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Meta-analysis of 123I-MIBG cardiac scintigraphy for the diagnosis of Lewy body–related disorders§

Authors

  • Alisha E. King MD,

    1. Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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  • Jim Mintz PhD,

    1. Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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  • Donald R. Royall MD

    Corresponding author
    1. Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
    2. Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
    3. Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
    4. Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
    5. South Texas Veterans' Health System Audie L. Murphy Division GRECC, San Antonio, Texas, USA
    • Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7792, USA

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  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • This study has been supported by the estate of Julia and Van Buren Parr.

  • §

    Full financial disclosures and author roles may be found in the online version of this article.

Abstract

Patients with parkinsonism pose a diagnostic challenge. Parkinson's disease may be difficult to distinguish from multiple system atrophy and progressive supranuclear palsy, whereas Parkinson's disease and dementia with Lewy bodies can be difficult to distinguish from Alzheimer's disease and other dementias. A number of studies have found diminished cardiac 123I-metaiodobenzylguanidine uptake in Lewy body–related conditions (Parkinson's disease and Lewy body dementia). In 2005, the Dementia With Lewy Bodies Consortium considered 123I-metaiodobenzylguanidine cardiac scintigraphy a “supportive” diagnostic feature, based on limited evidence. We report a meta-analysis of the literature and an assessment of the utility of 123I-metaiodobenzylguanidine for the diagnosis of dementia with Lewy bodies and Parkinson's disease. A search was conducted of articles published between 1950 and June 2010. Forty-six studies involving neuropsychiatric and movement disorders, comprising 2680 subjects, were included in the analysis. A mixed-effects regression model was used to analyze the delayed mean heart-to-mediastinum ratio of 123I-metaiodobenzylguanidine uptake. 123I-metaiodobenzylguanidine cardiac scintigraphy sensitively detected and specifically distinguished 2 diagnostic clusters: (1) Parkinson's disease, dementia with Lewy bodies, and rapid eye movement sleep behavior disorder; and (2) normal controls and patients with Alzheimer's disease, multiple system atrophy, progressive supranuclear palsy, vascular dementia, and frontotemporal dementia. The area under the receiver operating characteristic curve was 0.987 at a cluster discriminatory heart-to-mediastinum ratio threshold of 1.77. This threshold yielded 94% sensitivity and 91% specificity for the discrimination of these diagnostic clusters. 123I-metaiodobenzylguanidine cardiac scintigraphy can accurately distinguish between 2 movement disorders, Parkinson's disease and multiple system atrophy, and between 2 common causes of dementia, Alzheimer's disease and dementia with Lewy bodies. © 2011 Movement Disorder Society

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