Journal of Nuclear Cardiology

, Volume 23, Issue 3, pp 425–435 | Cite as

Quantitative iodine-123-metaiodobenzylguanidine (MIBG) SPECT imaging in heart failure with left ventricular systolic dysfunction: Development and validation of automated procedures in conjunction with technetium-99m tetrofosmin myocardial perfusion SPECT

  • Ian P. Clements
  • Ernest V. Garcia
  • Ji Chen
  • Russell D. Folks
  • Javed Butler
  • Arnold F. Jacobson
Original Article
First Online:
Received:
Revised:
Accepted:

Abstract

Background

The purpose of this study was to develop and validate new approaches to quantitative MIBG myocardial SPECT imaging in heart failure (HF) subjects.

Methods and results

Quantitative MIBG myocardial SPECT analysis methods, alone and in conjunction with 99mTc-tetrofosmin perfusion SPECT, were adapted from previously validated techniques for the analysis of SPECT and PET perfusion imaging. To account for underestimation of MIBG defect severity in subjects with global reduction in uptake, a mixed reference database based on planar heart/mediastinum (H/M) ratio categories was used. Extent and severity of voxel-based defects and number of myocardial segments with significant dysinnervation (derived score ≥2) were determined. MIBG/99mTc-tetrofosmin mismatch was quantified using regions with preserved innervation as the reference for scaling 99mTc-tetrofosmin voxel maps. Quantification techniques were tested on studies of 619 ischemic (I) and 319 non-ischemic (NI) HF subjects. Using all analytical techniques, IHF subjects had significantly greater and more severe MIBG SPECT abnormalities compared with NIHF subjects. Innervation/perfusion mismatches were also larger in IHF subjects. Findings were consistent between voxel- and myocardial-segment-based quantitation methods.

Conclusions

Multiple objective methods for quantitation of MIBG SPECT imaging studies provided internally consistent results for distinguishing the different patterns of uptake between IHF and NIHF subjects.

Keywords

MIBG imaging heart failure SPECT 
This is a preview of subscription content, log in to check access.

Notes

Disclosures

Ian P. Clements supported by Research grant or contract with GE Healthcare and GE stock ownership. Ernest V. Garcia supported by Research grant or contract with GE Healthcare and Royalties from or stock ownership in Emory Cardiac Toolbox. Ji Chen supported by Research grant or contract with GE Healthcare and Royalties from or stock ownership in Emory Cardiac Toolbox. Russell D. Folks supported by Research grant or contract with GE Healthcare and Royalties from or stock ownership in Emory Cardiac Toolbox. Javed Butler has no conflict of interest to disclosure. Arnold F. Jacobson GE stock ownership and GE employee until 6/30/2014.

