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. 2015 Aug;30(8):864-9.
doi: 10.1002/gps.4229. Epub 2014 Nov 3.

Diagnostic value of MIBG cardiac scintigraphy for differential dementia diagnosis

Sylvie Slaets  1 , Frank Van Acker  2 , Jan Versijpt  3 , Lothar Hauth  4 , Johan Goeman  4 , Jean-Jacques Martin  1 , Peter Paul De Deyn  1   4   5 , Sebastiaan Engelborghs  1   4
Affiliations

Diagnostic value of MIBG cardiac scintigraphy for differential dementia diagnosis

Sylvie Slaets et al. Int J Geriatr Psychiatry. 2015 Aug.

Abstract

Objective: Iodine-123 metaiodobenzylguanidine (MIBG) cardiac scintigraphy has shown the potential to discriminate dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). However, these studies did not reflect clinical practice, as patients with ischemic heart disease, heart failure, diabetes mellitus, arterial hypertension, and hyperlipidemia and patients treated with antidepressants like trazodone were excluded.

Methods: This study aimed to evaluate the use of MIBG cardiac scintigraphy to diagnose DLB in clinical practice. Moreover, the potential diagnostic value of MIBG cardiac scintigraphy in patients with clinically ambiguous dementia diagnosis (DLB versus AD) was tested. Eighty-five patients with a possible clinical diagnosis of DLB entered the study. MIBG uptake was determined by calculating the heart-to-mediastinum-uptake ratio (H/M).

Results: The average H/M ratio was 1.42 ± 0.35. The number of core features for DLB and the H/M ratio were negatively correlated (p = 0.001; r = -0.360). With an H/M ratio cutoff of 1.68 in 20 patients with clinically ambiguous dementia diagnoses (DLB versus AD) at the moment of MIBG cardiac scintigraphy, 95% (19/20) of the patients were correctly classified as compared with clinical or definite diagnosis at follow-up, with sensitivity and specificity values for diagnosing DLB of 100% (16/16) and 75% (3/4), respectively. The H/M ratio was influenced only by age (p = 0.046; r = -0.217) and gender (p = 0.024) and not by any other variable studied.

Conclusions: The MIBG cardiac scintigraphy H/M ratio is a possible diagnostic biomarker for DLB in routine clinical practice and might have an added diagnostic value in case of doubt between DLB and AD.

Keywords: Alzheimer's disease; MIBG cardiac scintigraphy; dementia; dementia with Lewy bodies; sensitivity; specificity.

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Figures

Figure 1
Figure 1
H/M ratios for the total population. The average H/M ratio was 1.42 ± 0.35. The H/M ratio cutoff of 1.68 of Yoshita et al. (Yoshita et al., 2006) to distinguish between AD and DLB is shown.
Figure 2
Figure 2
Correlation between number of core features of DLB and the H/M ratio (p = 0.001; r = −3.60).
See this image and copyright information in PMC

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