Myocardial Metaiodobenzylguanidine Research Articles

High clinical diagnostic accuracy of combined salivary gland and myocardial metaiodobenzylguanidine scintigraphy in the diagnosis of Parkinson's disease.

Decreased myocardial uptake of 131I-metaiodobenzylguanidine (MIBG) is known to be an important feature to diagnose Parkinson's disease (PD). However, the diagnosis accuracy of myocardial MIBG scintigraphy alone is often unsatisfying. Recent studies have found that the MIBG uptake of the major salivary glands was reduced in PD patients as well. To evaluate the diagnostic value of major salivary gland MIBG scintigraphy in PD, and explore the potential role of myocardial MIBG scintigraphy combined with salivary gland MIBG scintigraphy in distinguishing PD from non-PD (NPD). Thirty-seven subjects were performed with 131I-MIBG scintigraphy. They were classified into the PD group (N = 18) and the NPD group (N = 19), based on clinical diagnostic criteria, DAT PET and 18F-FDG PET imaging findings. Images of salivary glands and myocardium were outlined to calculated the MIBG uptake ratios. The combination of left parotid and left submandibular gland early images had a good performance in distinguishing PD from NPD, with sensitivity, specificity, and accuracy of 50.00, 94.74, and 72.37%, respectively. Combining the major salivary gland and myocardial scintigraphy results in the early period showed a good diagnostic value with AUC, sensitivity and specificity of 0.877, 77.78, and 94.74%, respectively. Meanwhile, in the delayed period yield an excellent diagnostic value with AUC, sensitivity and specificity of 0.904, 88.89, and 84.21%, respectively. 131I-MIBG salivary gland scintigraphy assisted in the diagnosis and differential diagnosis of PD. The combination of major salivary gland and myocardial 131I-MIBG scintigraphy further increased the accuracy of PD diagnosis.

DAT imaging and myocardial MIBG scintigraphy for Lewy body diseases: A clinical‐neuroimaging study

AbstractObjectivesNeuroimaging markers for Lewy body diseases (LBDs) include dopamine transporter (DAT) scanning and metaiodobenzylguanidine (MIBG) myocardial scintigraphy. It is unknown which marker is more useful for identifying the three major LBD subtypes: Parkinson's disease (PD), dementia with Lewy bodies (DLB), and the autonomic‐sleep variant. To answer this question, we analyzed clinical‐neuroimaging data of 450 LBD patients.MethodsThis study was a prospective cohort study with a recruiting period of 3.0 years, prospective follow‐up period of 2.0 ± 1.8 years, and visits at least once a year. We recruited 745 referred subjects who had undergone both DAT and MIBG tests, and the inclusion criteria accorded with published criteria of PD, DLB, and the autonomic/sleep variant (at least one of PD/DLB's known early features: orthostatic hypotension, constipation, overactive bladder, and REM sleep behavior disorder [RBD]).ResultsA total of 450 patients fulfilled the criteria. Among the LBD subtypes, the most common was PD (49.3%), followed by DLB (46.4%) and the autonomic/sleep variant (4.2%). DAT and MIBG tests were almost equally abnormal in PD (98.2%, 79.3%, respectively); however, between the two measures, DAT was more frequently abnormal in DLB (82.3%, 56.9%, respectively) and MIBG in the autonomic/sleep variant (57.9%, 94.7%, respectively). Still, these differences did not reach statistical significance.ConclusionBetween the two neuroimaging tests, the DAT scan tended to parallel brain disease (PD/DLB), while the MIBG test tended to parallel peripheral disease (autonomic/sleep variant).

Normal 'heart' in Parkinson's disease: is this a distinct clinical phenotype?

