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Pitton Rissardo J, Fornari Caprara AL. Cardiac 123I-Metaiodobenzylguanidine (MIBG) Scintigraphy in Parkinson's Disease: A Comprehensive Review. Brain Sci 2023; 13:1471. [PMID: 37891838 PMCID: PMC10605004 DOI: 10.3390/brainsci13101471] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/23/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Cardiac sympathetic denervation, as documented on 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, is relatively sensitive and specific for distinguishing Parkinson's disease (PD) from other neurodegenerative causes of parkinsonism. The present study aims to comprehensively review the literature regarding the use of cardiac MIBG in PD. MIBG is an analog to norepinephrine. They share the same uptake, storage, and release mechanisms. An abnormal result in the cardiac MIBG uptake in individuals with parkinsonism can be an additional criterion for diagnosing PD. However, a normal result of cardiac MIBG in individuals with suspicious parkinsonian syndrome does not exclude the diagnosis of PD. The findings of cardiac MIBG studies contributed to elucidating the pathophysiology of PD. We investigated the sensitivity and specificity of cardiac MIBG scintigraphy in PD. A total of 54 studies with 3114 individuals diagnosed with PD were included. The data were described as means with a Hoehn and Yahr stage of 2.5 and early and delayed registration H/M ratios of 1.70 and 1.51, respectively. The mean cutoff for the early and delayed phases were 1.89 and 1.86. The sensitivity for the early and delayed phases was 0.81 and 0.83, respectively. The specificity for the early and delayed phases were 0.86 and 0.80, respectively.
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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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Nuvoli S, Spanu A, Fravolini ML, Bianconi F, Cascianelli S, Madeddu G, Palumbo B. [ 123I]Metaiodobenzylguanidine (MIBG) Cardiac Scintigraphy and Automated Classification Techniques in Parkinsonian Disorders. Mol Imaging Biol 2021; 22:703-710. [PMID: 31309370 DOI: 10.1007/s11307-019-01406-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To provide reliable and reproducible heart/mediastinum (H/M) ratio cut-off values for parkinsonian disorders using two machine learning techniques, Support Vector Machines (SVM) and Random Forest (RF) classifier, applied to [123I]MIBG cardiac scintigraphy. PROCEDURES We studied 85 subjects, 50 with idiopathic Parkinson's disease, 26 with atypical Parkinsonian syndromes (P), and 9 with essential tremor (ET). All patients underwent planar early and delayed cardiac scintigraphy after [123I]MIBG (111 MBq) intravenous injection. Images were evaluated both qualitatively and quantitatively; the latter by the early and delayed H/M ratio obtained from regions of interest (ROIt1 and ROIt2) drawn on planar images. SVM and RF classifiers were finally used to obtain the correct cut-off value. RESULTS SVM and RF produced excellent classification performances: SVM classifier achieved perfect classification and RF also attained very good accuracy. The better cut-off for H/M value was 1.55 since it remains the same for both ROIt1 and ROIt2. This value allowed to correctly classify PD from P and ET: patients with H/M ratio less than 1.55 were classified as PD while those with values higher than 1.55 were considered as affected by parkinsonism and/or ET. No difference was found when early or late H/M ratio were considered separately thus suggesting that a single early evaluation could be sufficient to obtain the final diagnosis. CONCLUSIONS Our results evidenced that the use of SVM and CT permitted to define the better cut-off value for H/M ratios both in early and in delayed phase thus underlining the role of [123I]MIBG cardiac scintigraphy and the effectiveness of H/M ratio in differentiating PD from other parkinsonism or ET. Moreover, early scans alone could be used for a reliable diagnosis since no difference was found between early and late. Definitely, a larger series of cases is needed to confirm this data.
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Affiliation(s)
- Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medicine, Surgical and Experimental Science, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy.
