSP than in normals. This was superposed on a prominent trend of underestimation of longer (supra-second) durations, common to all groups, suggesting that the pace of the internal clock changed from fast to slow as time went by. In the time reproduction task, PD and, more prominently, PSP patients over-reproduced shorter durations and under-reproduced longer durations at extremes of the time range studied, with intermediate durations reproduced veridically, with a shallower slope of linear correlation between the presented and produced time. In the duration comparison task, PD patients overestimated the second presented duration relative to the first with shorter but not longer standard durations. In the bisection task, PD and PSP patients estimated the bisection point (BP50) between the two supra-second but not sub-second standards to be longer than normal subjects. Thus, perceptual timing tasks showed changes in opposite directions to motor timing tasks: underestimating shorter durations and overestimating longer durations. In PD, correlation of the mini-mental state examination score with supra-second BP50 and the slope of linear correlation in the reproduction task suggested involvement of short-term memory in these tasks. Dopamine deficiency didn’t correlate significantly with timing performances, suggesting that the slowed clock hypothesis cannot explain the entire results. Timing performance in PD may be determined by complex interactions among time scales on the motor and sensory sides, and by their distortion in memory.
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Affiliation(s)
- Yasuo Terao
- Department of Medical Physiology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Motoyasu Honma
- Department of Physiology, School of Medicine, Showa University, Tokyo, Japan
| | - Yuki Asahara
- Department of Neurology, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | | | - Toshiaki Furubayashi
- Graduate School of Health and Environment Science, Tohoku Bunka Gakuen University, Sendai, Japan
| | - Tai Miyazaki
- Department of Neurology, Kyorin University Hospital, Tokyo, Japan
| | - Satomi Inomata-Terada
- Department of Medical Physiology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Ayumi Uchibori
- Department of Neurology, Kyorin University Hospital, Tokyo, Japan
| | - Shinji Miyagawa
- Department of Neurology, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Yaeko Ichikawa
- Department of Neurology, Kyorin University Hospital, Tokyo, Japan
| | - Atsuro Chiba
- Department of Neurology, Kyorin University Hospital, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masahiko Suzuki
- Department of Neurology, The Jikei University Katsushika Medical Center, Tokyo, Japan
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Roberts G, Kane JPM, Lloyd JJ, Petrides GS, Howe K, O'Brien JT, Thomas AJ. A comparison of visual and semiquantitative analysis methods for planar cardiac 123I-MIBG scintigraphy in dementia with Lewy bodies. Nucl Med Commun 2019; 40:734-743. [PMID: 31058746 DOI: 10.1097/mnm.0000000000001024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Cardiac I-MIBG imaging is an established technique for the diagnosis of dementia with Lewy bodies but various analysis methods are reported in the literature. We assessed different methods in the same cohort of patients to inform best practice. PATIENTS AND METHODS Seventeen patients with dementia with Lewy bodies, 15 with Alzheimer's disease and 16 controls were included. Planar images were acquired 20 min and 4 h after injection. Nine operators produced heart-to-mediastinum ratios (HMRs) using freehand and 6, 7 and 8 cm diameter circular cardiac regions. Interoperator variation was measured using the coefficient of variation. HMR differences between methods were assessed using analysis of variance. Seven raters assessed the images visually. Accuracy was compared using receiver operating characteristic analysis. RESULTS There were significant differences in HMR between region methods (P=0.006). However, with optimised cut-offs there was no significant difference in accuracy (P=0.2-1.0). The sensitivity was 65-71% and specificity 100% for all HMR methods. Variation was lower with fixed regions than freehand (P<0.001). Visual rating sensitivity and specificity were 65 and 77% on early images and 76 and 71% on delayed images. There was no significant difference in HMR between early and delayed images (P=0.4-0.7) although a greater separation between means was seen on delayed images (0.73 vs. 0.95). CONCLUSION HMR analysis using a suitable cut-off is more accurate than visual rating. Accuracy is similar for all methods, but freehand regions are more variable and 6 cm circles easiest to place. We recommend calculating HMR using a 6 cm circular cardiac region of interest on delayed images.
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Affiliation(s)
- Gemma Roberts
- Institute of Neuroscience, Newcastle University.,Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne
| | | | - Jim J Lloyd
- Institute of Neuroscience, Newcastle University.,Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne
| | - George S Petrides
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne
| | - Kim Howe
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Giubbini R, Milan E, Marcassa C, Paghera B, Fracassi F, Camoni L, Rodella C, Bertagna F, Motta F, Bertoli M, Campini R. 1-23I-MIBG thyroid uptake: Implications for MIBG imaging of the heart. J Nucl Cardiol 2016; 23:1335-1339. [PMID: 25963285 DOI: 10.1007/s12350-015-0142-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/04/2015] [Accepted: 04/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND 123I-MIBG has been widely used in patients with heart failure and neurological disorders. The patients are pre-treated with Lugol's oral solution or potassium perchlorate to prevent thyroid uptake of unlabeled 123I to limit the thyroid radiation exposure. However, despite the inhibition of the iodide pump, the thyroid is frequently visualized. The aim of this study was to study the pattern of thyroid uptake. METHODS We reviewed the 123I-MIBG images of 57 patients studied in three different centers in Italy for cardiac (n = 42) or neurological (n = 15) indications. They were imaged at 15 minutes and 4 hours after injection and in all patients, the thyroid was included in the imaging field of view. In 2 of the 3 centers, the patients were pre-treated with Lugol's oral solution and/or potassium perchlorate (group 1) but in the third center, they were not (group 2). The following imaging parameters were evaluated: heart-to-mediastinum ratio (H/M), thyroid-to-mediastinum ratio (T/M) at 4 hours, and tracer wash out from the heart (HWO) and from the thyroid (TWO). RESULTS In the cardiac patients, the HWO was 22.98 ± 7.16% and TWO was 11.4 ± 11.86% (P < .0001). The TWO was 12.2 ± 13.1% in group 1 and 10.05 ± 8.97% in group 2 (P = NS). In the neurological patients the HWO was 26 ± 8.1% and the TWO was 20.32 ± 6.41 (P < .05). The difference in TWO was statistically significant (P < .01) between cardiac and neurological patients, whereas the HWO was not. The 4-hour H/M was 1.49 ± 0.23 in cardiac patients vs 1.4 ± 0.39 in neurological patients (P = NS). The 4-hour T/M was 1.33 ± 0.3 in cardiac patients vs 1.15 ± 0.13 in neurological patients (P < 0.05). CONCLUSION The thyroid visualization in MIBG imaging is likely an expression of thyroid sympathetic innervation. The differences in TWO and T/M ratio in cardiac and neurological patients probably express differences in thyroid dopaminergic receptors. Thus, pre-treatment with potassium perchlorate or Lugol's solution may not be justified in patients undergoing 123I-MIBG imaging in whom the risk of side effects due to pre-treatment could be higher than the risk due to thyroid radiation exposure.
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Affiliation(s)
- Raffaele Giubbini
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy.
| | - Elisa Milan
- Nuclear Medicine Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, TV, Italy
| | - Claudio Marcassa
- Cardiology Department, Fondazione Maugeri Centro Medico, Veruno, NO, Italy
| | - Barbara Paghera
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Federica Fracassi
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Luca Camoni
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Carlo Rodella
- Health Physics Department, Spedali Civili, Brescia, Italy
| | - Francesco Bertagna
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Federica Motta
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Mattia Bertoli
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Riccardo Campini
- Nuclear Medicine Unit, Fondazione Maugeri Centro Medico, Veruno, NO, Italy
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