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Cognitive neurology
Research paper
123I-MIBG myocardial scintigraphy for the diagnosis of DLB: a multicentre 3-year follow-up study
  1. Junji Komatsu1,
  2. Miharu Samuraki1,
  3. Kenichi Nakajima2,
  4. Heii Arai3,
  5. Hiroyuki Arai4,
  6. Tetsuaki Arai5,
  7. Takashi Asada5,
  8. Hiroshige Fujishiro6,
  9. Haruo Hanyu7,
  10. Osamu Iizuka8,
  11. Eizo Iseki6,
  12. Kenichi Kashihara9,
  13. Kenji Kosaka10,
  14. Hirotaka Maruno11,
  15. Katsuyoshi Mizukami12,
  16. Yoshikuni Mizuno13,
  17. Etsuro Mori8,
  18. Hiroyuki Nakamura14,
  19. Seigo Nakano15,
  20. Kenji Nakashima16,
  21. Yoshiyuki Nishio8,
  22. Satoshi Orimo17,
  23. Akira Takahashi18,
  24. Junichi Taki2,
  25. Takahiko Tokuda19,
  26. Katsuya Urakami20,
  27. Kumiko Utsumi21,
  28. Kenji Wada16,
  29. Yukihiko Washimi22,
  30. Shouhei Yamashina23,
  31. Junichi Yamasaki23,
  32. Mitsuhiro Yoshita1,24,
  33. Masahito Yamada1
  1. 1 Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
  2. 2 Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
  3. 3 Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
  4. 4 Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
  5. 5 Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
  6. 6 PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
  7. 7 Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
  8. 8 Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
  9. 9 Department of Neurology, Okayama Kyokuto Hospital, Okayama, Japan
  10. 10 Department of Neurology, Medical Care Court Clinic, Yokohama, Japan
  11. 11 Department of Radiology, Toranomon Hospital, Tokyo, Japan
  12. 12 Faculty of Health and Sport Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
  13. 13 Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
  14. 14 Department of Environmental and Preventive Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
  15. 15 Center for Treatment, Care and Research of Dementia, Medical Co. LTA, Tokyo, Japan
  16. 16 Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
  17. 17 Department of Neurology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
  18. 18 Tokai Central Hospital, Kakamigahara, Japan
  19. 19 Department of Molecular Pathobiology of Brain Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
  20. 20 Department of Biological Regulation, Faculty of Medicine, School of Health Science, Tottori University, Tottori, Japan
  21. 21 Department of Neuropsychiatry, Sunagawa City Medical Center, Sunagawa, Japan
  22. 22 Department for Cognitive Disorders, Hospital of National Center for Geriatrics and Gerontology, Toyota, Japan
  23. 23 Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Toho University School of Medicine, Tokyo, Japan
  24. 24 Department of Neurology, Hokuriku National Hospital, Toyama, Japan
  1. Correspondence to Professor Masahito Yamada, Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa 920-8640, Japan; m-yamada{at}med.kanazawa-u.ac.jp

Abstract

Background and purpose We previously reported the usefulness of iodine-123 metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy for differentiation of dementia with Lewy bodies (DLB) from Alzheimer’s disease (AD) in a cross-sectional multicentre study. The aim of this study was, by using reassessed diagnosis after 3-year follow-up, to evaluate the diagnostic accuracy of 123I-MIBG scintigraphy in differentiation of probable DLB from probable AD.

Methods We undertook 3-year follow-up of 133 patients with probable or possible DLB or probable AD who had undergone 123I-MIBG myocardial scintigraphy at baseline. An independent consensus panel made final diagnosis at 3-year follow-up. Based on the final diagnosis, we re-evaluated the diagnostic accuracy of 123I-MIBG scintigraphy performed at baseline.

