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Comparison of 123I-MIBG myocardial scintigraphy, brain perfusion SPECT, and voxel-based MRI morphometry for distinguishing between dementia with Lewy bodies and Alzheimer’s disease

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Abstract

Objective

This study aimed to compare the diagnostic value of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, N-isopropyl-p[123I]iodoamphetamine (IMP) brain perfusion single-photon emission computed tomography (SPECT), and brain magnetic resonance imaging (MRI) voxel-based morphometry (VBM) for the differentiation of dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD).

Methods

Thirty-five and 34 patients with probable DLB and probable AD, respectively, were enrolled. All patients underwent 123I-MIBG myocardial scintigraphy, 123I-IMP brain perfusion SPECT, and brain MRI. For 123I-MIBG imaging, we calculated early and delayed heart-to-mediastinum (H/M) uptake ratios. Three-dimensional stereotactic surface projections (3D-SSP) were used to analyze the results of 123I-IMP SPECT. VBM with statistical parametric mapping 8 plus diffeomorphic anatomical registration using exponentiated Lie algebra (DARTEL) was used to analyze the brain MRI data.

Results

The area under the receiver operating characteristic curves (AUC) for discriminating DLB and AD was highest (0.882) for the delayed H/M ratio on 123I-MIBG scintigraphy. AUC for z-score measurement in the occipital lobe was 0.818 and that for the extent of gray matter (GM) atrophy in the whole brain was 0.788. AUC for the combination of 3D-SSP and VBM analysis was 0.836. The respective sensitivities and specificities for distinguishing DLB from AD were 97.1 and 100 % for the delayed H/M ratio using 123I-MIBG scintigraphy; 88.6 and 73.5 % for the occipital lobe z-score using 3D-SSP analysis; 85.7 and 64.7 % for the extent of whole brain GM atrophy using voxel-based MRI morphometry; and 91.4 and 76.5 % for the combination of 3D-SSP analysis and VBM.

Conclusions

123I-MIBG myocardial scintigraphy was superior to brain perfusion SPECT and brain MRI using an advanced statistical technique to differentiate DLB and AD.

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Authors and Affiliations

  1. Department of Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Yoshitaka Inui & Hiroshi Toyama

  2. Department of Internal Medicine, Dementia Diagnostic Center, Yokohama Shintoshi Neurosurgical Hospital, Tokyo, Japan

    Yuta Manabe

  3. Department of Cardiology, Fujita Health University, Toyoake, Japan

    Masayoshi Sarai

  4. Department of Psychiatry, Fujita Health University, Toyoake, Japan

    Nakao Iwata

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  1. Yoshitaka Inui
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  2. Hiroshi Toyama
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  4. Masayoshi Sarai
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Correspondence to Yoshitaka Inui.

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Inui, Y., Toyama, H., Manabe, Y. et al. Comparison of 123I-MIBG myocardial scintigraphy, brain perfusion SPECT, and voxel-based MRI morphometry for distinguishing between dementia with Lewy bodies and Alzheimer’s disease. Ann Nucl Med 28, 796–804 (2014). https://doi.org/10.1007/s12149-014-0873-2

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  • DOI: https://doi.org/10.1007/s12149-014-0873-2

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