Alterations of left ventricular deformation and cardiac sympathetic derangement in patients with systolic heart failure: a 3D speckle tracking echocardiography and cardiac {sup 123}I-MIBG study

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Leosco, Dario; Parisi, Valentina; Pagano, Gennaro; Femminella, Grazia Daniela; Bevilacqua, Agnese; Formisano, Roberto; Ferro, Gaetana; De Lucia, Claudio; Ferrara, Nicola [University Federico II, Department of Translational Medical Science, Naples (Italy); Pellegrino, Teresa [Italian National Research Council (CNR), Institute of Biostructure and Bioimaging, Naples (Italy); University Federico II, Department of Advanced Biomedical Science, Naples (Italy); Paolillo, Stefania [University Federico II, Department of Advanced Biomedical Science, Naples (Italy); SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples (Italy); Prastaro, Maria; Filardi, Pasquale Perrone; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Science, Naples (Italy); Rengo, Giuseppe [University Federico II, Department of Translational Medical Science, Naples (Italy); Salvatore Maugeri Foundation, IRCCS, Istituto di Telese, Benevento, BN (Italy)

2015-09-15

Myocardial contractile function is under the control of cardiac sympathetic activity. Three-dimensional speckle tracking echocardiography (3D-STE) and cardiac imaging with {sup 123}I-metaiodobenzylguanidine ({sup 123}I-MIBG) are two sophisticated techniques for the assessment of left ventricular (LV) deformation and sympathetic innervation, respectively, which offer important prognostic information in patients with heart failure (HF). The purpose of this investigation was to explore, in patients with systolic HF, the relationship between LV deformation assessed by 3D-STE and cardiac sympathetic derangement evaluated by {sup 123}I-MIBG imaging. We prospectively studied 75 patients with systolic HF. All patients underwent a 3D-STE study (longitudinal, circumferential, area and radial) and {sup 123}I-MIBG planar and SPECT cardiac imaging. 3D-STE longitudinal, circumferential and area strain values were correlated with {sup 123}I-MIBG late heart to mediastinum (H/M) ratio and late SPECT total defect score. After stratification of the patients according to ischaemic or nonischaemic HF aetiology, we observed a good correlation of all 3D-STE measurements with late H/M ratio and SPECT data in the ischaemic group, but in patients with HF of nonischaemic aetiology, no correlation was found between LV deformation and cardiac sympathetic activity. At the regional level, the strongest correlation between LV deformation and adrenergic innervation was found for the left anterior descending coronary artery distribution territory for all four 3D-STE values. In multivariate linear regression analyses, including age, gender, LV ejection fraction, NYHA class, body mass index, heart rate and HF aetiology, only 3D-STE area and radial strain values significantly predicted cardiac sympathetic derangement on {sup 123}I-MIBG late SPECT. This study indicated that 3D-STE measurements are correlated with {sup 123}I-MIBG planar and SPECT data. Furthermore, 3D-STE area and radial strain values

Evaluation of the sympathetic nervous system in silent ischemia with 123I-metaiodobenzylguanidine (MIBG)

International Nuclear Information System (INIS)

Guertner, C.; Schacherer, C.; Krause, B.J.; Zickmann, J.; Klepzig, H. Jr.; Hoer, G.

1996-01-01

Stress and rest myocardial perfusion scintigraphy using either Thallium-201 or 99m Tc-isonitrile was performed in SPECT technique in order to localize ischemia or scar associated perfusion defects. 15 min and 4 h p.i. static anterior 123 I-MIBG uptake was acquired. In order to localize norepinephrine depletion 4 h p.i. additional 123 I-MIBG SPECT acquistion was performed. Incidence of arrhythmias was investigated by Holter ECG. Patients with diabetes mellitus were excluded. SPECT images showed in all patients regional 123 I-MIBG depletion which corresponded with scintigraphically infarcted or ischemic regions. Well perfused myocardial regions matched with regular 123 I-MIBG utpake. There was no evidence of increased arrhythmias in long-term ECG. The finding of regular 123 I-MIBG uptake in well-perfused myocardium and infarction- or ischemia-associated regional 123 I-MIBG depletion confirms that silent ischemia is not caused by a global sympathetic nervous dysfunction in a sense of cardiac polyneuropathy. (orig.) [de

Cardiac sympathetic innervation assessed with (123)I-MIBG retains prognostic utility in diabetic patients with severe left ventricular dysfunction evaluated for primary prevention implantable cardioverter-defibrillator.

Science.gov (United States)

García-González, P; Fabregat-Andrés, Ó; Cozar-Santiago, P; Sánchez-Jurado, R; Estornell-Erill, J; Valle-Muñoz, A; Quesada-Dorador, A; Payá-Serrano, R; Ferrer-Rebolleda, J; Ridocci-Soriano, F

2016-01-01

Scintigraphy with iodine-123-metaiodobenzylguanidine ((123)I-MIBG) is a non-invasive tool for the assessment of cardiac sympathetic innervation (CSI) that has proven to be an independent predictor of survival. Recent studies have shown that diabetic patients with heart failure (HF) have a higher deterioration in CSI. It is unknown if (123)I-MIBG has the same predictive value for diabetic and non-diabetic patients with advanced HF. An analysis is performed to determine whether CSI with (123)I-MIBG retains prognostic utility in diabetic patients with HF, evaluated for a primary prevention implantable cardioverter-defibrillator (ICD). Seventy-eight consecutive HF patients (48 diabetic) evaluated for primary prevention ICD implantation were prospectively enrolled and underwent (123)I-MIBG to assess CSI (heart-to-mediastinum ratio - HMR). A Cox proportional hazards multivariate analysis was used to determine the influence of (123)I-MIBG images for prediction of cardiac events in both diabetic and non-diabetic patients. The primary end-point was a composite of arrhythmic event, cardiac death, or admission due to HF. During a mean follow-up of 19.5 [9.3-29.3] months, the primary end-point occurred in 24 (31%) patients. Late HMR was significantly lower in diabetic patients (1.30 vs. 1.41, p=0.014). Late HMR≤1.30 was an independent predictor of cardiac events in diabetic (hazard ratio 4.53; p=0.012) and non-diabetic patients (hazard ratio 12.31; p=0.023). Diabetic patients with HF evaluated for primary prevention ICD show a higher deterioration in CSI than non-diabetics; nevertheless (123)I-MIBG imaging retained prognostic utility for both diabetic and non-diabetic patients. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

The utility of segmental analysis in cardiac I-123 MIBG SPECT in Parkinson's disease

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Kwon, Soo Hyun; Yoon, Joon Kee; Yoon, Jung Han; Lee, Su Jin; Jo, Kyung Soo; Lee, Dong Hyun; An, Young Sil [Ajou University School of Medicine, Suwon (Korea, Republic of)

2015-12-15

Cardiac images using I-123 metaiodobenzylguanidine (MIBG) are widely used to evaluate cardiac sympathetic denervation in Parkinson’s disease (PD). The aim of this study was to evaluate the utility of segmental analysis on cardiac MIBG SPECT in PD patients. In total, 36 patients with PD (n = 26) or essential tremor (ET, n = 10) who underwent MIBG cardiac SPECT were enrolled. The heart-to-mediastinum (H/M) ratios of MIBG uptake were acquired on planar images. For the segmental analysis of SPECT images, we evaluated the summed defect score (SDS) using a 17-segment model. The diagnostic abilities of H/M ratios and segmental parameters on MIBG SPECT were assessed by ROC curve analysis. The H/M ratios were significantly lower in PD than in ET patients (p < 0.05). On segmental analysis, SDS was significantly higher in PD patients than in the ET group (7.04 ± 4.09 vs. 2.90 ± 2.80; p = 0.006). The defect score of the anteroseptal region showed a significant difference between the groups (p = 0.002). The ROC analysis suggested only SDS (AUC = 0.785, p = 0.0003) and defect scores in the anteroseptal (AUC = 0.800, p < 0.0001) and inferior (AUC = 0.667, p = 0.013) regions showed significant diagnostic ability to differentiate PD from ET. Segmental parameters from cardiac MIBG SPECT images can provide additional information to differentiate PD from ET patients. Beyond H/M ratios from planar images, we recommend an MIBG SPECT study to evaluate sympathetic denervation in PD.

Cardiac I123-MIBG Correlates Better than Ejection Fraction with Symptoms Severity in Systolic Heart Failure

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Miranda, Sandra M.; Moscavitch, Samuel D.; Carestiato, Larissa R. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Felix, Renata M. [Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Rodrigues, Ronaldo C.; Messias, Leandro R. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Azevedo, Jader C. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Nóbrega, Antonio Cláudio L.; Mesquita, Evandro Tinoco [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Mesquita, Claudio Tinoco, E-mail: ctinocom@cardiol.br [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

2013-07-15

The association of autonomic activation, left ventricular ejection fraction (LVEF) and heart failure functional class is poorly understood. Our aim was to correlate symptom severity with cardiac sympathetic activity, through iodine-123-metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy and with LVEF in systolic heart failure (HF) patients without previous beta-blocker treatment. Thirty-one patients with systolic HF, class I to IV of the New York Heart Association (NYHA), without previous beta-blocker treatment, were enrolled and submitted to {sup 123}I-MIBG scintigraphy and to radionuclide ventriculography for LVEF determination. The early and delayed heart/mediastinum (H/M) ratio and the washout rate (WR) were performed. According with symptom severity, patients were divided into group A, 13 patients in NYHA class I/II, and group B, 18 patients in NYHA class III/IV. Compared with group B patients, group A had a significantly higher LVEF (25% ± 12% in group B vs. 32% ± 7% in group A, p = 0.04). Group B early and delayed H/M ratios were lower than group A ratios (early H/M 1.49 ± 0.15 vs. 1.64 ± 0.14, p = 0.02; delayed H/M 1.39 ± 0.13 vs. 1.58 ± 0.16, p = 0.001, respectively). WR was significantly higher in group B (36% ± 17% vs. 30% ± 12%, p= 0.04). The variable that showed the best correlation with NYHA class was the delayed H/M ratio (r= -0.585; p=0.001), adjusted for age and sex. This study showed that cardiac {sup 123}I-MIBG correlates better than ejection fraction with symptom severity in systolic heart failure patients without previous beta-blocker treatment.

Effects of anesthetic agents on cellular 123I-MIBG transport and in vivo 123I-MIBG biodistribution

International Nuclear Information System (INIS)

Ko, Bong-Ho; Paik, Jin-Young; Jung, Kyung-Ho; Bae, Jun-Sang; Lee, Eun Jung; Choe, Yearn Seong; Kim, Byung-Tae; Lee, Kyung-Han

2008-01-01

Small animal imaging with meta-iodobenzylguanidine (MIBG) allows characterization of animal models, optimization of tumor treatment strategies, and monitoring of gene expression. Anesthetic agents, however, can affect norepinephrine (NE) transport and systemic sympathetic activity. We thus elucidated the effects of anesthetic agents on MIBG transport and biodistribution. SK-N-SH neuroblastoma and PC-12 pheochromocytoma cells were measured for 123 I-MIBG uptake after treatment with ketamine (Ke), xylazine (Xy), Ke/Xy, or pentobarbital (Pb). NE transporters were assessed by Western blots. Normal ICR mice and PC-12 tumor-bearing mice were injected with 123 I-MIBG 10 min after anesthesia with Ke/Xy, Ke, Xy, or Pb. Plasma NE levels and MIBG biodistribution were assessed. Cellular 123 I-MIBG uptake was dose-dependently inhibited by Ke and Xy but not by Pb. Treatment for 2 h with 300 μM Ke, Xy, and Ke/Xy decreased uptake to 46.0 ± 1.6, 24.8 ± 1.5, and 18.3 ± 1.6% of controls. This effect was completely reversed by fresh media, and there was no change in NE transporter levels. In contrast, mice anesthetized with Ke/Xy showed no decrease of MIBG uptake in target organs. Instead, uptakes and organ-to-blood ratios were increased in the heart, lung, liver, and adrenals. Plasma NE was notably reduced in the animals with corresponding decreases in blood MIBG, which partly contributed to the increase in target organ uptake. In spite of their inhibitory effect at the transporter level, Ke/Xy anesthesia is a satisfactory method for MIBG imaging that allows favorable target tissue uptake and contrast by reducing circulating NE and MIBG. (orig.)

Labeling and quality control of 123I-MIBG

International Nuclear Information System (INIS)

Figols de Barboza, Marycel Rosa

2002-01-01

This report describes a method to facilitate routine production of 123 I-MIBG in Radiopharmacy Centre of IPEN-CNEN/SP. Iodine-123 radioisotope is produced in the form of sodium iodide in Cyclone-30 (IBA) at IPEN-CNEN/SP through proton irradiation of gaseous 124 Xe target. The labelling procedure uses MIBG-sulphate and leads to 123 I-MIBG with radiochemical purity at least 98% and specific activity of 300-380 MBq/mg

Variations in 123I-metaiodobenzylguanidine (MIBG) late heart mediastinal ratios in chronic heart failure: a need for standardisation and validation

International Nuclear Information System (INIS)

Verberne, Hein J.; Habraken, Jan B.A.; Eck-Smit, Berthe L.F. van; Agostini, Denis; Jacobson, Arnold F.

2008-01-01

There is lack of validation and standardisation of acquisition parameters for myocardial 123 I-metaiodobenzylguanidine (MIBG). This lack of standardisation hampers large scale implementation of 123 I-MIBG parameters in the evaluation of patients with chronic heart failure (CHF). In a retrospective multi-centre study 123 I-MIBG planar scintigrams obtained on 290 CHF patients (82% male; 58% dilated cardiomyopathy; New York Heart Association [NYHA classification] > I) were reanalysed to determine the late heart-to-mediastinum ratio (H/M). There was a large variation in acquisition parameters. Multivariate forward stepwise regression showed that a significant proportion (31%, p 123 I-MIBG uptake. Improved standardisation of cardiac 123 I-MIBG imaging parameters would contribute to increased clinical applicability for this procedure. (orig.)

Effects of anesthetic agents on cellular {sup 123}I-MIBG transport and in vivo {sup 123}I-MIBG biodistribution

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Ko, Bong-Ho; Paik, Jin-Young; Jung, Kyung-Ho; Bae, Jun-Sang; Lee, Eun Jung; Choe, Yearn Seong; Kim, Byung-Tae; Lee, Kyung-Han [Sungkyunkwan University School of Medicine, Department of Nuclear Medicine, Samsung Medical Center, Seoul (Korea)

2008-03-15

Small animal imaging with meta-iodobenzylguanidine (MIBG) allows characterization of animal models, optimization of tumor treatment strategies, and monitoring of gene expression. Anesthetic agents, however, can affect norepinephrine (NE) transport and systemic sympathetic activity. We thus elucidated the effects of anesthetic agents on MIBG transport and biodistribution. SK-N-SH neuroblastoma and PC-12 pheochromocytoma cells were measured for {sup 123}I-MIBG uptake after treatment with ketamine (Ke), xylazine (Xy), Ke/Xy, or pentobarbital (Pb). NE transporters were assessed by Western blots. Normal ICR mice and PC-12 tumor-bearing mice were injected with {sup 123}I-MIBG 10 min after anesthesia with Ke/Xy, Ke, Xy, or Pb. Plasma NE levels and MIBG biodistribution were assessed. Cellular {sup 123}I-MIBG uptake was dose-dependently inhibited by Ke and Xy but not by Pb. Treatment for 2 h with 300 {mu}M Ke, Xy, and Ke/Xy decreased uptake to 46.0 {+-} 1.6, 24.8 {+-} 1.5, and 18.3 {+-} 1.6% of controls. This effect was completely reversed by fresh media, and there was no change in NE transporter levels. In contrast, mice anesthetized with Ke/Xy showed no decrease of MIBG uptake in target organs. Instead, uptakes and organ-to-blood ratios were increased in the heart, lung, liver, and adrenals. Plasma NE was notably reduced in the animals with corresponding decreases in blood MIBG, which partly contributed to the increase in target organ uptake. In spite of their inhibitory effect at the transporter level, Ke/Xy anesthesia is a satisfactory method for MIBG imaging that allows favorable target tissue uptake and contrast by reducing circulating NE and MIBG. (orig.)

Differention of parkinson's disease, multiple system atrophy and pure autonomic failure using I-123 MIBG myocardial scintigraphy

International Nuclear Information System (INIS)

Zhang, Z.; Religiosol, D.; Machac, J.; Nahm, K.F.; Kaufmann, H.C.; Yahr, M.D.

2004-01-01

Purpose: Clinical differentiation of Parkinson's disease (PD), multiple system atrophy (MSA), and pure autonomic failure (PAF) may be difficult. 123I MIBG studies have shown significantly reduced cardiac uptake in patient with PD but not in MSA suggesting that postganglionic neurons are only affected in PD. No systematic study using 123I MIBG in patients with PAF has been reported. The Objective of this study is to investigate whether MSA, PD, and PAF can be differentiated by 1231 MIBG myocardial scintigraphy. Methods: 1231 MIBG was synthesized using Cu(I) assisted kit method (labeling efficiency 99.84±0.47%, n = 17). Five patients with a clinical diagnosis of MSA (age 63±11), 4 with PD (62±10), 4 with PAF (60±7), and 3 normal controls (50±19) were referred to NM blinded to the categories of the patients. SPECT and planar chest imaging was taken 15 min (early) and 4 hours (delayed) postinjection of 200-351 MBq 123I MIBG using a Picker triple head SPECT camera. Regions of interest were placed over the heart (H) and mediastinum (M); the average count ratios (H/M) were calculated. Each subject had a separate 201Tl perfusion imaging to exclude significant myocardial perfusion defects. Results: As shown in the Table, the H/M ratio in patients with MSA was significantly lower than that in normal subjects (P = 0.027) in early imaging, but not in the delayed imaging. Both H/M ratios in PD and PAF were significantly lower than that in MSA in early (P = 0.006, P = 0.008) and delayed (P< 0.0001, P < 0.00001) imaging. Only delayed uptake ratio showed significant difference (P = 0.013) between PD and PAF. Conclusions: 123I MIBG cardiac uptake in delayed imaging was significantly reduced in patients with PD and PAF while it was normal in MSA. Significant cardiac uptake difference was also found between PD and PAF. 123I MIBG myocardial scintigraphy appears to provide helpful information in the differential diagnosis of these disorders. (authors)

Variations in {sup 123}I-metaiodobenzylguanidine (MIBG) late heart mediastinal ratios in chronic heart failure: a need for standardisation and validation

Energy Technology Data Exchange (ETDEWEB)

Verberne, Hein J. [University of Amsterdam, Department of Nuclear Medicine, Academic Medical Center, Amsterdam (Netherlands); Academic Medical Center, F2-238, Department of Nuclear Medicine, P.O.Box 22700, Amsterdam (Netherlands); Habraken, Jan B.A.; Eck-Smit, Berthe L.F. van [University of Amsterdam, Department of Nuclear Medicine, Academic Medical Center, Amsterdam (Netherlands); Agostini, Denis [CHU Cote de Nacre, Department of Nuclear Medicine, Caen (France); Jacobson, Arnold F. [GE Healthcare, Princeton, NJ (United States)

2008-03-15

There is lack of validation and standardisation of acquisition parameters for myocardial {sup 123}I-metaiodobenzylguanidine (MIBG). This lack of standardisation hampers large scale implementation of {sup 123}I-MIBG parameters in the evaluation of patients with chronic heart failure (CHF). In a retrospective multi-centre study {sup 123}I-MIBG planar scintigrams obtained on 290 CHF patients (82% male; 58% dilated cardiomyopathy; New York Heart Association [NYHA classification] > I) were reanalysed to determine the late heart-to-mediastinum ratio (H/M). There was a large variation in acquisition parameters. Multivariate forward stepwise regression showed that a significant proportion (31%, p < 0.001) of the variation in late H/M could be explained by a model containing patient-related variables and acquisition parameters. Left ventricular ejection fraction (p < 0.001), type of collimation (p < 0.001), acquisition duration (p = 0.001), NYHA class (p = 0.028) and age (p = 0.034) were independent predictors of late H/M. Acquisitions parameters are independent contributors to the variation of semi-quantitative measurements of cardiac {sup 123}I-MIBG uptake. Improved standardisation of cardiac {sup 123}I-MIBG imaging parameters would contribute to increased clinical applicability for this procedure. (orig.)

Factors influencing the cardiac MIBG accumulation

International Nuclear Information System (INIS)

Takatsu, Hisato; Fujiwara, Hisayoshi

1997-01-01

Following factors possibly influencing the cardiac MIBG accumulation were examined mainly in mice. 1. The specific activity of the MIBG (meta-iodo-benzyl guanidine) on the neuronal and non-neuronal fractions. 2. Motor restriction stress on MIBG accumulation and washout. 3. Loading and restriction of sodium chloride on the accumulation and effect of suppression of renin-angiotensin system. 4. Examinations in Dahl rats. 125I- or 131I-MIBG was intravenously administered to mice at 74 kBq. At 30 min or 4 hr after administration, mice were sacrificed and their left ventricles were dissected out for measurement of radioactivity in a liquid scintillation counter. Salt-sensitive and -resistant Dahl rats were given with 37 MBq of 123I-MIBG and cardiac radioactivity was measured externally for calculation of washout. Factors examined were found highly correlated with the accumulation of MIBG and measurement of its washout was considered useful for evaluating sympathetic activity. (K.H.)

Evaluation of myocardial distribution of iodine-123 labeled metaiodobenzylguanidine (123I-MIBG) in normal subjects

International Nuclear Information System (INIS)

Tsuchimochi, Shinsaku; Tamaki, Nagara; Shirakawa, Seishi; Fujita, Toru; Yonekura, Yoshiharu; Konishi, Junji; Nohara, Ryuji; Sasayama, Shigetake; Nishioka, Kenya

1994-01-01

The normal pattern of the myocardial sympathetic innervation was studied in 15 subjects using gamma camera scintigraphy with iodine-123 labeled metaiodobenzylguanidine ( 123 I-MIBG). Seven younger subjects (mean age 24.6±3.6) and eight older patients (mean age 60.9±8.4) with normal cardiac function were studied. Planar imaging was obtained at 15 minutes and 3 hours, and SPECT was also performed 3 hours after injection of 111 MBq (3 mCi) of MIBG. The younger subjects showed higher the heart to mediastinum count ratio (2.91±0.25 vs. 2.67±0.34; p<0.05) and higher inferior to anterior count ratio (1.19±0.15 vs. 0.97±0.13; p<0.05) on the late scan. The bull's-eye polar map also differences in counts in the mid-inferior (p<0.005), basal-inferior (p<0.005) and mid-lateral sectors (p<0.01). But there was no significant difference in MIBG washout rate from myocardium between two groups. These data suggest that there is a difference of the cardiac sympathetic innervation, with older subjects having fewer sympathetic nerve terminals, especially in inferior than younger subjects. We conclude that the age difference in sympathetic nerve function should be considered in the interpretation of MIBG scan. (author)

Production and application of 123I-labeled M-iodobenzylguanidine (123I-MIBG)

International Nuclear Information System (INIS)

Washburn, L.C.; Khosla, R.C.; Williams, C.C.; Gelfand, M.J.; Maxon, H.R.

1993-01-01

For the past two years the authors have been producing 123 I-MIBG for diagnosis and evaluation of neural crest tumors in both pediatric and adult patients. The method of Mock and Weiner (Appl. Radiat. Isot. 39:939-942, 1988) was used. Out of 89 attempted runs, 87 were successful in meeting the 90% radiochemical purity required for patient administration; both failures occurred during the first six months of the project. The 87 runs provided 144 pediatric doses and 48 adult doses. The radiochemical yield, not corrected for decay, was 67.7 ± 10.3% (mean ± S.D.). The radiochemical purity of the successful runs was 99.3 ± 1.3%, with 71 of the 87 runs giving a radiochemical purity of >99%. The radionuclidic purity of the I-123, obtained as sodium [ 123 I]iodide from Nordion International, was 99.985 ± 0.008%. Bacterial endotoxins, determined by the Limulus amebocyte lysate technique, were below the detectable level of 0.31 EU/mL for all batches of 123 I-MIBG. Sterility tests using both trypticase soy broth and fluid thioglycollate medium were negative for all batches except two, which showed growth of nonpathogenic microorganisms probably introduced during inoculation of the culture medium. 123 I-MIBG has thus been reliably prepared in high yield and excellent purity, and it has proved to be a valuable agent for diagnosis and evaluation of neural crest tumors in both children and adults

Determination of the survival rate in patients with congestive heart failure stratified by 123I-MIBG imaging. A meta-analysis from the studies performed in Japan

International Nuclear Information System (INIS)

Kuwabara, Yoichi; Tamaki, Nagara; Nakata, Tomoaki; Yamashina, Shohei; Yamazaki, Junichi

2011-01-01

The goals of this meta-analysis were to determine survival rates in patients with heart failure (HF) assessed by 123 I-metaiodobenzylguanidine (MIBG) imaging results using recently published studies and to determine the prognostic value of 123 I-MIBG imaging. We reviewed published cohort studies carried out in Japan that compared the prognosis of patients with their 123 I-MIBG activity quantified as late heart-to-mediastinum ratio (H/M) or washout rate by performing a PubMed search for articles in English up to December 2006. Studies were selected if they analyzed a clearly defined lethal outcome (cardiovascular death) using life tables to estimate the odds ratio at 24 months after enrollment. Of 158 articles related to cardiac 123 I-MIBG, seven referred to studies that met the inclusion criteria: 5 evaluated H/M via 123 I-MIBG in a total of 866 patients and 4 calculated washout rate in a total of 491 patients. A low H/M indicated a high risk of cardiac death: pooled odds ratio, 5.2; 95% confidence interval (CI) of 3.1-5.7. A high washout was also associated with lethal events with a pooled odds ratio of 2.8 (CI: 1.6-5.0). The association between washout and cardiac death was heterogeneous (Chi-square=11.0, P 123 I-MIBG studies conducted in Japan indicated that both a decreased cardiac 123 I-MIBG activity (H/M) and an increased washout rate are indicative of a poor prognosis in patients with chronic heart failure. (author)

Reproducibility of planar {sup 123}I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy in patients with heart failure

Energy Technology Data Exchange (ETDEWEB)

Veltman, Caroline E.; Boogers, Mark J.; Wall, Ernst E.V. der [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); The Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht (Netherlands); Meinardi, Joris E.; Bax, Jeroen J.; Scholte, Arthur J.H.A. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Younis, Imad Al; Dibbets-Schneider, Petra [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands)

2012-10-15

Despite its high prognostic value, widespread clinical implementation of {sup 123}I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy is hampered by a lack of validation and standardization. The purpose of this study was to assess the reliability of planar {sup 123}I-MIBG myocardial scintigraphy in patients with heart failure (HF). Planar myocardial MIBG images of 70 HF patients were analysed by two experienced and one inexperienced observer. The reproducibility of early and delayed heart-to-mediastinum (H/M) ratios, as well as washout rate (WR) calculated by two different methods, was assessed using the intraclass correlation coefficient (ICC) and the Bland-Altman analysis. In addition, a subanalysis in patients with a very low H/M ratio (delayed H/M ratio <1.4) was performed. The delayed H/M ratio was also assessed using fixed-size oval and circular cardiac regions of interest (ROI). Intra- and interobserver analyses and experienced versus inexperienced observer analysis showed excellent agreement for the measured early and delayed H/M ratios and WR on planar {sup 123}I-MIBG images (the ICCs for the delayed H/M ratios were 0.98, 0.96 and 0.90, respectively). In addition, the WR without background correction resulted in higher reliability than the WR with background correction (the interobserver Bland-Altman 95 % limits of agreement were -2.50 to 2.16 and -10.10 to 10.14, respectively). Furthermore, the delayed H/M ratio measurements remained reliable in a subgroup of patients with a very low delayed H/M ratio (ICC 0.93 for the inter-observer analysis). Moreover, a fixed-size cardiac ROI could be used for the assessment of delayed H/M ratios, with good reliability of the measurement. The present study showed a high reliability of planar {sup 123}I-MIBG myocardial scintigraphy in HF patients, confirming that MIBG myocardial scintigraphy can be implemented easily for clinical risk stratification in HF. (orig.)

Use of myocardial tomo-scintigraphy by {sup 123}I - MIBG in right ventricle arrhythmia-gen dysplasia; Interet de la tomoscintigraphie myocardique a la {sup 123}I - MIBG dans la dysplasie arrythmogene du ventricule droit

Energy Technology Data Exchange (ETDEWEB)

Agostini, D.; Manrique, A.; Darlas, Y. [Service de Medecine Nucleaire, CHU Cote de Nacre, Caen (France); Loiselet, P.; Scanu, P.; Grollier, G.; Potier, J.C. [Service de Cardiologie, CHU Cote de Nacre, Caen (France); Bouvard, G. [Service de Medecine Nucleaire, CHU Cote de Nacre, Caen (France)

1997-12-31

The dysfunction of myocardial sympathetic system was implied in occurrence of ventricular arrhythmias in patients with a right ventricle arrhythmia-gen dysplasia (RVAD). The goal of this study is to evaluate the myocardial pre-synaptic adrenergic regional function by using the cardiac tomo-scintigraphy with {sup 123}I - meta-iodo-benzyl-guanidine (MIBG). Fourteen patients (12 M, 2 F, age: 46{+-} 13) in whom the disease`s diagnosis was done on the basis of the parameters of European Task Force (electric, angiographic, histologic), were studied. Six healthy subjects (32 {+-} 12 years) were at the same time studied as control group. Each patient benefited by an at-rest tomo-scintigraphy by {sup 201}Tl to eliminate any hypo-perfusion which could hinder the interpretation of MIBG fixation. A 48 h delay was necessary between the two isotopic examinations. After blocking the thyroid by Lugol fort, an at-rest tomo-scintigraphy by {sup 123}I - MIBG was effected 4 h after the injection IV of 259 MBq of tracer following a classical acquisition of a myocardial tomography with a tracer-adopted collimator (Elscint camera). Global and regional evaluations of the cardiac adrenergic neuronal function were effected by using the cardio-mediastinal ratio (CMR) and the circumferential profile, respectively, for the localization, extension and amplitude of regional adrenergic defects. The CMR is within the normal limits (236 {+-} 39% vs 234 {+-} 14% in healthy subjects). The adrenergic defects are present in 11/14 patients (a reduction of 50% of capture of MIBG as compared with the control group, < average - 2 ET) in the anterior and lateral regions of left ventricle. In conclusion, the tomo-scintigraphy by {sup 123}I - MIBG allows the detecting of presence of a sympathetic dys-innervation of left ventricle in patients afflicted with RVAD

123I-Mibg scintigraphy and 18F-Fdg-Pet imaging for diagnosing neuroblastoma

Science.gov (United States)

Bleeker, Gitta; Tytgat, Godelieve Am; Adam, Judit A; Caron, Huib N; Kremer, Leontien Cm; Hooft, Lotty; van Dalen, Elvira C

2015-01-01

Background Neuroblastoma is an embryonic tumour of childhood that originates in the neural crest. It is the second most common extracranial malignant solid tumour of childhood. Neuroblastoma cells have the unique capacity to accumulate Iodine-123-metaiodobenzylguanidine (123I-MIBG), which can be used for imaging the tumour. Moreover, 123I-MIBG scintigraphy is not only important for the diagnosis of neuroblastoma, but also for staging and localization of skeletal lesions. If these are present, MIBG follow-up scans are used to assess the patient's response to therapy. However, the sensitivity and specificity of 123I-MIBG scintigraphy to detect neuroblastoma varies according to the literature. Prognosis, treatment and response to therapy of patients with neuroblastoma are currently based on extension scoring of 123I-MIBG scans. Due to its clinical use and importance, it is necessary to determine the exact diagnostic accuracy of 123I-MIBG scintigraphy. In case the tumour is not MIBG avid, fluorine-18-fluorodeoxy-glucose (18F-FDG) positron emission tomography (PET) is often used and the diagnostic accuracy of this test should also be assessed. Objectives Primary objectives: 1.1 To determine the diagnostic accuracy of 123I-MIBG (single photon emission computed tomography (SPECT), with or without computed tomography (CT)) scintigraphy for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old. 1.2 To determine the diagnostic accuracy of negative 123I-MIBG scintigraphy in combination with 18F-FDG-PET(-CT) imaging for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old, i.e. an add-on test. Secondary objectives: 2.1 To determine the diagnostic accuracy of 18F-FDG-PET(-CT) imaging for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old. 2.2 To compare the diagnostic accuracy of 123I-MIBG

Usefulness of 123I-Meta-iodobenzylguanidine (MIBG) myocardial scintigraphy for evaluation of cardiac sympathetic nervous system function in diabetic patients

International Nuclear Information System (INIS)

Tamura, Koji; Nakatani, Yuko; Doi, Kenji; Adachi, Gakuji; Takada, Kou; Onishi, Satoshi

2001-01-01

The cardiac sympathetic nervous system function of diabetic patients with no definite cardiovascular complications other than hypertension was evaluated by 123 I -MIBG myocardial scintigraphy. The subjects consisted of 82 diabetic patients, 59 men, 23 women, mean age 57 years, 17 with hypertension and 65 with normal blood pressure, and they were compared with normal controls (8 men and 3 women, mean age 54 years). Myocardial scintigraphy was performed 10 minutes and 4 hours after administration of MIBG. The superior mediastinum and whole myocardium were set as regions of interest, and the heart-to-mediastinum ratio (H/M ratio) and the washout rate (%WR) were calculated. The mean observation period was 18±12 months, and 17 of the 65 diabetic patients with normal blood pressure before the study developed hypertension during the observation period. There were significant differences in H/M ratio and %WR between the diabetic patients and normal controls (H/M ratio; 1.96±0.34 vs 2.27±0.20, %WR; 24.71±16.99% vs 12.89±11.94). The diabetic patients with hypertension had higher morbidity with diabetic retinopathy and a lower H/M ratio. The 17 patients who developed hypertension during the observation period showed an increase in %WR and a reduction in the H/M ratio. Five patients who died during the observation period had a reduced H/M ratio and increased of %WR. 123 I-MIBG myocardial scintigraphy in diabetic patients was shown to be useful for detecting cardiac sympathetic nervous system dysfunction, predicting the development of hypertension, and identifying patients who had a poor outcome. Diabetic patients with abnormal signals on MIBG myocardial scintigraphy need to be monitored much more carefully. (K.H.)

Cardiac iodine-123 metaiodobenzylguanidine uptake in animals with diabetes mellitus and/or hypertension

International Nuclear Information System (INIS)

Dubois, E.A.; Kam, K.L.; Somsen, G.A.; Boer, G.J.; Bruin, K. de; Batink, H.D.; Pfaffendorf, M.; Royen, E.A. van; Zwieten, P.A. van

1996-01-01

The aim of the present study was to evaluate the use of the noradrenaline analogue iodine-123 metaiodobenzylguanidine ([ 123 I]MIBG) for the assessment of cardiac sympathetic activity in the presence of diabetes mellitus and/or hypertension in animal models. One model used Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) rendered diabetic at 12 weeks of age by an intravenous injection of streptozotocin (STZ). The other model used lean and obese Zucker rats. In all groups basic haemodynamic values were established and animals received an intravenous injection of 50 μCi [ 123 I]MIBG. Initial myocardial uptake and washout rates of [ 123 I]MIBG were measured scintigraphically during 4 h. After sacrifice, plasma noradrenaline and left cardiac ventricular β-adrenoceptor density was determined. The diabetic state, both in STZ-treated rats (direct induction) and in obese Zucker rats (genetic induction), appeared to induce a lower cardiac density of β-adrenoceptors, indicative of increased sympathetic activity. Cardiac [ 123 I]MIBG then showed increased washouts, thereby confirming enhanced noradrenergic activity. This parallism of results led to the conclusion that [ 123 I]MIBG wash-out measurements could provide an excellent tool to assess cardiac sympathetic activity noninvasively. However, in hypertension (WKY vs SHR), both parameters failed to show parallelism: no changes in β-adrenoceptor density were found, whereas [ 123 I]MIBG wash-out rate was increased. Thus, either [ 123 I]MIBG washout or β-adrenoceptor density may not be a reliable parameter under all circumstances to detect changes in the release of noradrenaline. (orig./MG)

Usefulness of {sup 123}I-Meta-iodobenzylguanidine (MIBG) myocardial scintigraphy for evaluation of cardiac sympathetic nervous system function in diabetic patients.

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Tamura, Koji; Nakatani, Yuko; Doi, Kenji; Adachi, Gakuji; Takada, Kou

2001-11-01

The cardiac sympathetic nervous system function of diabetic patients with no definite cardiovascular complications other than hypertension was evaluated by {sup 123}I -MIBG myocardial scintigraphy. The subjects consisted of 82 diabetic patients, 59 men, 23 women, mean age 57 years, 17 with hypertension and 65 with normal blood pressure, and they were compared with normal controls (8 men and 3 women, mean age 54 years). Myocardial scintigraphy was performed 10 minutes and 4 hours after administration of MIBG. The superior mediastinum and whole myocardium were set as regions of interest, and the heart-to-mediastinum ratio (H/M ratio) and the washout rate (%WR) were calculated. The mean observation period was 18{+-}12 months, and 17 of the 65 diabetic patients with normal blood pressure before the study developed hypertension during the observation period. There were significant differences in H/M ratio and %WR between the diabetic patients and normal controls (H/M ratio; 1.96{+-}0.34 vs 2.27{+-}0.20, %WR; 24.71{+-}16.99% vs 12.89{+-}11.94). The diabetic patients with hypertension had higher morbidity with diabetic retinopathy and a lower H/M ratio. The 17 patients who developed hypertension during the observation period showed an increase in %WR and a reduction in the H/M ratio. Five patients who died during the observation period had a reduced H/M ratio and increased of %WR. {sup 123}I-MIBG myocardial scintigraphy in diabetic patients was shown to be useful for detecting cardiac sympathetic nervous system dysfunction, predicting the development of hypertension, and identifying patients who had a poor outcome. Diabetic patients with abnormal signals on MIBG myocardial scintigraphy need to be monitored much more carefully. (K.H.)

Clinical evaluation of 123I-MIBG for assessment of sympathetic nervous system in the heart

International Nuclear Information System (INIS)

Hirosawa, Koushitiro; Tanaka, Takeshi; Hisada, Kin-ichi; Bunko, Hisashi.

1991-01-01

Multi-center clinical trial of 123 I-metaiodobenzylguanidine ( 123 I-MIBG) was carried out to assess its utility as a scintigraphic imaging agent reflecting sympathetic neuronal function in cardiovascular field. Studies were performed on patients with heart diseases of three categories, myocardial infarction, angina pectoris and cardiomyopathy. Scintigraphic images, reflecting sympathetic neuronal function, were obtained with 123 I-MIBG from all of those categories of patients and the efficacy of the imaging was revealed in 781 (95.0%) out of 822 patients. In some patients abnormality was suggested in sympathetic neuronal function with 123 I-MIBG imaging, in spite of normal findings with myocardial perfusion scintigraphy by 201 TlCl. In all 981 patients studied with 123 I-MIBG, there have been no severe adverse reactions, except complaints of burning on injection site of the agent or nausea, ect. from 4 patients. We conclude that 123 I-MIBG imaging is one of the effective tools for diagnostic use reflecting topical sympathetic neuronal function in the heart, judging from its safety and efficacy. (author)

Diagnostic application of 123I-MIBG in tumours of neuroendocrine origin

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Kostadinova, I.

1995-01-01

The diagnostic value of the widely applied receptor ligand 123 I-MIBG for visualization of tumours of neuroendocrine origin is investigated. A total of 13 patients with neuroblastoma, pheochromocytoma and carcinoid at min. 10, hours 18 and 42 p.i. of 185 MBq of 123 I-MIBG have been studied. Based on scintigraphic data obtained, it is estimated that the tumours are mostly located in the adrenal medulla with metastases in the liver, lymph nodes, bones and bone marrow. The advantage of the radionuclide method over the other visual methods is the possibility of detection of metastases in the whole body and subsequent treatment with 131 I-MIBG in patients with an advanced stage of the disease. 8 refs., 3 figs. (orig.)

Iodine-123 metaiodobenzylguanidine imaging of the heart in idiopathic congestive cardiomyopathy and cardiac transplants

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Glowniak, J.V.; Turner, F.E.; Gray, L.L.; Palac, R.T.; Lagunas-Solar, M.C.; Woodward, W.R.

1989-01-01

Iodine-123 metaiodobenzylguanidine ([ 123 I]MIBG) is a norepinephrine analog which can be used to image the sympathetic innervation of the heart. In this study, cardiac imaging with [ 123 I]MIBG was performed in patients with idiopathic congestive cardiomyopathy and compared to normal controls. Initial uptake, half-time of tracer within the heart, and heart to lung ratios were all significantly reduced in patients compared to normals. Uptake in lungs, liver, salivary glands, and spleen was similar in controls and patients with cardiomyopathy indicating that decreased MIBG uptake was not a generalized abnormality in these patients. Iodine-123 MIBG imaging was also performed in cardiac transplant patients to determine cardiac nonneuronal uptake. Uptake in transplants was less than 10% of normals in the first 2 hr and nearly undetectable after 16 hr. The decreased uptake of MIBG suggests cardiac sympathetic nerve dysfunction while the rapid washout of MIBG from the heart suggests increased cardiac sympathetic nerve activity in idiopathic congestive cardiomyopathy

Quantitative estimation of 123I-MIBG scintigraphy in neuroblastoma. Usefulness of the total body retention rate

International Nuclear Information System (INIS)

Okuyama, Chio; Ushijima, Yo; Sugihara, Hiroki; Nishimura, Tunehiko

2000-01-01

A new method of easily and simply quantifying 123 I-MIBG accumulation as a criterion for curative effect of chemotherapy in infants with neuroblastoma was developed. This method uses the data from two images: an early image (at 5-7.5 hr) and a delayed image (at 25-32 hr). Twenty infants with untreated neuroblastoma which showed clear accumulation of 123 I-MIBG at the primary site were examined. The differences between the accumulation counts on the early image and the delayed image showed that washout of 123 I-MIBG in the neuroblastomas was delayed in tumor regions. This finding indicated that the total body 123 I-MIBG retention rate reflects the total volume of the neuroblastoma. The 123 I-MIBG retention rate was significantly higher in patients with advanced stage neuroblastoma with systemic metastases, and there was a good correlation between the retention rate and tumor markers (VMA and HVA values in urine). The response to chemotherapy paralleled the change in markers. These results suggested that the total body 123 I-MIBG retention rate is useful as a criterion for curative effect in advanced neuroblastoma. (K.H.)

123I-MIBG myocardial imaging in hypertensive patients. Abnormality progresses with left ventricular hypertrophy

International Nuclear Information System (INIS)

Mitani, Isao; Sumita, Shinichi; Takahashi, Nobukazu; Ochiai, Hisao; Ishii, Masao

1996-01-01

Twenty-seven patients with essential hypertension were prospectively studied with 123 I-labeled metaiodobenzyl-guanidine ( 123 I-MIBG) to assess the presence and location of impaired sympathetic innervation in hypertrophied myocardium. Thirteen patients had left ventricular hypertrophy on echocardiography, and 14 had normal echocardiograms. The wash-out ratio of 123 I-MIBG in these two groups did not differ significantly (35.3±6.1 and 35.4±5.1) but was higher than in control subjects (29.4±6.7). The delayed heart-to-mediastinum count ratio was lower in the patients with hypertrophy than in the patients without hypertrophy (1.93±0.28 and 2.22±0.21; p<0.05) and the control subjects (1.93±0.28 and 2.33±0.25; p<0.05). On SPECT imaging, abnormalities in segmental uptake were frequent at the posterior and postero-lateral wall in both groups, although the hypertrophic group had more significant impairment. Our results lead to the hypothesis that hypertension in more advanced stages may be associated not only with hypertrophic changes but also with more advanced regional impairment of cardiac sympathetic innervation. (author)

Scintigraphic assessment of cardiac sympathetic innervation with I-123-metaiodobenzylguanidine in cardiomyopathy. Special reference to cardiac arrhythmia

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Asano, Takahisa; Otsuka, Nobuaki; Sone, Teruki; Mimura, Hiroaki; Yanagimoto, Shinichi; Tomomitsu, Tatsushi; Fukunaga, Masao [Kawasaki Medical School, Kurashiki, Okayama (Japan); Morita, Koichi

1999-07-01

Cardiac sympathetic imagings with I-123-metaiodobenzylguanidine (MIBG) were carried out in 5 cases with dilated cardiomyopathy (DCM), 26 cases with hypertrophic cardiomyopathy (HCM), and 4 cases without cardiac disease as a control to assess cardiac sympathetic innervation qualitatively and quantitatively, and to clarify the relation of MIBG accumulation to arrhythmia. MIBG scintigraphy was performed at 15 min. (early image) and 4 hr. (delayed image) after intravenous injection of MIBG 111 MBq. The MIBG uptake ratio of mediastinum (H/M) and the cardiac washout rate (WR) from early to delayed images were calculated. On both early and delayed SPECTs, MIBG uptake was assessed by defect scores (DSs). Regarding the cases with HCM, the MIBG uptake ratio, WR, and DS were also compared in cases with and without arrhythmia. In DCM, the MIBG uptake on delayed SPECT was markedly low, the H/M ratio was significantly lower, and the DS was significantly higher than in the control (all p<0.05). As for the WR, there was no significant difference between HCM, DCM and the control. In HCM, significantly reduced MIBG uptake was observed in cases with ventricular techycardia (VT) and in cases with atrial fibrillation (Af), as compared with cases without arrhythmia (all p<0.05). There results suggest that MIBG scintigraphy might be a useful tool in the assessment of cardiac sympathetic abnormalities in cardiomyopathy, especially in cases with arrhythmia. (author)

False Positive Radioiodinated Metaiodobenzylguanidine (123I-MIBG Uptake in Undifferentiated Adrenal Malignant Tumor

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Hee Soo Jung

2015-01-01

Full Text Available 123I-Metaiodobenzylguanidine (123I-MIBG scintigraphy is a widely used functional imaging tool with a high degree of sensitivity and specificity in diagnosis of pheochromocytoma. However, rare cases of false positive reactions have been reported. A 67-year-old male patient was admitted with epigastric pain. Abdominal computed tomography (CT revealed a heterogeneous left adrenal mass 6 cm in diameter; following hormone testing, 123I-MIBG scintigraphy was performed to determine the presence of pheochromocytoma, which confirmed eccentric uptake by a large left adrenal gland mass. Chest CT and PET-CT confirmed metastatic lymphadenopathy; therefore, endobronchial ultrasound transbronchial needle aspiration was performed. Metastatic carcinoma of unknown origin was suspected from a lymph node biopsy, and surgical resection was performed for definitive diagnosis and correction of excess hormonal secretion. A final diagnosis of undifferentiated adrenal malignant tumor was rendered, instead of histologically malignant pheochromocytoma, despite the uptake of 123I-MIBG demonstrated by scintigraphy.

Evaluation of long-term prognosis in patients with heart failure. Is cardiac imaging with iodine-123 metaiodobenzylguanidine useful?

International Nuclear Information System (INIS)

Narita, Michihiro; Kurihara, Tadashi

1998-01-01

The effect of cardiac sympathetic activity on long-term prognosis in patients with heart failure was evaluated by cardiac imaging with 123 I-MIBG in 46 patients admitted for the first episode of heart failure. Cardiac imaging was performed with 123 I-MIBG and 201 Tl at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (percentage uptake). The cardiac uptake ratio of 123 I-MIBG (percentage uptake of 123 I-MIBG divided by percentage uptake of 201 Tl) and percentage washout of 123 I-MIBG from the heart over 3 hours were calculated as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of heart failure requiring readmission. Scintigraphic parameters, clinical parameters, left ventricular function obtained by echocardiography and neurohumoral parameters were compared between the event group and event-free group. During the follow-up period, cardiac events developed in 14 patients (30%). Univariate analysis showed uptake ratio and washout rate of 123 I-MIBG, percentage uptake of 201 Tl, New York Heart Association class at discharge, fractional shortening of the left ventricle, serum norepinephrine and atrial natriuretic peptide levels differed significantly between the two groups. Cox proportional-hazard analysis showed that the uptake ratio was an independent predictor of cardiac events. When a cut-off point in the uptake ratio equal to or less than 0.50 and age equal to or more than 65 years old were included in the Cox proportional-hazard analysis instead of actual numbers, relative risks of cardiac events by each index were 31.2 and 4.2, respectively. These data suggest that cardiac uptake of 123 I-MIBG is a strong and independent predictor of long-term prognosis in patients with heart failure. (K.H.)

Evaluation of long-term prognosis in patients with heart failure. Is cardiac imaging with iodine-123 metaiodobenzylguanidine useful?

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Narita, Michihiro; Kurihara, Tadashi [Sumitomo Hospital, Osaka (Japan)

1998-06-01

The effect of cardiac sympathetic activity on long-term prognosis in patients with heart failure was evaluated by cardiac imaging with {sup 123}I-MIBG in 46 patients admitted for the first episode of heart failure. Cardiac imaging was performed with {sup 123}I-MIBG and {sup 201}Tl at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (percentage uptake). The cardiac uptake ratio of {sup 123}I-MIBG (percentage uptake of {sup 123}I-MIBG divided by percentage uptake of {sup 201}Tl) and percentage washout of {sup 123}I-MIBG from the heart over 3 hours were calculated as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of heart failure requiring readmission. Scintigraphic parameters, clinical parameters, left ventricular function obtained by echocardiography and neurohumoral parameters were compared between the event group and event-free group. During the follow-up period, cardiac events developed in 14 patients (30%). Univariate analysis showed uptake ratio and washout rate of {sup 123}I-MIBG, percentage uptake of {sup 201}Tl, New York Heart Association class at discharge, fractional shortening of the left ventricle, serum norepinephrine and atrial natriuretic peptide levels differed significantly between the two groups. Cox proportional-hazard analysis showed that the uptake ratio was an independent predictor of cardiac events. When a cut-off point in the uptake ratio equal to or less than 0.50 and age equal to or more than 65 years old were included in the Cox proportional-hazard analysis instead of actual numbers, relative risks of cardiac events by each index were 31.2 and 4.2, respectively. These data suggest that cardiac uptake of {sup 123}I-MIBG is a strong and independent predictor of long-term prognosis in patients with heart failure. (K.H.)

Multiple endocrine neoplasia detection on I-123 MIBG imaging

International Nuclear Information System (INIS)

Reinhardt, C.A.; McEwan, L.M.; Wong, J.C.H.

2000-01-01

Full text: An 123 I meta-iodobenzylguanidine (MIBG) scan was performed on a 54-year-old lady with familial phaeochromocytoma, to evaluate for bilateral or extra-adrenal disease. She has hypertension with raised catecholamines and CT evidence of a right adrenal phaeochromocytoma, and a female sibling with bilateral phaeochromocytoma. Thyroid blockade using Lugol's Iodine was given orally prior to intravenous administration of 370 MBq 123 I MIBG. Planar and SPECT imaging were acquired at 24 hours. There was intense uptake in the known right phaeochromocytoma. An unexpected finding was focal intense uptake in the region of the right thyroid lobe, which may be either a functioning paraganglioma arising from the cervical sympathetic ganglia or a medullary thyroid carcinoma (MTC). At 48 hours, a further image of the neck showed no changes. This was followed by a standard injection of 150 MBq 99 Tc m pertechnetate for thyroid scanning. Imaging obtained on 99 Tc m energy window setting showed a large hypofunctioning region in the right thyroid lobe, corresponding in location to the focal 123 I MIBG uptake. This is in keeping with a MTC, a neuroendocrine tumour, as other thyroid carcinomas are non-MIBG avid. A subsequent serum calcitonin assay showed elevated levels. The patient underwent surgical removal of the right phaeochromocytoma followed several weeks later by a right hemithyroidectomy. Histological reports confirmed the tumour diagnoses. The patient's familial phaeochromocytoma is therefore part of the multiple endocrine neoplasia syndrome Type 2A (MEN 2A). To date, biochemistry has not shown any evidence of hyperparathyroidism which occurs in 15-20 per cent of patients with MEN 2A. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

123I-MIBG lung uptake in patients with diabetes mellitus

International Nuclear Information System (INIS)

Nagamachi, Shigeki; Jinnouchi, Seishi; Flores, L.G. II

1997-01-01

The purpose of this study is to clarify the relationship between 123 I-MIBG lung uptake and silent myocardial ischemia (SMI), cardiac autonomic neuropathy (AN) or clinical characteristics. For the quantitative analysis, lung to upper mediastinum uptake ratio (L/M) and heart to upper mediastinum uptake ratio (H/M) were obtained from chest planar image. In addition, both lung washout ratio (%WR-L) and heart washout ratio (%WR-H) were calculated from early and delayed images. Each indices were compared in both diabetic and control groups. Mean values of H/M in diabetes with complication were significantly lower than those of control group. Particularly, AN(+)SMI(+) group showed lowest value. Similarly, mean values of %WR-H in diabetes with complication were significantly higher than those of control group and AN(+)SMI(+) group showed highest value. Although mean value of L/M in each diabetic group was significantly higher than that of control group, there was no statistical significance among each diabetes except AN(+)SMI(-) group on early image. Mean value of %WR-L in AN(+) or SMI(+) group was also significantly higher than that of control group, but there was no statistical significance among each diabetic group. The current study suggested that high pulmonary 123 I-MIBG uptake in diabetes was independent of the complication of SMI or AN. Pulmonary endothelial dysfunction related with severity of diabetes mellitus was considered to be the most important factor. (author)

Ageing effect on 18F-DOPA and 123I-MIBG uptake: a cross-sectional study.

Science.gov (United States)

Chiaravalloti, Agostino; Barbagallo, Gaetano; Ricci, Maria; Sannino, Pasqualina; Karalis, Georgios; Ursini, Francesco; Schillaci, Orazio

2018-06-01

The aim of this study was to investigate the relationship between age and uptake of fluorine-18-L-dihydroxyphenylalanine (F-DOPA) in the brain and myocardial uptake of iodine-123-metaiodobenzylguanidine (I-MIBG) in normal adult participants. To this end, a total of 72 healthy participants were enroled. Of these, 37 individuals (male, 21; female, 16; mean age: 60±12 years; age range: 38-85 years) underwent F-DOPA PET/CT, whereas 35 individuals (male, 19; female, 16; mean age: 61±17 years; age range: 17-87 years) underwent I-MIBG scintigraphy. For F-DOPA PET/CT, regions of interest were placed on the caudate nucleus, globus pallidus and putamen by means of the WFU Pickatlas tool implemented in SPM8 and further analysed after a normalization process. For I-MIBG scintigraphy, regions of interest were set over the upper mediastinum and a heart-to-mediastinum count ratio was calculated. The relation between age and normalized F-DOPA values or heart-to-mediastinum ratio values was examined using correlation analysis of variance and Pearson's correlation coefficient. We did not find any significant relationship between age and F-DOPA and I-MIBG uptake, respectively. Our findings suggest that both brain F-DOPA PET/CT and cardiac I-MIBG scintigraphy represent age-independent biomarkers whose analyses of quantitative uptake may not require adjustment for patients' age.

Long-term effects of the angiotensin-converting enzyme inhibitor enalapril on chronic heart failure. Examination by 123I-MIBG imaging

International Nuclear Information System (INIS)

Soeki, Takeshi; Tamura, Yoshiyuki; Bandou, Kanji; Tanaka, Hideji; Takeichi, Naoki; Shinohara, Hisanori; Yui, Yasuko; Fukuda, Nobuo; Sui, Osamu

1998-01-01

To examine the long-term effects of the angiotensin-converting enzyme (ACE) inhibitor enalapril on chronic heart failure, 10 patients (7 men and 3 women, mean age: 62±11 years) with chronic stable heart failure, classified as New York Heart Association (NYHA) functional class 2-3 for more than 3 months, and a left ventricular ejection fraction less than 45% were treated with 2.5-5.0 mg of enalapril once a day for 3-15 months (mean 7 months). The causes of heart failure were old myocardial infarction (n=7), hypertension (n=2), and atrial fibrillation (n=1). Radioiodinated metaiodobenzyl guanidine ( 123 I-MIBG) imaging, radionuclide angiography, and treadmill exercise test were performed before and after the treatment. With enalapril treatment, left ventricular ejection fraction (LVEF) increased significantly from 38.3±6.9% to 47.5±14.7%; sub-maximal exercise time increased significantly from 205±112 to 272±120 seconds; the heart to mediastinum (H/M) ratio of 123 I-MIBG increased significantly (early image: 1.99±0.38 versus 2.20±0.50; delayed image: 1.86±0.44 versus 2.09±0.51); and the washout rate of 123 I-MIBG decreased slightly from 29.1±9.1% to 25.4±7.0%. The improvement rate of LVEF was significantly correlated with the improvement rates of the H/M ratio and washout rate after treatment with enalapril. Thus, the long-term effects of enalapril can be observed in the cardiac sympathetic nervous system, and 123 I-MIBG imaging appears to be useful for evaluating the therapeutic effects of enalapril on the cardiac sympathetic nervous system in patients with chronic heart failure. (author)

Potential diagnostic value of regional myocardial adrenergic imaging using {sup 123}I-MIBG SPECT to identify patients with Lewy body diseases

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Lebasnier, Adrien; Peyronnet, Damien; Bouvard, Gerard [University Hospital Center of Caen, Department of Nuclear Medicine, Caen (France); Lamotte, Guillaume; Defer, Gilles [University Hospital Center of Caen, Department of Neurology, Caen (France); Manrique, Alain [University Hospital Center of Caen, Department of Nuclear Medicine, Caen (France); Cyceron PET Centre, Caen (France); Normandie Universite, Caen (France); Agostini, Denis [University Hospital Center of Caen, Department of Nuclear Medicine, Caen (France); Normandie Universite, Caen (France)

2015-01-28

The aim of this study was to determine the potential diagnostic value of regional myocardial adrenergic {sup 123}I-metaiodobenzylguanidine (MIBG) single photon emission computed tomography (SPECT) imaging to identify patients with Lewy body diseases (LBD+). Sixty-four consecutive patients who underwent cardiac {sup 123}I-MIBG SPECT to differentiate LBD+, including Parkinson's disease (PD) and dementia with Lewy bodies (DLB), from patients without LBD (LBD-) were retrospectively reviewed. A neurologist expert in memory disorders determined the final clinical diagnosis by using international clinical diagnostic criteria. Planar [heart to mediastinum ratio (HMR)] and {sup 123}I-MIBG SPECT[innervation defect score (IDS)] using the 17-segment left ventricular model (five-point scale) were obtained 4 h after the injection of {sup 123}I-MIBG on a low-energy high-resolution (LEHR) collimator. Receiver-operating characteristic (ROC) analysis was performed to determine the optimal HMR and IDS cut-off values to discriminate LBD+ from LBD-. Of the 64 patients, 45 (70 %) were diagnosed LBD+ (DLB, n = 27; PD, n = 18) and 19 were diagnosed LBD- (5 other dementias, 14 other parkinsonisms). The HMR and IDS of LBD+ were significantly different from those of LBD- (1.30 ± 0.21 vs 1.65 ± 0.26, p < 0.001; 39 ± 28 vs 8 ± 16, p = 0.001). The optimal HMR and IDS cut-off values to discriminate LBD+ (n = 45) from LBD- (n = 19) were 1.47 and 6/68, providing a sensitivity and specificity of 82.2 and 84.2 % and 86.7 and 73.7 %, respectively. Regional myocardial adrenergic {sup 123}I-MIBG imaging SPECT has a potential diagnostic value to identify LBD+. (orig.)

