Evaluation of probable or possible dementia with Lewy bodies using 123I-IMP brain perfusion SPECT, 123I-MIBG, and 99mTc-MIBI myocardial SPECT

Yoshitaka Inui, Hiroshi Toyama, Yuta Manabe, Takahisa Sato, Masayoshi Sarai, Kenji Kosaka, Nakao Iwata, Kazuhiro Katada

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Abstract

We evaluated the diagnostic usefulness of combination studies with a statistical mapping method in N-isopropyl-p-123I-iodoamphetamine (123I-IMP) brain perfusion SPECT, cardiac sympathetic nerve function by 123I-metaiodobenzylguanidine (123I-MIBG), and myocardial function by electrocardiographically gated 99mTc-sestamibi (99mTc-MIBI) SPECT for patients with probable or possible dementia with Lewy bodies (DLB). Methods: Twelve patients with probable DLB (7 male, 5 female; mean age ± SD, 72.3 ± 5.63 y; range, 65-82 y) and 9 patients with possible DLB (3 male, 6 female; mean age ± SD, 73.1 ± 9.23 y; range, 59-88 y) were enrolled in this study. 123I-IMP SPECT images were analyzed with 3-dimensional stereotactic surface projections (3D-SSP) and the severity of ischemia was classified objectively using quantitatively analytic and display software; stereotactic extraction estimation (SEE) methods were compared with a normal database. In addition, we evaluated 123I-MIBG heart-to-mediastinum (H/M) uptake ratios. Moreover, we performed 99mTc-MIBI SPECT to evaluate myocardial perfusion and the left ventricular ejection fraction (LVEF) compared with a normal database. Results: 3D-SSP images of group comparison with healthy control subjects showed significantly decreased perfusion in the parietotemporal, occipital cortex, posterior cingulated, and precuneus regions in the probable DLB group but no significant reduction in the possible DLB group. Mean H/M ratios in the probable DLB group were significantly lower than those of the possible DLB group and the control group, respectively. Ten of 12 patients (83.3%) with probable DLB and 1 of 9 patients (11.1%) with possible DLB showed severe reduction in the bilateral occipital lobe and also a low 123I-MIBG uptake. One patient (8.3%) with probable DLB and 2 patients (22.2%) with possible DLB showed no bilateral occipital hypoperfusion but showed low 123I-MIBG uptake. One patient (8.3%) with probable DLB and 6 patients (66.7%) with possible DLB showed no occipital hypoperfusion and normal 123I-MIBG uptake. 99mTc-MIBI gated SPECT did not indicate any wall motion abnormality in any subjects. Conclusion: These results suggest that combined examination of cerebral blood flow with 3D-SSP and SEE analysis, and cardiac sympathetic nerve function with 123I-MIBG, would be a useful supporting diagnostic method in patients with DLB - particularly, in possible DLB and when cerebral blood flow does not indicate occipital hypoperfusion.

Original languageEnglish
Pages (from-to)1641-1650
Number of pages10
JournalJournal of Nuclear Medicine
Volume48
Issue number10
DOIs
Publication statusPublished - 01-10-2007

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Iofetamine
Technetium Tc 99m Sestamibi
Lewy Body Disease
Single-Photon Emission-Computed Tomography
Perfusion
Brain
Cerebrovascular Circulation
Occipital Lobe
Mediastinum
Databases
Parietal Lobe