Reduction of metaiodobenzylguanidine (MIBG) uptake has been observed in almost all patients with Parkinson's disease (PD), associated with hyposmia, orthostatic hypotension and rapid eye movement sleep behavioral disorder (RBD). In contrast, a subgroup of patients with PD with normal MIBG uptake have been reported to have milder disease and preserved cognition compared with those with lower MIBG. The aim of this study was to investigate whether non-motor manifestations of PD differ between patients with normal and abnormal myocardial MIBG uptake. Among 160 de-novo cases of PD, 44 had normal MIBG uptake. Twelve candidate non-motor features were evaluated using questionnaires and laboratory tests. Patients with decreased MIBG uptake had more constipation, RBD, cognitive impairment, hyposmia and orthostatic hypotension than did those with normal MIBG uptake. On linear regression analysis, orthostatic hypotension, olfactory function and probable RBD were significantly associated with MIBG uptake in PD. The principal component analysis showed that the group with normal MIBG was not associated with non-motor impairments. These results suggest that patients with PD with normal MIBG scans have a relatively low disease burden compared with those with abnormal MIBG. Fewer synuclein pathologies in the myocardia and sympathetic ganglia in PD with preserved MIBG uptake might be associated with lower threshold patterns of Braak synuclein pathology for non-motor manifestations compared with PD with decreased MIBG.

Lewy Body Dementia as an Underlying Etiology for Posterior Cortical Atrophy Initially Presented with Visual Agnosia and Alexia: A Case Report

Posterior cortical atrophy (PCA) is a neurodegenerative disorder with cerebral atrophy in the parietal, occipital, or occipitotemporal cortices, and is characterized by visuospatial and visuoperceptual impairments. The majority of the disorder is compatible pathologically with Alzheimer’s disease (AD). However, many patients show no memory loss until late stages of the disease. We encountered a case where a combination of several imaging modalities, in conjunction with symptoms and neuropsychological exams, led not only to a diagnosis of PCA but also identified its underlying etiology. A 62-year-old Japanese man presented to ophthalmology with visual impairment and without abnormalities in his visual acuity or visual fields. Alexia was identified, particularly pertinent to reading Kanji, at the neurology clinic. His initial Mini-Mental State Examination (MMSE) revealed a score of 27/30 points with delayed recall (-2) and constructional apraxia (-1). The score dropped to 25 points six months later. Brain MRI demonstrated occipital atrophy. Brain single photon emission computed tomography (SPECT) showed hypoperfusion in the medial and lateral occipital lobes. The myocardial meta-iodobenzylguanidine (MIBG) scintigraphy showed no evidence of myocardial postganglionic sympathetic dysfunction. Posterior cortical atrophy (PCA) was diagnosed in conjunction with the symptoms, including alexia and visual impairment. He developed symmetric parkinsonism one year later. Lewy body dementia (DLB) was thus considered as the underlying etiology for the PCA. Additionally, alexia pertinent to reading Kanji has not been reported before. We herein report this rare case.

Pure psychiatric presentation of the Lewy body disease is depression--an analysis of 60 cases verified with myocardial meta-iodobenzylguanidine study.

Parkinson's disease (PD), Parkinson's disease with dementia (PDD) and dementia with Lewy bodies (DLB) were collectively termed Lewy body disease (LBD). Pure psychiatric presentation (PPP) of the LBD may be the fourth subtype in which psychiatric symptoms without definite parkinsonism and cognitive disturbance lasted for many years. The aim of this study is to localize the presence of the PPP in subjects with low uptake of myocardial meta-iodobenzylguanidine (MIBG). Sixty MIBG-verified patients (28 women and 32 men) were classified into three psychiatric pictures; depression (Group D: 27 patients), isolated visual hallucinations (Group V: 16 patients) and psychosis (Group P: 17 patients). Fifty six cases were examined with single photon emission tomography (SPECT) study of the brains in which hypoperfusion lobes were identified in 37 cases and 19 cases showed no abnormality. After that, we determined final diagnoses; PD, PDD, DLB and PPP with an aid of the DSM-IV, the unified Parkinson's disease rating scale (UPDRS) and Mini-mental state examination (MMSE). Of Group D patients 40% remained depressive without parkinsonism and about 50% had or developed typical parkinsonism. Most Group P patients developed clinical pictures of PDD or DLB. Statistics provided four combinations: Group V-DLB-occipital lobe hypoperfusion, Group D-PD without SPECT abnormality, Group P-PDD with temporal lobe hypoperfusion and Group D-PPP without SPECT abnormality. PPP featured major depressive disorder and can be preparative of incidental LBD and prodromal depression of PD. Psychosis and dementia were of the same quality that characterizes the PDD.

Reconstruction of semiautomated cardiac regions of interest using iodine-123 metaiodobenzylguanidine myocardial scintigraphy.

