Clinical validity of presynaptic dopaminergic imaging with123I-ioflupane and noradrenergic imaging with123I-MIBG in the differential diagnosis between Alzheimer's disease and dementia with Lewy bodies in the context of a structured 5-phase development framework.
The use of biomarkers (BMs) for accurate diagnosis of Alzheimer's disease (AD) has been proposed by recent diagnostic criteria; however, their maturity is not sufficient to grant implementation in the clinical routine. A proper diagnostic process requires not only confirmation of the disease but also the exclusion of similar disorders entering differential diagnosis, like dementia with Lewy bodies (DLB). This review is aimed at evaluating the clinical validity of123I-ioflupane brain single photon emission tomography and123I-MIBG cardiac scintigraphy as imaging BMs for DLB. For this purpose, we used an adapted version of the 5-phase oncology framework for BMs development. A review of the literature was conducted using homogenous search criteria with other BMs addressed in parallel reviews. Results of our literature search showed that the rationale for the use of both BMs in the differential diagnosis of DLB and AD is strong (phase 1) and that they allow a good discrimination ability (phase 2), but studies investigating BMs distribution antemortem and postmortem on pathology are lacking. Moreover, thresholds for test positivity have not been defined for123I-MIBG. The 2 BMs have not been yet assessed in early phases of DLB and AD (phase 3). No phase 4 and phase 5 studies have so far been carried out. This review highlights the priorities to address in future investigations to enable the proper use of123I-ioflupane and123I-MIBG for the differential diagnosis of dementia.
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, CA, USA; Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden. Electronic address: idasonni@gmail.com.
Ida
I
Sonni
Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospital of Geneva, Geneva, Switzerland.
Osman
O
Ratib
Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Fatebenefratelli, Brescia, Italy; LANVIE - Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland.
Marina
M
Boccardi
Department of Neuroscience (DINOGMI), Clinical Neurology, University of Genoa, Genoa, Italy.
Agnese
A
Picco
Wolfson Molecular Imaging Centre, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
Karl
K
Herholz
Department of Neuroscience (DINOGMI), Clinical Neurology, University of Genoa, Genoa, Italy.
Flavio
F
Nobili
Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
Andrea
A
Varrone
D019797:3-Iodobenzylguanidine; D000544:Alzheimer Disease / Q000000981:diagnostic imaging*; D015415:Biomarkers; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007457:Iodine Radioisotopes; D020961:Lewy Body Disease / Q000000981:diagnostic imaging*; D009662:Nortropanes; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D015899:Tomography, Emission-Computed, Single-Photon
D015415:Biomarkers; D007457:Iodine Radioisotopes; D009662:Nortropanes; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; C519528:ioflupane
(123)I-MIBG; (123)I-ioflupane; Alzheimer's disease; Biomarker-based diagnosis; Dementia with Lewy bodies; Differential diagnosis; Dopaminergic imaging; Noradrenergic imaging