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Sakurada H, Koyasu S, Sugimoto A, Nakanishi E, Nakamoto Y. Diffuse Large B-cell Lymphoma: Unexpected Uptake Observed on Cardiac 123I-MIBG Scintigraphy. Clin Nucl Med 2021; 46:850-852. [PMID: 34034331 DOI: 10.1097/rlu.0000000000003737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 77-year-old man with parkinsonism was referred to the department of neurology for further examination. Cardiac 123I-MIBG scintigraphy unexpectedly showed strong uptake in the left shoulder, suggestive of MIBG-avid tumors including paraganglioma. MRI revealed multiple nodules suggestive of lymphoma. A biopsy was performed, which led to the pathological diagnosis of diffuse large B-cell lymphoma. Cardiac MIBG scintigraphy sometimes shows unexpected findings outside the mediastinum. In addition, lymphoma should also be added to the list of differential diagnoses for MIBG-positive tumors.
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Affiliation(s)
- Hiroki Sakurada
- From the Departments of Diagnostic Imaging and Nuclear Medicine
| | - Sho Koyasu
- From the Departments of Diagnostic Imaging and Nuclear Medicine
| | | | - Etsuro Nakanishi
- Neurology, Graduate School of Medicine, Kyoto University, Kyoto City, Japan
| | - Yuji Nakamoto
- From the Departments of Diagnostic Imaging and Nuclear Medicine
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Kikuchi Y, Umezaki T, Uehara T, Yamaguchi H, Yamashita K, Hiwatashi A, Sawatsubashi M, Adachi K, Yamaguchi Y, Murakami D, Kira JI, Nakagawa T. A case of multiple system atrophy-parkinsonian type with stuttering- and palilalia-like dysfluencies and putaminal atrophy. JOURNAL OF FLUENCY DISORDERS 2018; 57:51-58. [PMID: 29157667 DOI: 10.1016/j.jfludis.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
Both developmental and acquired stuttering are related to the function of the basal ganglia-thalamocortical loop, which includes the putamen. Here, we present a case of stuttering- and palilalia-like dysfluencies that manifested as an early symptom of multiple system atrophy-parkinsonian type (MSA-P) and bilateral atrophy of the putamen. The patient was a 72-year-old man with no history of developmental stuttering who presented with a stutter for consultation with our otorhinolaryngology department. The patient was diagnosed with MSA-P based on parkinsonism, autonomic dysfunction, and bilateral putaminal atrophy revealed by T2-weighted magnetic resonance imaging. Treatment with levodopa improved both the motor functional deficits related to MSA-P and stuttering-like dysfluencies while reading; however, the palilalia-like dysfluencies were much less responsive to levodopa therapy. The patient died of aspiration pneumonia two years after his first consultation at our hospital. In conclusion, adult-onset stuttering- and palilalia-like dysfluencies warrant careful examination of the basal ganglia-thalamocortical loop, and especially the putamen, using neuroimaging techniques. Acquired stuttering may be related to deficits in dopaminergic function.