Focal Reduction in Cardiac 123I-Metaiodobenzylguanidine Uptake in Patients With Anderson-Fabry Disease.

Science.gov (United States)

Yamamoto, Saori; Suzuki, Hideaki; Sugimura, Koichiro; Tatebe, Shunsuke; Aoki, Tatsuo; Miura, Masanobu; Yaoita, Nobuhiro; Sato, Haruka; Kozu, Katuya; Ota, Hideki; Takanami, Kentaro; Takase, Kei; Shimokawa, Hiroaki

2016-11-25

It remains to be elucidated whether cardiac sympathetic nervous activity is impaired in patients with Anderson-Fabry disease (AFD).Methods and Results:We performed 123 I-meta-iodobenzylguanidine (MIBG) scintigraphy and gadolinium-enhanced cardiovascular magnetic resonance (CMR) in 5 AFD patients. MIBG uptake in the inferolateral wall, where wall thinning and delayed enhancement were noted on CMR, was significantly lower compared with the anteroseptal wall. The localized reduction in MIBG uptake was also noted in 2 patients with no obvious abnormal findings on CMR. Cardiac sympathetic nervous activity is impaired in AFD before development of structural myocardial abnormalities. (Circ J 2016; 80: 2550-2551).

Long-term effects of the angiotensin-converting enzyme inhibitor enalapril on chronic heart failure. Examination by {sup 123}I-MIBG imaging

Energy Technology Data Exchange (ETDEWEB)

Soeki, Takeshi; Tamura, Yoshiyuki; Bandou, Kanji; Tanaka, Hideji; Takeichi, Naoki; Shinohara, Hisanori; Yui, Yasuko; Fukuda, Nobuo; Sui, Osamu [Zentsuji National Hospital, Kagawa (Japan)

1998-11-01

To examine the long-term effects of the angiotensin-converting enzyme (ACE) inhibitor enalapril on chronic heart failure, 10 patients (7 men and 3 women, mean age: 62{+-}11 years) with chronic stable heart failure, classified as New York Heart Association (NYHA) functional class 2-3 for more than 3 months, and a left ventricular ejection fraction less than 45% were treated with 2.5-5.0 mg of enalapril once a day for 3-15 months (mean 7 months). The causes of heart failure were old myocardial infarction (n=7), hypertension (n=2), and atrial fibrillation (n=1). Radioiodinated metaiodobenzyl guanidine ({sup 123}I-MIBG) imaging, radionuclide angiography, and treadmill exercise test were performed before and after the treatment. With enalapril treatment, left ventricular ejection fraction (LVEF) increased significantly from 38.3{+-}6.9% to 47.5{+-}14.7%; sub-maximal exercise time increased significantly from 205{+-}112 to 272{+-}120 seconds; the heart to mediastinum (H/M) ratio of {sup 123}I-MIBG increased significantly (early image: 1.99{+-}0.38 versus 2.20{+-}0.50; delayed image: 1.86{+-}0.44 versus 2.09{+-}0.51); and the washout rate of {sup 123}I-MIBG decreased slightly from 29.1{+-}9.1% to 25.4{+-}7.0%. The improvement rate of LVEF was significantly correlated with the improvement rates of the H/M ratio and washout rate after treatment with enalapril. Thus, the long-term effects of enalapril can be observed in the cardiac sympathetic nervous system, and {sup 123}I-MIBG imaging appears to be useful for evaluating the therapeutic effects of enalapril on the cardiac sympathetic nervous system in patients with chronic heart failure. (author)

Impaired cardiac uptake of meta-[123I]iodobenzylguanidine in Parkinson's disease with autonomic failure

International Nuclear Information System (INIS)

Braune, S.; Luecking, C.H.; Reinhardt, M.; Bathmann, J.; Krause, T.; Lehmann, M.

1998-01-01

Objective - To selectively investigate postganglionic sympathetic cardiac neurons in patients with Parkinson's disease and autonomic failure. Material and methods - Metaiodobenzylguanidine (MIBG) is a pharmacologically inactive analogue of noradrenaline, which is similarly metabolized in noradrenergic neurons. Therefore the uptake of radiolabelled MIBG represents not only the localization of postganglionic sympathetic neurons but also their functional integrity. Ten patients with Parkinson's disease and autonomic failure underwent standardized autonomic testing, assessment of catecholamine plasma levels and scintigraphy with [ 123 I]MIGB. Results - The cardiac uptake of MIBG, as demonstrated by the heart/mediastinum ratio, was significantly lower in patients in comparison with controls. Scintigraphy with MIBG allowed the selective in-vivo investigation of postganglionic sympathetic cardiac efferent in patients with autonomic failure, a procedure which was previously confined to post-mortem examination. Conclusion - These findings point to a relevant postganglionic pattern of involvement of the autonomic nervous system (ANS) in Parkinson's disease and autonomic failure. (au)

Relationship between quantitative cardiac neuronal imaging with 123I-meta-iodobenzylguanidine and hospitalization in patients with heart failure

International Nuclear Information System (INIS)

Parker, Matthew W.; Sood, Nitesh; Ahlberg, Alan W.; Jacobson, Arnold F.; Heller, Gary V.; Lundbye, Justin B.

2014-01-01

Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by 123 I-meta-iodobenzylguanidine ( 123 I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between 123 I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using 123 I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

{sup 123}I-Labelled metaiodobenzylguanidine for the evaluation of cardiac sympathetic denervation in early stage amyloidosis

Energy Technology Data Exchange (ETDEWEB)

Noordzij, Walter; Glaudemans, Andor W.J.M.; Rheenen, Ronald W.J. van; Dierckx, Rudi A.J.O.; Slart, Riemer H.J.A. [University of Groningen, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, PO Box 30.001, Groningen (Netherlands); Hazenberg, Bouke P.C. [University of Groningen, Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen (Netherlands); Tio, Rene A. [University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen (Netherlands)

2012-10-15

Cardiac amyloidosis is a rare disorder, but it may lead to potentially life-threatening restrictive cardiomyopathy. Cardiac manifestations frequently occur in primary amyloidosis (AL) and familial amyloidosis (ATTR), but are uncommon in secondary amyloidosis (AA). Echocardiography is the method of choice for assessing cardiac amyloidosis. Amyloid deposits impair the function of sympathetic nerve endings. Disturbance of myocardial sympathetic innervations may play an important role in the remodelling process. {sup 123}I-MIBG can detect these innervation changes. Patients with biopsy-proven amyloidosis underwent general work-up, echocardiography and {sup 123}I-MIBG scintigraphy. Left ventricular internal dimensions and wall thickness were measured, and highly refractile cardiac echoes (sparkling) were analysed. Early (15 min) and late (4 h) heart-to-mediastinum ratio (HMR) and wash-out rate were determined after administration of MIBG. Included in the study were 61 patients (30 women and 31 men; mean age 62 years; 39 AL, 11 AA, 11 ATTR). Echocardiographic parameters were not significantly different between the groups. Sparkling was present in 72 % of ATTR patients, in 54 % of AL patients and in 45 % of AA patients. Mean late HMR in all patients was 2.3 {+-} 0.75, and the mean wash-out rate was 8.6 {+-} 14 % (the latter not significantly different between the patient groups). Late HMR was significantly lower in patients with echocardiographic signs of amyloidosis than in patients without (2.0 {+-} 0.70 versus 2.8 {+-} 0.58, p < 0.001). Wash-out rates were significantly higher in these patients (-3.3 {+-} 9.9 % vs. 17 {+-} 10 %, p < 0.001). In ATTR patients without echocardiographic signs of amyloidosis, HMR was lower than in patients with the other types (2.0 {+-} 0.59 vs. 2.9 {+-} 0.50, p = 0.007). MIBG HMR is lower and wash-out rate is higher in patients with echocardiographic signs of amyloidosis. Also, {sup 123}I-MIBG scintigraphy can detect cardiac denervation in

Clinical relationship of myocardial sympathetic nervous activity to cardiovascular functions in chronic heart failure. Assessment by myocardial scintigraphy with 123I-metaiodobenzylguanidine

International Nuclear Information System (INIS)

Wada, Yukoh; Miura, Masaetsu; Fujiwara, Satomi; Mori, Shunpei; Seiji, Kazumasa; Kimura, Tokihisa

2003-01-01

The aim of this study was to clarify the relationship between cardiac sympathetic nervous activity (SNA) assessed by radioiodinated metaiodobenzylguanidine ( 123 I-MIBG), an analogue of norepinephrine and cardiovascular functions in patients with chronic heart failure (CHF). Subjects were 17 patients with CHF. A dose of 111 MBq of 123 I-MIBG was administered intravenously, and 5-minute anterior planar images were obtained 15 minutes (early image) and 3 hours (delayed image) after the injection. The heart/mediastinum (H/M) count ratio was defined to quantify cardiac 123 I-MIBG uptake. The washout ratio (WR) of 123 I-MIBG from the heart was calculated as follows: (early counts-delayed counts)/early counts x 100 (%). Echocardiography was performed on all patients within 1 week of 123 I-MIBG scintigraphy to measure stroke volume index (SVI). Blood pressure and heart rate (HR) in the resting state were also recorded to calculate cardiovascular functions including cardiac output, pulse pressure (PP), and mean blood pressure. Significant linear correlations were found between the early H/M ratio of 123 I-MIBG and SVI, and between the delayed H/M ratio of 123 I-MIBG and SVI, respectively. WR of 123 I-MIBG was correlated with HR, and was inversely correlated with SVI and with PP, respectively. It is likely that a decrease in SVI is associated with enhanced cardiac SNA in severe CHF. 123 I-MIBG scintigraphy is effective in assessing the cardiac functional status and SNA in patients with CHF in vivo. Moreover, changes in PP and HR indicate well alteration in SNA. (author)

Challenging the neuronal MIBG uptake by pharmacological intervention: effect of a single dose of oral amitriptyline on regional cardiac MIBG uptake

Energy Technology Data Exchange (ETDEWEB)

Estorch, Montserrat; Carrio, Ignasi; Mena, Esther; Flotats, Albert; Camacho, Valle; Fuertes, Jordi [Autonomous University of Barcelona, Department of Nuclear Medicine, Hospital Sant Pau, Barcelona (Spain); Kulisewsky, Jaume [Autonomous University of Barcelona, Department of Neurology, Hospital Sant Pau, Barcelona (Spain); Narula, Jagat [Irvine College of Medicine, Division of Cardiology, University of California, Irvine, CA (United States)

2004-12-01

Imaging with metaiodobenzylguanidine (MIBG) is used for the assessment of neuronal dysfunction in various cardiovascular disorders. Although valuable information is obtained by resting MIBG imaging, it is conceivable that competitive interference with the re-uptake mechanism would exaggerate MIBG defects and might unmask subclinical neuronal dysfunction. Tricyclic antidepressants, such as amitriptyline, have been reported to significantly increase cardiac MIBG washout and inhibit uptake into presynaptic neurons. This study was undertaken to assess whether a single oral dose of amitriptyline could influence cardiac MIBG distribution. Six patients (aged 62-81 years; four males, two females) who had demonstrated a normal cardiac MIBG scan during work-up for movement disorders were studied. The patients underwent a second {sup 123}I-MIBG study after oral administration of 25 mg amitriptyline within 1 week. Single-photon emission computed tomography images were acquired at 4 h to assess the regional distribution of MIBG, after generation of polar maps and employing a 20-segment model. Mean percentage of peak activity was calculated for each segment at rest and after amitriptyline administration. After amitriptyline administration, there was a decrease in regional MIBG uptake in 10{+-}4 segments per patient [62/120 segments (52%): 37 segments with a 5-10% decrease, 25 segments with a >10% decrease]. This change was statistically significant in lateral (P=0.003), apical (P<0.0001) and inferior (P=0.03) regions. A single oral dose of amitriptyline can induce changes in the uptake and retention of cardiac MIBG, indicating the feasibility of use of pharmacological intervention in cardiac neurotransmission imaging. (orig.)

First determination of the heart-to-mediastinum ratio using cardiac dual isotope ({sup 123}I-MIBG/{sup 99m}Tc-tetrofosmin) CZT imaging in patients with heart failure: the ADRECARD study

Energy Technology Data Exchange (ETDEWEB)

Bellevre, Dimitri; Desmonts, Cedric [CHU Cote de Nacre, Department of Nuclear Medicine, Caen (France); Manrique, Alain; Agostini, Denis [CHU Cote de Nacre, Department of Nuclear Medicine, Caen (France); EA 4650, Normandie Universite, Caen (France); Legallois, Damien [EA 4650, Normandie Universite, Caen (France); CHU Cote de Nacre, Cardiology Department, Caen (France); Bross, Samy; Baavour, Rafael; Roth, Nathaniel [Spectrum Dynamics, Biosensors, Caesarea (Israel); Blaire, Tanguy; Bailliez, Alban [EA 4650, Normandie Universite, Caen (France); IRIS, Polyclinique du Bois, Nuclear Medicine Department, Lille (France)

2015-11-15

Cardiac innervation is assessed using the heart-to-mediastinum ratio (HMR) of metaiodobenzylguanidine (MIBG) on planar imaging using Anger single photon emission computed tomography (A-SPECT). The aim of the study was to determine the HMR of MIBG obtained using a CZT-based camera (D-SPECT; Spectrum Dynamics, Israel) in comparison with that obtained using conventional planar imaging. The ADRECARD study prospectively evaluated 44 patients with heart failure. They underwent planar acquisition using the A-SPECT camera 4 h after {sup 123}I-MIBG injection (236.4 ± 39.7 MBq). To localize the heart using D-SPECT, {sup 99m}Tc-tetrofosmin (753 ± 133 MBq) was administered and dual isotope acquisition was performed using the D-SPECT system. HMR was calculated using both planar A-SPECT imaging and front view D-SPECT cine data. In a phantom study, we estimated a model fitting the A-SPECT and the D-SPECT data that was further applied to correct for differences between the cameras. A total of 44 patients (39 men and 5 women, aged 60 ± 11 years) with ischaemic (31 patients) and nonischaemic (13 patients) cardiomyopathy completed the study. Most patients (28 of 44) were NYHA class II, and the mean left ventricular ejection fraction was 33 ± 7 %. The mean HMR values were 1.34 ± 0.15 and 1.45 ± 0.27 from A-SPECT and D-SPECT, respectively (p < 0.0001). After correction, Lin's concordance correlation showed an almost perfect concordance between corrected D-SPECT HMR and A-SPECT HMR, and Bland-Altman analysis demonstrated a high agreement between the two measurements. The ADRECARD study demonstrated that determination of late HMR during cardiac MIBG imaging using dual isotope ({sup 123}I and {sup 99m}Tc) acquisition on a CZT camera (D-SPECT) is feasible in patients with heart failure. A linear correction based on the phantom study yielded a high agreement between {sup 123}I MIBG HMR obtained using a CZT camera and that from conventional planar imaging. (orig.)

Relationship between quantitative cardiac neuronal imaging with {sup 123}I-meta-iodobenzylguanidine and hospitalization in patients with heart failure

Energy Technology Data Exchange (ETDEWEB)

Parker, Matthew W.; Sood, Nitesh [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Ahlberg, Alan W. [Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Jacobson, Arnold F. [GE Healthcare, Princeton, NJ (United States); Heller, Gary V. [The Intersocietal Accreditation Commission, Ellicott City, MD (United States); Lundbye, Justin B. [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); The Hospital of Central Connecticut, Division of Cardiology, New Britain, CT (United States)

2014-09-15

Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by {sup 123}I-meta-iodobenzylguanidine ({sup 123}I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between {sup 123}I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using {sup 123}I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

Prediction of effect of {beta}-blocker therapy in patients with dilated cardiomyopathy by using {sup 123}I-BMIPP, {sup 123}I-MIBG scintigraphy

Energy Technology Data Exchange (ETDEWEB)

Inoue, Aritomo; Yamazaki, Junichi; Nanjou, Shuji; Togane, Yuko; Amano, Hideo [Toho Univ., Tokyo (Japan). School of Medicine

2001-03-01

We investigated prediction of the efficacy of {beta}-blocker therapy in patients with dilated cardiomyopathy (DCM) by using myocardial scintigraphy with {sup 123}I-BMIPP (BMIPP) and {sup 123}I-MIBG (MIBG). Thirty-seven patients with DCM were examined by myocardial scintigraphy with BMIPP and MIBG before {beta}-blocker therapy. Patients were classified into two groups, based on whether they improved >10% of the left ventricular ejection fraction (LVEF) (improved group, n=21) or not (unimproved group, n=16). The extent and severity score of BMIPP for the improved group was significantly lower (p<0.001) than that for unimproved group. It has been suggested that BMIPP is useful in evaluating the prediction of efficacy of {beta}-blocker therapy in patients with DCM. (author)

Structural changes in Parkinson's disease: voxel-based morphometry and diffusion tensor imaging analyses based on 123I-MIBG uptake.

Science.gov (United States)

Kikuchi, Kazufumi; Hiwatashi, Akio; Togao, Osamu; Yamashita, Koji; Somehara, Ryo; Kamei, Ryotaro; Baba, Shingo; Yamaguchi, Hiroo; Kira, Jun-Ichi; Honda, Hiroshi

2017-12-01

Patients with Parkinson's disease (PD) may exhibit symptoms of sympathetic dysfunction that can be measured using 123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. We investigated the relationship between microstructural brain changes and 123 I-MIBG uptake in patients with PD using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) analyses. This retrospective study included 24 patients with PD who underwent 3 T magnetic resonance imaging and 123 I-MIBG scintigraphy. They were divided into two groups: 12 MIBG-positive and 12 MIBG-negative cases (10 men and 14 women; age range: 60-81 years, corrected for gender and age). The heart/mediastinum count (H/M) ratio was calculated on anterior planar 123 I-MIBG images obtained 4 h post-injection. VBM and DTI were performed to detect structural differences between these two groups. Patients with low H/M ratio had significantly reduced brain volume at the right inferior frontal gyrus (uncorrected p  90). Patients with low H/M ratios also exhibited significantly lower fractional anisotropy than those with high H/M ratios (p based morphometry can detect grey matter changes in Parkinson's disease. • Diffusion tensor imaging can detect white matter changes in Parkinson's disease.

Iodine-123 metaiodobenzylguanidine in the assessment of late cardiac effects from cancer therapy

International Nuclear Information System (INIS)

Valdes Olmos, R.A.; Bokkel Huinink, W.W. ten; Dewit, L.G.H.; Hoefnagel, C.A.; Liem, I.H.; Tinteren, H. van

1996-01-01

Recognition of adverse late cardiac effects from cancer therapy may enable identification of patients with risk of cardiotoxicity upon cancer retreatment. In this study the feasibility of using iodine-123 metaiodobenzylguanidine ( 123 I-MIBG) heart scintigraphy to detect abnormalities of the myocardial adrenergic neurone function in the late period after cancer therapy was evaluated in relation to the left ventricle ejection fraction (LVEF) in 18 cancer patients: 11 had undergone thoracic irradiation involving the heart, in five cases in combination with anthracycline therapy, 11-228 months (median 60 months) before radionuclide tests, while seven had not received previous anthracycline and/or radiotherapy (controls). The 123 I-MIBG cardiac uptake, expressed as a heart-to-mediastinum ratio on planar images after 4 h, ranged from 1.21 to 1.76 (median 1.56) in cancer therapy patients, which was significantly decreased (P=0.0006) in comparison with controls (range 1.81-2.06, median 1.9). The myocardial 123 I-MIBG washout, calculated from planar images after 15 min and 4 h, and LVEF also showed significant differences, but with some overlap in individual cases. In cancer therapy patients, cardiac abnormalities seen on planar images and additional single-photon emission tomographic images varied from focal defects to diffusely reduced myocardial uptake. It is concluded that 123 I-MIBG heart scintigraphy, which is able to identify cardiac adrenergic neurone abnormalities in the follow-up period after cancer therapy, may help to identify relapsed patients who are at increased risk of developing cardiotoxicity during retreatment with cardiotoxic therapy modalities. (orig.). With 4 figs., 2 tabs

123I-MIBG lung uptake in patients with diabetes mellitus. Correlation with cardiac autonomic neuropathy

International Nuclear Information System (INIS)

Nagamachi, Shigeki; Jinnouchi, Seishi; Flores, L.G. II; Ohnishi, Takashi; Tamura, Shozo; Watanabe, Katsushi; Kurose, Takeshi; Matsukura, Sigeru

1997-01-01

The purpose of this study is to investigate the relationship between 123 I-MIBG lung uptake and autonomic neuropathy (AN) in patients with diabetes mellitus. For the quantitative analysis, lung to upper mediastinum uptake ratio (L/M) and heart to upper mediastinum uptake ratio (H/M) were obtained from chest planar image. In addition, both lung washout ratio (%WR-L) and heart washout ratio (%WR-H) were calculated from early and delayed images. Similarly, exercised myocardial scintigraphy using 201 Tl-chloride was done to rule out ischemia and lung to upper mediastinum uptake ratio (L/M-Tl) and heart to upper mediastinum uptake ratio (H/M-Tl) were obtained from chest planar image. Each indexes were compared in both diabetic group and control group. Both mean value of H/M and %WR-H in AN (+) group were significantly higher than those of control group. Mean value of L/M in each diabetic group was significantly higher than that of control group. Particularly, L/M of AN (+) group is higher than that of AN (-) group on early study. Mean value of %WR-L in AN (+) group was also significantly higher than that of control group. Regarding the 201 Tl-uptake index, there was no statistical significance among in each group. The current study showed that abnormal pulmonary 123 I-MIBG uptake in the lung existed in patients with diabetes mellitus. The phenomenon might be related with sympathetic dysfunction or severity of diabetes mellitus. (author)

Structural changes in Parkinson's disease. Voxel-based morphometry and diffusion tensor imaging analyses based on 123I-MIBG uptake

International Nuclear Information System (INIS)

Kikuchi, Kazufumi; Hiwatashi, Akio; Togao, Osamu; Yamashita, Koji; Somehara, Ryo; Kamei, Ryotaro; Baba, Shingo; Honda, Hiroshi; Yamaguchi, Hiroo; Kira, Jun-ichi

2017-01-01

Patients with Parkinson's disease (PD) may exhibit symptoms of sympathetic dysfunction that can be measured using 123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. We investigated the relationship between microstructural brain changes and 123 I-MIBG uptake in patients with PD using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) analyses. This retrospective study included 24 patients with PD who underwent 3 T magnetic resonance imaging and 123 I-MIBG scintigraphy. They were divided into two groups: 12 MIBG-positive and 12 MIBG-negative cases (10 men and 14 women; age range: 60-81 years, corrected for gender and age). The heart/mediastinum count (H/M) ratio was calculated on anterior planar 123 I-MIBG images obtained 4 h post-injection. VBM and DTI were performed to detect structural differences between these two groups. Patients with low H/M ratio had significantly reduced brain volume at the right inferior frontal gyrus (uncorrected p < 0.0001, K > 90). Patients with low H/M ratios also exhibited significantly lower fractional anisotropy than those with high H/M ratios (p < 0.05) at the left anterior thalamic radiation, the left inferior fronto-occipital fasciculus, the left superior longitudinal fasciculus, and the left uncinate fasciculus. VBM and DTI may reveal microstructural changes related to the degree of 123 I-MIBG uptake in patients with PD. (orig.)

Clinical application of l-123 MlBG cardiac imaging

International Nuclear Information System (INIS)

Kang, Do Young

2004-01-01

Cardiac neurotransmission imaging allows in vivo assessment of presynaptic reuptake, neurotransmitter storage and postsynaptic receptors. Among the various neurotransmitter, I-123 MlBG is most available and relatively well-established. Metaiodobenzylguanidine (MIBG) is an analogue of the false neurotransmitter guanethidine. It is taken up to adrenergic neurons by uptake-1 mechanism as same as norepinephrine. As tagged with I-123, it can be used to image sympathetic function in various organs including heart with planar or SPECT techniques. I-123 MIBG imaging has a unique advantage to evaluate myocardial neuronal activity in which the heart has no significant structural abnormality or even no functional derangement measured with other conventional examination. In patients with cardiomyopathy and heart failure, this imaging has most sensitive technique to predict prognosis and treatment response of betablocker or ACE inhibitor. In diabetic patients, it allow very early detection of autonomic neuropathy. In patients with dangerous arrhythmia such as ventricular tachycardia or fibrillation, MIBG imaging may be only an abnormal result among various exams. In patients with ischemic heart disease, sympathetic derangement may be used as the method of risk stratification. In heart transplanted patients, sympathetic reinnervation is well evaluated. Adriamycin-induced cardiotoxicity is detected earlier than ventricular dysfunction with sympathetic dysfunction. Neurodegenerative disorder such as Parkinson's disease or dementia with Lewy bodies has also cardiac sympathetic dysfunction. Noninvasive assessment of cardiac sympathetic nerve activity with l-123 MlBG imaging may be improve understanding of the pathophysiology of cardiac disease and make a contribution to predict survival and therapy efficacy

Clinical application of l-123 MlBG cardiac imaging

Energy Technology Data Exchange (ETDEWEB)

Kang, Do Young [College of Medicine, Donga Univ., Busan (Korea, Republic of)

2004-10-01

Cardiac neurotransmission imaging allows in vivo assessment of presynaptic reuptake, neurotransmitter storage and postsynaptic receptors. Among the various neurotransmitter, I-123 MlBG is most available and relatively well-established. Metaiodobenzylguanidine (MIBG) is an analogue of the false neurotransmitter guanethidine. It is taken up to adrenergic neurons by uptake-1 mechanism as same as norepinephrine. As tagged with I-123, it can be used to image sympathetic function in various organs including heart with planar or SPECT techniques. I-123 MIBG imaging has a unique advantage to evaluate myocardial neuronal activity in which the heart has no significant structural abnormality or even no functional derangement measured with other conventional examination. In patients with cardiomyopathy and heart failure, this imaging has most sensitive technique to predict prognosis and treatment response of betablocker or ACE inhibitor. In diabetic patients, it allow very early detection of autonomic neuropathy. In patients with dangerous arrhythmia such as ventricular tachycardia or fibrillation, MIBG imaging may be only an abnormal result among various exams. In patients with ischemic heart disease, sympathetic derangement may be used as the method of risk stratification. In heart transplanted patients, sympathetic reinnervation is well evaluated. Adriamycin-induced cardiotoxicity is detected earlier than ventricular dysfunction with sympathetic dysfunction. Neurodegenerative disorder such as Parkinson's disease or dementia with Lewy bodies has also cardiac sympathetic dysfunction. Noninvasive assessment of cardiac sympathetic nerve activity with l-123 MlBG imaging may be improve understanding of the pathophysiology of cardiac disease and make a contribution to predict survival and therapy efficacy.

Comparative value of brain perfusion SPECT and [123I]MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and Alzheimer's disease

International Nuclear Information System (INIS)

Hanyu, Haruo; Shimizu, Soichiro; Hirao, Kentaro; Kanetaka, Hidekazu; Iwamoto, Toshihiko; Chikamori, Taishiro; Usui, Yasuhiro; Yamashina, Akira; Koizumi, Kiyoshi; Abe, Kimihiko

2006-01-01

Both decreased occipital perfusion on brain single-photon emission computed tomography (SPECT) and reduction in cardiac 123 I-metaiodobenzylguanidine (MIBG) uptake are characteristic features of dementia with Lewy bodies (DLB), and potentially support the clinical diagnosis of DLB. The aim of this study was to compare the diagnostic value of these two methods for differentiation of DLB from Alzheimer's disease (AD). The study population comprised 19 patients with probable DLB and 39 patients with probable AD who underwent both SPECT with N-isopropyl-p-[ 123 I]iodoamphetamine and MIBG myocardial scintigraphy. Objective and quantitative measurement of perfusion in the medial occipital lobe, including the cuneus and lingual gyrus, was performed by the use of three-dimensional stereotactic surface projections. Medial occipital perfusion was significantly decreased in the DLB group compared with the AD group. The mean heart/mediastinum ratios of MIBG uptake were significantly lower in the DLB group than in the AD group. Although SPECT failed to demonstrate significant hypoperfusion in the medial occipital lobe in five patients with DLB, marked reduction of MIBG uptake was found in all patients with DLB. Receiver operating characteristic analysis revealed that MIBG myocardial scintigraphy enabled more accurate discrimination between DLB and AD than was possible with perfusion SPECT. MIBG myocardial scintigraphy may improve the sensitivity in the detection of DLB. In particular, this method may provide a powerful differential diagnostic tool when it is difficult to distinguish cases of DLB from AD using brain perfusion SPECT. (orig.)

Structural changes in Parkinson's disease. Voxel-based morphometry and diffusion tensor imaging analyses based on {sup 123}I-MIBG uptake

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Kikuchi, Kazufumi; Hiwatashi, Akio; Togao, Osamu; Yamashita, Koji; Somehara, Ryo; Kamei, Ryotaro; Baba, Shingo; Honda, Hiroshi [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences, Fukuoka (Japan); Yamaguchi, Hiroo; Kira, Jun-ichi [Kyushu University, Department of Neurology, Graduate School of Medical Sciences, Fukuoka (Japan)

2017-12-15

Patients with Parkinson's disease (PD) may exhibit symptoms of sympathetic dysfunction that can be measured using {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. We investigated the relationship between microstructural brain changes and {sup 123}I-MIBG uptake in patients with PD using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) analyses. This retrospective study included 24 patients with PD who underwent 3 T magnetic resonance imaging and {sup 123}I-MIBG scintigraphy. They were divided into two groups: 12 MIBG-positive and 12 MIBG-negative cases (10 men and 14 women; age range: 60-81 years, corrected for gender and age). The heart/mediastinum count (H/M) ratio was calculated on anterior planar {sup 123}I-MIBG images obtained 4 h post-injection. VBM and DTI were performed to detect structural differences between these two groups. Patients with low H/M ratio had significantly reduced brain volume at the right inferior frontal gyrus (uncorrected p < 0.0001, K > 90). Patients with low H/M ratios also exhibited significantly lower fractional anisotropy than those with high H/M ratios (p < 0.05) at the left anterior thalamic radiation, the left inferior fronto-occipital fasciculus, the left superior longitudinal fasciculus, and the left uncinate fasciculus. VBM and DTI may reveal microstructural changes related to the degree of {sup 123}I-MIBG uptake in patients with PD. (orig.)

Assessment of cardiac sympathetic nerve activity in children with chronic heart failure using quantitative iodine-123 metaiodobenzylguanidine imaging

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Karasawa, Kensuke; Ayusawa, Mamoru; Noto, Nobutaka; Sumitomo, Naokata; Okada, Tomoo; Harada, Kensuke [Nihon Univ., Tokyo (Japan). School of Medicine

2000-12-01

Cardiac sympathetic nerve activity in children with chronic heart failure was examined by quantitative iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging in 33 patients aged 7.5{+-}6.1 years (range 0-18 years), including 8 with cardiomyopathy, 15 with congenital heart disease, 3 with anthracycrine cardiotoxicity, 3 with myocarditis, 3 with primary pulmonary hypertension and 1 with Pompe's disease. Anterior planar images were obtained 15 min and 3 hr after the injection of iodine-123 MIBG. The cardiac iodine-123 MIBG uptake was assessed as the heart to upper mediastinum uptake activity ratio of the delayed image (H/M) and the cardiac percentage washout rate (%WR). The severity of chronic heart failure was class I (no medication) in 8 patients, class II (no symptom with medication) in 9, class III (symptom even with medication) in 10 and class IV (late cardiac death) in 6. H/M was 2.33{+-}0.22 in chronic heart failure class I, 2.50{+-}0.34 in class II, 1.95{+-}0.61 in class III, and 1.39{+-}0.29 in class IV (p<0.05). %WR was 24.8{+-}12.8% in chronic heart failure class I, 23.3{+-}10.2% in class II, 49.2{+-}24.5% in class III, and 66.3{+-}26.5% in class IV (p<0.05). The low H/M and high %WR were proportionate to the severity of chronic heart failure. Cardiac iodine-123 MIBG showed cardiac adrenergic neuronal dysfunction in children with severe chronic heart failure. Quantitative iodine-123 MIBG myocardial imaging is clinically useful as a predictor of therapeutic outcome and mortality in children with chronic heart failure. (author)

Diagnosis of pheochromocytoma using (123I)-compared with (131I)-metaiodobenzylguanidine scintigraphy

International Nuclear Information System (INIS)

Furuta, Nozomu; Kiyota, Hiroshi; Yoshigoe, Fukuo; Hasegawa, Norio; Ohishi, Yukihiko

1999-01-01

Patient with pheochromocytoma (PCT) cannot be cured without operation, therefore, preoperative determination of the localization of PCT should be performed accurately. ( 131 I)-Metaiodobenzylguanidine (MIBG) scintigraphy is a gold standard for the diagnosis of PCT. However, ( 123 I)-MIBG is also found to accumulate in PCT. In order to clarify the usefulness of ( 123 I)-MIBG scintigraphy for the local detection of PCT, we compared the distribution of ( 123 I)- and ( 131 I)-MIBG in patients with or without PCT. ( 131 I)- and ( 123 I)-MIBG scintigraphy was performed in 29 and 16 patients, respectively. In the former group, 14 patients had PCT, 12 had hypertension without any adrenal disorder and three had other diseases. In the latter group, eight patients had PCT, two had hypertension without any adrenal disorder and six had other diseases. The sensitivity, specificity and accuracy of ( 123 I)- with ( 131 I)-MIBG scintigraphy were compared. The sensitivity of ( 131 I)- and ( 123 I)-MIBG scintigraphy was 85.7 and 90%, respectively. The specificity of each test was 100%. The accuracy of ( 131 I)- and ( 123 I)-MIBG scintigraphy was 93.1 and 95%, respectively. The quality of images obtained using ( 123 I)-MIBG was better than with ( 131 I)-MIBG, because ( 123 I)-MIBG generated a higher dose of γ-rays with a higher specificity than ( 131 I)-MIBG. In addition, normal adrenal grands were visualized in 50% of patients tested with ( 123 I)-MIBG scintigraphy. These results indicate that ( 123 I)-MIBG scintigraphy is a valuable tool for the local detection of PCT, as is ( 131 I)-MIBG scintigraphy. Furthermore, it is possible that ( 123 I)-MIBG can be used as an alternative to ( 131 I)-MIBG for the detection of PCT. Our study was not a prospective study and the background of the patients was not matched. Further prospective studies are needed in order to determine the efficacy of ( 123 I)-MIBG scintigraphy for the diagnosis of PCT. (author)

Influence of the polyol pathway on norepinephrine transporter reduction in diabetic cardiac sympathetic nerves: implications for heterogeneous accumulation of MIBG

International Nuclear Information System (INIS)

Kiyono, Yasushi; Kajiyama, Satomi; Fujiwara, Hiromi; Kanegawa, Naoki; Saji, Hideo

2005-01-01

Cardiac scintigraphic studies using 123 I-labeled metaiodobenzylguanidine ([ 123 I]MIBG) have demonstrated heterogeneous myocardial accumulation of MIBG in diabetes. The accumulation has been found to correlate with a heterogeneous decrease in the expression of norepinephrine transporter (NET). In diabetic peripheral nerve tissue, polyol pathways are activated and cause nerve dysfunction and degeneration. However, there has been little research on the polyol pathway and cardiac sympathetic nerves. Therefore, to assess the influence of the polyol pathway on cardiac sympathetic nervous function, we investigated the regional accumulation of MIBG and NET protein expression in diabetic model rats treated with aldose reductase inhibitor (ARI) for the blockade of polyol pathways. Rats were given a single intravenous injection of streptozotocin (n=76, STZ-D rats). Starting the day after STZ injection, ARI was administered daily to 42 of the rats for 4 weeks (ARI-D rats). To assess the cardiac sympathetic nervous function, [ 125 I]MIBG autoradiographic experiments were carried out. Finally, NET protein expression was assessed with a saturation binding assay. The myocardial sorbitol concentration was significantly higher in STZ-D rats than in ARI-D rats. There was no heterogeneous accumulation of MIBG in ARI-D rats. There was a heterogeneous decrease of NET expression in STZ-D rats, but not in ARI-D or control rats. The gathered data indicate that the enhanced polyol pathway correlates with the decrease in regional cardiac sympathetic nervous function, and this impairment may lead to the reduction of NET protein in cardiac sympathetic nerves of the diabetic inferior wall. (orig.)

Heart failure and 1231-M.I.B.G. scintigraphy: comeback; Scintigraphie cardiaque a la 1231-metaiodobenzylguanidine et cardiomyopathies: le retour

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Agostini, D.; Hugentobler, A.; Costo, S.; Bouvard, G. [Centre Hospitalier Universitaire Cote de Nacre, Service de Medecine Nucleaire, 14 - Caen (France); Manrique, A. [Centre de Lutte Contre le Cancer Henri-Becquerel, Service de Medecine Nucleaire, 76 - Rouen (France); Sabatier, R.; Grollier, G. [Centre Hospitalier Universitaire Cote de Nacre, Service de Cardiologie, 14 - Caen (France); Belin, A. [Hopital de Trouville, Service de Readaptation Cardiaque, 14 - Trouville (France)

2007-09-15

Congestive heart failure is a often associated with an impairment of sympathetic nervous system, i.e., global hyperactivity and regional impairment of adrenergic system. Cardiac {sup 123}I-meta-iodo-benzyl-guanidine (M.I.B.G.) scintigraphy is a radionuclide technique which can explore the presynaptic adrenergic function. Cardiac fixation of M.I.B.G. is decreased in congestive heart failure, reflecting a reduction of norepinephrine uptake by the myocardial presynaptic ending nerves. The impairment of presynaptic function is early and actually involved in the pathogenesis of cardiac failure. Cardiac M.I.B.G. scintigraphy is a useful tool to explore the myocardial adrenergic stores in patients with congestive heart failure. (authors)

Assessment of cardiac sympathetic nerve activity in children with chronic heart failure using quantitative iodine-123 metaiodobenzylguanidine imaging

International Nuclear Information System (INIS)

Karasawa, Kensuke; Ayusawa, Mamoru; Noto, Nobutaka; Sumitomo, Naokata; Okada, Tomoo; Harada, Kensuke

2000-01-01

Cardiac sympathetic nerve activity in children with chronic heart failure was examined by quantitative iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging in 33 patients aged 7.5±6.1 years (range 0-18 years), including 8 with cardiomyopathy, 15 with congenital heart disease, 3 with anthracycrine cardiotoxicity, 3 with myocarditis, 3 with primary pulmonary hypertension and 1 with Pompe's disease. Anterior planar images were obtained 15 min and 3 hr after the injection of iodine-123 MIBG. The cardiac iodine-123 MIBG uptake was assessed as the heart to upper mediastinum uptake activity ratio of the delayed image (H/M) and the cardiac percentage washout rate (%WR). The severity of chronic heart failure was class I (no medication) in 8 patients, class II (no symptom with medication) in 9, class III (symptom even with medication) in 10 and class IV (late cardiac death) in 6. H/M was 2.33±0.22 in chronic heart failure class I, 2.50±0.34 in class II, 1.95±0.61 in class III, and 1.39±0.29 in class IV (p<0.05). %WR was 24.8±12.8% in chronic heart failure class I, 23.3±10.2% in class II, 49.2±24.5% in class III, and 66.3±26.5% in class IV (p<0.05). The low H/M and high %WR were proportionate to the severity of chronic heart failure. Cardiac iodine-123 MIBG showed cardiac adrenergic neuronal dysfunction in children with severe chronic heart failure. Quantitative iodine-123 MIBG myocardial imaging is clinically useful as a predictor of therapeutic outcome and mortality in children with chronic heart failure. (author)

Norepinephrine, {beta}-adrenoceptor and {sup 123}I-MIBG myocardial scintigram in patients with congestive heart failure

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Watanabe, Kenichi; Miyajima, Seiichi; Kusano, Yoriko; Tanabe, Naohito [Tsubame Rosai Hospital, Niigata (Japan); Nagatomo, Takafumi

1997-06-01

Authors studied the relationships of norepinephrine (NE), {beta}-adrenoceptor and {sup 123}I-MIBG (meta-iodo-benzylguanidine) uptake in 26 patients with dilated cardiomyopathy or valvulitis. Blood NE concentrations were determined by high performance liquid chromatography in those patients and 10 healthy volunteers, and myocardial NE, in 7 patients and 5 cases without the congestive heart failure. The amounts of beta-receptors in lymphocytes of 21 patients and 7 volunteers and in myocardium obtained at autopsy of 3 patients and 3 other cases were estimated by the radioligand binding assay. Planar and SPECT images were taken at 15 min and 3 hr post intravenous administration of 111 MBq of {sup 123}I-MIBG. In the planar and SPECT images, the ratio heart/mediastinum (H/M) and MIBG uptake were computed respectively. Blood flow was evaluated by {sup 201}Tl scintigraphy. In patients with congestive heart failure, blood NE concentration was elevated and the number of lymphocytic and myocardial receptors was decreased. The H/M ratio was low. Low MIBG uptake was seen at the posterior to lateral wall. (K.H.)

Clinical usefulness of 123I-MIBG myocardial scintigraphy as a marker of the severity and prognosis of congestive heart failure

International Nuclear Information System (INIS)

Shiga, Koji

1999-01-01

To evaluate the clinical usefulness of 123 I-MIBG myocardial scintigraphy in patients with congestive heart failure. Myocardial dynamic imaging was performed immediately after 123 I-MIBG administration at 1 frame/sec for 500 sec in 52 patients with or without congestive heart failure. The %uptake/ROI, dynamic heart to mediastinum uptake ratio (H/M) and dynamic washout rate (WR) were calculated from their time activity curves to assess the relationship between the NYHA functional class and these values. In 52 other patients with heart failure, the initial and delayed MIBG anterior planar images were obtained, and H/M in delayed images and WR between initial and delayed images were measured. The patients were followed up for 31.8±16.8 months, and their survival rates were compared among three groups, H/M 123 I-MIBG myocardial scintigraphy is very useful to diagnose the severity and prognosis in patients with congestive heart failure. (K.H.)

Cardiac 123I-metaiodobenzylguanidine imaging allows early identification of dementia with Lewy bodies during life

International Nuclear Information System (INIS)

Estorch, Montserrat; Camacho, Valle; Paredes, Pilar; Rivera, Elisabet; Rodriguez-Revuelto, Ato; Flotats, Albert; Carrio, Ignasi; Kulisevsky, Jaume

2008-01-01

Differential diagnosis between dementia with Lewy bodies (DLB) and other neurodegenerative diseases with cognitive impairment represents a clinical challenge. Due to the overlapping of symptoms, the clinical diagnosis can be modified during the prolonged follow-up of these diseases. The purpose of this study was to assess the ability of cardiac metaiodobenzylguanidine (MIBG) imaging for early identification of DLB. Since January 2003, all patients with neurodegenerative diseases with cognitive impairment at their first visit at the Memory Unit and clinical criteria of DLB were consecutively recruited and underwent a cardiac 123 I-MIBG study. The heart-to-mediastinum ratio (HMR) and the washout rate (WR) of cardiac MIBG uptake were obtained. Sixty-five patients were included. After a clinical follow-up of 4 years, the progress of the disease procured a definite diagnosis in 44 (68%) patients: 19 DLB, 12 Alzheimer disease (AD), and 13 other neurodegenerative diseases with cognitive impairment. HMR was significantly decreased in DLB with respect to the other neurodegenerative diseases. WR was only significantly different between DLB and AD. The HMR cut off point of 1.36 differentiated DLB from the other dementias with a sensitivity of 94% and a specificity of 96% with an accuracy of 95%. Cardiac MIBG imaging performed at the time of the first clinical diagnosis of DLB can help early clinical identification or exclusion of this disease. (orig.)

Reduced cardiac {sup 123}I-metaiodobenzylguanidine uptake in patients with spinocerebellar ataxia type 2: a comparative study with Parkinson's disease

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De Rosa, Anna; De Leva, Maria Fulvia; Maddaluno, Gennaro; Filla, Alessandro; De Michele, Giuseppe [University Federico II, Department of Neurosciences and Reproductive and Odontostomatologic Sciences, Naples (Italy); Pappata, Sabina; Pellegrino, Teresa [National Council of Research, Institute of Biostructure and Bioimaging, Naples (Italy); Fiumara, Giovanni [Institute of Diagnostic and Nuclear Development, SDN Foundation, Naples (Italy); Carotenuto, Raffaella; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Petretta, Mario [University Federico II, Department of Translational Medical Sciences, Naples (Italy)

2013-12-15

Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant neurodegenerative disorder characterized by cerebellar ataxia, supranuclear ophthalmoplegia, and peripheral neuropathy. Autonomic nervous system dysfunction is often present. This study evaluated the cardiac sympathetic function in patients with SCA2 using {sup 123}I-metaiodobenzylguanidine (MIBG) in comparison with patients with Parkinson's disease (PD) and control subjects. Nine patients with SCA2, nine patients with PD, and nine control subjects underwent {sup 123}I-MIBG imaging studies from which early and late heart-to-mediastinum (H/M) ratios and myocardial washout rates were calculated. Early (F = 12.3, p < 0.0001) and late (F = 16.8, p < 0.0001) H/M ratios were significantly different among groups. In controls, early and late H/M ratios (2.2 {+-} 0.12 and 2.1 {+-} 0.20) were significantly higher than in patients with SCA2 (1.9 {+-} 0.23 and 1.8 {+-} 0.20, both p < 0.05) and with patients with PD (1.7 {+-} 0.29 and 1.4 {+-} 0.35, both p < 0.001). There was also a significant difference in washout rates among groups (F = 11.7, p < 0.0001). In controls the washout rate (19.9 {+-} 9.6 %) was significantly lower (p < 0.005) than in patients with PD (51.0 {+-} 23.7 %), but not different from that in SCA2 patients (19.5 {+-} 9.4 %). In SCA2 patients, in a multivariable linear regression analysis only the Scale for the Assessment and Rating of Ataxia score was independently associated with early H/M ratio ({beta} = -0.12, p < 0.05). {sup 123}I-MIBG myocardial scintigraphy demonstrated an impairment of cardiac sympathetic function in patients with SCA2, which was less marked than in PD patients. These results suggest that {sup 123}I-MIBG cardiac imaging could become a useful tool for analysing the pathophysiology of SCA2. (orig.)

Study of the association between left ventricular diastolic impairment and cardiac autonomic neuropathy in diabetic patients using [123I] metaiodobenzylguanidine scintigraphy

International Nuclear Information System (INIS)

Suzuki, Rokuro; Tanaka, Shiro; Tojo, Osamu; Ishii, Tomofusa; Sato, Toshihiko; Fujii, Satoru; Tumura, Kei.

1994-01-01

The association between left ventricular (LV) diastolic dysfunction and myocardial MIBG accumulation was investigated. The subjects were 14 Type II diabetic patients who had no evidence of ischemic heat disease, LV hypertrophy or dilated cardiomyopathy as determined by exercise Tl-201 myocardial scintigraphy and echocardiography. In 14 diabetic patients, isovolumic relaxation time (IRT) was measured by M-mode echocardiography, and the subjects were subdivided into two groups: Group1, 8 patients with impaired left ventricular diastolic function (IRT≥80 msec), and Group 2, 6 patients with normal left ventricular diastolic function (IRT 123 I-MIBG myocardial scintigraphy was performed, and the myocardial accumulation of 123 I-MIBG was investigated. The ratio of myocardial to mediastinal MIBG uptake was significantly (p<0.01) lower in Group 1 than in Group 2. And scintigraphic defects were significantly (p<0.05) more numerous in Group 1 than in Group 2. Patients in Group 1 had a greater frequency of cardiac autonomic neuropathy evaluated by QTc interval and coefficient of variation of R-R interval, when compared with Group 2. These data suggest that, in diabetic patients with no evidence of ischemic heart disease, LV hypertrophy or dilated cardiomyopathy, impairment of left ventricular diastolic function is associated with cardiac autonomic neuropathy. (author)

Association of myocardial inotropic reserve and adrenergic nerve alterations in idiopathic dilated cardiomyopathy. A dobutamine stress echocardiographic and 123-I-MIBG scintigraphic study

International Nuclear Information System (INIS)

Prassopoulos, V.P.; Koukouraki, S.; Velidaki, A.; Karkavitsas, N.; Parthenakis, F.; Patrianakos, A.; Kochiadakis, G.; Papadimitriou, E.; Vardas, P.

2002-01-01

Aim: Evaluation of contractile reserve is important in congestive hear failure. The aim of this study was to examine the relationship between the myocardial response to dobutamine by stress echocardiography and the sympathetic nerve alterations by 123-I-Metaiodobenzylguanidine (MIBG)scintigraphy and how both contribute to predict exercise capacity in patients with idiopathic dilated cardiomyopathy. Materials-Methods: We studied 20 patients with idiopathic dilated cardiomyopathy (IDC) and ejection fraction < 45% (M/F 13/7, age 56±11 years) while 15 healthy individuals served as controls. Echocardiography and myocardial scintigraphic study with 123-I- MIBG, provided quantitative assessment of left ventricular (LV) wall motion and heart to mediastinum uptake(H/M) ratio and washout. All patients underwent a cardiopulmonary exercise test with a modified Naughton protocol and gas exchange data were analyzed. According to LV response to dobutamine, patients were divided into two groups: those in whom contractility improved in ≥ five segments (Group I: 11 patients) and those in whom contractility improved in < 5 segments (Group II : 9 patients). Results: MIBG uptake was significantly lower in patients than in controls (p < 0.001). MIBG uptake and washout was higher in Group I compared to Group II (P<0,01 and p<0,05). Late MIBG H/M was correlated with resting ejection fraction (r=0,70), wall motion score index (WMSI) (r=-0,50), end systolic wall stress (r=-0,61), washout (r=-0,57), and oxygen consumption at peak exercise (r=0,64) and at anaerobic threshold (r=0,67). LV ejection fraction increased in both groups at Dobutamine, with a higher increase in Group I (p=0,008). WMSI changes at dobutamine correlated significantly with resting ejection fraction (r=0,46) early (r=0,53) and late (r=0,54) MIBG. Multivariate analysis revealed that only the late MIBG uptake was independently associated with the improvement in WMSI. Conclusions: The present data indicate that in

Role of {sup 18F} FDG PET/CT, {sup 123I} MIBG SPECT, and CT in Restaging patients Affected by Malignant Pheochromocytoma

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Cantalamessa, Antonio; Caobelli, Antonio; Vavassori, Francesca [Habilita Istituto Clinico, Bergamo (Italy); Caobelli, Federico [Univ. of Brescia, Brescia (Italy); Paghera, Barbara [Spedali Civili, Brescia (Italy)

2011-06-15

Pheochromocytoma (PH) is a rare catecholamine secreting tumor that arises from chromaffin tissue within the adrenal medulla and extra adrenal sites; commonly it is sporadic, and malignant PH accounts for about 10% of all cases. Several imaging modalities have been used for the diagnosis and staging og this tumor: functional imaging using radio labelled metaiodobenzylguanidine and, more recently, {sup 18F} fluorodeoxyglucose positron emission tomography ({sup 18F} FDG PET/CT), which offers substantial sensitivity and specificity to correctly detect metastatic PH and helps to identify patients suitable for treatment with radiopharmaceuticals. The aim of our study was to compare CT, {sup 18F} FDG PET/CT, and {sup 123I} metaiodobenzylguanidine single photon emission tomography ({sup 123I} MIBG SPECT) as feasible methods to restage patients diagnosed histologically with PH. We retrospectively evaluated 38 patients (27 females and 11 males; mean age: 44{+-}15 years) with malignant PH documented histologically after surgical intervention. These patients underwent CT, {sup 18F} FDG PET/CT, and {sup 123I} MIBG SPECT. {sup 18F} FDG PET/CT showed positive results for neoplastic tissue in 33/38 patients (86.8%) and negative in 5/38 (13.2%), in concordance with CT alone. {sup 123I} MIBG SPECT was positive in 30/38 patients (78.9%) and negative in 8/38 (21.1%). No differences in lesion numbers were found between {sup 18F} FDG PET/CT and {sup 123I} MIBG SPECT. {sup 18F} FDG PET/CT could more accurately restage patients with PH than CT and {sup 123I} MIBG SPECT, also in the absence of a staging study.

A study on crosstalk correction in dual energy acquisition of 123I-MIBG and 201TlCl in myocardial SPECT

International Nuclear Information System (INIS)

Onoguchi, Masahisa; Satoh, Keiko; Murata, Hajime; Takao, Yuji; Ohtake, Eiji; Katoh, Kenichi; Saitoh, Kyoko; Toyama, Hinako; Ueno, Takashi.

1991-01-01

In the simultaneous dual energy acquisition, energy spectrums of two radionuclides crosstalk each other and this phenomenon is a cause of the poor quality of images. In order to obtain the image of high quality in dual energy acquisition of 123 I-MIBG and 201 TlCl, a crosstalk correction method was originated. The crosstalk from 201 Tl to 123 I window (RI) and the crosstalk from 123 I to 201 Tl window (R2) were determined by the cardiac phantom studies. R1 and R2 showed almost constant value throughout the myocardial wall. The crosstalk correction was performed using R1 and R2. After the crosstalk correction, the defect region placed in the cardiac phantom was detected more clearly both in visual interpretation and in quantitative analysis. The crosstalk correction method with R1 and R2 was applied to some clinical cases. By the crosstalk correction, the quality of image was improved and a false defect caused by crosstalk disappeared in a clinical case. The crosstalk correction was considered to be useful for improving the quality of image on dual energy acquisition. (author)

Comparative value of brain perfusion SPECT and [{sup 123}I]MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and Alzheimer's disease

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Hanyu, Haruo; Shimizu, Soichiro; Hirao, Kentaro; Kanetaka, Hidekazu; Iwamoto, Toshihiko [Tokyo Medical University, Department of Geriatric Medicine, Tokyo (Japan); Chikamori, Taishiro; Usui, Yasuhiro; Yamashina, Akira [Tokyo Medical University, 2. Department of Internal Medicine, Tokyo (Japan); Koizumi, Kiyoshi; Abe, Kimihiko [Tokyo Medical University, Department of Radiology, Tokyo (Japan)

2006-03-15

Both decreased occipital perfusion on brain single-photon emission computed tomography (SPECT) and reduction in cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) uptake are characteristic features of dementia with Lewy bodies (DLB), and potentially support the clinical diagnosis of DLB. The aim of this study was to compare the diagnostic value of these two methods for differentiation of DLB from Alzheimer's disease (AD). The study population comprised 19 patients with probable DLB and 39 patients with probable AD who underwent both SPECT with N-isopropyl-p-[{sup 123}I]iodoamphetamine and MIBG myocardial scintigraphy. Objective and quantitative measurement of perfusion in the medial occipital lobe, including the cuneus and lingual gyrus, was performed by the use of three-dimensional stereotactic surface projections. Medial occipital perfusion was significantly decreased in the DLB group compared with the AD group. The mean heart/mediastinum ratios of MIBG uptake were significantly lower in the DLB group than in the AD group. Although SPECT failed to demonstrate significant hypoperfusion in the medial occipital lobe in five patients with DLB, marked reduction of MIBG uptake was found in all patients with DLB. Receiver operating characteristic analysis revealed that MIBG myocardial scintigraphy enabled more accurate discrimination between DLB and AD than was possible with perfusion SPECT. MIBG myocardial scintigraphy may improve the sensitivity in the detection of DLB. In particular, this method may provide a powerful differential diagnostic tool when it is difficult to distinguish cases of DLB from AD using brain perfusion SPECT. (orig.)

MIBG

International Nuclear Information System (INIS)

Orimo, Satoshi

2010-01-01

MIBG ([ 123 I]meta-iodobenzylguanidine) exhibits a similar behavior to noradrenaline (NA) in uptake, storage and release at presynaptic nerve ending (sympathetic nerve ending, SNE). This paper explains the outline of MIBG myocardial scintigraphy (MIBG-ms), MIBG-ms in Parkinson disease (PD), Parkinsonism and dementia (D), and patho-morphological base which authors have revealed, of reduced MIBG accumulation in Lewy body disease (DLB). At SNE, MIBG is actively taken up through NA transporter, stored in NA storage vesicle through the vesicle monoamine transporter and released at the nerve excitation by exocytosis, but does not bind to alpha/beta receptors: the mechanism of cardiac MIBG accumulation. Usually, authors inject MIBG at 111 MBq (3 mCi) to patients, and 15-30 min and 3-4 hr later, the early and late heart images are acquisitioned to see the accumulation and retention, respectively, with gamma-/single photon emission computed tomography (SPECT)-cameras. H/M (heart/mediastinum) count ratio and washout rate (difference between early and late counts/early count) for evaluation of sensitivity and specificity are applied for differential diagnosis of the subclasses of above mentioned diseases. For instance, early H/M is significantly lower than control in PD, PD I-II, and D with Lb, but not in multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration and Alzheimer disease. Authors have found through autopsy of 52 patients with DLB, Parkinsonism and/or Alzheimer disease that there are degeneration and denervation of cardiac SN in DLB and PARK 4 (a familial PD caused by LRRK2 alpha-synuclein gene redundancy), which are closely correlated with reduced MIBG accumulation in the heart. Thus the reduction is thought to be a bio-marker of the presence of LB, suggesting MIBG-ms can be a subsidiary diagnostic mean of such diseases as possessing LB. (T.T.)