Analysis using cardiac iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy with regions of interest (ROIs) is useful for assessing myocardial sympathetic activity. However, manual placement of the cardiac ROI is sometimes difficult because myocardial MIBG uptake is reduced in patients with heart failure. A new method was developed to reconstruct the semiautomated cardiac ROI in a sympathetic denervated heart. Using dynamic planar data, a summed image was generated and the matrix size was changed. Then, the radial count profiles originating from the center of the left ventricle were generated to extract the myocardial count profiles. An asymmetric Gaussian distribution was fitted to each profile and the epicardial border was defined by the threshold method. This program was tested in 50 patients, and its reproducibility was validated when compared with the manual tracing method. The semiautomated method yielded a better quality image compared with the standard image with higher counts. Cardiac ROIs were generated successfully in each patient within normal limits. The intraobserver and interobserver agreements were excellent (P<0.0001 each). This approach showed a significantly higher consistency in measuring the heart-to-mediastinum ratio as compared with the manual tracing method (P<0.05). The semiautomated method is useful in generating cardiac ROIs with high reproducibility in myocardial MIBG imaging.

EPA-0409 – Depression, incidental lewy body disease and pure psychiatric presentation of the lewy body disease

Introduction Parkinson's disease (PD), PD dementia (PDD) and dementia with Lewy body (DLB), collectively termed Lewy body disease (LBD), characterize an array of emotional, neurobehavioral and cognitive symptoms. Pure psychiatric presentation (PPP) of LBD is the fourth subtype of LBD in which psychiatric symptoms lasted for many years in the absence of neurological disturbance. Aims The aim of this study is to localize the PPP and its clinical characteristics in subjects with low uptake of myocardial metaiodobenzylguanidine (MIBG) study. Methods Sixty MIBG-verified patients (28 women and 32 men) were grouped into three psychiatric pictures; depression (group D: 27 patients), isolated visual hallucinations (group V: 16 patients) and psychotic picture (group P: 17 patients). Fifty six cases were examined with cerebral single photon emission tomography study. Thirty-seven cases had hypoperfusion regions and 19 cases showed no abnormality. Final diagnoses of PD, PDD, DLB and PPP were evaluated with an aid of DSM-IV-TR, UPDRS part III, the Hoehn and Yahr Scale, MMSE and the movement disorder society task force diagnostic criteria. Results Three clusters, PDD and Group P, DLB and Group V, and Group D and PPP-PD were found significantly with correspondence analysis. UPDRS average score showed negative correlation with average MMSE scores. All patients with PPP and majority of patients with PD featured depression. Conclusions PPP subjects are considered to be incidental LBD or depression of pre-motor PD. Psychotic parkinsonian features contributed highly to dementia of LBD, and visual hallucination was closely associated with DLB.

Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital.

Context:Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources.Aim:The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method.Materials and Methods:A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied.Results:The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates.Conclusion:ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments.

Myocardial Sympathetic Nervous Activity and Symptomatic Heart Failure Patients with Preserved Ejection Fraction

Iodine-123 metaiodobenzylguanidine (MIBG) is used to assess myocardial sympathetic nervous activity, and a decrease in myocardial MIBG uptake and an increase in spillover have been observed in heart failure patients with reduced ejection fraction. However, kinetics and clinical significance of MIBG remain unclear in heart failure patients with preserved ejection fraction (HFpEF).

Cardiac sympathetic innervation imaging with myocardial MIBG scintigraphy

Metaiodobenzylguanidine (MIBG) was developed initially as a tracer for oncological imaging; when labeled with 123 I or 131 I, it may detect APUDomas, such as pheochromocytomas and paragangliomas. In the last years, MIBG has found an important role also in neurology and cardiology, as cardiac innervation tracer. Actually, MIBG cardiac imaging is a universally accepted method to estimate cardiac sympathetic innervations. This review covers the role of MIBG cardiac imaging in Parkinson disease and parkinsonisms, from the pathophysiological premises for cardiac denervation to new emerging data.

