Diagnostic and Pathophysiological Impact of Myocardial MIBG Scintigraphy in Parkinson's Disease

Jörg Spiegel

doi:10.4061/2010/295346

Abstract

Myocardial MIBG scintigraphy is established in the diagnosis and differential diagnosis of Parkinson's disease (PD). Numerous studies address the pathophysiological impact of myocardial MIBG scintigraphy: the myocardial MIBG uptake correlates with the clinical phenotype of PD; the background of this phenomenon is unclear. Furthermore MIBG scintigraphy enables to study the extracranial Lewy body type-degeneration. In combination with cerebral dopamine transporter imaging, MIBG scintigraphy allows to correlate cerebral and extracranial Lewy body type-degeneration in PD.

Highlights

Metaiodobenzylguanidine (MIBG) is a norepinephrine analogue which competes with norepinephrine for the same cellular transporter mechanisms of postganglionic adrenergic neurons
In multiple system atrophy (MSA), the autonomic nervous system is mainly affected in its preganglionic structures, whereas postganglionic involvement of the autonomic nervous system predominates in Parkinson’s disease (PD) [43]
The intraindividual comparison between cerebral nigrostriatal dopamine transporters (DAT) SPECT and myocardial MIBG scintigraphy may clarify this aspect: Spiegel et al [53] and Spiegel et al [18] stated a significant correlation between cerebral nigrostriatal dopaminergic and extracranial myocardial sympathetic degeneration at each Hoehn and Yahr stage

Summary

Introduction

Metaiodobenzylguanidine (MIBG) is a norepinephrine (noradrenaline) analogue which competes with norepinephrine for the same cellular transporter mechanisms of postganglionic adrenergic neurons. MIBG is actively transported into noradrenaline granules of sympathetic nerve terminals by the noradrenaline transporter (uptake 1 mechanism; [1]). Due to its affinity to sympathetic nerve endings MIBG accumulates predominantly in organs with a high sympathetic activity such as the adrenal gland, the liver, the spleen, the heart, and the salivary glands [2]. The accumulation of MIBG is visualized and measured by planar whole-body scintigraphy. The MIBG scintigraphy is mainly used to detect (and sometimes to treat) neuroendocrine tumours, primarily pheochromocytomas and neuroblastomas [3,4,5,6,7,8]

MIBG Scintigraphy in the Diagnosis of Parkinson’s Disease

Factors Interfering with Myocardial MIBG Scintigraphy

Sensitivity and Specificity of MIBG Scintigraphy

Correlation of MIBG Scintigraphy with Clinical Parameters

Pathophysiological Impact of MIBG Scintigraphy

Conclusions