References

  1. 1.
    Merlet P, Valette H, Dubois-Rande JL, Moyse D, Duboc D, Dove P, et al. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure. J Nucl Med 1992;33:471-7.PubMedGoogle Scholar
  2. 2.
    Merlet P, Benvenuti C, Moyse D, Proicuillart F, Dubois-Rande JL, Duval AM, et al. Prognostic value of I123-mIBG imaging in idiopathic dilated cardiomyopathy. J Nucl Med 1999;40:917-23.PubMedGoogle Scholar
  3. 3.
    Verberne HJ, Brewster LM, Somsen GA, van Eck-Smit BLF. Prognostic value of myocardial 123I-metaiodobenzylguanidine (MIBG) parameters in patients with heart failure: A systematic review. Eur Heart J 2008;29:1147-59.CrossRefPubMedGoogle Scholar
  4. 4.
    Jacobson AF, Senior R, Cerqueira MD, Wong ND, Thomas GS, Lopez VA, et al. Myocardial iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure. Results of the prospective ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study. J Am Coll Cardiol 2010;55:2212-21.CrossRefPubMedGoogle Scholar
  5. 5.
    Kawaguchi T, Nomura M, Tujikawa T, Nakaya Y, Ito S. 123I-metaiodo-benzylguanidine myocardial scintigraphy in the Brugada-type ECG. J Med Invest 2006;53:95-102.CrossRefPubMedGoogle Scholar
  6. 6.
    Paul M, Schafers M, Kies P, Acil T, Schäfers K, Breithardt G, et al. Impact of sympathetic innervation on recurrent life-threatening arrhythmias in the follow-up of patients with idiopathic ventricular fibrillation. Eur J Nucl Med Mol Imaging 2006;33:866-70.CrossRefPubMedGoogle Scholar
  7. 7.
    Wichter T, Matheja P, Eckardt L, Kies P, Schäfers K, Schulze-Bahr E, et al. Cardiac autonomic dysfunction in Brugada syndrome. Circulation 2002;105:702-6.CrossRefPubMedGoogle Scholar
  8. 8.
    Miranda CH, Figueiredo AB, Maciel BC, Marin-Neto JA, Simões MV. Sustained ventricular tachycardia is associated with regional myocardial sympathetic denervation assessed with 123I-metaiodobenzylguanidine in chronic Chagas cardiomyopathy. J Nucl Med 2011;52:504-10.CrossRefPubMedGoogle Scholar
  9. 9.
    Gill JS, Hunter GJ, Gane G, Camm AJ. Asymmetry of I123-mIBG scans in patients with VT and a “normal” heart. Br Heart J 1993;69:6-13.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Zipes DP. Influence of myocardial ischemia and infarction on autonomic innervation of heart. Circulation 1990;82:1095-105.CrossRefPubMedGoogle Scholar
  11. 11.
    Stanton MS, Zipes DP. Modulation of drug effects by regional sympathetic denervation and supersensitivity. Circulation 1991;84:1709-14.CrossRefPubMedGoogle Scholar
  12. 12.
    Boogers MJ, Borleffs CJW, Henneman MM, van Bommel RJ, van Ramshorst J, Boersma E, et al. Cardiac sympathetic denervation assessed with 123-iodine metaiodobenzylguanidine imaging predicts ventricular arrhythmias in implantable cardioverter-defibrillator patients. J Am Coll Cardiol 2010;55:2769-77.CrossRefPubMedGoogle Scholar
  13. 13.
    Bax JJ, Kraft O, Buxton AE, Fjeld JK, Parízek P, Agostini D, et al. 123 I-mIBG scintigraphy to predict inducibility of ventricular arrhythmias on cardiac electrophysiology testing: A prospective multicenter pilot study. Circ Cardiovasc Imaging 2008;1:131-40.CrossRefPubMedGoogle Scholar
  14. 14.
    Arora R, Ferrick KJ, Nakata T, Kaplan RC, Rozengarten M, Latif F, et al. 123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter-defibrillator. J Nucl Cardiol 2003;10:121-31.CrossRefPubMedGoogle Scholar
  15. 15.
    Zhao C, Shuke N, Yamamoto W, Okizaki A, Sato J, Ishikawa Y, et al. Comparison of cardiac sympathetic nervous function with left ventricular function and perfusion in cardiomyopathies by (123)I-MIBG SPECT and (99m)Tc-tetrofosmin electrocardiographically gated SPECT. J Nucl Med 2001;42:1017-24.PubMedGoogle Scholar
  16. 16.
    Gill JS, Hunter GJ, Gane G, Camm AJ. Heterogeneity of the human myocardial sympathetic innervation: In vivo demonstration by iodine 123-labeled meta-iodobenzylguanidine scintigraphy. Am Heart J 1993;126:390-8.CrossRefPubMedGoogle Scholar
  17. 17.
    Flotats A, Carrio I, Agostini D, Le Guludec D, Marcassa C, Schaffers M, et al. Proposal for standardization of 123 I metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EAMN Cardiovascular Committee and the European Council of Nuclear Cardiology. Eur J Nucl Med Mol Imaging 2010;37:1802-12.CrossRefPubMedGoogle Scholar
  18. 18.
    Chen J, Folks RD, Verdes L, Manatunga DN, Jacobson AF, Garcia EV. Quantitative I-123 MIBG SPECT in differentiating abnormal and normal I123-mIBGmyocardial uptake. J Nucl Cardiol 2012;19:92-9.CrossRefPubMedGoogle Scholar
  19. 19.
    Jacobson AF, Lombard J, Banerjee G, Camici PG. I123-mIBG scintigraphy to predict risk for adverse cardiac outcomes in heart failure patients: Design of two prospective multicenter international trials. J Nucl Cardiol 2009;16:113-21.CrossRefPubMedGoogle Scholar
  20. 20.
    Kuruvilla S, Adenaw N, Katwal AB, Lipinski MJ, Kramer CM, Salerno M. Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: A systematic review and meta-analysis. Circ Cardiovasc Imaging 2014;7:250-8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Paterson I, Mielniczuk LM, O’Meara E, So A, White JA. Imaging heart failure: Current and future applications. Can J Cardiol 2013;29:317-28.CrossRefPubMedGoogle Scholar
