Data_Sheet_1_Cardiac 123I-MIBG Scintigraphy in Neurodegenerative Parkinson Syndromes: Performance and Pitfalls in Clinical Practice.pdf
Purpose: Cardiac [123I]metaiodobenzylguanidine scintigraphy (123I-MIBG), reflecting postganglionic cardiac autonomic denervation, is proposed for early detection of Parkinson's disease (PD; reduced tracer uptake) and separation from Multiple System Atrophy (MSA; preserved tracer uptake). However, several recent studies report on frequent unexpected 123I-MIBG results in PD and MSA. We sought to determine, whether 123I-MIBG is feasible to discriminate PD from MSA in unselected geriatric patients in clinical practice.
Materials and Methods: We screened consecutive patients, that underwent 123I-MIBG for diagnostic reasons. Delayed 123I-MIBG uptake (heart/mediastinum ratio; H/M ratio) was verified by clinical diagnosis of PD, MSA, and ET based on a two-stage clinical assessment: comprehensive baseline (including autonomic testing and additional neuroimaging) and confirmatory clinical follow-up.
Results: 28 patients with clinical diagnosis of PD (N = 11), MSA (N = 9), and Essential Tremor (ET, N = 8) were identified. In one third (9/28) nuclear medical diagnosis deviated from clinically suspected syndrome. Visual interpretation of 123I-MIBG identified two cases (MSA and ET) with indeed normal 123I-MIBG uptake. Detailed review of clinical phenotypes provided only in two cases (PD and ET) an adequate explanation (correction of initial diagnosis and confounding drug history) for unexpected 123I-MIBG. In conclusion, 123I-MIBG did not match initial clinical phenotype in 27% PD, 44% MSA, and 25% ET patients.
Conclusion: 123I-MIBG scintigraphy is a known specific and valuable technique in scientific approaches and well-defined and highly selected samples. However, predictability of 123I-MIBG based nuclear medical diagnosis for individual cases and thus, feasibility in routine clinical practice is limited. Our clinical series emphasize clinical verification of 123I-MIBG results on an individual basis in clinical routine.
History
References
- https://doi.org//10.1212/01.wnl.0000324625.00404.15
- https://doi.org//10.1016/j.parkreldis.2014.04.019
- https://doi.org//10.1002/mds.22499
- https://doi.org//10.1111/j.1750-3639.2006.00032.x
- https://doi.org//10.1002/mds.23659
- https://doi.org//10.1016/j.clineuro.2011.09.004
- https://doi.org//10.1111/ene.12022
- https://doi.org//10.1136/jnnp.2004.037028
- https://doi.org//10.1002/mds.23338
- https://doi.org//10.1002/mds.21614
- https://doi.org//10.1007/s10072-010-0218-4
- https://doi.org//10.1007/s12350-015-0170-z
- https://doi.org//10.1002/mds.22340
- https://doi.org//10.1002/mds.20255
- https://doi.org//10.1093/brain/awv138
- https://doi.org//10.1016/S0025-6196(12)60631-4
- https://doi.org//10.2337/dc12-2147
- https://doi.org//10.1111/j.1600-0404.1988.tb05926.x
- https://doi.org//10.1002/mds.25880
- https://doi.org//10.1136/jnnp-2015-310327
- https://doi.org//10.1111/ene.13206
- https://doi.org//10.1016/j.parkreldis.2005.12.008
- https://doi.org//10.1371/journal.pone.0061066
- https://doi.org//10.1007/s00401-006-0160-y
- https://doi.org//10.1007/s00401-005-1013-9
- https://doi.org//10.1016/j.parkreldis.2014.04.003
- https://doi.org//10.1016/j.parkreldis.2012.01.009