Usefulness of {sup 123}I-MIBG scintigraphy for prediction of effect of {beta}-blocker therapy in dilated cardiomyopathy

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Tawarahara, Kei; Sugiyama, Tsuyoshi; Nakano, Tomoyasu; Matou, Fumitaka [Hamamatsu Red Cross Hospital, Shizuoka (Japan); Kurata, Chinori; Wakabayashi, Yasushi; Shouda, Sakae; Mikami, Tadashi

1998-07-01

To determine whether {sup 123}I-MIBG (MIBG) scintigraphy is useful for predicting the effect of {beta}-blocker therapy in patients with dilated cardiomyopathy (DCM), we studied MIBG scintigraphy in 11 controls and 9 patients with DCM before starting {beta}-blocker therapy. First, initial and delayed heart-to-mediastinum ratios (H/M ratio) of MIBG activity in patients with DCM were significantly lower than those in 11 controls, respectively (initial H/M; 1.8{+-}0.3 vs. 2.1{+-}0.3, p<0.02, delayed H/M; 1.6{+-}0.3 vs. 2.4{+-}0.2, p<0.0001), and MIBG washout rate from the heart was significantly higher in patients than in controls (washout rate; 33{+-}7% vs. 22{+-}4%, p<0.0005). Second, {beta}-blocker therapy improved LVEF in 7 patients (improved group), while it resulted in deterioration of heart failure, followed by death in 2 patients (deteriorated group). Although initial and delayed H/M ratios in the improved group were not significantly different from those in the deteriorated group, respectively, MIBG washout rate was significantly higher in the deteriorated group than in the improved group (45{+-}8% vs. 30{+-}3%, p=0.04). Our study suggests that DCM patients with markedly rapid MIBG clearance may be deteriorated by {beta}-blocker therapy. In contrast, there were no differences in LVEF and plasma norepinephrine between improved and deteriorated groups. In conclusion, {sup 123}I-MIBG scintigraphy is useful for predicting the effects of {beta}-blocker therapy in patients with DCM. (author)

Relationship between cardiac 123I-Metaiodobenzylguanidine imaging and the transcardiac gradient of neurohumoral factors in patients with dilated cardiomyopathy

International Nuclear Information System (INIS)

Matsui, Toshiki; Tsutamoto, Takayoshi; Kinoshita, Masahiko

2001-01-01

Cardiac sympathetic nervous function is altered in congestive heart failure (CHF) and the uptake and washout rate of cardiac 123 I-metaiodobenzylguanidine (MIBG) are useful markers for evaluating the severity of it. To assess what parameters predict decreased uptake or increased washout rate of MIBG, the concentrations of neurohumoral factor in both the aorta (Ao) and coronary sinus (CS) were measured, as well as hemodynamic parameters by catheterization, in patients with dilated cardiomyopathy (DCM). MIBG imaging was performed within 1 week of cardiac catheterization. Regarding MIBG parameters, the correlation with the transcardiac gradient of norepinephrine (NE), brain natriuretic peptide (BNP) and hemodynamics was investigated. Stepwise multivariate regression analysis was used to determine which variables closely correlated with cardiac MIBG parameters. There was a significant increase in the NE level between the Ao (446 pg/ml) and the CS (727 pg/ml). According to stepwise multivariate regression analysis, the heart/mediastinum (H/M) ratio independently correlated with the transcardiac gradient of BNP (r=-0.480, p<0.01), and the washout rate independently correlated with the transcardiac gradient of NE (r=0.481, p<0.01). These findings indicate that the H/M ratio may reflect the transcardiac gradient of BNP, which implies the degree of left ventricular dysfunction and/or damage and the washout rate may reflect altered cardiac sympathetic nerve terminal in DCM patients with CHF, suggesting that both the H/M ratio and washout rate provide important information about the failing ventricle. (author)

I-123-mIBG myocardial imaging for assessment of risk for a major cardiac event in heart failure patients: insights from a retrospective European multicenter study

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Agostini, Denis [CHU Cote de Nacre, Caen (France); Verberne, Hein J. [Academic Medical Centre, Amsterdam (Netherlands); Burchert, Wolfgang [Ruhr University Bochum, Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Bad Oeyenhausen (Germany); Knuuti, Juhani [Turku University Central Hospital, Turku (Finland); Povinec, Pavol [Comenius University School of Medicine, Bratislava (Slovakia); Sambuceti, Gianmario [University of Genova, Genova (Italy); Unlu, Mustafa [Gazi University, Ankara (Turkey); Estorch, Montserrat [Hospital Sant Pau, Barcelona (Spain); Banerjee, Gopa; Jacobson, Arnold F. [GE Healthcare, Princeton, NJ (United States)

2008-03-15

Single-center experiences have shown that myocardial meta-iodobenzylguanidine (mIBG) uptake has prognostic value in heart failure (HF) patients. To verify these observations using a rigorous clinical trial methodology, a retrospective review and prospective quantitative reanalysis was performed on a series of cardiac {sup 123}I-mIBG scans acquired during a 10-year period at six centers in Europe. {sup 123}I-mIBG scans obtained on 290 HF patients [(262 with left ventricular ejection fraction (LVEF) < 50%)] from 1993 to 2002 were reanalyzed using a standardized methodology to determine the heart-to-mediastinum ratio (H/M) on delayed planar images. All image results were verified by three independent reviewers. Major cardiac events [MCEs; cardiac death, cardiac transplant, potentially fatal arrhythmia (including implantable cardioverter-defibrillator discharge)] during 24-month follow-up were confirmed by an adjudication committee. MCEs occurred in 67 patients (26%): mean H/M ratio was 1.51 {+-} 0.30 for the MCE group and 1.97 {+-} 0.54 for the non-MCE group (p < 0.001). Two-year event-free survival using an optimum H/M ratio threshold of 1.75 was 62% for H/M ratio less than 1.75, 95% for H/M ratio greater than or equal to 1.75 (p < 0.0001). Logistic regression showed H/M ratio and LVEF as the only significant predictors of MCE. Using the lower and upper H/M quartiles of 1.45 and 2.17 as high- and very low-risk thresholds, 2-year event-free survival rates were 52% and 98%, respectively. Among patients with LVEF {<=} 35% and H/M {>=} 1.75 (n = 73), there were nine MCEs because of progressive HF and only one because of an arrhythmia. Application of a clinical trial methodology via the retrospective reanalysis of {sup 123}I-mIBG images confirms the previously reported prognostic value of this method in HF patients, including potential identification of a quantitative threshold for low risk for cardiac mortality and potentially fatal ventricular arrhythmias. (orig.)

Impact of exercise rehabilitation on cardiac neuronal function in heart failure. An iodine-123 metaiodobenzylguanidine scintigraphy study

International Nuclear Information System (INIS)

Agostini, D.; Bouvard, G.; Lecluse, E.; Grollier, G.; Potier, J.C.; Belin, A.; Babatasi, G.; Amar, M.H.

1998-01-01

Exercise training can induce important haemodynamic and metabolic adaptations in patients with chronic heart failure due to severe left ventricular dysfunction. This study examined the impact of exercise rehabilitation on cardiac neuronal function using iodine-123 metaiobodenzylguanidine (MIBG) scintigraphy. Fourteen patients (11 men, 3 women; mean age 48 years; range: 36-66 years) with stable chronic heart failure of NYHA class II-III and an initial resting radionuclide left ventricular ejection fraction (LVEF) 123 I-MIBG scintigraphy provided measurements of cardiac neuronal uptake (heart-mediastinum ratio activity, 4 h after intravenous injection of 185 MBq of MIBG). Radionuclide LVEF was also assessed at the outset and after 6 months of exercise training. Workload (801±428 vs 1229±245 kpm.min -1 , P=0.001), exercise duration (504±190 vs 649±125 s, P=0.02), and myocardial MIBG uptake (135%±19% vs 156%±25%, P=0.02) increased significantly after rehabilitation. However, LVEF did not change significantly (23%±9% vs 21%±10%, p=NS). It is concluded that exercise rehabilitation induces improvement of cardiac neuronal function without having negative effects on cardiac contractility in patients with stable chronic heart failure. (orig.)

Diagnostic cutoff points for {sup 123}I-MIBG myocardial scintigraphy in a Caucasian population with Parkinson's disease

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Muxi, Africa; Paredes, Pilar [Hospital Clinic, Universitat de Barcelona, Nuclear Medicine Department, Barcelona (Spain); Institut d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); RECAVA, Instituto de Salud Carlos III, Barcelona (Spain); Agencia de Gestio d' Ajuts Universitaris i de Recerca (AGAUR 2009 SGR 1049), Barcelona (Spain); Navales, Ignacio; Sola, Oriol; Domenech, Beatriz [Hospital Clinic, Universitat de Barcelona, Nuclear Medicine Department, Barcelona (Spain); Valldeoriola, Francesc; Gaig, Carles; Cerda, Andres de la; Tolosa, Eduardo [Hospital Clinic, Universitat de Barcelona, Movement Disorders Unit, Neurology Department, Barcelona (Spain); Institut d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); Lomena, Francisco [Hospital Clinic, Universitat de Barcelona, Nuclear Medicine Department, Barcelona (Spain); Institut d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); Pons, Francesca [Hospital Clinic, Universitat de Barcelona, Nuclear Medicine Department, Barcelona (Spain); Institut d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); Agencia de Gestio d' Ajuts Universitaris i de Recerca (AGAUR 2009 SGR 1049), Barcelona (Spain)

2011-06-15

Molecular imaging with {sup 123}I-metaiodobenzylguanidine (MIBG) has been used in Parkinson's disease (PD), but there is no consensual index to discriminate between normal and PD patients in the Caucasian population. The purpose of this study was to determine diagnostic cutoff points in the quantification of MIBG cardiac uptake in our population of PD patients. We have also calculated the reproducibility over a range of interpretation expertise. The study included 14 PD patients and 14 normal age- and sex-matched controls. Heart to mediastinum ratios (H/M) were calculated at 15 min (H/M15m) and 4 h (H/M4h) post-injection by three observers with different interpretation expertise, one of whom drew the regions of interest at three different times. The intraobserver and interobserver reliability was calculated (interclass correlation coefficient and coefficient of variability). Diagnosis was estimated by maximizing the Youden index for H/M and washout ratios. Discrimination ability was assessed by the area under the curve (AUC). Sensitivity and specificity were reported, using our thresholds. The parameter with the best diagnostic accuracy was the H/M4h ratio, with a major AUC (0.976 area under the receiver-operating characteristic curve). The threshold was 1.43 with a 95% confidence interval of 1.37-1.50. Using this threshold, the sensitivity and specificity were 93 and 100%. The interobserver and intraobserver variabilities measuring this ratio were 3.2 and 3.1%, respectively. The diagnostic cutoff point for {sup 123}I-MIBG myocardial scintigraphy in a Caucasian population with PD was 1.43 for the H/M4h index, with a good sensitivity and specificity. The technique is easy to use, with a good reproducibility over a range of interpretation expertise. (orig.)

Estimation of regional myocardial sympathetic neuronal function with I-123 metaiodobenzylguanidine (MIBG) myocardial images in patients with cardiomyopathy

International Nuclear Information System (INIS)

Tanaka, Takeshi; Aizawa, Tadanori; Kato, Kazuzo; Nakano, Hajime; Igarashi, Masaki; Ueno, Takashi; Hirosawa, Koshichiro; Kusakabe, Kiyoko.

1989-01-01

Myocardial SPECT images with I-123 metaiodobenzylguanidine (MIBG) were obtained in 10 patients with cardiomyopathy under stable state. For myocardial imaging, MIBG and Tl-201 (Tl) were simultaneously injected and collected. The ratio of MIBG to Tl (M/T ratio) in ROI was obtained with 50% cut off levels in order to eliminate background activity. The patients were divided into three major groups: (l) those who had the M/T ratio ranging from 0.8 to l.20 at rest and had marked defects in the infero-lateral region on delayed MIBG images, where pathophysiologically accelerated regional sympathetic neuronal function was suspected (n=5), (II) those who had increased M/T ratios (l.6 and l.7) in the basal septal wall (n=3), and (III) those who had decreased M/T ratios (0.7 and 0.75) in the apical septal wall, where depletion of myocardial norepinephrine was suspected (n=2). These findings indicate the potential of myocardial MIBG images to evaluate myocardial distribution of norepinephrine, i.e. myocardial sympathetic neuronal function. Certain shortcomings, such as an increased background due to dual isotopes and an increased pulmonary uptake of MIBG, require further study on quantitative methods. (Namekawa, K)

The relationship between the improvement of cardiac function and the myocardial uptake of I-123 metaiodobenzylguanidine in patients with dilated cardiomyopathy treated by beta-blocker

International Nuclear Information System (INIS)

Wakita, Tomio; Numata, Yuichi; Ogata, Yasuhiro; Harada, Eisaku; Mizumasa, Yutaka

1995-01-01

Chronic β-blocker therapy improves hemodynamics and cardiac function in patients with idiopathic dilated cardiomyopathy. However, the change in myocardial uptake of I-123 metaiodobenzylguanidine ( 123 I-MIBG) before and after treatment has not been determined. Myocardial imaging with 123 I-MIBG was performed before and 2 or 3 months after β-blocker (bisoprolol) therapy in 11 patients with dilated cardiomyopathy. The following parameters were compared before and after the treatment : 1) New York Heart Association functional class, 2) X-ray cardiothoracic ratio, 3) heart rate and blood pressure, 4) echocardiographic data (left ventricular end-diastolic and end-systolic diameters, and left ventricular ejection fraction), 5) plasma concentrations of epinephrine, norepinephrine and human atrial natriuretic peptide (HANP), and 6) exercise tolerance time by treadmill. The heart-to-mediastinum ratio of 123 I-MIBG activities obtained 3 hours after intravenous injection (late H/M) and washout rate improved significantly after β-blocker therapy. Cardiothoracic ratio, heart rate, echocardiographic parameters, HANP and exercise tolerance also improved significantly. Late H/M had no significant relationship with any of the clinical parameters, but washout rate was significantly related to left ventricular ejection fraction. These findings suggest that washout rate may be useful to assess the effect of short-term β-blocker therapy in dilated cardiomyopathy patients. (author)

Usefulness of rCBF analysis in diagnosing Parkinson's disease. Supplemental role with MIBG myocardial scintigraphy

International Nuclear Information System (INIS)

Nagamachi, Shigeki; Wakamatsu, Hideyuki; Kiyohara, Shogo

2008-01-01

123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a useful tool for differentiating idiopathic Parkinson's disease (PD) from parkinsonism (PS) caused by other disorders. However, cardiac MIBG uptake is affected by various causes. Alternatively, hypoperfusion in the occipital lobe of PD is reported recently. The objective is to clarify the correlation between regional cerebral blood flow (rCBF) alteration and cardiac MIBG uptake in PD. In addition, we examined whether additional brain perfusion analysis improved the differential diagnostic ability for PD from PS when compared with MIBG scintigraphy alone. Forty-nine patients with PD (27 mild groups: Hoehn and Yahr stages I, II; 22 severe groups: Hoehn and Yahr stages III, IV) and 28 patients with PS participated. We compared absolute rCBF values between PD and PS. In addition, we determined correlation between MIBG parameters and each rCBF value. Finally, we compared the diagnostic ability for the differentiation of PD from PS between two diagnostic criteria, each MIBG index abnormality alone [heart-to-mediastinum ratio, H/M (E) 40%] and each MIBG index abnormality or occipital lobe hypoperfusion ( 123 I-MIBG myocardial imaging can be recommended. (author)

Evaluation of image reconstruction methods for 123I-MIBG-SPECT. A rank-order study

International Nuclear Information System (INIS)

Soederberg, Marcus; Mattsson, Soeren; Oddstig, Jenny; Uusijaervi-Lizana, Helena; Leide-Svegborn, Sigrid; Valind, Sven; Thorsson, Ola; Garpered, Sabine; Prautzsch, Tilmann; Tischenko, Oleg

2012-01-01

Background: There is an opportunity to improve the image quality and lesion detectability in single photon emission computed tomography (SPECT) by choosing an appropriate reconstruction method and optimal parameters for the reconstruction. Purpose: To optimize the use of the Flash 3D reconstruction algorithm in terms of equivalent iteration (EI) number (number of subsets times the number of iterations) and to compare with two recently developed reconstruction algorithms ReSPECT and orthogonal polynomial expansion on disc (OPED) for application on 123 I-metaiodobenzylguanidine (MIBG)-SPECT. Material and Methods: Eleven adult patients underwent SPECT 4 h and 14 patients 24 h after injection of approximately 200 MBq 123 I-MIBG using a Siemens Symbia T6 SPECT/CT. Images were reconstructed from raw data using the Flash 3D algorithm at eight different EI numbers. The images were ranked by three experienced nuclear medicine physicians according to their overall impression of the image quality. The obtained optimal images were then compared in one further visual comparison with images reconstructed using the ReSPECT and OPED algorithms. Results: The optimal EI number for Flash 3D was determined to be 32 for acquisition 4 h and 24 h after injection. The average rank order (best first) for the different reconstructions for acquisition after 4 h was: Flash 3D 32 > ReSPECT > Flash 3D 64 > OPED, and after 24 h: Flash 3D 16 > ReSPECT > Flash 3D 32 > OPED. A fair level of inter-observer agreement concerning optimal EI number and reconstruction algorithm was obtained, which may be explained by the different individual preferences of what is appropriate image quality. Conclusion: Using Siemens Symbia T6 SPECT/CT and specified acquisition parameters, Flash 3D 32 (4 h) and Flash 3D 16 (24 h), followed by ReSPECT, were assessed to be the preferable reconstruction algorithms in visual assessment of 123 I-MIBG images

Brain 18F-FDG, 18F-florbtaben PET/CT, 123I-FP-CIT SPECT and cardiac 123I-MBG imaging for diagnosis of a 'cerebral type' of Lewy Body disease

International Nuclear Information System (INIS)

Gucht, Axel Van Der; Bélissant, Ophélie; Rabu, Corenti; Cottereau, Anne-Ségolène; Evangelista, Eva; Chalaye, Julia; Bonnot-Lours, Sophie; Fénelon, Gilles; Itti, Emmanuel; De Langavant, Laurent Cleret

2016-01-01

A 67-year-old man was referred for fluctuating neuropsychiatric symptoms, featuring depression, delirious episodes, recurrent visual hallucinations and catatonic syndrome associated with cognitive decline. No parkinsonism was found clinically even under neuroleptic treatment. 18 F-FDG PET/CT showed hypometabolism in the posterior associative cortex including the occipital cortex, suggesting Lewy body dementia, but 123 I-FP-CIT SPECT was normal and cardiac 123 I-MIBG imaging showed no signs of sympathetic denervation. Alzheimer's disease was excluded by a normal 18 F-florbetaben PET/CT. This report suggests a rare case of α-synucleinopathy without brainstem involvement, referred to as 'cerebral type' of Lewy body disease

Technetium-99m labeled 1-(4-fluorobenzyl)-4-(2-mercapto-2-methyl-4-azapentyl)-4- (2-mercapto-2-methylp ropylamino)-piperidine and iodine-123 metaiodobenzylguanidine for studying cardiac adrenergic function: a comparison of the uptake characteristics in vascular smooth muscle cells and neonatal cardiac myocytes, and an investigation in rats

International Nuclear Information System (INIS)

Samnick, Samuel; Scheuer, Claudia; Muenks, Sven; El-Gibaly, Amr M.; Menger, Michael D.; Kirsch, Carl-Martin

2004-01-01

In developing technetium-99m-based radioligands for in vivo studies of cardiac adrenergic neurons, we compared the uptake characteristics of the 99m Tc-labeled 1-(4-fluorobenzyl)-4-(2-mercapto-2-methyl-4-azapentyl)-4- (2-mercapto-2-methylpropylamino)-piperidine ( 99m Tc-FBPBAT) with those of the clinically established meta-[ 123 I]iodobenzylguanidine ( 123 I-MIBG) in rat vascular smooth muscle cells and neonatal cardiac myocytes. Furthermore, the cardiac and extracardiac uptake of both radiopharmaceuticals was assessed in intact rats and in rats pretreated with various α- and β-adrenoceptor drugs, and adrenergic reuptake blocking agents. The uptake of 99m Tc-FBPBAT and 123 I-MIBG into vascular smooth muscle cells and neonatal cardiac myocytes was rapid; more than 85% of the radioactivity accumulation into the cells occurring within the first 3 minutes. Radioactivity uptake after a 60-minute incubation at 37 degree sign C (pH 7.4) varied from 15% to 65% of the total loaded activity per million cells. In all cases, 99m Tc-FBPBAT showed the higher uptake, relative to 123 I-MIBG, at any given cell concentration. The cellular uptake of 99m Tc-FBPBAT was lower at 4 degree sign C and 20 degree sign C than at 37 degree sign C. In contrast, the 123 I-MIBG uptake was only slightly temperature dependent. Inhibition experiments confirmed that the cellular uptake of 123 I-MIBG is mediated by the uptake-I carrier, whereas α 1 - and β 1 -adrenoceptors were predominantly involved in the uptake of 99m Tc-FBPBAT into the cardiovascular tissues. Biodistribution studies in rats showed that 99m Tc-FBPBAT accumulated in myocardium after intravenous injection. Radioactivity in rat heart amounted to 2.32% and 1.91% of the injected dose per gram at 15 and 60 minutes postinjection, compared with 3.10% and 2.21% injected dose per gram of tissue (%ID/g) in the experiment with 123 I-MIBG, respectively. Prazosin, urapidil, and metoprolol were as effective as treatment with other adrenergic

Technetium-99m labeled 1-(4-fluorobenzyl)-4-(2-mercapto-2-methyl-4-azapentyl)-4- (2-mercapto-2-methylp ropylamino)-piperidine and iodine-123 metaiodobenzylguanidine for studying cardiac adrenergic function: a comparison of the uptake characteristics in vascular smooth muscle cells and neonatal cardiac myocytes, and an investigation in rats

Energy Technology Data Exchange (ETDEWEB)

Samnick, Samuel E-mail: rassam@uniklinik-saarland.de; Scheuer, Claudia; Muenks, Sven; El-Gibaly, Amr M.; Menger, Michael D.; Kirsch, Carl-Martin

2004-05-01

In developing technetium-99m-based radioligands for in vivo studies of cardiac adrenergic neurons, we compared the uptake characteristics of the {sup 99m}Tc-labeled 1-(4-fluorobenzyl)-4-(2-mercapto-2-methyl-4-azapentyl)-4- (2-mercapto-2-methylpropylamino)-piperidine ({sup 99m}Tc-FBPBAT) with those of the clinically established meta-[{sup 123}I]iodobenzylguanidine ({sup 123}I-MIBG) in rat vascular smooth muscle cells and neonatal cardiac myocytes. Furthermore, the cardiac and extracardiac uptake of both radiopharmaceuticals was assessed in intact rats and in rats pretreated with various {alpha}- and {beta}-adrenoceptor drugs, and adrenergic reuptake blocking agents. The uptake of {sup 99m}Tc-FBPBAT and {sup 123}I-MIBG into vascular smooth muscle cells and neonatal cardiac myocytes was rapid; more than 85% of the radioactivity accumulation into the cells occurring within the first 3 minutes. Radioactivity uptake after a 60-minute incubation at 37 degree sign C (pH 7.4) varied from 15% to 65% of the total loaded activity per million cells. In all cases, {sup 99m}Tc-FBPBAT showed the higher uptake, relative to {sup 123}I-MIBG, at any given cell concentration. The cellular uptake of {sup 99m}Tc-FBPBAT was lower at 4 degree sign C and 20 degree sign C than at 37 degree sign C. In contrast, the {sup 123}I-MIBG uptake was only slightly temperature dependent. Inhibition experiments confirmed that the cellular uptake of {sup 123}I-MIBG is mediated by the uptake-I carrier, whereas {alpha}{sub 1}- and {beta}{sub 1}-adrenoceptors were predominantly involved in the uptake of {sup 99m}Tc-FBPBAT into the cardiovascular tissues. Biodistribution studies in rats showed that {sup 99m}Tc-FBPBAT accumulated in myocardium after intravenous injection. Radioactivity in rat heart amounted to 2.32% and 1.91% of the injected dose per gram at 15 and 60 minutes postinjection, compared with 3.10% and 2.21% injected dose per gram of tissue (%ID/g) in the experiment with {sup 123}I-MIBG

131I-MIBG and neuroendocrine tumours

International Nuclear Information System (INIS)

Oliva Gonzalez, Juan Perfecto; Gonzalez Gonzalez, Joaquin Jorge; Calderon Marin, Carlos Fabian

2012-01-01

Neuroendocrine tumours are neoplasms that arise from various tissues closely linked to the neural crest by their common embryological origin. These tumours have the ability to synthesize neurotransmitter peptides and hormones, as well as to store catecholamines. Some of these tumours express somatostatin receptors at their membranes, what have allowed nuclear medicine to be involved in their diagnosis, treatment and monitoring. Since they arise from different and varied types of tissues, these tumours have a wide range of signs and symptoms different for every one of them. These signs and symptoms mainly depend on their biochemical characteristics, given by the substances they secrete, as well as by their location, and consequently, they also depend on the place where the tumour appears, its local infiltration, and potential long-distance metastasis resulting from the tumour). Neuroendocrine tumours are diagnosed by means of nuclear medicine images, which are obtained by using different techniques and radiopharmaceuticals such as 99 mTc dimercaptosuccinic acid (DMSA(V)), 99 mTc-methoxy-isobutyl-isonitrile (MIBI), metaiodobenzylguanidine (MIBG) labelled with 131 I or 123 I ( 131 I-MIBG or 123 I -MIBG), 111 In-labelled octreotide, positron emission tomography, using 68 Ga-labelled somatostatin analogues and carcinoembryonic antigen monoclonal antibodies. Nuclear medicine uses mainly somatostatin analogues labelled with 90 Y or 177 Lu for the treatment of these tumours. This paper is aimed at showing our experience in the use of 131 I-MIBG for the diagnosis and treatment of neuroendocrine tumours.(author)

{sup 123}I-meta-iodo-benzyl-guanidine myocardial scintigraphy and congestive heart failure: current data and perspective; Scintigraphie myocardique a la {sup 123}I-meta-iodobenzylguanidine et insuffisance cardiaque congestibe: donnees actuelles et perspectives

Energy Technology Data Exchange (ETDEWEB)

Agostini, D.; Darlas, Y.; Quennelle, F.; Bouvard, G.; Scanu, P.; Grollier, G.; Potier, J.C.; Babatasi, G. [Centre Hospitalier Universitaire, 14 - Caen (France); Belin, A. [Hopital de Trouville, Trouville (France)

1997-12-31

Congestive heart failure is often associated with an impairment of the sympathetic nervous system, i.e., global hyperactivity and regional impairment of the adrenergic system. Cardiac {sup 123}I-MIBG scintigraphy is a radionuclide technique which can explore the presynaptic adrenergic function. Myocardial MIBG fixation is decreased in congestive heart failure, reflecting a reduction of norepinephrine uptake by the myocardial presynaptic nerve endings. The impairment of presynaptic function occurs early in the disease and is actually involved in the pathogenesis of cardiac failure. Cardiac MIBG scintigraphy is a useful tool to explore the myocardial adrenergic stores in patients with congestive heart failure. It could be proposed in patients with severe ventricular dysfunction in order to assist physicians in setting-up the timing of heart transplantation. (authors). 52 refs.

Abdominal visceral fat accumulation is associated with the results of 123I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients

International Nuclear Information System (INIS)

Anan, Futoshi; Masaki, Takayuki; Takahashi, Naohiko; Yoshimatsu, Hironobu; Yonemochi, Hidetoshi; Nakagawa, Mikiko; Saikawa, Tetsunori; Eshima, Nobuoki

2007-01-01

We tested the hypothesis that increased abdominal visceral accumulation (VFA) is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients not receiving insulin treatment. The fat distribution was evaluated by measuring the VFA by abdominal computed tomography at the umbilical level. The study group consisted of 24 type 2 diabetic patients with high VFA (≥100 cm 2 , age 60 ± 8 years, high VFA group). The control group consisted of 19 age-matched type 2 diabetic patients with normal VFA ( 2 , age 60 ± 7 years, normal VFA group). Cardiovascular autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations, and cardiac 123 I-metaiodobenzylguanidine (MIBG) scintigraphy. Early and delayed 123 I-MIBG myocardial uptake values were lower (p 123 I-MIBG was higher (p 123 I-MIBG during the delayed phase. Our results demonstrate that the level of VFA is associated with depressed cardiovascular autonomic function and insulin resistance in patients with type 2 diabetes mellitus. (orig.)

123I-meta-iodo-benzyl-guanidine myocardial scintigraphy and congestive heart failure: current data and perspective

International Nuclear Information System (INIS)

Agostini, D.; Darlas, Y.; Quennelle, F.; Bouvard, G.; Scanu, P.; Grollier, G.; Potier, J.C.; Babatasi, G.; Belin, A.

1997-01-01

Congestive heart failure is often associated with an impairment of the sympathetic nervous system, i.e., global hyperactivity and regional impairment of the adrenergic system. Cardiac 123 I-MIBG scintigraphy is a radionuclide technique which can explore the presynaptic adrenergic function. Myocardial MIBG fixation is decreased in congestive heart failure, reflecting a reduction of norepinephrine uptake by the myocardial presynaptic nerve endings. The impairment of presynaptic function occurs early in the disease and is actually involved in the pathogenesis of cardiac failure. Cardiac MIBG scintigraphy is a useful tool to explore the myocardial adrenergic stores in patients with congestive heart failure. It could be proposed in patients with severe ventricular dysfunction in order to assist physicians in setting-up the timing of heart transplantation. (authors)

Clinical usefulness of 123I-metaiodobenzylguanidine myocardial scintigraphy in diabetic patients with cardiac sympathetic nerve dysfunction

International Nuclear Information System (INIS)

Miyanaga, Hajime; Yoneyama, Satoshi; Kamitani, Tadaaki; Kawasaki, Shingo; Takahashi, Toru; Kunishige, Hiroshi

1995-01-01

To assess the clinical utility of 123 I-metaiodobenzylguanidine (MIBG) scintigraphy in evaluating cardiac sympathetic nerve disturbance in diabetic patients, we performed MIBG scintigraphy in 18 diabetic patients and 11 normal controls. Diabetic patients with symptomatic neuropathy (DM2) had a significantly lower heart to mediastinum uptake ratio than did those without neuropathy or normal controls in initial and delayed images (initial image, 1.90±0.27 vs 2.32±0.38, 2.41±0.40, p<0.01; delayed image, 1.80±0.31 vs 2.48±0.35, 2.56±0.28, p<001, respectively). Defect score, assessed visually, were higher in DM2 patients than in patients in the other two groups (initial image, 7±2.6 vs 1.5±1.9, 0.7±0.9; delayed image 10.6±3.3 vs 4.0±2.5, 1.7±1.6 p<0.01, respectively). The maximum washout rate in DM2 patients was also higher than those in patients in the other two groups. The findings of these indices obtained from MIBG scintigraphy coincided with the % low-frequency power extracted from heart rate fluctuations using a power spectral analysis and the results of the Schellong test, which were used to evaluate sympathetic function. These results suggest that MIBG scintigraphy may be useful for evaluating cardiac sympathetic nerve disturbance in patients with diabetes. (author)

Homocysteine levels are associated with the results of 123I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients

International Nuclear Information System (INIS)

Anan, Futoshi; Yonemochi, Hidetoshi; Nakagawa, Mikiko; Saikawa, Tetsunori; Masaki, Takayuki; Takahashi, Naohiko; Yoshimatsu, Hironobu; Eshima, Nobuoki

2007-01-01

Elevated total plasma homocysteine (tHcy) levels and cardiovascular autonomic dysfunction are associated with a high mortality in type 2 diabetic patients. We tested the hypothesis that hyperhomocysteinemia is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients not receiving insulin treatment. The study group consisted of 17 type 2 diabetic patients with high tHcy levels (>15 mmol/l, age 58±5 years, high tHcy group). The control group consisted of 23 age-matched type 2 diabetic patients with normal tHcy levels (≤15 mmol/l, age 58±9 years, normal tHcy group). Cardiovascular autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations, and cardiac 123 I-metaiodobenzylguanidine (MIBG) scintigraphy. Early and delayed 123 I-MIBG myocardial uptake values were lower (p 123 I-MIBG was higher (p 123 I-MIBG at the delayed phase. Our results demonstrate that high levels of tHcy are associated with depressed cardiovascular autonomic function and insulin resistance in patients with type 2 diabetes mellitus. (orig.)

Assessment of takotsubo (ampulla) cardiomyopathy using iodine-123 metaiodobenzylguanidine scintigraphy

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Pessoa, Pinheiro M.C.; Xavier, Salles S.; Lima, Souza Leao R.; Mansur, J.; Almeida, Altino S. de; Carvalho, Pires A.C.; Gutfilen, B.; Fonseca, Barbosa L.M. da [Hospital Univ. Clementino Fraga Filho, Univ. Federal do Rio de Janeiro (Brazil). Dept. de Radiologia

2006-12-15

Purpose: To evaluate the role of cardiac sympathetic innervation in patients whose clinical features consisted of chest pain, transient ST-segment elevation, left ventricular apical akinesis, minimal elevation of cardiac enzymes, and onset of symptoms shortly after a severe stress condition. Material and Methods: Five female patients, mean age 67{+-}14 years, underwent thoracic {sup 123}I-MIBG (planar and SPECT) and 67Ga citrate (planar) scans within 5 days after the onset of symptoms. The {sup 123}I-MIBG myocardial washout rate between early (30 min) and delayed (3 hours) planar images was calculated. All patients presented findings consistent with takotsubo-like syndrome. Echocardiograms showed the characteristic wall motion pattern of significant apical dysfunction. Acute-phase coronary angiographies revealed a non-obstructive pattern. A peculiar apical akinesis and basal normokinesis were observed on the ventriculograms. Results: Impairment of cardiac neuronal uptake of {sup 123}I-MIBG based on a reduction of the heart-to-mediastinum uptake ratio was observed in all patients, while the washout rate was raised in four patients. All patients presented an apical uptake defect in the {sup 123}I-MIBG SPECT and planar images and a normal 67Ga scintigraphy. Conclusion: Our data indicate that ampulla cardiomyopathy (AC) is associated with a cardiac sympathetic innervation deficit characterized by a reduced global {sup 123}I-MIBG uptake and an apical uptake defect. The lack of 67Ga uptake in the acute phase of this syndrome indicates that AC is probably not associated with an inflammatory process.

Preliminary evaluation of the protocol scintigraphy of neuroendocrine tumor with metaiodobenzylguanidine (mIBG) labeled with {sup 123}I; Avaliacao preliminar do protocolo de cintilografia de tumores neuroendocrinos com meta-iodobenzilguanidina (mIBG) marcado com {sup 123}I

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Oliveira, Danillo M. [Hospital de Urgencia de Sergipe Gov. Joao Alves Filho, Aracaju, SE (Brazil); Mendes, Janaina Dutra Silvestre, E-mail: danillo_90@hotmail.com [Instituto Nacional de Cancer Jose Alencar Gomes da Silva, Rio de Janeiro, RJ (Brazil). Setor de Medicina Nuclear

2014-04-15

Neuroendocrine tumors have a property of capturing metaiodobenzylguanidine (mIBG) and because of this is possible to perform scintigraphy for diagnosis marking this molecule with {sup 123}I. However, {sup 123}I has some particularities, such as the release of X-ray low energy, which complicates the measurement of activity by activity meter, moreover emits a significant intensity of high energy gamma radiation, damaging the image quality. The acquisition protocol scintigraphy of neuroendocrine tumor was evaluated and the necessary recommendations for its optimization will be studied to ensure image quality with the least possible expense to the patient. (author)

Evaluation of image reconstruction methods for {sup 123}I-MIBG-SPECT. A rank-order study

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Soederberg, Marcus; Mattsson, Soeren; Oddstig, Jenny; Uusijaervi-Lizana, Helena; Leide-Svegborn, Sigrid [Medical Radiation Physics, Dept. of Clinical Sciences Malmoe, Lund Univ., Skaane Univ. Hospital, Malmoe (Sweden)], e-mail: marcus.soderberg@med.lu.se; Valind, Sven; Thorsson, Ola; Garpered, Sabine [Dept. of Clinical Physiology, Skaane Univ. Hospital, Malmoe (Sweden); Prautzsch, Tilmann [Scivis wissenschaftlice Bildverarbeitung GmbH, Goettingen (Germany); Tischenko, Oleg [Research Unit Medical Radiation Physics and Diagnostics (AMSD), Helmholtz Zentrum Muenchen (Germany); German Research Center for Environmental Health, Neuherberg (Germany)

2012-09-15

Background: There is an opportunity to improve the image quality and lesion detectability in single photon emission computed tomography (SPECT) by choosing an appropriate reconstruction method and optimal parameters for the reconstruction. Purpose: To optimize the use of the Flash 3D reconstruction algorithm in terms of equivalent iteration (EI) number (number of subsets times the number of iterations) and to compare with two recently developed reconstruction algorithms ReSPECT and orthogonal polynomial expansion on disc (OPED) for application on {sup 123}I-metaiodobenzylguanidine (MIBG)-SPECT. Material and Methods: Eleven adult patients underwent SPECT 4 h and 14 patients 24 h after injection of approximately 200 MBq {sup 123}I-MIBG using a Siemens Symbia T6 SPECT/CT. Images were reconstructed from raw data using the Flash 3D algorithm at eight different EI numbers. The images were ranked by three experienced nuclear medicine physicians according to their overall impression of the image quality. The obtained optimal images were then compared in one further visual comparison with images reconstructed using the ReSPECT and OPED algorithms. Results: The optimal EI number for Flash 3D was determined to be 32 for acquisition 4 h and 24 h after injection. The average rank order (best first) for the different reconstructions for acquisition after 4 h was: Flash 3D{sub 32} > ReSPECT > Flash 3D{sub 64} > OPED, and after 24 h: Flash 3D{sub 16} > ReSPECT > Flash 3D{sub 32} > OPED. A fair level of inter-observer agreement concerning optimal EI number and reconstruction algorithm was obtained, which may be explained by the different individual preferences of what is appropriate image quality. Conclusion: Using Siemens Symbia T6 SPECT/CT and specified acquisition parameters, Flash 3D{sub 32} (4 h) and Flash 3D{sub 16} (24 h), followed by ReSPECT, were assessed to be the preferable reconstruction algorithms in visual assessment of {sup 123}I-MIBG images.

Relationship between quantitative cardiac neuronal imaging with ¹²³I-meta-iodobenzylguanidine and hospitalization in patients with heart failure.

Science.gov (United States)

Parker, Matthew W; Sood, Nitesh; Ahlberg, Alan W; Jacobson, Arnold F; Heller, Gary V; Lundbye, Justin B

2014-09-01

Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by (123)I-meta-iodobenzylguanidine ((123)I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between (123)I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using (123)I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships.

Impact of exercise rehabilitation on cardiac neuronal function in heart failure. An iodine-123 metaiodobenzylguanidine scintigraphy study

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Agostini, D.; Bouvard, G. [Service de Medecine Nucleaire, CHU Cote de Nacre, Caen (France); Lecluse, E.; Grollier, G.; Potier, J.C. [Service de Cardiologie, CHU Cote de Nacre, Caen (France); Belin, A. [Service de Readaptation Cardiaque, CHU Cote de Nacre, Caen (France); Babatasi, G. [Service de Chirurgie Cardio-Thoracique, CHU Cote de Nacre, Caen (France); Amar, M.H. [Centre Francois Baclesse, Caen (France). Service de Recherche Clinique

1998-03-01

Exercise training can induce important haemodynamic and metabolic adaptations in patients with chronic heart failure due to severe left ventricular dysfunction. This study examined the impact of exercise rehabilitation on cardiac neuronal function using iodine-123 metaiobodenzylguanidine (MIBG) scintigraphy. Fourteen patients (11 men, 3 women; mean age 48 years; range: 36-66 years) with stable chronic heart failure of NYHA class II-III and an initial resting radionuclide left ventricular ejection fraction (LVEF) <50% were enrolled in the study. Patients underwent progressive, supervised endurance training (treadmill test, Bruce protocol) during a 6-month period (60 sessions, 3 sessions per week) at a cardiac rehabilitation referral centre in order to measure exercise parameters. Planar {sup 123}I-MIBG scintigraphy provided measurements of cardiac neuronal uptake (heart-mediastinum ratio activity, 4 h after intravenous injection of 185 MBq of MIBG). Radionuclide LVEF was also assessed at the outset and after 6 months of exercise training. Workload (801{+-}428 vs 1229{+-}245 kpm.min{sup -1}, P=0.001), exercise duration (504{+-}190 vs 649{+-}125 s, P=0.02), and myocardial MIBG uptake (135%{+-}19% vs 156%{+-}25%, P=0.02) increased significantly after rehabilitation. However, LVEF did not change significantly (23%{+-}9% vs 21%{+-}10%, p=NS). It is concluded that exercise rehabilitation induces improvement of cardiac neuronal function without having negative effects on cardiac contractility in patients with stable chronic heart failure. (orig.)

Cardiac neuronal imaging with 123I-meta-iodobenzylguanidine in heart failure: implications of endpoint selection and quantitative analysis on clinical decisions

International Nuclear Information System (INIS)

Petretta, Mario; Pellegrino, Teresa; Cuocolo, Alberto

2014-01-01

There are a number of radiopharmaceuticals that can be used to investigate autonomic neuronal functions. Among these, the norepinephrine analogue meta-iodobenzylguanidine (MIBG) labelled with 123 I has been widely used and validated as a marker of adrenergic neuron function. The first study addressing the prognostic value of 123 I-MIBG imaging in heart failure (HF) was that of Merlet et al. in 90 patients suffering from either ischaemic or idiopathic cardiomyopathy. After publication of this study, more recent studies have indicated that patients with HF and decreased late heart-to-mediastinum (H/M) ratio or increased myocardial MIBG washout have a worse prognosis than those with normal quantitative myocardial MIBG parameters. However, MIBG scintigraphy has still to reach widespread clinical application mainly because of the value of other cheaper variables such as left ventricular (LV) ejection fraction and brain natriuretic peptide (BNP) plasma levels. The possibility that the detection of mechanical dyssynchrony by innervation imaging might identify patients who would benefit from resynchronization pacing is another area of research interest. In 2010, the landmark AdreView Myocardial Imaging for Risk Evaluation in Heart Failure (ADMIRE-HF) study was published. This trial consisted of two identical open-label phase III studies enrolling patients in 96 sites in North America and Europe to provide prospective validation of the prognostic role of quantitation of sympathetic cardiac innervation using MIBG. The primary endpoint was the relationship between late HIM ratio and time-to-occurrence of the first event among a combination of HF progression, potentially life-threatening arrhythmic event, and cardiac death. The authors found that a HIM ratio <1.6 provided prognostic information beyond LV ejection fraction, BNP, and New York Heart Association (NYHA) functional class at the time of enrolment. In a recent article in this journal, Parker et al. present the results

Assessment of central chemosensitivity and cardiac sympathetic nerve activity using I-123 MIBG imaging in central sleep apnea syndrome in patients with dilated cardiomyopathy

International Nuclear Information System (INIS)

Meguro, Kentaro; Nagai, Ryozo; Toyama, Takuji; Adachi, Hitoshi; Ohshima, Shigeru; Taniguchi, Koichi

2007-01-01

Iodine-123 m-iodobenzylguanidine (MIBG) imaging has been used to study cardiac sympathetic function in various cardiac diseases. Central sleep apnea syndrome (CSAS) occurs frequently in patients with chronic heart failure (CHF) and is reported to be associated with a poor prognosis. One of the mechanisms of its poor prognosis may be related to impaired cardiac sympathetic activity. However, the relationship between chemosensitivity to carbon dioxide, which is reported to correlate with the severity of CSAS, and cardiac sympathetic activity has not been investigated. Therefore, this study was undertaken to assess cardiac sympathetic function and chemosensitivity to carbon dioxide in CHF patients. The oxygen desaturation index (ODI) was evaluated in 21 patients with dilated cardiomyopathy (male/female: 19/2, left ventricular ejection fraction (LVEF) 5 times/h underwent polysomnography. Patients with an apnea hypopnea index >15/h but without evidence of obstructive apnea were defined as having CSAS. Early (15 min) and delayed (4 hr) planar MIBG images were obtained from these patients. The mean counts in the whole heart and the mediastinum were obtained. The heart-to-mediastinum count ratio of the delayed image (H/M) and the corrected myocardial washout rate (WR) were also calculated. The central chemoreflex was assessed with the rebreathing method using a hypercapnic gas mixture (7% CO 2 and 93% O 2 ). Ten of the 21 patients had CSAS. The H/M ratio was similar in patients both with and without CSAS (1.57±0.18 vs. 1.59±0.14, p=0.82). However, the WR was higher in patients with CSAS than in patients without CSAS (40±8% vs. 30±12%, p<0.05). ODI significantly correlated with central chemosensitivity to carbon dioxide. Moreover, there was a highly significant correlation between WR and central chemosensitivity (r=0.65, p<0.05). However, there was no correlation between ODI and the WR (r=0.36, p=0.11). Cardiac sympathetic nerve activity in patients with CHF and CSAS is

Evaluation of diabetic autonomic neuropathy by 123I-metaiodobenzyl-guanidine (MIBG) cardiac imaging. Initial report

International Nuclear Information System (INIS)

Osonoi, Takeshi; Fukumoto, Yoshihiro; Saitou, Miyoko; Kuroda, Yasuhisa; Uchimi, Nobuo; Ishioka, Kuniharu; Onuma, Tomio; Suga, Shigeki; Takebe, Kazuo.

1994-01-01

Single-photon emission computed tomography was performed in 52 diabetics and 10 healthy volunteers using MIBG. The diabetics had no particular findings of electrocardiography, echocardiography, or exercise thallium imaging and no cardiovascular episodes. The healthy volunteers had no abnormal findings on exercise thallium imaging or glucose tolerance test. The average relative regional uptake (RRU) was decreased in the inferoposterior wall compared with the anterior or lateral wall in both the diabetics and volunteers. According to the RRU and visual images, we divided the diabetics into the following four groups: 14 who were normal (group N), 30 with segmental defects (group S), 4 with diffuse defects (group D) and 4 without accumulation (group DH). Diabetic complications (retinopathy, nephropathy, and neuropathy) and hypertension were more frequent in group S than group N. However, there were no significant differences in the physiological evidence of autonomic neuropathy (C.V. of the R-R interval on the ECG and blood pressure response to standing or deep breathing) between groups S and N. Vibration sense was significantly more impaired in group S than in group N. These results suggest that cardiac imaging with MIBG might be a useful examination for the early diagnosis of diabetic autonomic neuropathy. (author)

Cardiac neuronal imaging with {sup 123}I-meta-iodobenzylguanidine in heart failure: implications of endpoint selection and quantitative analysis on clinical decisions

Energy Technology Data Exchange (ETDEWEB)

Petretta, Mario [University Federico II, Department of Translational Medicine, Naples (Italy); Pellegrino, Teresa [National Council of Research, Institute of Biostructure and Bioimaging, Naples (Italy); Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy)

2014-09-15

There are a number of radiopharmaceuticals that can be used to investigate autonomic neuronal functions. Among these, the norepinephrine analogue meta-iodobenzylguanidine (MIBG) labelled with {sup 123}I has been widely used and validated as a marker of adrenergic neuron function. The first study addressing the prognostic value of {sup 123}I-MIBG imaging in heart failure (HF) was that of Merlet et al. in 90 patients suffering from either ischaemic or idiopathic cardiomyopathy. After publication of this study, more recent studies have indicated that patients with HF and decreased late heart-to-mediastinum (H/M) ratio or increased myocardial MIBG washout have a worse prognosis than those with normal quantitative myocardial MIBG parameters. However, MIBG scintigraphy has still to reach widespread clinical application mainly because of the value of other cheaper variables such as left ventricular (LV) ejection fraction and brain natriuretic peptide (BNP) plasma levels. The possibility that the detection of mechanical dyssynchrony by innervation imaging might identify patients who would benefit from resynchronization pacing is another area of research interest. In 2010, the landmark AdreView Myocardial Imaging for Risk Evaluation in Heart Failure (ADMIRE-HF) study was published. This trial consisted of two identical open-label phase III studies enrolling patients in 96 sites in North America and Europe to provide prospective validation of the prognostic role of quantitation of sympathetic cardiac innervation using MIBG. The primary endpoint was the relationship between late HIM ratio and time-to-occurrence of the first event among a combination of HF progression, potentially life-threatening arrhythmic event, and cardiac death. The authors found that a HIM ratio <1.6 provided prognostic information beyond LV ejection fraction, BNP, and New York Heart Association (NYHA) functional class at the time of enrolment. In a recent article in this journal, Parker et al. present

Potential diagnostic value of 131I-MIBG myocardial scintigraphy in discrimination between Alzheimer disease and dementia with Lewy bodies.

Science.gov (United States)

Abbasi, Mehrshad; Ghalandari, Nafise; Farzanefar, Saeed; Aghamollaii, Vajiheh; Ahmadi, Mona; Ganji, Morsaleh; Afarideh, Mohsen; Loloee, Sogol; Naseri, Maryam; Tafakhori, Abbas

2017-12-01

Clinical difficulty to discriminate between the Alzheimer disease (AD) and dementia with Lewy bodies (DLB) has led researchers to focus on highly sensitive functional imaging modalities. The aim of the present study was to assess 131 I-MIBG cardiac imaging to distinguish between AD and DLB. Seventeen patients who were known cases of dementia underwent 131 I-MIBG myocardial scintigraphy to differentiate AD from DLB. Planar and 131 I-MIBG SPECT were obtained 2h after the injection of 1mCi 131 I-MIBG on a dual head gamma camera. The visual assessment of the heart uptake compared with lungs and the quantification based on the heart to mediastinal ratio (HMR) were done. The cardiac receiver operating characteristic (ROC) curve was designed for the optimal HMR cut-off values to predict the diagnoses of the patients. The diagnoses were clinically confirmed during the follow up of 14±8.2 months. Out of 17 patients (13 males; 76.5%), 10 patients had AD (7 males; 70%) and 7 patients had DLB (6 males; 85%). The pooled HMR was 1.74±0.33 in the study population; with 1.95±0.22 in the AD group and 1.43±0.20 in the DLB group to demonstrate significantly different HMR scores between patients with AD and DLB (p value=0.001). The visual interpretation was positive in 10 patients (accuracy of 88.2%). The shortest distance on the ROC curve to the optimal value corresponding to HMR=1.57 identified 10 patients with a high HMR (positive cardiac uptake) and 7 patients with a low HMR (negative cardiac uptake), the accuracy calculated at 88.2%. 131 I-MIBG myocardial scintigraphy is a potential alternative diagnostic modality for discrimination between AD and DLB when 123 I is not available. Copyright © 2017 Elsevier B.V. All rights reserved.

Prognostic value of sympathetic innervation and cardiac asynchrony in dilated cardiomyopathy

International Nuclear Information System (INIS)

Manrique, Alain; Hitzel, Anne; Vera, Pierre; Bernard, Mathieu; Bauer, Fabrice; Menard, Jean-Francois; Sabatier, Remi; Jacobson, Arnold; Agostini, Denis

2008-01-01

The purpose of the study is to examine prognostic values of cardiac I-123 metaiodobenzylguanidine (MIBG) uptake and cardiac dyssynchrony in patients with dilated cardiomyopathy (DCM). Ninety-four patients with non-ischemic DCM underwent I-123 MIBG imaging for assessing cardiac sympathetic innervation and equilibrium radionuclide angiography. Mean phase angles and SD of the phase histogram were computed for both right ventricular (RV) and left ventricular (LV). Phase measures of interventricular (RV-LV) and intraventricular (SD-RV and SD-LV) asynchrony were computed. Most patients were receiving beta-blockers (89%) and angiotensin-converting enzyme inhibitors (88%). One patient (1%) was lost to follow-up, six had cardiac death (6.4%), eight had heart transplantation (8.6%), and seven had unplanned hospitalization for heart failure (7.5%; mean follow-up: 37 ± 16 months). Patients with poor clinical outcome were older, had higher The New York Heart Association functional class, impaired right ventricular ejection fraction and left ventricular ejection fraction, and impaired cardiac I-123 MIBG uptake. On multivariate analysis, I-123 MIBG heart-to-mediastinum (H/M) uptake ratio <1.6 was the only predictor of both primary (cardiac death or heart transplantation, RR = 7.02, p < 0.01) and secondary (cardiac death, heart transplantation, or recurrent heart failure, RR = 8.10, p = 0.0008) end points. In patients receiving modern medical therapy involving beta-blockers, I-123 MIBG uptake, but not intra-LV asynchrony, was predictive of clinical outcome. The impact of beta-blockers on the prognostic value of ventricular asynchrony remains to be clarified. (orig.)

A prediction model for 5-year cardiac mortality in patients with chronic heart failure using {sup 123}I-metaiodobenzylguanidine imaging

Energy Technology Data Exchange (ETDEWEB)

Nakajima, Kenichi; Matsuo, Shinro [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa (Japan); Nakata, Tomoaki [Sapporo Medical University School of Medicine, Second Department of Internal Medicine (Cardiology), Sapporo (Japan); Hakodate-Goryoukaku Hospital, Department of Cardiology, Hakodate (Japan); Yamada, Takahisa [Osaka Prefectural General Medical Center, Department of Cardiology, Osaka (Japan); Yamashina, Shohei [Toho University Omori Medical Center, Department of Cardiovascular Medicine, Tokyo (Japan); Momose, Mitsuru [Tokyo Women' s Medical University, Department of Nuclear Medicine, Tokyo (Japan); Kasama, Shu [Cardiovascular Hospital of Central Japan, Department of Cardiology, Shibukawa (Japan); Matsui, Toshiki [Social Insurance Shiga General Hospital, Department of Cardiology, Otsu (Japan); Travin, Mark I. [Albert Einstein Medical College, Department of Cardiology and Nuclear Medicine, Montefiore Medical Center, Bronx, NY (United States); Jacobson, Arnold F. [GE Healthcare, Medical Diagnostics, Princeton, NJ (United States)

2014-09-15

Prediction of mortality risk is important in the management of chronic heart failure (CHF). The aim of this study was to create a prediction model for 5-year cardiac death including assessment of cardiac sympathetic innervation using data from a multicenter cohort study in Japan. The original pooled database consisted of cohort studies from six sites in Japan. A total of 933 CHF patients who underwent {sup 123}I-metaiodobenzylguanidine (MIBG) imaging and whose 5-year outcomes were known were selected from this database. The late MIBG heart-to-mediastinum ratio (HMR) was used for quantification of cardiac uptake. Cox proportional hazard and logistic regression analyses were used to select appropriate variables for predicting 5-year cardiac mortality. The formula for predicting 5-year mortality was created using a logistic regression model. During the 5-year follow-up, 205 patients (22 %) died of a cardiac event including heart failure death, sudden cardiac death and fatal acute myocardial infarction (64 %, 30 % and 6 %, respectively). Multivariate logistic analysis selected four parameters, including New York Heart Association (NYHA) functional class, age, gender and left ventricular ejection fraction, without HMR (model 1) and five parameters with the addition of HMR (model 2). The net reclassification improvement analysis for all subjects was 13.8 % (p < 0.0001) by including HMR and its inclusion was most effective in the downward reclassification of low-risk patients. Nomograms for predicting 5-year cardiac mortality were created from the five-parameter regression model. Cardiac MIBG imaging had a significant additive value for predicting cardiac mortality. The prediction formula and nomograms can be used for risk stratifying in patients with CHF. (orig.)

Clinical usefulness of {sup 123}I-MIBG myocardial scintigraphy as a marker of the severity and prognosis of congestive heart failure

Energy Technology Data Exchange (ETDEWEB)

Shiga, Koji [Kyoto Prefectural Univ. of Medicine (Japan)

1999-04-01

To evaluate the clinical usefulness of {sup 123}I-MIBG myocardial scintigraphy in patients with congestive heart failure. Myocardial dynamic imaging was performed immediately after {sup 123}I-MIBG administration at 1 frame/sec for 500 sec in 52 patients with or without congestive heart failure. The %uptake/ROI, dynamic heart to mediastinum uptake ratio (H/M) and dynamic washout rate (WR) were calculated from their time activity curves to assess the relationship between the NYHA functional class and these values. In 52 other patients with heart failure, the initial and delayed MIBG anterior planar images were obtained, and H/M in delayed images and WR between initial and delayed images were measured. The patients were followed up for 31.8{+-}16.8 months, and their survival rates were compared among three groups, H/M<1.5, 1.5{<=}H/M<2.0 and H/M{>=}2.0, or WR<45, 45{<=}WR<60 and WR{>=}60[%], respectively. The parameter, such as H/M, WR, age, X-ray cardiothoracic ratio (CTR), echocardiographic end-diastolic diameter (Dd), fractional shortening (%FS) or radionuclide left ventricular ejection fraction (LVEF), which was the most important prognostic predictor was analyzed. MIBG showed that the dynamic kinetics immediately after administration which reflected the severity of congestive heart failure, %uptake/ROI and dynamic H/M were significantly lower and dynamic WR was significantly higher in the advanced NYHA functional class. During the follow-up period, 13 patients died of heart failure. The survival rate in the group of H/M<1.5 or WR{>=}60[%] was significantly poorer than the other groups, and the most important predictive indicator for the prognosis was found to be H/M or WR exceeding age, CTR, Dd, %FS and LVEF {sup 123}I-MIBG myocardial scintigraphy is very useful to diagnose the severity and prognosis in patients with congestive heart failure. (K.H.)

