Diagnostic accuracy of 123I-meta-iodobenzylguanidine myocardial scintigraphy in dementia with Lewy bodies: a multicenter study

• Published in: PloS one Vol. 10; no. 3; p. e0120540
• Main Authors: Yoshita, Mitsuhiro, Arai, Heii, Arai, Hiroyuki, Arai, Tetsuaki, Asada, Takashi, Fujishiro, Hiroshige, Hanyu, Haruo, Iizuka, Osamu, Iseki, Eizo, Kashihara, Kenichi, Kosaka, Kenji, Maruno, Hirotaka, Mizukami, Katsuyoshi, Mizuno, Yoshikuni, Mori, Etsuro, Nakajima, Kenichi, Nakamura, Hiroyuki, Nakano, Seigo, Nakashima, Kenji, Nishio, Yoshiyuki, Orimo, Satoshi, Samuraki, Miharu, Takahashi, Akira, Taki, Junichi, Tokuda, Takahiko, Urakami, Katsuya, Utsumi, Kumiko, Wada, Kenji, Washimi, Yukihiko, Yamasaki, Junichi, Yamashina, Shouhei, Yamada, Masahito
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 2015; Public Library of Science (PLoS)
• Subjects: 3-Iodobenzylguanidine; Accuracy; Aged; Aged, 80 and over; Aging; Alzheimer Disease - diagnosis; Alzheimer's disease; Alzheimers disease; Brain research; Clinical medicine; Correlation analysis; Degeneration; Dementia; Dementia disorders; Diagnosis; Diagnosis, Differential; Diagnostic systems; Disease control; Dopamine; Female; Geriatrics; Heart; Heart diseases; Hospitals; Humans; Inspection; Internal medicine; Iodine; Iodine Radioisotopes; Lewy Bodies; Lewy Body Disease - diagnosis; Male; Mathematical analysis; Mediastinum; Medical diagnosis; Medical imaging; Middle Aged; Myocardial Perfusion Imaging - methods; Neurobiology; Neurodegenerative diseases; Neurology; Neurosciences; Noradrenaline; Norepinephrine; Nuclear medicine; Parkinson's disease; Patients; Preventive medicine; Reproducibility of Results; ROC Curve; Science; Scintigraphy; Sensitivity; Sensitivity analysis; Sensitivity and Specificity; University graduates; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0120540

Dementia with Lewy bodies (DLB) needs to be distinguished from Alzheimer's disease (AD) because of important differences in patient management and outcome. Severe cardiac sympathetic degeneration occurs in DLB, but not in AD, offering a potential system for a biological diagnostic marker. The primary aim of this study was to investigate the diagnostic accuracy, in the ante-mortem differentiation of probable DLB from probable AD, of cardiac imaging with the ligand 123I-meta-iodobenzylguanidine (MIBG) which binds to the noradrenaline reuptake site, in the first multicenter study. We performed a multicenter study in which we used 123I-MIBG scans to assess 133 patients with clinical diagnoses of probable (n = 61) or possible (n = 26) DLB or probable AD (n = 46) established by a consensus panel. Three readers, unaware of the clinical diagnosis, classified the images as either normal or abnormal by visual inspection. The heart-to-mediastinum ratios of 123I-MIBG uptake were also calculated using an automated region-of-interest based system. Using the heart-to-mediastinum ratio calculated with the automated system, the sensitivity was 68.9% and the specificity was 89.1% to differentiate probable DLB from probable AD in both early and delayed images. By visual assessment, the sensitivity and specificity were 68.9% and 87.0%, respectively. In a subpopulation of patients with mild dementia (MMSE ≥ 22, n = 47), the sensitivity and specificity were 77.4% and 93.8%, respectively, with the delayed heart-to-mediastinum ratio. Our first multicenter study confirmed the high correlation between abnormal cardiac sympathetic activity evaluated with 123I-MIBG myocardial scintigraphy and a clinical diagnosis of probable DLB. The diagnostic accuracy is sufficiently high for this technique to be clinically useful in distinguishing DLB from AD, especially in patients with mild dementia.