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General Principles of [123I]-MIBG Scintigraphy for the Assessment of the Cardiac Sympathetic Activity: From Planar to SPECT

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Autonomic Innervation of the Heart

Abstract

In patients with heart failure, increased sympathetic activity and cardiac sympathetic dysfunction are present and are related to an unfavorable outcome. In recent years, large-scale clinical trials have documented the benefits of pharmacological therapies aimed at limiting left ventricular remodeling and even reversing this process. These beneficial effects were associated with an increase in myocardial uptake of [123I]-metaiodobenzylguanidine (MIBG), a radiolabeled norepinephrine analog. However, despite the large number of published studies on cardiac [123I]-MIBG imaging, methodological and analytical limitations have interfered with the unequivocal interpretation of the imaging data. In this chapter, the assessment of myocardial sympathetic innervation with [123I]-MIBG is discussed with emphasis on patient preparation, image acquisition, and analysis. Special attention is given to overcoming the aforementioned possible methodological and analytical limitations. In conclusion, improving the standardization and validation of [123I]-MIBG myocardial scintigraphy and thus reducing variations in obtained results will lead to much more accepted application of the findings to clinical patient management.

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Abbreviations

CHF:

Chronic heart failure

DAT:

Dopamine transporter

EANM:

European Association of Nuclear Medicine

EMT:

Extraneuronal monoamine transporters

H/M ratio:

Heart-to-mediastinum ratio

ICD:

Implantable cardioverter defibrillator

JCS:

Japanese Circulation Society

JSNM:

Japanese Society of Nuclear Medicine

LE:

Low energy

LEHR:

Low energy, high resolution

ME:

Medium energy

MIBG:

Metaiodobenzylguanidine

NET:

Norepinephrine transporter

OCT:

Organic cation transporters

ROI(s):

Region(s) of interest

SCD:

Sudden cardiac death

SLC:

Solute carrier transporters

SPECT:

Single-photon emission computed tomography

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Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, F2-238, 22700, Amsterdam, 1100 DE, The Netherlands

    Hein J. Verberne MD, PhD

  2. Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands

    Arthur J. H. A. Scholte MD, PhD

Authors
  1. Hein J. Verberne MD, PhD
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  2. Arthur J. H. A. Scholte MD, PhD
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Corresponding author

Correspondence to Hein J. Verberne MD, PhD .

Editor information

Editors and Affiliations

  1. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Riemer H.J.A. Slart

  2. Thorax center Cardiology, University Medical Center Groningen, Groningen, The Netherlands

    René A. Tio

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Philip H. Elsinga

  4. Nuklearmedizinische Klinik, Klinikum Rechts der Isar Technische Universität München, München, Germany

    Markus Schwaiger

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Verberne, H.J., Scholte, A.J.H.A. (2015). General Principles of [123I]-MIBG Scintigraphy for the Assessment of the Cardiac Sympathetic Activity: From Planar to SPECT. In: Slart, R., Tio, R., Elsinga, P., Schwaiger, M. (eds) Autonomic Innervation of the Heart. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45074-1_9

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  • DOI: https://doi.org/10.1007/978-3-662-45074-1_9

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