title: (123) I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane single photon emission computed tomography and (123) I-metaiodobenzylguanidine myocardial scintigraphy in differentiating dementia with lewy bodies from other dementias: A comparative study.
abstract: OBJECTIVE
  To compare the diagnostic value of striatal (123) I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ((123) I-FP-CIT) single photon emission computed tomography (SPECT) and (123) I-metaiodobenzylguanidine ((123) I-MIBG) myocardial scintigraphy in differentiating dementia with Lewy bodies (DLB) from other dementia types.
  
  
  METHODS
  This prospective longitudinal study included 30 patients with a clinical diagnosis of DLB and 29 patients with non-DLB dementia (Alzheimer disease, n = 16; behavioral variant frontotemporal dementia, n = 13). All patients underwent (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy within a few weeks of clinical diagnosis. All diagnoses at each center were agreed upon by the local clinician and an independent expert, both unaware of imaging data, and re-evaluated after 12 months. Each image was visually classified as either normal or abnormal by 3 independent nuclear physicians blinded to patients' clinical data.
  
  
  RESULTS
  Overall, sensitivity and specificity to DLB were respectively 93% and 100% for (123) I-MIBG myocardial scintigraphy, and 90% and 76% for (123) I-FP-CIT SPECT. Lower specificity of striatal compared to myocardial imaging was due to decreased (123) I-FP-CIT uptake in 7 non-DLB subjects (3 with concomitant parkinsonism) who had normal (123) I-MIBG myocardial uptake. Notably, in our non-DLB group, myocardial imaging gave no false-positive readings even in those subjects (n = 7) with concurrent medical illnesses (diabetes and/or heart disease) supposed to potentially interfere with (123) I-MIBG uptake.
  
  
  CONCLUSIONS
  (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy have similar sensitivity for detecting DLB, but the latter appears to be more specific for excluding non-DLB dementias, especially when parkinsonism is the only "core feature" exhibited by the patient. Our data also indicate that the potential confounding effects of diabetes and heart disease on (123) I-MIBG myocardial scintigraphy results might have been overestimated. Ann Neurol 2016;80:368-378.
authors.affiliation: Division of Neurology V/Neuropathology, Scientific Institute for Research, Hospitalization, and Care (IRCCS), Foundation "Carlo Besta" Neurological Institute, Milan, Italy.
authors.forename: Pietro
authors.identifier: http://orcid.org/0000-0002-2171-1720
authors.initials: P
authors.lastname: Tiraboschi
authors.affiliation: Department of Nuclear Medicine, Sant'Anna Hospital, Como, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Corso
authors.affiliation: Department of Nuclear Medicine, Poliambulanza Foundation, Brescia, Italy.
authors.forename: Ugo Paolo
authors.initials: UP
authors.lastname: Guerra
authors.affiliation: Department of Neuroscience, University of Genoa, Genoa, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Nobili
authors.affiliation: Nuclear Medicine Unit, Department of Diagnostic Imaging, E. O. Galliera Hospital, Genoa, Italy.
authors.forename: Arnoldo
authors.initials: A
authors.lastname: Piccardo
authors.affiliation: Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Calcagni
authors.affiliation: Nuclear Medicine Unit, University Hospital of Pisa, Pisa, Italy.
authors.forename: Duccio
authors.initials: D
authors.lastname: Volterrani
authors.affiliation: Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cecchin
authors.affiliation: Laboratory of Geriatric Neuropsychiatry, Institute of Hospitalization and Scientific Care Mario Negri Institute of Pharmacological Research, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.affiliation: Health Department, Institute of Hospitalization and Scientific Care Foundation Carlo Besta Neurological Institute, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Antelmi
authors.affiliation: Department of Neurology and Stroke Unit, Sant'Anna Hospital, Como, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Vidale
authors.affiliation: Department of Neurology and Stroke Unit, Sant'Anna Hospital, Como, Italy.|Neurocenter of Southern Switzerland, Lugano, Switzerland.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Sacco
authors.affiliation: European Foundation for Biomedical Research, Alzheimer Center of Excellence, Briolini Hospital of Gazzaniga, Bergamo, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Merello
authors.affiliation: European Foundation for Biomedical Research, Alzheimer Center of Excellence, Briolini Hospital of Gazzaniga, Bergamo, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Stefanini
authors.affiliation: Neurology Unit, San Francesco Clinic, Bergamo, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Micheli
authors.affiliation: Department of Nuclear Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Vai
authors.affiliation: Department of Nuclear Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Selene
authors.initials: S
authors.lastname: Capitanio
authors.affiliation: Department of Nuclear Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Sara Vincenzina
authors.initials: SV
authors.lastname: Gabanelli
authors.affiliation: Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Riva
authors.affiliation: Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pinto
authors.affiliation: Department of Psychology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Ave Maria
authors.initials: AM
authors.lastname: Biffi
authors.affiliation: Division of Neurology V/Neuropathology, Scientific Institute for Research, Hospitalization, and Care (IRCCS), Foundation "Carlo Besta" Neurological Institute, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Muscio
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000000981:diagnostic imaging*; D003342:Corpus Striatum / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D057180:Frontotemporal Dementia / Q000000981:diagnostic imaging*; D006801:Humans; D020961:Lewy Body Disease / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000592:standards; D014326:Tropanes
chemical_list: D019275:Radiopharmaceuticals; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane; D019797:3-Iodobenzylguanidine