Results Sixty-five patients completed 3-year follow-up assessment. The final diagnoses were probable DLB (n=30), possible DLB (n=3) and probably AD (n=31), and depression (n=1). With a receiver operating characteristic curve analysis of heart-to-mediastinum (H/M) ratios for differentiating probable DLB from probable AD, the sensitivity/specificity were 0.77/0.94 for early images using 2.51 as the threshold of early H/M ratio, and 0.77/0.97 for delayed images using 2.20 as the threshold of delayed H/M ratio. Five of six patients who were diagnosed with possible DLB at baseline and with probable DLB at follow-up had low H/M ratio at baseline.

Conclusions Our follow-up study confirmed high correlation between abnormal cardiac sympathetic activity evaluated with 123I-MIBG myocardial scintigraphy at baseline and the clinical diagnosis of probable DLB at 3-year follow-up. Its diagnostic usefulness in early stage of DLB was suggested.

Trial registration number UMIN00003419.

https://doi.org/10.1136/jnnp-2017-317398

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    Footnotes

    • Contributors MYo, HeA, KKo, YM, KNakaj, HN, AT, JT, JY and MYa were involved in conception and design of the study. JK, TAr, TAs, HF, HH, OI, EI, KKa, KM, EM, KNakas, YN, MS, TT, KUt, KW, YW and MYo were study investigators and recruited the patients. HiA, SN and KUr were members of the clinical evaluation committee. HM, SO and SY assessed myocardial MIBG uptake visually. KNakaj performed the statistical analyses and prepared the paper with JK. JK wrote the initial draft of the paper and all authors contributed to its preparation. The final version was read and approved by all authors with JK and MYa incorporating their additional comments.

    • Funding The study was funded by the grant of Japan Foundation for Neuroscience and Mental Health.

    • Competing interests HeA, TAr and KW received honoraria for sponsored lectures from Fujifilm RI Pharma. TAs and SY received honoraria for sponsored lectures and research grant from Fujifilm RI Pharma Co and Nihon Medi-Physics. HF, SN, SO, JT and MYo received honoraria for sponsored lectures from Fujifilm RI Pharma and Nihon Medi-Physics. HH and KUt received honoraria for sponsored lectures from Nihon Medi-Physics. EI received honoraria for consultancies, sponsored lectures and presiding at lecture meetings from Nihon Medi-Physics. OI received honoraria for sponsored lectures and travel costs from Nihon Medi-Physics. KKo received honoraria for sponsored lectures, writing and editing from Fujifilm RI Pharma, and honoraria for sponsored lectures from Nihon Medi-Physics. HM received honoraria for sponsored lectures and travel costs from Fujifilm RI Pharma and Nihon Medi-Physics. KNakaj has collaborative research works with Fujifilm RI Pharma and received research funds for joint research and honoraria for lectures and writing. KNakas received sponsored scholarship and honoraria for presiding at meetings from Fujifilm RI Pharma and honoraria for presiding at lecture meetings from Nihon Medi-Physics. EM received research grant from Fujifilm RI Pharma and honoraria for sponsored lectures from Nihon Medi-Physics and Fujifilm RI Pharma. TT received honoraria for sponsored lectures and presiding at lecture meetings from Nihon Medi-Physics. KUr received research grant from Fujifilm RI Pharma and honoraria for sponsored lectures from Nihon Medi-Physics. MYa received honoraria for sponsored lectures and research grant from Fujifilm RI Pharma. JY received sponsored scholarship, honoraria for sponsored lectures and travel costs from Fujifilm RI Pharma, and honoraria for sponsored lectures and research grant from Nihon Medi-Physics. JK, HiA, EI, KKa, KM, YM, HN, YN, MS, AT and YW declare that they have no conflicts of interest.

    • Patient consent Obtained.

    • Ethics approval This study was approved by the Medical Ethics Committee of Kanazawa University and also by institutional review boards of all participating centres.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The authors can share data of each participant in this study under the approval of the Medical Ethics Committee of Kanazawa University and institutional review boards of participating centres.