title: Comparison of I-123 MIBG planar imaging and SPECT for the detection of decreased heart uptake in Parkinson disease.
abstract: Decreased myocardial uptake of I-123 metaiodobenzylguanidine (MIBG) is an important finding for diagnosis of Parkinson's disease (PD). This study compared I-123 MIBG SPECT and planar imaging with regard to their diagnostic yield for PD. 52 clinically diagnosed PD patients who also had decreased striatal uptake on FP-CIT PET/CT were enrolled. 16 normal controls were also included. All underwent cardiac MIBG planar scintigraphy and SPECT separately. Myocardial I-123 MIBG uptake was interpreted on planar and SPECT/CT images separately by visual and quantitative analysis. The final diagnosis was made by consensus between two readers. Kappa analyses were performed to determine inter-observer agreement for both methods. Sensitivity, specificity, and accuracy were compared with McNemar's test. The sensitivity, specificity, and accuracy were 84.6, 100, and 88.2% for planar images and 96.2, 100 and 97.1% for SPECT, respectively, with a significant difference between the two imaging methods (p < 0.031). All inter-observer agreements were almost perfect (planar scintigraphy: κ = 0.82; SPECT: κ = 0.93). Heart-to-mediastinum ratios from PD patients with negative planar and positive SPECT scans (group A) and patients with positive planar and positive SPECT scans (group B) were 1.69 ± 0.16 (1.59-1.85) and 1.41 ± 0.15 (1.20-1.53), respectively, and showed significant difference (p = 0.023). Lung-to-mediastinum ratios for groups A and B were 2.16 ± 0.20 (1.96-2.37) and 1.6 ± 0.19 (1.3-1.78), respectively, and were significantly higher in the former (p = 0.001). I-123 MIBG SPECT has a significantly higher diagnostic performance for PD than planar images. Increased lung uptake may cause false-negative results on planar imaging.
authors.affiliation: Department of Radiology, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, South Korea.
authors.forename: Jin-Kyoung
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Department of Radiology, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, South Korea.
authors.forename: Eun-Kyoung
authors.initials: EK
authors.lastname: Choi
authors.affiliation: Department of Neurology, College of Medicine, The Catholic University of Korea, 505, Banpo-dong, Seocho-gu, Seoul, 137-701, South Korea. siuy@catholic.ac.kr.
authors.forename: In-Uk
authors.initials: IU
authors.lastname: Song
authors.affiliation: Department of Neurology, College of Medicine, The Catholic University of Korea, 505, Banpo-dong, Seocho-gu, Seoul, 137-701, South Korea.
authors.forename: Joong-Seok
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Radiology, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 403-720, South Korea. nm@catholic.ac.kr.
authors.forename: Yong-An
authors.initials: YA
authors.lastname: Chung
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes
chemical_list: D019275:Radiopharmaceuticals; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane; D019797:3-Iodobenzylguanidine
keywords: I-123 MIBG; Parkinson's disease; Planar scintigraphy; SPECT; Sensitivity and specificity