All Science Journal Classification (ASJC) codes

  • Radiological and Ultrasound Technology

Cite this

@article{5401219df39a44afa46b29343bd260e9,
title = "Evaluation of probable or possible dementia with Lewy bodies using 123I-IMP brain perfusion SPECT, 123I-MIBG, and 99mTc-MIBI myocardial SPECT",
abstract = "We evaluated the diagnostic usefulness of combination studies with a statistical mapping method in N-isopropyl-p-123I-iodoamphetamine (123I-IMP) brain perfusion SPECT, cardiac sympathetic nerve function by 123I-metaiodobenzylguanidine (123I-MIBG), and myocardial function by electrocardiographically gated 99mTc-sestamibi (99mTc-MIBI) SPECT for patients with probable or possible dementia with Lewy bodies (DLB). Methods: Twelve patients with probable DLB (7 male, 5 female; mean age ± SD, 72.3 ± 5.63 y; range, 65-82 y) and 9 patients with possible DLB (3 male, 6 female; mean age ± SD, 73.1 ± 9.23 y; range, 59-88 y) were enrolled in this study. 123I-IMP SPECT images were analyzed with 3-dimensional stereotactic surface projections (3D-SSP) and the severity of ischemia was classified objectively using quantitatively analytic and display software; stereotactic extraction estimation (SEE) methods were compared with a normal database. In addition, we evaluated 123I-MIBG heart-to-mediastinum (H/M) uptake ratios. Moreover, we performed 99mTc-MIBI SPECT to evaluate myocardial perfusion and the left ventricular ejection fraction (LVEF) compared with a normal database. Results: 3D-SSP images of group comparison with healthy control subjects showed significantly decreased perfusion in the parietotemporal, occipital cortex, posterior cingulated, and precuneus regions in the probable DLB group but no significant reduction in the possible DLB group. Mean H/M ratios in the probable DLB group were significantly lower than those of the possible DLB group and the control group, respectively. Ten of 12 patients (83.3{\%}) with probable DLB and 1 of 9 patients (11.1{\%}) with possible DLB showed severe reduction in the bilateral occipital lobe and also a low 123I-MIBG uptake. One patient (8.3{\%}) with probable DLB and 2 patients (22.2{\%}) with possible DLB showed no bilateral occipital hypoperfusion but showed low 123I-MIBG uptake. One patient (8.3{\%}) with probable DLB and 6 patients (66.7{\%}) with possible DLB showed no occipital hypoperfusion and normal 123I-MIBG uptake. 99mTc-MIBI gated SPECT did not indicate any wall motion abnormality in any subjects. Conclusion: These results suggest that combined examination of cerebral blood flow with 3D-SSP and SEE analysis, and cardiac sympathetic nerve function with 123I-MIBG, would be a useful supporting diagnostic method in patients with DLB - particularly, in possible DLB and when cerebral blood flow does not indicate occipital hypoperfusion.",
author = "Yoshitaka Inui and Hiroshi Toyama and Yuta Manabe and Takahisa Sato and Masayoshi Sarai and Kenji Kosaka and Nakao Iwata and Kazuhiro Katada",
year = "2007",
month = "10",
day = "1",
doi = "10.2967/jnumed.107.042143",
language = "English",
volume = "48",
pages = "1641--1650",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine Inc.",
number = "10",

}

Evaluation of probable or possible dementia with Lewy bodies using 123I-IMP brain perfusion SPECT, 123I-MIBG, and 99mTc-MIBI myocardial SPECT. / Inui, Yoshitaka; Toyama, Hiroshi; Manabe, Yuta; Sato, Takahisa; Sarai, Masayoshi; Kosaka, Kenji; Iwata, Nakao; Katada, Kazuhiro.

In: Journal of Nuclear Medicine, Vol. 48, No. 10, 01.10.2007, p. 1641-1650.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evaluation of probable or possible dementia with Lewy bodies using 123I-IMP brain perfusion SPECT, 123I-MIBG, and 99mTc-MIBI myocardial SPECT

