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Normal values and within-subject variability of cardiac I-123 MIBG scintigraphy in healthy individuals: Implications for clinical studies

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Although several myocardial iodine 123 metaiodobenzylguanidine (MIBG) indices are increasingly used to detect alterations in myocardial sympathetic activity in various forms of cardiac pathology, published measurements of normal values and within-subject variability are lacking.

Methods and Results

Twenty-five healthy volunteers underwent planar and single photon emission computed tomography (SPECT) imaging. Heart-mediastinum ratio (H/M) and myocardial washout were calculated from planar images comparing three different methods for the assessment of myocardial activity: (1) global region over the myocardium (cavity included), (2) global region over the myocardium (cavity excluded), and (3) fixed small myocardial region. Segmental (relative) uptake and washout were assessed by SPECT. For all MIBG indices, the interindividual variation was the lowest for methods 1 and 2. In SPECT this variation was low for relative segmental uptake compared with washout. In 9 subjects a second MIBG scintigraphy was performed after 3 months. The within-subject variability of H/M and washout assessed by planar methods 1 and 2 was 5%, whereas it was approximately 9% for planar method 3. For relative segmental uptake from SPECT, this variability was 5%.

Conclusion

MIBG H/M (planar) and relative segmental uptake (SPECT) show a low interindividual and within-subject variability. This enables the detection of small (regional) variations in myocardial sympathetic nervous function, especially to monitor the effect of therapeutic interventions in patients with various cardiac diseases. (J Nucl Cardiol 2004;11: 126-33.)

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References

  1. Merlet P, Valette H, Dubois-Rande JL, et al. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure. J Nucl Med 1992;33:471–7.

    CAS  PubMed  Google Scholar 

  2. Ogita H, Shimonagata T, Fukunami M, et al. Prognostic significance of cardiac (123)I metaiodobenzylguanidine imaging for mortality and morbidity in patients with chronic heart failure: a prospective study. Heart 2001;86:656–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Somsen GA, van Vlies B, de Milliano PA, et al. Increased myocardial [123I]-metaiodobenzylguanidine uptake after enalapril treatment in patients with chronic heart failure. Heart 1996;76:218–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Takeishi Y, Atsumi H, Fujiwara S, Takahashi K, Tomoike H. ACE inhibition reduces cardiac iodine-123-MIBG release in heart failure. J Nucl Med 1997;38:1085–9.

    CAS  PubMed  Google Scholar 

  5. Yamazaki J, Muto H, Kabano T, et al. Evaluation of beta-blocker therapy in patients with dilated cardiomyopathy-clinical meaning of iodine 123-metaiodobenzylguanidine myocardial single-photon emission computed tomography. Am Heart J 2001;141:645–52.

    Article  CAS  PubMed  Google Scholar 

  6. Eichhorn EJ, McGhie AL, Bedotto JB, et al. Effects of bucindolol on neurohormonal activation in congestive heart failure. Am J Cardiol 1991;67:67–73.

    Article  CAS  PubMed  Google Scholar 

  7. Gerson MC, Craft LL, McGuire N, et al. Carvedilol improves left ventricular function in heart failure patients with idiopathic dilated cardiomyopathy and a wide range of sympathetic nervous system function as measured by iodine 123 metaiodobenzylguanidine. J Nucl Cardiol 2002;9:608–15.

    Article  PubMed  Google Scholar 

  8. de Milliano PA, de Groot AC, Tijssen JG, et al. Beneficial effects of metoprolol on myocardial sympathetic function: Evidence from a randomized, placebo-controlled study in patients with congestive heart failure. Am Heart J 2002;144:E3.

    Article  PubMed  Google Scholar 

  9. Kasama S, Toyama T, Kumakura H, et al. Spironolactone improves cardiac sympathetic nerve activity and symptoms in patients with congestive heart failure. J Nucl Med 2002;43:1279–85.

    CAS  PubMed  Google Scholar 

  10. Kasama S, Toyama T, Kumakura H, et al. Effect of spironolactone on cardiac sympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy. J Am Coll Cardiol 2003;41:574–81.

    Article  CAS  PubMed  Google Scholar 

  11. Miyanaga H, Yoneyama S, Kamitani T, et al. Abnormal myocardial uptake and clearance of 123I-labeled metaiodobenzylguanidine in patients with chronic renal failure and autonomic dysfunction. J Nucl Cardiol 1996;3(6 Pt 1):508–15.

    Article  CAS  PubMed  Google Scholar 

  12. Parthenakis FI, Prassopoulos VK, Koukouraki SI, et al. Segmental pattern of myocardial sympathetic denervation in idiopathic dilated cardiomyopathy: relationship to regional wall motion and myocardial perfusion abnormalities. J Nucl Cardiol 2002;9:15–22.

    Article  CAS  PubMed  Google Scholar 

  13. Sakata K, Shirotani M, Yoshida H, et al. Effects of amlodipine and cilnidipine on cardiac sympathetic nervous system and neurohormonal status in essential hypertension. Hypertension 1999;33:1447–52.

    Article  CAS  PubMed  Google Scholar 

  14. Bland JM. Statistics notes: measurement error proportional to the mean [Letter]. BMJ 1996;313:106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Morozumi T, Kusuoka H, Fukuchi K, et al. Myocardial iodine- 123-metaiodobenzylguanidine images and autonomic nerve activity in normal subjects. J Nucl Med 1997;38:49–52.

    CAS  PubMed  Google Scholar 

  16. Merlet P, Benvenuti C, Moyse D, et al. Prognostic value of MIBG imaging in idiopathic dilated cardiomyopathy. J Nucl Med 1999; 40:917–23.

    CAS  PubMed  Google Scholar 

  17. 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.

    Article  CAS  PubMed  Google Scholar 

  18. Hubertus Bülow H, Nekolla SG, Schwaiger M, Bengel F. Comparison of the normal distribution of three tracers used for evaluation of the presynaptic sympathetic neuron. J Nucl Cardiol 2003;10:S44.

    Google Scholar 

  19. Tsuchimochi S, Tamaki N, Tadamura E, et al. Age and gender differences in normal myocardial adrenergic neuronal function evaluated by iodine-123-MIBG imaging. J Nucl Med 1995;36:969–74.

    CAS  PubMed  Google Scholar 

  20. Somsen GA, Borm JJ, Dubois EA, 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 

  21. Estorch M, Carrio I, Berna L, Lopez-Pousa J, Torres G. Myocardial iodine-labeled metaiodobenzylguanidine 123 uptake relates to age. J Nucl Cardiol 1995;2(2 Pt 1):126–32.

    CAS  PubMed  Google Scholar 

  22. Leineweber K, Wangemann T, Giessler C, et al. Age-dependent changes of cardiac neuronal noradrenaline reuptake transporter (uptake1) in the human heart. J Am Coll Cardiol 2002;40:1459–65.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to G. Aernout Somsen.

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Somsen, G.A., Verberne, H.J., Fleury, E. et al. Normal values and within-subject variability of cardiac I-123 MIBG scintigraphy in healthy individuals: Implications for clinical studies. J Nucl Cardiol 11, 126–133 (2004). https://doi.org/10.1016/j.nuclcard.2003.10.010

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  • DOI: https://doi.org/10.1016/j.nuclcard.2003.10.010

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