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Diagnostic cutoff points for 123I-MIBG myocardial scintigraphy in a Caucasian population with Parkinson’s disease

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Abstract

Purpose

Molecular imaging with 123I-metaiodobenzylguanidine (MIBG) has been used in Parkinson’s disease (PD), but there is no consensual index to discriminate between normal and PD patients in the Caucasian population. The purpose of this study was to determine diagnostic cutoff points in the quantification of MIBG cardiac uptake in our population of PD patients. We have also calculated the reproducibility over a range of interpretation expertise.

Methods

The study included 14 PD patients and 14 normal age- and sex-matched controls. Heart to mediastinum ratios (H/M) were calculated at 15 min (H/M15m) and 4 h (H/M4h) post-injection by three observers with different interpretation expertise, one of whom drew the regions of interest at three different times. The intraobserver and interobserver reliability was calculated (interclass correlation coefficient and coefficient of variability). Diagnosis was estimated by maximizing the Youden index for H/M and washout ratios. Discrimination ability was assessed by the area under the curve (AUC). Sensitivity and specificity were reported, using our thresholds.

Results

The parameter with the best diagnostic accuracy was the H/M4h ratio, with a major AUC (0.976 area under the receiver-operating characteristic curve). The threshold was 1.43 with a 95% confidence interval of 1.37–1.50. Using this threshold, the sensitivity and specificity were 93 and 100%. The interobserver and intraobserver variabilities measuring this ratio were 3.2 and 3.1%, respectively.

Conclusion

The diagnostic cutoff point for 123I-MIBG myocardial scintigraphy in a Caucasian population with PD was 1.43 for the H/M4h index, with a good sensitivity and specificity. The technique is easy to use, with a good reproducibility over a range of interpretation expertise.

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Acknowledgements

This work was supported by Instituto de Salud Carlos III (FISS PI070426 and RECAVA) and by Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR 2009 SGR 1049).

The authors wish to thank nuclear medicine technicians Manel Tantull and Josep L. Carrasco for their skilful help in the realization of these studies.

Conflicts of interest

None.

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Authors and Affiliations

  1. Nuclear Medicine Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain

    África Muxí, Pilar Paredes, Ignacio Navales, Francisco Lomeña, Oriol Solà, Beatriz Domenech & Francesca Pons

  2. Movement Disorders Unit, Neurology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain

    Francesc Valldeoriola, Carles Gaig, Andres de la Cerda & Eduardo Tolosa

  3. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    África Muxí, Pilar Paredes, Francesc Valldeoriola, Carles Gaig, Francisco Lomeña, Andres de la Cerda, Eduardo Tolosa & Francesca Pons

  4. RECAVA, Instituto de Salud Carlos III, Barcelona, Spain

    África Muxí & Pilar Paredes

  5. Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR 2009 SGR 1049), Barcelona, Spain

    África Muxí, Pilar Paredes & Francesca Pons

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  1. África Muxí
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Correspondence to África Muxí.

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Muxí, Á., Paredes, P., Navales, I. et al. Diagnostic cutoff points for 123I-MIBG myocardial scintigraphy in a Caucasian population with Parkinson’s disease. Eur J Nucl Med Mol Imaging 38, 1139–1146 (2011). https://doi.org/10.1007/s00259-011-1754-8

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  • DOI: https://doi.org/10.1007/s00259-011-1754-8

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