Yoshita Mitsuhiro, Arai Heii, Arai Hiroyuki, Arai Tetsuaki, Asada Takashi, Fujishiro Hiroshige, Hanyu Haruo, Iizuka Osamu, Iseki Eizo, Kashihara Kenichi, Kosaka Kenji, Maruno Hirotaka, Mizukami Katsuyoshi, Mizuno Yoshikuni, Mori Etsuro, Nakajima Kenichi, Nakamura Hiroyuki, Nakano Seigo, Nakashima Kenji, Nishio Yoshiyuki, Orimo Satoshi, Samuraki Miharu, Takahashi Akira, Taki Junichi, Tokuda Takahiko, Urakami Katsuya, Utsumi Kumiko, Wada Kenji, Washimi Yukihiko, Yamasaki Junichi, Yamashina Shouhei, Yamada Masahito
Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8640, Japan; Department of Neurology, Hokuriku National Hospital, Nanto, Toyama 939-1893, Japan.
Department of Psychiatry, Juntendo University School of Medicine, Bunkyo, Tokyo 113-8431, Japan.
PLoS One. 2015 Mar 20;10(3):e0120540. doi: 10.1371/journal.pone.0120540. eCollection 2015.
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.
路易体痴呆（DLB）需要与阿尔茨海默病（AD）相鉴别，因为在患者管理和预后方面存在重要差异。严重的心脏交感神经退变发生在DLB中，而不在AD中，这为生物诊断标志物提供了一个潜在系统。本研究的主要目的是在第一项多中心研究中，调查使用与去甲肾上腺素再摄取位点结合的配体123I-间碘苄胍（MIBG）进行心脏成像在生前鉴别可能的DLB与可能的AD中的诊断准确性。
我们进行了一项多中心研究，使用123I-MIBG扫描评估133例经共识小组确定临床诊断为可能（n = 61）或可能（n = 26）的DLB或可能的AD（n = 46）的患者。三位不知临床诊断的阅片者通过视觉检查将图像分类为正常或异常。还使用基于自动感兴趣区域的系统计算123I-MIBG摄取的心脏与纵隔比值。
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鉴别可能的DLB与可能的AD时，敏感性为68.9%，特异性为89.1%。通过视觉评估，敏感性和特异性分别为68.9%和87.0%。在轻度痴呆患者亚组（MMSE≥22，n = 47）中，延迟心脏与纵隔比值的敏感性和特异性分别为77.4%和93.8%。
我们的第一项多中心研究证实了用123I-MIBG心肌闪烁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。该技术的诊断准确性足够高，在临床上有助于区分DLB与AD，尤其是在轻度痴呆患者中。