Catecholamines influence myocardial 123I MIBG uptake in neuroblastoma patients

Cardiac 123I metaiodobenzylguanidine (MIBG) imaging can be influenced by several factors. We evaluated the relationship between catecholamine measurements and cardiac 123I MIBG uptake in neuroblastoma patients. 30 neuroblastoma patients were retrospectively assessed on cardiac 123I MIBG uptake and urinary catecholamine dopamine and metabolites, homovanillic acid (HVA) and vanillylmandelic acid (VMA). Cardiac 123I MIBG uptake was quantified by heart-to-mediastinum (H/M) ratios, which were calculated into standard deviation scores (SDS) using age-specific reference values. In 17 (57%) and 12 patients (40%) H/M ratio measurements were below -1.0 and -2.0 SDS at diagnosis. A significant inverse correlation between the average of urine metabolites HVA and VMA, and H/M ratio SDS was observed (r -.39, p = 0.04). Furthermore, there was a significant correlation between the urinary catecholamine metabolite HVA and H/M ratio SDS (r -.40, p=0.04). Routine calculation of H/M ratios in 123I MIBG scintigrams of neuroblastoma patients is not helpful because it will not identify cardiac ventricular dysfunction in this patient category. A low H/M ratio on 123I MIBG scintigraphy is explained by increased cathecholamine levels secreted by neuroblastoma tumours.

Differentiating Parkinson’s disease from multiple system atrophy by [123I] meta-iodobenzylguanidine myocardial scintigraphy and olfactory test

We aimed to study whether either [123l] myocardial meta-iodobenzylguanidine (MIBG) myocardial scintigraphy or the odor stick identification test for Japanese (OSIT-J) is effective in differentiating Parkinson’s disease (PD) from multiple system atrophy (MSA). We compared the MIBG accumulation and olfactory score between 42 PD and 42 MSA (19 MSA-P and 23 MSA-C) patients in the early stages. [123l] MIBG myocardial scintigraphy showed higher sensitivity and the olfactory test higher specificity in differentiating PD from MSA. There were significant differences between PD and MSA-C (p = 0.0019) instead of MSA-P (p > 0.05) in the MIBG accumulation, while there were significant differences between PD and MSA-P (p = 0.0003) or MSA-C (p = 0.0003) in the OSIT-J score. Our data suggest that the olfactory test can be useful as a clinical tool with its higher specificity in differentiating PD from MSA in the early stages and, moreover, support the discrimination of PD from MSA-P.

Sympathetic Reinnervation 1 Year After Heart Transplantation, Assessed Using Iodine-123 Metaiodobenzylguanidine Imaging

Complete allograft denervation occurs during heart transplantation (HT). Partial ventricular sympathetic reinnervation that may develop after transplantation can be measured using iodine-123 meta iodobenzylguanidine (MIBG) uptake. Previous studies have suggested that reinnervation is likely to be a slow process, only occurring after 1 year posttransplantation. However, the reinnervation prevalence at 1 year after HT remains unknown. This study sought to determine sympathetic reinnervation measured by MIBG at 12 months after surgery. We performed serial cardiac MIBG imaging in 45 cardiac transplant recipients, including 32 males and 13 females, early (2 months) and late (12 months) after the operation. The intensity of myocardial MIBG uptaken was quantified by heart-to-mediastinum ratios (HMR). Reinnervation was considered when the HMR was >1.3. HMR was significantly higher at 12 months: 1.16 ± 0.10 at 2 vs 1.30 ± 0.15 at 12 months (P < .001). Eighteen (40%) of 45 subjects developed visible cardiac MIBG uptake at 1 year after transplantation with HMR >1.3. In conclusion, partial sympathetic reinnervation increases with time after HT; it was seen in 40% of patients at 1 year after the operation.

Myocardial MIBG scintigraphy may predict the course of motor symptoms in Parkinson’s disease

Background The metaiodobenzylguanidine (MIBG) scintigraphy is a well established nuclear medicine method to support the clinical diagnosis of Parkinson’s disease. In this study we examined the predictive value of the MIBG scintigraphy concerning the severity and progression of the parkinsonian motor symptoms. Patients and methods This study included 40 patients with idiopathic Parkinson’s disease (age 56 ± 9 years, Hoehn and Yahr stage 1.4 ± 0.7, mean ± standard deviation). All patients underwent a baseline visit and a follow-up visit 3–8 years (5.3 ± 1.6 years) after the baseline visit. 123I-MIBG scintigraphy was performed only once at the baseline visit. At both visits the motor symptoms bradykinesia, rigidity, resting tremor, postural tremor and axial symptoms were quantified by means of the motor part of the Unified Parkinson’s disease rating scale. Results The myocardial MIBG uptake correlated significantly with the annual progress of rigidity ( r = −0.41, p < 0.05; Pearson’s correlation) and axial symptoms ( r = −0.49, p < 0.01). There was no significant correlation ( p > 0.05) between the initial myocardial MIBG uptake and the annual progress of the other motor symptoms. Conclusion The MIBG scintigraphy may predict the velocity of progress of rigidity and axial symptoms in the following 3–8 years. Such a prediction is not possible for the other motor symptoms resting tremor, postural tremor and bradykinesia.

