Diagnostic Accuracy of 123I-Meta-Iodobenzylguanidine Myocardial Scintigraphy in Dementia with Lewy Bodies: A Multicenter Study

被引：102

作者：

Yoshita, Mitsuhiro ^{[1
,2
]}

Arai, Heii ^{[3
]}

Arai, Hiroyuki ^{[4
]}

Arai, Tetsuaki ^{[5
]}

Asada, Takashi ^{[5
]}

Fujishiro, Hiroshige ^{[6
]}

Hanyu, Haruo ^{[7
]}

Iizuka, Osamu ^{[8
]}

Iseki, Eizo ^{[6
]}

Kashihara, Kenichi ^{[9
]}

Kosaka, Kenji ^{[10
]}

Maruno, Hirotaka ^{[11
]}

Mizukami, Katsuyoshi ^{[12
]}

Mizuno, Yoshikuni ^{[13
]}

Mori, Etsuro ^{[8
]}

Nakajima, Kenichi ^{[14
]}

Nakamura, Hiroyuki ^{[15
]}

Nakano, Seigo ^{[16
]}

Nakashima, Kenji ^{[17
]}

Nishio, Yoshiyuki ^{[8
]}

Orimo, Satoshi ^{[18
]}

Samuraki, Miharu ^{[1
]}

Takahashi, Akira ^{[19
]}

Taki, Junichi ^{[14
]}

Tokuda, Takahiko ^{[20
]}

Urakami, Katsuya ^{[21
]}

Utsumi, Kumiko ^{[22
]}

Wada, Kenji ^{[17
]}

Washimi, Yukihiko ^{[23
]}

Yamasaki, Junichi ^{[24
]}

Yamashina, Shouhei ^{[24
]}

Yamada, Masahito ^{[1
]}

机构：

[1] Kanazawa Univ, Dept Neurol & Neurobiol Aging, Grad Sch Med Sci, Kanazawa, Ishikawa 9208640, Japan

[2] Hokuriku Natl Hosp, Dept Neurol, Nanto, Toyama 9391893, Japan

[3] Juntendo Univ, Sch Med, Dept Psychiat, Bunkyo Ku, Tokyo 1138431, Japan

[4] Tohoku Univ, Inst Dev Aging & Canc, Sendai, Miyagi 9808575, Japan

[5] Univ Tsukuba, Inst Clin Med, Dept Neuropsychiat, Tsukuba, Ibaraki 3058576, Japan

[6] Juntendo Univ, Sch Med, PET CT Dementia Res Ctr, Juntendo Tokyo Koto Geriatr Med Ctr,Koto Ku, Tokyo 1360075, Japan

[7] Tokyo Med Univ, Dept Geriatr Med, Shinjuku Ku, Tokyo 1600023, Japan

[8] Tohoku Univ, Dept Behav Neurol & Cognit Neurosci, Grad Sch Med, Sendai, Miyagi 9808575, Japan

[9] Okayama Kyokuto Hosp, Dept Neurol, Okayama 7038265, Japan

[10] Med Care Court Clin, Yokohama, Kanagawa 2250014, Japan

[11] Toranomon Gen Hosp, Dept Radiol, Minato Ku, Tokyo 1058470, Japan

[12] Univ Tsukuba, Grad Sch Comprehens Human Sci, Bunkyo Ku, Tokyo 1120012, Japan

[13] Kitasato Univ, Div Neurogenerat Med, Dept Neurol, Sch Med, Sagamihara, Kanagawa 2520374, Japan

[14] Kanazawa Univ Hosp, Dept Nucl Med, Kanazawa, Ishikawa 9208640, Japan

[15] Kanazawa Univ, Grad Sch Med Sci, Dept Environm & Prevent Med, Kanazawa, Ishikawa 9208640, Japan

[16] Med Co LTA, Ctr Treatment Care & Res Dementia, Sumida Ku, Tokyo 1300004, Japan

[17] Tottori Univ, Fac Med, Div Neurol, Dept Brain & Neurosci, Yonago, Tottori 6838504, Japan

[18] Mutual Aid Assoc Publ Sch Teachers, Dept Neurol, Kanto Cent Hosp, Tokyo 1588531, Japan

[19] Tokai Cent Hosp, Kakamigahara, Gifu 5040816, Japan

[20] Kyoto Prefectural Univ Med, Grad Sch Med Sci, Dept Mol Pathobiol Brain Dis, Kyoto 6020841, Japan

[21] Tottori Univ, Sch Hlth Sci, Fac Med, Dept Regulat Biol, Yonago, Tottori 6838503, Japan

[22] Sunagawa City Med Ctr, Dept Neuropsychiat, Sunagawa, Hokkaido 0730196, Japan

[23] Hosp Natl Ctr Geriatr & Gerontol, Dept Cognit Disorders, Obu, Aichi 4748511, Japan

[24] Toho Univ, Ohmori Hosp, Div Cardiovasc Med, Dept Internal Med,Sch Med, Ota, Tokyo 1438541, Japan

来源：

PLOS ONE | 2015年 / 10卷 / 03期

关键词：

ALZHEIMERS-DISEASE; DIFFERENTIAL-DIAGNOSIS; PARKINSONS-DISEASE; CLINICAL-DIAGNOSIS; SENILE DEMENTIA; BODY TYPE; FP-CIT; DLB; CARDIOMYOPATHY; CONSORTIUM;

D O I：

10.1371/journal.pone.0120540

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background and Purpose Dementia with Lewy bodies (DLB) needs to be distinguished from Alzheimer's disease (AD) because of important differences in patient management and outcome. Severe cardiac sympathetic degeneration occurs in DLB, but not in AD, offering a potential system for a biological diagnostic marker. The primary aim of this study was to investigate the diagnostic accuracy, in the ante-mortem differentiation of probable DLB from probable AD, of cardiac imaging with the ligand I-123-meta-iodobenzylguanidine (MIBG) which binds to the noradrenaline reuptake site, in the first multicenter study. Methods We performed a multicenter study in which we used I-123-MIBG scans to assess 133 patients with clinical diagnoses of probable (n = 61) or possible (n = 26) DLB or probable AD (n = 46) established by a consensus panel. Three readers, unaware of the clinical diagnosis, classified the images as either normal or abnormal by visual inspection. The heart-to-mediastinum ratios of I-123-MIBG uptake were also calculated using an automated region-of-interest based system. Results Using the heart-to-mediastinum ratio calculated with the automated system, the sensitivity was 68.9% and the specificity was 89.1% to differentiate probable DLB from probable AD in both early and delayed images. By visual assessment, the sensitivity and specificity were 68.9% and 87.0%, respectively. In a subpopulation of patients with mild dementia (MMSE >= 22, n = 47), the sensitivity and specificity were 77.4% and 93.8%, respectively, with the delayed heart-to-mediastinum ratio. Conclusions Our first multicenter study confirmed the high correlation between abnormal cardiac sympathetic activity evaluated with I-123-MIBG myocardial scintigraphy and a clinical diagnosis of probable DLB. The diagnostic accuracy is sufficiently high for this technique to be clinically useful in distinguishing DLB from AD, especially in patients with mild dementia.

引用

页数：13

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