Prognostic value of 123I-metaiodobenzylguanidine in patients with various heart diseases

International Nuclear Information System (INIS)

Nagamatsu, Hitoshi; Momose, Mitsuru; Kobayashi, Hideki; Kusakabe, Kiyoko; Kasanuki, Hiroshi

2007-01-01

It has been reported that 123 I-metaiodobenzylguanidine (MIBG) scintigraphy can predict the poor prognosis in patients with dilated cardiomyopathy (DCM). However, the prognostic significance of MIBG is still unknown in patients with other heart diseases. In this study, we compared the prognosis and MIBG findings in various heart diseases. Consecutive 565 patients undergoing MIBG scintigraphy were enrolled (392 men, 52±16 years). Indications were that 127 had ischemic heart disease (IHD), 120 DCM, 101 hypertrophic cardiomyopathy (HCM), 21 hypertensive heart disease (HHD), 58 volume-load valvular disease (VVD), 38 pressure-load valvular disease (PVD), and 101 ventricular tachycardia or fibrillation (VTF). Heart-to-mediastinum ratio (H/M) and washout rate (WR) of MIBG were evaluated. Cardiac events were defined as sudden cardiac death, heart failure, and acute ischemic event (follow-up, 22.7±17.0 months). A total of 106 cardiac events including 40 cardiac deaths occurred. Cox hazard model analysis showed that in the IHD, HCM, and DCM groups, H/M and WR were associated with cardiac death, but not in the HHD, PVD, VVD, or VTF groups. Only death and congestive heart failure (CHF) episodes were related to H/M and WR. On the other hand, fatal arrhythmia, myocardial infarction, or angina pectoris were not related to H/M and WR. The data indicated that WR or H/M may predict death and CHF but does not predict fatal arrhythmia or acute ischemic event. MIBG WR and H/M were associated with heart failure, sudden death, and cardiac death events, and were useful to predict the prognosis in DCM, HCM, and IHD. In contrast, fatal arrhythmia events were not associated with MIBG indices, and thus it does not appear to be useful in predicting cardiac events in patients with VTF. (author)

Frequency and characteristics of extremely low accumulation of 123I-metaiodobenzylguanidine (MIBG) in patients with and without cardiovascular diseases

International Nuclear Information System (INIS)

Sakata, Kazuyuki; Iida, Kei; Motiduki, Nao; Nakaya, Yoshihiro

2008-01-01

Very low accumulation of 123 I-metaiodobenzylguanidine (LoMIBG) in the human heart has been reported. This study assessed the frequency and characteristics of LoMIBG in the human heart. A total of 2212 patients (male/female ratio 1442/770, mean age 64±12 years) who underwent MIBG imaging were included. LoMIBG was defined as an initial heart-to-mediastinum (H/M) ratio of less than 1.4. Of the 114 patients with LoMIBG, 2 patients were excluded because of taking imipramine. Patients with LoMIBG were older than those without LoMIBG (P<0.0001). The main diagnosis and the number of patients with each disease were as follows: 28 of 410 coronary artery disease patients, 13 of 371 vasospastic angina patients, 3 of 86 various arrhythmias patients, 4 of 23 valvular heart disease patients, 9 of 101 dilated cardiomyopathy patients, 13 of 512 essential hypertension patients, 2 of 20 hypertrophic cardiomyopathy patients, 24 of 511 subjects without any definite disease (control), and 16 of 176 patients with miscellaneous diseases. When compared with patients without LoMIBG in each cardiovascular disease, LoMIBG patients had left ventricular function and frequency similar to critically ill patients. In the control group, the subjects with LoMIBG were significantly older (P<0.0001) and had significantly higher HF (P<0.03) and lower LF/HF (P<0.001) than those without LoMIBG. In addition, the incidence of LoMIBG was significantly elevated in the elderly (P<0.002). LoMIBG occurred in patients both with various diseases and without obvious diseases. Aging may be one of the mechanisms contributing to LoMIBG, especially in patients without obvious diseases. (author)

Iodine-123-labeled meta-iodobenzylguanidine myocardial scintigraphy evaluation of Machado-Joseph disease

International Nuclear Information System (INIS)

Kazuta, Toshinari; Hayashi, Michiyuki; Yoshita, Mitsuhiro; Hirai, Shunsaku

1998-01-01

Iodine-123-labeled meta-iodobenzylguanidine (( 123 I)MIBG), an analogue of guanetidine, is used as a tracer for evaluation of the function of sympathetic neurons. To investigate cardiac sympathetic function in Machado-Joseph disease (MJD), ( 123 I)MIBG myocardial scintigraphy was performed in 12 patients with MJD and 20 controls. In planar imaging studies, the heart to the mediastinum of the average count ratio (H/M) was calculated for both early and delayed images. The mean values of H/M in delayed images of MJD was lower than those of controls (p 123 I)MIBG myocardial scintigraphy in MJD can be seen earlier than abnormal sudomotor system detected by SSR. (author)

Brain {sup 18}F-FDG, {sup 18}F-florbtaben PET/CT, {sup 123}I-FP-CIT SPECT and cardiac {sup 123}I-MBG imaging for diagnosis of a 'cerebral type' of Lewy Body disease

Energy Technology Data Exchange (ETDEWEB)

Gucht, Axel Van Der; Bélissant, Ophélie; Rabu, Corenti; Cottereau, Anne-Ségolène; Evangelista, Eva; Chalaye, Julia; Bonnot-Lours, Sophie; Fénelon, Gilles; Itti, Emmanuel [Dept. of Nuclear Medicine, AP-HP, Henri-Mondor Teaching Hospital, Crteil (France); De Langavant, Laurent Cleret [Cognitive Neurology Unit, H. Mondor Hospital, Creteil (France)

2016-09-15

A 67-year-old man was referred for fluctuating neuropsychiatric symptoms, featuring depression, delirious episodes, recurrent visual hallucinations and catatonic syndrome associated with cognitive decline. No parkinsonism was found clinically even under neuroleptic treatment. {sup 18}F-FDG PET/CT showed hypometabolism in the posterior associative cortex including the occipital cortex, suggesting Lewy body dementia, but {sup 123}I-FP-CIT SPECT was normal and cardiac {sup 123}I-MIBG imaging showed no signs of sympathetic denervation. Alzheimer's disease was excluded by a normal {sup 18}F-florbetaben PET/CT. This report suggests a rare case of α-synucleinopathy without brainstem involvement, referred to as 'cerebral type' of Lewy body disease.

Relation between myocardial response to dobutamine stress and sympathetic nerve activation in patients with idiopathic dilated cardiomyopathy. A comparison of 123I-MIBG scintigraphic and echocardiographic data

International Nuclear Information System (INIS)

Naruse, Hitoshi; Arii, Tohru; Kondo, Tomohiro

2000-01-01

It is likely that a close association exists between findings obtained by two methods: dobutamine stress echocardiography and 123 I-MIBG scintigraphy. Both of these methods are associated with β-adrenergic receptor mechanisms. This study was conducted to demonstrate the relation between myocardial response to dobutamine stress and sympathetic nerve release of norepinephrine in the failing heart. In 12 patents with heart failure due to idiopathic dilated cardiomyopathy, the myocardial effects of dobutamine stress were evaluated by low-dose dobutamine stress echocardiography; and sympathetic nerve function was evaluated by scintigraphic imaging with iodine-123[ 123 I]meta-iodobenzylguanidine (MIBG), an analogue of norepinephrine. Echocardiography provided quantitative assessment of wall motion and left ventricular dilation; radiotracer studies with 123 I-MIBG provided quantitative assessment of the heart-to-mediastinum (H/M) uptake ratio and washout rate. Results showed that H/M correlated with baseline wall motion (r=0.682, p=0.0146), wall motion after dobutamine stress (r=0.758, p=0.0043), the change in wall motion (r=0.667, p=0.0178), and with left ventricular diastolic diameter (r=0.837, p=0.0007). In addition, the 123 I-MIBG washout rate correlated with baseline wall motion (r=0.608, p=0.0360), wall motion after dobutamine stress (r=0.703, p=0.0107), and with the change in wall motion (r=0.664, p=0.0185). Wall motion, especially in the myocardial response to dobutamine stress, is related to sympathetic nerve activity in heart failure. (author)

Ongoing myocardial damage relates to cardiac sympathetic nervous disintegrity in patients with heart failure

International Nuclear Information System (INIS)

Arimoto, Takanori; Takeishi, Yasuchika; Niizeki, Takeshi

2005-01-01

Iodine-123-metaiodobenzylguanidine ( 123 I-MIBG) has been used to assess the integrity and function of the cardiac sympathetic nervous system in patients with heart failure. Heart-type fatty acid binding protein (H-FABP) is released into the circulation when the myocardium is injured, and H-FABP has been recently used as a novel marker for the diagnosis of ongoing myocardial damage. The aim of the present study was to compare cardiac sympathetic nervous activity assessed by 123 I-MIBG imaging with serum levels of H-FABP in patients with heart failure. Fifty patients with chronic heart failure were studied. 123 I-MIBG imaging was carried out at 30 min (early) and 240 min (delayed) after the tracer injection. We measured serum levels of H-FABP using a sandwich enzyme linked immunosorbent assay. Heart to mediastinum (H/M) ratios of 123 I-MIBG decreased and washout rate increased with higher New York Heart Association (NYHA) functional class. H-FABP, norepinephrine and brain natriuretic peptide (BNP) levels increased as the severity of NYHA class advanced. Delayed H/M ratio was significantly correlated with H-FABP (r=-0.296, p=0.029) and BNP (r=-0.335, p=0.0213). Myocardial washout rate of 123 I-MIBG was also correlated with H-FABP (r=0.469, p 123 I-MIBG imaging is an appropriate approach to evaluate non-invasively not only cardiac sympathetic nervous activity, but also latent ongoing myocardial damage in the failing heart. (author)

Asymmetry of salivary gland I123 Metaiodobenzylguanidine (MIBG) uptake in a patient with cervical neuroblastoma and Horner's syndrome - possible etiologic mechanisms

International Nuclear Information System (INIS)

Sandler, E.D.; Hattner, R.S.; Parisi, M.T.

1992-01-01

Horner's syndrome may be due to a variety of serious underlying disorders including cervical neuroblastoma. Horner's syndrome results from a unilateral disruption of the sympathetic innervation to the head and neck. We report a patient with cervical neuroblastoma in whom post operative metaiodobenzylguanidine (MIBG) scans showed a striking decrease in uptake in the ipselateral salivary glands. Since the biodistribution of I 123 metaiodobenzylguanidine in the salivary glands is also dependent on sympathetic innervation, the presence of Horner's syndrome can be reflected in the MIBG scan. (orig.)

Clinical value of lung uptake of iodine-123 metaiodobenzylguanidine (MIBG), a myocardial sympathetic nerve imaging agent, in patients with chronic heart failure

Energy Technology Data Exchange (ETDEWEB)

Mu, Xiuli; Hasegawa, Shinji; Yoshioka, Jun [Osaka Univ., Suita (Japan). Graduate School of Medicine] (and others)

2001-10-01

This study investigated the clinical value of I-123 MIBG pulmonary accumulation and washout in patients with chronic heart failure (CHF). Nineteen patients with CHF and 15 normal volunteers (NL) were included. The uptake ratio of heart to mediastinum (H/M), that of lung fields to mediastinum (L/M), and washout rate (WR) of the heart and lung fields were calculated in anterior planar images and compared with results of echocardiography and cardiac catheterization. In the CHF group, the lung uptake in delayed images increased and lung WR was decreased, suggesting pulmonary endothelial lesions. Furthermore, there was a negative correlation between right and left lung WR and pulmonary arterial diastolic pressure (PA(D)) and pulmonary arterial systolic pressure (PA(S)) in the CHF group. Since the WR of MIBG reflected PA, it may be used as an index of severity of cardiac dysfunction. (author)

Development and validation of a direct-comparison method for cardiac {sup 123}I-metaiodobenzylguanidine washout rates derived from late 3-hour and 4-hour imaging

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Okuda, Koichi; Hashimoto, Mitsumasa [Kanazawa Medical University, Department of Physics, Kahoku, Ishikawa (Japan); Nakajima, Kenichi; Matsuo, Shinro; Taki, Junichi; Kinuya, Seigo [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa, Ishikawa (Japan); Sugino, Shuichi [Okayama Kyokuto Hospital, Department of Radiology, Okayama, Okayama (Japan); Kirihara, Yumiko [FUJIFILM RI Pharma Co., Ltd., Chuo-Ku, Tokyo (Japan)

2016-02-15

The washout rate (WR) has been used in {sup 123}I-metaiodobenzylguanidine (MIBG) imaging to evaluate cardiac sympathetic innervation. However, WR varies depending on the time between the early and late MIBG scans. Late scans are performed at either 3 or 4 hours after injection of MIBG. The aim of this study was to directly compare the WR at 3 hours (WR{sub 3h}) with the WR at 4 hours (WR{sub 4h}). We hypothesized that the cardiac count would reduce linearly between the 3-hour and 4-hour scans. A linear regression model for cardiac counts at two time-points was generated. We enrolled a total of 96 patients who underwent planar {sup 123}I-MIBG scintigraphy early (15 min) and during the late phase at both 3 and 4 hours. Patients were randomly divided into two groups: a model-creation group (group 1) and a clinical validation group (group 2). Cardiac counts at 15 minutes (count{sub early}), 3 hours (count{sub 3h}) and 4 hours (count{sub 4h}) were measured. Cardiac count{sub 4h} was mathematically estimated using the linear regression model from count{sub early} and count{sub 3h}. In group 1, the actual cardiac count{sub 4h}/count{sub early} was highly significantly correlated with count{sub 3h}/count{sub early} (r = 0.979). In group 2, the average estimated count{sub 4h} was 92.8 ± 31.9, and there was no significant difference between this value and the actual count{sub 4h} (91.9 ± 31.9). Bland-Altman analysis revealed a small bias of -0.9 with 95 % limits of agreement of -6.2 and +4.3. WR{sub 4h} calculated using the estimated cardiac count{sub 4h} was comparable to the actual WR{sub 4h} (24.3 ± 9.6 % vs. 25.1 ± 9.7 %, p = ns). Bland-Altman analysis and the intraclass correlation coefficient showed that there was excellent agreement between the estimated and actual WR{sub 4h}. The linear regression model that we used accurately estimated cardiac count{sub 4h} using count{sub early} and count{sub 3h}. Moreover, WR{sub 4h} that was mathematically calculated using

Study of sympathetic nervous function under effort induced ischemia in patients with angina pectoris with I-123 metaiodobenzylguanidine (MIBG) myocardial SPECT images

International Nuclear Information System (INIS)

Tanaka, Takeshi; Aizawa, Tadanori; Kato, Kazuzo; Ogasawara, Ken; Sakuma, Toru; Kirigaya, Hajime; Hirosaka, Akira; Igarashi, Masaki

1990-01-01

I-123 metaiodobenzylguanidine (MIBG) is a norepinephrine analog, which can be used to study the sympathetic nervous function of the heart. With MIBG myocardial SPECT images sympathetic nervous function under effort induced ischemia were studied in 18 patients with significant coronary artery lesions. In 5 patients with effort induced ischemic region in stress Tl-201 myocardial images rest MIBG images were collected and then exercise stress test was performed. Patients continued exercising for 3 minutes after onset of symptom. Post-stress MIBG images were collected. Definite ischemic region was noted in stress Tl-201 myocardial images, however no differences were noted between rest and post-stress MIBG images. These results suggested that exercise induced ischemia did not enhance release of uptaken MIBG. In 13 patients with significant coronary artery lesions symptom-limited exercise stress test was performed MIBG and Tl-201 were simultaneously injected at onset of symptom and patients continued exercising for an additional one minute. In 6 cases (46%, 6/13) MIBG defects with Tl-201 uptake were noted. These results showed that exercise induced ischemia depressed net MIBG uptake and that sympathetic nervous function (MIBG images) may be more sensitive to ischemic damage than muscle (Tl-201 images). It is suggested that exercise induced ischemia depressed reuptake of norepinephrine at sympathetic nervous endings. MIBG myocardial SPECT images may be useful for evaluating sympathetic nervous function under ischemia. (author)

Cardiac sympathetic neuronal damage precedes myocardial fibrosis in patients with Anderson-Fabry disease

International Nuclear Information System (INIS)

Imbriaco, Massimo; Piscopo, Valentina; Ponsiglione, Andrea; Nappi, Carmela; Puglia, Marta; Dell'Aversana, Serena; Spinelli, Letizia; Cuocolo, Alberto; Pellegrino, Teresa; Petretta, Mario; Riccio, Eleonora; Pisani, Antonio

2017-01-01

Cardiac sympathetic denervation may be detectable in patients with Anderson-Fabry disease (AFD), suggesting its usefulness for early detection of the disease. However, the relationship between sympathetic neuronal damage measured by 123 I-metaiodobenzylguanidine (MIBG) imaging with myocardial fibrosis on cardiac magnetic resonance (CMR) is still unclear. Cardiac sympathetic innervation was assessed by 123 I-MIBG single-photon emission computed tomography (SPECT) in 25 patients with genetically proved AFD. Within one month from MIBG imaging, all patients underwent contrast-enhanced CMR. MIBG defect size and fibrosis size on CMR were measured for the left ventricle (LV) and expressed as %LV. Patients were divided into three groups according to MIBG and CMR findings: (1) matched normal, without MIBG defects and without fibrosis on CMR (n = 10); (2) unmatched, with MIBG defect but without fibrosis (n = 5); and (3) matched abnormal, with MIBG defect and fibrosis (n = 10). The three groups did not differ with respect to age, gender, α-galactosidase, proteinuria, glomerular filtration rate, and troponin I, while New York Heart Association class (p = 0.008), LV hypertrophy (p = 0.05), and enzyme replacement therapy (p = 0.02) were different among groups. Although in patients with matched abnormal findings, there was a significant correlation between MIBG defect size and area of fibrosis at CMR (r 2 = 0.98, p < 0.001), MIBG defect size was larger than fibrosis size (26 ± 23 vs. 18 ± 13%LV, p = 0.02). Sympathetic neuronal damage is frequent in AFD patients, and it may precede myocardial damage, such as fibrosis. Thus, 123 I-MIBG imaging can be considered a challenging technique for early detection of cardiac involvement in AFD. (orig.)

Comparison of chromatography and Sep-pak methods for estimating the radiochemical purity of I-123 and I-131 labelled meta-iodobenzylguanidine (mIBG), synthesised in house

International Nuclear Information System (INIS)

Kumar, V.

1998-01-01

Full text: Radioiodine (I-123 or I-131) labelled mlBG has been prepared routinely in-house in a number of radiopharmacy laboratories. The radiochemical purity can be estimated by several methods. Available literature suggests that the results of chronatographic analysis are comparable with electrophoresis and high pressure liquid chromatography (HPLC) methods which are considered as gold-standard procedures. However, due to the cost involved with these equipments most of the radiopharmacy laboratories are not fortunate enough to have them. The present study compares the validity of reverse-phase Sep-pak cartridge method against chromatographic technique. We analysed twenty four preparations of mIBG by both Sep-pak and chromatography methods (20 batches of I-123 mD3G and 4 batches of I-131 mIBG). Chromatographic analysis, which takes >2hrs, was performed with Whatman No 1/ n-butanol: acetic acid: water (60:15:25 v/v) and the activity associated with the peaks for free iodine and I-123 mD3G were measured. Sep-pak cartridge method, which takes less than 10 min, was performed as follows: the cartridge was activated by injecting 5 mL ethanol (200% pure) followed by flushing with 5mL distilled water. A sample (0.1mL) of radioiodine labelled mD3G was applied to the column and was eluted with 5mL distilled water. Subsequently two aliquots of 5mL solution containing tetrahydrofuran: (0.1M) sodium dihydrogen phosphate (25:75v/v) were passed through and the activity in each elute was measured. Analysing the results by Student's paired t-test for I-123 mlBG using the Sep-pak method gave a mean + SD of 98.8+ 0.6 % which correlated well (r 2 = 0.780) with the results obtained by the chromatographic method 99.3+0.5% (p <0.05). The results obtained for free I-123 by the two methods were 1.09 + 0.56% and 0.6 + 0.5% (p <0.05) respectively. The parameters did not differ significantly when I-131, instead of I-123, was used to synthesise mIBG. The results clearly indicate that the Sep

The effect of β-blocker on hamster model BIO 53.58 with dilated cardiomyopathy determined using 123I-MIBG myocardial scintigraphy

International Nuclear Information System (INIS)

Inoue, Aritomo; Yamashina, Shohei; Yamazaki, Junichi

2003-01-01

123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is currently used to evaluate cardiac sympathetic nerve function, but MIBG also has the capacity to evaluate dilated cardiomyopathy (DCM) severity and therapeutic effectiveness. In this study, we administered β-blockers to a DCM hamster model and evaluated the effect of therapy using MIBG. We also pathologically compared the effects of myocardial fibrosis suppression. BIO 53.58 hamsters were divided into the following five groups based on β-blocker administration: vehicle (COT), 2 mg/kg/day carvedilol (CLT), 20 mg/kg/day (CHT) carvedilol, 4 mg/kg/day (MLT) metoprolol, 40 mg/kg/day (MHT) metoprolol. F1B hamsters were administered a vehicle (COF). Plasma catecholamine, noradrenaline (p-NADR), adrenaline (p-ADR), and dopamine (p-DOPA) were assayed, and MIBG was performed. The count ratio of the heart to the mediastinum (H/M) and left ventricle myocardial washout ratio (WR) were calculated. We then performed an autopsy and calculated the percent change in fibrotic area from myocardial sections. H/M of the initial image in the COT group was significantly lower at 2.4±0.2 than the 2.9±0.7 in the COF group (p<0.05). The CLT and CHT groups had higher H/M values compared to the COT group (3.1±0.6, 3.0±0.6 versus 2.4±0.2: p<0.05). Significant correlations were evident between the H/M of the delayed image and p-NADR and p-DOPA (p<0.05, p<0.01, respectively) as well as between WR and p-NADR and p-DOPA (p<0.05). Percent change in fibrotic area was significantly lower in the β-blocker groups than in the COT group (p<0.05). Significant negative correlations were seen between the H/M of the delayed image and the percent change in fibrosis area. The delayed image H/M and WR acutely reflected cardiac disorder and sympathetic nerve function disorder in BIO 53.58 hamsters. In the carvedilol-administered groups, there was improvement compared to the initial H/M image, indicating the efficacy of the β-blocker in DCM

A phantom study : should (124) I-mIBG PET/CT replace (123) I-mIBG SPECT/CT?

NARCIS (Netherlands)

Beijst, Casper; de Keizer, Bart; Lam, Marnix G E H; Janssens, Geert O; Tytgat, Godelieve A M; de Jong, Hugo W A M

2017-01-01

PURPOSE: The isotope (123) I is commonly labeled with meta-iodobenzylguanidine (mIBG) for imaging of neuroendocrine tumors, such as pheochromocytomas and neuroblastomas. (123) I-mIBG SPECT/CT imaging is performed for staging, follow-up and selection of patients for treatment with (131) I mIBG. As an

Cardiac sympathetic neuronal damage precedes myocardial fibrosis in patients with Anderson-Fabry disease

Energy Technology Data Exchange (ETDEWEB)

Imbriaco, Massimo; Piscopo, Valentina; Ponsiglione, Andrea; Nappi, Carmela; Puglia, Marta; Dell' Aversana, Serena; Spinelli, Letizia; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Pellegrino, Teresa [National Council of Research, Institute of Biostructure and Bioimaging, Naples (Italy); Petretta, Mario [University Federico II, Department of Translational Medical Sciences, Naples (Italy); Riccio, Eleonora; Pisani, Antonio [University of Naples Federico II, Department of Public Health, Naples (Italy)

2017-12-15

Cardiac sympathetic denervation may be detectable in patients with Anderson-Fabry disease (AFD), suggesting its usefulness for early detection of the disease. However, the relationship between sympathetic neuronal damage measured by {sup 123}I-metaiodobenzylguanidine (MIBG) imaging with myocardial fibrosis on cardiac magnetic resonance (CMR) is still unclear. Cardiac sympathetic innervation was assessed by {sup 123}I-MIBG single-photon emission computed tomography (SPECT) in 25 patients with genetically proved AFD. Within one month from MIBG imaging, all patients underwent contrast-enhanced CMR. MIBG defect size and fibrosis size on CMR were measured for the left ventricle (LV) and expressed as %LV. Patients were divided into three groups according to MIBG and CMR findings: (1) matched normal, without MIBG defects and without fibrosis on CMR (n = 10); (2) unmatched, with MIBG defect but without fibrosis (n = 5); and (3) matched abnormal, with MIBG defect and fibrosis (n = 10). The three groups did not differ with respect to age, gender, α-galactosidase, proteinuria, glomerular filtration rate, and troponin I, while New York Heart Association class (p = 0.008), LV hypertrophy (p = 0.05), and enzyme replacement therapy (p = 0.02) were different among groups. Although in patients with matched abnormal findings, there was a significant correlation between MIBG defect size and area of fibrosis at CMR (r{sup 2} = 0.98, p < 0.001), MIBG defect size was larger than fibrosis size (26 ± 23 vs. 18 ± 13%LV, p = 0.02). Sympathetic neuronal damage is frequent in AFD patients, and it may precede myocardial damage, such as fibrosis. Thus, {sup 123}I-MIBG imaging can be considered a challenging technique for early detection of cardiac involvement in AFD. (orig.)

Uptake and washout of I-123-MIBG in neuronal and non-neuronal sites in rat hearts. Relationship to renal clearance

International Nuclear Information System (INIS)

Arbab, A.S.; Koizumi, Kiyoshi; Araki, Tsutomu

1996-01-01

We investigated the uptake and washout of I-123-metaiodobenzylguanidine (MIBG) in neuronal (both intra-and extravesicular) and non-neuronal sites in the heart and its relationship to renal clearance. Acute renal failure was induced in rats by ligating the renal vessels, and the findings were compared with those of sham-operated rats. Each group consisted of control, reserpine-treated and 6-hydroxydopamine (6-OHDA)-treated subgroups. Rats were sacrificed at 10 minutes and 4 hours after injection of MIBG. MIBG activity was calculated in specimens of heart, spleen, lung and blood. At 10 minutes, no significant difference in MIBG uptake in the heart was observed among the subgroups or between sham-operated and renal failure rats despite a significantly higher blood MIBG activity in the latter. At 4 hours, however, the hearts of both reserpine-treated and 6-OHDA-treated rats showed significantly lower MIBG uptake than control rats. Furthermore, the hearts of renal failure rats showed higher MIBG uptake in the control and reserpine-treated rats than in the corresponding subgroups in sham-operated rats. Intra and extravesicular neuronal uptake of MIBG in the heart were estimated using control, reserpine-treated and 6-OHDA-treated rats. Vesicular uptake values were similar in both the sham-operated group (0.51% ID/g) and the renal failure group (0.44% ID/g). But extravesicular neuronal uptake values were quite different in the renal failure group (0.86% ID/g) and the sham-operated group (0.19% ID/g). In conclusion, uptake to and washout from extravesicular neuronal sites may depend on the concentration of MIBG in the blood or the state of renal clearance, but vesicular uptake may be independent of these factors. (author)

Relationship between late ventricular potentials and myocardial 123I-metaiodobenzylguanidine scintigraphy in patients with dilated cardiomyopathy with mild to moderate heart failure: results of a prospective study of sudden death events

International Nuclear Information System (INIS)

Kasama, Shu; Toyama, Takuji; Kaneko, Yoshiaki; Kurabayashi, Masahiko; Iwasaki, Toshiya; Sumino, Hiroyuki; Kumakura, Hisao; Minami, Kazutomo; Ichikawa, Shuichi; Matsumoto, Naoya; Sato, Yuichi

2012-01-01

Late ventricular potentials (LPs) are considered to be useful for identifying patients with heart failure at risk of developing ventricular arrhythmias. 123 I-metaiodobenzylguanidine (MIBG) scintigraphy, which is used to evaluate cardiac sympathetic activity, has demonstrated cardiac sympathetic denervation in patients with malignant ventricular tachyarrhythmias. This study was undertaken to clarify the relationship between LPs and 123 I-MIBG scintigraphy findings in patients with dilated cardiomyopathy (DCM). A total of 56 patients with DCM were divided into an LP-positive group (n = 24) and an LP-negative group (n = 32). During the compensated period, the delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from 123 I-MIBG images and plasma brain natriuretic peptide (BNP) concentrations were measured. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) were simultaneously determined by echocardiography. LVEDV, LVESV, LVEF and plasma BNP concentrations were similar in the two groups. However, TDS was significantly higher (35 ± 8 vs. 28 ± 6, p 123 I-MIBG scintigraphic parameters were worse in LP-positive DCM patients than in LP-negative DCM patients. Furthermore, in LP-positive DCM patients with a high WR, the incidence of sudden death events was higher than that in other subgroups of DCM patients. (orig.)

Usefulness of Cardiac MIBG Scintigraphy, Olfactory Testing and Substantia Nigra Hyperechogenicity as Additional Diagnostic Markers for Distinguishing between Parkinson's Disease and Atypical Parkinsonian Syndromes.

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Hiroaki Fujita

Full Text Available We aimed to evaluate the utility of the combined use of cardiac 123I-metaiodobenzylguanidine (MIBG scintigraphy, olfactory testing, and substantia nigra (SN hyperechogenicity on transcranial sonography (TCS in differentiating Parkinson's disease (PD from atypical parkinsonian syndromes (APSs, such as multiple system atrophy (MSA and progressive supranuclear palsy (PSP.Cardiac MIBG scintigraphy, card-type odor identification testing (Open Essence (OE, Wako, Japan, and TCS were performed with 101 patients with PD and 38 patients with APSs (MSA and PSP. Receiver operating characteristic (ROC curve analysis was used to assess the sensitivity and specificity of these batteries for diagnosing PD from APSs. The diagnostic accuracy of the three tests was also assessed among patients at the early disease stage (drug-naïve patients with a disease duration of 3 years or less.In differentiating PD from APSs, the area under the ROC curve was 0.74 (95% CI, 0.65-0.83, 0.8 (95% CI, 0.73-0.87, and 0.75 (95% CI, 0.67-0.82 for TCS, cardiac MIBG scintigraphy, and olfactory testing, respectively. The diagnostic sensitivity and specificity were 53.1% and 91.7%, respectively, for TCS, 70.3% and 86.8%, respectively, for cardiac MIBG scintigraphy, 58.4% and 76.3%, respectively, for OE. Among early-stage patients, sensitivity and specificity were 50.0% and 93.8%, respectively, for TCS, 57.1% and 87.5%, respectively, for cardiac MIBG scintigraphy, and 54.8% and 79.2%, respectively, for OE. At least one positive result from 3 tests improved sensitivity (86.1% but decreased specificity (63.2%. In contrast, at least 2 positive results from 3 tests had good discrimination for both early-stage patients (50.0% sensitivity and 93.8% specificity and patients overall (57.8% sensitivity and 95.8% specificity. Positive results for all 3 tests yielded 100% specificity but low sensitivity (25%.At least 2 positive results from among TCS, cardiac MIBG scintigraphy, and olfactory

Iodine-123-metaiodobenzylguanidine cardiac scintigraphy in patients with diabetes mellitus. Therapeutic effects of aldose reductase inhibitor and vitamin B{sub 12}

Energy Technology Data Exchange (ETDEWEB)

Utsunomiya, Keita [Osaka Medical Coll., Takatsuki (Japan)

1997-12-01

Twenty normal volunteers (C group) and 56 patients with non-insulin-dependent diabetes mellitus (NIDDM) who did not have ischemic heart diseases (DM group), were evaluated by means of iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy. The uptake ratio between the cardiac muscle and the upper mediastinum was calculated. The ratio determined from the initial I-123-MIBG scintigraphy image was expressed as HMi, and that determined from the delayed image was expressed as HMd. The washout rate percentage (%WR) was calculated. At least one instance of either the HMi, the HMd, or %WR was outside the mean{+-}1 standard deviation of C group in 34 DM group patients. Aldose reductase inhibitor (ARI) was administered to 17 of the 34 patients and Vitamin B{sub 12} (VB{sub 12}) to the remaining 17 patients, for 3 to 5 months. Before and after treatment, scintigraphic studies with I-123-MIBG were carried out, and the HMi, HMd, and %WR were calculated. There were no significant differences found in FBG, HbA1c, or 1.5-AG levels after treatment with either drug, when compared to the pretreatment values. Both HMi and HMd in the DM group were significantly lower, and %WR was significantly higher than in the C group. The changes in HMi, HMd, and %WR after treatment with ARI were not significant. After treatment with VB{sub 12}, the HMi and HMd levels were significantly increased (p<0.01). Thus, measurement of myocardial MIBG accumulation is a promising new method to detect cardiac sympathetic denervation in diabetic patients. With these changes in treatment, VB{sub 12} was shown to be effective for improvement of HMi and HMd in NIDDM. (author)

Odour identification test and its relation to cardiac 123I‐metaiodobenzylguanidine in patients with drug induced parkinsonism

Science.gov (United States)

Lee, Phil Hyu; Yeo, Seung Hyeon; Yong, Seok Woo; Kim, Yun Joong

2007-01-01

We investigated olfactory function and its relation to cardiac 123I‐metaiodobenzylguanidine (MIBG) uptake in 15 patients with drug induced parkinsonism (DIP). The mean Cross Cultural Smell Identification (CCSI) score was significantly greater in patients with DIP than in those with Parkinson's disease (PD: 6.9 (1.6) vs 4.4 (2.2); p<0.001); however, the mean CCSI score in patients with DIP was not significantly different from controls. One patient with DIP, whose CCSI score was significantly reduced, also exhibited decreased cardiac MIBG uptake. DIP patients with CCSI scores within the normal range had normal cardiac MIBG uptake. Our study suggests that an olfactory function test may be a useful tool for detecting DIP unrelated to PD and for identifying patients with DIP who have subclinical PD. PMID:17557797

Feasibility of performing 123I MIBG scintigraphy in patients with neuroblastoma in the Maltese Islands

International Nuclear Information System (INIS)

Samuel, A.; Debattista, A.; Delia, M.; Grima, K.; Apap Bologna, G.

2004-01-01

Full text: The Maltese Islands lie in the middle of the Mediterranean Sea, 90 km south of Sicily and 300 km north of Libya. The supply of short-lived radioisotopes for medical use from mainland Europe is therefore logistically difficult. Due to this, several of our patients in the past were sent to centers in UK for various nuclear medicine procedures. Neuroblastoma is the commonest paediatric malignancy with an incidence in the Maltese islands similar to the figures in Western European. Tc-99m MDP and I-123 MIBG scans are important diagnostic tools in the management of these patients. We report our experience of I-123 MIBG scanning in paediatric patients with neuroblastoma. Between March 1997 and March 2003, 4 patients were examined and a total 8 scans were performed at the time of initial diagnosis and follow-up period. All these patients also underwent bone scintigraphy as a part of the protocol used in our hospital. We will discuss the problems encountered by us in obtaining the radiopharmaceutical and how these were circumvented. The procedure in place requires excellent coordination between all links of the supply chain namely manufacturers, overseas transporters, local customs officials, local delivery men, hospital staff and last but not least the patients (or their parents) themselves. Nowadays, these scans are performed on a routine basis whenever requested by the paediatric department and no patient in the last 4 years required rescheduling of the scan. The facts that the procedures are performed in the patient's own country rather than overseas reduces the psychological trauma that both the children as well as the parents go through. Furthermore, the convenience of performing the scans locally has resulted in significant cost savings to the National Health Service. (author)

The Value of the 123 I-MIBG Scintigraphy in Diagnosis and Follow-Up of Patients with Pepper Syndrome

International Nuclear Information System (INIS)

Davidescu, L.; Anghel, A.; Jeandot, R.; Guyot, M.; Fernandez, P.; Farid, K.; Allard, Michele; Codorean, Ioan; Marinescu, G.; Rimbu, A.; Mititelu, R.; Ghita, S.; Mazilu, C.

2006-01-01

Full text: Objective: The poster highlights the importance of scintigraphy with 123 I-MIBG in the complete evaluation of a patient with Pepper syndrome. Pepper syndrome is a particular form of the metastatic neuroblastoma in stage 4S (hepatic metastasis without bone involvement) with a good prognosis, which affects mainly newborns. MIBG (metaiodobenzyl-guanidine) being an analogue of norephinephrine - is captured (active mechanism) by the neuroendocrine cells and is concentrated in the medula of the adrenal glands, sympathetic paraganglia, myocardium sympathetic nervous terminations, APUD system and in the tumours originating from these structures. Materials and Methods: EN, 3 months old, feminine sex, suspected of having 4S stage neuroblastoma (Pepper syndrome) has been evaluated by a scintigraphic examination 24 hours after intravenous injection of 80 MBq 123 I-MIBG. We used a dual-head GE gamma camera, LEUHR collimator with parallels channels for low energy, with high resolution; energy window:159 keV +/- 10%. We performed static images of the cranium (anterior, posterior and lateral view), thorax, abdomen, pelvis and limbs (anterior and posterior view). Thyroid gland was blocked with Lugol. We have repeated the scintigraphic examinations at 3, 4, 6 and 7 months after the initial exam. Results and Discussions: First examination confirmed the diagnosis of Pepper syndrome putting in evidence a hyper fixation of the radio pharmaceutic in the right abdominal side corresponding with the primitive tumour of the adrenal medula; a heterogeneous hyper fixation of the liver evoking a multi nodular secondary hepatomegaly and some hyper fixations focalized to the cranial box (frontal right), to the superior epiphysis of the left tibia and to the superior extremity of the left femur (osteomedullary invasion). The next examinations have shown an amelioration of the scintigraphic imaging of the abdominal localisations but also of the osteomedullary ones. The scintigraphy has

Homocysteine levels are associated with the results of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients

Energy Technology Data Exchange (ETDEWEB)

Anan, Futoshi; Yonemochi, Hidetoshi; Nakagawa, Mikiko; Saikawa, Tetsunori [Oita University, Department of Cardiovascular Science, Faculty of Medicine, Hasama, Oita (Japan); Masaki, Takayuki; Takahashi, Naohiko; Yoshimatsu, Hironobu [Oita University, Department of Internal Medicine I, Oita (Japan); Eshima, Nobuoki [Oita University, Department of Biostatistics, School of Medicine, Oita (Japan)

2007-01-15

Elevated total plasma homocysteine (tHcy) levels and cardiovascular autonomic dysfunction are associated with a high mortality in type 2 diabetic patients. We tested the hypothesis that hyperhomocysteinemia is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients not receiving insulin treatment. The study group consisted of 17 type 2 diabetic patients with high tHcy levels (>15 mmol/l, age 58{+-}5 years, high tHcy group). The control group consisted of 23 age-matched type 2 diabetic patients with normal tHcy levels ({<=}15 mmol/l, age 58{+-}9 years, normal tHcy group). Cardiovascular autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations, and cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy. Early and delayed {sup 123}I-MIBG myocardial uptake values were lower (p<0.005 and p<0.01, respectively) and the percent washout rate of {sup 123}I-MIBG was higher (p<0.001) in the high tHcy group than in the normal tHcy group. The fasting plasma insulin concentrations (p<0.0001) and the homeostasis model assessment (HOMA) index values (p<0.0001) were higher in the high tHcy group than in the normal tHcy group. Multiple regression analysis revealed that the level of tHcy was independently predicted by the HOMA index values and the myocardial uptake of {sup 123}I-MIBG at the delayed phase. Our results demonstrate that high levels of tHcy are associated with depressed cardiovascular autonomic function and insulin resistance in patients with type 2 diabetes mellitus. (orig.)

The therapeutic use of I-131 meta-iodobenzylguanidine (MIBG) in neuroblastoma

International Nuclear Information System (INIS)

Hartmann, O.; Lumbroso, J.D.; Lemerle, J.; Schlumberger, M.; Parmentier, C.; Ricard, M.; Aubert, B.; Coornaert, S.; Merlin, L.

1988-01-01

Despite the use of intensified conventional chemotherapy the complete response rate of advanced neuroblastoma remains low. The use of high-dose chemo-radiotherapy followed by bone marrow transplantation (BMT) improved the duration of disease free survival but, even after these high-dose regimens the relapse rate remains high. Metaiodobenzylguanidine (MIBG) labelled with I-131 or I-123 can be used for scintigraphic imaging of neuroblastoma. In order to evaluate the therapeutic role of I-131-MIBG in the treatment of neuroblastoma patients, a phase II study was performed in 12 patients. Results are presented in this paper

Clinical application of cardiac SPECT

International Nuclear Information System (INIS)

Nishimura, Shigeyuki

1999-01-01

Single-photon emission computed tomography (SPECT) has replaced planar imaging techniques for myocardial scintigraphy. Thallium-201 was the dominant agent employed for myocardial perfusion imaging. Today new technetium-99m labelled radionuclides have been used as excellent alternatives to 201 Tl for detection of coronary artery disease, prognostification, and even assessment of myocardial viability. Pharmacologic stress imaging using either dipyridamole, adenosine or dobutamine is a substitute for exercise stress. Accurate determination of myocardial viability is vitally important for clinical decision making for patients with LV dysfunction who will most benefit from revascularization. Stunned and hibernated myocardium may result in profound regional LTV dysfunction in absence of necrosis. The various approach such as stress-redistribution-reinjection imaging, rest-redistribution imaging and stress-redistribution-24 hours delayed imaging has been utilized to assess myocardial viability with 201 Tl. Quantitative assessment of 99m Tc MIBI uptake reflect the degree of viability. 123 I-Metaiodobenzylguanidine (MIBG), an analog of norepinephrine, has been used for scintigraphic assessment of regional cardiac adrenergic innervation. Cardiac sympathetic denervation, assessed by 123 I-MIBG, due to ischemia in non-Q myocardial infarction and unstable angina has been shown. Quantitative cardiac MIBG scintigram was shown to have prognostic value in patients with severe congestive heart failure. 23 I-BMIPP (ρ-methyl-iodophenyl pentadecanoic acid) has been used to assess myocardial fatty acid utilization. BMIPP has the memory function of ischemia in unstable angina, since decreased BMIPP uptake persists several days after ischemic episode. Nuclear cardiology in Japan has experienced an expansion in the techniques including use of new radionuclides, 99m Tc perfusion agents, 123 I-MIBG and 23 I-BMIPP and in associated clinical application to the various cardiac diseases

Abdominal visceral fat accumulation is associated with the results of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients

Energy Technology Data Exchange (ETDEWEB)

Anan, Futoshi [Oita Red Cross Hospital, Department of Cardiology, Oita (Japan); Oita University, Department of Internal Medicine I, Oita (Japan); Masaki, Takayuki; Takahashi, Naohiko; Yoshimatsu, Hironobu [Oita University, Department of Internal Medicine I, Oita (Japan); Yonemochi, Hidetoshi; Nakagawa, Mikiko; Saikawa, Tetsunori [Oita University, Department of Cardiovascular Science, Oita (Japan); Eshima, Nobuoki [Oita University, Department of Biostatistics, School of Medicine, Oita (Japan)

2007-08-15

We tested the hypothesis that increased abdominal visceral accumulation (VFA) is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients not receiving insulin treatment. The fat distribution was evaluated by measuring the VFA by abdominal computed tomography at the umbilical level. The study group consisted of 24 type 2 diabetic patients with high VFA ({>=}100 cm{sup 2}, age 60 {+-} 8 years, high VFA group). The control group consisted of 19 age-matched type 2 diabetic patients with normal VFA (<100 cm{sup 2}, age 60 {+-} 7 years, normal VFA group). Cardiovascular autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations, and cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy. Early and delayed {sup 123}I-MIBG myocardial uptake values were lower (p < 0.005 and p < 0.0001, respectively) and the percent washout rate of {sup 123}I-MIBG was higher (p < 0.0005) in the high VFA group than in the normal VFA group. The fasting plasma insulin concentrations (p < 0.005) and the homeostasis model assessment (HOMA) index values (p < 0.0005) were higher in the high VFA group than in normal VFA group. Multiple regression analysis revealed that the level of VFA was independently predicted by the HOMA index values and the myocardial uptake of {sup 123}I-MIBG during the delayed phase. Our results demonstrate that the level of VFA is associated with depressed cardiovascular autonomic function and insulin resistance in patients with type 2 diabetes mellitus. (orig.)

Usefulness of cardiac 125I-metaiodobenzylguanidine uptake for evaluation of cardiac sympathetic nerve abnormalities in diabetic rats

International Nuclear Information System (INIS)

Abe, Nanami; Kashiwagi, Atsunori; Shigeta, Yukio

1992-01-01

We investigated cardiac sympathetic nerve abnormalities in streptozocin-induced diabetic rats using 125 I-metaiodobenzylguanidine (MIBG). The radioactivity ratio of cardiac tissue to 1 ml blood (H/B) was used as an index of cardiac MIBG uptake. Cardiac 125 I-MIBG uptake (H/B) in 4-, 8- and 20-wk diabetic rats was 48% lower than that in control rats. Similar results were obtained even when the data were corrected for g wet tissue weight. Although there was no improvement in H/B following 2-wk insulin treatment, the H/B ratio increased significantly, to 85% of control levels, following 4 wk insulin treatment indicating the reversibility of impaired MIBG uptake in diabetic rats. In vivo reserpine treatment resulted in a 50% reduction in the H/B value in control rats. However, the treatment did not significantly suppress uptake in diabetic rats. Cardiac norepinephrine content in both * 4- and ** 8-wk diabetic rats was significantly ( * p ** p 125 I-MIBG in diabetic rats is significantly impaired due to cardiac sympathetic nerve abnormalities. These abnormalities are reversible, however, dependent on the diabetic state. (author)

Use of scatter correction in quantitative I-123 MIBG scintigraphy for differentiating patients with Parkinsonism: Results from Phantom experiment and clinical study

International Nuclear Information System (INIS)

Bai, J.; Hashimoto, J.; Suzuki, T.; Nakahara, T.; Kubo, A.; Ohira, M.; Takao, M.; Ogawa, K.

2007-01-01

The aims of this study were to elucidate the feasibility of scatter correction in improving the quantitative accuracy of the Heart-to-Mediastinum (H/M) ratio in I-123 MIBG imaging and to clarify whether the H/M ratio calculated from the scatter corrected image improves the accuracy of differentiating patients with Parkinsonism from other neurological disorders. The H/M ratio was calculated using the counts from planar images processed with and without scatter correction in the phantom and on patients. The triple energy window (TEW) method was used for scatter correction. Fifty five patients were enrolled in the clinical study. The Receiver Operating Characteristic (ROC) Curve analysis was used to evaluate diagnostic performance. The H/M ratio was found to be increased after scatter correction in the phantom simulating normal cardiac uptake, while no changes were observed in the phantom simulating no uptake. It was observed that scatter correction stabilized the H/M ratio by eliminating the influence of scatter photons originating from the liver, especially in the condition of no cardiac uptake. Similarly, scatter correction increased the H/M ratio in conditions other than Parkinson's disease but did not show any change in Parkinson's disease itself to widen the differences in the H/M ratios between the two groups. The overall power of the test did not show any significant improvement after scatter correction in differentiating patients with Parkinsonism. Based on the results of this study it has been concluded that scatter correction improves the quantitative accuracy of H/M ratio in MIBG imaging, but it does not offer any significant incremental diagnostic value over conventional imaging (without scatter correction). Nevertheless it is felt that the scatter correction technique deserves special consideration in order to make the test more robust and obtain stable H/M ratios. (author)

Functional imaging in phaeochromocytoma and neuroblastoma with 68Ga-DOTA-Tyr3-octreotide positron emission tomography and 123I-metaiodobenzylguanidine

International Nuclear Information System (INIS)

Kroiss, Alexander; Putzer, Daniel; Uprimny, Christian; Decristoforo, Clemens; Gabriel, Michael; Warwitz, Boris; Waitz, Dietmar; Kendler, Dorota; Virgolini, Irene Johanna; Santner, Wolfram; Kranewitter, Christof

2011-01-01

68 Ga-DOTA-Tyr 3 -octreotide positron emission tomography ( 68 Ga-DOTA-TOC PET) has proven to be superior to 111 In-DTPA-D-Phe 1 -octreotide ( 111 In-octreotide) planar scintigraphy and SPECT imaging in neuroendocrine tumours (NETs). Because of these promising results, we compared the accuracy of 123 I-metaiodobenzylguanidine ( 123 I-MIBG) imaging with PET in the diagnosis and staging of metastatic phaeochromocytoma and neuroblastoma, referring to radiological imaging as reference standard. Three male and eight female patients (age range 3 to 68 years) with biochemically and histologically proven disease were included in this study. Three male and three female patients were suffering from phaeochromocytoma, and five female patients from neuroblastoma. Comparative evaluation included morphological imaging with CT or MRI, functional imaging with 68 Ga-DOTA-TOC PET and 123 I-MIBG imaging. Imaging results were analysed on a per-patient and on a per-lesion basis. On a per-patient basis, both 68 Ga-DOTA-TOC and 123 I-MIBG showed a sensitivity of 100%, when compared with anatomical imaging. In phaeochromocytoma patients, on a per-lesion basis, the sensitivity of 68 Ga-DOTA-TOC was 91.7% and that of 123 I-MIBG was 63.3%. In neuroblastoma patients, on a per-lesion basis, the sensitivity of 68 Ga-DOTA-TOC was 97.2% and that of 123 I-MIBG was 90.7%. Overall, in this patient cohort, 68 Ga-DOTA-TOC PET identified 257 lesions, anatomical imaging identified 216 lesions, and 123 I-MIBG identified only 184 lesions. In this patient group, the overall sensitivity of 68 Ga-DOTA-TOC PET on a lesion basis was 94.4% (McNemar p 123 I-MIBG was 76.9% (McNemar p 68 Ga-DOTA-TOC PET may be superior to 123 I-MIBG gamma-scintigraphy and even to the reference CT/MRI technique in providing particularly valuable information for pretherapeutic staging of phaeochromocytoma and neuroblastoma. (orig.)

Functional imaging in phaeochromocytoma and neuroblastoma with 68Ga-DOTA-Tyr 3-octreotide positron emission tomography and 123I-metaiodobenzylguanidine.

Science.gov (United States)

Kroiss, Alexander; Putzer, Daniel; Uprimny, Christian; Decristoforo, Clemens; Gabriel, Michael; Santner, Wolfram; Kranewitter, Christof; Warwitz, Boris; Waitz, Dietmar; Kendler, Dorota; Virgolini, Irene Johanna

2011-05-01

(68)Ga-DOTA-Tyr(3)-octreotide positron emission tomography ((68)Ga-DOTA-TOC PET) has proven to be superior to (111)In-DTPA-D-Phe(1)-octreotide ((111)In-octreotide) planar scintigraphy and SPECT imaging in neuroendocrine tumours (NETs). Because of these promising results, we compared the accuracy of (123)I-metaiodobenzylguanidine ((123)I-MIBG) imaging with PET in the diagnosis and staging of metastatic phaeochromocytoma and neuroblastoma, referring to radiological imaging as reference standard. Three male and eight female patients (age range 3 to 68 years) with biochemically and histologically proven disease were included in this study. Three male and three female patients were suffering from phaeochromocytoma, and five female patients from neuroblastoma. Comparative evaluation included morphological imaging with CT or MRI, functional imaging with (68)Ga-DOTA-TOC PET and (123)I-MIBG imaging. Imaging results were analysed on a per-patient and on a per-lesion basis. On a per-patient basis, both (68)Ga-DOTA-TOC and (123)I-MIBG showed a sensitivity of 100%, when compared with anatomical imaging. In phaeochromocytoma patients, on a per-lesion basis, the sensitivity of (68)Ga-DOTA-TOC was 91.7% and that of (123)I-MIBG was 63.3%. In neuroblastoma patients, on a per-lesion basis, the sensitivity of (68)Ga-DOTA-TOC was 97.2% and that of (123)I-MIBG was 90.7%. Overall, in this patient cohort, (68)Ga-DOTA-TOC PET identified 257 lesions, anatomical imaging identified 216 lesions, and (123)I-MIBG identified only 184 lesions. In this patient group, the overall sensitivity of (68)Ga-DOTA-TOC PET on a lesion basis was 94.4% (McNemar p<0.0001) and that of (123)I-MIBG was 76.9% (McNemar p<0.0001). Our analysis in this relatively small patient cohort indicates that (68)Ga-DOTA-TOC PET may be superior to (123)I-MIBG gamma-scintigraphy and even to the reference CT/MRI technique in providing particularly valuable information for pretherapeutic staging of phaeochromocytoma and

Metaiodobenzylguanidine (MIBG) uptake in Parkinson's disease also decreases at thyroid

International Nuclear Information System (INIS)

Matsui, Hideaki; Udaka, Fukashi; Oda, Masaya; Tamura, Akiko; Kubori, Tamotsu; Nishinaka, Kazuto; Kameyama, Masakuni

2005-01-01

Decreased cardiac metaiodobenzylguanidine (MIBG) uptake was reported in Parkinson's disease and this contributes to the differential diagnosis between Parkinson's disease and other forms of parkinsonism such as multiple system atrophy. However, decreased MIBG uptake of the thyroid has not been demonstrated. The objective of this study was to compare MIBG uptake of the thyroid among Parkinson's disease, multiple system atrophy and controls. Twenty-six patients with Parkinson's disease, 11 patients with multiple system atrophy and 14 controls were examined in this study. Planar images were taken 15 minutes (early images) and 3 hours (late images) after intravenous injection of 111 MBq 123 I-MIBG. MIBG uptake of the thyroid on early images decreased significantly in Parkinson's disease compared to controls (p<0.0001) and multiple system atrophy (p=0.018). MIBG uptake of the thyroid on early images decreased significantly also in multiple system atrophy compared to controls (p=0.027). On late images, thyroid uptake differed significantly only between Parkinson's disease and controls (p=0.010). Our study is the first to demonstrate decreased MIBG uptake of the thyroid in Parkinson's disease. Sympathetic nervous denervation of Parkinson's disease occurred not only in the heart but also in the thyroid. (author)

131I-MIBG scintigraphy in carcinoid tumor with liver metastases (case report)

International Nuclear Information System (INIS)

Eftekhari, M.; Olamaei, R.; Fard, A.; Beiki, D.; Saghari, M.

2003-01-01

A 65 year old male presented with abdominal pain (R.U.Q) and constipation, associated with weight loss and anorexia since 40 days prior to admission. Serum biochemical tests were normal. Colonoscopy showed hemorrhagic polyploid lesion in the cecum Barium enema revealed filling defect in the cecum. Sonography revealed a target-shaped lesion(3cm X 2.5 cm)in upper segment of the right hepatic lobe. CT scan confirmed the same finding as a hypodense lesion. Following segmental resection of the cecum, pathology indicated the presence of the carcinoid tumor. For the better evaluation, 131 I-MIBG scintigraphy was carried out, demonstrating tracer avid metastatic lesions in the right and left hepatic lobes. A review of the series reported in the literature, shows that approximately 50-60% of carcinoids are able to concentrate radiolabeled MIBG. MIBG uptake apparently correlated with the urinary excretion of 5-HIAA, although this is not a universal finding. The most frequently occurring midgut carcinoids probably concentrate the radiolabeled MIBG more readily than those in the hind gut and fore gut. Primary and residual tumors are sometimes visualized , but the most striking imaging is that of carcinoids metastases in the peritoneum and liver(provided that SPECT images with 123 I-MIBG or alternatively 131 I-MIBG delayed scans are performed). Lymph node involvement, bone deposits and ovarian metastases have been reported as well. When radioiodinated MIBG and somatostatin scintigraphy results are compared, somatostatin scintigraphy shows a better sensitivity (>80%) in detecting both primary and metastatic lesions. These radiopharmaceuticals play complementary roles in that each give unique information concerning possible treatment either with octreotide or 131 I-MIBG, or both. MIBG imaging can not generally relied upon either to detect a carcinoid, or to rule out the disease.When a tumor is strongly suspected of being carcinoid however, the test can be worthwhile for the

Comparison of 18F-fluoro-L-DOPA, 18F-fluoro-deoxyglucose, and 18F-fluorodopamine PET and 123I-MIBG scintigraphy in the localization of pheochromocytoma and paraganglioma.

NARCIS (Netherlands)

Timmers, H.J.L.M.; Chen, C.C.; Carrasquillo, J.A.; Whatley, M.; Ling, A.; Havekes, B.; Eisenhofer, G.; Martiniova, L.; Adams, K.T.; Pacak, K.

2009-01-01

CONTEXT: Besides (123)I-metaiodobenzylguanidine (MIBG), positron emission tomography (PET) agents are available for the localization of paraganglioma (PGL), including (18)F-3,4-dihydroxyphenylalanine (DOPA), (18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG), and (18)F-fluorodopamine ((18)F-FDA). OBJECTIVE:

Clinical significance of power spectral analysis of heart rate variability and {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial imaging for assessing the severity of heart failure

Energy Technology Data Exchange (ETDEWEB)

Ishida, Yoshio; Fukuoka, Shuji; Shimotsu, Yoriko; Sasaki, Tatsuya; Kamakura, Shiro; Yasumura, Yoshio; Miyatake, Kunio; Shimomura, Katsuro [National Cardiovascular Center, Suita, Osaka (Japan); Tani, Akihiro

1997-04-01

The significance of power spectral analysis of heart rate variability and of MIBG myocardial imaging to see the sympathetic nervous function was evaluated in patients with congestive heart failure due to dilated cardiomyopathy. Subjects were 10 normal volunteers and 8 patients with severity NYHA II; 10 normals and 25 patients with NYHA II and III; and 17 patients treated with a beta-blocker (metoprolol 5-40 mg). ECG was recorded with a portable ECG recorder for measuring RR intervals for 24 hr, which were applied for power spectral analysis. Early and delayed imagings with 111 MBq of {sup 123}I-MIBG were performed at 15 min and 4 hr, respectively, after its intravenous administration for acquisition of anterior planar and SPECT images. Myocardial blood flow SPECT was also done with 111 MBq of {sup 201}Tl given intravenously, and difference of total defect scores between MIBG and Tl images was computed. MIBG myocardial sympathetic nerve imaging in those patients was found useful to assess the severity of heart failure, to predict the risk patients for beta-blocker treatment and to assess the risk in complicated ventricular tachycardia. (K.H.)

Discrepant uptake of the radiolabeled norepinephrine analogues hydroxyephedrine (HED) and metaiodobenzylguanidine (MIBG) in rat hearts

Energy Technology Data Exchange (ETDEWEB)

Rischpler, Christoph [Johns Hopkins University, Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology, Baltimore, MD (United States); Klinikum rechts der Isar, Nuklearmedizinische Klinik und Poliklinik, Munich (Germany); Fukushima, Kenji; Isoda, Takuro; Javadi, Mehrbod S.; Dannals, Robert F.; Wahl, Richard [Johns Hopkins University, Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology, Baltimore, MD (United States); Abraham, Roselle [Johns Hopkins University, Division of Cardiology, Department of Medicine, Baltimore, MD (United States); Bengel, Frank M. [Johns Hopkins University, Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology, Baltimore, MD (United States); Hannover Medical School, Department of Nuclear Medicine, Hannover (Germany); Higuchi, Takahiro [Johns Hopkins University, Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology, Baltimore, MD (United States); Wuerzburg University, CHFC/Department of Nuclear Medicine, Wuerzburg (Germany); Universitaetsklinikum Wuerzburg, Nuklearmedizinische Klinik und Poliklinik, Wuerzburg (Germany)

2013-07-15

{sup 11}C-Hydroxyephedrine (HED) and radioiodinated metaiodobenzylguanidine ({sup 123}I/{sup 131}I-MIBG) are catecholamine analogue tracers for sympathetic nerve positron emission tomography/single photon emission computed tomography (PET/SPECT) imaging. In contrast to humans, rat hearts demonstrate high nonneural catecholamine uptake-2 in addition to neural uptake-1, the contributions of which to tracer accumulation are not fully elucidated. Wistar rats were studied using the following pretreatments: uptake-1 blockade with desipramine 2 mg/kg IV, both uptake-1 and -2 blockade with phenoxybenzamine 50 mg/kg IV, or control with saline IV. HED or {sup 123}I-MIBG was injected 10 min after pretreatment, and rats were sacrificed 10 min later. Heart to blood tissue count ratio (H/B ratio) was obtained using a gamma counter. To determine regional tracer uptake, dual-tracer autoradiography was performed with HED and {sup 131}I-MIBG in Wistar rats with chronic infarction by transient coronary occlusion and reperfusion and in healthy control rats. Local tracer distributions were analyzed, and the infarcted rats' local tracer distributions were compared with histology. The H/B ratios in control hearts were 34.4 {+-} 1.7 and 25.5 {+-} 2.1 for HED and {sup 123}I-MIBG, respectively. Desipramine led to a significant decrease in HED (3.2 {+-} 0.5, p < 0.0001), while there was no change in {sup 123}I-MIBG (25.5 {+-} 6.4, p = n.s.). Phenoxybenzamine led to a significant decrease in both HED and {sup 123}I-MIBG (3.5 {+-} 0.02, 4.3 {+-} 0.7, p < 0.0001). Only HED showed a subepicardium-subendocardium gradient in healthy control hearts which is consistent with physiological innervation, while {sup 131}I-MIBG was evenly distributed throughout the myocardium. {sup 131}I-MIBG uptake defect closely matched the scar area determined by histology [3.8 {+-} 2.3 % ({sup 131}I-MIBG defect) vs 4.0 {+-} 2.4 % (scar)]. However, the scar area was clearly exceeded by the HED uptake defect (9

Iodine-123-metaiodobenzylguanidine cardiac scintigraphy in patients with diabetes mellitus. Therapeutic effects of aldose reductase inhibitor and vitamin B12

International Nuclear Information System (INIS)

Utsunomiya, Keita

1997-01-01

Twenty normal volunteers (C group) and 56 patients with non-insulin-dependent diabetes mellitus (NIDDM) who did not have ischemic heart diseases (DM group), were evaluated by means of iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy. The uptake ratio between the cardiac muscle and the upper mediastinum was calculated. The ratio determined from the initial I-123-MIBG scintigraphy image was expressed as HMi, and that determined from the delayed image was expressed as HMd. The washout rate percentage (%WR) was calculated. At least one instance of either the HMi, the HMd, or %WR was outside the mean±1 standard deviation of C group in 34 DM group patients. Aldose reductase inhibitor (ARI) was administered to 17 of the 34 patients and Vitamin B 12 (VB 12 ) to the remaining 17 patients, for 3 to 5 months. Before and after treatment, scintigraphic studies with I-123-MIBG were carried out, and the HMi, HMd, and %WR were calculated. There were no significant differences found in FBG, HbA1c, or 1.5-AG levels after treatment with either drug, when compared to the pretreatment values. Both HMi and HMd in the DM group were significantly lower, and %WR was significantly higher than in the C group. The changes in HMi, HMd, and %WR after treatment with ARI were not significant. After treatment with VB 12 , the HMi and HMd levels were significantly increased (p 12 was shown to be effective for improvement of HMi and HMd in NIDDM. (author)

Evaluation of cardiac adrenergic neuronal damage in rats with doxorubicin-induced cardiomyopathy using iodine-131 MIBG autoradiography and PGP 9.5 immunohistochemistry

International Nuclear Information System (INIS)

Jeon, T.J.; Lee, J.D.; Ha, J.-W.; Yang, W.I.; Cho, S.H.