  22. 22.
    McArdle B, Dowsley TF, Cocker MS, Ohira H, deKemp RA, DaSilva J, et al. Cardiac PET: Metabolic and functional imaging of the myocardium. Semin Nucl Med 2013;43:434-48.CrossRefPubMedGoogle Scholar
  23. 23.
    Rischpler C, Nekolla S, Schwaiger M. PET and SPECT in heart failure. Current Cardiol Rep 2013;15:337.CrossRefGoogle Scholar
  24. 24.
    Osborn EA, Jaffer FA. The advancing clinical impact of molecular imaging in CVD. JACC Cardiovasc Imaging 2013;6:1327-41.CrossRefPubMedGoogle Scholar
  25. 25.
    Notghi A, Low CS. Myocardial perfusion scintigraphy: Past, present and future. Br J Radiol 2011;84:S229-36.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Chen J, Garcia EV, Galt JR, Folks RD, Carrio I. Improved quantification in 123-I cardiac SPECT imaging with deconvolution of septal penetration. Nucl Med Commun 2006;27:551-8.CrossRefPubMedGoogle Scholar
  27. 27.
    Van Train KF, Areeda J, Garcia EV, Cooke CD, Maddahi J, Kiat H, et al. Quantitative same-day rest-stress technetium-99m-Sestamibi SPECT: Definition and validation of stress normal limits and criteria for abnormality. J Nucl Med 1993;34:1494-502.PubMedGoogle Scholar
  28. 28.
    Garcia EV, Faber TL, Cooke CD, Folks RD, Chen J, Santana C. The increasing role of quantification in nuclear cardiology: The Emory approach. J Nucl Cardiol 2007;14:420-32.CrossRefPubMedGoogle Scholar
  29. 29.
    Maddahi J, Van Train K, Prigent F, Garcia EV, Friedman J, Ostrzega E, et al. Quantitative single photon emission computed thallium-201 tomography for detection and localization of coronary artery disease: Optimization and prospective validation of a new technique. J Am Coll Cardiol 1989;14:1689-99.CrossRefPubMedGoogle Scholar
  30. 30.
    DePuey EG, Roubin GS, DePasquale EE, Nody AC, Garcia EV, King SB, et al. Sequential multivessel coronary angioplasty assessed by thallium-201 tomography. Cathet Cardiovasc Diagn 1989;18:213-21.CrossRefPubMedGoogle Scholar
  31. 31.
    Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: Incremental prognostic value and use in risk stratification. Circulation 1996;93:905-14.CrossRefPubMedGoogle Scholar
  32. 32.
    Garcia EV, Cooke CD, Van Train K, Folks R, Peifer J, DePuey G, et al. Technical aspects of myocardial SPECT imaging with Tc-99m sestamibi. Am J Cardiol 1990;66:23E-31E.CrossRefPubMedGoogle Scholar
  33. 33.
    Santana CA, Faber TL, Soler-Peter M, Sanyala R, Estevesa FP, Ornelasa M, et al. Prognostic performance of quantitative PET tools for stratification of patients with ischemic cardiomyopathy undergoing myocardial viability assessment. Nucl Med Commun 2008;29:970-81.CrossRefPubMedGoogle Scholar
  34. 34.
    Botvinick EH, Dunn RF, Hattner RS, Massie BM. A consideration of factors affecting the diagnostic accuracy of thallium-201 myocardial perfusion scintigraphy in detecting coronary artery disease. Semin Nucl Med 1980;10:157-67.CrossRefPubMedGoogle Scholar
  35. 35.
    Chen J, Garcia EV, Galt JR, Folks RD, Carrio I. Optimized acquisition and processing protocols for I-123 cardiac SPECT imaging. J Nucl Cardiol 2006;13:251-60.CrossRefPubMedGoogle Scholar
  36. 36.
    Kline RC, Swanson DP, Wieland DM, Thrall JH, Gross MD, Pitt B, et al. Myocardial imaging in man with I-123 meta-iodobenzylguanidine. J Nucl Med 1981;22:129-32.PubMedGoogle Scholar
  37. 37.
    Wafelman AR, Hoefnagel CA, Maes RA, Beijnen JH. Radioiodinated metaiodobenzylguanidine: A review of its biodistribution and pharmacokinetics, drug interactions, cytotoxicity and dosimetry. Eur J Nucl Med 1994;21:545-59.CrossRefPubMedGoogle Scholar
  38. 38.
    Fintel DJ, Links JM, Brinker JA, Frank TL, Parker M, Becker LC. Improved diagnostic performance of exercise thallium-201 single photon emission computed tomography over planar imaging in the diagnosis of coronary artery disease: A receiver operating characteristic analysis. J Am Coll Cardiol 1989;13:600-12.CrossRefPubMedGoogle Scholar
  39. 39.
    Slomka P, Xu Y, Berman D, Germano G. Quantitative analysis of perfusion studies: Strengths and pitfalls. J Nucl Cardiol 2012;19:338-46.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Luisi AJ, Fallavollita JA, Suzuki G, Canty JM. Spatial inhomogeneity of sympathetic nerve function in hibernating myocardium. Circulation 2012;106:779-81.CrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2015

Authors and Affiliations

  • Ian P. Clements
    • 1
  • Ernest V. Garcia
    • 2
  • Ji Chen
    • 2
  • Russell D. Folks
    • 3
  • Javed Butler
    • 2
  • Arnold F. Jacobson
    • 4
  1. 1.Cardiovascular DiseasesMayo ClinicRochesterUSA
  2. 2.Department of Radiology, School of MedicineEmory UniversityAtlantaUSA
  3. 3.Division of Nuclear MedicineEmory UniversityAtlantaUSA
  4. 4.GE Health CarePrincetonUSA

Personalised recommendations