Abstract
Purpose
Metaiodobenylguanidine (MIBG) scintigraphy has been shown to enhance the probability of correct diagnosis in patients with parkinsonian syndromes (PS). Thus far, studies of the clinical usefulness of MIBG have been confined to cross-sectional assessments, which are inevitably associated with diagnostic uncertainty during the early stages of these syndromes. In this study, the initial clinical diagnosis was reevaluated longitudinally to assess the sensitivity and specificity of clinical and MIBG parameters in the early diagnosis of PS.
Methods
167 patients with PS (age 67.03 ± 8.92 years (mean ± standard deviation), duration of symptoms 2.48 ± 5.27 years, median Hoehn and Yahr score 2) underwent an initial clinical assessment and MIBG scintigraphy. Eighty seven of those patients (56 with Parkinson’s disease (PD), 1 with multiple system atrophy (MSA), 23 with atypical PS, 7 with tremor syndrome) were clinically reevaluated a mean of 3 years later in order to verify their initial diagnosis.
Results
The use of a lower limit of normal value of 1.74 for the heart-to-mediastinum ratio (HMR) achieved the best discrimination between PD and other PS. The sensitivity of MIBG scintigraphy to PD was 94%; it also had a specificity of 65%, a positive predictive value of 88%, and a negative predictive value of 79%. MIBG scintigraphy was better than initial clinical diagnosis alone (sensitivity 83%, specificity 39%) or levodopa responsiveness (sensitivity 92%, specificity 10%). However, a combination of clinical diagnosis and MIBG scintigraphy was found to be especially clinically useful (specificity 95%, sensitivity 83%, positive predictive value 95%, negative predictive value 83%).
Conclusion
MIBG scintigraphy was demonstrated to be a reliable tool for the diagnosis of early PD. The best diagnostic accuracy was achieved by combining a clinical examination with MIBG scintigraphy.
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References
Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56(1):33–39
Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G (2015) MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 30(12):1591–1601
Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55(3):181–184
Satoh A, Serita T, Tsujihata M (1997) Total defect of metaiodobenzylguanidine (MIBG) imaging on heart in Parkinson’s disease: assessment of cardiac sympathetic denervation. Nihon Rinsho 55(1):202–206
Braune S, Reinhardt M, Bathmann J, Krause T, Lehmann M, Lücking CH (1998) Impaired cardiac uptake of meta [123I] iodobenzylguanidine in Parkinson’s disease and autonomic failure. Acta Neurol Scand 97:307–314
Orimo S, Suzuki M, Inaba A, Mizusawa H (2012) 123I-MIBG myocardial scintigraphy for differentiating Parkinson’s disease from other neurodegenerative parkinsonism: a systematic review and meta-analysis. Parkinsonism Relat Disord 18(5):494–500
Yoshita M (1998) Differentiation of idiopathic Parkinson’s disease from striatonigral degeneration and progressive supranuclear palsy using iodine 123 metaiodobenzyl-guanidine myocardial scintigraphy. J Neurol Sci 155:60–67
Braune S (2001) The role of cardiac metaiodobenzylguanidine uptake in the differential diagnosis of parkinsonian syndromes. Clin Auton Res 11(6):351–355
Takatsu H, Nagashima K, Murase M, Fujiwara H, Nishida H, Matsuo H, Watanabe S, Satomi K (2000) Differentiating Parkinson disease from multiple-system atrophy by measuring cardiac iodine-123 metaiodobenzylguanidine accumulation. JAMA 284(1):44–45
Treglia G, Cason E, Stefanelli A, Cocciolillo F, Di Giuda D, Fagioli G, Giordano A (2012) MIBG scintigraphy in differential diagnosis of Parkinsonism: a meta-analysis. Clin Auton Res 22:43–55
Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, Wood NW, Colosimo C, Dürr A, Fowler CJ, Kaufmann H, Klockgether T, Lees A, Poewe W, Quinn N, Revesz T, Robertson D, Sandroni P, Seppi K, Vidailhet M (2008) Second consensus statement on the diagnosis of multiple system atrophy. Neurology 71(9):670–676
Osaki YL, Ben-Shlomo Y, Lees AJ, Wenning GK, Quinn NP (2009) A validation exercise on the new consensus criteria for multiple system atrophy. Mov Disord 24(15):2272–2276
Sisson JC, Wieland DM, Sherman P, Mangner TJ, Tobes MC, Jacques S Jr (1987) Metaiodobenzylguanidine as an index of the adrenergic nervous system integrity and function. J Nucl Med 28:1620–1624
Sisson JC, Shapiro B, Meyers L, Mallette S, Mangner TJ, Wieland DM, Glownaik JV, Sherman P, Beierwaltes WH (1987) Metaiodobenzylguanidine to map scintigraphically the adrenergic nervous system in man. J Nucl Med 28:1625–1636
Solanki KK, Bomanji J, Moyes J, Mather SJ, Trainer PJ, Britton KE (1992) A pharmacological guide to medicines which interfere with the biodistribution of radiolabeled meta-iodobenzylguanidine (MIBG). Nucl Med Commun 13:513–521
