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Usefulness of rCBF analysis in diagnosing Parkinson’s disease: supplemental role with MIBG myocardial scintigraphy

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Abstract

Abstract

123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a useful tool for differentiating idiopathic Parkinson’s disease (PD) from parkinsonism (PS) caused by other disorders. However, cardiac MIBG uptake is affected by various causes. Alternatively, hypoperfusion in the occipital lobe of PD is reported recently.

Objective

The objective is to clarify the correlation between regional cerebral blood flow (rCBF) alteration and cardiac MIBG uptake in PD. In addition, we examined whether additional brain perfusion analysis improved the differential diagnostic ability for PD from PS when compared with MIBG scintigraphy alone.

Methods

Forty-nine patients with PD (27 mild groups: Hoehn and Yahr stages I, II; 22 severe groups: Hoehn and Yahr stages III, IV) and 28 patients with PS participated. We compared absolute rCBF values between PD and PS. In addition, we determined correlation between MIBG parameters and each rCBF value. Finally, we compared the diagnostic ability for the differentiation of PD from PS between two diagnostic criteria, each MIBG index abnormality alone [heart-to-mediastinum ratio, H/M (E) < 1.9, H/E (D) < 1.7, washout rate > 40%] and each MIBG index abnormality or occipital lobe hypoperfusion (<36 ml/100 g per min).

Results

Absolute rCBF value of occipital lobe was significantly lower in severe PD as compared with PS or mild PD. In the correlation analysis, rCBF of occipital lobe correlated positively with MIBG parameters (H/M). Regarding the diagnostic ability, sensitivity improved by accounting for occipital hypoperfusion as compared with MIBG indices alone. In contrast, neither specificity nor accuracy improved by adding occipital lobe analysis.

Conclusions

MIBG parameters (H/M) correlated positively with occipital hypoperfusion in PD. In the differential diagnosis between PD and PS, although its usefulness might be limited, analysis of rCBF in the occipital lobe added to 123I-MIBG myocardial imaging can be recommended.

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Authors and Affiliations

  1. Department of Radiology, Miyazaki Medical College, 5200 Kihara, Kiyotake, Miyazaki-gun, Miyazaki, 889-1692, Japan

    Shigeki Nagamachi, Hideyuki Wakamatsu, Shogo Kiyohara, Seigo Fujita, Shigemi Futami, Shozo Tamura & Hideo Arita

  2. Department of 3rd Internal Medicine, Miyazaki Medical College, Miyazaki, Japan

    Masamitsu Nakazato & Syuichi Yamashita

  3. Shiga Medical Center for Adults, Shiga, Japan

    Ryuichi Nishii

  4. Faculty of Health Science, School of Medicine, Kanazawa University, Ishikawa, Japan

    Keiichi Kawai

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  1. Shigeki Nagamachi
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Correspondence to Shigeki Nagamachi.

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Nagamachi, S., Wakamatsu, H., Kiyohara, S. et al. Usefulness of rCBF analysis in diagnosing Parkinson’s disease: supplemental role with MIBG myocardial scintigraphy. Ann Nucl Med 22, 557–564 (2008). https://doi.org/10.1007/s12149-008-0156-x

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  • DOI: https://doi.org/10.1007/s12149-008-0156-x

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