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123I-meta-iodobenzylguanidine (MIBG) cardiac scintigraphy can be used to assess the pathophysiology of postganglionic presynaptic cardiac sympathetic nerve endings and is the most frequently used imaging agent to assess cardiac sympathetic innervation. In 1994, Hakusui et al1 were the first to report reduced cardiac MIBG and preserved thallium accumulation in Parkinson's disease (PD). Subsequently, many studies confirmed the usefulness of 123I-MIBG cardiac scintigraphy for investigating early sympathetic involvement in PD and for differentiating PD from neurodegenerative parkinsonism including multiple system atrophy (MSA), progressive supranuclear palsy, and corticobasal degeneration together with vascular parkinsonism and essential tremor.
With respect to the pathophysiology involved in reduced MIBG uptake in …