Estorch Montserrat, Camacho Valle, Paredes Pilar, Rivera Elisabet, Rodríguez-Revuelto Ato, Flotats Albert, Kulisevsky Jaume, Carrio Ignasi
Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, C. Sant Antoni M. Claret 167, Barcelona, Spain.
Eur J Nucl Med Mol Imaging. 2008 Sep;35(9):1636-41. doi: 10.1007/s00259-008-0828-8. Epub 2008 May 29.
Differential diagnosis between dementia with Lewy bodies (DLB) and other neurodegenerative diseases with cognitive impairment represents a clinical challenge. Due to the overlapping of symptoms, the clinical diagnosis can be modified during the prolonged follow-up of these diseases. The purpose of this study was to assess the ability of cardiac metaiodobenzylguanidine (MIBG) imaging for early identification of DLB.
Since January 2003, all patients with neurodegenerative diseases with cognitive impairment at their first visit at the Memory Unit and clinical criteria of DLB were consecutively recruited and underwent a cardiac (123)I-MIBG study. The heart-to-mediastinum ratio (HMR) and the washout rate (WR) of cardiac MIBG uptake were obtained.
Sixty-five patients were included. After a clinical follow-up of 4 years, the progress of the disease procured a definite diagnosis in 44 (68%) patients: 19 DLB, 12 Alzheimer disease (AD), and 13 other neurodegenerative diseases with cognitive impairment. HMR was significantly decreased in DLB with respect to the other neurodegenerative diseases. WR was only significantly different between DLB and AD. The HMR cut off point of 1.36 differentiated DLB from the other dementias with a sensitivity of 94% and a specificity of 96% with an accuracy of 95%.
Cardiac MIBG imaging performed at the time of the first clinical diagnosis of DLB can help early clinical identification or exclusion of this disease.
路易体痴呆（DLB）与其他伴有认知障碍的神经退行性疾病之间的鉴别诊断是一项临床挑战。由于症状重叠，这些疾病在长期随访过程中临床诊断可能会发生改变。本研究的目的是评估心脏间碘苄胍（MIBG）显像对DLB早期识别的能力。
自2003年1月起，连续招募所有首次就诊于记忆门诊且符合DLB临床标准的伴有认知障碍的神经退行性疾病患者，并进行心脏（123）I-MIBG检查。获取心脏MIBG摄取的心脏与纵隔比值（HMR）和洗脱率（WR）。
纳入65例患者。经过4年的临床随访，44例（68%）患者的病情进展获得了明确诊断：19例DLB，12例阿尔茨海默病（AD），13例其他伴有认知障碍的神经退行性疾病。与其他神经退行性疾病相比，DLB患者的HMR显著降低。WR仅在DLB和AD之间存在显著差异。HMR截断点为1.36时，区分DLB与其他痴呆的敏感性为94%，特异性为96%，准确性为95%。
在首次临床诊断DLB时进行心脏MIBG显像有助于早期临床识别或排除该病。
