Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Radiology, Chiba University Hospital, Chiba, Japan.
J Alzheimers Dis. 2024;100(1):127-137. doi: 10.3233/JAD-231395.
Dementia with Lewy bodies (DLB) presents with various symptoms, posing challenges for early diagnosis challenging. Dopamine transporter (123I-FP-CIT) single-photon emission tomography (SPECT) and 123I-meta-iodobenzylguanidine (123I-MIBG) imaging are crucial diagnostic biomarkers. Hypothesis about body- and brain-first subtypes of DLB indicate that some DLB may show normal 123I-FP-CIT or 123I-MIBG results; but the characteristic expression of these two subtypes remains unclear.
This study aimed to evaluate the diagnostic sensitivity of 123I-FP-CIT and 123I-MIBG imaging alone, combined in patients with DLB and explore symptoms associated with the abnormal imaging results.
Demographic data, clinical status, and imaging results were retrospectively collected from patients diagnosed with possible DLB. Both images were quantified using semi-automated software, and the sensitivity of each imaging modality and their combination was calculated. Demographic data, cognition, and motor and non-motor symptoms were compared among the subgroups based on the imaging results. Symptoms related to each imaging abnormality were examined using binomial logistic regression analyses.
Among 114 patients with DLB, 80 underwent 123I-FP-CIT SPECT (sensitivity: 80.3%), 83 underwent 123I-MIBG imaging (68.2%), and 66 both (sensitivity of either abnormal result: 93.9%). Visual hallucinations differed among the four subgroups based on imaging results. Additionally, nocturia and orthostatic hypotension differed between abnormal and normal 123I-MIBG images.
Overall, 123I-FP-CIT SPECT was slightly higher sensitivity than 123I-MIBG imaging, with combined imaging increasing diagnostic sensitivity. Normal results of a single imaging test may not refute DLB. Autonomic symptoms may lead to abnormal 123I-MIBG scintigraphy findings indicating body-first subtype of patients with DLB.
路易体痴呆（DLB）表现出多种症状，这对早期诊断构成了挑战。多巴胺转运体（123I-FP-CIT）单光子发射断层扫描（SPECT）和 123I-间碘苄胍（123I-MIBG）成像，是至关重要的诊断生物标志物。关于 DLB 的躯体和脑先型亚型的假说表明，一些 DLB 可能表现出正常的 123I-FP-CIT 或 123I-MIBG 结果；但这两种亚型的特征性表现仍不清楚。
本研究旨在评估 123I-FP-CIT 和 123I-MIBG 成像单独及联合应用于 DLB 患者的诊断灵敏度，并探讨与异常影像结果相关的症状。
回顾性收集了经诊断为可能的 DLB 患者的人口统计学数据、临床状况和影像结果。使用半自动软件对两种图像进行定量，计算每种成像方式及其组合的灵敏度。根据影像结果，比较各亚组的人口统计学数据、认知、运动和非运动症状。使用二项逻辑回归分析检查与每种影像异常相关的症状。
在 114 例 DLB 患者中，80 例行 123I-FP-CIT SPECT（灵敏度：80.3%），83 例行 123I-MIBG 成像（灵敏度：68.2%），66 例行两种检查（任一异常结果的灵敏度：93.9%）。根据影像结果，四亚组间存在视觉幻觉差异。此外，夜尿症和直立性低血压在 123I-MIBG 影像异常和正常之间存在差异。
总体而言，123I-FP-CIT SPECT 的灵敏度略高于 123I-MIBG 成像，联合成像可提高诊断灵敏度。单一影像检查结果正常并不能排除 DLB。自主症状可能导致 123I-MIBG 闪烁显像异常，提示 DLB 患者存在躯体先型亚型。
