Shimizu Soichiro, Hirao Kentaro, Kanetaka Hidekazu, Namioka Nayuta, Hatanaka Hirokuni, Hirose Daisuke, Fukasawa Raita, Umahara Takahiko, Sakurai Hirohumi, Hanyu Haruo
Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Eur J Nucl Med Mol Imaging. 2016 Jan;43(1):184-192. doi: 10.1007/s00259-015-3146-y. Epub 2015 Aug 2.
(123)I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ((123)I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT SPECT) and (123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy can be used to assist in the diagnosis of patients with dementia with Lewy bodies (DLB). We compared the diagnostic value of these two methods in differentiating DLB from Alzheimer's disease (AD). Furthermore, we evaluated whether a combination of DAT SPECT and MIBG myocardial scintigraphy would provide a more useful means of differentiating between DLB and AD.
Patients with AD (n = 57) and patients with DLB (n = 76) who underwent both DAT SPECT and MIBG myocardial scintigraphy were enrolled. The sensitivity, specificity, and accuracy of both methods as well as their combination for differentiating DLB from AD were calculated. Moreover, we examined whether symptoms of the patients with DLB were associated with the patterns of the abnormalities displayed on DAT SPECT and MIBG myocardial scintigraphy.
The sensitivity and specificity of differentiating DLB from AD were 72.4 and 94.4 % by the heart to mediastinum ratio of MIBG uptake, 88.2 and 88.9 % by the specific binding ratio on DAT SPECT, and 96.1 and 90.7 % by their combination, respectively. The combined use of DAT SPECT and MIBG myocardial scintigraphy enabled more accurate differentiation between DLB and AD compared with either DAT SPECT or MIBG myocardial scintigraphy alone. There was a significantly higher frequency of parkinsonism in the abnormal DAT SPECT group than the normal DAT SPECT group. On the other hand, there was a higher frequency of the appearance of rapid eye movement (REM) sleep behavior disorder in the abnormal MIBG uptake group than the normal MIBG uptake group.
These results suggested that using a combination of these scintigraphic methods is a useful and practical approach to differentiate DLB from AD.
123I-2β-甲氧基羰基-3β-（4-碘苯基）-N-（3-氟丙基）去甲托烷（（123）I-FP-CIT）多巴胺转运体单光子发射计算机断层扫描（DAT SPECT）和123I-间碘苄胍（MIBG）心肌闪烁显像可用于协助诊断路易体痴呆（DLB）患者。我们比较了这两种方法在鉴别DLB与阿尔茨海默病（AD）方面的诊断价值。此外，我们评估了DAT SPECT和MIBG心肌闪烁显像联合使用是否能提供一种更有效的鉴别DLB和AD的方法。
纳入同时接受DAT SPECT和MIBG心肌闪烁显像的AD患者（n = 57）和DLB患者（n = 76）。计算两种方法及其联合使用在鉴别DLB与AD方面的敏感性、特异性和准确性。此外，我们检查了DLB患者的症状是否与DAT SPECT和MIBG心肌闪烁显像显示的异常模式相关。
通过MIBG摄取的心脏与纵隔比值鉴别DLB与AD的敏感性和特异性分别为72.4%和94.4%，通过DAT SPECT上的特异性结合率分别为88.2%和88.9%，通过两者联合使用分别为96.1%和90.7%。与单独使用DAT SPECT或MIBG心肌闪烁显像相比，DAT SPECT和MIBG心肌闪烁显像联合使用能更准确地鉴别DLB和AD。异常DAT SPECT组帕金森综合征的发生率显著高于正常DAT SPECT组。另一方面，异常MIBG摄取组快速眼动（REM）睡眠行为障碍的出现频率高于正常MIBG摄取组。
这些结果表明，联合使用这些闪烁显像方法是鉴别DLB与AD的一种有用且实用的方法。
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