Differentiation of idiopathic Parkinson’s disease from striatonigral degeneration and progressive supranuclear palsy using iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. J Neurol Sci

Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
Journal of the Neurological Sciences (Impact Factor: 2.47). 03/1998; 155(1):60-7. DOI: 10.1016/S0022-510X(97)00278-5
Source: PubMed


Iodine-123 meta-iodobenzylguanidine ([123I]MIBG), an analogue of norepinephrine, is a tracer for functioning of sympathetic neurons. To investigate cardiac sympathetic function in PD, SND, and PSP, [123I]MIBG myocardial scintigraphy was performed in 25 patients with PD, 15 patients with SND, 14 patients with PSP, and 20 control subjects. In planar imaging studies, the heart-to-mediastinum average count ratio (H/M) was calculated for both early and delayed images. The mean value of H/M in patients with PD was significantly lower than those with SND, PSP, or no disease. Regardless of disease severity or intensity of anti-Parkinsonian pharmacotherapy, mean values for H/M were always low in patients with PD. The mean value of H/M in SND with orthostatic hypotension (OH) was lower than that in SND without OH. Although the mean value of H/M in PSP with amitriptyline treatment was significantly lower than that in PSP patients without amitriptyline treatment, there was no significant difference between the mean value of H/M in PSP patients without amitriptyline treatment and that in control. Thus, PD may have a abnormality of cardiac sympathetic function which has not been detected by previous cardiovascular autonomic studies. Moreover, particularly in early stages, [123I]MIBG myocardial scintigraphy may provide helpful diagnostic information in these akinetic-rigid syndromes.

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Available from: Mitsuhiro Yoshita
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    • "In particular , decreased myocardial uptake in 123 I-metaiodobenzylguanidine (MIBG) scintigraphy is observed in approximately 90% of PD cases. Therefore, it has been regarded as a useful biomarker for early differential diagnosis, as a decrease in MIBG uptake often exists even in the early stages of PD [5] [6] [7]. However, approximately 10% of PD cases show normal myocardial MIBG uptake; therefore, a diagnosis differentiating between PD and other disorders displaying parkinsonisms is sometimes difficult. "
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    ABSTRACT: Background: Although most patients with Parkinson's disease (PD) show decreased cardiac (123)I-metaiodobenzylguanidine (MIBG) uptake, some exhibit normal uptake. We evaluated the clinical characteristics of such patients. Methods: We enrolled 154 non-demented patients showing parkinsonism with normal cardiac MIBG uptake and had been clinically followed up during 29.9±27.6months. We defined the patients who did not fit the exclusion criteria for PD and demonstrated ≥30% reduction in the Unified Parkinson's Disease Rating Scale (UPDRS) motor score after anti-Parkinson agent administration as probable PD. We compared clinical characteristics and the cardiac MIBG heart-to-mediastinum (H/M) ratio between the probable PD group (N=37) and other groups (N=117). Results: The probable PD group showed significantly higher UPDRS motor scores and greater incidence of tremor/rigidity than those of other groups. In addition, they showed a significantly lower cardiac MIBG H/M ratio in the delayed phase (delayed, p<0.0001). Washout-rate (WR) was significantly higher in probable PD cases (p<0.0001). Among 16 probable PD patients undergoing serial cardiac MIBG scintigraphy, the delayed phase cardiac MIBG H/M ratio showed a significant decrease and WR significantly increased during follow-up periods. Conclusions: An increase in WR and lower delayed phase cardiac MIBG uptake were found to be characteristics of such patients.
    Full-text · Article · Nov 2015 · Journal of the neurological sciences
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    • "In wenigen Studien mit kleineren Fallzahlen zeigt sich, dass wohl die meisten Patienten mit corticobasaler Degeneration eine normale kardiale MIBG-Aufnahme haben [24] [30] [31]. Für die progressive supranukleäre Blickparese fanden sich bei bisher 20 Patienten widersprüchliche Ergebnisse [7] [30] [32]. Eine Abgrenzung gelingt sowohl gegenüber dem atypischen Parkinsonsyndrom, als auch gegenüber dem essenziellen Tremor [33–35]. "
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    ABSTRACT: Parkinsonsyndrome | Die Diagnose eines Parkinsonsyndroms wird nach wie vor klinisch gestellt. In den meisten Fällen gelingt klinisch auch die differenzialdiagnosti-sche Abgrenzung des idiopathischen Parkinsonsyndroms. Bei unklaren Fällen empfiehlt sich die MIBG-Szintigrafie, da sie mit hoher Sensitivität und Spezifität ein idiopathisches Parkinsonsyndrom respektive eine Demenz mit Lewy-Körperchen nachweist. Die Unter-suchung wird flächendeckend angeboten, die Strahlenbelastung ist vergleichbar hoch wie bei den SPECT-Methoden, die Kosten sind jedoch deutlich geringer. Die MIBG-Szinti-grafie ist in der Differenzialdiagnostik des Parkinsonsyndroms unverzichtbar.
    Full-text · Article · Jan 2010
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    • "MIBG myocardial scintigraphy was originally used to assess myocardial sympathetic nerve damage in heart disease.84-86 Later this method was applied to detect cardiac sympathetic denervation in PD and clinically used to discriminate PD from other neurological disorders with extrapyramidal signs (EPS).87-89 The heart-to-mediastinum ratio of myocardial MIBG uptake and the washout rate in percent are used to assess the severity of the postganglionic cardiac sympathetic nerve denervation. "
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    ABSTRACT: Dementia with Lewy bodies (DLB) is the second most common cause of degenerative dementia after Alzheimer's disease (AD), and is clinically characterized by the progressive cognitive decline with fluctuations in cognition and alertness, recurrent visual hallucinations and Parkinsonism. Once these characteristic symptoms of DLB emerge, discriminating it from AD is relatively easy. However, in the early disease stages, the clinical symptoms of various types of dementias largely overlap and it is difficult to distinguish DLB from other neurodegenerative dementias based on clinical manifestations alone. To increase the accuracy of antemortem diagnosis of DLB, the latest diagnostic criteria incorporate findings from 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, or from neuroimaging such as computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). In the present guidelines, decreased dopamine transporter uptake revealed by SPECT or PET receives the greatest importance among various neuroimaging findings and is listed as one of the suggestive features. Supportive features that commonly present but are not proven to have diagnostic specificity include relatively-preserved medial-temporal-lobe structures, occipital hypoperfusion, and abnormal MIBG myocardial scintigraphy. In this paper, we review the major findings on various neuroimaging modalities and discuss the clinical usefulness of them for the diagnosis of DLB. Although there is not enough evidence to reach the conclusion, considering the accessibility in clinical practice, in our personal views, we recommend the use of brain-perfusion SPECT and MIBG myocardial scintigraphy to improve the diagnosis of DLB.
    Full-text · Article · Dec 2009 · Psychiatry investigation
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