Comparative value of brain perfusion SPECT and [123I]MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and Alzheimer’s disease
- 363 Downloads
Both decreased occipital perfusion on brain single-photon emission computed tomography (SPECT) and reduction in cardiac 123I-metaiodobenzylguanidine (MIBG) uptake are characteristic features of dementia with Lewy bodies (DLB), and potentially support the clinical diagnosis of DLB. The aim of this study was to compare the diagnostic value of these two methods for differentiation of DLB from Alzheimer’s disease (AD).
The study population comprised 19 patients with probable DLB and 39 patients with probable AD who underwent both SPECT with N-isopropyl-p-[123I]iodoamphetamine and MIBG myocardial scintigraphy. Objective and quantitative measurement of perfusion in the medial occipital lobe, including the cuneus and lingual gyrus, was performed by the use of three-dimensional stereotactic surface projections.
Medial occipital perfusion was significantly decreased in the DLB group compared with the AD group. The mean heart/mediastinum ratios of MIBG uptake were significantly lower in the DLB group than in the AD group. Although SPECT failed to demonstrate significant hypoperfusion in the medial occipital lobe in five patients with DLB, marked reduction of MIBG uptake was found in all patients with DLB. Receiver operating characteristic analysis revealed that MIBG myocardial scintigraphy enabled more accurate discrimination between DLB and AD than was possible with perfusion SPECT.
MIBG myocardial scintigraphy may improve the sensitivity in the detection of DLB. In particular, this method may provide a powerful differential diagnostic tool when it is difficult to distinguish cases of DLB from AD using brain perfusion SPECT.
KeywordsBrain SPECT Perfusion MIBG Dementia with Lewy bodies Alzheimer’s disease
We thank J. Umeda and H. Hirose of the Department of Nuclear Medicine of Tokyo Medical University for their support and technical assistance. We are also grateful to Professor J. Patrick Barron of the International Medical Communications Center of Tokyo Medical University for his review of the manuscript.
- 10.Donnemiller E, Heilmann J, Wenning G, Berger W, Decristoforo C, Moncayo R, et al. Brain perfusion scintigraphy with 99mTc-HMPAO or 99mTc-ECD and 123I-β-CIT single-photon emission tomography in dementia of the Alzheimer-type and diffuse Lewy body disease. Eur J Nucl Med 1997;24:320–5PubMedGoogle Scholar
- 24.Talairach J, Tournoux P. Co-planar stereotactic atlas of the human brain. New York: Thieme; 1998Google Scholar