2000-01-01

Doxorubicin is one of the most useful anticancer agents, but its repeated administration can induce irreversible cardiomyopathy as a major complication. The purpose of this study was to investigate doxorubicin toxicity on cardiac sympathetic neurons using iodine-131-metaiodobenzylguanidine (MIBG) and protein gene product (PGP) 9.5 immunohistochemistry, which is a marker of cardiac innervation. Wistar rats were treated with doxorubicin (2 mg/kg, i.v.) once a week for 4 (n=5), 6 (n=6) or 8 (n=7) weeks consecutively. Left ventricular ejection fraction (LVEF), calculated by M-mode echocardiography, was used as an indicator of cardiac function. Plasma noradrenaline (NA) concentration was measured by high-performance liquid chromatography (HPLC). 131 I-MIBG uptake of the left ventricular wall (24 ROIs) was measured by autoradiography. 131 I-MIBG uptake pattern was compared with histopathological results, the neuronal population on PGP 9.5 immunohistochemistry and the degree of myocyte damage assessed using a visual scoring system on haematoxylin and eosin and Masson's trichrome staining. LVEF was significantly decreased in the 8-week group (P 131 I-MIBG uptake ratio of subepicardium to subendocardium were significantly increased (P<0.05) in the 8-week group as compared with the control group. It may be concluded that radioiodinated MIBG is a reliable marker for the detection of cardiac adrenergic neuronal damage in doxorubicin-induced cardiomyopathy; it detects such damage earlier than do other clinical parameters and in this study showed a good correlation with the reduction in the neuronal population on PGP 9.5 stain. The subendocardial layer appeared to be more vulnerable to doxorubicin than the subepicardium. (orig.)

Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study

International Nuclear Information System (INIS)

Gimelli, Alessia; Genovesi, Dario; Giorgetti, Assuero; Kusch, Annette; Liga, Riccardo; Marzullo, Paolo

2014-01-01

To evaluate the relationships among myocardial sympathetic innervation, perfusion and mechanical synchronicity assessed with cardiac cadmium-zinc-telluride (CZT) scintigraphy. A group of 29 patients underwent an evaluation of myocardial perfusion with 99m Tc-tetrofosmin CZT scintigraphy and adrenergic innervation with 123 I-metaiodobenzylguanidine (MIBG) CZT scintigraphy. The summed rest score (SRS), motion score (SMS) and thickening score (STS), as well as the summed 123 I-MIBG defect score (SS-MIBG), were determined. Regional tracer uptake for both 99m Tc-tetrofosmin and 123 I-MIBG was also calculated. Finally, the presence of significant myocardial mechanical dyssynchrony was evaluated in phase analysis on gated CZT images and the region of latest mechanical activation identified. Significant mechanical dyssynchrony was present in 17 patients (59 %) and associated with higher SRS (P = 0.030), SMS (P 123 I-MIBG uptake (P = 0.012) that overwhelmed the effect of depressed regional perfusion. Left ventricular mechanical dyssynchrony is associated with greater depression in contractile function and greater impairments in regional myocardial perfusion and sympathetic activity. In patients with dyssynchrony, the region of latest mechanical activation is characterized by a significantly altered adrenergic tone. (orig.)

Functional imaging in phaeochromocytoma and neuroblastoma with {sup 68}Ga-DOTA-Tyr{sup 3}-octreotide positron emission tomography and {sup 123}I-metaiodobenzylguanidine

Energy Technology Data Exchange (ETDEWEB)

Kroiss, Alexander; Putzer, Daniel; Uprimny, Christian; Decristoforo, Clemens; Gabriel, Michael; Warwitz, Boris; Waitz, Dietmar; Kendler, Dorota; Virgolini, Irene Johanna [Innsbruck Medical University, Department of Nuclear Medicine, Innsbruck (Austria); Santner, Wolfram; Kranewitter, Christof [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria)

2011-05-15

{sup 68}Ga-DOTA-Tyr{sup 3}-octreotide positron emission tomography ({sup 68}Ga-DOTA-TOC PET) has proven to be superior to {sup 111}In-DTPA-D-Phe{sup 1}-octreotide ({sup 111}In-octreotide) planar scintigraphy and SPECT imaging in neuroendocrine tumours (NETs). Because of these promising results, we compared the accuracy of {sup 123}I-metaiodobenzylguanidine ({sup 123}I-MIBG) imaging with PET in the diagnosis and staging of metastatic phaeochromocytoma and neuroblastoma, referring to radiological imaging as reference standard. Three male and eight female patients (age range 3 to 68 years) with biochemically and histologically proven disease were included in this study. Three male and three female patients were suffering from phaeochromocytoma, and five female patients from neuroblastoma. Comparative evaluation included morphological imaging with CT or MRI, functional imaging with {sup 68}Ga-DOTA-TOC PET and {sup 123}I-MIBG imaging. Imaging results were analysed on a per-patient and on a per-lesion basis. On a per-patient basis, both {sup 68}Ga-DOTA-TOC and {sup 123}I-MIBG showed a sensitivity of 100%, when compared with anatomical imaging. In phaeochromocytoma patients, on a per-lesion basis, the sensitivity of {sup 68}Ga-DOTA-TOC was 91.7% and that of {sup 123}I-MIBG was 63.3%. In neuroblastoma patients, on a per-lesion basis, the sensitivity of {sup 68}Ga-DOTA-TOC was 97.2% and that of {sup 123}I-MIBG was 90.7%. Overall, in this patient cohort, {sup 68}Ga-DOTA-TOC PET identified 257 lesions, anatomical imaging identified 216 lesions, and {sup 123}I-MIBG identified only 184 lesions. In this patient group, the overall sensitivity of {sup 68}Ga-DOTA-TOC PET on a lesion basis was 94.4% (McNemar p<0.0001) and that of {sup 123}I-MIBG was 76.9% (McNemar p<0.0001). Our analysis in this relatively small patient cohort indicates that {sup 68}Ga-DOTA-TOC PET may be superior to {sup 123}I-MIBG gamma-scintigraphy and even to the reference CT/MRI technique in providing

Imaging the primate adrenal medulla with [123I] and [131I] metaiodobenzylguanidine: concise communication

International Nuclear Information System (INIS)

Wieland, D.M.; Brown, L.E.; Tobes, M.C.; Rogers, W.L.; Marsh, D.D.; Mangner, T.J.; Swanson, D.P.; Beierwaltes, W.H.

1981-01-01

An evaluation of radioiodinated meta-iodobenzylguanidine (m-IBG) as an adrenomedullary imaging agent is reported in 15 rhesus monkeys. Scintiscans of the monkey adrenal medulla have been obtained with [ 123 I]- and [m- 131 ]IBG at 2 to 6 days after injection. The imaging superiority of m-IBG over its positional isomer, para-iodobenzylguanidine (p-IBG), is documented in both dogs and monkeys. Administration of reserpine, a depletor of catecholamine stores, markedly lowers the [m- 131 I]-IBG content of the dog adrenal medulla, but the adrenergic blocking agents phenoxybenzamine and propanolol have no effect. Subcellular fractionation of the dog's adrenal medullae reveals that m-IBG is sequestered mainly in the chromaffin storage granules. The results of this study suggest that radioiodinated m-IBG, previously reported to image the primate myocardium, also merits evaluation as a clinical radiopharmaceutical for the adrenal medulla

Iodobell in vivo kits for labelling with 123I or 131I

International Nuclear Information System (INIS)

Koernyei, J.; Horvath, M.; Pszota, A.; Lakatos, M.; Szirtes, L.

1988-01-01

Iodobell in vivo kits provide an easy and fast method for 'on the spot' radioiodination with 123 I (or 131 I). Until now three kits have been developed in the Institute of Isotopes Budapest, the heptadecanoic acid, the hippurate and the MIBG kits. From these, the heptadecanoic acid kit is being tested in humans in Hungary, the other two are under the registration procedure. The Iodobell in vivo kits may contribute to the application of 123 I radioisotope in Hungary. (orig.)

Characteristics of left ventricular hypertrophy estimated by MIBG and BMIPP cardiac scintigraphy in patients undergoing peritoneal dialysis

Energy Technology Data Exchange (ETDEWEB)

Ohashi, Hiroshige; Oda, Hiroshi; Ohno, Michiya; Watanabe, Sachirow; Kotoo, Yasunori; Matsuno, Yukihiko [Gifu Prefectural Hospital (Japan)

2002-12-01

Left ventricular hypertrophy (LVH) has been reported as a major factor in morbidity and mortality in chronic dialysis patients. However, cardiovascular mortality in peritoneal dialysis (PD) patients with LVH is substantially similar to that in hemodialysis (HD) patients. The present study sought to study whether sympathetic nerve activity and fatty acid metabolism of the myocardium estimated by {sup 123}I metaiodobenzylguanidine (MIBG) and {sup 123}I {beta}-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) myocardial scintigraphy are impaired or not in PD patients with LVH. The underlying disease of 45 PD patients enrolled in this study was chronic glomerulonephritis in all cases. Serum levels of natriuretic peptides (arterial natriuretic peptide (ANP), brain natriuretic peptide (BNP)) and free carnitine and MIBG, BMIPP myocardial scintigraphy and 2-dimensional echocardiography were measured in these 45 PD patients. The following results were obtained. The prevalence of increased left ventricular mass index (LVMI) was 84.4%. LVMI correlated with age, and serum levels of ANP and BNP, and inversely correlated with a heart-to-mediastinum ratio (H/M) estimated by MIBG and BMIPP myocardial scintigraphy. Percentages of the normal image of MIBG and BMIPP measured with a single photon emission computed tomography (SPECT) were 37.8% and 62.2%, respectively. The PD patients showing the diffuse defect of MIBG or BMIPP imaging had the decrease in left ventricular ejection fraction (LVEF). Especially, the serum level of free carnitine was reduced in the PD patients with diffuse defect of BMIPP SPECT. From these results, we concluded that PD patients with LVH showed impaired sympathetic nerve activity and fatty acid metabolism of the myocardium. Metabolic and functional disturbances of the myocardium may influence mortality in PD patients. (author)

Alternating myocardial sympathetic neural function of athlete's heart in professional cycle racers examined with iodine-123-MIBG myocardial scintigraphy

International Nuclear Information System (INIS)

Koyama, Keiko; Inoue, Tomio; Hasegawa, Akira; Oriuchi, Noboru; Okamoto, Eiichi; Tomaru, Yumi; Endo, Keigo

2001-01-01

Myocardial sympathetic neural function in professional athletes who had the long-term tremendous cardiac load has not been fully investigated by myocardial iodine-123-metaiodobenzylguanidine (MIBG) uptake in comparison with power spectral analysis (PSA) in electrocardiography. Eleven male professional cycle racers and age-matched 11 male healthy volunteers were enrolled in this study. The low frequency components in the power spectral density (LF), the high frequency components in the power spectral density (HF), the LF/HF ratio and mean R-R interval were derived from PSA and time-domain analysis of heart rate variability in electrocardiography. The mean heart-to-mediastinum uptake ratio (H/M ratio) of the MIBG uptake, in professional cycle racers was significantly lower than that in healthy volunteers (p<0.01) and HF power in professional cycle racers was significantly higher than that in healthy volunteers (p<0.05). In the group of professional cycle racers, the H/M ratio showed a significant correlation with the R-R interval, as indices of parasympathetic nerve activity (r=0.80, p<0.01), but not with the LF/HF ratio as an index of sympathetic nerve activity. These results may indicate that parasympathetic nerve activity has an effect on MIBG uptake in a cyclist's heart. (author)

Individualized risk assessment in neuroblastoma. Does the tumoral metabolic activity on 123I-MIBG SPECT predict the outcome?

International Nuclear Information System (INIS)

Rogasch, Julian M.M.; Furth, Christian; Wedel, Florian; Brenner, Winfried; Amthauer, Holger; Schatka, Imke; Hundsdoerfer, Patrick; Hofheinz, Frank; Krueger, Paul-Christian; Lode, Holger; Eggert, Angelika

2017-01-01

Risk-adapted treatment in children with neuroblastoma (NB) is based on clinical and genetic factors. This study evaluated the metabolic tumour volume (MTV) and its asphericity (ASP) in pretherapeutic 123 I-MIBG SPECT for individualized image-based prediction of outcome. This retrospective study included 23 children (11 girls, 12 boys; median age 1.8 years, range 0.3-6.8 years) with newly diagnosed NB consecutively examined with pretherapeutic 123 I-MIBG SPECT. Primary tumour MTV and ASP were defined using semiautomatic thresholds. Cox regression analysis, receiver operating characteristic analysis (cut-off determination) and Kaplan-Meier analysis with the log-rank test for event-free survival (EFS) were performed for ASP, MTV, laboratory parameters (including urinary homovanillic acid-to-creatinine ratio, HVA/C), and clinical (age, stage) and genetic factors. Predictive accuracy of the optimal multifactorial model was determined in terms of Harrell's C and likelihood ratio χ 2 . Median follow-up was 36 months (range 7-107 months; eight patients showed disease progression/relapse, four patients died). The only significant predictors of EFS in the univariate Cox regression analysis were ASP (p = 0.029; hazard ratio, HR, 1.032 for a one unit increase), MTV (p = 0.038; HR 1.012) and MYCN amplification status (p = 0.047; HR 4.67). The mean EFS in patients with high ASP (>32.0%) and low ASP were 21 and 88 months, respectively (p = 0.013), and in those with high MTV (>46.7 ml) and low MTV were 22 and 87 months, respectively (p = 0.023). A combined risk model of either high ASP and high HVA/C or high MTV and high HVA/C best predicted EFS. In this exploratory study, pretherapeutic image-derived and laboratory markers of tumoral metabolic activity in NB (ASP, MTV, urinary HVA/C) allowed the identification of children with a high and low risk of progression/relapse under current therapy. (orig.)

Increased cardiac sympathetic activity in patients with hypothyroidism as determined by iodine-123 metaiodobenzylguanidine scintigraphy

International Nuclear Information System (INIS)

Momose, Mitsuru; Inaba, Shigeki; Emori, Toshiaki; Imamura, Kimiharu; Kawano, Katsunori; Ueda, Tetsuro; Kobayashi, Hideki; Hosoda, Saichi

1997-01-01

Clinical manifestations of hypothyroidism, such as bradycardia, suggest decreased sympathetic tone. However, previous studies in patients with hypothyroidism have suggested that increased plasma noradrenaline (NA) levels represent enhanced general sympathetic activity. As yet, cardiac sympathetic activity (CSA) in hypothyroidism has not been clarified. To evaluate CSA in patients with hypothyroidism, iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy was performed in eight patients with hypothyroidism before therapy and in ten normal control patients. Planar images were obtained at 15 min and 4 h after injection of MIBG. The ratio of early myocardial uptake to the total injected dose (MU) and myocardial clearance of MIBG within 4 h p.i. (MC) were calculated. Plasma NA was also measured, and echocardiography was performed in all patients. Those patients with hypothyroidism in the euthyroid state after medical therapy were also evaluated in a similar manner. Left ventricular ejection fraction, measured by echocardiography, did not differ significantly between the groups. NA, MU and MC were significantly higher in patients with hypothyroidism than in controls, and all parameters were decreased after therapy. MC was well correlated with NA in hypothyroidism (r=0.86) before therapy. We conclude that CSA is increased in patients with hypothyroidism, in parallel with the enhanced general sympathetic activity. (orig.). With 4 figs., 2 tabs

Uterine uptake of iodine-123 metaiodobenzylguanidine during the menstrual phase of uterine cycle

International Nuclear Information System (INIS)

Bomanji, J.; Britton, K.E.

1987-01-01

Radioiodinated I-123 metaiodobenzylguanidine (MIBG) has been used for diagnostic purposes for detection of apudomas. In this paper normal physiological uptake of I-123 MIBG by the uterus during the menstrual phase of the uterine cycle is reported. It is likely that I-123 MIBG can be used to evaluate some of the problems in this context

Uterine uptake of iodine-123 metaiodobenzylguanidine during the menstrual phase of uterine cycle

Energy Technology Data Exchange (ETDEWEB)

Bomanji, J.; Britton, K.E.

1987-08-01

Radioiodinated I-123 metaiodobenzylguanidine (MIBG) has been used for diagnostic purposes for detection of apudomas. In this paper normal physiological uptake of I-123 MIBG by the uterus during the menstrual phase of the uterine cycle is reported. It is likely that I-123 MIBG can be used to evaluate some of the problems in this context.

Local delivery of 131I-MIBG to treat peritoneal neuroblastoma

International Nuclear Information System (INIS)

Kinuya, Seigo; Li, Xiao-Feng; Yokoyama, Kunihiko; Michigishi, Takatoshi; Tonami, Norihisa; Mori, Hirofumi; Shiba, Kazuhiro; Watanabe, Naoto; Shuke, Noriyuki; Bunko, Hisashi

2003-01-01

Internal radiotherapy involving systemic administration of iodine-131 metaiodobenzylguanidine ( 131 I-MIBG) in neural crest tumours such as neuroblastoma has shown considerable success. Although peritoneal seeding of neuroblastoma occurs less often than metastases to organs such as the liver, no effective treatments exist in this clinical setting. Previous reports have demonstrated the effectiveness of peritoneal application of chemotherapeutic drugs or radiolabelled monoclonal antibodies in several kinds of carcinomas. Local delivery of 131 I-MIBG should produce more favourable dosimetry in comparison with its systemic administration in the treatment of peritoneal neuroblastoma. In the current investigation, a peritoneal model of neuroblastoma was established in Balb/c nu/nu mice by i.p. injection of SK-N-SH neuroblastoma cells. Two weeks after cell inoculation, comparative biodistribution studies were performed following i.v. or i.p. administration of 131 I-MIBG. Mice were treated with 55.5 MBq of 131 I-MIBG administered either i.v. or i.p. at 2 weeks. Intraperitoneal injection of 131 I-MIBG produced significantly higher tumour accumulation than did i.v. injection (P 131 I-MIBG failed to improve the survival of mice; mean survival of untreated mice and mice treated with i.v. administration of 131 I-MIBG was 59.3±3.9 days and 60.6±2.8 days, respectively. On the other hand, radiotherapy delivered via i.p. administration of 131 I-MIBG prolonged survival of mice to 94.7±17.5 days (P 131 I-MIBG therapy). Radiation doses absorbed by tumours at 55.5 MBq of 131 I-MIBG were estimated to be 4,140 cGy with i.p. injection and 450 cGy with i.v. injection. These results indicate the benefits of locoregional delivery of 131 I-MIBG in the treatment of peritoneal neuroblastoma. (orig.)

Relationship between late ventricular potentials and myocardial {sup 123}I-metaiodobenzylguanidine scintigraphy in patients with dilated cardiomyopathy with mild to moderate heart failure: results of a prospective study of sudden death events

Energy Technology Data Exchange (ETDEWEB)

Kasama, Shu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma (Japan); Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Toyama, Takuji; Kaneko, Yoshiaki; Kurabayashi, Masahiko [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma (Japan); Iwasaki, Toshiya; Sumino, Hiroyuki; Kumakura, Hisao; Minami, Kazutomo; Ichikawa, Shuichi [Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Matsumoto, Naoya [Nihon University School of Medicine, Department of Cardiology, Tokyo (Japan); Sato, Yuichi [Health Park Clinic, Department of Imaging, Gunma (Japan)

2012-06-15

Late ventricular potentials (LPs) are considered to be useful for identifying patients with heart failure at risk of developing ventricular arrhythmias. {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy, which is used to evaluate cardiac sympathetic activity, has demonstrated cardiac sympathetic denervation in patients with malignant ventricular tachyarrhythmias. This study was undertaken to clarify the relationship between LPs and {sup 123}I-MIBG scintigraphy findings in patients with dilated cardiomyopathy (DCM). A total of 56 patients with DCM were divided into an LP-positive group (n = 24) and an LP-negative group (n = 32). During the compensated period, the delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from {sup 123}I-MIBG images and plasma brain natriuretic peptide (BNP) concentrations were measured. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) were simultaneously determined by echocardiography. LVEDV, LVESV, LVEF and plasma BNP concentrations were similar in the two groups. However, TDS was significantly higher (35 {+-} 8 vs. 28 {+-} 6, p < 0.005), the H/M ratio was significantly lower (1.57 {+-} 0.23 vs. 1.78 {+-} 0.20, p < 0.005), and the WR was significantly higher (60 {+-} 14% vs. 46 {+-} 12%, p < 0.001) in the LP-positive than in the LP-negative group. The average follow-up time was 4.5 years, and there were nine sudden deaths among the 56 patients (16.1%). In logistic regression analysis, the incidences of sudden death events were similar in those LP-negative with WR <50%, LP-negative with WR {>=}50% and LP-positive with WR <50% (0%, 10.0% and 14.3%, respectively), but was significantly higher (41.2%) in those LP-positive with WR {>=}50% (p < 0.01, p < 0.05, and p < 0.05, respectively). The present study demonstrated that the values of cardiac {sup 123}I-MIBG scintigraphic parameters

Clinical evaluation of 123I-metaiodobenzylguanidine myocardial scintigram in patients with vascular heart disease

International Nuclear Information System (INIS)

Terada, Kouji; Sugihara, Hiroki; Shiga, Koji

1995-01-01

Myocardial sympathetic nerve function can be evaluated by 123 I-metaiodobenzylguanidine (MIBG) scintigraphy. Congestive heart failure is closely related to myocardial sympathetic nerve function. This study evaluated the severity of congestive heart failure in 30 patients with valvular heart disease [aortic regurgitation (AR): n=20, mean age=70±13 years; mitral regurgitation (MR): n=10, mean age=61±18 years], who had chronic heart failure by MIBG myocardial scintigraphy. Single photon emission computed tomography (SPECT) and anterior planar myocardial images were obtained 15 minutes (initial images) and 4 hours (delayed images) after injection of MIBG (111 MBq). Defect score was determined by the delayed SPECT images visually as a semi-quantitative index. Myocardial MIBG uptake was quantified by the heart to upper mediastinum uptake ratio on the delayed anterior planar images (H/M) and mean cardiac MIBG washout rate during 4 hours was calculated from the bull's eye display data (clearance). These indices were compared with the NYHA class and echocardiographic findings of the patients. MIBG regional defect in the delayed image was most frequently seen in the inferoposterior wall, and defect score and clearance were significantly higher and the H/M ratio was significantly lower in NYHA class III patients than in class II patients. In patients with AR, clearance significantly correlated with left ventricular end-systolic dimension. In patients with MR, both the H/M ratio and clearance significantly correlated with left atrial dimension. Defect score, H/M, and clearance were closely related to the severity of AR and MR. These results indicate that MIBG scan can be used to assess the severity of valvular heart disease. (author)

Decreased myocardial 123I-MIBF uptake in Parkinson's disease

International Nuclear Information System (INIS)

Iwasa, K.; Takamori, M.; Nakajima, K.; Taki, J.; Yoshikawa, H.; Tada, A.

1998-01-01

We studied myocardial 123 I-metaiodobenzylguanidine (MIBG) accumulation in 12 patients with Parkinson's disease (PD). MIBG is an analog of norepinephrine (NE) and a tracer for sympathetic neuron integrity and function. MIBG uptake of the myocardium was significantly lower in PD than in controls. The heart to mediastinum ratio (H/M) was calculated by using the average count per pixel for the heart and mediastinum. In PD, H/M was lower than in controls (P<0.0001), while the washout ratio of the heart was higher (P<0.001). A decrease in myocardial accumulation of MIBG was observed in the early stage of PD. This suggests that the measurement of MIBF may help the diagnosis of early PD, and the causative factor underlying in PD may be operating the NE neuron as well as dopamine neuron. (au)

131I Metaiodobenzylguanidine (131I MIBG) kinetics in a carcinoid tumor

International Nuclear Information System (INIS)

Schiavo, R.; Concolino, G.; Fazi, F.; Iannantuono, P.; Voti, S. Li; Manzara, A.; Pavoni, P.

1987-01-01

The 131 I-MIBG kinetics was studied in vivo in patients with carcinoid tumors and liver metastases. Activity curve analysis showed that the maximum uptake of 131 I-MIBG in a carcinoid tumor occurred after 48 hours, while its biological half time was of 8 days and a half. Although more data are necessary to understand a significant variation in 131 I-MIBG kinetics between the different kinds of APUD neoplasms, it is thought that a dynamic-funtional study allowing the evaluation of the different biological half-time, could be helpful for the selection of these neoplasms, which could be treated with 131 I-MIBG. Radiation doses required for the treatment are also estimated. (M.E.L.) [es

Reduced 125I-meta-iodobenzylguanidine uptake and norepinephrine transporter density in the hearts of mice with MPTP-induced parkinsonism

International Nuclear Information System (INIS)

Fukumitsu, Nobuyoshi; Suzuki, Masahiko; Fukuda, Takahiro; Kiyono, Yasushi; Kajiyama, Satomi; Saji, Hideo

2006-01-01

Uptake of 123 I-meta-iodobenzylguanidine ( 123 I-MIBG) is markedly reduced in the hearts of patients with Parkinson's disease. Although the mechanism of this reduction is unclear, 12 5 I-MIBG uptake is similarly reduced in the hearts of mice with 1-methyl-4-phenyl-1,2,3,6-tetrahydroxypyridine (MPTP)-induced parkinsonism. Three groups of ten 15-week-old C57BL6 mice received intraperitoneal injections of (1) saline (control) (2) 10 mg/kg MPTP or (3) 40 mg/kg MPTP. After 0.185 MBq of 125 I-MIBG was injected, the percent injected dose of 125 I-MIBG per gram of tissue (%ID/g) was determined and cardiac concentrations of norepinephrine were measured. Cardiac concentrations of norepinephrine transporter (NET) were measured in three groups of twenty 15-week-old C57BL6 mice receiving these same treatments. The %ID/g in mice receiving 10 or 40 mg/kg MPTP (5.7±1.1 and 4.4±1.2%/g) was significantly lower than that in control mice (11.3±2.2%/g; P 5 and 7.50±0.89x10 5 pg/wet g) was significantly lower than that in control mice (9.21±0.97x10 5 pg/wet g; P 125 I-MIBG and NET density decreased as the dose of MPTP increased. This study clearly shows that reduced cardiac 12 5 I-MIBG uptake in mice with MPTP-induced parkinsonism is closely related to the reduced NET density in postganglionic cardiac sympathetic nerve terminals

Individualized risk assessment in neuroblastoma. Does the tumoral metabolic activity on {sup 123}I-MIBG SPECT predict the outcome?

Energy Technology Data Exchange (ETDEWEB)

Rogasch, Julian M.M.; Furth, Christian; Wedel, Florian; Brenner, Winfried; Amthauer, Holger; Schatka, Imke [Charite - Universitaetsmedizin Berlin, Department of Nuclear Medicine, Berlin (Germany); Hundsdoerfer, Patrick [Charite - Universitaetsmedizin Berlin, Department of Pediatric Oncology/Hematology, Berlin (Germany); Berlin Institute of Health (BIH), Berlin (Germany); Hofheinz, Frank [Helmholtz Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, PET Center, Dresden (Germany); Krueger, Paul-Christian [University Medicine Greifswald, Institute for Diagnostic Radiology and Neuroradiology, Greifswald (Germany); Lode, Holger [University Medicine Greifswald, Department of Pediatric Oncology and Hematology, Greifswald (Germany); Eggert, Angelika [Charite - Universitaetsmedizin Berlin, Department of Pediatric Oncology/Hematology, Berlin (Germany)

2017-12-15

Risk-adapted treatment in children with neuroblastoma (NB) is based on clinical and genetic factors. This study evaluated the metabolic tumour volume (MTV) and its asphericity (ASP) in pretherapeutic {sup 123}I-MIBG SPECT for individualized image-based prediction of outcome. This retrospective study included 23 children (11 girls, 12 boys; median age 1.8 years, range 0.3-6.8 years) with newly diagnosed NB consecutively examined with pretherapeutic {sup 123}I-MIBG SPECT. Primary tumour MTV and ASP were defined using semiautomatic thresholds. Cox regression analysis, receiver operating characteristic analysis (cut-off determination) and Kaplan-Meier analysis with the log-rank test for event-free survival (EFS) were performed for ASP, MTV, laboratory parameters (including urinary homovanillic acid-to-creatinine ratio, HVA/C), and clinical (age, stage) and genetic factors. Predictive accuracy of the optimal multifactorial model was determined in terms of Harrell's C and likelihood ratio χ {sup 2}. Median follow-up was 36 months (range 7-107 months; eight patients showed disease progression/relapse, four patients died). The only significant predictors of EFS in the univariate Cox regression analysis were ASP (p = 0.029; hazard ratio, HR, 1.032 for a one unit increase), MTV (p = 0.038; HR 1.012) and MYCN amplification status (p = 0.047; HR 4.67). The mean EFS in patients with high ASP (>32.0%) and low ASP were 21 and 88 months, respectively (p = 0.013), and in those with high MTV (>46.7 ml) and low MTV were 22 and 87 months, respectively (p = 0.023). A combined risk model of either high ASP and high HVA/C or high MTV and high HVA/C best predicted EFS. In this exploratory study, pretherapeutic image-derived and laboratory markers of tumoral metabolic activity in NB (ASP, MTV, urinary HVA/C) allowed the identification of children with a high and low risk of progression/relapse under current therapy. (orig.)

Clinical evaluation of {sup 123}I-metaiodobenzylguanidine myocardial scintigram in patients with vascular heart disease

Energy Technology Data Exchange (ETDEWEB)

Terada, Kouji; Sugihara, Hiroki; Shiga, Koji [Kyoto Prefectural Univ. of Medicine (Japan)] [and others

1995-05-01

Myocardial sympathetic nerve function can be evaluated by {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy. Congestive heart failure is closely related to myocardial sympathetic nerve function. This study evaluated the severity of congestive heart failure in 30 patients with valvular heart disease [aortic regurgitation (AR): n=20, mean age=70{+-}13 years; mitral regurgitation (MR): n=10, mean age=61{+-}18 years], who had chronic heart failure by MIBG myocardial scintigraphy. Single photon emission computed tomography (SPECT) and anterior planar myocardial images were obtained 15 minutes (initial images) and 4 hours (delayed images) after injection of MIBG (111 MBq). Defect score was determined by the delayed SPECT images visually as a semi-quantitative index. Myocardial MIBG uptake was quantified by the heart to upper mediastinum uptake ratio on the delayed anterior planar images (H/M) and mean cardiac MIBG washout rate during 4 hours was calculated from the bull`s eye display data (clearance). These indices were compared with the NYHA class and echocardiographic findings of the patients. MIBG regional defect in the delayed image was most frequently seen in the inferoposterior wall, and defect score and clearance were significantly higher and the H/M ratio was significantly lower in NYHA class III patients than in class II patients. In patients with AR, clearance significantly correlated with left ventricular end-systolic dimension. In patients with MR, both the H/M ratio and clearance significantly correlated with left atrial dimension. Defect score, H/M, and clearance were closely related to the severity of AR and MR. These results indicate that MIBG scan can be used to assess the severity of valvular heart disease. (author).

Area at risk can be assessed by iodine-123-meta-iodobenzylguanidine single-photon emission computed tomography after myocardial infarction: a prospective study.

Science.gov (United States)

Hedon, Christophe; Huet, Fabien; Ben Bouallegue, Fayçal; Vernhet, Hélène; Macia, Jean-Christophe; Cung, Thien-Tri; Leclercq, Florence; Cade, Stéphane; Cransac, Frédéric; Lattuca, Benoit; Vandenberghe, D'Arcy; Bourdon, Aurélie; Benkiran, Meriem; Vauchot, Fabien; Gervasoni, Richard; D'estanque, Emmanuel; Mariano-Goulart, Denis; Roubille, François

2018-02-01

Myocardial salvage is an important surrogate endpoint to estimate the impact of treatments in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the correlation between cardiac sympathetic denervation area assessed by single-photon emission computed tomography (SPECT) using iodine-123-meta-iodobenzylguanidine (I-MIBG) and myocardial area at risk (AAR) assessed by cardiac magnetic resonance (CMR) (gold standard). A total of 35 postprimary reperfusion STEMI patients were enrolled prospectively to undergo SPECT using I-MIBG (evaluates cardiac sympathetic denervation) and thallium-201 (evaluates myocardial necrosis), and to undergo CMR imaging using T2-weighted spin-echo turbo inversion recovery for AAR and postgadolinium T1-weighted phase sensitive inversion recovery for scar assessment. I-MIBG imaging showed a wider denervated area (51.1±16.0% of left ventricular area) in comparison with the necrosis area on thallium-201 imaging (16.1±14.4% of left ventricular area, Parea (P=0.23) and was adequately correlated (R=0.56, P=0.0002). Myocardial salvage evaluated by SPECT imaging (mismatch denervated but viable myocardium) was significantly higher than by CMR (P=0.02). In patients with STEMI, I-MIBG SPECT, assessing cardiac sympathetic denervation may precisely evaluate the AAR, providing an alternative to CMR for AAR assessment.

Collimator Selection in Nuclear Medicine Imaging Using I-123 Generated by Te-124 Reaction

International Nuclear Information System (INIS)

Kim, Hee Joung; Son, Hye Kyung; Nam, Ki Pyo; Lee, Hee Kyung; Bong, Joung Kyun

1996-01-01

In the case of I-123 from the Te-124(p,2n)reaction, the radionuclidic impurity is the high-energy gamma-emitting I-124, which interferes greatly with nuclear medicine images. The choice of a collimator can affect the quality of clinical SPECT images of [I-123]MIBG, [I-123]μ-CIT, or [I-123]IPT. The tradeoffs that two different collimators make among spatial resolution, sensitivity, and scatter were studied by imaging a line source at 5 cm, 10 cm, 15 cm distance using a number of plexiglass sheets between source and collimator, petridish, two-dimensional Hoffman brain phantom, Jaszczak phantom, and three-dimensional Hoffman brain phantom after filling with I-123. (FWHM, FWTM, Sensitivity) for low-energy ultrahigh-resolution parallel-hole(LEUHRP) collimator and medium-energy general-purpose(MEGP) collimator were measured as (9.27 mm, 61.27 mm, 129 CPM/μCi) and (10.53 mm, 23.17 mm, 105CPM/μ/Ci), respectively. The image quality of two-dimensional Hoffman brain phantom with LEUHRP looked better than the one with MEGP. However, the image quality of Jaszczak phantom and three-dimensional Hoffman brain phantom with LEUHRP looked much worse than the one with MEGP because of scatter contributions in three-dimensional imaging situation. The results suggest that the MEGP is preferable to LEUHRP for three-dimensional imaging studies of [I-123]MIBG, [I-123] β-CIT, or [I-123] IPT.

Evaluation for Preparation of I-131-MIBG for Diagnosis and Therapy Neuroblastoma

International Nuclear Information System (INIS)

Laksmi Andri A; Purwoko; Sri Setyowati; Maskur; Cahya Nova Ardianto; Adang Hardi G

2012-01-01

Evaluation for preparation of 131 I-MIBG have been carried out. Production/preparation of 131 I-MIBG was carried out by labeling MIBG with I-131, the radiochemical purity of 131 I-MIBG was analysed using TLC/paper chromatography. The stability in the human body by using fresh human plasma, at room temperature and at 8°C was carried out. The chemical purity of synthesized MIBG was found to be > 95%, the labeled MIBG with I-131 was analysed using TLC/paper chromatography. The radiochemical purity of 131 I-MIBG was obtained at higher than 95 %. The stability of labeled MIBG in fresh human plasma and at 8°C was stable up to 141 hours, while at room temperature was stable up to 120 hours. The results of labeling of 131 I-MIBG from 2010-2012 showed that these products were colorless clear solution with pH between 5.5.0-7.0, sterile and pyrogen-free, radiochemical purity > 95%. The quality control results were found to be met with the requirements of 131 I-MIBG injection solution used for diagnosis and therapy of neuroblastoma in Hospital. (author)

The significance of 123I-BMIPP delayed scintigraphic imaging in cardiac patients.

Science.gov (United States)

Akashi, Yoshihiro J; Kida, Keisuke; Suzuki, Kae; Inoue, Koji; Kawasaki, Kensuke; Yamauchi, Masahiro; Musha, Haruki; Anker, Stefan D

2007-04-25

Earlier studies have not fully investigated the significance of radionuclide planar imaging in cardiac patients using the fatty acid analogue 123I-beta-methyl-iodophenylpentadecanoic acid (123I-BMIPP). This study was to clarify the effectiveness of 123I-BMIPP in assessing the heart-to-mediastinum ratio (H/M) and myocardial washout rate (WR) in patients with heart disease. Myocardial 123I-BMIPP imaging was performed in 33 patients (20 with chronic heart failure [CHF] and 13 with stable angina pectoris [AP]) and 11 control subjects. Myocardial 123I-BMIPP planner images were obtained 30 min (early image) and 4 h (delayed image) after tracer injection. The left ventricular ejection fraction (LVEF) was measured by quantitative gated single photon emission computed tomography. The concentration of plasma brain natriuretic peptide (BNP) was measured before the scintigraphic study. (1) Delayed H/M was much lower in CHF than in AP (1.93 +/- 0.37 vs. 2.21 +/- 0.38, p acid metabolism disorders in patients with heart disease in both masked and unmasked conditions.

Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure

International Nuclear Information System (INIS)

Koutelou, M.; Katsikis, A.; Livanis, E.; Georgiadis, M.; Voudris, V.; Flevari, P.; Kremastinos, D.; Theodorakis, G.

2009-01-01

We aimed at evaluating the combined use of heart rate variability (HRV), baroreflex sensitivity (BRS), and metaiodobenzylguanidine (MIBG) imaging in the risk stratification for sudden cardiac death (SCD) of patients with mild to moderate heart failure. Twenty-five patients (17 male and 8 female, mean age 63±5 years, mean left ventricular ejection fraction (LVEF) 36±3%) with a recently implanted cardioverter-defibrillator (ICD) and mild (NYHA I-II) heart failure due to either ischemic (n=15) or dilated (n=10) cardiomyopathy were studied. One week after ICD implantation they underwent baroreflex sensitivity (BRS) evaluation to bolus phenylephrine by the Oxford method, 24-h heart rate variability (HRV) assessment, and MIBG imaging. The mean patient follow-up was 32±10 months. Simple correlation and stepwise multiple regression analysis was performed to evaluate if the number of sustained ventricular tachycardia (cycle length <330 ms) or fibrillation episodes per month is related to one or more of MIBG, BRS, and HRV indexes and if MIBG % washout is related to HRV and/or BRS. The frequency of fast ventricular arrhythmic episodes (FVAE) demonstrated an inverse relation to BRS (p<0.0001), rMSSD (p=0.001), and pNN50 (p=0.0034), while it was positively related to low frequency (LF) (p<0.0001) and MIBG % washout (p=0.001). BRS, LF, rMSSD, and MIBG washout were also independent predictors of FVAE. MIBG washout was related to only one HRV marker (SDNN-I, p<0.0001), while no correlation was observed with BRS. In ICD recipients with well-compensated heart failure, autonomic markers derived from BRS, HRV, and MIBG studies are related to FVAE. These markers have limited inter-dependency and constitute useful means for SCD risk stratification in this subgroup of patients. (author)

Evaluation of sympathetic activity by 123I-metaiodobenzylguanidine myocardial scintigraphy in dilated cardiomyopathy patients with sleep breathing disorder

International Nuclear Information System (INIS)

Nanjo, Shuji; Fujimoto, Shinichiro; Yamashiro, Yoshihiro

2009-01-01

Because increased sympathetic nervous activity (SNA) in patients with dilated cardiomyopathy (DCM) associated with sleep breathing disorder (SBD) is known to deteriorate the prognosis of cardiac failure, 123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was used as the investigative tool in the present study. The study group comprised 53 patients (47 men, 6 women; mean age 56±3 years) with chronic stable DCM. Patients were divided into SBD(+) or SBD(-) group according to 24-h pulse oximetry results. SBD(+) was defined when the 3% oxygen desaturation index was more than 15/h during sleep. In total, 32 patients were SBD(-) and 21 were SBD(+). In both groups, pulse oximetry were performed during sleep and awakening pulse rate, and measurement of the blood levels of catecholamines and B-type natriuretic peptide was performed. MIBG myocardial scintigraphy and echocardiography were performed at the same time. No significant difference was found between the 2 groups in catecholamine levels or left ventricular ejection fraction. However, MIBG had a significantly increased washout rate and a significantly decreased delayed heart to mediastinum ratio in the SBD(+) group compared with the SBD(-) group. SNA is increased in DCM patients when associated with SBD. MIBG myocardial scintigraphy may be a sensitive method of detecting increased SNA. (author)

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

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Messias, Leandro Rocha, E-mail: lmessias@cardiol.br; Ferreira, Aryanne Guimarães; Miranda, Sandra Marina Ribeiro de; Teixeira, José Antônio Caldas [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Azevedo, Jader Cunha de [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Hospital Procardíaco, Rio de Janeiro, RJ (Brazil); Messias, Ana Carolina Nader Vasconcelos [Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Maróstica, Elisabeth [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Mesquita, Claudio Tinoco [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Hospital Procardíaco, Rio de Janeiro, RJ (Brazil)

2016-05-15

More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO{sub 2}). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO{sub 2} and 123I-MIBG scintigraphic parameters. Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

International Nuclear Information System (INIS)

Messias, Leandro Rocha; Ferreira, Aryanne Guimarães; Miranda, Sandra Marina Ribeiro de; Teixeira, José Antônio Caldas; Azevedo, Jader Cunha de; Messias, Ana Carolina Nader Vasconcelos; Maróstica, Elisabeth; Mesquita, Claudio Tinoco

2016-01-01

More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO 2 ). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO 2 and 123I-MIBG scintigraphic parameters. Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity

Integrated imaging using MRI and 123I metaiodobenzylguanidine scintigraphy to improve sensitivity and specificity in the diagnosis of pediatric neuroblastoma.

Science.gov (United States)

Pfluger, Thomas; Schmied, Christoph; Porn, Ute; Leinsinger, Gerda; Vollmar, Christian; Dresel, Stefan; Schmid, Irene; Hahn, Klaus

2003-10-01

The objectives of this study were to compare MRI and iodine-123 ((123)I) metaiodobenzylguanidine (MIBG) scintigraphy in the detection of neuroblastoma lesions in pediatric patients and to assess the additional value of combined imaging. Fifty MRI and 50 (123)I MIBG examinations (mean interval, 6.4 days) were analyzed retrospectively with regard to suspected or proven neuroblastoma lesions (n = 193) in 28 patients. MRI and MIBG scans were reviewed by two independent observers each. Separate and combined analyses of MRI and MIBG scintigraphy were compared with clinical and histologic findings. With regard to the diagnosis of neuroblastoma lesion, MIBG scintigraphy, MRI, and combined analysis showed a sensitivity of 69%, 86%, and 99% and a specificity of 85%, 77%, and 95%, respectively. On MRI, 15 false-positive findings were recorded: posttherapeutic reactive changes (n = 10), benign adrenal tumors (n = 3), and enlarged lymph nodes (n = 2). On MIBG scintigraphy, 10 false-positive findings occurred: ganglioneuromas (n = 2), benign liver tumors (n = 2), and physiologic uptake (n = 6). Thirteen neuroblastoma metastases and two residual masses under treatment with chemotherapy were judged to be false-negative findings on MRI. Two primary or residual neuroblastomas and one orbital metastasis were misinterpreted as Wilms' tumor, reactive changes after surgery, and rhabdomyosarcoma on MRI. Thirty-two bone metastases, six other neuroblastoma metastases, and one adrenal neuroblastoma showed no MIBG uptake. On combined imaging, one false-negative (bone metastasis) and three false-positive (two ganglioneuromas and one pheochromocytoma) findings remained. In the assessment of neuroblastoma lesions in pediatric patients, MRI showed a higher sensitivity and MIBG scintigraphy a higher specificity. However, integrated imaging showed an increase in both sensitivity and specificity.

Over-the-counter drugs block heart accumulation of MIBG

International Nuclear Information System (INIS)

Sherman, P.S.; Fisher, S.J.; Wieland, D.M.; Sisson, J.C.

1985-01-01

Previous work in the authors' laboratory using chemically sympathectomized animals showed that > 50% of meta-iodobenzyl-guanidine (MIBG) in the heart is localized in adrenergic nerves. In the present study, commonly used drugs known to alter the uptake and/or release of norepinephrine by adrenergic neurons have been evaluated for their effect on the biodistribution of MIBG. Pseudoephedrine (Sudafed), phenylpropanolamine (Dexatrim) and phenylephrine (Neosynephrine) were administered (5 mg/kg, i.p.) to rats; amphetamine was also evaluated (0.8mg/kg, i.p.). Thirty minutes later I-125-MIBG (0.2-0.4 Ci/mm) was injected i.v.; animals (N=3) were sacrificed 2 h following radiotracer. Compared to controls (N = 3), drug pretreatments resulted in large decreases in radiotracer concentration in adrenergic-rich tissues such as left atrium, left ventricle, spleen and parotid glands. Pseudoephedrine caused decreases (%) of 78, 57, 48 and 35 in the four tissues, respectively. Each of the four drugs caused a greater decrease in I-125-MIBG concentration in the left atrium than in the left ventricle. Comparative studies using H-3-norepinephrine are in progress. Entex, a nasal decongestant containing both phenylephrine and phenylpropanolamine, markedly diminished the heart and salivary gland accumulation of I-123-MIBG in a normal male volunteer. These preliminary studies suggest that commonly used sympathomimetic agents, including some over-the-counter preparations, decrease the accumulation of MIBG in adrenergic neurons. These results also suggest that patients should be carefully screened for drug usage prior to MIBG scintigraphy of the heart

Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study

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Gimelli, Alessia; Genovesi, Dario; Giorgetti, Assuero; Kusch, Annette [Fondazione Toscana Gabriele Monasterio, Pisa (Italy); Liga, Riccardo [Scuola Superiore Sant' Anna, Pisa (Italy); Marzullo, Paolo [Fondazione Toscana Gabriele Monasterio, Pisa (Italy); CNR, Institute of Clinical Physiology, Pisa (Italy)

2014-05-15

To evaluate the relationships among myocardial sympathetic innervation, perfusion and mechanical synchronicity assessed with cardiac cadmium-zinc-telluride (CZT) scintigraphy. A group of 29 patients underwent an evaluation of myocardial perfusion with {sup 99m}Tc-tetrofosmin CZT scintigraphy and adrenergic innervation with {sup 123}I-metaiodobenzylguanidine (MIBG) CZT scintigraphy. The summed rest score (SRS), motion score (SMS) and thickening score (STS), as well as the summed {sup 123}I-MIBG defect score (SS-MIBG), were determined. Regional tracer uptake for both {sup 99m}Tc-tetrofosmin and {sup 123}I-MIBG was also calculated. Finally, the presence of significant myocardial mechanical dyssynchrony was evaluated in phase analysis on gated CZT images and the region of latest mechanical activation identified. Significant mechanical dyssynchrony was present in 17 patients (59 %) and associated with higher SRS (P = 0.030), SMS (P < 0.001), STS (P = 0.003) and early SS-MIBG (P = 0.037) as well as greater impairments in left ventricular ejection fraction (P < 0.001) and end-diastolic volume (P < 0.001). In multivariate analysis a higher end-diastolic volume remained the only predictor of mechanical dyssynchrony (P = 0.047). Interestingly, while in the whole population regional myocardial perfusion and adrenergic activity were strongly correlated (R = 0.68), in patients with mechanical dyssynchrony the region of latest mechanical activation was predicted only by greater impairment in regional {sup 123}I-MIBG uptake (P = 0.012) that overwhelmed the effect of depressed regional perfusion. Left ventricular mechanical dyssynchrony is associated with greater depression in contractile function and greater impairments in regional myocardial perfusion and sympathetic activity. In patients with dyssynchrony, the region of latest mechanical activation is characterized by a significantly altered adrenergic tone. (orig.)

Study of 123I-metaiodobenzylguanidine (MIBG) myocardial imaging in diabetics. Comparison between patients with type 1 diabetes mellitus and those with type 2 diabetes mellitus

International Nuclear Information System (INIS)

Kawanaka, Masahiro

2000-01-01

Myocardial accumulation of MIBG was studied in forty diabetic patients, including 17 with type 1 diabetes mellitus (type 1 DM, mean age 52.1±17 y.) and 23 with type 2 diabetes mellitus (type 2 DM, mean age 61.6±12 y.). Sixteen nondiabetic normal volunteers without hypertension (mean age 54.6±16 y.) were studied as controls. Type 2 DM patients showed a significantly lower heart-to-mediastinum ratio (15 min.: 2.34±0.35, 3 hr.: 2.27±0.41) than control subjects (15 min.: 2.73±0.25, 3 hr.: 2.95±0.40) (p<0.05), but Type 2 DM patients did not. Type 2 DM patients showed higher washout rate of MIBG (31.7±12%) than control subjects (19.3±7.4%) (p<0.05), but type 2 DM patients did not. Thirteen of the 17 type 1 DM patients (76.4%) and 12 of the 23 type 2 DM patients (52.2%) showed regional defects on MIBG SPECT. Myocardial MIBG defects in diabetics were mainly found in the inferior, septal and lateral regions of the myocardium. In type 1 DM, the patients with MIBG defects had longer duration of the disease, showed much more decrease of the systolic pressure with standing and lower CV level of the R-R interval on ECG than the patients without MIBG defects, but not in type 2 DM patients. These results show that type 1 DM patients show much more abnormal MIBG accumulation than type 2 DM patients. It suggests that the glycemic control including the early stage of diabetes influences the cardiac sympathetic function in diabetics. (author)

Prognostic value of repeated {sup 123}I-metaiodobenzylguanidine imaging in patients with dilated cardiomyopathy with congestive heart failure before and after optimized treatments. Comparison with neurohumoral factors

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Matsui, Toshiki; Tsutamoto, Takayoshi; Maeda, Keiko; Kusukawa, Junya; Kinoshita, Masahiko [Shiga Univ. of Medical Science, Otsu (Japan)

2002-06-01

The present study was undertaken to assess whether repeated measurement of cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) imaging parameters before and after optimized treatments is useful for predicting the prognosis of patients with congestive heart failure (CHF) resulting from dilated cardiomyopathy (DCM). The subjects were 85 consecutive patients with DCM who had a left ventricular ejection fraction (LVEF) of less than 45%. The MIBG and the concentrations of neurohumoral factors were measured at baseline and after 6 months of optimized treatments. Cox proportional hazards analysis was performed to assess the various parameters before and after treatment. Twenty-three patients had a cardiac event (12 died; 11 hospitalized) during a mean follow-up period of 2 years. Although there was no difference between the baseline heart to mediastinum (H/M) ratio measured by MIBG between survivors and nonsurvivors, the H/M ratio was significantly decreased in nonsurvivors after 6 months. Multivariate analysis revealed that a high plasma concentration of brain natriuretic peptide level after 6 months (p=0.0049) and absolute changes in the H/M ratio (p=0.0046) were independent predictors of mortality. Comparison of the H/M ratio on MIBG imaging before and after optimized additional treatment provided useful information for predicting mortality and was independent of clinical and neurohumoral factors previously shown to be associated with poor prognosis in patients with DCM. (author)

Impact of aging on cardiac sympathetic innervation measured by {sup 123}I-mIBG imaging in patients with systolic heart failure

Energy Technology Data Exchange (ETDEWEB)

Rengo, Giuseppe; Ferrara, Nicola [Scientific Institute of Telese Terme, Salvatore Maugeri Foundation, IRCCS, Telese Terme (Italy); University of Naples Federico II, Division of Geriatrics, Department of Translational Medical Sciences, Naples (Italy); Pagano, Gennaro; Formisano, Roberto; Komici, Klara; Petraglia, Laura; Parisi, Valentina; Femminella, Grazia Daniela; De Lucia, Claudio; Cannavo, Alessandro; Memmi, Alessia; Leosco, Dario [University of Naples Federico II, Division of Geriatrics, Department of Translational Medical Sciences, Naples (Italy); Vitale, Dino Franco [Scientific Institute of Telese Terme, Salvatore Maugeri Foundation, IRCCS, Telese Terme (Italy); Paolillo, Stefania [Institute of Diagnostic and Nuclear Development, SDN Foundation, Naples (Italy); Attena, Emilio [Fatebenefratelli Hospital, Department of Cardiology, Naples (Italy); Pellegrino, Teresa [Institute of Biostructures and Bioimages of the National Council of Research, Naples (Italy); Federico II University of Naples, Division of Imaging, Radiotherapy, Neuroradiology, and Medical Physics, Department of Advanced Biomedical Sciences, Naples (Italy); Dellegrottaglie, Santo [Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Division of Cardiology, Acerra, Naples (Italy); Trimarco, Bruno; Filardi, Pasquale Perrone [Federico II University of Naples, Division of Cardiology, Department of Advanced Biomedical Sciences, Naples (Italy); Cuocolo, Alberto [Institute of Diagnostic and Nuclear Development, SDN Foundation, Naples (Italy); Federico II University of Naples, Division of Imaging, Radiotherapy, Neuroradiology, and Medical Physics, Department of Advanced Biomedical Sciences, Naples (Italy)

2016-12-15

Sympathetic nervous system (SNS) hyperactivity is a salient characteristic of chronic heart failure (HF) and contributes to the progression of the disease. Iodine-123 meta-iodobenzylguanidine ({sup 123}I-mIBG) imaging has been successfully used to assess cardiac SNS activity in HF patients and to predict prognosis. Importantly, SNS hyperactivity characterizes also physiological ageing, and there is conflicting evidence on cardiac {sup 123}I-mIBG uptake in healthy elderly subjects compared to adults. However, little data are available on the impact of ageing on cardiac sympathetic nerve activity assessed by {sup 123}I-mIBG scintigraphy, in patients with HF. We studied 180 HF patients (age = 66.1 ± 10.5 years [yrs]), left ventricular ejection fraction (LVEF = 30.6 ± 6.3 %) undergoing cardiac {sup 123}I-mIBG imaging. Early and late heart to mediastinum (H/M) ratios and washout rate were calculated in all patients. Demographic, clinical, and echocardiographic data were also collected. Our study population consisted of 53 patients aged >75 years (age = 77.7 ± 4.0 year), 67 patients aged 62-72 years (age = 67.9 ± 3.2 years) and 60 patients aged ≤61 year (age = 53.9 ± 5.6 years). In elderly patients, both early and late H/M ratios were significantly lower compared to younger patients (p < 0.05). By multivariate analysis, H/M ratios (both early and late) and washout rate were significantly correlated with LVEF and age. Our data indicate that, in a population of HF patients, there is an independent age-related effect on cardiac SNS innervation assessed by {sup 123}I-mIBG imaging. This finding suggests that cardiac {sup 123}I-mIBG uptake in patients with HF might be affected by patient age. (orig.)

Diagnostic accuracy of apparent diffusion coefficient and 123I-metaiodobenzylguanidine for differentiation of multiple system atrophy and Parkinson's disease.

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Atsushi Umemura

Full Text Available BACKGROUND: It is often hard to differentiate Parkinson's disease (PD and parkinsonian variant of multiple system atrophy (MSA-P, especially in the early stages. Cardiac sympathetic denervation and putaminal rarefaction are specific findings for PD and MSA-P, respectively. PURPOSE: We investigated diagnostic accuracy of putaminal apparent diffusion coefficient (ADC test for MSA-P and (123I-metaiodobenzylguanidine (MIBG scintigram for PD, especially in early-stage patients. METHODS: The referral standard diagnosis of PD and MSA-P were the diagnostic criteria of the United Kingdom Parkinson's Disease Society Brain Bank Criteria and the second consensus criteria, respectively. Based on the referral standard criteria, diagnostic accuracy [area under the receiver-operator characteristic curve (AUC, sensitivity and specificity] of the ADC and MIBG tests was estimated retrospectively. Diagnostic accuracy of these tests performed within 3 years of symptom onset was also investigated. RESULTS: ADC and MIBG tests were performed on 138 patients (20 MSA and 118 PD. AUC was 0.95 and 0.83 for the ADC and MIBG tests, respectively. Sensitivity and specificity were 85.0% and 89.0% for MSA-P diagnosis by ADC test and 67.0% and 80.0% for PD diagnosis by MIBG test. When these tests were restricted to patients with disease duration ≤ 3 years, the sensitivity and specificity were 75.0% and 91.4% for the ADC test (MSA-P diagnosis and 47.7% and 92.3% for the MIBG test (PD diagnosis. CONCLUSIONS: Both tests were useful in differentiating between PD and MSA-P, even in the early stages. In early-stage patients, elevated putaminal ADC was a diagnostic marker for MSA-P. Despite high specificity of the MIBG test, careful neurological history and examinations were required for PD diagnosis because of possible false-negative results.

Diagnostic accuracy of apparent diffusion coefficient and 123I-metaiodobenzylguanidine for differentiation of multiple system atrophy and Parkinson's disease.

