Value of combining activated brain FDG-PET and cardiac MIBG for the differential diagnosis of dementia: differentiation of dementia with Lewy bodies and Alzheimer disease when the diagnoses based on clinical and neuroimaging criteria are difficult.
Dementia with Lewy bodies (DLB) is the second most common cause of dementia. The diagnosis of DLB is particularly important because these patients show good response to cholinesterase inhibitors. Clinical and neuroimaging criteria for DLB have not been acceptable for predictive accuracy. We report a case of progressive dementia in which the differentiation of DLB and Alzheimer disease (AD) on the basis of clinical criteria alone was not possible. The patient was admitted to the hospital because he became worse after he had started treatment for severe AD. Both MRI and brain magnetic resonance spectroscopy were normal. The patient underwent myocardial scintigraphy with I-123 MIBG showing marked reduction in cardiac MIBG accumulation. The heart to mediastinum ratio of MIBG uptake was impaired in both early and delayed images. FDG-PET scan before and after activation with a visual attention task showed occipital cortex hypometabolism as compared with AD and a normal control. This case illustrates the value of combining activated brain FDG PET and cardiac MIBG. The association of these 2 techniques could be used as a potential diagnostic tool in a patient with dementia misdiagnosed as AD.
Schmidt
Sergio L
SL
State University of Rio de Janeiro (UERJ, Niteroi, Rio de Janerio, Brazil.
Correa
Patricia L
PL
Tolentino
Julio C
JC
Manhães
Alex C
AC
Felix
Renata M
RM
Azevedo
Jader C
JC
Barbirato
Gustavo B
GB
Mendes
Marcelo H F
MH
Boechat
Yolanda
Y
Cabral
Herbert
H
Schmidt
Guilherme J
GJ
Dohmann
Hans F
HF
Mesquita
Claudio T
CT
D019797:3-Iodobenzylguanidine; D000368:Aged; D000544:Alzheimer Disease / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D020961:Lewy Body Disease / Q000000981:diagnostic imaging*; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D019797:3-Iodobenzylguanidine