Pietro Tiraboschi1, Angelo Corso2, Ugo Paolo Guerra3, Flavio Nobili4, Arnoldo Piccardo5, Maria Lucia Calcagni6, Duccio Volterrani7, Diego Cecchin8, Mauro Tettamanti9, Luigi Antelmi10, Simone Vidale11, Leonardo Sacco11,12, Maria Merello13, Stefano Stefanini13, Anna Micheli14, Paola Vai15, Selene Capitanio15, Sara Vincenzina Gabanelli15, Riccardo Riva16, Patrizia Pinto16, Ave Maria Biffi17, Cristina Muscio1. 1. Division of Neurology V/Neuropathology, Scientific Institute for Research, Hospitalization, and Care (IRCCS), Foundation "Carlo Besta" Neurological Institute, Milan, Italy. 2. Department of Nuclear Medicine, Sant'Anna Hospital, Como, Italy. 3. Department of Nuclear Medicine, Poliambulanza Foundation, Brescia, Italy. 4. Department of Neuroscience, University of Genoa, Genoa, Italy. 5. Nuclear Medicine Unit, Department of Diagnostic Imaging, E. O. Galliera Hospital, Genoa, Italy. 6. Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy. 7. Nuclear Medicine Unit, University Hospital of Pisa, Pisa, Italy. 8. Department of Medicine, University of Padua, Padua, Italy. 9. Laboratory of Geriatric Neuropsychiatry, Institute of Hospitalization and Scientific Care Mario Negri Institute of Pharmacological Research, Milan, Italy. 10. Health Department, Institute of Hospitalization and Scientific Care Foundation Carlo Besta Neurological Institute, Milan, Italy. 11. Department of Neurology and Stroke Unit, Sant'Anna Hospital, Como, Italy. 12. Neurocenter of Southern Switzerland, Lugano, Switzerland. 13. European Foundation for Biomedical Research, Alzheimer Center of Excellence, Briolini Hospital of Gazzaniga, Bergamo, Italy. 14. Neurology Unit, San Francesco Clinic, Bergamo, Italy. 15. Department of Nuclear Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy. 16. Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy. 17. Department of Psychology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Abstract
OBJECTIVE: To compare the diagnostic value of striatal (123) I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ((123) I-FP-CIT) single photon emission computed tomography (SPECT) and (123) I-metaiodobenzylguanidine ((123) I-MIBG) myocardial scintigraphy in differentiating dementia with Lewy bodies (DLB) from other dementia types. METHODS: This prospective longitudinal study included 30 patients with a clinical diagnosis of DLB and 29 patients with non-DLB dementia (Alzheimer disease, n = 16; behavioral variant frontotemporal dementia, n = 13). All patients underwent (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy within a few weeks of clinical diagnosis. All diagnoses at each center were agreed upon by the local clinician and an independent expert, both unaware of imaging data, and re-evaluated after 12 months. Each image was visually classified as either normal or abnormal by 3 independent nuclear physicians blinded to patients' clinical data. RESULTS: Overall, sensitivity and specificity to DLB were respectively 93% and 100% for (123) I-MIBG myocardial scintigraphy, and 90% and 76% for (123) I-FP-CIT SPECT. Lower specificity of striatal compared to myocardial imaging was due to decreased (123) I-FP-CIT uptake in 7 non-DLB subjects (3 with concomitant parkinsonism) who had normal (123) I-MIBG myocardial uptake. Notably, in our non-DLB group, myocardial imaging gave no false-positive readings even in those subjects (n = 7) with concurrent medical illnesses (diabetes and/or heart disease) supposed to potentially interfere with (123) I-MIBG uptake. INTERPRETATION: (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy have similar sensitivity for detecting DLB, but the latter appears to be more specific for excluding non-DLB dementias, especially when parkinsonism is the only "core feature" exhibited by the patient. Our data also indicate that the potential confounding effects of diabetes and heart disease on (123) I-MIBG myocardial scintigraphy results might have been overestimated. Ann Neurol 2016;80:368-378.
OBJECTIVE: To compare the diagnostic value of striatal (123) I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ((123) I-FP-CIT) single photon emission computed tomography (SPECT) and (123) I-metaiodobenzylguanidine ((123) I-MIBG) myocardial scintigraphy in differentiating dementia with Lewy bodies (DLB) from other dementia types. METHODS: This prospective longitudinal study included 30 patients with a clinical diagnosis of DLB and 29 patients with non-DLB dementia (Alzheimer disease, n = 16; behavioral variant frontotemporal dementia, n = 13). All patients underwent (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy within a few weeks of clinical diagnosis. All diagnoses at each center were agreed upon by the local clinician and an independent expert, both unaware of imaging data, and re-evaluated after 12 months. Each image was visually classified as either normal or abnormal by 3 independent nuclear physicians blinded to patients' clinical data. RESULTS: Overall, sensitivity and specificity to DLB were respectively 93% and 100% for (123) I-MIBG myocardial scintigraphy, and 90% and 76% for (123) I-FP-CIT SPECT. Lower specificity of striatal compared to myocardial imaging was due to decreased (123) I-FP-CIT uptake in 7 non-DLB subjects (3 with concomitant parkinsonism) who had normal (123) I-MIBG myocardial uptake. Notably, in our non-DLB group, myocardial imaging gave no false-positive readings even in those subjects (n = 7) with concurrent medical illnesses (diabetes and/or heart disease) supposed to potentially interfere with (123) I-MIBG uptake. INTERPRETATION: (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy have similar sensitivity for detecting DLB, but the latter appears to be more specific for excluding non-DLB dementias, especially when parkinsonism is the only "core feature" exhibited by the patient. Our data also indicate that the potential confounding effects of diabetes and heart disease on (123) I-MIBG myocardial scintigraphy results might have been overestimated. Ann Neurol 2016;80:368-378.
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