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medicine, Surgical and Experimental Science, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy
| | | | | | | | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medicine, Surgical and Experimental Science, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
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Ferris T, Carroll L, Jenner S, Aboagye EO. Use of radioiodine in nuclear medicine—A brief overview. J Labelled Comp Radiopharm 2020; 64:92-108. [DOI: 10.1002/jlcr.3891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/06/2020] [Accepted: 10/11/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Trevor Ferris
- Department of Chemistry, Molecular Sciences Research Hub Imperial College London White City Campus London UK
| | - Laurence Carroll
- Russell H. Morgan Department of Radiology and Radiological Sciences Johns Hopkins Medical Institutions Baltimore Maryland USA
| | | | - Eric O. Aboagye
- Comprehensive Cancer Imaging Centre, Department of Surgery and Cancer Imperial College, Hammersmith Campus London UK
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Recent advances in radiotracers targeting norepinephrine transporter: structural development and radiolabeling improvements. J Neural Transm (Vienna) 2020; 127:851-873. [PMID: 32274584 PMCID: PMC7223405 DOI: 10.1007/s00702-020-02180-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/21/2020] [Indexed: 12/13/2022]
Abstract
The norepinephrine transporter (NET) is a major target for the evaluation of the cardiac sympathetic nerve system in patients with heart failure and Parkinson's disease. It is also used in the therapeutic applications against certain types of neuroendocrine tumors, as exemplified by the clinically used 123/131I-MIBG as theranostic single-photon emission computed tomography (SPECT) agent. With the development of more advanced positron emission tomography (PET) technology, more radiotracers targeting NET have been reported, with superior temporal and spatial resolutions, along with the possibility of functional and kinetic analysis. More recently, fluorine-18-labelled NET tracers have drawn increasing attentions from researchers, due to their longer radiological half-life relative to carbon-11 (110 min vs. 20 min), reduced dependence on on-site cyclotrons, and flexibility in the design of novel tracer structures. In the heart, certain NET tracers provide integral diagnostic information on sympathetic innervation and the nerve status. In the central nervous system, such radiotracers can reveal NET distribution and density in pathological conditions. Most radiotracers targeting cardiac NET-function for the cardiac application consistent of derivatives of either norepinephrine or MIBG with its benzylguanidine core structure, e.g. 11C-HED and 18F-LMI1195. In contrast, all NET tracers used in central nervous system applications are derived from clinically used antidepressants. Lastly, possible applications of NET as selective tracers over organic cation transporters (OCTs) in the kidneys and other organs controlled by sympathetic nervous system will also be discussed.
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Jeong YJ, Jeong JE, Cheon SM, Yoon BA, Kim JW, Kang DY. Relationship between the washout rate of I-123 MIBG scans and autonomic function in Parkinson's disease. PLoS One 2020; 15:e0229860. [PMID: 32134983 PMCID: PMC7058312 DOI: 10.1371/journal.pone.0229860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/19/2020] [Indexed: 01/18/2023] Open
Abstract
Purpose We have evaluated the clinical significance of the washout rate (WR) on I-123 MIBG scans through the analysis of the relationship between the I-123 MIBG scans and autonomic status in patients with Parkinson’s disease (PD). Materials and methods Sixty patients with clinical PD who had decreased HMR were enrolled. An autonomic symptom was evaluated using a head-up tilt test and the Composite Autonomic Severity Score (CASS). An I-123 MIBG scan and F-18 FP-CIT positron emission tomography (PET) were performed. All of the patients were classified into three groups according to the WR. The differences in patient characteristics and the imaging parameters among the three groups were evaluated, and a correlation analysis was also performed. Results The frequency of orthostatic hypotension was significantly different among the three groups. The difference in systolic pressure (dSysPr) and the difference in diastolic pressure (dDiaPr) of group 3 was significantly larger than those of groups 1 and 2. From the correlation analysis, it can be seen that age, Hoehn and Yahr (H&Y) stage, dSysPr, and dDiaPr had a weak positive correlation with the WR. The total CASS score was significantly higher in group 3 compared with groups 1 and 2. The WR had a moderate positive correlation with the cardiosympathetic score and the total CASS score. Conclusion The WR is related to autonomic dysfunction. An I-123 MIBG cardiac scan is considered to be a good method to evaluate not only the differential diagnosis of Parkinson's disease but also the degree of autonomic dysfunction.
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Affiliation(s)
- Young Jin Jeong
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Republic of Korea
| | - Ji-Eun Jeong
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Sang-Myung Cheon
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Byeol-A Yoon
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jae Woo Kim
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Do-Young Kang
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Republic of Korea
- * E-mail:
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