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1-23I-MIBG thyroid uptake: Implications for MIBG imaging of the heart

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

123I-MIBG has been widely used in patients with heart failure and neurological disorders. The patients are pre-treated with Lugol’s oral solution or potassium perchlorate to prevent thyroid uptake of unlabeled 123I to limit the thyroid radiation exposure. However, despite the inhibition of the iodide pump, the thyroid is frequently visualized. The aim of this study was to study the pattern of thyroid uptake.

Methods

We reviewed the 123I-MIBG images of 57 patients studied in three different centers in Italy for cardiac (n = 42) or neurological (n = 15) indications. They were imaged at 15 minutes and 4 hours after injection and in all patients, the thyroid was included in the imaging field of view. In 2 of the 3 centers, the patients were pre-treated with Lugol’s oral solution and/or potassium perchlorate (group 1) but in the third center, they were not (group 2). The following imaging parameters were evaluated: heart-to-mediastinum ratio (H/M), thyroid-to-mediastinum ratio (T/M) at 4 hours, and tracer wash out from the heart (HWO) and from the thyroid (TWO).

Results

In the cardiac patients, the HWO was 22.98 ± 7.16% and TWO was 11.4 ± 11.86% (P < .0001). The TWO was 12.2 ± 13.1% in group 1 and 10.05 ± 8.97% in group 2 (P = NS). In the neurological patients the HWO was 26 ± 8.1% and the TWO was 20.32 ± 6.41 (P < .05). The difference in TWO was statistically significant (P < .01) between cardiac and neurological patients, whereas the HWO was not. The 4-hour H/M was 1.49 ± 0.23 in cardiac patients vs 1.4 ± 0.39 in neurological patients (P = NS). The 4-hour T/M was 1.33 ± 0.3 in cardiac patients vs 1.15 ± 0.13 in neurological patients (P < 0.05).

Conclusion

The thyroid visualization in MIBG imaging is likely an expression of thyroid sympathetic innervation. The differences in TWO and T/M ratio in cardiac and neurological patients probably express differences in thyroid dopaminergic receptors. Thus, pre-treatment with potassium perchlorate or Lugol’s solution may not be justified in patients undergoing 123I-MIBG imaging in whom the risk of side effects due to pre-treatment could be higher than the risk due to thyroid radiation exposure.

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Authors and Affiliations

  1. Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy

    Raffaele Giubbini MD, Barbara Paghera MD, Federica Fracassi MD, Luca Camoni MD, Francesco Bertagna MD, Federica Motta MD & Mattia Bertoli MD

  2. Nuclear Medicine Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, TV, Italy

    Elisa Milan MD

  3. Cardiology Department, Fondazione Maugeri Centro Medico, Veruno, NO, Italy

    Claudio Marcassa MD

  4. Health Physics Department, Spedali Civili, Brescia, Italy

    Carlo Rodella MD

  5. Nuclear Medicine Unit, Fondazione Maugeri Centro Medico, Veruno, NO, Italy

    Riccardo Campini MD

Authors
  1. Raffaele Giubbini MD
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  2. Elisa Milan MD
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  3. Claudio Marcassa MD
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Correspondence to Raffaele Giubbini MD.

Additional information

See related editorial, doi:10.1007/s12350-015-0168-6.

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Giubbini, R., Milan, E., Marcassa, C. et al. 1-23I-MIBG thyroid uptake: Implications for MIBG imaging of the heart. J. Nucl. Cardiol. 23, 1335–1339 (2016). https://doi.org/10.1007/s12350-015-0142-3

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  • DOI: https://doi.org/10.1007/s12350-015-0142-3

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