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Cardiac 123I-MIBG scintigraphy in neurodegenerative Parkinson syndromes: performance and pitfalls in clinical practice

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Item Type:Article
Title:Cardiac 123I-MIBG scintigraphy in neurodegenerative Parkinson syndromes: performance and pitfalls in clinical practice
Creators Name:Skowronek, C. and Zange, L. and Lipp, A.
Abstract:PURPOSE: Cardiac [(123)I]metaiodobenzylguanidine scintigraphy (123I-MIBG), reflecting postganglionic cardiac autonomic denervation, is proposed for early detection of Parkinson's disease (PD; reduced tracer uptake) and separation from Multiple System Atrophy (MSA; preserved tracer uptake). However, several recent studies report on frequent unexpected 123I-MIBG results in PD and MSA. We sought to determine, whether 123I-MIBG is feasible to discriminate PD from MSA in unselected geriatric patients in clinical practice. MATERIALS AND METHODS: We screened consecutive patients, that underwent 123I-MIBG for diagnostic reasons. Delayed 123I-MIBG uptake (heart/mediastinum ratio; H/M ratio) was verified by clinical diagnosis of PD, MSA, and ET based on a two-stage clinical assessment: comprehensive baseline (including autonomic testing and additional neuroimaging) and confirmatory clinical follow-up. RESULTS: 28 patients with clinical diagnosis of PD (N = 11), MSA (N = 9), and Essential Tremor (ET, N = 8) were identified. In one third (9/28) nuclear medical diagnosis deviated from clinically suspected syndrome. Visual interpretation of 123I-MIBG identified two cases (MSA and ET) with indeed normal 123I-MIBG uptake. Detailed review of clinical phenotypes provided only in two cases (PD and ET) an adequate explanation (correction of initial diagnosis and confounding drug history) for unexpected 123I-MIBG. In conclusion, 123I-MIBG did not match initial clinical phenotype in 27% PD, 44% MSA, and 25% ET patients. CONCLUSION: 123I-MIBG scintigraphy is a known specific and valuable technique in scientific approaches and well-defined and highly selected samples. However, predictability of 123I-MIBG based nuclear medical diagnosis for individual cases and thus, feasibility in routine clinical practice is limited. Our clinical series emphasize clinical verification of 123I-MIBG results on an individual basis in clinical routine.
Keywords:Parkinson's Disease, Lewy Body Disorders, Multiple System Atrophy, MIBG Scintigraphy, Autonomic Function
Source:Frontiers in Neurology
ISSN:1664-2295
Publisher:Frontiers Research Foundation (Switzerland)
Volume:10
Page Range:152
Date:February 2019
Official Publication:https://doi.org/10.3389/fneur.2019.00152
PubMed:View item in PubMed

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