123I-MIBG myocardial scintigraphy for the diagnosis of DLB: a multicentre 3-year follow-up study

Author:

Komatsu Junji,Samuraki Miharu,Nakajima Kenichi,Arai Heii,Arai Hiroyuki,Arai Tetsuaki,Asada Takashi,Fujishiro Hiroshige,Hanyu Haruo,Iizuka Osamu,Iseki Eizo,Kashihara Kenichi,Kosaka Kenji,Maruno Hirotaka,Mizukami Katsuyoshi,Mizuno Yoshikuni,Mori Etsuro,Nakamura Hiroyuki,Nakano Seigo,Nakashima Kenji,Nishio Yoshiyuki,Orimo Satoshi,Takahashi Akira,Taki Junichi,Tokuda Takahiko,Urakami Katsuya,Utsumi Kumiko,Wada Kenji,Washimi Yukihiko,Yamashina Shouhei,Yamasaki Junichi,Yoshita Mitsuhiro,Yamada Masahito

Abstract

Background and purposeWe previously reported the usefulness of iodine-123 metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy for differentiation of dementia with Lewy bodies (DLB) from Alzheimer’s disease (AD) in a cross-sectional multicentre study. The aim of this study was, by using reassessed diagnosis after 3-year follow-up, to evaluate the diagnostic accuracy of 123I-MIBG scintigraphy in differentiation of probable DLB from probable AD.MethodsWe undertook 3-year follow-up of 133 patients with probable or possible DLB or probable AD who had undergone 123I-MIBG myocardial scintigraphy at baseline. An independent consensus panel made final diagnosis at 3-year follow-up. Based on the final diagnosis, we re-evaluated the diagnostic accuracy of 123I-MIBG scintigraphy performed at baseline.ResultsSixty-five patients completed 3-year follow-up assessment. The final diagnoses were probable DLB (n=30), possible DLB (n=3) and probably AD (n=31), and depression (n=1). With a receiver operating characteristic curve analysis of heart-to-mediastinum (H/M) ratios for differentiating probable DLB from probable AD, the sensitivity/specificity were 0.77/0.94 for early images using 2.51 as the threshold of early H/M ratio, and 0.77/0.97 for delayed images using 2.20 as the threshold of delayed H/M ratio. Five of six patients who were diagnosed with possible DLB at baseline and with probable DLB at follow-up had low H/M ratio at baseline.ConclusionsOur follow-up study confirmed high correlation between abnormal cardiac sympathetic activity evaluated with 123I-MIBG myocardial scintigraphy at baseline and the clinical diagnosis of probable DLB at 3-year follow-up. Its diagnostic usefulness in early stage of DLB was suggested.Trial registration numberUMIN00003419.

Funder

Japan Foundation for Neuroscience and Mental Health

Publisher

BMJ

Subject

Psychiatry and Mental health,Clinical Neurology,Surgery

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