123I-MIBG for detection of subacute doxorubicin-induced cardiotoxicity in patients with malignant lymphoma

  • Adam Høgsbro LaursenEmail author
  • Rasmus Sejersten Ripa
  • Philip Hasbak
  • Andreas Kjær
  • Marie Bayer Elming
  • Lars Køber
  • Martin Hutchings
  • Jens Jakob Thune
Original Article



Doxorubicin is the mainstay of curative lymphoma treatment but is associated with a dose-dependent cardiotoxicity that is often recognized too late to avoid substantial irreversible cardiac injury. Iodine-123 metaiodobenzylguanidine (123I-MIBG) is a gamma-emitting tracer that mimics noradrenaline uptake, storage, and release mechanisms in adrenergic presynaptic neurons. 123I-MIBG scintigraphy can be used for assessment of doxorubicin-induced injury to myocardial adrenergic neurons during treatment and could be the tool for early detection of doxorubicin cardiotoxicity, which is currently lacking.

Methods and Results

A total of 37 lymphoma patients scheduled for doxorubicin treatment were included in our study. 123I-MIBG imaging was performed prior to chemotherapy and after a median of 4 cycles of doxorubicin. Early and late heart-to-mediastinum ratios (H/Mearly and H/Mlate) and washout rate (WOR) were used for evaluation of cardiotoxicity. The prognostic value of 123I-MIBG results was assessed using left ventricular ejection fraction (LVEF) as measured by cardiac magnetic resonance at 1-year follow-up. We found a post-therapy increase in WOR (including nine patients with > 10% increase), which was not statistically significant (18.6 vs 23.4%, P = 0.09). The difference appeared to be driven by an increase in H/Mearly. LVEF decreased from baseline to 1-year follow-up (64 vs 58%, P = 0.03). LVEF change was not associated with changes in WOR (P = 0.5).


The present study does not provide evidence for 123I-MIBG imaging as a clinically applicable tool for early detection of doxorubicin-induced cardiotoxicity.


123I-MIBG sympathetic nervous system cardiotoxicity doxorubicin lymphoma 



Iodine-123 metaiodobenzylguanidine


Cardiac magnetic resonance


Early heart-to-mediastinum ratio


Late heart-to-mediastinum ratio


Left ventricular ejection fraction


Washout rate



The authors have no conflicts of interest to declare

Supplementary material

12350_2018_1566_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 19 kb)
12350_2018_1566_MOESM2_ESM.pptx (228 kb)
Supplementary material 2 (PPTX 227 kb)


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Copyright information

© American Society of Nuclear Cardiology 2018

Authors and Affiliations

  • Adam Høgsbro Laursen
    • 1
    Email author
  • Rasmus Sejersten Ripa
    • 2
  • Philip Hasbak
    • 2
  • Andreas Kjær
    • 2
  • Marie Bayer Elming
    • 3
  • Lars Køber
    • 3
  • Martin Hutchings
    • 1
  • Jens Jakob Thune
    • 3
    • 4
  1. 1.Department of Hematology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Cardiology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  4. 4.Department of Cardiology, Bispebjerg and Frederiksberg HospitalUniversity of CopenhagenCopenhagenDenmark

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