Comparison of I-123 MIBG planar imaging and SPECT for the detection of decreased heart uptake in Parkinson disease

Decreased myocardial uptake of I-123 metaiodobenzylguanidine (MIBG) is an important finding for diagnosis of Parkinson's disease (PD). This study compared I-123 MIBG SPECT and planar imaging with regard to their diagnostic yield for PD. 52 clinically diagnosed PD patients who also had decreased striatal uptake on FP-CIT PET/CT were enrolled. 16 normal controls were also included. All underwent cardiac MIBG planar scintigraphy and SPECT separately. Myocardial I-123 MIBG uptake was interpreted on planar and SPECT/CT images separately by visual and quantitative analysis. The final diagnosis was made by consensus between two readers. Kappa analyses were performed to determine inter-observer agreement for both methods. Sensitivity, specificity, and accuracy were compared with McNemar's test. The sensitivity, specificity, and accuracy were 84.6, 100, and 88.2 % for planar images and 96.2, 100 and 97.1 % for SPECT, respectively, with a significant difference between the two imaging methods (p < 0.031). All inter-observer agreements were almost perfect (planar scintigraphy: kappa = 0.82; SPECT: kappa = 0.93). Heart-to-mediastinum ratios from PD patients with negative planar and positive SPECT scans (group A) and patients with positive planar and positive SPECT scans (group B) were 1.69 +/- 0.16 (1.59-1.85) and 1.41 +/- 0.15 (1.20-1.53), respectively, and showed significant difference (p = 0.023). Lung-to-mediastinum ratios for groups A and B were 2.16 +/- 0.20 (1.96-2.37) and 1.6 +/- 0.19 (1.3-1.78), respectively, and were significantly higher in the former (p = 0.001). I-123 MIBG SPECT has a significantly higher diagnostic performance for PD than planar images. Increased lung uptake may cause false-negative results on planar imaging.