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Validity of the mediastinum as a reference region to evaluate cardiac accumulation of iodine-123 metaiodobenzylguanidine

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Abstract

Objective

The heart-to-mediastinum (H/M) ratio, the heart count normalized for the mediastinum count, is commonly used in cardiac 123I-metaiodobenzylguanidine (MIBG) imaging. However, there are reports describing age-dependent increases in the mediastinum count with or without correction for the injected dose (ID) and a poor correlation between the H/M ratio and heart count normalized for ID. We evaluated the validity of the mediastinum count as a reference in comparison with the ID.

Methods

Results of cardiac 123I-MIBG imaging in 200 patients were analyzed. The mean counts for the heart and mediastinum were estimated to calculate the H/M ratio. Additionally, the heart and mediastinum counts were normalized for ID measured with a dose calibrator. ID was corrected for body size represented by body weight, body surface area, or lean body mass.

Results

The coefficient of variance of the ID-normalized mediastinum count was reduced by correcting ID for body size. The indicators of body size showed significant negative correlations with age. Although a positive correlation was found between age and the ID-normalized mediastinum counts, the age-dependence was reduced by body size correction. There was a close correlation between the H/M ratio and ID-normalized heart counts, and body size correction improved the correlation.

Conclusion

The results of this study indicate the validity of the mediastinum as a reference region and support the use of the H/M ratio as an index of cardiac accumulation of 123I-MIBG.

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References

  1. Flotats A, Carrió I, Agostini D, Le Guludec D, Marcassa C, Schaffers M, et al. Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular Committee and the European Council of Nuclear Cardiology. Eur J Nucl Med Mol Imaging. 2010;37:1802–12.

    Article  PubMed  Google Scholar 

  2. Nakata T, Nakajima K, Yamashina S, Yamada T, Momose M, Kasama S, et al. A pooled analysis of multicenter cohort studies of 123I-mIBG imaging of sympathetic innervation for assessment of long-term prognosis in heart failure. JACC Cardiovasc Imaging. 2013;6:772–84.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. Carrió I, Cowie MR, Yamazaki J, Udelson J, Camici PG. Cardiac sympathetic imaging with mIBG in heart failure. JACC Cardiovasc Imaging. 2010;3:92–100.

    Article  PubMed  Google Scholar 

  5. Treglia G, Cason E, Stefanelli A, Cocciolillo F, Di Giuda D, Fagioli G, et al. MIBG scintigraphy in differential diagnosis of Parkinsonism: a meta-analysis. Clin Auton Res. 2012;22:43–55.

    Article  PubMed  Google Scholar 

  6. Treglia G, Cason E. Diagnostic performance of myocardial innervation imaging using MIBG scintigraphy in differential diagnosis between dementia with lewy bodies and other dementias: a systematic review and a meta-analysis. J Neuroimaging. 2012;22:111–7.

    Article  PubMed  Google Scholar 

  7. Fletcher AM, Motherwell DW, Small AD, McCurrach GM, Goodfield NE, Petrie MC, et al. I-123 MIBG cardiac uptake measurements: limitations of collimator choice and scatter correction in the clinical context. Nucl Med Commun. 2010;31:629–36.

    PubMed  Google Scholar 

  8. Somsen GA, Borm JJ, Dubois EA, Schook MB, Van Der Wall EE, et al. Cardiac 123I-MIBG uptake is affected by variable uptake in reference regions: implications for interpretation in clinical studies. Nucl Med Commun. 1996;17:872–6.

    Article  CAS  PubMed  Google Scholar 

  9. Jacobson AF, Chen J, Verdes L, Folks RD, Manatunga DN, Garcia EV. Impact of age on myocardial uptake of 123I-mIBG in older adult subjects without coronary heart disease. J Nucl Cardiol. 2013;20:406–14.

    Article  PubMed  Google Scholar 

  10. Gehan EA, George SL. Estimation of human body surface area from height and weight. Cancer Chemother Rep. 1970;54:225–35.

    CAS  PubMed  Google Scholar 

  11. James W, Waterlow J. UK Department of Health and Social Security/Medical Research Council Group on obesity research. Research on obesity: a report of the DHSS/MRC Group. London, England: H.M.S.O. 1976.

  12. Ito H, Ohshima A, Ohto N, Ogasawara M, Tsuzuki M, Takao K, et al. Relation between body composition and age in healthy Japanese subjects. Eur J Clin Nutr. 2001;55:462–70.

    Article  CAS  PubMed  Google Scholar 

  13. Green B, Duffull S. Caution when lean body weight is used as a size descriptor for obese subjects. Clin Pharmacol Ther. 2002;72:743–4.

    Article  PubMed  Google Scholar 

  14. Tahari AK, Chien D, Azadi JR, Wahl RL. Optimum lean body formulation for correction of standardized uptake value in PET imaging. J Nucl Med. 2014;55:1481–4.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Inoue Y, Suzuki A, Shirouzu I, Machida T, Yoshizawa Y, Akita F, et al. Effect of collimator choice on quantitative assessment of cardiac iodine 123 MIBG uptake. J Nucl Cardiol. 2003;10:623–32.

    Article  PubMed  Google Scholar 

  16. Inoue Y, Abe Y, Itoh Y, Asano Y, Kikuchi K, Sakamoto Y, et al. Acquisition protocols and correction methods for estimation of the heart-to-mediastinum ratio in 123I-metaiodobenzylguanidine cardiac sympathetic imaging. J Nucl Med. 2013;54:707–13.

    Article  CAS  PubMed  Google Scholar 

  17. Inoue Y, Abe Y, Asano Y, Kikuchi K, Matsunaga K, Iizuka T, et al. An improved method for estimating the heart-to-mediastinum ratio from cardiac sympathetic nerve imaging with low-energy high-resolution collimators. J Nucl Cardiol. 2014;21:614–21.

    Article  PubMed  Google Scholar 

  18. Inoue Y. 123I-MIBG cardiac imaging: acquisition protocols and correction methods for quantitative evaluation. Curr Cardiovasc Imaging Rep. 2015;8:9306.

    Article  Google Scholar 

  19. Jacobson AF, Centofanti R, Babalola OI, Dean B. Survey of the performance of commercial dose calibrators for measurement of 123I activity. J Nucl Med Technol. 2011;39:302–6.

    Article  PubMed  Google Scholar 

  20. Inoue Y, Shirouzu I, Machida T, Yoshizawa Y, Akita F, Doi I, et al. Physical characteristics of low and medium energy collimators for 123I imaging and simultaneous dual-isotope imaging. Nucl Med Commun. 2003;24:1195–202.

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

There are no conflicts of interest in relation to this study.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Yusuke Inoue & Yuji Asano

  2. Department of Radiology, Kitasato University Hospital, Sagamihara, Japan

    Yutaka Abe & Kei Kikuchi

Authors
  1. Yusuke Inoue
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  2. Yutaka Abe
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  3. Yuji Asano
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  4. Kei Kikuchi
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Correspondence to Yusuke Inoue.

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Inoue, Y., Abe, Y., Asano, Y. et al. Validity of the mediastinum as a reference region to evaluate cardiac accumulation of iodine-123 metaiodobenzylguanidine. Ann Nucl Med 29, 650–657 (2015). https://doi.org/10.1007/s12149-015-0989-z

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  • DOI: https://doi.org/10.1007/s12149-015-0989-z

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