Estorch M, Carrió I, Berná L, López-Pousa J, Torres G (1995) Myocardial iodine-labeled metaiodobenzylguanidine 123 uptake relates to age. J Nucl Cardiol. 2(2 Pt 1):126–132
Lamotte G, Morello R, Lebasnier A, Agostini D, Defer GL (2015) Accuracy and cutoff values of delayed heart to mediastinum ratio with (123)I-metaiodobenzylguanidine cardiac scintigraphy for Lewy body disease diagnoses. BMC Neurol 15(15):83
Muxí A, Paredes P, Navales I, Valldeoriola F, Gaig C, Lomeña F, de la Cerda A, Solà O, Domenech B, Tolosa E, Pons F (2011) Diagnostic cutoff points for 123I-MIBG myocardial scintigraphy in a Caucasian population with Parkinson’s disease. Eur J Nucl Med Mol Imaging 38(6):1139–1146
Rajput AH, Rozdilsky B (1991) Accuracy of clinical diagnosis in parkinsonism—a prospective study. Can J Neurol Sci 18(3):275–278
Hughes AJ, Daniel SE, Lees AJ (2001) Improved accuracy of clinical diagnosis of Lewy body Parkinson’s disease. Neurology 57(8):1497–1499
Asayama S, Wate R, Kaneko S, Asayama T, Oki M, Tsuge A, Nagashima M, Morita J, Nakamura S, Nakamura M, Nishii M, Fujita K, Saito A, Nakano S, Ito H, Kusaka H (2013) Levodopa challenge test and (123)I-metaiodobenzylguanidine scintigraphy for diagnosing Parkinson’s disease. Acta Neurol Scand 128(3):160–165
Yekhlef F, Ballan G, Macia F, Delmer O, Sourgen C, Tison F (2003) Routine MRI for the differential diagnosis of Parkinson’s disease, MSA, PSP, and CBD. J Neural Transm 110:151–169
Sako W, Abe T, Murakami N, Miyazaki Y, Izumi Y, Harada M, Kaji R (2016) Imaging-based differential diagnosis between multiple system atrophy and Parkinson’s disease. J Neurol Sci 368:104–108
Umemura A, Oeda T, Hayashi R, Tomita S, Kohsaka M, Yamamoto K, Sawada H (2013) Diagnostic accuracy of apparent diffusion coefficient and 123I-metaiodobenzylguanidine for differentiation of multiple system atrophy and Parkinson’s disease. PLoS One 8(4):e61066
Cummings JL, Henchcliffe C, Schaier S, Simuni T, Waxman A, Kemp P (2011) The role of dopaminergic imaging in patients with symptoms of dopaminergic system neurodegeneration. Brain 134:3146–3166
Vlaar AM, de Nijs T, Kessels AG, Vreeling FW, Winogrodzka A, Mess WH, Tromp SC, van Kroonenburgh MJ, Weber WE (2008) Diagnostic value of 123I-ioflupane and 123I-iodobenzamide SPECT scans in 248 patients with Parkinsonian syndromes. Eur Neurol 59:258–266
Pifarré P, Cuberas G, Hernández J, Lorenzo C, Miquel F, Castell-Conesa J (2010) Cortical and subcortical patterns of I-123 iodobenzamide SPECT in striatal D(2) receptor parkinsonisms. Clin Nucl Med 35:228–233
Mo SJ, Linder J, Forsgren L, Larsson A, Johansson L, Riklund K (2010) Pre- and postsynaptic dopamine SPECT in the early phase of idiopathic parkinsonism: a population-based study. Eur J Nucl Med Mol Imaging 37(11):2154–2164
Tang CC, Poston KL, Eckert T, Feigin A, Frucht S, Gudesblatt M, Dhawan V, Lesser M, Vonsattel JP, Fahn S, Eidelber D (2010) Differential diagnosis of parkinsonism: a metabolic imaging study using pattern analysis. Lancet Neurol 9:149–158
Chiaravalloti A, Stefani A, Pierantozzi M, Stanzione P, Schillaci O (2013) Does 123I-MIBG scintigraphy really assist the diagnosis of Parkinson’s disease? Parkinsonism Relat Disord 8:772–773
Montgomery EB Jr (2006) Practice parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 67(12):2266–2267
Berardelli A, Wenning GK, Antonini A, Berg D, Bloem BR, Bonifati V, Brooks D, Burn DJ, Colosimo C, Fanciulli A, Ferreira J, Gasser T, Grandas F, Kanovsky P, Kostic V, Kulisevsky J, Oertel W, Poewe W, Reese JP, Relja M, Ruzicka E, Schrag A, Seppi K, Taba P, Vidailhet M (2013) EFNS/MDS-ES/ENS recommendations for the diagnosis of Parkinson’s disease. Eur J Neurol 20(1):16–34
Acknowledgments
We wish to thank our patients and neurological colleagues, in particular Wolfgang Klein, Herbert Lehner, Christoph Schormaier, Michael Bauer, allowing us to include their data and examinations into this study.
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The authors declare no conflicts of interest with respect to the research, authorship, and/or publication of the article.
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The authors declare that this study has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.
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Brandl, S.J., Braune, S. Sensitivity and specificity of cardiac metaiodobenzylguanidine scintigraphy in the early diagnosis of Parkinson’s disease. Clin Auton Res 29, 567–574 (2019). https://doi.org/10.1007/s10286-018-0534-y
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DOI: https://doi.org/10.1007/s10286-018-0534-y