Science.gov (United States)

Umemura, Atsushi; Oeda, Tomoko; Hayashi, Ryutaro; Tomita, Satoshi; Kohsaka, Masayuki; Yamamoto, Kenji; Sawada, Hideyuki

2013-01-01

It is often hard to differentiate Parkinson's disease (PD) and parkinsonian variant of multiple system atrophy (MSA-P), especially in the early stages. Cardiac sympathetic denervation and putaminal rarefaction are specific findings for PD and MSA-P, respectively. We investigated diagnostic accuracy of putaminal apparent diffusion coefficient (ADC) test for MSA-P and (123)I-metaiodobenzylguanidine (MIBG) scintigram for PD, especially in early-stage patients. The referral standard diagnosis of PD and MSA-P were the diagnostic criteria of the United Kingdom Parkinson's Disease Society Brain Bank Criteria and the second consensus criteria, respectively. Based on the referral standard criteria, diagnostic accuracy [area under the receiver-operator characteristic curve (AUC), sensitivity and specificity] of the ADC and MIBG tests was estimated retrospectively. Diagnostic accuracy of these tests performed within 3 years of symptom onset was also investigated. ADC and MIBG tests were performed on 138 patients (20 MSA and 118 PD). AUC was 0.95 and 0.83 for the ADC and MIBG tests, respectively. Sensitivity and specificity were 85.0% and 89.0% for MSA-P diagnosis by ADC test and 67.0% and 80.0% for PD diagnosis by MIBG test. When these tests were restricted to patients with disease duration ≤ 3 years, the sensitivity and specificity were 75.0% and 91.4% for the ADC test (MSA-P diagnosis) and 47.7% and 92.3% for the MIBG test (PD diagnosis). Both tests were useful in differentiating between PD and MSA-P, even in the early stages. In early-stage patients, elevated putaminal ADC was a diagnostic marker for MSA-P. Despite high specificity of the MIBG test, careful neurological history and examinations were required for PD diagnosis because of possible false-negative results.

Iodine-123 metaiodobenzylguanidine scintigraphy and iodine-123 ioflupane single photon emission computed tomography in Lewy body diseases: complementary or alternative techniques?

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Treglia, Giorgio; Cason, Ernesto; Cortelli, Pietro; Gabellini, Anna; Liguori, Rocco; Bagnato, Antonio; Giordano, Alessandro; Fagioli, Giorgio

2014-01-01

To compare myocardial sympathetic imaging using (123)I-Metaiodobenzylguanidine (MIBG) scintigraphy and striatal dopaminergic imaging using (123)I-Ioflupane (FP-CIT) single photon emission computed tomography (SPECT) in patients with suspected Lewy body diseases (LBD). Ninety-nine patients who performed both methods within 2 months for differential diagnosis between Parkinson's disease (PD) and other parkinsonism (n = 68) or between dementia with Lewy bodies (DLB) and other dementia (n = 31) were enrolled. Sensitivity, specificity, accuracy, positive and negative predictive values of both methods were calculated. For (123) I-MIBG scintigraphy, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 83%, 79%, 82%, 86%, and 76%, respectively. For (123)I-FP-CIT SPECT, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 93%, 41%, 73%, 71%, and 80%, respectively. There was a statistically significant difference between these two methods in patients without LBD, but not in patients with LBD. LBD usually present both myocardial sympathetic and striatal dopaminergic impairments. (123)I-FP-CIT SPECT presents high sensitivity in the diagnosis of LBD; (123)I-MIBG scintigraphy may have a complementary role in differential diagnosis between PD and other parkinsonism. These scintigraphic methods showed similar diagnostic accuracy in differential diagnosis between DLB and other dementia. Copyright © 2012 by the American Society of Neuroimaging.

I-Metaiodobenzylguanidine Myocardial Scintigraphy in Lewy Body-Related Disorders: A Literature Review

Directory of Open Access Journals (Sweden)

Eun Joo Chung

2015-05-01

Full Text Available Lewy body-related disorders are characterized by the presence of Lewy bodies and Lewy neurites, which have abnormal aggregations of α-synuclein in the nigral and extranigral areas, including in the heart. 123I-metaiodobenzylguanidine (MIBG scintigraphy is a well-known tool to evaluate cardiac sympathetic denervation in the Lewy body-related disorders. MIBG scintigraphy showed low uptake of MIBG in the Lewy body-related disorders, including Parkinson’s disease, dementia with Lewy bodies, pure autonomic failure and rapid eye movement sleep behavior disorder. This review summarizes previous results on the diagnostic applications of MIBG scintigraphy in Lewy body-related disorders.

Evaluation of cardiac autonomic nerves by iodine-123 metaiodobenzylguanidine scintigraphy and ambulatory electrocardiography in patients after arterial switch operations

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Sakurai, Hajime; Maeda, Masanobu; Miyahara, Ken [Shakaihoken Chukyo Hospital, Nagoya (Japan)] [and others

2000-05-01

The autonomic cardiac nerves reach the heart after passing through the vicinity of the aortic root and the pulmonary trunk. The arterial switch operation (ASO) completely transects the ascending aorta and the pulmonary trunk. Therefore, this surgical procedure virtually denerves the heart. Cardiac sympathetic denervation and reinnervation were evaluated in patients after ASO using iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy and parasympathetic denervation and reinnervation using ambulatory electrocardiography [Holter electrocardiogram (ECG)]. MIBG scintigraphy was performed in 14 patients who underwent ASO (ASO group) and 3 patients who underwent other open heart surgery (control group). All patients in the ASO group underwent the operation in the neonatal or infantile period. Planar and single photon emission computed tomography (SPECT) images of the myocardium were obtained. Defect score was determined by the SPECT images as a semi-quantitative index. The mean interval between ASO and MIBG scintigraphy was 25.6{+-}14.6 months. Holter ECG was also performed in 14 patients in the ASO group and 19 age-matched normal children. The Holter ECGs were plotted on a Lorenz plot. The H index, which is related to vagal tone for the cardiovascular system, was calculated from the R-R intervals. The mean interval between the ASO and Holter ECG was 8.3{+-}9.7 months. MIBG scintigraphy in the control group demonstrated an almost normal homogeneous tracer uptake, but showed extremely reduced tracer uptake and significantly higher defect score in the ASO group. The extent and degree of the reduction of MIBG uptake improved with time after the ASO. The heart-to-mediastinum MIBG count ratio tended to increase with time. The H index of the ASO group was lower than that of normal children (<12 months: Control group 0.0280{+-}0.0068 vs ASO group 0.0219{+-}0.0083), and gradually increased with time (1-3 years: 0.0470{+-}0.0157 vs 0.0314{+-}0.0124). (author)

Evaluation of cardiac autonomic nerves by iodine-123 metaiodobenzylguanidine scintigraphy and ambulatory electrocardiography in patients after arterial switch operations

International Nuclear Information System (INIS)

Sakurai, Hajime; Maeda, Masanobu; Miyahara, Ken

2000-01-01

The autonomic cardiac nerves reach the heart after passing through the vicinity of the aortic root and the pulmonary trunk. The arterial switch operation (ASO) completely transects the ascending aorta and the pulmonary trunk. Therefore, this surgical procedure virtually denerves the heart. Cardiac sympathetic denervation and reinnervation were evaluated in patients after ASO using iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy and parasympathetic denervation and reinnervation using ambulatory electrocardiography [Holter electrocardiogram (ECG)]. MIBG scintigraphy was performed in 14 patients who underwent ASO (ASO group) and 3 patients who underwent other open heart surgery (control group). All patients in the ASO group underwent the operation in the neonatal or infantile period. Planar and single photon emission computed tomography (SPECT) images of the myocardium were obtained. Defect score was determined by the SPECT images as a semi-quantitative index. The mean interval between ASO and MIBG scintigraphy was 25.6±14.6 months. Holter ECG was also performed in 14 patients in the ASO group and 19 age-matched normal children. The Holter ECGs were plotted on a Lorenz plot. The H index, which is related to vagal tone for the cardiovascular system, was calculated from the R-R intervals. The mean interval between the ASO and Holter ECG was 8.3±9.7 months. MIBG scintigraphy in the control group demonstrated an almost normal homogeneous tracer uptake, but showed extremely reduced tracer uptake and significantly higher defect score in the ASO group. The extent and degree of the reduction of MIBG uptake improved with time after the ASO. The heart-to-mediastinum MIBG count ratio tended to increase with time. The H index of the ASO group was lower than that of normal children (<12 months: Control group 0.0280±0.0068 vs ASO group 0.0219±0.0083), and gradually increased with time (1-3 years: 0.0470±0.0157 vs 0.0314±0.0124). (author)

Diagnostic accuracy of combined FP-CIT, IBZM, and MIBG scintigraphy in the differential diagnosis of degenerative parkinsonism: a multidimensional statistical approach.

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Südmeyer, Martin; Antke, Christina; Zizek, Tanja; Beu, Markus; Nikolaus, Susanne; Wojtecki, Lars; Schnitzler, Alfons; Müller, Hans-Wilhelm

2011-05-01

In vivo molecular imaging of pre- and postsynaptic nigrostriatal neuronal degeneration and sympathetic cardiac innervation with SPECT is used to distinguish idiopathic Parkinson disease (PD) from atypical parkinsonian disorder (APD). However, the diagnostic accuracy of these imaging approaches as stand-alone procedures is often unsatisfying. The aim of this study was therefore to evaluate to which extent diagnostic accuracy can be increased by their combined use together with a multidimensional statistical algorithm. The SPECT radiotracers (123)I-(S)-2-hydroxy-3-iodo-6-methoxy-N-[1-ethyl-2-pyrrodinyl)-methyl]benzamide (IBZM), (123)I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropan (FP-CIT), and meta-(123)I-iodobenzylguanidine (MIBG) were used to assess striatal postsynaptic D(2) receptor binding, striatal presynaptic dopamine transporter binding, and myocardial adrenergic innervation, respectively. Thirty-one PD and 17 APD patients were prospectively investigated. PD and APD diagnoses were established using consensus criteria and reevaluated after 37.4 ± 12.4 and 26 ± 11.6 mo in PD and APD, respectively. Test accuracy (TA) for PD-APD differentiation was computed for all logical (Boolean) combinations of imaging modalities by receiver-operating-characteristic analysis--that is, after multidimensional optimization of cutoff values. Analysis showed moderate TA for PD-APD differentiation using each molecular approach alone (IBZM, 79%; MIBG, 73%; and FP-CIT, 73%). For combined use, the highest TA resulted under the assumption that at least 2 of the 3 biologic markers had to be positive for APD using the following cutoff values: 1.46 or less for IBZM, less than 2.10 for FP-CIT, and greater than 1.43 for MIBG. This algorithm distinguished APD from PD with a sensitivity of 94%, specificity of 94% (TA, 94%), positive predictive value of 89%, and negative predictive value of 97%. Results suggest that the multidimensional combination of FP-CIT, IBZM, and MIBG

Diabetic cardiac autonomic dysfunction. Parasympathetic versus sympathetic

International Nuclear Information System (INIS)

Uehara, Akihiko; Kurata, Chinori; Sugi, Toshihiko; Mikami, Tadashi; Shouda, Sakae

1999-01-01

Diabetic cardiac autonomic dysfunction often causes lethal arrhythmia and sudden cardiac death. 123 I-Metaiodobenzylguanidine (MIBG) can evaluate cardiac sympathetic dysfunction, and analysis of heart rate variability (HRV) can reflect cardiac parasympathetic activity. We examined whether cardiac parasympathetic dysfunction assessed by HRV may correlate with sympathetic dysfunction assessed by MIBG in diabetic patients. In 24-hour electrocardiography, we analyzed 4 HRV parameters: high-frequency power (HF), HF in the early morning (EMHF), rMSSD and pNN50. MIBG planar images and SPECT were obtained 15 minutes (early) and 150 minutes (late) after injection and the heart washout rate was calculated. The defect score in 9 left ventricular regions was scored on a 4 point scale (0=normal - 3=severe defect). In 20 selected diabetic patients without congestive heart failure, coronary artery disease and renal failure, parasympathetic HRV parameters had a negative correlation with the sum of defect scores (DS) in the late images (R=-0.47 to -0.59, p<0.05) and some parameters had a negative correlation with the washout rate (R=-0.50 to -0.55, p<0.05). In a total of 64 diabetic patients also, these parameters had a negative correlation with late DS (R=-0.28 to -0.35, p<0.05) and early DS (R=-0.27 to -0.32, p<0.05). The progress of diabetic cardiac parasympathetic dysfunction may parallel the sympathetic one. (author)

I-123 metaiodobenzylguanidine cardiac scintigraphy in patients with an implanted permanent pacemaker

International Nuclear Information System (INIS)

Nakata, Akio; Hirota, Satoshi; Tsuji, Hiroshi; Takazakura, Eisuke

1995-01-01

Tl scintigraphic abnormalities have been reported in patients with an implanted permanent pacemaker, but little is known about the MIBG scintigraphic findings in such patients. This study was performed to assess the MIBG scintigraphic findings in patients with an implanted permanent pacemaker, and to test the hypothesis that imaging characteristics of MIBG scintigraphy differ according to its mode. Twelve patients (4 men and 8 women, mean age: 72.4±9.5 years), who had undergone the implantation of a permanent pacemaker for bradyarrhythmias, underwent MIBG scintigraphy. The patients were divided into VVI pacemaker and DDD pacemaker groups. The tomograms were divided into nine segments and the MIBG defect in each segment scored on a scale ranging from 0 (normal uptake) to 3 (no uptake). Total MIBG defect scores were generated by summing the scores for the nine segments in each patient. MIBG scintigraphic abnormalities were found in ten of the twelve patients. The six patients with the VVI pacemaker manifested MIBG scintigraphic abnormalities. These MIBG scintigraphic abnormalities were observed in all segments, particularly in the posterior segments. The mean total defect score of the VVI group was higher than that of the DDD group (14.8±9.8 vs 3.0±3.5, respectively p<0.05). Therefore, we conclude that despite several limitations of the study, MIBG scintigraphic abnormalities occur in patients with implanted permanent pacemakers, and that such abnormalities are more prominent with the VVI than DDD pacemaker. (author)

Interleucina 1β correlaciona-se com MIBG e parâmetros do exercício, na insuficiência cardíaca? Do interleukin-1β levels correlate with MIBG and exercise parameters in heart failure?

Directory of Open Access Journals (Sweden)

Leandro Rocha Messias

2013-05-01

Full Text Available FUNDAMENTO: Na insuficiência cardíaca, níveis de interleucina 1β (IL 1β se associam a prognóstico. A atividade adrenérgica cardíaca avaliada através da cintilografia com metiodobenzilguanidina (I123 MIBG e parâmetros do exercício são importantes preditores de prognóstico. A relação entre essas variáveis não está bem definida. OBJETIVO: Avaliar associação entre níveis de IL 1β com parâmetros do exercício e do I123 MIBG. MÉTODOS: Estudo observacional transversal, com avaliação de 25 pacientes consecutivos com insuficiência cardíaca e fração de ejeção menor que 45%, através de: dosagem de IL 1β; parâmetros do I123 MIBG [relação coração/mediastino precoce e tardia, taxa de washout (WO]; e teste ergométrico em esteira pelo protocolo de Rampa. RESULTADOS: Separados em dois grupos pelos níveis de IL 1β (normal vs. elevado, o grupo com níveis aumentados apresentava menor reserva de duplo produto (RDP, menor capacidade funcional (CF e recuperação mais lenta da frequência cardíaca no 1º (RFC 1º e 2º minuto (RFC 2º, e maior WO. Na análise univariada, todas as variáveis se correlacionaram com a IL 1β; RDP: r = 0,203, p = 0,024; CF: r = 0,181, p = 0,034; RFC 1º: r = 0,182, p = 0,034; RFC 2º: r = 0,204, p = 0,023; WO: r = 0,263, p = 0,009. Na multivariada, apenas a WO permaneceu com correlação significativa (r2 = 0,263, p = 0,009. CONCLUSÃO: A hipertonia adrenérgica foi o principal determinante dos níveis de IL 1β, demonstrando que a atividade simpática excessiva influencia a atividade inflamatória sistêmica. As variáveis do teste ergométrico não foram capazes de identificar pacientes com níveis elevados de IL 1β.BACKGROUND: Interleukin 1β (IL 1β levels are associated with prognosis in heart failure. The cardiac adrenergic activity as assessed by metaiodobenzylguanidine (I123 MIBG scintigraphy along with exercise parameters are important predictors of prognosis. The relationship between

I131-MIBG in early diagnose of neuroblastoma in symptomatic children

International Nuclear Information System (INIS)

Saddadi, F.S.; Kargarzadeh, F.K.; Yaghoobi, N.Y.

2002-01-01

Aim: Neuroblastoma is the second most common solid tumors in childhood which derivates from neural crest. It is very malignant and almost always patient comes with metastasis. However there are some diagnostic tools to detection of lesion in the early stage of tumor. We decided to have a review with using I-131 MIBG in patients suspected and/or proved to have neuroblastoma. Material and Methods: 300-500 μci I 131 MIBG was injected intravenously in patients (5 patients with age range 4 years old) referred for their bone pain and pelvic mass(detected with anatomical tools). Images were obtained 24 to 72 hours throughout the body with ADAC gamma camera and SPECT was performed in each local abnormal uptake. Each patient has already had a WBBS with TcMDP. Results: All abnormal tracer uptakes were seen in bone scan were revealed clearly in I131 MIBG. However, three to five other abnormal tracer activities were only seen in MIBG scan. The main tumoral lesions were showed perfectly in pelvic,that was not seen in WBBS. With a statistical analysis, I131 MIBG has 94% sensitivity 85-100% specificity, compare to Tc99m-MDP that was 78% and 51% respectively. Conclusions: We found that I131 MIBG is the most useful method to diagnose of patients with neuroblastoma and reproved that it has a competitive role in management, follow-up of these tumors especially in detection of metastasis

Regional sympathetic denervation after myocardial infarction in humans detected noninvasively using I-123-metaiodobenzylguanidine

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Stanton, M.S.; Tuli, M.M.; Radtke, N.L.; Heger, J.J.; Miles, W.M.; Mock, B.H.; Burt, R.W.; Wellman, H.N.; Zipes, D.P. (Indiana Univ. School of Medicine, IN (USA))

1989-11-15

Transmural myocardial infarction in dogs produces denervation of sympathetic nerves in viable myocardium apical to the infarct that may be arrhythmogenic. It is unknown whether sympathetic denervation occurs in humans. The purpose of this study was to use iodine-123-metaiodobenzylguanidine (MIBG), a radiolabeled guanethidine analog that is actively taken up by sympathetic nerve terminals, to image noninvasively the cardiac sympathetic nerves in patients with and without ventricular arrhythmias after myocardial infarction. Results showed that 10 of 12 patients with spontaneous ventricular tachyarrhythmias after myocardial infarction exhibited regions of thallium-201 uptake indicating viable perfused myocardium, with no MIBG uptake. Such a finding is consistent with sympathetic denervation. One patient had frequent episodes of nonsustained ventricular tachycardia induced at exercise testing that was eliminated by beta-adrenoceptor blockade. Eleven of the 12 patients had ventricular tachycardia induced at electrophysiologic study and metoprolol never prevented induction. Sympathetic denervation was also detected in two of seven postinfarction patients without ventricular arrhythmias. Normal control subjects had no regions lacking MIBG uptake. This study provides evidence that regional sympathetic denervation occurs in humans after myocardial infarction and can be detected noninvasively by comparing MIBG and thallium-201 images. Although the presence of sympathetic denervation may be related to the onset of spontaneous ventricular tachyarrhythmias in some patients, it does not appear to be related to sustained ventricular tachycardia induced at electrophysiologic study.

Utility of the combination of DAT SPECT and MIBG myocardial scintigraphy in differentiating dementia with Lewy bodies from Alzheimer's disease

International Nuclear Information System (INIS)

Shimizu, Soichiro; Hirao, Kentaro; Kanetaka, Hidekazu; Namioka, Nayuta; Hatanaka, Hirokuni; Hirose, Daisuke; Fukasawa, Raita; Umahara, Takahiko; Sakurai, Hirohumi; Hanyu, Haruo

2016-01-01

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. (orig.)

Sequelae and survivorship in patients treated with (131)I-MIBG therapy.

Science.gov (United States)

Sze, W C C; Grossman, A B; Goddard, I; Amendra, D; Shieh, S C C; Plowman, P N; Drake, W M; Akker, S A; Druce, M R

2013-08-06

(131)I-meta-iodobenzylguanidine ((131)I-MIBG) has been in therapeutic use since 1980s. Newer treatment modalities are emerging for neuroendocrine tumours (NETs) and chromaffin cell tumours (CCTs), but many of these do not yet have adequate long-term follow-up to determine their longer term efficacy and sequelae. Fifty-eight patients with metastatic NETs and CCTs who had received (131)I-MIBG therapy between 2000 and 2011 were analysed. Survival and any long-term haematological or renal sequelae were investigated. In the NET group, the overall median survival and median survival following the diagnosis of metastatic disease was 124 months. The median survival following the commencement of (131)I-MIBG was 66 months. For the CCT group, median survival had not been reached. The 5-year survival from diagnosis and following the diagnosis of metastatic disease was 67% and 67.5% for NETs and CCTs, respectively. The 5-year survival following the commencement of (131)I-MIBG therapy was 68%. Thirty-two patients had long-term haematological sequelae: 5 of these 32 patients developed haematological malignancies. Two patients developed a mild deterioration in renal function. Long follow up of (131)I-MIBG therapy reveals a noteable rate of bone marrow toxicities and malignancy and long term review of all patients receiving radionuclide therapies is recommended.

Quantitative analysis of 123I-metaiodobenzylguanidine myocardial scintigraphy by myocardial uptake using a phantom

International Nuclear Information System (INIS)

Momose, Mitsuru; Kobayashi, Hideki; Kashikura, Kenichi; Kanaya, Shinichi; Maki, Masako; Hosoda, Saichi; Kusakabe, Kiyoko

1994-01-01

To evaluate the quantitative analysis of 123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, total injected dose measured by first pass (FP) method (T FP ) was compared with that measured by phantom method using an acrylic phantom in 45 patients with cardiac disease. Heart per mediastinum ratio (H/M) was compared to myocardial uptake calculated with T FP . The total injected dose measured using the phantom in which the syringe was set in depth of 3.5 cm (T pham ) was correlated with T FP (r=0.73, p=0.0001). When T pham was corrected by body weight (c-T pham ), c-T pham showed better correlation with T FP . MU calculated by T FP (MU-FP) was well correlated with MU by c-T pham (MU-pham) (r=0.94, p=0.001). These results indicate that phantom method is sufficient to substitute for FP method. Though H/M was correlated with MU-FP (p<0.001), the interpatient variation was relatively large. Then the analysis by H/M is insufficient to substitute for the myocardial uptake. It is thought to be enough to use the phantom method on daily routine work, since this method is accurate and easy to quantitate the myocardial uptake of MIBG taking a short time. (author)

Semi-automated measurements of heart-to-mediastinum ratio on 123I-MIBG myocardial scintigrams by using image fusion method with chest X-ray images

Science.gov (United States)

Kawai, Ryosuke; Hara, Takeshi; Katafuchi, Tetsuro; Ishihara, Tadahiko; Zhou, Xiangrong; Muramatsu, Chisako; Abe, Yoshiteru; Fujita, Hiroshi

2015-03-01

MIBG (iodine-123-meta-iodobenzylguanidine) is a radioactive medicine that is used to help diagnose not only myocardial diseases but also Parkinson's diseases (PD) and dementia with Lewy Bodies (DLB). The difficulty of the segmentation around the myocardium often reduces the consistency of measurement results. One of the most common measurement methods is the ratio of the uptake values of the heart to mediastinum (H/M). This ratio will be a stable independent of the operators when the uptake value in the myocardium region is clearly higher than that in background, however, it will be unreliable indices when the myocardium region is unclear because of the low uptake values. This study aims to develop a new measurement method by using the image fusion of three modalities of MIBG scintigrams, 201-Tl scintigrams, and chest radiograms, to increase the reliability of the H/M measurement results. Our automated method consists of the following steps: (1) construct left ventricular (LV) map from 201-Tl myocardium image database, (2) determine heart region in chest radiograms, (3) determine mediastinum region in chest radiograms, (4) perform image fusion of chest radiograms and MIBG scintigrams, and 5) perform H/M measurements on MIBG scintigrams by using the locations of heart and mediastinum determined on the chest radiograms. We collected 165 cases with 201-Tl scintigrams and chest radiograms to construct the LV map. Another 65 cases with MIBG scintigrams and chest radiograms were also collected for the measurements. Four radiological technologists (RTs) manually measured the H/M in the MIBG images. We compared the four RTs' results with our computer outputs by using Pearson's correlation, the Bland-Altman method, and the equivalency test method. As a result, the correlations of the H/M between four the RTs and the computer were 0.85 to 0.88. We confirmed systematic errors between the four RTs and the computer as well as among the four RTs. The variation range of the H

Use of iodine-123 metaiodobenzylguanidine myocardial imaging to predict the effectiveness of β-blocker therapy in patients with dilated cardiomyopathy

International Nuclear Information System (INIS)

Fukuoka, Shuji; Hayashida, Kohei; Hirose, Yoshiaki; Shimotsu, Yoriko; Ishida, Yoshio; Kakuchi, Hiroyuki; Eto, Tanenao

1997-01-01

We studied 13 patients with dilated cardiomyopathy (DCM) and seven normal subjects. We obtained myocardial SPET images 15 min and 4 h after administration of 123 I-MIBG (111 MBq). Studies were performed in the patients with DCM before and 1 and 3 months after the administration of metoprolol and in the normal subjects. We calculated the regional 123 I-MIBG washout rate (r-WR) in the SPET image, and the global 123 I-MIBG washout rate (g-WR) and heart-mediastinum activity ratio (H/M) using the anterior planar image. We classified patients into those showing a ≥5% increase in LV ejection fraction (LVEF) at 3 months compared with LVEF values before the treatment (group I, n=7) and those showing a 123 I-MIBG SPET imaging can be used to predict the functional improvement of LVEF at 1 month of β-blocker therapy in patients with DCM. (orig./VHE). With 4 figs., 1 tab

Toxicity of upfront {sup 131}I-metaiodobenzylguanidine ({sup 131}I-MIBG) therapy in newly diagnosed neuroblastoma patients: a retrospective analysis

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Bleeker, Gitta; Schoot, Reineke A.; Caron, Huib N.; Kraker, Jan de; Tytgat, Godelieve A. [Emma Children' s Hospital, Academic Medical Centre (AMC), Department of Paediatric Oncology, PO Box 22700, Amsterdam (Netherlands); Hoefnagel, Cees A. [National Cancer Institute (NKI-AvL), Department of Nuclear Medicine, Amsterdam (Netherlands); Eck, Berthe L. van [Academic Medical Centre (AMC), Department of Nuclear Medicine, Amsterdam (Netherlands)

2013-10-15

In the treatment of patients with high-risk neuroblastoma, different doses of {sup 131}I-metaiodobenzylguanidine ({sup 131}I-MIBG) are administered at different time points during treatment. Toxicity, mainly haematological (thrombocytopenia), from {sup 131}I-MIBG therapy is known to occur in extensively chemotherapy pretreated neuroblastoma patients. Up to now, acute toxicity from {sup 131}I-MIBG as initial treatment has never been studied in a large cohort. The aim of this retrospective study was to document acute toxicity related to upfront {sup 131}I-MIBG. All neuroblastoma patients (stages 1-4 and 4S) treated upfront with {sup 131}I-MIBG at the Emma Children's Hospital, Academic Medical Centre (1992 - 2008) were included in this retrospective analysis. The acute toxicity (during therapy) and short-term toxicity (1st month following therapy) of the first two {sup 131}I-MIBG therapies were studied. Of 66 patients (34 boys, 32 girls; median age 2.2 years, range 0.1 - 9.4 years), 49 had stage 4 disease, 5 stage 4S, 6 stage 3, 1 stage 2 and 5 stage 1. The median first dose was 441 MBq/kg (range 157 - 804 MBq/kg). The median second dose was 328 MBq/kg (range 113 - 727 MBq/kg). The most frequently observed symptoms were nausea and vomiting (21 %, maximum grade II). The main toxicity was grade IV haematological, occurring only in stage 4 patients, after the first and second {sup 131}I-MIBG therapies: anaemia (5 % and 4 %, respectively), leucocytopenia (3 % and 4 %) and thrombocytopenia (2 % and 4 %). No stem cell rescue was needed. The main acute toxicity observed was haematological followed by nausea and vomiting. One patient developed posterior reversible encephalopathy syndrome during {sup 131}I-MIBG therapy, possibly related to {sup 131}I-MIBG. We consider {sup 131}I-MIBG therapy to be a safe treatment modality. (orig.)

Our first experience in the application of I-131 MIBG in a patient with neuroblastoma (A case report)

International Nuclear Information System (INIS)

Samarina, G.; Poksi, A.

2005-01-01

Full text: Neuroblastomas (NB) belong to a group of neuroendocrine tumors that are thought to arise from cells in the neural crest from the pelvis to neck, produce high levels of the urinary catecholamines vanillylmandelic acid (VMA) or homovanillic acid (HVA) in more than 90% of cases, and often metastasize to bones, bone marrow (BM), lymph nodes, and the liver. I-123 MIBG and I-131 MIBG are clinically important radiopharmaceuticals, which are routinely used for diagnostic imaging and treatment of NB. 90% percent of NB takes up the MIBG. If, however, the MIBG cannot successfully attach to a patient's tumor, it cannot be used to find or treat it. A 20-month-old girl presented with a 6-month history of a rapidly growing tumor mass 3.5 cm in diameter in the left orbital region. The first CT scan revealed a soft tissue tumor 22 x 28 mm, extending from the inferolateral wall of the left orbit and destroying the surrounding bone (os zygomaticus). CT scans of the chest and abdomen were negative. Histopathology showed high malignancy (G3) of NB (immunohistochemical reactions: NSE positive, CgA positive, SY positive, Ki-67 70% of tumor cells positive). First BM histological examination revealed no pathological findings. Urinary VMA and HVA levels were within the normal range. Tc-99m MDP scans showed increased uptake of radiopharmaceutical in the bones around the left orbital region but no evidence of skeletal metastases. 123 I-MIBG studies revealed a hypermetabolic focus in the left orbital region, concordance with the CT and bone scans. The child was treated with preoperative chemotherapy, but without any results: the CT-scan performed four months later showed that the tumor had grown to 45 x 37 x 40 mm. The clinical test demonstrated the progress of the disease and the tumor at that stage was inoperable. Clinicians decided to change the chemotherapy regimen and a CT study carried out three months later showed that the tumor had decreased to 26 x 10 x 30 mm. The patient

Present state of the I-131-MIBG therapy

International Nuclear Information System (INIS)

Fischer, M.

1986-01-01

Treatment of malignant pheochromocytoma and neuroblastoma stage III and IV is unsatisfactory. Locally invasive tumors may be cured by radical extirpation. The role of irradiation and/or chemotherapy in malignant pheochromocytoma is disappointing, in neuroblastoma in many cases debatable. From 1981 to the present we studied more than 250 patients by MIBG scintigraphy. 5 patients with malignant pheochromocytoma, one female patient with an intra-adrenal, probably benign pheochromocytoma and 3 children with neuroblastoma stage IV were treated with I-131-MIBG

Use of iodine-123 metaiodobenzylguanidine scintigraphy to assess cardiac sympathetic denervation and the impact of hypertension in patients with non-insulin-dependent diabetes mellitus

International Nuclear Information System (INIS)

Tamura, Koji; Nakatani, Yuko; Onishi, Satoshi; Utsunomiya, Keita; Saika, Yoshinori; Iwasaka, Toshiji

1999-01-01

The objectives of this clinical study using iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy were (a) to evaluate cardiac sympathetic denervation in non-insulin-dependent diabetes mellitus (NIDDM) patients with and without hypertension and (b) to investigate the relation between cardiac sympathetic denervation and prognosis in NIDDM patients. We compared clinical characteristics and MIBG data [heart to mediastinum (H/M) ratio and % washout rate (WR)] in a control group and NIDDM patients with and without hypertension. MIBG scintigraphy was performed in 11 controls and 82 NIDDM patients without overt cardiovascular disease except for hypertension (systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 mmHg). After MIBG examination, blood pressure was measured regularly in all NIDDM patients. There were significant differences between 65 normotensive and 17 hypertensive NIDDM patients with respect to age (55±11 vs 63±12 years, respectively, P<0.05), prevalence of diabetic retinopathy (12% vs 35%, respectively, P<0.05) and systolic blood pressure (120±12 vs 145±16 mmHg, respectively, P<0.001). The H/M ratio in hypertensive NIDDM patients was significantly lower than in the control group (1.81±0.29 vs 2.27±0.20, respectively, P<0.01). During the follow-up period (18± 12 months), 17 NIDDM patients newly developed hypertension after MIBG examination. There were no significant differences in their clinical characteristics compared with persistently normotensive or hypertensive NIDDM patients. %WR in patients with new onset hypertension was significantly higher than in the control group (30.88%±16.87% vs 12.89%±11.94%, respectively, P<0.05). Moreover, in these patients %WR correlated with duration from the date of MIBG scintigraphy to the onset of hypertension (r=-0.512, P<0.05). Five NIDDM patients died during the follow-up period (four newly hypertensive patients and one normotensive patient). There were significant statistical differences

Use of iodine-123 metaiodobenzylguanidine scintigraphy to assess cardiac sympathetic denervation and the impact of hypertension in patients with non-insulin-dependent diabetes mellitus

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Tamura, Koji; Nakatani, Yuko; Onishi, Satoshi [Dept. of Internal Medicine, Keihanna Hospital, Hirakata City, Osaka (Japan); Utsunomiya, Keita; Saika, Yoshinori [Dept. of Radiology, Keihanna Hospital, Hirakata City (Japan); Iwasaka, Toshiji [Cardiovascular Center, Kansai Medical University, Osaka (Japan)

1999-10-01

The objectives of this clinical study using iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy were (a) to evaluate cardiac sympathetic denervation in non-insulin-dependent diabetes mellitus (NIDDM) patients with and without hypertension and (b) to investigate the relation between cardiac sympathetic denervation and prognosis in NIDDM patients. We compared clinical characteristics and MIBG data [heart to mediastinum (H/M) ratio and % washout rate (WR)] in a control group and NIDDM patients with and without hypertension. MIBG scintigraphy was performed in 11 controls and 82 NIDDM patients without overt cardiovascular disease except for hypertension (systolic blood pressure {>=}140 and/or diastolic blood pressure {>=}90 mmHg). After MIBG examination, blood pressure was measured regularly in all NIDDM patients. There were significant differences between 65 normotensive and 17 hypertensive NIDDM patients with respect to age (55{+-}11 vs 63{+-}12 years, respectively, P<0.05), prevalence of diabetic retinopathy (12% vs 35%, respectively, P<0.05) and systolic blood pressure (120{+-}12 vs 145{+-}16 mmHg, respectively, P<0.001). The H/M ratio in hypertensive NIDDM patients was significantly lower than in the control group (1.81{+-}0.29 vs 2.27{+-}0.20, respectively, P<0.01). During the follow-up period (18{+-} 12 months), 17 NIDDM patients newly developed hypertension after MIBG examination. There were no significant differences in their clinical characteristics compared with persistently normotensive or hypertensive NIDDM patients. %WR in patients with new onset hypertension was significantly higher than in the control group (30.88%{+-}16.87% vs 12.89%{+-}11.94%, respectively, P<0.05). Moreover, in these patients %WR correlated with duration from the date of MIBG scintigraphy to the onset of hypertension (r=-0.512, P<0.05). Five NIDDM patients died during the follow-up period (four newly hypertensive patients and one normotensive patient). There were significant

Influence of drugs on myocardial iodine-123 metaiodobenzylguanidine uptake in rabbit myocardium

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Mayer, S.; Karanikas, G.; Rodrigues, M.; Sinzinger, H. [Dept. of Nuclear Medicine, University of Vienna (Austria)

2000-03-01

About 15 years ago, iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging was introduced for the evaluation of myocardial sympathetic nerve function. Two uptake mechanisms for MIBG have so far been identified: uptake type I, a saturable, energy-dependent mechanism, and uptake type II, a non-saturable, energy-independent mechanism. We incubated isolated rabbit myocardial tissue samples with{sup 123}I-MIBG in order to assess the uptake characteristics and the influence of varying incubation conditions. Furthermore, we examined the effects of several drugs and uptake inhibitors on the myocardial uptake of MIBG. The in vitro myocardial uptake of MIBG reached a steady plateau at 23.87%{+-}3.63% after 1 h, i.e. a concentration gradient of 10, in a thermo-independent manner within a concentration range from 1.5 to 1500 {mu}M. This indicates an unsaturable uptake process in the tested concentrations. Pre-incubation with the following drugs caused a significant inhibitory effect on myocardial MIBG uptake: haloperidol, levomepromazine, metoprolol, labetalol and clomipramine. According to our findings, the uptake mechanism seems to be an unspecific process, but the concentration gradient of 10 makes passive diffusion unlikely. Further studies with uptake-II-blocking substances as well as with isolated myocardial cells will be needed to clarify the nature of the myocardial MIBG uptake mechanism. (orig.)

Clinical usefulness of a dual L/N-type Ca2+ channel blocker, cilnidipine, in patients with chronic heart failure. Assessment with 123I-MIBG myocardial scintigraphy

International Nuclear Information System (INIS)

Ito, Kazuki; Nishikawa, Susumu; Adachi, Yoshihiko; Kato, Shuuji; Azuma, Akihiro; Matsubara, Hiroaki

2003-01-01

Sympathetic nerve system is activated as a compensatory mechanism in heart failure. However excessive activation of sympathetic nerve system deteriorates disease state. Sympathetic nerve system can be suppressed with N-type Ca 2+ channel blocker. An antihypertensive drug, cilnidipine, is a dual L/N-type Ca 2+ channel blocker. We studies usefulness of cilnidipine in treating with chronic heart failure with 123 I-MIBG myocardial scintigraphy. We enrolled 24 patients with stable chronic heart failure. Twelve patients were treated with angiotensin converting enzyme (ACE)-inhibitors, diuretics and cardiotonics (control group), and the other 12 patients were treated with ACE-inhibitors, diuretics, cardiotonics and cilnidipine (cilnidipine group). We examined blood pressure, heart rate, norepinephrine level, brain natriuretic peptide (BNP) level, cardiothoracic ratio on chest X-ray, ejection fraction of left ventricle on two-dimensional echocardiography, count rate of heart to mediastinum (H/M) and washout rate (WOR) on 123 I-MIBG myocardial scintigraphy before and six months after medication. Symptom was improved in 8 patients in the control group and 10 patients in the cilnidipine group after medication. And another parameters were also improved in the both groups after medication. However the degree of change in blood pressure (mmHg) was 21.2±8.0 in the cilnidipine group and 10.8±9.1 in the control group, that in heart rate (/min) was 24.1±6.8 and 16.2±11.0, that in BNP level (pg/ml) was 65.2±12.0 and 42.8±11.1, that in H/M was 0.30±0.08 and 0.19±0.09, that in WOR was 19.4±5.6 and 12.2±7.0, respectively. And the degree of these changes were larger in the cilnidipine group (p 2+ channel blocker, might be useful in treating with chronic heart failure. (author)

Dynamic low dose I-123-iodophenylpentadecanoic acid metabolic cardiac imaging

International Nuclear Information System (INIS)

Murray, G.L.; Magill, H.L.; Schad, N.C.

1993-01-01

Recognition of stunned and hibernating myocardium is essential in this era of cardiac revascularization. Positron emission tomography (PET) accurately identifies viability but is costly and unavailable to most patients. Dynamic low dose I-123-iodophenylpentadecanoic acid (IPPA) metabolic cardiac imaging is a potentially cost-effective alternative to PET. Using transmural myocardial biopsies obtained during coronary bypass surgery as the viability gold standard, resting IPPA imaging agreed with 39/43 (91%) biopsies, with a sensitivity for viability of 33/36(92%) and a specificity of 6/7 (86%) in patients with severe ischemic cardiomyopathy. Eighty percent of IPPA viable, infarcted segments improved wall motion postoperatively. Furthermore, when compared to reinjection thallium (SPECT-Tl) scans after myocardial infarction, there was IPPA-Tl concordance in 27/35 (77%)(Kappa=0.536, p=0.0003). Similar to PET, IPPA demonstrated more viability than SPECT-Tl, 26/35 (74%) vs. 18/35 (51%)(p=0.047). Finally, when compared to transvenous endomyocardial biopsy for detecting rejection following cardiac transplantation, IPPA sensitivity for ≥Grade II rejection was 100%, and IPPA screening assessment for the necessity of biopsy could result in a 31% cost-savings. Therefore, IPPA metabolic cardiac imaging is a safe, inexpensive technique with a promising future. (author)

Utility of the combination of DAT SPECT and MIBG myocardial scintigraphy in differentiating dementia with Lewy bodies from Alzheimer's disease

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Shimizu, Soichiro; Hirao, Kentaro; Kanetaka, Hidekazu; Namioka, Nayuta; Hatanaka, Hirokuni; Hirose, Daisuke; Fukasawa, Raita; Umahara, Takahiko; Sakurai, Hirohumi; Hanyu, Haruo [Tokyo Medical University, Department of Geriatric Medicine, Shinjuku-ku, Tokyo (Japan)

2016-01-15

{sup 123}I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ({sup 123}I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT SPECT) and {sup 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. (orig.)

Adrenocortical Carcinoma: False Positive in an I-123 Metaiodobenzylguanidine Scan

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Rey, Cristina Rodriguez; Candil, Aida Ortega; Galvan, Eliseo Vano; Martin, Maria Nieves Cabrera; Delgado, Jose Luis Carreras [Clinico San Carlos Hospital, Madrid (Spain)

2016-06-15

A 55-year-old man with a personal his history of left pheochromocytoma 2 years previously presented with an abdominal ultrasound showed a large left upper quadrant solid mass (calipers), with heterogeneous echogenicity and central cystic degeneration areas or necrosis. F-18 Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT was performed as ACC was suspected. ACC is an uncommon malignant neoplasm of unknown cause; however, smoking and oral contraceptives may be risk factors. Patients usually present with advanced-stage disease and have poor prognosis, with a 2-year recurrence rate that ranges form 73 to 86 %. An MIBG scan was performed after injection of 185 MBq of I-123 MIBG intravenously. Single photon emission tomography (SPECT)/CT scan showed abnormal isotope accumulation in the tumor region. The patient underwent total resection of the tumor. The histology was of ACC, with areas of necrosis and cystic areas, so the result of the MIBG scan was a false positive. Authors divided false-positive MIBG studies into three categories. The first category is neuroendocrine lesions other than pheochromocytomas (tumors of the APUD series). the second category consists in adrenal lesions other than pheochromocytomas (adenomas, ACC) the reasons for this abnormal uptake are unclear. The third category consists of tracer uptake adjacent to the adrenal due to abnormalities in the route of excretion.

Comparative study between 131I-MIBG scintigraphy and other tumor markers in diagnosis of neuroblastoma

International Nuclear Information System (INIS)

Ohsawa, Yoshihiro; Iwafuchi, Makoto; Odano, Ikuo; Yamagiwa, Iwao.

1989-01-01

In order to prove the clinical usefulness in diagnosis of neuroblastoma, comparative studies between iodine-131 metaiodobenzylguanidine ( 131 I-MIBG) scintigraphy and other related tumor markers were attempted. Sixteen children diagnosed as having a neuroblastoma in recent 2 years were examined. In 5 postoperative patients in complete remission, who were negative to other tumor markers, showed no pathological accumulation of 131 I-MIBG (specificity 100%). In other 11 patients with remains of neuroblastoma, 131 I-MIBG was negative only in 2 patients (sensitivity 82%) and these 2 patients showed negative urinary excretion of catecholamine metabolites (VMA). (Negative urinary VMA was proved in 3 of 11 patients). Serum neuron-specific enolase (NSE) was elevated in all 8 preoperative patients, but only in 2 of 11 postoperative patients. On the other hand 131 I-MIBG was positive in 9 among these 11 postoperative patients in whom neuroblastoma remained. Similar relationship was obtained between 131 I-MIBG scintigraphy and serum LDH. On the basis of our present experience, we like to regard 131 I-MIBG scintigraphy as one of the most sensitive parameters for neuroblastoma during a follow-up period after treatment. (author)

Myocardial adrenergic nerve activity in valvular diseases assessed by iodine-123-metaiodobenzylguanidine myocardial scintigraphy

International Nuclear Information System (INIS)

Imamura, Yoshihiro; Fukuyama, Takaya

1997-01-01

Iodine-123-metaiodobenzylguanidine (MIBG) imaging was used to assess myocardial adrenergic nerve activity in patients with heart failure. MIBG planar images were obtained in 94 patients. The uptake of MIBG, calculated as the heart-to-mediastinum activity ratio in the immediate image (15 min), showed a significant decrease only in patients with severe heart failure due to cardiomyopathy, but was not changed in those with valvular diseases. Storage and release of MIBG, calculated as the percentage myocardial MIBG washout from 15 min to 4 hours after isotope injection, was substantially accelerated in both patients with cardiomyopathy and valvular diseases in proportion to the severity of heart failure. These data suggest that, in severe heart failure associated with cardiomyopathy, norepinephrine uptake is reduced. Also, myocardial adrenergic nerve activity is accelerated in proportion to the severity of heart failure independent of the underlying cause. MIBG images were analyzed in 20 patients with mitral stenosis with the same methods to clarify whether myocardial adrenergic nerve activity is different in patients with heart failure without left ventricular volume or pressure overload. Myocardial uptake of MIBG did not show any significant difference. The percentage myocardial MIBG washout was increased in patients with severe heart failure. The closest correlation was between myocardial washout and cardiac output. In heart failure due to mitral stenosis, myocardial adrenergic nerve activity is intensified. Decrease in cardiac output associated with mitral stenosis acts as a potent stimulus for this intensification. (author)

A rapid and efficient preparation of [{sup 123}I]radiopharmaceuticals using a small HPLC Rocket[reg] column

Energy Technology Data Exchange (ETDEWEB)

Katsifis, Andrew [Radiopharmaceuticals Division R and D, Australian Nuclear Science and Technology, Organisation, Menai, NSW 2234, Sydney (Australia)]. E-mail: akx@ansto.gov.au; Papazian, Vahan [Radiopharmaceuticals Division R and D, Australian Nuclear Science and Technology, Organisation, Menai, NSW 2234, Sydney (Australia); Jackson, Timothy [Radiopharmaceuticals Division R and D, Australian Nuclear Science and Technology, Organisation, Menai, NSW 2234, Sydney (Australia); Loc' h, Christian [Radiopharmaceuticals Division R and D, Australian Nuclear Science and Technology, Organisation, Menai, NSW 2234, Sydney (Australia)

2006-01-01

A simplified method for the rapid and efficient preparation of [{sup 123}I]radiopharmaceuticals is described. Three radiopharmaceuticals, [{sup 123}I]{beta}-CIT, [{sup 123}I]MIBG and [{sup 123}I]clioquinol, were synthesised and purified as model compounds. The radiotracers were labelled with iodine-123 using electrophilic oxidative conditions and purified by a compact semi-preparative reverse phase column (C-18, 3 {mu}m, 7x53 mm, Alltima Rocket[reg, Alltech] using aqueous-ethanol as HPLC solvents that were directly used for radiopharmaceutical formulation. The radiochemical purity of the radioiodinated tracers as assessed by analytical HPLC was higher than 99% with specific activity higher than 3 GBq/nmol. The total preparation time of a radiotracer ranged from 40 to 60 min and, starting from 3.7 GBq of iodine-123, more than 2.5 GBq of formulated radiopharmaceuticals were available for clinical investigations.

Evaluation of therapy for dilated cardiomyopathy with heart failure by iodine-123 metaiodobenzyl-guanidine imaging. Comparison with heart rate variability power spectral analysis

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Li, Shou-lin; Ikeda, Jun; Takita, Tamotsu; Sekiguchi, Yohei; Demachi, Jun; Chikama, Hisao; Goto, Atsushi; Shirato, Kunio [Tohoku Univ., Sendai (Japan). School of Medicine

1998-11-01

The relationship between the myocardial uptake of iodine-123 metaiodobenzylguanidine ({sup 123}I-MIBG) and heart rate variability parameters has not been determined. This study determined the relationship between the change in myocardial uptake of {sup 123}I-MIBG and improvement in left ventricular function after treatment, to determine the usefulness of {sup 123}I-MIBG imaging to assess the effect of therapy on heart failure due to dilated cardiomyopathy (DCM). {sup 123}I-MIBG imaging and power spectral analysis of heart rate variability were performed before and after treatment in 17 patients with heart failure due to DCM. The following parameters were compared before and after treatment: New York Heart Association (NYHA) functional class, radiographic cardiothoracic ratio (CTR), blood pressure, echocardiographic data (left ventricular end-systolic (LVDs) and end-diastolic (LVDd) diameters, left ventricular ejection fraction (LVEF)), plasma concentrations of norepinephrine and epinephrine, heart rate variability power spectral analysis data (mean low frequency (MLF) and high frequency power (MHF)) and the myocardium to mediastinum activity ratio (MYO/M) obtained in early and late images, and washout rate calculated by anterior planar imaging of {sup 123}I-MIBG. The NYHA functional class, LVEF, LVDs, CTR, MLF and MHF improved after treatment. Early MYO/M and late MYO/M improved after treatment. The rate of increase in late MYO/M was positively correlated with the rate of improvement of LVEF after treatment. Furthermore, the late MYO/M was negatively correlated with MLF. Washout rate revealed no correlation with hemodynamic parameters. These findings suggest that late MYO/M is more useful than washout rate to assess the effect of treatment on heart failure due to DCM. Furthermore, the {sup 123}I-MIBG imaging and heart rate variability parameters are useful to assess the autonomic tone in DCM with heart failure. (author)

Evaluation of therapy for dilated cardiomyopathy with heart failure by iodine-123 metaiodobenzyl-guanidine imaging. Comparison with heart rate variability power spectral analysis

International Nuclear Information System (INIS)

Li, Shou-lin; Ikeda, Jun; Takita, Tamotsu; Sekiguchi, Yohei; Demachi, Jun; Chikama, Hisao; Goto, Atsushi; Shirato, Kunio

1998-01-01

The relationship between the myocardial uptake of iodine-123 metaiodobenzylguanidine ( 123 I-MIBG) and heart rate variability parameters has not been determined. This study determined the relationship between the change in myocardial uptake of 123 I-MIBG and improvement in left ventricular function after treatment, to determine the usefulness of 123 I-MIBG imaging to assess the effect of therapy on heart failure due to dilated cardiomyopathy (DCM). 123 I-MIBG imaging and power spectral analysis of heart rate variability were performed before and after treatment in 17 patients with heart failure due to DCM. The following parameters were compared before and after treatment: New York Heart Association (NYHA) functional class, radiographic cardiothoracic ratio (CTR), blood pressure, echocardiographic data (left ventricular end-systolic (LVDs) and end-diastolic (LVDd) diameters, left ventricular ejection fraction (LVEF)), plasma concentrations of norepinephrine and epinephrine, heart rate variability power spectral analysis data (mean low frequency (MLF) and high frequency power (MHF)) and the myocardium to mediastinum activity ratio (MYO/M) obtained in early and late images, and washout rate calculated by anterior planar imaging of 123 I-MIBG. The NYHA functional class, LVEF, LVDs, CTR, MLF and MHF improved after treatment. Early MYO/M and late MYO/M improved after treatment. The rate of increase in late MYO/M was positively correlated with the rate of improvement of LVEF after treatment. Furthermore, the late MYO/M was negatively correlated with MLF. Washout rate revealed no correlation with hemodynamic parameters. These findings suggest that late MYO/M is more useful than washout rate to assess the effect of treatment on heart failure due to DCM. Furthermore, the 123 I-MIBG imaging and heart rate variability parameters are useful to assess the autonomic tone in DCM with heart failure. (author)

123I-β-methyl-iodophenyl-pentadecanoic acid myocardial scintigraphy in diabetic patients without overt ischemic heart disease

International Nuclear Information System (INIS)

Shinmura, Ken; Tani, Masato; Suganuma, Yukako; Hasegawa, Hiroshi; Kawamura, Masatoshi; Nakamura, Yoshiro; Hashimoto, Jun; Kubo, Atsushi

1995-01-01

We evaluated 123 I-β-methyl-iodophenyl-pentadecanoic acid (BMIPP) myocardial scintigraphy in 15 diabetes mellitus patients without overt coronary heart disease. Patients with overt coronary heart disease were excluded by careful history taking, resting electrocardiography, treadmill exercise testing echocardiography and resting 201 Tl scintigraphy. Patients with remarkably impaired left ventricular (LV) systolic function (%FS 2 , FBS: 178 vs 114 mg/dl, HbA1c: 7.6 vs 6.2%, IRI: 18.5 vs 9.5 μU/ml, LVEDD: 52 vs 44 mm). 123 I-metaiodobenzyl-guanidine (MIBG) scintigraphy in the 5 patients with abnormal BMIPP uptake showed more severe defects than in the 10 patients with normal BMIPP imaging. BMIPP scintigraphy demonstrated a significant correlation between H/M and L/M by BMIPP (r=0.74). Correlation between H/M by BMIPP scintigraphy and clinical parameters (BMI, systolic blood pressure, FBS, HbA1c, IRI) were found, suggesting that diabetes mellitus patients without over coronary heart disease show abnormal BMIPP imaging when their general glucose utility and 123 I-MIBG uptake are severely impaired (progression of insulin resistance and sympathetic nerve involvement). BMIPP scintigraphy may be useful in investigating the pathogenesis and subclinical abnormality of diabetic heart. (J.P.N.)

6-[F-18]Fluoro-L-Dihydroxyphenylalanine Positron Emission Tomography Is Superior to Conventional Imaging with I-123-Metaiodobenzylguanidine Scintigraphy, Computer Tomography, and Magnetic Resonance Imaging in Localizing Tumors Causing Catecholamine Excess

NARCIS (Netherlands)

Fiebrich, Helle-Brit; Brouwers, Adrienne H.; Kerstens, Michiel N.; Pijl, Milan E. J.; Kema, Ido P.; de Jong, Johan R.; Jager, Pieter L.; Elsinga, Philip H.; Dierckx, Rudi A. J. O.; van der Wal, Jacqueline E.; Sluiter, Wim J.; de Vries, Elisabeth G. E.; Links, Thera P.

2009-01-01

Context: Catecholamine excess is rare, but symptoms may be life threatening. Objective: The objective of the study was to investigate the sensitivity of 6-[F-18]fluoro-L-dihydroxyphenylalanine positron emission tomography (F-18-DOPAPET), compared with I-123-metaiodobenzylguanidine (I-123-MIBG)

131I-MIBG Scintigraphy in the Evaluation of Suspected Pheochromocytoma

International Nuclear Information System (INIS)

Oh, Sei Jung; Yoo, Hyung Sik; Park, Chang Yun; Lee, So Jin

1992-01-01

Pheochromocytomas are catecholamine producing tumors of neuroectodermal origin. Diagnosis of pheochromocytoma is significant due to potentially curable hypertension. But they have a significant associated morbidity due to uncontrolled hypertension and mortality since 10% are malignant. From Aug. 1989 to Jul. 1992, 12 patients of our institution had 131 I-MIBG scan during work up of suspected primary or recurrent pheochromocytoma. In our studies conclude that 131 I-MIBG scan is recommended as the initial localizing study of choice (especially for the detection of extraadrenal disease and postoperative recurrence) as a guide for CT and/or MR and specific functional confirmation of their findings.

Use of iodine-123 metaiodobenzylguanidine myocardial imaging to predict the effectiveness of {beta}-blocker therapy in patients with dilated cardiomyopathy

Energy Technology Data Exchange (ETDEWEB)

Fukuoka, Shuji [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Hayashida, Kohei [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Hirose, Yoshiaki [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Shimotsu, Yoriko [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Ishida, Yoshio [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Kakuchi, Hiroyuki [Department of Internal Medicine, National Cardiovascular Center, Osaka (Japan); Eto, Tanenao [First Department of Internal Medicine, Miyazaki Medical College, Miyazaki (Japan)

1997-05-01

We studied 13 patients with dilated cardiomyopathy (DCM) and seven normal subjects. We obtained myocardial SPET images 15 min and 4 h after administration of {sup 123}I-MIBG (111 MBq). Studies were performed in the patients with DCM before and 1 and 3 months after the administration of metoprolol and in the normal subjects. We calculated the regional {sup 123}I-MIBG washout rate (r-WR) in the SPET image, and the global {sup 123}I-MIBG washout rate (g-WR) and heart-mediastinum activity ratio (H/M) using the anterior planar image. We classified patients into those showing a {>=}5% increase in LV ejection fraction (LVEF) at 3 months compared with LVEF values before the treatment (group I, n=7) and those showing a <5% increase in LVEF (group II, n=6). In normal subjects, the r-WR values in each of the anterior, lateral, septal and inferior segments were significantly lower than those in groups I and II. These values were 18%{+-}9%, 18%{+-}15%, 20%{+-}12% and 21%{+-}15%, respectively. This study demonstrated that with regional assessment {sup 123}I-MIBG SPET imaging can be used to predict the functional improvement of LVEF at 1 month of {beta}-blocker therapy in patients with DCM. (orig./VHE). With 4 figs., 1 tab.

Miniaturized chromatographic radiochemical procedure for 131I - MIBG

International Nuclear Information System (INIS)

Barboza, M.F. de; Pereira, N.S. de; Colturato, M.T.; Silva, C.P.G. da.

