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Can early phase cardiac [¹²³I]mIBG images be used to diagnose Lewy body disease?

Lookup NU author(s): Dr Gemma RobertsORCiD, Dr Joseph Kane, Dr James LloydORCiD, Dr Michael FirbankORCiD, Dr Paul DonaghyORCiD, Dr George Petrides, Professor John-Paul TaylorORCiD, Professor John O'Brien, Professor Alan ThomasORCiD

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).

Abstract

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. Purpose Some studies have suggested that cardiac [123I]metaiodobenzylguanidine images obtained 15-20 min after tracer administration are as accurate for dementia with Lewy bodies (DLB) diagnosis as standard images acquired after a delay of 3-4 h; some suggest delayed imaging is preferable. We compare early and delayed heart-to-mediastinum ratios (HMR) in a well-characterised research dataset and make recommendations for clinical practice. Methods Images were acquired using a Siemens gamma camera with medium energy collimators. Early images were obtained at 20 min and delayed at 4 h (± 30) min. In total 167 pairs of images were reviewed: 30 controls, 39 people with dementia and 98 with mild cognitive impairment. HMR normal cutoff values derived from control data were ≥2.10 for early imaging and ≥1.85 for delayed. Results HMR tended to drop between early and delayed for abnormal images, but increase for normal images. Histograms of early and delayed HMR showed a slightly better separation of results into two groups for delayed imaging. Accuracy results were slightly higher for delayed imaging than early imaging (73 vs. 77%), sensitivity 63 vs. 65% and specificity 82 vs. 88%. However, this was not statistically significant-in total only 8/167 (5%) of scans changed designation between early and delayed imaging. Conclusion We suggest that a delayed image could be acquired only if the early result is borderline. This removes the need for delayed imaging in about 70% of patients. Adopting this protocol in clinical practice would reduce the time most patients have to wait and could free up scanner time.

Publication metadata

Author(s): Roberts G, Kane JPM, Lloyd J, Firbank M, Donaghy PC, Petrides GS, Taylor J-P, O'Brien J, Thomas AJ

Publication type: Article

Publication status: Published

Journal: Nuclear Medicine Communications

Year: 2022

Volume: 43

Issue: 7

Pages: 770-777

Print publication date: 01/07/2022

Online publication date: 20/05/2022

Acceptance date: 12/04/2022

Date deposited: 08/09/2022

ISSN (print): 0143-3636

ISSN (electronic): 1473-5628

Publisher: Lippincott Williams and Wilkins

URL: https://doi.org/10.1097/MNM.0000000000001581

DOI: 10.1097/MNM.0000000000001581

PubMed id: 35603421

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