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Abstract
IntroductionSome studies report that assessing regional 123I-cardiac MIBG uptake can aid in the diagnosis of Lewy body disease, but others report heterogeneity in healthy controls. We aimed to evaluate regional cardiac MIBG uptake patterns in healthy older adults and patients with dementia. Methods31 older adults with normal cognition, 15 Alzheimer’s disease (AD), and 17 Dementia with Lewy bodies (DLB) patients were recruited. 5 individuals had previous myocardial infarction. Participants with sufficient cardiac uptake for regional SPECT analysis (29/31 controls, 15/15 AD, 5/17 DLB) had relative uptake pattern recorded. Controls were assessed for risk of future cardiovascular events using QRISK2, a validated online tool. ResultsIn controls uptake was reduced in the inferior wall (85%), apex (23%), septum (15%), and lateral wall (8%). AD and DLB showed similar patterns to controls. Lung or liver interference was present in 61% of cases. Myocardial infarction cases showed regional reductions in uptake, but normal/borderline planar uptake. In controls, there was no relationship between cardiovascular risk score and uptake pattern. ConclusionsSignificant variability of regional cardiac 123I-MIBG uptake is common in cases with normal planar cardiac uptake. Heterogeneity of regional uptake appears non-specific and unlikely to aid in the diagnosis of Lewy body disease.
Highlights
Some studies report that assessing regional 123I-cardiac MIBG uptake can aid in the diagnosis of Lewy body disease, but others report heterogeneity in healthy controls
Significant variability of regional cardiac 123I-MIBG uptake is common in cases with normal planar cardiac uptake
Heterogeneity of regional uptake appears non-specific and unlikely to aid in the diagnosis of Lewy body disease. (J Nucl Cardiol 2019)
Summary
Some studies report that assessing regional 123I-cardiac MIBG uptake can aid in the diagnosis of Lewy body disease, but others report heterogeneity in healthy controls. Sympathetic denervation occurs in DLB, resulting in low cardiac MIBG uptake on the scan, whereas healthy controls and patients with other dementias such as Alzheimer’s disease have normal uptake.[8,9,10,11,12,13,14] The technique has been used in Japan in Lewy body disease for over a decade and was recently included as an indicative biomarker in the fourth DLB consensus criteria, alongside 123I-FP-CIT SPECT.[6]. Regional variation of uptake can be assessed using SPECT imaging
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