Department of Molecular Medicine, Sapienza, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy.
Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy.
Curr Radiopharm. 2020;13(2):120-129. doi: 10.2174/1874471013666200127122033.
The use of 123I-mIBG has been approved for decades for Parkinson's disease (PD) diagnosis and as a predictor of mortality and potentially fatal events in patients with Heart Failure (HF). The standardized technique includes an early acquisition (15 minutes from injection), and a late acquisition (240 minutes). Early images mainly represent interstitial uptake, whereas delayed images represent actual neuronal uptake, however, it is reasonable to affirm that different pathological situations, such as PD and HF, imply a different meaning for early and late imaging.
This prospective study aims to investigate the clinical usefulness of an immediate planar 123I-mIBG image acquisition (5 minutes) both in patients with PD and in patients with HF.
115 patients referred to 123I-mIBG cardiac imaging in Nuclear Medicine Center have been enrolled (60 patients with PD, absence of diabetes and/or cardiologic pathology, Hoehn e Yahr classification ≤ 1.5; 55 patients with cardiomyopathy, diagnosis of HF, NYHA class I-III). 123I-mIBG planar anterior thoracic acquisitions were performed after 5 (immediate), 15 (early) and 240 (late) minutes from injection and H/M ratios were calculated.
In PD group H/M mean values resulted in 1.58±0.22 for immediate (5 min), 1.61±0.26 for early (15 min) and 1.59±0.37 for late (240 min) acquisitions. In the HF group, H/M mean values resulted in 1.63±0.24 for immediate (5 min), 1.65±0.22 for early (15 min) and 1.57±0.17 for late (240 min) acquisitions, respectively. H/M values obtained at 5 min and 15 min are provided similar results, with no statistical difference (p = ns) regardless of the pathology examined (PD or HF groups). The statistical analyses validated the diagnostic role of immediate acquisition (5 min) and early acquisition (15 min) in PD group as compared to the standardized late acquisition (240 min). On the contrary, in HF group, immediate and early acquisition, as compared to late acquisition (240 min), is not validated as a major cardiac events predictor.
Our results indicate the potential role of immediate (5 min) or early (15 min) acquisition in replacement of standardized 240 minutes acquisition in PD patients, but this result is not confirmed in HF patients, in which the acquisition at 240 min is confirmed as the most affordable timing for image interpretation, emphasizing the different pathophysiology that underlies these two pathologies.
123I-mIBG 的使用已被批准用于诊断帕金森病（PD）数十年，并且可以预测心力衰竭（HF）患者的死亡率和潜在致命事件。标准化技术包括早期采集（注射后 15 分钟）和晚期采集（240 分钟）。早期图像主要代表间质摄取，而延迟图像代表实际的神经元摄取，但是，可以肯定的是，不同的病理情况，例如 PD 和 HF，对早期和晚期成像有不同的意义。
本前瞻性研究旨在研究立即进行 123I-mIBG 平面图像采集（5 分钟）在 PD 患者和 HF 患者中的临床用途。
核医学中心对 115 例接受 123I-mIBG 心脏成像的患者进行了研究（60 例 PD 患者，无糖尿病和/或心脏病史，Hoehn e Yahr 分类≤1.5；55 例心肌病患者，诊断为 HF，NYHA 分级 I-III）。在注射后 5（立即），15（早期）和 240（晚期）分钟进行 123I-mIBG 平面前胸部采集，并计算 H/M 比值。
PD 组的 H/M 平均值分别为 1.58±0.22（立即，5 分钟），1.61±0.26（早期，15 分钟）和 1.59±0.37（晚期，240 分钟）。HF 组的 H/M 平均值分别为 1.63±0.24（立即，5 分钟），1.65±0.22（早期，15 分钟）和 1.57±0.17（晚期，240 分钟）。无论检查的病理学如何（PD 组或 HF 组），5 分钟和 15 分钟获得的 H/M 值均提供相似的结果，无统计学差异（p = ns）。统计分析验证了立即采集（5 分钟）和早期采集（15 分钟）在 PD 组中替代标准化 240 分钟采集的诊断作用。相反，在 HF 组中，立即和早期采集与晚期采集（240 分钟）相比，不能作为主要心脏事件预测指标。
我们的结果表明，在 PD 患者中，立即（5 分钟）或早期（15 分钟）采集可能替代标准化的 240 分钟采集，但这一结果在 HF 患者中未得到证实，在 HF 患者中，240 分钟的采集被证实是最适合图像解释的时间，强调了这两种病理学背后的不同病理生理学。
