Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
J Neurol Neurosurg Psychiatry. 2018 Nov;89(11):1167-1173. doi: 10.1136/jnnp-2017-317398. Epub 2018 May 31.
We previously reported the usefulness of iodine-123 metaiodobenzylguanidine (I-MIBG) myocardial scintigraphy for differentiation of dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) in a cross-sectional multicentre study. The aim of this study was, by using reassessed diagnosis after 3-year follow-up, to evaluate the diagnostic accuracy of I-MIBG scintigraphy in differentiation of probable DLB from probable AD.
We undertook 3-year follow-up of 133 patients with probable or possible DLB or probable AD who had undergone I-MIBG myocardial scintigraphy at baseline. An independent consensus panel made final diagnosis at 3-year follow-up. Based on the final diagnosis, we re-evaluated the diagnostic accuracy of I-MIBG scintigraphy performed at baseline.
Sixty-five patients completed 3-year follow-up assessment. The final diagnoses were probable DLB (n=30), possible DLB (n=3) and probably AD (n=31), and depression (n=1). With a receiver operating characteristic curve analysis of heart-to-mediastinum (H/M) ratios for differentiating probable DLB from probable AD, the sensitivity/specificity were 0.77/0.94 for early images using 2.51 as the threshold of early H/M ratio, and 0.77/0.97 for delayed images using 2.20 as the threshold of delayed H/M ratio. Five of six patients who were diagnosed with possible DLB at baseline and with probable DLB at follow-up had low H/M ratio at baseline.
Our follow-up study confirmed high correlation between abnormal cardiac sympathetic activity evaluated with I-MIBG myocardial scintigraphy at baseline and the clinical diagnosis of probable DLB at 3-year follow-up. Its diagnostic usefulness in early stage of DLB was suggested.
UMIN00003419.
我们曾在一项横断面多中心研究中报道碘-123 间碘苄胍（I-MIBG）心肌闪烁显像术对于鉴别路易体痴呆（DLB）与阿尔茨海默病（AD）的有用性。本研究的目的是通过对 3 年随访后的重新评估诊断，评估 I-MIBG 闪烁显像术对鉴别可能的 DLB 与可能的 AD 的诊断准确性。
我们对基线时接受 I-MIBG 心肌闪烁显像术的 133 例可能或可能的 DLB 或可能的 AD 患者进行了 3 年随访。一个独立的共识小组在 3 年随访时做出最终诊断。根据最终诊断，我们重新评估了基线时进行的 I-MIBG 闪烁显像术的诊断准确性。
65 例患者完成了 3 年随访评估。最终诊断为可能的 DLB（n=30）、可能的 DLB（n=3）和可能的 AD（n=31）以及抑郁（n=1）。使用区分可能的 DLB 与可能的 AD 的心脏与纵隔（H/M）比值的受试者工作特征曲线分析，早期图像的敏感性/特异性为 2.51 作为早期 H/M 比值阈值时为 0.77/0.94，延迟图像的敏感性/特异性为 2.20 作为延迟 H/M 比值阈值时为 0.77/0.97。基线时诊断为可能的 DLB 且随访时诊断为可能的 DLB 的 6 例患者中的 5 例基线时 H/M 比值较低。
我们的随访研究证实了基线时用 I-MIBG 心肌闪烁显像术评估的异常心脏自主神经活性与 3 年随访时的可能的 DLB 临床诊断之间的高度相关性。提示其在 DLB 的早期阶段具有诊断价值。
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