Pure akinesia with low myocardial metaiodobenzylguanidine uptake

The objective of this study was to delineate the clinical features of patients with pure akinesia and a low heart versus mediastinum ratio below 2.0 in the delayed images of myocardial metaiodobenzylguanidine scintigraphy, a marker for the clinical diagnosis of Lewy body diseases. A total of 13 patients was enrolled. The clinical features of the patients were uniformly elderly (mean age, 73.7 years), a male gender preponderance (10 men and 3 women), relatively mild motor disability (mean Hoehn Yahr grade 2.4) without laterality, festinating gait (77%) and loss of postural reflex (69%), which were the most common; also observed were fair levodopa responses (70%), cognitive dysfunction in some (23%), common autonomic dysfunction (urinary urgency and frequency, 85%; constipation, 77%; and postural hypotension, 38%) and common occipital hypoperfusion (62%). These features may facilitate the clinical differential diagnosis of these patients from patients with pure akinesia due to progressive supranuclear palsy.

123I-MIBG cardiac uptake and smell identification in parkinsonian patients with LRRK2 mutations

Reduced uptake of 123I- metaiodobenzylguanidine (MIBG) on cardiac gammagraphy and impaired odor identification are markers of neurodegenerative diseases with Lewy bodies (LB) as a pathological hallmark, such as idiopathic Parkinson’s disease (IPD). LRRK2 patients present with a clinical syndrome indistinguishable from IPD, but LB have not been found in some cases. Patients with such mutations could behave differently than patients with IPD with respect to MIBG cardiac uptake and olfaction. We studied 14 LRRK2 patients, 14 IPD patients matched by age, gender, disease duration and severity, and 13 age and gender matched control subjects. Olfaction was analyzed through the University of Pennsylvania Smell Identification Test (UPSIT). MIBG cardiac uptake was evaluated through the H/M ratio. The late H/M was 1.44 ± 0.31 for LRRK2 patients, 1.19 ± 0.15 for PD patients, and 1.67 ± 0.16 for control subjects. LRRK2 patients presented lower but not statistically significant MIBG cardiac uptake than controls (p = 0.08) and significant higher uptake than PD patients (p = 0.04). UPSIT mean scores were 21.5 ± 7.3 for LRRK2 patients, 18.7 ± 6.2 for IPD patients and 29.7 ± 5.7 for control subjects. UPSIT score was lower in both LRRK2 and PD than in controls. In LRRK2 patients a positive correlation was found between myocardial MIBG uptake and UPSIT scores, (R = 0.801, p < 0.001). In LRRK2 patients, MIBG cardiac uptake was less impaired than in PD; a positive correlation between MIBG cardiac uptake and UPSIT scores was observed. As MIBG cardiac reduced uptake and impaired odor identification are markers of LB pathology, this findings may represent neuropathological heterogeneity among LRRK2 patients.

Usefulness of MIBG scintigraphy in idiopathic REM sleep behavior disorder: a systematic review

Correspondence: Giorgio Treglia institute of Nuclear Medicine, Catholic University of the Sacred Heart, Largo Gemelli, 8, Rome 00168, italy Tel +390630156200 Fax +39063013745 email giorgiomednuc@libero.it Background and purpose: It has been widely demonstrated that Parkinson’s disease (PD) and dementia with Lewy bodies (DLB) share one clinicopathological entity; Lewy body disease (LBD) has thus become a general term for these diseases. LBD presents an impairment of adrenergic function and consequently an abnormal myocardial metaiodobenzylguanidine (MIBG) innervation imaging. Like PD and DLB, other Lewy body disorders, including pure autonomic failure and idiopathic rapid eye movement sleep behavior disorder (RBD), have been reported to develop cardiac sympathetic denervation. This study is designed to systematically review whether iodine-123-MIBG scintigraphy in patients with RBD demonstrates reduced myocardial uptake thereby suggesting cardiac sympathetic denervation, a typical finding of LBD, in these patients. Methods: A comprehensive computer literature search of studies published through December 2010 regarding MIBG scintigraphy in patients with RBD was performed in PubMed/Medline and EMBASE databases. Only studies in which MIBG scintigraphy was performed in more than two patients with RBD were selected. Results: Ultimately, six studies comprising a total of 139 patients with RBD were identified and discussed. Conclusions: RBD usually show a markedly reduced cardiac MIBG uptake, consistent with a sympathetic denervation, a typical finding of a LBD.

