title: Diagnostic accuracy of 123I-meta-iodobenzylguanidine myocardial scintigraphy in dementia with Lewy bodies: a multicenter study.
abstract: OBJECTIVE
  Dementia with Lewy bodies (DLB) needs to be distinguished from Alzheimer's disease (AD) because of important differences in patient management and outcome. Severe cardiac sympathetic degeneration occurs in DLB, but not in AD, offering a potential system for a biological diagnostic marker. The primary aim of this study was to investigate the diagnostic accuracy, in the ante-mortem differentiation of probable DLB from probable AD, of cardiac imaging with the ligand 123I-meta-iodobenzylguanidine (MIBG) which binds to the noradrenaline reuptake site, in the first multicenter study.
  
  
  METHODS
  We performed a multicenter study in which we used 123I-MIBG scans to assess 133 patients with clinical diagnoses of probable (n = 61) or possible (n = 26) DLB or probable AD (n = 46) established by a consensus panel. Three readers, unaware of the clinical diagnosis, classified the images as either normal or abnormal by visual inspection. The heart-to-mediastinum ratios of 123I-MIBG uptake were also calculated using an automated region-of-interest based system.
  
  
  RESULTS
  Using the heart-to-mediastinum ratio calculated with the automated system, the sensitivity was 68.9% and the specificity was 89.1% to differentiate probable DLB from probable AD in both early and delayed images. By visual assessment, the sensitivity and specificity were 68.9% and 87.0%, respectively. In a subpopulation of patients with mild dementia (MMSE ≥ 22, n = 47), the sensitivity and specificity were 77.4% and 93.8%, respectively, with the delayed heart-to-mediastinum ratio.
  
  
  CONCLUSIONS
  Our first multicenter study confirmed the high correlation between abnormal cardiac sympathetic activity evaluated with 123I-MIBG myocardial scintigraphy and a clinical diagnosis of probable DLB. The diagnostic accuracy is sufficiently high for this technique to be clinically useful in distinguishing DLB from AD, especially in patients with mild dementia.
authors: Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8640, Japan; Department of Neurology, Hokuriku National Hospital, Nanto, Toyama 939-1893, Japan.
authors: Mitsuhiro
authors: M
authors: Yoshita
authors: Department of Psychiatry, Juntendo University School of Medicine, Bunkyo, Tokyo 113-8431, Japan.
authors: Heii
authors: H
authors: Arai
authors: Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi 980-8575, Japan.
authors: Hiroyuki
authors: H
authors: Arai
authors: Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaragi 305-8576, Japan.
authors: Tetsuaki
authors: T
authors: Arai
authors: Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaragi 305-8576, Japan.
authors: Takashi
authors: T
authors: Asada
authors: PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto, Tokyo 136-0075, Japan.
authors: Hiroshige
authors: H
authors: Fujishiro
authors: Department of Geriatric Medicine, Tokyo Medical University, Shinjuku, Tokyo 160-0023, Japan.
authors: Haruo
authors: H
authors: Hanyu
authors: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan.
authors: Osamu
authors: O
authors: Iizuka
authors: PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto, Tokyo 136-0075, Japan.
authors: Eizo
authors: E
authors: Iseki
authors: Department of Neurology, Okayama Kyokuto Hospital, Okayama, Okayama 703-8265, Japan.
authors: Kenichi
authors: K
authors: Kashihara
authors: Medical Care Court Clinic, Yokohama, Kanagawa 225-0014, Japan.
authors: Kenji
authors: K
authors: Kosaka
authors: Department of Radiology, Toranomon Hospital, Minato, Tokyo 105-8470, Japan.
authors: Hirotaka
authors: H
authors: Maruno
authors: Graduate School of Comprehensive Human Sciences, University of Tsukuba, Bunkyo, Tokyo 112-0012, Japan.
authors: Katsuyoshi
authors: K
authors: Mizukami
authors: Department of Neurology, Division of Neurogenerative Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan.
authors: Yoshikuni
authors: Y
authors: Mizuno
authors: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan.
authors: Etsuro
authors: E
authors: Mori
authors: Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8640, Japan.
authors: Kenichi
authors: K
authors: Nakajima
authors: Department of Environmental and Preventive Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8640, Japan.
authors: Hiroyuki
authors: H
authors: Nakamura
authors: Center for Treatment, Care and Research of Dementia, Medical Co. LTA, Sumida, Tokyo 130-0004, Japan.
authors: Seigo
authors: S
authors: Nakano
authors: Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8504, Japan.
authors: Kenji
authors: K
authors: Nakashima
authors: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan.
authors: Yoshiyuki
authors: Y
authors: Nishio
authors: Department of Neurology Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya, Tokyo 158-8531, Japan.
authors: Satoshi
authors: S
authors: Orimo
authors: Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8640, Japan.
authors: Miharu
authors: M
authors: Samuraki
authors: Tokai Central Hospital, Kakamigahara, Gifu 504-0816, Japan.
authors: Akira
authors: A
authors: Takahashi
authors: Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8640, Japan.
authors: Junichi
authors: J
authors: Taki
authors: Department of Molecular Pathobiology of Brain Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602-0841, Japan.
authors: Takahiko
authors: T
authors: Tokuda
authors: Department of Biological Regulation, School of Health Science, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan.
authors: Katsuya
authors: K
authors: Urakami
authors: Department of Neuropsychiatry, Sunagawa City Medical Center, Sunagawa, Hokkaido 073-0196, Japan.
authors: Kumiko
authors: K
authors: Utsumi
authors: Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8504, Japan.
authors: Kenji
authors: K
authors: Wada
authors: Department for Cognitive Disorders, Hospital of National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan.
authors: Yukihiko
authors: Y
authors: Washimi
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Toho University School of Medicine, Ota, Tokyo143-8541, Japan.
authors: Junichi
authors: J
authors: Yamasaki
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Toho University School of Medicine, Ota, Tokyo143-8541, Japan.
authors: Shouhei
authors: S
authors: Yamashina
authors: Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8640, Japan.
authors: Masahito
authors: M
authors: Yamada
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D016631:Lewy Bodies; D020961:Lewy Body Disease / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D007457:Iodine Radioisotopes; D019797:3-Iodobenzylguanidine