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Appropriate assessment method of 123I-MIBG myocardial scintigraphy for the diagnosis of Lewy body diseases and idiopathic REM sleep behavior disorder.
J Neurol. 2020 Jun 16 [Online ahead of print]JN

Abstract

BACKGROUND

In 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy, the early heart-to-mediastinum (H/M) ratio is considered to reflect the density of the cardiac sympathetic nerve endings, washout rate (WR) is an indicator of the cardiac sympathetic tone, and the delayed H/M ratio reflects both. The Delayed H/M ratio is usually used to support the diagnosis of Lewy body diseases (LBDs) and idiopathic REM sleep behavior disorder (iRBD); however, which values should be used have not been specified. Here, we hypothesized that the combination of these values is appropriate for the diagnostic purpose.

METHODS

In this single-center retrospective cohort study, we recruited 106 patients with LBDs or iRBD and 33 patients without those diseases, of whom we reviewed the 123I-MIBG myocardial scintigraphy results.

RESULTS

Sensitivity/specificity to diagnose LBDs and iRBD were 0.77/0.94 for the early H/M ratio (≤ 2.0), 0.82/0.94 for the delayed H/M ratio (≤ 2.0), and 0.89/0.91 for WR (≥ 23.0). When patients were considered positive if at least either the early H/M ratio or WR was abnormal, the sensitivity significantly increased to 0.97, whereas the specificity remained similar at 0.91. Furthermore, our subgroup analyses revealed that WR enhancement preceded H/M ratio reduction, but, in patients with a severely reduced early H/M ratio, paradoxically normal WR could be observed.

CONCLUSION

We propose the highly sensitive, combined early H/M ratio and WR assessments for 123I-MIBG myocardial scintigraphy. The temporal precedence of cardiac sympathetic dysfunction over denervation and the floor effect in 123I-MIBG uptake may underlie the sensitivity improvement.

Authors+Show Affiliations

Department of Neurology and Center for Sleep-Related Disorders, Kansai Electric Power Hospital, 2-1-7, Fukushima, Osaka, 553-0003, Japan. kazusan@kuhp.kyoto-u.ac.jp. Center for Sleep-Related Disorders, Kansai Electric Power Hospital, Osaka, Japan. kazusan@kuhp.kyoto-u.ac.jp. Division of Sleep Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan. kazusan@kuhp.kyoto-u.ac.jp. Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. kazusan@kuhp.kyoto-u.ac.jp.Center for Sleep-Related Disorders, Kansai Electric Power Hospital, Osaka, Japan. Division of Sleep Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan.Department of Neurology and Center for Sleep-Related Disorders, Kansai Electric Power Hospital, 2-1-7, Fukushima, Osaka, 553-0003, Japan. Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Osaka, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32556568

Citation

Tsukita, Kazuto, et al. "Appropriate Assessment Method of 123I-MIBG Myocardial Scintigraphy for the Diagnosis of Lewy Body Diseases and Idiopathic REM Sleep Behavior Disorder." Journal of Neurology, 2020.
Tsukita K, Tachibana N, Hamano T. Appropriate assessment method of 123I-MIBG myocardial scintigraphy for the diagnosis of Lewy body diseases and idiopathic REM sleep behavior disorder. J Neurol. 2020.
Tsukita, K., Tachibana, N., & Hamano, T. (2020). Appropriate assessment method of 123I-MIBG myocardial scintigraphy for the diagnosis of Lewy body diseases and idiopathic REM sleep behavior disorder. Journal of Neurology. https://doi.org/10.1007/s00415-020-09992-0
Tsukita K, Tachibana N, Hamano T. Appropriate Assessment Method of 123I-MIBG Myocardial Scintigraphy for the Diagnosis of Lewy Body Diseases and Idiopathic REM Sleep Behavior Disorder. J Neurol. 2020 Jun 16; PubMed PMID: 32556568.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Appropriate assessment method of 123I-MIBG myocardial scintigraphy for the diagnosis of Lewy body diseases and idiopathic REM sleep behavior disorder. AU - Tsukita,Kazuto, AU - Tachibana,Naoko, AU - Hamano,Toshiaki, Y1 - 2020/06/16/ PY - 2020/04/03/received PY - 2020/06/10/accepted PY - 2020/06/09/revised PY - 2020/6/20/entrez KW - 123I-MIBG myocardial scintigraphy KW - Idiopathic REM sleep behavior disorder KW - Lewy body diseases JF - Journal of neurology JO - J. Neurol. N2 - BACKGROUND: In 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy, the early heart-to-mediastinum (H/M) ratio is considered to reflect the density of the cardiac sympathetic nerve endings, washout rate (WR) is an indicator of the cardiac sympathetic tone, and the delayed H/M ratio reflects both. The Delayed H/M ratio is usually used to support the diagnosis of Lewy body diseases (LBDs) and idiopathic REM sleep behavior disorder (iRBD); however, which values should be used have not been specified. Here, we hypothesized that the combination of these values is appropriate for the diagnostic purpose. METHODS: In this single-center retrospective cohort study, we recruited 106 patients with LBDs or iRBD and 33 patients without those diseases, of whom we reviewed the 123I-MIBG myocardial scintigraphy results. RESULTS: Sensitivity/specificity to diagnose LBDs and iRBD were 0.77/0.94 for the early H/M ratio (≤ 2.0), 0.82/0.94 for the delayed H/M ratio (≤ 2.0), and 0.89/0.91 for WR (≥ 23.0). When patients were considered positive if at least either the early H/M ratio or WR was abnormal, the sensitivity significantly increased to 0.97, whereas the specificity remained similar at 0.91. Furthermore, our subgroup analyses revealed that WR enhancement preceded H/M ratio reduction, but, in patients with a severely reduced early H/M ratio, paradoxically normal WR could be observed. CONCLUSION: We propose the highly sensitive, combined early H/M ratio and WR assessments for 123I-MIBG myocardial scintigraphy. The temporal precedence of cardiac sympathetic dysfunction over denervation and the floor effect in 123I-MIBG uptake may underlie the sensitivity improvement. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/32556568/Appropriate_assessment_method_of_123I-MIBG_myocardial_scintigraphy_for_the_diagnosis_of_Lewy_body_diseases_and_idiopathic_REM_sleep_behavior_disorder L2 - https://dx.doi.org/10.1007/s00415-020-09992-0 DB - PRIME DP - Unbound Medicine ER -
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