1989-12-01

Different solvents were used in paper chromatographic methods to obtain the best system in routine radiochemical control for 131 I-MIBG produced at IPEN-CNEN/SP. The dates were compared with those obtained with eletrophoresis method in buffer acetate, pH=4.5, 350V, during 40 minutes. The stability of the labeled compound store under 4 0 C was studied during 15 days. Miniaturized chromatographic procedures were established using Whatman 3MM (8x1cm) and n-butanol-:acetic acid: water (S:2:1) as a solvent. the Rf values were: 0.3 (I - ) and 1.0 (MIBG). The radiochemical purity was 99.3 and 99.2% (first day) obtained with eletrophoresis and miniaturized chromatographic procedures, respectively and, 84.7% after 15 days of its preparation. It is a rapid, practical and reproductive method. (author) [pt

Diabetic retinopathy is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients

International Nuclear Information System (INIS)

Anan, Futoshi; Takayuki, Masaki; Takahashi, Naohiko; Nakagawa, Mikiko; Eshima, Nobuoki; Saikawa, Tetsunori; Yoshimatsu, Hironobu

2009-01-01

Diabetic retinopathy (DR) and cardiovascular autonomic dysfunction are associated with high mortality in type 2 diabetic patients. This preliminary study was therefore designed to test the hypothesis that DR is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients without insulin treatment. Seventy persons were diagnosed to have type 2 diabetes in the examination from June 2004 to May 2006. The study group consisted of 29 type 2 diabetic patients with DR (age: 58±6 years, mean±standard deviation (s.d.)) and 41 type 2 diabetic patients with no DR (NDR) (n=41, 58±5 years). Cardiovascular autonomic function was assessed by baroreflex sensitivity (BRS), heart rate variability, plasma norepinephrine concentration and cardiac 123 I-metaiodobenzylguanidine (MIBG) scintigraphic findings. DR patients had lower BRS, early and delayed 123 I-MIBG myocardial uptake values and higher percent washout rate (WR) of 123 I-MIBG than the NDR patients. With respect to metabolic findings, DR patients had higher fasting plasma insulin concentration (P 123 I-MIBG (P 123 I-MIBG are independently associated with DR in Japanese patients with type 2 diabetes mellitus. (author)

Impact of sympathetic innervation on recurrent life-threatening arrhythmias in the follow-up of patients with idiopathic ventricular fibrillation

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Paul, Matthias; Acil, Tayfun; Breithardt, Guenter; Wichter, Thomas [Hospital of the University of Muenster, Department of Cardiology and Angiology, Muenster (Germany); Schaefers, Michael; Kies, Peter; Schaefers, Klaus; Schober, Otmar [Hospital of the University of Muenster, Department of Nuclear Medicine, Muenster (Germany)

2006-08-15

Idiopathic ventricular fibrillation (IVF) is defined as VF in the absence of any identifiable structural or functional cardiac disease. The underlying pathophysiological mechanisms are unknown. This study was performed to investigate the potential impact of sympathetic dysfunction, assessed by {sup 123}I-meta-iodo-benzylguanidine scintigraphy ({sup 123}I-MIBG SPECT), on the long-term prognosis of patients with IVF. {sup 123}I-MIBG SPECT was performed in 20 patients (mean age 37{+-}13 years) with IVF. Mean follow-up of patients after study entry was 7.2{+-}1.5 years (range 4.9-10.5 years). Ten patients (five men, five women; mean age 43{+-}12 years; p=NS versus study group) with medullary carcinoma of the thyroid gland served as an age-matched control group. Abnormal {sup 123}I-MIBG uptake was observed in 13 patients (65%). During follow-up, 18 episodes of VF/fast polymorphic ventricular tachycardias occurred in four IVF patients with abnormal {sup 123}I-MIBG uptake whereas only two episodes of monomorphic ventricular tachycardia (and no VF) occurred in a single IVF patient with normal {sup 123}I-MIBG uptake. Impairment of sympathetic innervation may indicate a higher risk of future recurrent episodes of life-threatening ventricular tachyarrhythmias in patients with IVF. Studies in larger cohorts are required to validate the significance of {sup 123}I-MIBG SPECT during the long-term follow-up of these patients. (orig.)

Insulin resistance is associated with impaired cardiac sympathetic innervation in patients with heart failure.

Science.gov (United States)

Paolillo, S; Rengo, G; Pellegrino, T; Formisano, R; Pagano, G; Gargiulo, P; Savarese, G; Carotenuto, R; Petraglia, L; Rapacciuolo, A; Perrino, C; Piscitelli, S; Attena, E; Del Guercio, L; Leosco, D; Trimarco, B; Cuocolo, A; Perrone-Filardi, P

2015-10-01

Insulin resistance (IR) represents, at the same time, cause and consequence of heart failure (HF) and affects prognosis in HF patients, but pathophysiological mechanisms remain unclear. Hyperinsulinemia, which characterizes IR, enhances sympathetic drive, and it can be hypothesized that IR is associated with impaired cardiac sympathetic innervation in HF. Yet, this hypothesis has never been investigated. Aim of the present observational study was to assess the relationship between IR and cardiac sympathetic innervation in non-diabetic HF patients. One hundred and fifteen patients (87% males; 65 ± 11.3 years) with severe-to-moderate HF (ejection fraction 32.5 ± 9.1%) underwent iodine-123 meta-iodobenzylguanidine ((123)I-MIBG) myocardial scintigraphy to assess sympathetic innervation and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) evaluation to determine the presence of IR. From (123)I-MIBG imaging, early and late heart to mediastinum (H/M) ratios and washout rate were calculated. Seventy-two (63%) patients showed IR and 43 (37%) were non-IR. Early [1.68 (IQR 1.53-1.85) vs. 1.79 (IQR 1.66-1.95); P = 0.05] and late H/M ratio [1.50 (IQR 1.35-1.69) vs. 1.65 (IQR 1.40-1.85); P = 0.020] were significantly reduced in IR compared with non-IR patients. Early and late H/M ratio showed significant inverse correlation with fasting insulinemia and HOMA-IR. Cardiac sympathetic innervation is more impaired in patients with IR and HF compared with matched non-IR patients. These findings shed light on the relationship among IR, HF, and cardiac sympathetic nervous system. Additional studies are needed to clarify the pathogenetic relationship between IR and HF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Comparison of parameters of 123I-metaiodobenzylguanidine scintigraphy for differential diagnosis in patients with parkinsonism. Correlation with clinical features

International Nuclear Information System (INIS)

Uchiyama, Yumiko; Momose, Mitsuru; Kondo, Chisato; Kusakabe, Kiyoko; Uchiyama, Shinichiro

2011-01-01

The purpose of this study was to estimate the diagnostic accuracy of 123 I-metaiodobenzylguanidine (MIBG) scintigraphy to diagnose Lewy body disease (LBD), including Parkinson's disease (PD) and dementia with Lewy bodies, and to clarify the relationship between MIBG parameters and the clinical findings. One hundred-and-forty-four patients with parkinsonism without diabetes mellitus or a history of cardiac disease were retrospectively selected in the study. Clinical diagnosis was confirmed by follow-up during more than 6 months by neurologists. All patients underwent MIBG imaging at 15 min (initial) and 4 h (delayed) after the tracer injection, and clinical features such as Hoehn and Yahr (H-Y) classification or symptoms specific to parkinsonism were also investigated. The heart to mediastinum ratio (H/M) and the washout ratio (WR) of MIBG were calculated, and correlation with the clinical features was analyzed. Ninety-seven and 47 patients were diagnosed as LBD and Parkinson's syndrome (PS), respectively. Initial and delayed H/M were significantly lower and WR was significantly higher in LBD than in PS (p<0.0001). The initial H/M was independently correlated with tremor (F value 10.45), hesitation (F=4.49), and hallucinations (F=5.09) (p<0.0001). The sensitivity and specificity for the diagnosis of LBD were 64.9 and 87.2% with initial H/M, 78.4 and 68.1% with delayed H/M, and 80.4 and 61.7% with WR, respectively. Using multivariate analysis, initial H/M (F=39.33) and tremor (F=10.46) were independently correlated to the diagnosis of LBD (r=0.562, p<0.0001) among the MIBG and various clinical parameters. The initial H/M was the most useful of the 3 different parameters of MIBG for the diagnosis of LBD, but had low sensitivity. WR and delayed H/M had no incremental value to initial H/M for the diagnosis of PD. Careful long-term follow-up is needed for patients with parkinsonism who are clinically diagnosed as LBD with normal initial H/M, or diagnosed as no LBD with

Magnesium sulphate and (123)I-MIBG in pheochromocytoma: Two useful techniques for a complicated disease.

Science.gov (United States)

Vendrell, M; Martín, N; Tejedor, A; Ortiz, J T; Muxí, À; Taurà, P

2016-01-01

Pheochromocytoma is a tumour of the chromaffin tissue. It may, through catecholamine release, have deleterious effects on myocardial structure. A 48-year-old woman with a history of hypertension and type II diabetes mellitus (ASA II) was diagnosed of pheochromocytoma-induced myocarditis, which caused severe cardiogenic shock, with an ejection fraction of 20%. Extreme blood pressure swings required aggressive therapy with vasoactive drugs (norepinephrine and dopamine) and an intra-aortic balloon pump, despite which severe haemodynamic instability persisted. Finally, the use of magnesium sulphate allowed for cardiovascular stabilization and weaning off vasoactive drugs prior to surgery. (123)I-metaiodobenzylguanidine scintigraphy helps not only to functionally confirm tumour tissue, but also to assess severity and prognosis of cardiac failure. Prognosis of pheochromocytoma-induced heart failure can be very poor. The use of these two well-known and relatively simple 'tools' for treatment and prognosis is a helpful option to keep in mind. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Comparison of I-131 MIBG scintigrapy and F-18 FDG PET in neuroblastoma

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Pai, M.; Lee, S.; Yoo, E [Seoul National University College of Medicine, Seoul (Korea, Republic of)

2004-07-01

The purpose of this preliminary study was to compare the utility of metaiodobenzylguanidine(MIBG) scintigraphy and F-18 FDG PET for the detection of primary and metastatic lesions of neuroblatoma. F-18 FDG PET and I-131 MIBG scan or SPECT were performed with in 1 month of each other in 4 patients (age: 4-5, all female) with known neuroblastoma after primary treatment. In 3 of 4 patients with confirmed neuroblastoma, FDG PET and MIBG scans were concordant for the presence or absence of diseased sites. In two cases, residual abdominal masses less than 1cm in which the X -ray computed tomography showed no change in tumor volume had a simultaneous negative uptake in both MIBG scan and FDG PET. In a patient with histologic evidence of bone marrow involvement, there was no skeletal uptake of both MIBG and FDG but Tc-99m HDP bone scan revealed disseminated bone marrow involvement, while a large mediastinal primary mass of this patient showed intense MIBG and FDG uptake. In one patient whose large abdominal mass of neuroblastoma failed to accumulate FDG, MIBG uptake in the tumor was intense. We concluded that FDG PET could reveal metabolic state of primary or residual neuroblastoma as much as MIBG in majority of our cases but it did not show any advantages over MIBG or even bone scan. FDG PET had an obvious defect in detection of residual viable disease in one patient. FDG PET may not replace MIBG or bone scan for evaluation of primary or metastatic disease of neuroblastoma in the diagnostic and staging procedure from INSS recommendation.

Comparison of I-131 MIBG scintigrapy and F-18 FDG PET in neuroblastoma

International Nuclear Information System (INIS)

Pai, M.; Lee, S.; Yoo, E

2004-01-01

The purpose of this preliminary study was to compare the utility of metaiodobenzylguanidine(MIBG) scintigraphy and F-18 FDG PET for the detection of primary and metastatic lesions of neuroblatoma. F-18 FDG PET and I-131 MIBG scan or SPECT were performed with in 1 month of each other in 4 patients (age: 4-5, all female) with known neuroblastoma after primary treatment. In 3 of 4 patients with confirmed neuroblastoma, FDG PET and MIBG scans were concordant for the presence or absence of diseased sites. In two cases, residual abdominal masses less than 1cm in which the X -ray computed tomography showed no change in tumor volume had a simultaneous negative uptake in both MIBG scan and FDG PET. In a patient with histologic evidence of bone marrow involvement, there was no skeletal uptake of both MIBG and FDG but Tc-99m HDP bone scan revealed disseminated bone marrow involvement, while a large mediastinal primary mass of this patient showed intense MIBG and FDG uptake. In one patient whose large abdominal mass of neuroblastoma failed to accumulate FDG, MIBG uptake in the tumor was intense. We concluded that FDG PET could reveal metabolic state of primary or residual neuroblastoma as much as MIBG in majority of our cases but it did not show any advantages over MIBG or even bone scan. FDG PET had an obvious defect in detection of residual viable disease in one patient. FDG PET may not replace MIBG or bone scan for evaluation of primary or metastatic disease of neuroblastoma in the diagnostic and staging procedure from INSS recommendation

Usefulness of {sup 123}I-MIBG myocardial scintigraphy for determining the severity and prognosis in chronic hemodialysis patients with congestive heart failure

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Tsukamoto, Masaki; Kato, Shuji; Okamoto, Akio; Kawasaki, Tatsuya; Yamamoto, Teruyuki; Yoneyama, Satoshi; Tatsukawa, Hirotaka; Ida, Kazunori [Asahi Univ., Hozumi, Gifu (Japan). Murakami Memorial Hospital; Terada, Koji

1997-11-01

The subjects were 32 patients who had undergone hemodialysis treatment for an average of 17 yr. MIBG myocardial scintigraphy was obtained from SPECT and anterior planar images at 15 min and 4 hr after MIBG injection. Myocardial MIBG uptake was quantified by the heart-to-mediastinum uptake ratio on delayed planar images (H/M) and the mean myocardial MIBG washout rate at 4 hr was calculated by using the Bull`s eye map (MC). The mean lung MIBG washout rate at 4 hr was also obtained from planar images (LC). The left ventricular end diastolic dimension (LVDd), percent fractional shortening (%FS), wall thickness and the ratio of peak velocity of early rapid filling to peak velocity of inflow due to the atrial contraction (E/A) were measured by echocardiography. The patients were divided according to the severity of congestive heart failure (CHF): NYHA classification grade I or II vs. grade III or IV. The severe CHF group showed decreased H/M, LC and dilatation of LVDd. Twenty-two patients were clinically followed up for one and a half years. Seven had acute worsening of CHF and required admission to a hospital. The other 15 patients did not require admission. H/M and LC were decreased, and E/A was increased in the former group. Eighteen of the 24 patients with mild CHF were followed up and classified according to the clinical course whether or not they had acute worsening of CHF. In the acute worsening group, H/M and LC were decreased, and E/A was increased compared with the non-acute worsening group. Thus, H/M and LC indicate the severity and the prognosis of chronic hemodialysis patients with CHF. Dilatation of LVDd reflects the severity of CHF, but it cannot predict the clinical course, because LVDd is always reduced by the medication for CHF. Increased E/A was found in the acute worsening CHF group, but many factors influence the E/A value and increased E/A alone cannot be prognostic for the clinical course of CHF. (K.H.)

Phase I Study of Vorinostat as a Radiation Sensitizer with 131I-Metaiodobenzylguanidine (131I-MIBG) for Patients with Relapsed or Refractory Neuroblastoma.

Science.gov (United States)

DuBois, Steven G; Groshen, Susan; Park, Julie R; Haas-Kogan, Daphne A; Yang, Xiaodong; Geier, Ethan; Chen, Eugene; Giacomini, Kathy; Weiss, Brian; Cohn, Susan L; Granger, M Meaghan; Yanik, Gregory A; Hawkins, Randall; Courtier, Jesse; Jackson, Hollie; Goodarzian, Fariba; Shimada, Hiroyuki; Czarnecki, Scarlett; Tsao-Wei, Denice; Villablanca, Judith G; Marachelian, Araz; Matthay, Katherine K

2015-06-15

(131)I-metaiodobenzylguanidine (MIBG) is a radiopharmaceutical with activity in neuroblastoma. Vorinostat is a histone deacetylase inhibitor that has radiosensitizing properties. The goal of this phase I study was to determine the MTDs of vorinostat and MIBG in combination. Patients ≤ 30 years with relapsed/refractory MIBG-avid neuroblastoma were eligible. Patients received oral vorinostat (dose levels 180 and 230 mg/m(2)) daily days 1 to 14. MIBG (dose levels 8, 12, 15, and 18 mCi/kg) was given on day 3 and peripheral blood stem cells on day 17. Alternating dose escalation of vorinostat and MIBG was performed using a 3+3 design. Twenty-seven patients enrolled to six dose levels, with 23 evaluable for dose escalation. No dose-limiting toxicities (DLT) were seen in the first three dose levels. At dose level 4 (15 mCi/kg MIBG/230 mg/m(2) vorinostat), 1 of 6 patients had DLT with grade 4 hypokalemia. At dose level 5 (18 mCi/kg MIBG/230 mg/m(2) vorinostat), 2 patients had dose-limiting bleeding (one grade 3 and one grade 5). At dose level 5a (18 mCi/kg MIBG/180 mg/m(2) vorinostat), 0 of 6 patients had DLT. The most common toxicities were neutropenia and thrombocytopenia. The response rate was 12% across all dose levels and 17% at dose level 5a. Histone acetylation increased from baseline in peripheral blood mononuclear cells collected on days 3 and 12 to 14. Vorinostat at 180 mg/m(2)/dose is tolerable with 18 mCi/kg MIBG. A phase II trial comparing this regimen to single-agent MIBG is ongoing. ©2015 American Association for Cancer Research.

99mTc-HYNIC-TOC scintigraphy is superior to 131I-MIBG imaging in the evaluation of extraadrenal pheochromocytoma.

Science.gov (United States)

Chen, Libo; Li, Fang; Zhuang, Hongming; Jing, Hongli; Du, Yanrong; Zeng, Zhengpei

2009-03-01

In this investigation, the efficacy of scintigraphy using (99m)Tc-labeled hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC) in the evaluation of extraadrenal pheochromocytoma was assessed and compared with (131)I-labeled metaiodobenzylguanidine (MIBG) imaging. Ninety-seven patients who were suspected of having pheochromocytoma but showed no definite adrenal abnormalities on CT were evaluated by both (99m)Tc-HYNIC-TOC scintigraphy and (131)I-MIBG imaging. The results were compared with pathology findings or clinical follow-up. Of 58 patients proven to be without pheochromocytoma, (99m)Tc-HYNIC-TOC and (131)I-MIBG imaging excluded 56 and 58 patients, respectively, rendering a specificity of 96.6% for (99m)Tc-HYNIC-TOC imaging and 100% for (131)I-MIBG imaging. In the evaluation of adrenal pheochromocytoma (14 patients), the sensitivity of (99m)Tc-HYNIC-TOC scintigraphy and (131)I-MIBG imaging was 50% and 85.7%, respectively. However, in the evaluation of extraadrenal pheochromocytomas (25 patients), the sensitivity of (99m)Tc-HYNIC-TOC scintigraphy and (131)I-MIBG imaging was 96.0% and 72.0%, respectively. (99m)Tc-HYNIC-TOC scintigraphy is more sensitive than (131)I-MIBG imaging in the detection of extraadrenal pheochromocytomas.

Extension of myocardial necrosis differently affects MIBG retention in heart failure caused by ischaemic heart disease or by dilated cardiomyopathy

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Marini, Cecilia; Giorgetti, Assuero; Gimelli, Alessia; Kusch, Annette; Sereni, Nadia; Marzullo, Paolo; Sambuceti, Gianmario [CNR Institute of Clinical Physiology, Pisa (Italy); L' Abbate, Antonio [Scuola Superiore di Studi Universitari Sant' Anna, Pisa (Italy)

2005-06-01

This study aims to investigate the relationship between cardiac sympathetic nervous function (CSNF) and myocardial perfusion/function in patients with heart failure (HF) due to dilated cardiomyopathy (DCM) or ischaemic heart disease (CAD). Twenty patients (10 DCM, 10 CAD, 17 males, age 69{+-}5 years) with NYHA class IIIb HF were studied. CSNF was evaluated by early/delayed {sup 123}I-metaiodobenzylguanidine (MIBG) uptake and regional washout (WO). Myocardial perfusion and function were evaluated by {sup 99m}Tc-tetrofosmin gated single-photon emission tomography (G-SPECT) using a 20-segment model for 400 segments. In each segment, regional MIBG WO was computed as (count density in early images-count density in delayed images/count density in early images) x 100. DCM and CAD showed similar summed rest perfusion score (6.7{+-}5 vs 9.5{+-}5, p=NS) and mean ejection fraction values (29{+-}7% vs 30{+-}9%, p=NS). By contrast, the summed thickening score was higher in DCM than in CAD patients (26{+-}7 vs 17{+-}6, p<0.05). QGS analysis identified akinesis/dyskinesis in 129/137 (94%) severely hypoperfused segments which were considered as damaged. According to the underlying aetiology of HF, marked differences in regional MIBG WO were observed. In fact, within the CAD group, regional MIBG WO was lower in reference than in damaged segments (38{+-}21% vs 46{+-}19%, p<0.05). By contrast, in DCM patients, regional MIBG WO was faster in reference than in damaged segments (49{+-}18% vs 41{+-}30%, p<0.05). When the two groups were directly compared, regional MIBG WO from damaged areas was similar irrespective of the underlying disease, while it was faster in DCM than in CAD patients from reference segments. These data confirm the hypothesis that the presence of myocardial necrosis in HF due to CAD and the consequent loss of neuronal endings cause alterations in regional MIBG WO different from those observed in DCM. (orig.)

Metaiodobenzylguanidine and heart rate variability in heart failure

International Nuclear Information System (INIS)

Kurata, Chinori; Shouda, Sakae; Mikami, Tadashi; Uehara, Akihiko; Ishikawa, Keiko; Tawarahara, Kei; Nakano, Tomoyasu; Matoh, Fumitaka; Takeuchi, Kazuhiko

1998-01-01

It is assumed that the low-frequency power (LF) of heart rate variability (HRV) increases with progress of congestive heart failure (CHF), therefore positively correlating with cardiac 123 I-metaiodobenzylguanidine (MIBG) washout. It is demonstrated here that HRV, including normalized LF, correlated inversely with MIBG washout and positively with the ratio of heart-to-mediastinum MIBG activity in controls and CHF patients, whereas these correlations were not observed within CHF patients. Thus MIBG washout may increase and HRV including normalized LF may decrease with CHF, although the HRV and MIBG measures may not similarly change in proportion to the severity of the cardiac autonomic dysfunction in CHF. (author)

Metaiodobenzylguanidine and heart rate variability in heart failure

Energy Technology Data Exchange (ETDEWEB)

Kurata, Chinori; Shouda, Sakae; Mikami, Tadashi; Uehara, Akihiko; Ishikawa, Keiko [Hamamatsu Univ., Shizuoka (Japan). School of Medicine; Tawarahara, Kei; Nakano, Tomoyasu; Matoh, Fumitaka; Takeuchi, Kazuhiko

1998-10-01

It is assumed that the low-frequency power (LF) of heart rate variability (HRV) increases with progress of congestive heart failure (CHF), therefore positively correlating with cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) washout. It is demonstrated here that HRV, including normalized LF, correlated inversely with MIBG washout and positively with the ratio of heart-to-mediastinum MIBG activity in controls and CHF patients, whereas these correlations were not observed within CHF patients. Thus MIBG washout may increase and HRV including normalized LF may decrease with CHF, although the HRV and MIBG measures may not similarly change in proportion to the severity of the cardiac autonomic dysfunction in CHF. (author)

Significance of cardiac sympathetic nervous system abnormality for predicting vascular events in patients with idiopathic paroxysmal atrial fibrillation

International Nuclear Information System (INIS)

Akutsu, Yasushi; Kaneko, Kyouichi; Kodama, Yusuke; Li, Hui-Ling; Kawamura, Mitsuharu; Asano, Taku; Hamazaki, Yuji; Tanno, Kaoru; Kobayashi, Youichi; Suyama, Jumpei; Shinozuka, Akira; Gokan, Takehiko

2010-01-01

Neuronal system activity plays an important role for the prognosis of patients with atrial fibrillation (AF). Using 123 I metaiodobenzylguanidine ( 123 I-MIBG) scintigraphy, we investigated whether a cardiac sympathetic nervous system (SNS) abnormality would be associated with an increased risk of vascular events in patients with paroxysmal AF. 123 I-MIBG scintigraphy was performed in 69 consecutive patients (67 ± 13 years, 62% men) with paroxysmal AF who did not have structural heart disease. SNS integrity was assessed from the heart to mediastinum (H/M) ratio on delayed imaging. Serum concentration of C-reactive protein (CRP) was measured before 123 I-MIBG study. During a mean of 4.5 ± 3.6 years follow-up, 19 patients had myocardial infarction, stroke or heart failure (range: 0.2-11.5 years). SNS abnormality (H/M ratio <2.7) and high CRP (≥0.3 mg/dl) were associated with the vascular events (58.3% in 14 of 24 patients with SNS abnormality vs 11.1% in 5 of 45 patients without SNS abnormality, p < 0.0001, 52.4% in 11 of 21 patients with high CRP vs 16.7% in 8 of 48 patients without high CRP, p < 0.0001). After adjustment for potential confounding variables such as age, left atrial dimension and left ventricular function, SNS abnormality was an independent predictor of vascular events with a hazard ratio of 4.1 [95% confidence interval (CI): 1.3-12.6, p = 0.014]. Further, SNS abnormality had an incremental and additive prognostic power in combination with high CRP with an adjusted hazard ratio of 4.1 (95% CI: 1.5-10.9, p = 0.006). SNS abnormality is predictive of vascular events in patients with idiopathic paroxysmal AF. (orig.)

Significance of cardiac sympathetic nervous system abnormality for predicting vascular events in patients with idiopathic paroxysmal atrial fibrillation

Energy Technology Data Exchange (ETDEWEB)

Akutsu, Yasushi; Kaneko, Kyouichi; Kodama, Yusuke; Li, Hui-Ling; Kawamura, Mitsuharu; Asano, Taku; Hamazaki, Yuji; Tanno, Kaoru; Kobayashi, Youichi [Showa University School of Medicine, Division of Cardiology, Department of Medicine, Tokyo (Japan); Suyama, Jumpei; Shinozuka, Akira; Gokan, Takehiko [Showa University School of Medicine, Department of Radiology, Tokyo (Japan)

2010-04-15

Neuronal system activity plays an important role for the prognosis of patients with atrial fibrillation (AF). Using {sup 123}I metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy, we investigated whether a cardiac sympathetic nervous system (SNS) abnormality would be associated with an increased risk of vascular events in patients with paroxysmal AF. {sup 123}I-MIBG scintigraphy was performed in 69 consecutive patients (67 {+-} 13 years, 62% men) with paroxysmal AF who did not have structural heart disease. SNS integrity was assessed from the heart to mediastinum (H/M) ratio on delayed imaging. Serum concentration of C-reactive protein (CRP) was measured before {sup 123}I-MIBG study. During a mean of 4.5 {+-} 3.6 years follow-up, 19 patients had myocardial infarction, stroke or heart failure (range: 0.2-11.5 years). SNS abnormality (H/M ratio <2.7) and high CRP ({>=}0.3 mg/dl) were associated with the vascular events (58.3% in 14 of 24 patients with SNS abnormality vs 11.1% in 5 of 45 patients without SNS abnormality, p < 0.0001, 52.4% in 11 of 21 patients with high CRP vs 16.7% in 8 of 48 patients without high CRP, p < 0.0001). After adjustment for potential confounding variables such as age, left atrial dimension and left ventricular function, SNS abnormality was an independent predictor of vascular events with a hazard ratio of 4.1 [95% confidence interval (CI): 1.3-12.6, p = 0.014]. Further, SNS abnormality had an incremental and additive prognostic power in combination with high CRP with an adjusted hazard ratio of 4.1 (95% CI: 1.5-10.9, p = 0.006). SNS abnormality is predictive of vascular events in patients with idiopathic paroxysmal AF. (orig.)

A new method for crosstalk correction in simultaneous dual-isotope myocardial imaging with Tl-201 and I-123

International Nuclear Information System (INIS)

Tsuji, Akinori; Kojima, Akihiro; Oyama, Yoichi; Tomiguchi, Seiji; Kira, Tomohiro; Takagi, Yoshikazu; Shimomura, Osamu; Takahashi, Mutsumasa; Matsumoto, Masanori

1999-01-01

We have developed a new method of crosstalk correction in simultaneous dual-isotope imaging with Tl-201 and I-123 by using crosstalk ratios and a blurring filter. Single isotope myocardial studies (10 for Tl-201 and 7 for I-123) were performed with a dual energy window acquisition mode and two low energy general-purpose collimators. Then two planar images acquired with dual energy windows for a Tl-201 line source and an I-123 line source were obtained to measure line spread functions (LSFs) and crosstalk ratios for each image. The line source experiments showed that the LSFs for the Tl-201 imaging window from the single Tl-201 source were very similar to those for the I-123 imaging window from the single Tl-201 source, but the LSFs for the Tl-201 imaging window from the single I-123 source had broad shapes which differed from those for the I-123 imaging window from the single I-123. To obtain accurate I-123 crosstalk images in the Tl-201 imaging window from the I-123 images in the I-123 imaging window, we designed a low-pass blurring filter. In 7 clinical I-123 MIBG studies, I-123 window images processed with this filter became very similar to the Tl-201 window image from the single I-123 source. The method proposed in this study can accurately correct the crosstalk in dual isotope studies with Tl-201 and I-123 and is easily applicable to conventional gamma camera systems with any dual energy window acquisition mode. (author)

Physiological changes in human cardiac sympathetic innervation and activity assessed by 123I-metaiodobenzylguanidine (MIBG) imaging

International Nuclear Information System (INIS)

Sakata, Kazuyuki; Iida, Kei; Mochizuki, Nao; Ito, Michitoshi; Nakaya, Yoshihiro

2009-01-01

Physiologic changes in the human sympathetic nervous system (SNS) may be associated with cardiovascular diseases, so the present study assessed the age and gender differences in global cardiac SNS in normal subjects. The 163 subjects (74 men, 89 women; age range 40-89 years) whose coronary arteriogram was normal, and who had no other cardiac or neurohormonal diseases, and no medication affecting the autonomic nervous system were included. All study subjects underwent metaiodobenzylguanidine imaging. Both initial and delayed heart-to-mediastinum (H/M) ratios had a significant gender difference and showed a progressive decrease with aging. In addition, the initial H/M ratio had a significant positive correlation with the delayed H/M ratio (r=0.89, P<0.0001). Females (50-59 years) demonstrated significantly higher delayed H/M ratio than males of the same age. After the age of 60, the delayed H/M ratio in females progressively decreased with aging, similar to males. As for the washout rate, both genders had a significantly progressive increase with aging. In addition, there was a significant decrease in the delayed H/M ratio in 10 females with surgical menopause compared with 15 age-matched females without surgical menopause. Cardiac SNS appears to be regulated by various physiological factors. (author)

Cardiac metaiodobenzylguanidine activity can predict the long-term efficacy of angiotensin-converting enzyme inhibitors and/or beta-adrenoceptor blockers in patients with heart failure

Energy Technology Data Exchange (ETDEWEB)

Nakata, Tomoaki; Wakabayashi, Takeru; Kyuma, Michifumi; Takahashi, Toru; Tsuchihashi, Kazufumi; Shimamoto, Kazuaki [Sapporo Medical University School of Medicine, Second Department of Internal Medicine (Cardiology), Sapporo (Japan)

2005-02-01

Although the benefits of treatment with angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are well known, no method has as yet been established to predict the efficacy of drug therapy. This study tested whether cardiac{sup 123}I-metaiodobenzylguanidine (MIBG) activity is of prognostic value and can predict the improvement in heart failure patients resulting from treatment with ACE inhibitors and/or beta-blockers. Following quantification of the heart-to-mediastinum ratio (HMR) of MIBG activity, 88 patients with heart failure who were treated with ACE inhibitors and/or beta-blockers (treated group) and 79 patients with heart failure who were treated conventionally without the aforementioned agents, and who served as controls, were followed up for 43 months with a primary endpoint of cardiac death. The treated group had a significantly lower prevalence of cardiac death and a significantly lower mortality at 5 years compared with the control group (15% vs 37% and 21% vs 42%, p<0.05, respectively). Multivariate analysis revealed that significant predictors were HMR, age, nitrate use and ventricular tachycardia for the treated group, and HMR, nitrate use and NYHA class for the control group. The drug treatment significantly reduced mortality from 36% to 12% when HMR was 1.53 or more and from 53% to 37% when HMR was less than 1.53. The reduction in risk of mortality within 5 years in patients without a severe MIBG defect (67%) was twice that in patients with such a defect (32%) (p<0.05). The reduction in mortality risk achieved by using ACE inhibitors and/or beta-blockers is associated with the severity of impairment of cardiac MIBG uptake. Cardiac MIBG activity can consequently be of long-term prognostic value in predicting the effectiveness of such treatment in patients with heart failure. (orig.)

Cardiac metaiodobenzylguanidine activity can predict the long-term efficacy of angiotensin-converting enzyme inhibitors and/or beta-adrenoceptor blockers in patients with heart failure

International Nuclear Information System (INIS)

Nakata, Tomoaki; Wakabayashi, Takeru; Kyuma, Michifumi; Takahashi, Toru; Tsuchihashi, Kazufumi; Shimamoto, Kazuaki

2005-01-01

Although the benefits of treatment with angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are well known, no method has as yet been established to predict the efficacy of drug therapy. This study tested whether cardiac 123 I-metaiodobenzylguanidine (MIBG) activity is of prognostic value and can predict the improvement in heart failure patients resulting from treatment with ACE inhibitors and/or beta-blockers. Following quantification of the heart-to-mediastinum ratio (HMR) of MIBG activity, 88 patients with heart failure who were treated with ACE inhibitors and/or beta-blockers (treated group) and 79 patients with heart failure who were treated conventionally without the aforementioned agents, and who served as controls, were followed up for 43 months with a primary endpoint of cardiac death. The treated group had a significantly lower prevalence of cardiac death and a significantly lower mortality at 5 years compared with the control group (15% vs 37% and 21% vs 42%, p<0.05, respectively). Multivariate analysis revealed that significant predictors were HMR, age, nitrate use and ventricular tachycardia for the treated group, and HMR, nitrate use and NYHA class for the control group. The drug treatment significantly reduced mortality from 36% to 12% when HMR was 1.53 or more and from 53% to 37% when HMR was less than 1.53. The reduction in risk of mortality within 5 years in patients without a severe MIBG defect (67%) was twice that in patients with such a defect (32%) (p<0.05). The reduction in mortality risk achieved by using ACE inhibitors and/or beta-blockers is associated with the severity of impairment of cardiac MIBG uptake. Cardiac MIBG activity can consequently be of long-term prognostic value in predicting the effectiveness of such treatment in patients with heart failure. (orig.)

Biokinetic and therapeutic use of 131I-MIBG in nude mice hosting human neuroblastoma xenografts

International Nuclear Information System (INIS)

Laubenbacher, C.; Kriegel, H.; Moellenstaedt, S.; Senekowitsch, R.; Technische Univ. Muenchen

1988-01-01

The biological halflife of 131 I-MIBG in nude mice with xenotransplanted human neuroblastoma derived from the SK-N-SH cell line comes to 6 h. The adrenal gland and the neuroblastoma show the highest uptake of MIBG. Based on these datas it could be calculated that 185 MBq would be necessary to get 60 Gy radiation absorbed dose in the tumor. 15-20 days after injection of this activity the tumors could no longer be palpated and they remained missing over the whole observation period. 92.5 MBq weren't enough getting a stable remission. Eleven days p.i. neuroblastoma started growing again. For the first time it could be shown that only high activity of 131 I-MIBG is able to restrain neuroblastoma totally. (orig.)

Diagnosis of pheochromocytome by 131-I-MIBG

International Nuclear Information System (INIS)

Kerik Rotenberg, N.E.

1985-01-01

The purpose of this project is to evaluate the specificity and sensitivity of 131-I-metaiodobenzylguanidine (MIBG), a newly developed radiopharmaceutical which accumulated in the neuro transmitter adrenergic sacs, in diagnosing pheochromocytomes, which originate from well-differentiated cells in the adrenergic region of the autonomous nervous system. A sizeable number of these cells appear in the adrenal medulla, the para-spinal ganglion and the para-aortic (Organ of Zuckerkandl), however, a certain number of pheochromocytomes are found in other sites including the bladder, heart and vagus nerves. Adrenergic tumors which are located outside the adrenal medulla and which secrete both norepinephrine and epinephrine are called pheochromocytomes. Scintigraphic distribution of 131-I-MIBG, an imaging agent for the adrenal medulla, was studied to determine the uptake in patients suspected of harboring pheochromocytomes. Normal distribution of the radiotracer includes: the salivary glands, liver, spleen, gall-bladder, kidneys and heart. Accumulations in the thyroids are detected only in cases of inadequate thyroid blocking. Injected were 0.5 mCi/1.7 m 2 and scans taken 24, 48 and 72 hours afterward. The five patients investigated showed high levels of epinephrine and norepinephrine and revealed abnormal accumulations of radioactive material. These data were surgically verified. (author)

Repeated Radionuclide therapy in metastatic paraganglioma leading to the highest reported cumulative activity of 131I-MIBG

International Nuclear Information System (INIS)

Ezziddin, Samer; Sabet, Amir; Ko, Yon-Dschun; Xun, Sunny; Matthies, Alexander; Biersack, Hans-Jürgen

2012-01-01

131 I-MIBG therapy for neuroendocrine tumours may be dose limited. The common range of applied cumulative activities is 10-40 GBq. We report the uneventful cumulative administration of 111 GBq (= 3 Ci) 131 I-MIBG in a patient with metastatic paraganglioma. Ten courses of 131 I-MIBG therapy were given within six years, accomplishing symptomatic, hormonal and tumour responses with no serious adverse effects. Chemotherapy with cisplatin/vinblastine/dacarbazine was the final treatment modality with temporary control of disease, but eventually the patient died of progression. The observed cumulative activity of 131 I-MIBG represents the highest value reported to our knowledge, and even though 12.6 GBq of 90 Y-DOTATOC were added intermediately, no associated relevant bone marrow, hepatic or other toxicity were observed. In an individual attempt to palliate metastatic disease high cumulative activity alone should not preclude the patient from repeat treatment

High-tension electrical injury to the heart as assessed by radionuclide imaging

Energy Technology Data Exchange (ETDEWEB)

Iino, Hitoshi; Chikamori, Taishiro; Hatano, Tsuguhisa [Tokyo Medical Coll. (Japan)] [and others

2002-12-01

The purpose of this study was to evaluate cardiac complications associated with electrical injury, 7 patients with high-tension electrical injury (6,600 V alternating current) underwent {sup 201}Tl and {sup 123}I-metaiodobenzylguanidine (MIBG) imaging in addition to conventional electrocardiographic and echocardiographic assessments. Electrocardiography showed transient atrial fibrillation, second degree atrioventricular block, ST-segment depression, and sinus bradycardia in each patient. Echocardiography showed mild hypokinesis of the anterior wall in only 2 patients, but {sup 201}Tl and {sup 123}I-MIBG myocardial scintigraphy showed an abnormal scan image in 6/7 and 5/6 patients, respectively. Decreased radionuclide accumulation was seen primarily in areas extending from the anterior wall to the septum. Decreased radionuclide accumulation was smaller in extent and milder in degree in {sup 123}I-MIBG than in {sup 201}Tl imaging. These results suggest that even in patients without definite evidence of severe cardiac complications in conventional examinations, radionuclide imaging detects significant damage due to high-tension electrical injury, in which sympathetic nerve dysfunction might be milder than myocardial cell damage. (author)

mIBG; La mIBG

Energy Technology Data Exchange (ETDEWEB)

Kraeber-Bodere, F.; Bodet-Milin, C.; Ansquer, C. [Hotel-Dieu de Nantes, Service de Medecine Nucleaire, 44 (France); Rousseau, C. [Centre Regional de Lutte Contre le Cancer Rene-Gauducheau, Service de Medecine Nucleaire, 44 - Nantes (France)

2004-08-01

mIBG is a norepinephrine functional analog with presynaptic adrenergic function used as molecular tracer for more than 20 years in Nuclear Oncology and in Cardiology. Organs can be classed in four groups, depending on the tracer's uptake mechanism: group 1: no uptake, group 2: non specific uptake, group 3: uptake in sympathetic nervous system with short retention and group 4: uptake in sympathetic nervous system with long-term retention. At cellular level, mIBG transport across the plasma membrane involves an active mechanism (uptake 1) and a passive diffusion (uptake 2). Intra-cellular becoming depends on the existence of secretory granules. In the absence of secretory granules, mIBG is stored in the cytoplasm and shows no inactivation by MAO. In the presence of secretory granules, mIBG is transported into secretory granules by an active monoamine transport protein (uptake 3), which catalyzes an amine/H{sup +} antiport. Alteration of mIBG biodistribution by parameters, such as circulating catecholamine in pheochromocytoma, hypoxia, tumoral histo-type and medication, should be considered in routine clinical applications. (authors)

Does reducing unnecessary right ventricular pacing improve sympathetic activity and innervation of heart in sinus node disease patients? MVP and SafeR study.

Science.gov (United States)

Miyamoto, Mihoko; Kimura, Yuichiro; Hosoda, Junya; Matsumoto, Katsumi; Matsushita, Kohei; Ishikawa, Toshiyuki; Umemura, Satoshi

2012-01-01

Ventricular desynchronization imposed by ventricular pacing causes regional disturbances of adrenergic innervation in the left ventricular myocardium and increases the risk of heart failure and atrial fibrillation (AF) in patients with sinus node disease (SND). As a result, decreased iodine-123 metaiodobenzylguanidine (I-(123 )MIBG) uptake occurs in patients with an implanted permanent pacemaker. Fourteen SND patients with an implanted pacemaker equipped with an algorithm for reducing unnecessary right ventricular pacing (RURVP) were enrolled. Pacemakers were programmed to RURVP mode for the first 12 weeks, and then reprogrammed to DDD for the last 12 weeks. At the end of each mode, data on cumulative percent ventricular pacing (%Vp), atrial high rate episodes (%AHR), I-(123 )MIBG myocardial scintigraphy, brain natriuretic peptide (BNP), human atrial natriuretic peptide (hANP), and myocardial damage indices typified by troponin T and C-reactive protein (CRP) were collected. %Vp was lower in RURVP than in DDD (0.2% versus 95.7%, P = 0.00098). BNP, hANP, troponin T, and CRP did not differ significantly between the pacing modes. However, I-(123 )MIBG findings of patients with full ventricular pacing in DDD improved in RURVP. In contrast, among patients without full ventricular pacing in DDD, their I-(123 )MIBG findings did not differ significantly between the pacing modes. In SND patients with normal cardiac function and intact atrioventricular conduction, the reduction of %Vp in RURVP was due to the reduction of ineffective pacing and fusion pacing in DDD. Therefore, these 2 types of pacing do not affect cardiac pump function.

Neuronal imaging using SPECT

International Nuclear Information System (INIS)

Yamashina, Shohei; Yamazaki, Jun-ichi

2007-01-01

123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is one of only a few methods available for objective evaluation of cardiac sympathetic function at the clinical level. Disorders of cardiac sympathetic function play an important role in various heart diseases, and MIBG provides an abundance of useful information for the evaluation of severity, prognosis and therapeutic effects; this is particularly useful in cases of heart failure, ischaemic heart disease and arrhythmic disease. On the other hand, the quantitative indices for MIBG differ between institutions, and evidence has not been sufficiently well established for MIBG scintigraphy when compared with myocardial perfusion imaging in ischaemic heart diseases. In consideration of these difficulties, this review provides fundamental information regarding MIBG, its usefulness for various diseases and future difficulties. (orig.)

Neuronal imaging using SPECT

International Nuclear Information System (INIS)

Yamashina, Shohei; Yamazaki, Jun-ichi

2007-01-01

123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is one of only a few methods available for objective evaluation of cardiac sympathetic function at a clinical level. Disorders in cardiac sympathetic function play an important role in various heart diseases, and MIBG provides an abundance of useful information for evaluation of disease severity, prognosis, and therapeutic effects; this information is of particular value in patients with heart failure, ischemic heart diseases, or arrhythmic disorders. On the other hand, the quantitative indices for MIBG differ between institutions, and evidence has not been sufficiently well established for MIBG, compared with myocardial perfusion imaging, in ischemic heart diseases. In view of these difficulties, this review provides fundamental information regarding MIBG, its usefulness for various diseases and future difficulties. (orig.)

The results of questionnaire on quantitative assessment of 123I-metaiodobenzylguanidine myocardial scintigraphy in heart failure

International Nuclear Information System (INIS)

Nishimura, Tsunehiko; Sugishita, Yasurou; Sasaki, Yasuhito.

1997-01-01

This study was done by working group under the cooperation between Japanese Society of Nuclear Medicine and Japanese Circulation Society. We evaluated the usefulness of quantitative assessment of 123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in heart failure by the results of questionnaire. Forty-nine (72.1%) of 68 selected institutions participated in this study. The incidence of MIBG myocardial scintigraphy used in heart failure was 41.1%. The imaging protocol was mostly done by both planar and SPECT at 15 min and 3.6 hr after intravenous injection of 111 MBq of MIBG. The quantitative assessment was mostly done by heart/mediastinum (H/M) ratio and washout rate analysis based on planar imaging. The mean normal value of H/M ratio were 2.34±0.36, and 2.49±0.40, at early and delayed images, respectively. The normal value of washout rate was 27.74±5.34%. On the other hand, those of H/M ratio in heart failure were 1.87±0.27, and 1.75±0.24, at early and delayed images, respectively. That of washout rate was 42.30±6.75%. These parameters were very useful for the evaluation of heart failure. In conclusion, MIBG myocardial scintigraphy was widely used for not only early detection and severity assessment, but also indication for therapy and prognosis evaluation in heart failure patients. (author)

Iodine-131 metaiodobenzylguanidine intra- and extravesicular accumulation in the rat heart

International Nuclear Information System (INIS)

Nakajo, M.; Shimabukuro, K.; Yoshimura, H.; Yonekura, R.; Nakabeppu, Y.; Tanoue, P.; Shinohara, S.

1986-01-01

In order to establish the appropriate time for [ 123 I]MIBG human myocardial imaging to assess the adrenergic nerve activity, the time courses of metaiodobenzylguanidine (MIBG) intra- and extravesicular accumulation in the rat heart were estimated by using [ 131 I]MIBG and reserpine. In the heart, the intravesicular accumulation was relatively constant, while the extravesicular accumulation decreased rapidly from 5 min to 6 hr. The intravesicular percentage of the total cardiac tissue concentration reached a plateau value of 50% at 4 hr after i.v. injection of [ 131 I]MIBG. In the spleen, similar time courses were observed as those in the heart, both of these organs being richly innervated by adrenergic nerves. Along with the time activity difference previously observed in the human hearts, these results suggest that at 4 hr post i.v. injection, [ 123 I]MIBG myocardial imaging will best express the neuronal accumulation of the tracer and may be useful for the assessment of adrenergic function in various pathological conditions of the human heart

Normal and abnormal distribution of the adrenomedullary imaging agent m-[I-131]iodobenzylguanidine (I-131 MIBG) in man; evaluation by scintigraphy

International Nuclear Information System (INIS)

Nakajo, M.; Shapiro, B.; Copp, J.; Kalff, V.; Gross, M.D.; Sisson, J.C.; Beierwaltes, W.H.

1983-01-01

The scintigraphic distribution of m-[ 131 I]iodobenzylguanidine (I-131 MIBG), an adrenal medullary imaging agent, was studied to determine the patterns of uptake of this agent in man. The normal distribution of I-131 MIBG includes clear portrayal of the salivary glands, liver, spleen, and urinary bladder. The heart, middle and lower lung zones, and colon were less frequently or less clearly seen. The upper lung zones and kidneys were seldom visualized. The thyroid appeared only in cases of inadequate thyroidal blockade. The normal adrenal glands were seldom seen and faintly imaged in 2% at 24 h after injection and in 16% at 48 h, in patients shown not to have pheochromocytomas, whereas intra-adrenal, extra-adrenal, and malignant pheochromocytomas usually appeared as intense focal areas of I-131 MIBG uptake at 24 through 72 h

Beneficial effect of perindopril on cardiac sympathetic nerve activity and brain natriuretic peptide in patients with chronic heart failure. Comparison with enalapril

International Nuclear Information System (INIS)

Tsutamoto, Takayoshi; Tanaka, Toshinari; Sakai, Hiroshi

2008-01-01

In patients with chronic heart failure (CHF), it remains unclear whether perindopril is more cardioprotective than enalapril. Forty-five stable CHF outpatients undergoing conventional therapy including enalapril therapy were randomized to 2 groups [group I (n=24): continuous enalapril treatment; group II (n=21): enalapril was changed to perindopril]. Cardiac sympathetic nerve activity was evaluated using cardiac 123 I-metaiodobenzylguanidine (MIBG) scintigraphy, hemodynamic parameters and neurohumoral factors before and 6 months after treatment. There was no difference in baseline characteristics between the 2 groups. In group I, there were no changes in MIBG parameters, left ventricular ejection fraction (LVEF) or plasma level of brain natriuretic peptide (BNP). In contrast, in group II delayed heart/mediastinum count ratio was significantly increased (2.0±0.07 vs 2.15±0.07, p=0.013) and the washout rate was significantly decreased (33.0±1.4 vs 30.5±1.2, p=0.030) after 6 months compared with the baseline value. In addition, LVEF was significantly increased and the plasma BNP level was significantly decreased. These findings suggest that for the treatment of CHF, perindopril is superior to enalapril with respect of cardiac sympathetic nerve activity and BNP. (author)

Neurohumoral indicators of efficacy radiofrequency cardiac denervation

Energy Technology Data Exchange (ETDEWEB)

Evtushenko, A. V., E-mail: ave@cardio-tomsk.ru; Evtushenko, V. V. [National Research Tomsk State University, Tomsk (Russian Federation); Federal State Budgetary Scientific Institution “Research Institute for Cardiology”, Tomsk (Russian Federation); Saushkina, Yu. V.; Gusakova, A. M.; Suslova, T. E.; Dymbrylova, O. N.; Smyshlyaev, K. A.; Kurlov, I. O. [Federal State Budgetary Scientific Institution “Research Institute for Cardiology”, Tomsk (Russian Federation); Lishmanov, Yu. B.; Anfinogenova, Ya. D. [National Research Tomsk Polytechnic University, Tomsk (Russian Federation); Federal State Budgetary Scientific Institution “Research Institute for Cardiology”, Tomsk (Russian Federation); Sergeevichev, D. S. [Academician E.N. Meshalkin State Research Institute of Circulation Pathology, Novosibirsk (Russian Federation); Bykov, A. N.; Syryamkin, V. I.; Kistenev, Yu. V. [National Research Tomsk State University, Tomsk (Russian Federation); Lotkov, A. I. [Institute of Strength Physics and Materials Science of the Siberian Branch of the RAS, Tomsk (Russian Federation); Pokushalov, E. A.

2015-11-17

In this study, we compared pre- and postoperative parameters of the cardiac sympathetic innervation. The aim of the study was to examine the approaches to evaluating the quality of radiofrequency (RF)-induced cardiac denervation by using non-invasive and laboratory methods. The study included 32 people with long-lasting persistent atrial fibrillation (AF). The patients were divided into 2 groups according to the objectives of the study: group 1 (main) - 21 patients with mitral valve diseases, which simultaneously with radiofrequency ablation (RFA) AF carried out on the effects of the paraganglionic nervous plexuses by C. Pappone (2004) and N. Doll (2008) schemes. The second group (control) contained 11 patients with heart diseases in sinus rhythm (the RF denervation not been performed). All patients, who underwent surgical treatment, were received examination of cardiac sympathetic tone by using {sup 123}I-MIBG. All of them made blood analysis from ascending aorta and coronary sinus to determine the level of norepinephrine and its metabolites before and after cardiac denervation. Data of radionuclide examination are correlating with laboratory data.

The clinical value of cardiac sympathetic imaging in heart failure

DEFF Research Database (Denmark)

Christensen, Thomas Emil; Kjaer, Andreas; Hasbak, Philip

2014-01-01

The autonomic nervous system plays an important role in the pathology of heart failure. The single-photon emission computed tomography tracer iodine-123-metaiodobenzylguanidine ((123) I-MIBG) can be used to investigate the activity of the predominant neurotransmitter of the sympathetic nervous...

MIBG-treatment in neuroblastoma

International Nuclear Information System (INIS)

Treuner, J.; Gerein, V.; Klingebiel, T.; Schwabe, D.; Feine, U; Happ, J.; Niethammer, D.; Maul, F.; Dopfer, R.; Kornhuber, B.; Berthold, F.; Jurgens, H.; Hor, G.

1988-01-01

This paper reports the results of 27 children with neuroblastoma treated with 131 I-Metaiodobenzylguanidine (MIBG). They were either refractory to conventional therapy or experienced relapse after initially successful treatment. 7 children revealed stage IV and 20 stage III at the beginning of MIBG-treatment. MIBG was administered by infusion lasting from 30 min to 30 hrs. In most children the dose was split into two portions each infused over a period of 4 hrs with a 24 hrs interval between. Courses were repeated up to 6 times and maximum activity given to one patient cumulatively was 38,221 MBq. 24 patients were valuable for analysis of results

The results of questionnaire on quantitative assessment of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy in heart failure

Energy Technology Data Exchange (ETDEWEB)

Nishimura, Tsunehiko [Osaka Univ., Suita (Japan). Medical school; Sugishita, Yasurou; Sasaki, Yasuhito

1997-12-01

This study was done by working group under the cooperation between Japanese Society of Nuclear Medicine and Japanese Circulation Society. We evaluated the usefulness of quantitative assessment of {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in heart failure by the results of questionnaire. Forty-nine (72.1%) of 68 selected institutions participated in this study. The incidence of MIBG myocardial scintigraphy used in heart failure was 41.1%. The imaging protocol was mostly done by both planar and SPECT at 15 min and 3.6 hr after intravenous injection of 111 MBq of MIBG. The quantitative assessment was mostly done by heart/mediastinum (H/M) ratio and washout rate analysis based on planar imaging. The mean normal value of H/M ratio were 2.34{+-}0.36, and 2.49{+-}0.40, at early and delayed images, respectively. The normal value of washout rate was 27.74{+-}5.34%. On the other hand, those of H/M ratio in heart failure were 1.87{+-}0.27, and 1.75{+-}0.24, at early and delayed images, respectively. That of washout rate was 42.30{+-}6.75%. These parameters were very useful for the evaluation of heart failure. In conclusion, MIBG myocardial scintigraphy was widely used for not only early detection and severity assessment, but also indication for therapy and prognosis evaluation in heart failure patients. (author)

The normal and abnormal distribution of the adrenomedullary imaging agent m-[I-131]iodobenzylguanidine (I-131 MIBG) in man: evaluation by scintigraphy

International Nuclear Information System (INIS)

Nakajo, M.; Shapiro, B.; Copp, J.; Kalff, V.; Gross, M.D.; Sisson, J.C.; Beierwaltes, W.H.

1983-01-01

The scintigraphic distribution of m-[ 131 I]iodobenzylguanidine (I- 131 MIBG), an adrenal medullary imaging agent, was studied to determine the patterns of uptake of this agent in man. The normal distribution of I- 131 MIBG includes clear portrayal of the salivary glands, liver, spleen, and urinary bladder. The heart, middle and lower lung zones, and colon were less frequently or less clearly seen. The upper lung zones and kidneys were seldom visualized. The thyroid appeared only in cases of inadequate thyroidal blockade. The ''normal'' adrenal glands were seldom seen and faintly imaged in 2% at 24 hr after injection and in 16% at 48 hr, in patients shown not to have pheochromocytomas, whereas intra-adrenal, extraadrenal, and malignant pheochromocytomas usually appeared as intense focal areas of I- 131 MIBG uptake at 24 through 72 hr

A significant discrepancy of uptake between I-131 MIBG and F-18 FDG in a patient with malignant paraganglioma

Energy Technology Data Exchange (ETDEWEB)

Kim, Jong Su; Kim, Hyun Keun; Choi, Kyu Young; Park, Hyung Ki; Kim, Eun Sil; Kim, Yun Kwon; Kim, So Yon [National Police Hospital, Seoul (Korea, Republic of)

2007-06-15

A 38-year-old man who was diagnosed with malignant paraganglioma underwent computed tomography (CT) and I-131 metaiodobenzylguanidine (MIBG) scan. CT showed extensive lymph node enlargement in right iliac area and retroperitoneum with severe hydronephrosis and mass on posterior bladder wall. However, I-131 MIBG scan didn't showed abnormal uptake. He also underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography/CT for localizing accurate tumor site. F-18 FDG PET/CT showed multiple metastases of left supraclavicular, hilar, mediastinal para-aortic, inguinal, right iliac lymph nodes, lung, vertebrae, and pelvis. There are a few reports showing that the F-18 FDG PET/CT is helpful for staging and localizing tumor site of patients who are diagnosed with negative on the MIBG scans. Thus, we report a case with paraganglioma which showed negative I-131 MIBG scan, but revealed multiple intense hypermetabolic foci in F-18 FDG PET/CT.

Survival improvement in patients with disseminated medullary thyroid carcinoma treated with 131I-MIBG therapy

International Nuclear Information System (INIS)

Mihaljevic, I.; Topuzovi, N.; Snajder, D.

2015-01-01

Full text of publication follows. Introduction and aim: The aim of this paper is to present our experience of 131 I-MIBG therapy in the cases of aggressive form of medullary thyroid carcinoma (MTC) with local and distant metastases. MTC is an uncommon thyroid tumor, accounting from 3-5% of all thyroid malignancies, and arises from para-follicular C cells which produce calcitonin (CT). Prognosis of MTC is related to tumor extension at disease detection, but long-term survival in patients with disseminated MTC is still unsatisfactory. Methods: 4 female patients with metastatic MTC (63, 69 and 2 patients aged 73 years), which already underwent total thyroidectomy and selective neck dissection, received therapy with 100 mCi 131 I-MIBG in our Institute. Patients had widespread disease with neck recurrences (all 4 cases), liver and bone metastases (2 cases) and lung metastases (1 case). All those patients received the therapy twice, second one 3 months up to 1 year after the first cycle. After therapy, whole body scintigraphy was performed; tumor marker levels (CT, carcinoembryonic antigen - CEA, neuron specific enolase - NSE, chromogranin A - CgA and pro-gastrin releasing peptide - pro-GRP) were measured before and after therapy. Results: in one patient we observed a slight decrease in CT level after first MIBG therapy, in another one a slight decrease in CEA serum level, and no lung metastases were visible on whole body scan after second 131 I-MIBG therapy. In one of the two remaining cases there was a significant decrease in CT serum level only after neck dissection. In all cases the patients reported an improvement in subjective symptom reduction. Conclusion: 131 I-MIBG therapy could provide additional benefit to patients with MTC and could improve overall survival, but more patient should be treated in order to define the true potential of the therapy. The aim of this paper is to present our experience of 131 I-MIBG therapy in the cases of aggressive form of

Radiochemical and biological control of metaiodobenzyl-guanidine (MIBG) labeled with 131I

International Nuclear Information System (INIS)

Barboza, M.R.F.F. de; Muramoto, E.; Colturato, M.T.; Silva Valente Goncalves, R. da; Pereira, N.P.S. de; Almeida, M.A.T.M. de; Silva, C.P.G. da.

1988-07-01

This study shows the standardization of the radiochemical control of MIBG - 131 I in eletrophoretic system and also the biological control in Wistar rat for a period of time, not longer than 60 minutes after tracer administration. (author) [pt

Whole body dosimetry for treatment individualized neuroblastoma with 131I-MIBG

International Nuclear Information System (INIS)

Ferrer Gracia, C.; Luquero Llopis, N.; Sanchez Munoz, F.; Plaza Aparicio, R.; Huerga Cabrerizo, C.; Corredoira Silva, E.; Serrada Hierro, A.

2013-01-01

It according to in this study, that in therapy with 1 31I-MIBG for the treatment of neuroblastoma, it can prescribe and manage dose whole body accurately, allowing individualized treatments and major activities that in the treatments based on a fixed activity according to weight management. (Author)

131I-MIBG followed by consolidation with busulfan, melphalan and autologous stem cell transplantation for refractory neuroblastoma.