AU - Inui, Yoshitaka

AU - Toyama, Hiroshi

AU - Manabe, Yuta

AU - Sato, Takahisa

AU - Sarai, Masayoshi

AU - Kosaka, Kenji

AU - Iwata, Nakao

AU - Katada, Kazuhiro

PY - 2007/10/1

Y1 - 2007/10/1

N2 - We evaluated the diagnostic usefulness of combination studies with a statistical mapping method in N-isopropyl-p-123I-iodoamphetamine (123I-IMP) brain perfusion SPECT, cardiac sympathetic nerve function by 123I-metaiodobenzylguanidine (123I-MIBG), and myocardial function by electrocardiographically gated 99mTc-sestamibi (99mTc-MIBI) SPECT for patients with probable or possible dementia with Lewy bodies (DLB). Methods: Twelve patients with probable DLB (7 male, 5 female; mean age ± SD, 72.3 ± 5.63 y; range, 65-82 y) and 9 patients with possible DLB (3 male, 6 female; mean age ± SD, 73.1 ± 9.23 y; range, 59-88 y) were enrolled in this study. 123I-IMP SPECT images were analyzed with 3-dimensional stereotactic surface projections (3D-SSP) and the severity of ischemia was classified objectively using quantitatively analytic and display software; stereotactic extraction estimation (SEE) methods were compared with a normal database. In addition, we evaluated 123I-MIBG heart-to-mediastinum (H/M) uptake ratios. Moreover, we performed 99mTc-MIBI SPECT to evaluate myocardial perfusion and the left ventricular ejection fraction (LVEF) compared with a normal database. Results: 3D-SSP images of group comparison with healthy control subjects showed significantly decreased perfusion in the parietotemporal, occipital cortex, posterior cingulated, and precuneus regions in the probable DLB group but no significant reduction in the possible DLB group. Mean H/M ratios in the probable DLB group were significantly lower than those of the possible DLB group and the control group, respectively. Ten of 12 patients (83.3%) with probable DLB and 1 of 9 patients (11.1%) with possible DLB showed severe reduction in the bilateral occipital lobe and also a low 123I-MIBG uptake. One patient (8.3%) with probable DLB and 2 patients (22.2%) with possible DLB showed no bilateral occipital hypoperfusion but showed low 123I-MIBG uptake. One patient (8.3%) with probable DLB and 6 patients (66.7%) with possible DLB showed no occipital hypoperfusion and normal 123I-MIBG uptake. 99mTc-MIBI gated SPECT did not indicate any wall motion abnormality in any subjects. Conclusion: These results suggest that combined examination of cerebral blood flow with 3D-SSP and SEE analysis, and cardiac sympathetic nerve function with 123I-MIBG, would be a useful supporting diagnostic method in patients with DLB - particularly, in possible DLB and when cerebral blood flow does not indicate occipital hypoperfusion.

AB - We evaluated the diagnostic usefulness of combination studies with a statistical mapping method in N-isopropyl-p-123I-iodoamphetamine (123I-IMP) brain perfusion SPECT, cardiac sympathetic nerve function by 123I-metaiodobenzylguanidine (123I-MIBG), and myocardial function by electrocardiographically gated 99mTc-sestamibi (99mTc-MIBI) SPECT for patients with probable or possible dementia with Lewy bodies (DLB). Methods: Twelve patients with probable DLB (7 male, 5 female; mean age ± SD, 72.3 ± 5.63 y; range, 65-82 y) and 9 patients with possible DLB (3 male, 6 female; mean age ± SD, 73.1 ± 9.23 y; range, 59-88 y) were enrolled in this study. 123I-IMP SPECT images were analyzed with 3-dimensional stereotactic surface projections (3D-SSP) and the severity of ischemia was classified objectively using quantitatively analytic and display software; stereotactic extraction estimation (SEE) methods were compared with a normal database. In addition, we evaluated 123I-MIBG heart-to-mediastinum (H/M) uptake ratios. Moreover, we performed 99mTc-MIBI SPECT to evaluate myocardial perfusion and the left ventricular ejection fraction (LVEF) compared with a normal database. Results: 3D-SSP images of group comparison with healthy control subjects showed significantly decreased perfusion in the parietotemporal, occipital cortex, posterior cingulated, and precuneus regions in the probable DLB group but no significant reduction in the possible DLB group. Mean H/M ratios in the probable DLB group were significantly lower than those of the possible DLB group and the control group, respectively. Ten of 12 patients (83.3%) with probable DLB and 1 of 9 patients (11.1%) with possible DLB showed severe reduction in the bilateral occipital lobe and also a low 123I-MIBG uptake. One patient (8.3%) with probable DLB and 2 patients (22.2%) with possible DLB showed no bilateral occipital hypoperfusion but showed low 123I-MIBG uptake. One patient (8.3%) with probable DLB and 6 patients (66.7%) with possible DLB showed no occipital hypoperfusion and normal 123I-MIBG uptake. 99mTc-MIBI gated SPECT did not indicate any wall motion abnormality in any subjects. Conclusion: These results suggest that combined examination of cerebral blood flow with 3D-SSP and SEE analysis, and cardiac sympathetic nerve function with 123I-MIBG, would be a useful supporting diagnostic method in patients with DLB - particularly, in possible DLB and when cerebral blood flow does not indicate occipital hypoperfusion.

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