Diagnostic accuracy of 123I-meta-iodobenzylguanidine myocardial scintigraphy in dementia with Lewy bodies: a multicenter study.
Diagnostic accuracy of 123I-meta-iodobenzylguanidine myocardial scintigraphy in dementia with Lewy bodies: a multicenter study.
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DOI：
10.1371/journal.pone.0120540
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Yamada M
中科院分区：
文献类型：
--
作者：
Yoshita M;Arai H;Arai H;Arai T;Asada T;Fujishiro H;Hanyu H;Iizuka O;Iseki E;Kashihara K;Kosaka K;Maruno H;Mizukami K;Mizuno Y;Mori E;Nakajima K;Nakamura H;Nakano S;Nakashima K;Nishio Y;Orimo S;Samuraki M;Takahashi A;Taki J;Tokuda T;Urakami K;Utsumi K;Wada K;Washimi Y;Yamasaki J;Yamashina S;Yamada M
由于患者管理和预后的重要差异，需要将路易体痴呆（DLB）与阿尔茨海默病（AD）区分开来。严重的心脏交感退行性变发生在DLB中，但在AD中没有，这为生物诊断标记提供了一个潜在的系统。本研究的主要目的是在第一项多中心研究中，通过与去甲肾上腺素再摄取部位结合的配体123i -间碘苄基胍（MIBG）进行心脏成像，在死前鉴别可能的DLB和可能的AD的诊断准确性。我们进行了一项多中心研究，我们使用123I-MIBG扫描评估了133例临床诊断为可能（n = 61）或可能（n = 26） DLB或可能AD （n = 46）的患者，这些患者由共识小组确定。三个读者，不知道临床诊断，分类图像正常或不正常的视觉检查。心脏与纵隔的123I-MIBG摄取比率也使用基于兴趣区域的自动系统计算。使用自动系统计算的心脏与纵隔比值，在早期和延迟图像中区分可能的DLB和可能的AD的敏感性为68.9%，特异性为89.1%。目测灵敏度为68.9%，特异性为87.0%。在轻度痴呆患者亚群（MMSE≥22,n = 47）中，心脏与纵隔比值延迟的敏感性和特异性分别为77.4%和93.8%。我们的第一个多中心研究证实了用123I-MIBG心肌显像评估的异常心脏交感神经活动与可能的DLB临床诊断之间的高度相关性。诊断准确性足够高，因此该技术在临床上用于区分DLB和AD，特别是在轻度痴呆患者中。
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 123I-meta-iodobenzylguanidine (MIBG) which binds to the noradrenaline reuptake site, in the first multicenter study. We performed a multicenter study in which we used 123I-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 123I-MIBG uptake were also calculated using an automated region-of-interest based system. 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. Our first multicenter study confirmed the high correlation between abnormal cardiac sympathetic activity evaluated with 123I-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.
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