Advertisement

Clinical Autonomic Research

, Volume 29, Issue 6, pp 567–574 | Cite as

Sensitivity and specificity of cardiac metaiodobenzylguanidine scintigraphy in the early diagnosis of Parkinson’s disease

  • Sebastian J. Brandl
  • Stefan BrauneEmail author
Research Article

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.

Keywords

Parkinson’s disease MIBG scintigraphy Early clinical diagnostic Heart-to-mediastinum ratio 

Notes

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.

Conflict of interest

The authors declare no conflicts of interest with respect to the research, authorship, and/or publication of the article.

Ethical standards

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.

References

  1. 1.
    Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56(1):33–39CrossRefPubMedGoogle Scholar
  2. 2.
    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):1591–1601CrossRefPubMedGoogle Scholar
  3. 3.
    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):181–184CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    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):202–206PubMedGoogle Scholar
  5. 5.
    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 97:307–314CrossRefPubMedGoogle Scholar
  6. 6.
    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):494–500CrossRefPubMedGoogle Scholar
  7. 7.
    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 155:60–67CrossRefPubMedGoogle Scholar
  8. 8.
    Braune S (2001) The role of cardiac metaiodobenzylguanidine uptake in the differential diagnosis of parkinsonian syndromes. Clin Auton Res 11(6):351–355CrossRefPubMedGoogle Scholar
  9. 9.
    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):44–45CrossRefPubMedGoogle Scholar
  10. 10.
    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 22:43–55CrossRefPubMedGoogle Scholar
  11. 11.
    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):670–676CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    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):2272–2276CrossRefPubMedGoogle Scholar
  13. 13.
    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 28:1620–1624PubMedGoogle Scholar
  14. 14.
    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 28:1625–1636PubMedGoogle Scholar
  15. 15.
    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 13:513–521CrossRefPubMedGoogle Scholar
  16. 16.
    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):126–132PubMedGoogle Scholar
  17. 17.
    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):83CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    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):1139–1146CrossRefPubMedGoogle Scholar
  19. 19.
    Rajput AH, Rozdilsky B (1991) Accuracy of clinical diagnosis in parkinsonism—a prospective study. Can J Neurol Sci 18(3):275–278CrossRefPubMedGoogle Scholar
  20. 20.
    Hughes AJ, Daniel SE, Lees AJ (2001) Improved accuracy of clinical diagnosis of Lewy body Parkinson’s disease. Neurology 57(8):1497–1499CrossRefPubMedGoogle Scholar
  21. 21.
    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):160–165CrossRefPubMedGoogle Scholar
  22. 22.
    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 110:151–169CrossRefPubMedGoogle Scholar
  23. 23.
    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 368:104–108CrossRefPubMedGoogle Scholar
  24. 24.
    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):e61066CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    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 134:3146–3166CrossRefPubMedGoogle Scholar
  26. 26.
    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 59:258–266CrossRefPubMedGoogle Scholar
  27. 27.
    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 35:228–233CrossRefPubMedGoogle Scholar
  28. 28.
    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):2154–2164CrossRefPubMedGoogle Scholar
  29. 29.
    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 9:149–158CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    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 8:772–773CrossRefGoogle Scholar
  31. 31.
    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):2266–2267CrossRefPubMedGoogle Scholar
  32. 32.
    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):16–34CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic for Trauma, Hand, Plastic and Reconstructive SurgeryUniversitätsklinikum UlmFriedbergGermany
  2. 2.Neurozentrum PrienPrienGermany

Personalised recommendations