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Affiliation(s)
- Yoshikazu Kikuchi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Toshiro Umezaki
- Voice and Swallowing Center, Fukuoka Sanno Hospital, Fukuoka, Japan; International University of Health and Welfare, Fukuoka, Japan
| | - Taira Uehara
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroo Yamaguchi
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yamashita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akio Hiwatashi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Sawatsubashi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuo Adachi
- Voice and Swallowing Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yumi Yamaguchi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Murakami
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Validation of Iodine-131-meta-iodobenzylguanidine cardiac scintigraphy in Parkinsonism: A preliminary study. Parkinsonism Relat Disord 2018; 50:69-73. [PMID: 29475590 DOI: 10.1016/j.parkreldis.2018.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/26/2017] [Accepted: 02/08/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION 123I-MIBG is the most commonly used radiopharmaceutical to depict cardiac sympathetic innervation. The purpose of this study was to validate the feasibility of 131I-MIBG as an alternative myocardial sympathetic imaging probe in differential diagnosis of Parkinsonism. METHODS We recruited 17 patients with PD, 21 patients with other parkinsonism (17 with MSA and 4 with PSP), and 6 normal controls. All participants underwent 131I-MIBG scintigraphy for both early and delayed imaging. The image quality was independently assessed by two experienced nuclear medicine specialists and graded into three categories: 1, good image quality; 2, suboptimal but sufficient for diagnosis; and 3, poor or nondiagnostic. Cardiac MIBG uptake was quantitatively measured using H/M ratio and washout rate. RESULTS The image quality was good (Grade 1) in 74 and 73 of a total of 88 images by the two reviewers, respectively. No image was poor or nondiagnostic (Grade 3). Patients with PD had a significantly lower H/M ratio for both the early and the delayed images than did those with MSA or PSP and the controls (P < 0.001). For differentiating PD from other parkinsonism, the sensitivity and specificity were 95% and 94% for the early images and 100% and 94% for the delayed images, respectively. Patients with MSA or PSP has a significantly lower WR compared with those with PD. (WR = 0.15 ± 0.23 and 0.48 ± 0.17, respectively; P < 0.001). CONCLUSION 131I-MIBG scintigraphy is a feasible method to depict cardiac sympathetic activity. The diagnostic performance is comparable to that of 123I-MIBG.
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Ballanger B, Poisson A, Broussolle E, Thobois S. Functional imaging of non-motor signs in Parkinson's disease. J Neurol Sci 2012; 315:9-14. [DOI: 10.1016/j.jns.2011.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/28/2011] [Accepted: 11/03/2011] [Indexed: 12/12/2022]
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Treglia G, Stefanelli A, Cason E, Cocciolillo F, Di Giuda D, Giordano A. Diagnostic performance of iodine-123-metaiodobenzylguanidine scintigraphy in differential diagnosis between Parkinson's disease and multiple-system atrophy: A systematic review and a meta-analysis. Clin Neurol Neurosurg 2011; 113:823-9. [DOI: 10.1016/j.clineuro.2011.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 08/29/2011] [Accepted: 09/10/2011] [Indexed: 01/18/2023]
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MIBG scintigraphy in differential diagnosis of Parkinsonism: a meta-analysis. Clin Auton Res 2011; 22:43-55. [PMID: 21792729 DOI: 10.1007/s10286-011-0135-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/13/2011] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Differential diagnosis between Parkinson's disease (PD) and other Parkinsonism using clinical criteria or imaging methods is often difficult. The purpose of this study is to systematically review and meta-analyze published data about the diagnostic performance of myocardial innervation imaging using (123)I-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between PD and other Parkinsonism. METHODS A comprehensive computer literature search of studies published through March 2011 regarding MIBG scintigraphy in patients with PD and other Parkinsonism was performed in PubMed/MEDLINE and Embase databases. Only studies in which MIBG scintigraphy was performed for differential diagnosis between PD and other Parkinsonism were selected. Pooled sensitivity, pooled specificity and area under the ROC curve were calculated to measure the accuracy of MIBG scintigraphy in differential diagnosis between PD and other Parkinsonism. RESULTS Nineteen studies comprising 1,972 patients (1,076 patients with PD, 117 patients with other Lewy body diseases and 779 patients with other diseases) were included in this meta-analysis. The pooled sensitivity of MIBG scintigraphy in detecting PD was 88% (95% CI 86-90%); the pooled specificity of MIBG scintigraphy in discriminating between PD and other Parkinsonism was 85% (95% CI 81-88%). The area under the ROC curve was 0.93. CONCLUSIONS In patients with clinically suspected PD, myocardial innervation imaging demonstrated high sensitivity and specificity. MIBG scintigraphy is an accurate test in this setting. Nevertheless, possible causes of false-negative and false-positive results should be kept in mind when interpreting the scintigraphic results.
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