Abnormal cardiac [123I]‐meta‐iodobenzylguanidine uptake in multiple system atrophy

[(123)I]-Meta-iodobenzylguanidine (MIBG) myocardial scintigraphy is useful for distinguishing multiple system atrophy (MSA) from Parkinson disease. In this study, longitudinal observation using MIBG myocardial scintigraphy was carried out in patients with MSA to evaluate the association of myocardial MIBG uptake with clinical features. A total of 96 MIBG examinations were performed in 52 patients with MSA. The heart/mediastinum (H/M) ratio of MIBG uptake at 240 minutes after injection was below the lower limit in 16 patients with MSA (31.3%). Overall, the H/M ratio correlated with neither disease duration nor severity. In the follow-up observations, the H/M ratio did not show any specific trends, in contrast with the continuous decrease observed in patients with Parkinson's disease. This data clearly showed that cardiac MIBG uptake cannot necessarily be preserved in patients with MSA and that approximately 30% of patients with MSA showed decreased MIBG uptake without any correlation to disease duration or severity.

Long-term prognostic value of cardiac autonomic nervous activity in postoperative patients with congenital heart disease

BackgroundAbnormal cardiac autonomic nervous activity (CANA) is not uncommon in postoperative patients with congenital heart disease (CHD). Methods and resultsWe attempted to clarify the prognostic value of the CANA variables in postoperative CHD patients and prospectively evaluated the CANA variables in 292 consecutive biventricular and 91 Fontan repair patients. The CANA variables included the heart rate variability, arterial baroreflex sensitivity (BRS), washout ratio of the myocardial metaiodobenzylguanidine scintigraphy, and plasma norepinephrine level. With a follow-up of 10±2years, 98 total events that required hospitalization, including 13 deaths and 48 unscheduled cardiac events (UCEs), occurred. In all the CHD patients, all the CANA indices predicted the total events and UCEs. Of those, the NE level (p=0.0004) and BRS (p=0.0373) predicted the mortality. In a multivariate analysis, the BRS was an independent CANA-predictor for the total events (p=0.007). In the biventricular patients, the plasma NE level, heart rate variability, and BRS predicted the total events and UCEs and the BRS was the only independent CANA-predictor for the total events (p=0.0329). In the Fontan patients, the plasma NE level was the only predictor for the UCEs (p=0.0242) and no other CANA variables were independent predictors of the total events or UCEs. ConclusionsAll CANA variables, especially the BRS, were useful predictors for future clinical events in biventricular CHD patients, whereas no CANA variables, except for the plasma NE level, predicted future clinical events in the Fontan patients.

Recent developments in innervation imaging using iodine-123-metaiodobenzylguanidine scintigraphy in Lewy body diseases

Radiolabeled metaiodobenzylguanidine (MIBG) is an analog of guanethidine and is taken up by the postganglionic presynaptic nerve endings. MIBG uptake in the heart correlates with adrenergic function, which can be reduced in Lewy body diseases. We described the recent developments in innervation imaging using (123)I-MIBG scintigraphy in Lewy body diseases including Parkinson's disease and dementia with Lewy bodies. Particularly, we underlined the role of MIBG scintigraphy in differential diagnosis of movement disorders. As described by recent studies, MIBG scintigraphy is a valuable diagnostic tool for differentiation between Lewy body diseases and parkinsonian syndromes or other movement disorders with parkinsonism. Furthermore, this method may provide a powerful differential diagnostic tool between dementia with Lewy bodies and Alzheimer's disease. We also reported the results of clinical investigations about the correlation between characteristics of Parkinson's disease and myocardial MIBG uptake.