Abstract
ObjectiveThe clinical significance of decreased physiological lung uptake of 123I-metaiodobenzylguanidine (MIBG) has not been well investigated. This study aimed to elucidate the association between a decrease in lung MIBG uptake with antidepressant intake and the myocardial MIBG uptake in patients who were clinically diagnosed with Lewy body disease (LBD) and patients who were diagnosed as not having LBD.MethodsWe retrospectively reviewed the heart and lung uptakes on 167 consecutive MIBG scans, antidepressant status, and clinical diagnosis of LBD. The images were visually classified into two groups: decreased lung uptake and preserved lung uptake. A semi-quantitative analysis was performed using the heart-to-mediastinum ratio (H/M), lung-to-mediastinum ratio (L/M), and myocardial washout rate (WR).ResultsAll 17 patients with decreased lung uptake were on treated with antidepressants, while none of the 150 patients with preserved lung uptake were treated with any antidepressants. Of the 17 patients with decreased lung uptake, 6 patients were clinically diagnosed as LBD and other 11 were clinically diagnosed as non-LBD. There was not significant difference in early H/M, delayed H/M, and myocardial WR between the 11 non-LBD patients with decreased lung uptake and 83 non-LBD patients with preserved lung uptake (2.87 ± 0.69 vs. 2.89 ± 0.44, 3.09 ± 0.48 vs. 2.98 ± 0.59, and 21.8 ± 11.3% vs. 21.1 ± 12.5%, respectively). Moreover, in LBD patients, there were no significant differences in those values between six patients with decreased lung uptake and 67 patients with preserved lung uptake (1.68 ± 0.32 vs. 1.73 ± 0.42, 1.34 ± 0.21 vs. 1.54 ± 0.57, 46.2 ± 22.8% vs. 42.8 ± 21.3%, respectively).ConclusionsAntidepressants probably blocked MIBG uptake in the lungs, and a decreased lung uptake was not significantly associated with heart uptake. A remarkable decrease in lung uptake can be a signal to check a patient’s medication status.
Highlights
Scintigraphy using 123I-metaiodobenzylguanidine (MIBG), a norepinephrine (NE) analog, is helpful for discriminating Lewy body disease (LBD) from other neurodegenerative disorders [1,2,3]
lung-to-mediastinum ratio (L/M) were available for 70 patients, including 64 preserved lung uptake scans and 6 decreased lung uptake scans; early L/M and delayed L/M were significantly lower in the decreased lung uptake scans than in the preserved lung uptake scans, a finding that is consistent with the visual classification
Our findings showed that the use of antidepressants, including selective serotonin reuptake inhibitor (SSRI), serotonin noradrenaline reuptake inhibitor (SNRI), and
Summary
Scintigraphy using 123I-metaiodobenzylguanidine (MIBG), a norepinephrine (NE) analog, is helpful for discriminating Lewy body disease (LBD) from other neurodegenerative disorders [1,2,3]. Myocardial MIBG accumulation is decreased in patients with LBD because Lewy body pathology involves the peripheral autonomic nervous system as well as the central nervous system [5, 6]. We previously reported two cases in which MIBG lung uptake remarkably decreased with the use of a selective serotonin reuptake inhibitor (SSRI)/serotonin noradrenaline reuptake inhibitor (SNRI) and was preserved during the medicationnaive or withdrawal state [10]. MIBG uptake in the lungs may be affected by antidepressants through serotonin transporters (SERTs) and norepinephrine transporters (NETs).
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