123 I-MIBG myocardial scintigraphy for the evaluation of Lewy body disease: are delayed images essential? Is visual assessment useful?

• Published in: British journal of radiology 2016-08, Vol.89 (1064), p.20160144
• Main Authors: Sakamoto, Fumi, Shiraishi, Shinya, Tsuda, Noriko, Ogasawara, Koji, Yoshida, Morikatsu, Yuki, Hideaki, Hashimoto, Mamoru, Tomiguchi, Seiji, Ikeda, Manabu, Yamashita, Yasuyuki
• Format: Article
• Language: English
• ISSN: 0007-1285; 1748-880X
• DOI: 10.1259/bjr.20160144

We performed I-meta-iodobenzylguanidine ( I-MIBG) myocardial scintigraphy for the diagnosis of Lewy body disease (LBD) and assessed whether the early heart-to-mediastinum (H/M) ratio was diagnostic and whether visual image analysis was useful. Our study included 453 patients with clinically suspected LBD who had undergone I-MIBG myocardial scintigraphy. We evaluated semi-quantitative values (early and delayed H/M ratio, washout rate) and performed visual image analysis. The sensitivity, specificity, accuracy, positive-predictive value (PPV) and negative-predictive value (NPV) of both analyses were calculated. The early H/M ratio exhibited the best diagnostic ability. Its overall sensitivity, specificity, accuracy, PPV and NPV were 72.2%, 93.1%, 84.3%, 88.5% and 82.2%, respectively (cut-off value 2.2 or less). However, there was no significant difference from the delayed H/M ratio or the results of visual assessment. I-MIBG myocardial scintigraphy accurately differentiates between patients with and without LBD and a correct diagnosis can be established based on the early H/M ratio. We also document that visual evaluation of scintigrams is useful. Therefore, patients may benefit from the single performance of the procedure because a correct diagnosis can be obtained early in the disease process and their prognosis and appropriate treatment can be determined. I-MIBG myocardial scintigraphy on the early H/M ratio makes it possible to differentiate between patients with LBD and patients without LBD.