Value of MIBG in the Differential Diagnosis of Neurodegenerative Disorders

Abstract

123I-Metaiodobenzylguanidine (MIBG) has a history of 30 years as a marker of myocardial sympathetic activity and has been used for assessment of various cardiac diseases. Reduced cardiac MIBG uptake in myocardial scintigraphy has been reported in patients with Parkinson's disease (PD), dementia with Lewy bodies (DLB), pure autonomic failure (PAF), rapid eye movement sleep behavior disorder (RBD), and familial PD linked to SNCA duplication. In 2005, the Dementia with Lewy Bodies Consortium considered 123I-MIBG myocardial scintigraphy a "supportive" diagnostic tool. Recently, reliable and clear evidence for the usefulness of 123I-MIBG scintigraphy in the diagnosis of Lewy body disorders has been accumulated, and it has become increasingly popular, whereas reduction of cardiac MIBG accumulation was reported in some cases of atypical parkinsonian syndromes such as progressive supranuclear palsy and multiple system atrophy. In 123I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropan (FP-CIT) SPECT-supplemented MIBG scintigraphy of PD and DLB, FP-CIT binding in basal ganglia is closely related to cardiac MIBG uptake. Based on the high diagnostic specificity in our multicenter study with standardized techniques, weighting of 123I-MIBG myocardial scintigraphy was upgraded in the revised criteria for the clinical diagnosis of DLB.