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Diagnostic Value of the Early Heart-to-Mediastinum Count Ratio in Cardiac 123I-mIBG Imaging for Parkinson's Disease

[ Vol. 14 , Issue. 1 ]

Author(s):

Viviana Frantellizzi, Valentina Lavelli*, Cristina Ferrari, Angela Sardaro, Alessio Farcomeni, Massimiliano Pacilio, Cristian Borrazzo, Roberto Pani, Giuseppe Rubini and Giuseppe De Vincentis   Pages 64 - 69 ( 6 )

Abstract:


Background: Early diagnosis of Parkinson's disease (PD) is of primary importance. The delayed (3-4 h after injection) Iodine-123-Metaiodobenzylguanidine (123I-mIBG) scintigraphy has been proven to be effective in early differential diagnosis for Lewy body disease. But early imaging (15-30 min after injection) has only been marginally studied for its possible diagnostic role. In this prospective study, a threshold for the early Heart-to-Mediastinum (H/M) count ratio has been investigated, obtaining a diagnostic accuracy analogous to conventional, delayed imaging.

Methods: One hundred and eight patients with suspected Parkinson's disease (PD) were acquired after 15 and 240 minutes from the injection of 150-185 MBq of 123I-mIBG. The early and late H/M (He/Me and Hl/Ml) were evaluated by drawing Region-of-Interests on the heart and the upper half of the mediastinum. Optimal threshold (Youden index) and overall predictive performance were determined by receiver operating characteristic curve, classifying tentatively patients having an Hl/Ml lower than 1.6 as suffering from PD.

Results: He/Me was not significantly different from Hl/Ml (p-value=0.835). The Area-under-curve was 0.935 (95%CI: 0.845-1.000). The He/Me optimal threshold was 1.66, with sensitivity, specificity, and diagnostic accuracy of 95.5%, 85.7 and 90.7% respectively.

Conclusion: The He/Me Ratio is almost as accurate as the widely used delayed 123I-mIBG imaging, reducing the burden of delayed imaging but preserving the diagnostic accuracy of the method. Moreover the differential diagnosis in Parkinson's disease can be made in just 25 minutes against the 4 hours currently needed, lowering costs of the healthcare system and improving patients compliance.

Keywords:

Cardiac imaging, Parkinson's disease, 123I-mIBG, planar imaging, heart-to-mediastinum, lewy body disease.

Affiliation:

Department of Molecular Medicine, Sapienza, “Sapienza” University of Rome, viale Regina Elena,324, 00161Rome, Nuclear Medicine Unit, Interdisciplinary Department of Medicine – University of Bari “Aldo Moro”, Bari, Nuclear Medicine Unit, Interdisciplinary Department of Medicine – University of Bari “Aldo Moro”, Bari, Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, Bari, Department of Economic and Finance, “Tor Vergata” University of Rome, via Columbia, 2, 00133Rome, Department of Medical Physics, Azienda Ospedaliera Universitaria Policlinico Umberto I, viale del Policlinico 155, 00161Rome, Department of Medical Physics, Azienda Ospedaliera Universitaria Policlinico Umberto I, viale del Policlinico 155, 00161Rome, Department of Sciences and Medico-Surgical Biotechnologies, “Sapienza” University of Rome, viale Regina Elena,324, 00161Rome, Nuclear Medicine Unit, Interdisciplinary Department of Medicine – University of Bari “Aldo Moro”, Bari, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, “Sapienza” University of Rome, viale Regina Elena,324, 00161Rome

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