Science.gov (United States)

French, Sarah; DuBois, Steven G; Horn, Biljana; Granger, Meaghan; Hawkins, Randall; Pass, Amy; Plummer, Ellen; Matthay, Katherine

2013-05-01

(131) I-metaiodobenzylguanidine (MIBG) produces a 37% response rate in relapsed/refractory neuroblastoma, and could be used to improve remission status prior to myeloablative chemotherapy with autologous stem cell transplant (ASCT). The purpose of our report was to evaluate safety and response with MIBG therapy followed by myeloablative busulfan and melphalan (BuMel) with ASCT in patients with refractory neuroblastoma. Retrospective chart review was done on patients treated with MIBG (18 mCi/kg) on Day 1 and ASCT on day 14. Six to eight weeks after MIBG, patients without progressive disease received IV busulfan on days -6 to -2 (target Css 700-900), melphalan (140 mg/m2 IV) on day -1, and ASCT on Day 0. Response and toxicity were evaluated after MIBG and again after myeloablative therapy. Eight patients completed MIBG/ASCT followed by BuMel/ASCT. MIBG was well tolerated, with grade 3 or 4 non-hematologic toxicity limited to one patient with sepsis. Grade 3 mucositis occurred in six patients after BuMel/ASCT. One patient developed sinusoidal obstructive syndrome (SOS) and died 50 days post-ASCT following myeloablative conditioning. All patients engrafted neutrophils (median 16.5 days) and platelets (median 32 days) after BuMel, excluding the patient with SOS. After all therapy, there were three complete, two partial, and one minor response in seven evaluable patients. MIBG at doses up to 18 mCi/kg can be safely administered 6 weeks prior to a BuMel consolidative regimen for refractory neuroblastoma. Preceding MIBG did not impair engraftment following BuMel. This regimen is being further evaluated in a Children's Oncology Group (COG) trial. Copyright © 2012 Wiley Periodicals, Inc.

Usefulness of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy for predicting the effectiveness of {beta}-blockers in patients with dilated cardiomyopathy from the standpoint of long-term prognosis

Energy Technology Data Exchange (ETDEWEB)

Fujimoto, Shinichiro; Inoue, Aritomo; Hisatake, Shinji; Yamashina, Shohei; Yamashina, Hisayo; Nakano, Hajime; Yamazaki, Junichi [Toho University School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Tokyo (Japan)

2004-10-01

The usefulness of {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in predicting the effectiveness of {beta}-blocker therapy in dilated cardiomyopathy (DCM) was investigated from the standpoint of long-term prognosis. The subjects were 53 DCM patients in whom {beta}-blockers had been successfully introduced and used for 6 months or longer. When symptoms were stable before the introduction of {beta}-blockers and for up to 1 year thereafter, MIBG myocardial single-photon emission computed tomography was performed and the images analysed to obtain the extent score (EXT), severity score (SEV) and washout rate (WR). At the same time, echocardiography was performed to measure left ventricular ejection fraction (LVEF). Thereafter, patients were placed under observation for an average of 1,314{+-}986 days, with the occurrence of cardiac events as the endpoint. The degree of improvement in WR after introduction of {beta}-blockers was a significant predictor of cardiac events. In fact, none of the patients whose improvement in WR was valued at 10 or higher had cardiac events. Accordingly, using improvement in WR of 10 as the cut-off value, the patients were divided into two groups, ''improved'' and ''unimproved''. There were significant differences between the groups in respect of early EXT, early SEV and WR before the introduction of {beta}-blockers. As regards predictors of WR improvement, multivariate logistic regression analysis demonstrated that early EXT, WR and LVEF were significant predictors. This study shows that, from the standpoint of long-term prognosis, DCM patients who would benefit the most from {beta}-blocker therapy are those with low early EXT and early SEV and high WR before {beta}-blocker introduction regardless of LVEF values. (orig.)

Clinical usefulness of {sup 123}I-BMIPP myocardial SPECT in collagen disease

Energy Technology Data Exchange (ETDEWEB)

Ito, Kazuki; Zen, Kan [Asahi Univ., Gifu (Japan). Murakami Memorial Hospital; Sugihara, Hiroki (and others)

2000-07-01

This study was designed to evaluate the clinical usefulness of {sup 123}I-BMIPP myocardial SPECT for detecting cardiac involvement in patients with collagen disease. We studied 12 patients with systemic lupus erythematosus (SLE), 8 with progressive systemic sclerosis (PSS), 6 with polymyositis/dermatomyositis (PM/DM) and 3 with allergic granulomatosis and angiitis (AGA). A 111 MBq of {sup 123}I-BMIPP was intravenously injected at rest, and SPECT images were obtained at 15 min after the injection. Seven of 12 SLE, 6 of 8 PSS, 3 of 6 PM/DM and all 3 AGA patients showed an abnormal tracer uptake. The left ventricular ejection fraction was inversely correlated with a BMIPP abnormality. The regional wall motion abnormality was reduced in regions with reduced tracer uptake. These findings suggest that {sup 123}I-BMIPP imaging could be useful for assessment of cardiac involvement in patients with collagen disease. (author)

Evaluation of sympathetic nerve system activity with MIBG. Comparison with heart rate variability

International Nuclear Information System (INIS)

Kurata, Chinori; Wakabayashi, Yasushi; Shouda, Sakae; Mikami, Tadashi; Tawarahara, Kei; Sugiyama, Tsuyoshi; Nakano, Tomoyasu; Suzuki, Toshihiko.

1997-01-01

Authors attempted to elucidate the relations of plasma concentration of norepinephrine (pNE) and findings of heart rate variability and MIBG myocardial scintigraphy and evaluated cardiac autonomic nervous activity in chronic renal failure. Subjects were 211 patients with various heart diseases (coronary artery lesion, cardiomyopathy, hypertension, diabetes mellitus, renal failure and so on), 60 patients with artificial kidney due to chronic renal failure, 13 of whom were found to have coronary arterial disease by Tl myocardial scintigraphy, and 14 normal volunteers. ECG was recorded with the portable recorder for heart rate variability. Together with collection of blood for pNE measurement, myocardial scintigraphy was done at 15 and 150 min after intravenous administration of 111 MBq of MIBG for acquisition of early and delayed, respectively, images of the frontal breast. Accumulation at and elimination during the time points of MIBG were computed in cps unit. Variability of heart rate was found to have the correlation positive with MIBG delayed accumulation and negative with the elimination, and pNE, negative with heart rate variability and the delayed accumulation and positive with the elimination. Thus cardiac autonomic nervous abnormality was suggested to occur before uremic cardiomyopathy. (K.H.)

Malign pheochromocytoma: importance of the scintigraphic follow-up with metaiodobenzulguanidine 131I (MIBG-131I)

International Nuclear Information System (INIS)

Kato, M.; Velhote, V.V.; Souto, F.J.P.; Long, Y.J.; Costa, P.L.A.

1989-01-01

The authors report a case of pheochromocytoma investigated with metaiodobenzylguanidine labeled with 131 I (MIBG- 131 I). The methodology identify primitive lesion, its recurrence and metastasis. The authors mention the advantage of the technique due to the high specificity, sensitivity and because it is harmless, offering optimal information about the morphology and functional nature, concerning diagnosis and follow-up of the disease. (author) [pt

{sup 123}I-mIBG scintigraphy in neuroblastoma: development of a SIOPEN semi-quantitative reporting,method by an international panel

Energy Technology Data Exchange (ETDEWEB)

Lewington, V. [King' s College, London (United Kingdom); Lambert, B. [Ghent University, Radiology and Nuclear Medicine, Ghent (Belgium); Poetschger, U. [Children' s Cancer Research Institute, Department for Studies and Statistics on Integrated Research and Projects (S2IRP), Vienna (Austria); Sever, Z. Bar [Schneider Children' s Medical Centre of Israel, Petach-Tikva (Israel); Giammarile, F. [CHLS, Pierre-Benite (France); McEwan, A.J.B. [Cross Cancer Institute, Edmonton (Canada); Castellani, Rita [Fondazione IRCCS Istituto Nazionale dei Tumori, Nuclear Medicine, Milan (Italy); Lynch, T. [Northern Ireland Cancer Centre, Belfast (United Kingdom); Shulkin, B. [St Jude' s Children' s Research Hospital, Memphis (United States); Drobics, M. [Information Management and eHealth, AIT Austrian Institute of Technology GmbH Safety and Security Department, Vienna (Austria); Staudenherz, A. [AKH, Vienna (Austria); Ladenstein, R. [Children' s Cancer Research Institute, Department for Studies and Statistics on Integrated Research and Projects (S2IRP), Vienna (Austria); St. Anna Children' s Hospital and Medical University, Vienna (Austria)

2017-02-15

A robust method is required to standardise objective reporting of diagnostic {sup 123}I-mIBG images in neuroblastoma. Prerequisites for an appropriate system are low inter- and intra-observer error and reproducibility across a broad disease spectrum. We present a new reporting method, developed and tested for SIOPEN by an international expert panel. Patterns of abnormal skeletal {sup 123}I-mIBG uptake were defined and assigned numerical scores [0-6] based on disease extent within 12 body segments. Uptake intensity was excluded from the analysis. Data sets from 82 patients were scored independently by six experienced specialists as unblinded pairs (pre- and post-induction chemotherapy) and in random order as a blinded study. Response was defined as ≥50 % reduction in post induction score compared with baseline. In total, 1968 image sets were reviewed individually. Response rates of 88 % and 82 % were recorded for patients with baseline skeletal scores ≤23 and 24-48 respectively, compared with 44 % response in patients with skeletal scores >48 (p = 0.02). Reducing the number of segments or extension scale had a small but statistically negative impact upon the number of responses detected. Intraclass correlation coefficients [ICCs] calculated for the unblinded and blinded study were 0.95 at diagnosis and 0.98 and 0.99 post-induction chemotherapy, respectively. The SIOPEN mIBG score method is reproducible across the full spectrum of disease in high risk neuroblastoma. Numerical assessment of skeletal disease extent avoids subjective evaluation of uptake intensity. This robust approach provides a reliable means with which to examine the role of 123I mIBG scintigraphy as a prognostic indicator in neuroblastoma. (orig.)

Impaired mitochondrial respiration and stimulated glycolysis by m-iodobenzylguanidine (MIBG)

NARCIS (Netherlands)

Loesberg, C.; van Rooij, H.; Nooijen, W. J.; Meijer, A. J.; Smets, L. A.

1990-01-01

m-Iodobenzylguanidine (MIBG) is a functional analogue of the neurotransmitter norepinephrine. Radio-iodinated 131I-MIBG is used clinically as a tumor-targeted radiopharmaceutical agent in the diagnosis and treatment of adrenergic tumors. Native MIBG has previously been demonstrated to be cytotoxic

New horizons in cardiac innervation imaging. Introduction of novel 18F-labeled PET tracers

International Nuclear Information System (INIS)

Kobayashi, Ryohei; Chen, Xinyu; Werner, Rudolf A.; Lapa, Constantin; Javadi, Mehrbod S.; Higuchi, Takahiro

2017-01-01

Cardiac sympathetic nervous activity can be uniquely visualized by non-invasive radionuclide imaging techniques due to the fast growing and widespread application of nuclear cardiology in the last few years. The norepinephrine analogue 123 I-meta-iodobenzylguanidine ( 123 I-MIBG) is a single photon emission computed tomography (SPECT) tracer for the clinical implementation of sympathetic nervous imaging for both diagnosis and prognosis of heart failure. Meanwhile, positron emission tomography (PET) imaging has become increasingly attractive because of its higher spatial and temporal resolution compared to SPECT, which allows regional functional and dynamic kinetic analysis. Nevertheless, wider use of cardiac sympathetic nervous PET imaging is still limited mainly due to the demand of costly on-site cyclotrons, which are required for the production of conventional 11 C-labeled (radiological half-life, 20 min) PET tracers. Most recently, more promising 18 F-labeled (half-life, 110 min) PET radiopharmaceuticals targeting sympathetic nervous system have been introduced. These tracers optimize PET imaging and, by using delivery networks, cost less to produce. In this article, the latest advances of sympathetic nervous imaging using 18 F-labeled radiotracers along with their possible applications are reviewed. (orig.)

Effect of Atorvastatin vs. Rosuvastatin on cardiac sympathetic nerve activity in non-diabetic patients with dilated cardiomyopathy

Energy Technology Data Exchange (ETDEWEB)

Tsutamoto, Takayoshi; Ibe, Kunihiro [Toyosato Hospital, Toyosato, Shiga (Japan); Sakai, Hiroshi; Yamaji, Masayuki; Kawahara, Chiho; Nakae, Ichiro; Fujii, Masanori; Yamamoto, Takashi; Horie, Minoru [Shiga Univ. of Medical Science, Faculty of Medicine, Otsu, Shiga (Japan)

2011-08-15

Effects of statin therapy on cardiac sympathetic nerve activity in patients with chronic heart failure (CHF) have not previously been evaluated. To compare the effects of lipophilic atorvastatin and hydrophilic rosuvastatin on cardiac sympathetic nerve activity in CHF patients with dilated cardiomyopathy (DCM), 63 stable outpatients with DCM, who were already receiving standard therapy for CHF, were randomized to atorvastatin (n=32) or rosuvastatin (n=31). We evaluated cardiac sympathetic nerve activity by cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy, hemodynamic parameters and neurohumoral factors before and after 6 months of treatment. There were no differences in the baseline characteristics of the 2 groups. In the rosuvastatin group, there were no changes in MIBG parameters, left ventricular ejection fraction or plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) after 6 months of treatment. In contrast, the atorvastatin group showed a significant increase in the delayed heart/mediastinum count ratio (2.18{+-}0.4 vs. 2.36{+-}0.4, P<0.0001), and the washout rate was significantly decreased (34.8{+-}5.7 vs. 32.6{+-}6.3%, P=0.0001) after 6 months of treatment compared with the baseline values. The plasma NT-proBNP level was also significantly decreased (729{+-}858 vs. 558{+-}747 pg/ml, P=0.0139). Lipophilic atorvastatin but not hydrophilic rosuvastatin improves cardiac sympathetic nerve activity in CHF patients with DCM. (author)

Is it time for cardiac innervation imaging?

Energy Technology Data Exchange (ETDEWEB)

Knuuti, J. [Turku Univ., Turku (Finland) Turku PET Center; Sipola, P. [Kuopio Univ., Kuopio (Finland)

2005-03-01

The autonomic nervous system plays an important role in the regulation of cardiac function and the regional distribution of cardiac nerve terminals can be visualized using scintigraphic techniques. The most commonly used tracer is iodine-123-metaiodobenzylguanidine (MIBG) but C-11-hydroxyephedrine has also been used with PET. When imaging with MIBG, the ratio of heart-to-mediastinal counts is used as an index of tracer uptake, and regional distribution is also assessed from tomographic images. The rate of clearance of the tracer can also be measured and indicates the function of the adrenergic system. Innervation imaging has been applied in patients with susceptibility to arrythmias, coronary artery disease, hypertrophic and dilated cardiomyopathy and anthracycline induced cardiotoxicity. Abnormal adrenergic innervation or function appear to exist in many pathophysiological conditions indicating that sympathetic neurons are very susceptible to damage. Abnormal findings in innervation imaging also appear to have significant prognostic value especially in patients with cardiomyopathy. Recently, it has also been shown that innervation imaging can monitor drug-induced changes in cardiac adrenergic activity. Although innervation imaging holds great promise for clinical use, the method has not received wider clinical acceptance. Larger randomized studies are required to confirm the value of innervation imaging in various specific indications.

"1"2"3I-mIBG scintigraphy in neuroblastoma: development of a SIOPEN semi-quantitative reporting,method by an international panel

International Nuclear Information System (INIS)

Lewington, V.; Lambert, B.; Poetschger, U.; Sever, Z. Bar; Giammarile, F.; McEwan, A.J.B.; Castellani, Rita; Lynch, T.; Shulkin, B.; Drobics, M.; Staudenherz, A.; Ladenstein, R.

2017-01-01

A robust method is required to standardise objective reporting of diagnostic "1"2"3I-mIBG images in neuroblastoma. Prerequisites for an appropriate system are low inter- and intra-observer error and reproducibility across a broad disease spectrum. We present a new reporting method, developed and tested for SIOPEN by an international expert panel. Patterns of abnormal skeletal "1"2"3I-mIBG uptake were defined and assigned numerical scores [0-6] based on disease extent within 12 body segments. Uptake intensity was excluded from the analysis. Data sets from 82 patients were scored independently by six experienced specialists as unblinded pairs (pre- and post-induction chemotherapy) and in random order as a blinded study. Response was defined as ≥50 % reduction in post induction score compared with baseline. In total, 1968 image sets were reviewed individually. Response rates of 88 % and 82 % were recorded for patients with baseline skeletal scores ≤23 and 24-48 respectively, compared with 44 % response in patients with skeletal scores >48 (p = 0.02). Reducing the number of segments or extension scale had a small but statistically negative impact upon the number of responses detected. Intraclass correlation coefficients [ICCs] calculated for the unblinded and blinded study were 0.95 at diagnosis and 0.98 and 0.99 post-induction chemotherapy, respectively. The SIOPEN mIBG score method is reproducible across the full spectrum of disease in high risk neuroblastoma. Numerical assessment of skeletal disease extent avoids subjective evaluation of uptake intensity. This robust approach provides a reliable means with which to examine the role of 123I mIBG scintigraphy as a prognostic indicator in neuroblastoma. (orig.)

Iodine-131 MIBG scintigraphy of the extremities in metastatic pheochromocytoma and neuroblastoma

International Nuclear Information System (INIS)

Shulkin, B.L.; Shen, S.W.; Sisson, J.C.; Shapiro, B.

1987-01-01

Iodine-131 MIBG scintigraphy may be used to determine the presence or absence of metastases to the appendicular skeleton in malignant pheochromocytoma and neuroblastoma. Normal bones show no uptake of [ 131 I]MIBG and the joints are seen as photon-deficient areas surrounded by background muscle activity. Discrete concentrations of radioactivity in bone are often seen in patients with malignant pheochromocytoma and neuroblastoma. Bone marrow involvement in neuroblastoma may be indicated by diffuse uptake of [ 131 I]MIBG or focal accumulation at the metaphyses. Uncommonly, bone involvement may not be displayed by the [ 131 I]MIBG images. Since conventional bone scanning agents may also fail to detect these tumors, skeletal scintigraphy with both [ 131 I]MIBG and [/sup 99m/Tc]MDP is necessary to reliably stage malignant pheochromocytoma and neuroblastoma

New horizons in cardiac innervation imaging. Introduction of novel {sup 18}F-labeled PET tracers

Energy Technology Data Exchange (ETDEWEB)

Kobayashi, Ryohei [University Hospital of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Nihon Medi-Physics Co., Ltd., Research Centre, Chiba (Japan); Chen, Xinyu [University Hospital of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); University Hospital of Wuerzburg, Comprehensive Heart Failure Center, Wuerzburg (Germany); Werner, Rudolf A. [University Hospital of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); University Hospital of Wuerzburg, Comprehensive Heart Failure Center, Wuerzburg (Germany); Johns Hopkins School of Medicine, The Russell H Morgan Department of Radiology and Radiological Sciences, Baltimore, MD (United States); Lapa, Constantin [University Hospital of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Javadi, Mehrbod S. [Johns Hopkins School of Medicine, The Russell H Morgan Department of Radiology and Radiological Sciences, Baltimore, MD (United States); Higuchi, Takahiro [University Hospital of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); University Hospital of Wuerzburg, Comprehensive Heart Failure Center, Wuerzburg (Germany); National Cerebral and Cardiovascular Center, Department of Biomedical Imaging, Research Institute, Suita (Japan)

2017-12-15

Cardiac sympathetic nervous activity can be uniquely visualized by non-invasive radionuclide imaging techniques due to the fast growing and widespread application of nuclear cardiology in the last few years. The norepinephrine analogue {sup 123}I-meta-iodobenzylguanidine ({sup 123}I-MIBG) is a single photon emission computed tomography (SPECT) tracer for the clinical implementation of sympathetic nervous imaging for both diagnosis and prognosis of heart failure. Meanwhile, positron emission tomography (PET) imaging has become increasingly attractive because of its higher spatial and temporal resolution compared to SPECT, which allows regional functional and dynamic kinetic analysis. Nevertheless, wider use of cardiac sympathetic nervous PET imaging is still limited mainly due to the demand of costly on-site cyclotrons, which are required for the production of conventional {sup 11}C-labeled (radiological half-life, 20 min) PET tracers. Most recently, more promising {sup 18}F-labeled (half-life, 110 min) PET radiopharmaceuticals targeting sympathetic nervous system have been introduced. These tracers optimize PET imaging and, by using delivery networks, cost less to produce. In this article, the latest advances of sympathetic nervous imaging using {sup 18}F-labeled radiotracers along with their possible applications are reviewed. (orig.)

A novel route to radioiodinated [{sup 123}I]-N-succinimidyl-3-iodobenzoate, a reagent for radioiodination of bioactive peptides

Energy Technology Data Exchange (ETDEWEB)

Al-Jammaz, I.; Al-Otaibi, B.; Amartey, J.K. E-mail: amarty@kfshrc.edu.sa

2002-11-01

Radiolabeled peptides continue to emerge as potential radiopharmaceuticals for targeting several diseases such as cancer, infection and inflammation and even tissue and organ rejection. The classical method for labeling these molecules has been the electrophilic route. Evidence suggests that most molecules labeled via this route perturb their biological activity. Moreover, this method is not applicable to peptides lacking a tyrosine moiety in their structure. Hence, there is the need to develop alternate methods such as the prosthetic approach. We have optimized a solid-state radioiodination by exchange to produce [{sup 123}I]-metaiodobenzylguanidine ([{sup 123}I]-mIBG). The mIBG served as a precursor to obtain an activated N-succinimidyl ester for efficient coupling to amine functions in peptides, preferably the lysine group(s). The method was used to label a model chemotactic peptide and evaluated in vivo.

Whole body dosimetry for treatment individualized neuroblastoma with {sup 1}31I-MIBG; Dosimetria de cuerpo entero para el tratamiento individualizado del neuroblastoma con {sup 1}31I-MIBG

Energy Technology Data Exchange (ETDEWEB)

Ferrer Gracia, C.; Luquero Llopis, N.; Sanchez Munoz, F.; Plaza Aparicio, R.; Huerga Cabrerizo, C.; Corredoira Silva, E.; Serrada Hierro, A.

2013-07-01

It according to in this study, that in therapy with {sup 1}31I-MIBG for the treatment of neuroblastoma, it can prescribe and manage dose whole body accurately, allowing individualized treatments and major activities that in the treatments based on a fixed activity according to weight management. (Author)

Estimation of 123I-metaiodobenzylguanidine lung uptake in heart and lung diseases. With reference to lung uptake ratio and decrease of lung uptake

International Nuclear Information System (INIS)

Fujii, Tadashige; Tanaka, Masao; Yazaki, Yoshikazu; Kitabayashi, Hiroshi; Koizumi, Tomonori; Sekiguchi, Morie; Gomi, Tsutomu; Yano, Kesato; Itoh, Atsuko.

1997-01-01

123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was performed in 64 patients with heart and lung diseases. Distribution of MIBG in the chest was evaluated by planar images, using counts ratios of the heart to the mediastinum (H/M) and the unilateral lung to the mediastinum (Lu/M). Most of patients with heart diseases showed obvious lung uptake of MIBG. The ratios of H/M were 1.75±0.20 in the group without heart failure and 1.55±0.19 in the group with heart failure. The ratios of Lu/M in the right and left lung were 1.56±0.16 and 1.28±0.16 in the group without heart failure. And those were 1.45±0.16 and 1.19±0.15 in the group with heart failure. But 3 patients complicated with chronic pulmonary emphysema and one patient with interstitial pneumonia due to dermatomyositis showed markedly decreased lung uptake. The ratios of Lu/M in the right and left lung of these patients were 1.20, 1.17; 1.17, 1.13; 1.01, 0.97 and 1.27, 0.94, respectively. These results suggest that the lung uptake of MIBG may reflect the state of pulmonary endothelial cell function in clinical situations, considering that it has been demonstrated that MIBG may be useful as a marker of pulmonary endothelial cell function in the isolated rat lung. (author)

Pitfall of Sipple's syndrome diagnosis by 131I-metaiodobenzylguanidine (MIBG)

International Nuclear Information System (INIS)

Talbot, J.N.; Coutris, G.; Milhaud, G.

1987-01-01

In a patient apparently cured by surgery from bronchial carcinoid tumor, MIBG uptake occurred both in an adrenal glan and in thyroid nodules (cold with 131 I), suggesting the presence of a Sipple's syndrome (association of pheochromocytoma and medullary carcinoma of the thyroid, MCT), the more so since plasma calcitonin levels were markedly increased. Histological findings showed however that the tumoral tissues were neither pheochromocytoma nor MCT but rather a neuroendocrine metastatic tissue

MIBG scintigraphy of the heart

International Nuclear Information System (INIS)

Hacker, M.; Weiss, M.

2009-01-01

The sympathetic nervous system plays an important role in cardiovascular physiology. Planar MIBG with or without SPECT can be used to visualize the sympathetic innervation of the heart and the abnormalities in innervation caused by, for example, ischemia, heart failure, and arrhythmogenic disorders. Furthermore, cardiac neuronal imaging allows early detection of autonomic neuropathy in diabetes mellitus. Assessment of sympathetic nerve activity in patients with heart failure has been shown to provide important prognostic information, and cardiac neuronal imaging can potentially identify patients who are at increased risk of sudden death. Moreover, therapeutic effects of different treatment strategies can be evaluated by imaging. To establish the clinical utility of cardiac neuronal imaging, it will be necessary to determine the incremental value of innervation imaging to triage heart failure patients to medical therapy, CRT (with or without ICD), or heart transplantation. (orig.)

Prediction of cardiac sympathetic nerve activity and cardiac functional outcome after treatment in patients with dilated cardiomyopathy. Examination using dobutamine gated blood pool scintigraphy

Energy Technology Data Exchange (ETDEWEB)

Kasama, Shu; Toyama, Takuji; Iwasaki, Tsutomu; Suzuki, Tadashi [Gunma Univ., Maebashi (Japan). School of Medicine; Hoshizaki, Hiroshi; Oshima, Shigeru; Taniguchi, Koichi; Nagai, Ryozo

2000-07-01

This study evaluated whether dobutamine gated blood pool scintigraphy can predict improvement of cardiac sympathetic nerve activity and cardiac function. Sixteen patients (10 men and 6 women, mean age 59{+-}13 years) with dilated cardiomyopathy underwent dobutamine gated blood pool scintigraphy to measure left ventricular ejection fraction (LVEF) using tracer at 0, 5, 10 and 15 {mu}g/kg/min before treatment. Patients were divided into good responders (LVEF increase {>=}15%) 8 patients (GR Group) and poor responders (LVEF increase <15%) 8 patients (PR Group) after treatment with {beta}-blocker or amiodarone with a background treatment of digitalis, diuretics and angiotensin converting enzyme inhibitor. I-123 metaiodobenzylguanidine (MIBG) imaging to evaluate cardiac sympathetic nerve activity and echocardiography were performed before and at one year after treatment. MIBG imaging was obtained 4 hours after tracer injection, and the heart/mediastinum count ratio (H/M ratio) calculated from the anterior planar image and the total defect score (TDS) from the single photon emission computed tomography image. LVEF and left ventricular endo-diastolic dimension (LVDd) were measured by echocardiography and New York Heart Association (NYHA) functional class was evaluated. The GR Group showed TDS decreased from 28{+-}6 to 17{+-}12 (p<0.05), H/M ratio increased from 1.79{+-}0.26 to 2.07{+-}0.32 (p<0.05), LVEF increased from 29{+-}8% to 48{+-}10% (p<0.01), and LVDd decreased from 65{+-}4 mm to 58{+-}5 mm (p<0.05). In contrast, the PR group showed no significant changes in TDS. H/M ratio, LVEF and LVDd. NYHA functional class improved in both groups. The improvement was better in the GR Group than in the PR group. Dobutamine gated blood pool scintigraphy is useful to predict the improvement of the cardiac sympathetic nerve activity and cardiac function, and symptoms after treatment in patients with dilated cardiomyopathy. (author)

Iodine 123-labeled meta-iodobenzylguanidine myocardial scintigraphy in the cases of idiopathic Parkinson`s disease, multiple system atrophy, and progressive supranuclear palsy

Energy Technology Data Exchange (ETDEWEB)

Yoshita, Mitsuhiro; Hayashi, Michiyuki; Hirai, Shunsaku [Tokyo Metropolitan Neurological Hospital (Japan)

1997-06-01

To investigate cardiac sympathetic function in Parkinson`s disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP), {sup 123}I-MIBG myocardial scintigraphy was performed in 25 patients with PD, 25 patients with MSA, 14 patients with PSP, and 20 control subjects. In planar imaging studies, the heart-to-mediastinum average count ratio (H/M) was calculated for both early and delayed images. The mean value of H/M in patients with PD was significantly lower than in those with MSA, PSP, or no disease. Regardless of disease severity or intensity of anti-parkinsonian pharmacotherapy, mean values for H/M were always low in patients with PD. The mean values of H/M in patients with MSA and PSP were significantly lower than in controls. There was no significant difference between the mean value of H/M in MSA with orthostatic hypotension (OH) and that in MSA without OH, and also there was no significant difference between the mean value of H/M in MSA with striatonigral degeneration and that in MSA with olivopontocerebellar atrophy. Although the mean value of H/M in PSP with amitriptyline treatment was significantly lower than that in PSP patients without amitriptyline treatment, there was no significant difference between the mean value of H/M in PSP patients without amitriptyline treatment and that in controls. There was no correlation between H/M and disease duration in those three akinetic-rigid disorders that we have studied here. Thus, PD may have an abnormality of cardiac sympathetic function which has not been detected by previous cardiovascular autonomic studies. Particularly in early stages, {sup 123}I-MIBG myocardial scintigraphy may help to differentiate PD from MSA and PSP. (K.H.)

Production of 123I

International Nuclear Information System (INIS)

Britto, J.L.Q. de; Silva, A.G. da; Teixeira, F.C.M.; Costa e Silva, A.; Souza, A.S.F. de

1981-01-01

The 12 I is prepared by 122 Te( 3 He, 2n) 123 Xe sup(β+) → 123 I reaction. The remotization of the Xe diffusion and capture system and the retired of the 123 I produced by the 123 Xe precursory decaying. (E.G.) [pt

Labelling of metaiodobenzylguanidine (MIBG) with Technetium-99m radionuclide

International Nuclear Information System (INIS)

Maula Eka Sriyani; Dini Natanegara; Aang Hanafiah Ws

2015-01-01

Various neuroendocrine tumors and their metastases are able to localized and staged by Metaiodobenzylguanidine (MIBG). MIBG is a molecule that has a chemical structure similarities with noradrenaline in the adrenal. The research on 131 I-MIBG has been successfully conducted in the tumor imaging. This research of preparing 99m Tc-MIBG that will be used as a diagnostic agent for adrenal tumors was carried out. MIBG labeling activities with technetium-99m radionuclide were carried out through labeling of MIBG with technetium-99m and radiochemical purity analysis. The labeling of MIBG was carried out using both direct and indirect methods with diethylene triamine pentaacetic acid (DTPA) as a co-ligand. Determination of 99m Tc-MIBG labeling efficiency was performed using paper chromatography with Whatman 3MM/dried acetone and Whatman 31ET/acetonitrile 50%. The results of labeling efficiency using the indirect method with DTPA as a co-ligand was obtained 93.44 ± 1.93%, which the concentration of MIBG was 2 mg/0.5 mL H 2 O, concentration of co-ligand was 37,5 μg of SnCl 2 .2H 2 O and DTPA of 1,125 mg at pH 6.5 for 15 minutes incubation in the room temperature ( 25 °C). (author)

Dosimetry estimation of SPECT/CT for iodine 123-labeled metaiodobenzylguanidine in children

Directory of Open Access Journals (Sweden)

Aida Mhiri

2015-09-01

Full Text Available Purpose: To evaluate the additional radiation exposure in terms of effective dose incurred by patients in the CT (computed tomography portion of 123I-MIBG (123II-metaiodobenzylguanidine study with SPECT/CT (Single photon emission computed tomography associated to computed tomography in some pediatric patients of our department. Methods: Data from 123II-MIBG scans comprising 50 children were presented in this study. The contribution of total effective dose imparted by the nuclear tracer and patient's age was calculated. Effective dose from the CT portion of the examination is also estimated.SPECT acquisitions were performed with a dual-headed SPECT unit with an integrated 2-slice CT scanner (Symbia T E-Cam, Siemens Medical Systems, Erlangen, Germany. The CT acquisition were performed using a tube current modulation system (Care Dose 4D. Parameters used were: tube current of 30 - 60 mAs, slice thickness of 3-5 mm, and tube voltage of 110 kV. Results: Our results show that SPECT dosimetry depends on administered activity and patient’s age and weight. For CT scan, effective dose is affected by tube current (mA, tube potential (kVp, rotation speed, pitch, slice thickness, patient mass, and the exact volume of the patient that is being imaged. Conclusion: For children, 123II-MIBG study with SPECT/CT should be performed using the lowest available voltage and current. A sensible choice of these two parameters used can significantly reduce radiation dose, without any compromise in the quality of the diagnostic information.

Cyclotron production of high-purity 123I for medical applications via the 127I(p,5n)123Xe → 123I nuclear reaction

International Nuclear Information System (INIS)

Lagunas-Solar, M.C.

1985-01-01

The use of iodine-123 in nuclear medicine procedures is well documented in the scientific literature. Also, several methods for its production based on accelerator techniques have been described. Indirectly made 123 I via the 127 I(p,5n) 123 Xe → 123 I reaction produces 123 I of > 99.9% radionuclidic purity, with only 125 I ( 123 I production were developed at the University of California at Davis, where since 1974 the 76-in. isochronous cyclotron of the Crocker Nuclear Laboratory has been used for routine biweekly production of high-purity no-carrier-added 123 I

Evaluation of cardiac sympathetic nerve activity and aldosterone suppression in patients with acute decompensated heart failure on treatment containing intravenous atrial natriuretic peptide

International Nuclear Information System (INIS)

Kasama, Shu; Toyama, Takuji; Kurabayashi, Masahiko; Iwasaki, Toshiya; Sumino, Hiroyuki; Kumakura, Hisao; Minami, Kazutomo; Ichikawa, Shuichi; Matsumoto, Naoya; Nakata, Tomoaki

2014-01-01

Aldosterone prevents the uptake of norepinephrine in the myocardium. Atrial natriuretic peptide (ANP), a circulating hormone of cardiac origin, inhibits aldosterone synthase gene expression in cultured cardiocytes. We evaluated the effects of intravenous ANP on cardiac sympathetic nerve activity (CSNA) and aldosterone suppression in patients with acute decompensated heart failure (ADHF). We studied 182 patients with moderate nonischemic ADHF requiring hospitalization and treated with standard therapy containing intravenous ANP and 10 age-matched normal control subjects. ANP was continuously infused for >96 h. In all subjects, delayed total defect score (TDS), heart to mediastinum ratio, and washout rate were determined by 123 I-metaiodobenzylguanidine (MIBG) scintigraphy. Left ventricular (LV) end-diastolic volume, end-systolic volume, and ejection fraction were determined by echocardiography. All patients with acute heart failure (AHF) were examined once within 3 days and then 4 weeks after admission, while the control subjects were examined only once (when their hemodynamics were normal). Moreover, for 62 AHF patients, plasma aldosterone concentrations were measured at admission and 1 h before stopping ANP infusion. 123 I-MIBG scintigraphic and echocardiographic parameters in normal subjects were more favorable than those in patients with AHF (all p < 0.001). After treatment, all these parameters improved significantly in AHF patients (all p < 0.001). We also found significant correlation between percent changes of TDS and aldosterone concentrations (r = 0.539, p < 0.001) in 62 AHF patients. The CSNA and LV performance were all improved in AHF patients. Furthermore, norepinephrine uptake of myocardium may be ameliorated by suppressing aldosterone production after standard treatment containing intravenous ANP. (orig.)

{sup 123}I-{beta}-methyl-iodophenyl-pentadecanoic acid myocardial scintigraphy in diabetic patients without overt ischemic heart disease

Energy Technology Data Exchange (ETDEWEB)

Shinmura, Ken; Tani, Masato; Suganuma, Yukako; Hasegawa, Hiroshi; Kawamura, Masatoshi; Nakamura, Yoshiro; Hashimoto, Jun; Kubo, Atsushi [Keio Univ., Tokyo (Japan). School of Medicine

1995-07-01

We evaluated {sup 123}I-{beta}-methyl-iodophenyl-pentadecanoic acid (BMIPP) myocardial scintigraphy in 15 diabetes mellitus patients without overt coronary heart disease. Patients with overt coronary heart disease were excluded by careful history taking, resting electrocardiography, treadmill exercise testing echocardiography and resting {sup 201}Tl scintigraphy. Patients with remarkably impaired left ventricular (LV) systolic function (%FS<30%) were also excluded. BMIPP uptake scores as the ratio of heart/mediastinum (H/M) and liver/mediastinum (L/M) at 20 minutes after injection were analyzed and compared with clinical profile, serum parameters, and LV parameters obtained from echocardiography. Five of the 15 patients showed abnormal BMIPP images; two patients showed a decreased uptake in the inferior segments, while three showed a diffuse decrease in BMIPP uptake. Body mass index (BMI), fasting blood sugar (FBS), HbA1c, IRI, and LV end-diastolic diameter (LVEDD) were higher in these five patients with abnormal BMIPP findings (abnormal BMIPP group vs normal BMIPP group, BMI: 29 vs 23 kg/m{sup 2}, FBS: 178 vs 114 mg/dl, HbA1c: 7.6 vs 6.2%, IRI: 18.5 vs 9.5 {mu}U/ml, LVEDD: 52 vs 44 mm). {sup 123}I-metaiodobenzyl-guanidine (MIBG) scintigraphy in the 5 patients with abnormal BMIPP uptake showed more severe defects than in the 10 patients with normal BMIPP imaging. BMIPP scintigraphy demonstrated a significant correlation between H/M and L/M by BMIPP (r=0.74). Correlation between H/M by BMIPP scintigraphy and clinical parameters (BMI, systolic blood pressure, FBS, HbA1c, IRI) were found, suggesting that diabetes mellitus patients without over coronary heart disease show abnormal BMIPP imaging when their general glucose utility and {sup 123}I-MIBG uptake are severely impaired (progression of insulin resistance and sympathetic nerve involvement). BMIPP scintigraphy may be useful in investigating the pathogenesis and subclinical abnormality of diabetic heart. (J.P.N.).

Dynamic molecular imaging of cardiac innervation using a dual head pinhole SPECT system

International Nuclear Information System (INIS)

Hu, Jicun; Boutchko, Rostyslav; Sitek, Arkadiusz; Reutter, BryanW.; Huesman, Ronald H.; Gullberg, Grant T.

2008-01-01

Typically 123I-MIBG is used for the study of innervation and function of the sympathetic nervous system in heart failure. The protocol involves two studies: first a planar or SPECT scan is performed to measure initial uptake of the tracer, followed some 3-4 hours later by another study measuring the wash-out of the tracer from the heart. A fast wash-out is indicative of a compromised heart. In this work, a dual head pinhole SPECT system was used for imaging the distribution and kinetics of 123I-MIBG in the myocardium of spontaneous hypertensive rats (SHR) and normotensive Wistar Kyoto (WKY) rats. The system geometry was calibrated based on a nonlinear point projection fitting method using a three-point source phantom. The angle variation effect of the parameters was modeled with a sinusoidal function. A dynamic acquisition was performed by injecting 123I-MIBG into rats immediately after starting the data acquisition. The detectors rotated continuously performing a 360o data acquisition every 90 seconds. We applied the factor analysis (FA)method and region of interest (ROI) sampling method to obtain time activity curves (TACs)in the blood pool and myocardium and then applied two-compartment modeling to estimate the kinetic parameters. Since the initial injection bolus is too fast for obtaining a consistent tomographic data set in the first few minutes of the study, we applied the FA method directly to projections during the first rotation. Then the time active curves for blood and myocardial tissue were obtained from ROI sampling. The method was applied to determine if there were differences in the kinetics between SHR and WKY rats and requires less time by replacing the delayed scan at 3-4 hours after injection with a dynamic acquisition over 90 to 120 minutes. The results of a faster washout and a smaller distribution volume of 123I-MIBG near the end of life in the SHR model of hypertrophic cardiomyopthy may be indicative of a failing heart in late stages of heart

Clinical uses of I-123 produced by 127I(p, 5n)123Xe to 123I reaction in NIRS

International Nuclear Information System (INIS)

Saegusa, Kenji; Arimizu, Noboru; Uchiyama, Guio; Tateno, Yukio; Rikitake, Tomoyuki.

1978-01-01

123 I capsules produced by NIRS which are believed to be uncontaminated by radioactive impurities other than 125 I were compared with commercial 123 I capsules regarding gamma-ray spectra, thyroid phantoms and clinical scintigrams. Absorbed radiation doses of 123 I contaminated with nuclides other than 123 I to thyroid and whole body were also estimated. Regarding gamma-ray spectra, any nuclides other than 125 I(0.53%) did not contaminate in 123 I produced by NIRS, and it was superior to commercial capsules. Regarding phantoms and clinical scintigrams, background counts around the thyroid gland seemed to be slightly higher in commercial capsules than that produced by NIRS because of contamination with other nuclides. Exposed doses in thyroid and whole body were counted. Ratios in thyroid and whole body were increased by 30% and 9%, respectively in 123 I produced by NIRS because of contamination with 0.53% of 125 I in the event that the intake ratio of thyroid was determined as 25%. In commercial capsules the doses in thyroid and whole body were increased by 500% and 150%, respectively. Doses of commercial capsules and NIRS capsules were 7.87 rad and 1.72 rad, respectively per 100 μCi in thyroid. The ratio of NIRS capsules to commercial capsules in thyroid was 1/4.6, and that in the whole body was less than 1/2. (Ichikawa, K.)

Clinical results with beta-methyl-p-(123I)iodophenylpentadecanoic acid, single-photon emission computed tomography in cardiac disease.

Science.gov (United States)

Nishimura, T; Uehara, T; Shimonagata, T; Nagata, S; Haze, K

1994-01-01

This study was undertaken to evaluate the relationships, between myocardial perfusion and metabolism. Simultaneous beta-methyl-p(123I)iodophenylpentadecanoic acid (123I-BMIPP) and thallium 201 myocardial single-photon emission computed tomography (SPECT) were performed in 25 patients with myocardial infarction (group A) and 16 patients with hypertrophic cardiomyopathy (group B). The severity scores of 123I-BMIPP and 201Tl myocardial SPECT images were evaluated semiquantitatively by segmental analysis. In Group A, dissociations between thallium- and 123I-BMIPP-imaged defects were frequently observed in patients with successful reperfusion compared with those with no reperfusion and those with reinfarction. In four patients with successful reperfusion, repeated 123I-BMIPP and 201Tl myocardial SPECT showed gradual improvement of the 123I-BMIPP severity score compared with the thallium severity score. In group B, dissociations between thallium- and 123I-BMIPP-imaged defects were also demonstrated in hypertrophic myocardium. In addition, nonhypertrophic myocardium also had decreased 123I-BMIPP uptake. In groups A and B, 123I-BMIPP severity scores correlated well with left ventricular function compared with thallium severity scores. These findings indicate that 123I-BMIPP is a suitable agent for the assessment of functional integrity, because left ventricular wall motion is energy dependent and 123I-BMIPP may reflect an aspect of myocardial energy production. This agent may be useful for the early detection and patient management of various heart diseases as an alternative to positron emission tomographic study.

The usefulness of I-131 MIBG scintigraphy in assessing the staging of neuroectodermal tumors in children - Our experience

International Nuclear Information System (INIS)

Budlewski, T.; Rogowski, F.; Luczynski, W.; Krawczuk-Rybak, M.

2004-01-01

Full text: Neuroendodermal tumors include pheochromocytoma, paraganglioma, medullary thyroid cancer and neuroblastoma. These malignant tumors derive from the primitive neural crest, which develops to sympathic nervous system. The tumors consist of cells that are capable of incorporating the amine precursors such as I-131 MIBG. The most common malignant tumor in childhood is neuroblastoma. The tested group included patients with neuroblastoma and one with pheochromocytoma treated in the Department of Oncology at the Paediatric University Hospital in Bialystok. There were 8 patients between the ages of 2 and 13. They have all undergone standard whole body scanning with a tomographic Nucline X-Ring camera made by Mediso, fitted with high-energy all purpose parallel hole collimator, a scan speed 5cm/ min and static images of 250,000 counts or 10 min per image. The study was performed 24-48 h after I-131 MIBG injection of 35 MBq activity. The results were obtained by antero-posterior and posterio-anterior projections (a whole body scan) and, if necessary, additional static images of chest and abdomen, skull, pelvis, and lower limbs. Clinical Characteristics of the Group: M.E. 12-year-old child with a right suprarenal tumor with morrow metastases. HP-neuroblastoma. The child was treated with a preoperative chemotherapy, operated and given postoperative chemotherapy (palliative therapy). The MIBG scintigraphy showed hypermetabolic focus in the pelvis and in the left vertex bone. Clinical test pointed to the progress of the disease. M.J. 6-year-old child with infiltrative retroperitoneal on both sides of celiac trunk with a metastases to mediastinum and bone marrow. HP-neuroblastoma. The first MIBG scintigraphy performed after Tsishidy operative procedure was negative. The second MIBG scintigraphy, one year later showed metastases to thigh bone, spine, and sacroiliac joint. Clinically proven progress of the disease. G.G. 2-year-old child with facial skeleton tumor and

Evaluation of cardiac sympathetic nerve activity and aldosterone suppression in patients with acute decompensated heart failure on treatment containing intravenous atrial natriuretic peptide

Energy Technology Data Exchange (ETDEWEB)

Kasama, Shu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Toyama, Takuji; Kurabayashi, Masahiko [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Iwasaki, Toshiya; Sumino, Hiroyuki; Kumakura, Hisao; Minami, Kazutomo; Ichikawa, Shuichi [Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Matsumoto, Naoya [Nihon University School of Medicine, Department of Cardiology, Tokyo (Japan); Nakata, Tomoaki [Sapporo Medical University School of Medicine, Second (Cardiology) Department of Internal Medicine, Sapporo, Hokkaido (Japan)

2014-09-15

Aldosterone prevents the uptake of norepinephrine in the myocardium. Atrial natriuretic peptide (ANP), a circulating hormone of cardiac origin, inhibits aldosterone synthase gene expression in cultured cardiocytes. We evaluated the effects of intravenous ANP on cardiac sympathetic nerve activity (CSNA) and aldosterone suppression in patients with acute decompensated heart failure (ADHF). We studied 182 patients with moderate nonischemic ADHF requiring hospitalization and treated with standard therapy containing intravenous ANP and 10 age-matched normal control subjects. ANP was continuously infused for >96 h. In all subjects, delayed total defect score (TDS), heart to mediastinum ratio, and washout rate were determined by {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy. Left ventricular (LV) end-diastolic volume, end-systolic volume, and ejection fraction were determined by echocardiography. All patients with acute heart failure (AHF) were examined once within 3 days and then 4 weeks after admission, while the control subjects were examined only once (when their hemodynamics were normal). Moreover, for 62 AHF patients, plasma aldosterone concentrations were measured at admission and 1 h before stopping ANP infusion. {sup 123}I-MIBG scintigraphic and echocardiographic parameters in normal subjects were more favorable than those in patients with AHF (all p < 0.001). After treatment, all these parameters improved significantly in AHF patients (all p < 0.001). We also found significant correlation between percent changes of TDS and aldosterone concentrations (r = 0.539, p < 0.001) in 62 AHF patients. The CSNA and LV performance were all improved in AHF patients. Furthermore, norepinephrine uptake of myocardium may be ameliorated by suppressing aldosterone production after standard treatment containing intravenous ANP. (orig.)

[Nuclear cardiology with new radiopharmaceuticals].

Science.gov (United States)

Bunko, H

1994-08-01

In the field of nuclear cardiology, 99mTc labeled myocardial perfusion agents such as MIBI, Tetrofosmin and Teboroxime, 111In-antimyosin for imaging of myocardial necrosis, 123I-betamethyl-iodophenylpentadecanoic acid (BMIPP) for imaging of myocardial fatty acid metabolism and 123I-metaiodobenzylguanidine (MIBG) for imaging of myocardial adrenergic function are introduced recently in Japan. Improved image quality and simultaneous evaluation of myocardial perfusion, function and wall motion can be obtained with use of 99mTc labeled myocardial perfusion agents. 111In-antimyosin enables specific imaging of myocardial necrosis which leads to the use for wide variety of heart diseases. Discrepancy of the myocardial perfusion and metabolism in case of stunned myocardium or cardiomyopathy can be evaluated by 123I-BMIPP in conjunction with perfusion agent. Recently wide variety of diseases which may have cardiac adrenergic abnormality are targeted for 123I-MIBG imaging. These new radiopharmaceuticals are expected to be powerful tool for evaluation of the pathophysiology including severity and prognosis and evaluation of the etiology of the various heart diseases.

MIBG: A model for therapy with a neurotransmitter analog

International Nuclear Information System (INIS)

Wieland, D.M.

1989-01-01

Since its introduction in 1980 as a radiotracer mimic of norepinephrine, radiolabeled meta-iodobenzylguanidine has undergone world-wide study as a therapeutic agent for treatment of tumors of sympathetic nervous system origin. The design rationale and structure-activity studies that led to the discovery of MIBG will be presented, as will the practical difficulties encountered in synthesizing and administering large (> 250 mCi) batches of 131 I-MIBG on a routine basis. The efficacy of treatment strategies such as the multiple, escalating dose regimen and the more recent use of 125 I-MIBG in treatment of neuroblastoma, a virulent childhood cancer, will be reviewed. Emphasis will be placed on the challenges that remain in this important research are for medicinal chemists

Application of 123I-labelled long-chained fatty acids for the study of myocardial metabolism

International Nuclear Information System (INIS)

Freundlieb, C.; Hoeck, A.; Vyska, F.; Feinendegen, L.E.; Machulla, H.J.; Stoecklin, G.

1978-01-01

Radioiodine-labelled fatty acids are useful tracers for myocardial imaging. The present study extends myocardial scintigraphy with ω-123-I-heptadecanoic acid to measuring myocardial metabolism. 4 normal individuals and 6 patients with cardiac disease received i.v. 1-2 mCi ω-123-I-heptadecanoic acid. Immediately fast serial scintigrams of the myocardium were taken for 30 minutes. Disappearance of the tracer, and appearance of anorganic 123-I, was measured in the peripheral blood. The myocardial images were of high quality later than 5 minutes after injection. By correcting for anorganic 123-I in the peripheral blood and the interstitium, the turnover of tracer in the myocardial cells could be measured. Activity was lost from the myocardium with a half time between 14 and 32 minutes. Within regions of old myocardials infarctions the half time of tracer loss was prolonged. The data clearly indicate the feasibility of using ω-123-I-heptadecanoic acid for measuring myocardial metabolism. (author)

Cardiac abnormalities in diabetic patients with mutation in the mitochondrial tRNA {sup Leu(UUR)}Gene

Energy Technology Data Exchange (ETDEWEB)

Ueno, Hiroshi [Hyogo Medical Center for Adults, Akashi (Japan); Shiotani, Hideyuki

1999-11-01

An A-to-G transition at position 3243 of the mitochondrial DNA is known to be a pathogenic factor for mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), diabetes and cardiomyopathy. This mutation causes dysfunction of the central nervous system in MELAS. Because the heart, as well as the brain and nervous system, is highly dependent on the energy produced by mitochondrial oxidation, these tissues are more vulnerable to mitochondrial defects. Cardiac abnormalities were assessed in 10 diabetic patients associated with this mutation using echocardiography and {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy, and compared with 19 diabetic patients without the mutation. Duration of diabetes, therapy, control of blood glucose and diabetic complications, such as diabetic retinopathy and nephropathy, were not different between the 2 groups. Diabetic patients with the mutation had a significantly thicker interventricular septum (16.8{+-}3.7 vs 11.0{+-}1.6 mm, p<0.001) than those without the mutation. Fractional shortening was lower in diabetic patients with the mutation than those without it (30.7{+-}7.0 vs 42.5{+-}6.6, p<0.001). MIBG uptake on the delayed MIBG image was significantly lower in diabetic patients with the mutation than in those without the mutation (mean value of the heart to mediastinum ratio: 1.6{+-}0.2 vs 2.0{+-}0.4, p>0.05). In conclusion, left ventricular hypertrophy with or without abnormal wall motion and severely reduced MIBG uptake may be characteristic in diabetic patients with a mutation in the mitochondrial tRNA {sup Leu(UUR)} gene. (author)

Diagnosis and treatment of neuroblastoma using metaiodobenzylguanidine

International Nuclear Information System (INIS)

Edeling, C.J.; Frederiksen, P.B.; Kamper, J.; Jeppesen, P.

1987-01-01

Neuroblastoma is a lethal and not uncommon tumor in childhood. Early detection and display of the spread of the tumor is highly desirable for proper treatment. Nine children suspected of having neuroblastomas were examined by I-131 metaiodobenzylguanidine (I-131 MIBG) imaging. In two recent studies I-123 metaiodobenzylguanidine (I-123 MIBG) was used. A primary adrenal neuroblastoma was correctly identified in three cases. In two patients additional tumor sites were found. In one patient, who was in complete remission, no pathologic accumulation of I-131 MIBG was found. I-131 MIBG images were also normal in four patients with other types of neoplastic diseases. A boy with multiple metastases was treated with 100 mCi of I-131 MIBG. He developed transient gastrointestinal illness and there was no regression of the tumor deposits. In one girl with a large adrenal neuroblastoma high uptake of I-131 MIBG was observed. She received two therapy doses of I-131 MIBG (35 mCi and 75 mCi) with curative intention giving a total absorbed dose in the tumor of approximately 76 Gy. In spite of high retention of radioactivity in the tumor, regression did not occur, but her general condition was improved. In the present study, images of superior quality were obtained with I-123 MIBG imaging. It is concluded that imaging using I-131 MIBG or I-123 MIBG should be used in both the initial evaluation and the follow-up of children with neuroblastoma

Recurrence of pheochromocytoma in 11 years old school child, diagnosed by I-131 MIBG

International Nuclear Information System (INIS)

Jara Yorg, J. A; Arias, Cohl; Gimenez, J; Rodriguez, E; Ortiz, L; Mendieta, B; Ayala, R. M; Rodriguez, C; Delgadillo, J. L

2000-01-01

Pheocromocytoma is a paraganglioma with an incidence of arterial hypertension approximately of 1%,but its diagnosis has several important issues from the clinical point of view. 1-The tumor resection frequently cure the hypertension. 2.-Its manifestations might simulates other diseases like carcinoid Sx, hypertiroidism,etc. 3.-It is a familiar disease transmitted by an autosomic dominant way. It is 10% bilateral,10%extraadrenal,10% occur in children and 10% are malignant. We present a case of pheochromocytoma recurrency in a young girl,11 y.o. operated 8 months before, at the Clinical Hospital, National University of Paraguay, School of Medicine for a right suprarenal gland pheochromocytoma of 2cms of diameter, who consults the Pediatric Department for arterial hypertension and cefalea. She also had a Von Hippel Sx and Glaucoma. Nuclear Medicine is a non invasive method that use the I-131 Methayodobencylguanidine(MIBG-I-131) with high accuracy to diagnose and treat both neuroblastoma and pheochromocytoma I-131 MIBG is the gold standard for the diagnosis of both entities with a sensitivity between 94-100%6-7 and specificity of 100% being the best method to evaluate these diseases in the pre and post operatory (Au)

Cardiac sympathetic imaging with mIBG in cirrhosis and portal hypertension

DEFF Research Database (Denmark)

Møller, Søren; Mortensen, Christian; Bendtsen, Flemming

2012-01-01

of HRV and BRS. mIBG-scintigraphy revealed significantly increased WOR in patients with cirrhosis compared with controls (P equal in the groups. Forty percent of the patients had reduced uptake of mIBG in the infero-lateral segment of the left ventricle. WOR correlated...

Dynamic molecular imaging of cardiac innervation using a dual headpinhole SPECT system

Energy Technology Data Exchange (ETDEWEB)

Hu, Jicun; Boutchko, Rostyslav; Sitek, Arkadiusz; Reutter, BryanW.; Huesman, Ronald H.; Gullberg, Grant T.

2008-03-29

Typically 123I-MIBG is used for the study of innervation andfunction of the sympathetic nervous system in heart failure. The protocolinvolves two studies: first a planar or SPECT scan is performed tomeasure initial uptake of the tracer, followed some 3-4 hours later byanother study measuring the wash-out of the tracer from the heart. A fastwash-out is indicative of a compromised heart. In this work, a dual headpinhole SPECT system was used for imaging the distribution and kineticsof 123I-MIBG in the myocardium of spontaneous hypertensive rats (SHR) andnormotensive Wistar Kyoto (WKY) rats. The system geometry was calibratedbased on a nonlinear point projection fitting method using a three-pointsource phantom. The angle variation effect of the parameters was modeledwith a sinusoidal function. A dynamic acquisition was performed byinjecting 123I-MIBG into rats immediately after starting the dataacquisition. The detectors rotated continuously performing a 360o dataacquisition every 90 seconds. We applied the factor analysis (FA)methodand region of interest (ROI) sampling method to obtain time activitycurves (TACs)in the blood pool and myocardium and then appliedtwo-compartment modeling to estimate the kinetic parameters. Since theinitial injection bolus is too fast for obtaining a consistenttomographic data set in the first few minutes of the study, we appliedthe FA method directly to projections during the first rotation. Then thetime active curves for blood and myocardial tissue were obtained from ROIsampling. The method was applied to determine if there were differencesin the kinetics between SHR and WKY rats and requires less time byreplacing the delayed scan at 3-4 hours after injection with a dynamicacquisition over 90 to 120 minutes. The results of a faster washout and asmaller distribution volume of 123IMIBG near the end of life in the SHRmodel of hypertrophic cardiomyopthy may be indicative of a failing heartin late stages of heart failure.

High-dose I-131 MIBG treatment for young children with high-risk neuroblastoma, and its practical problem. From the experience of the youngest case in Japan

International Nuclear Information System (INIS)

Araki, Raita; Nishimura, Ryosei; Mase, Shintaro

2012-01-01

High-dose I-131 MIBG (metaiodobenzylguanidine) therapy combined with auto- or allo-hematopoietic stem cell transplantation is becoming a potential treatment for patients with high-risk neuroblastoma worldwide. However, only older children, who can perform personal care, had been given high-dose I-131 MIBG treatment to avoid the needless radiation exposure to caregivers and medical staff in Japan. In this case report, we have used the high dose MIBG therapy followed by autologous PBSCT (peripheral blood stem cell transplantation) for a 1-year-old boy with a newly diagnosed high-risk neuroblastoma with MYCN amplifications. The total radiation exposure to all parties involved was very limited, even in the youngest case in Japan, probably due to adequate preparations. This encouraging experience may remove the age limit for high-dose I-131 MIBG treatment for the patients with high-risk neuroblastoma in Japan. (author)

Behavior of Na131I and meta(131I) iodobenzylguanidine (MIBG) in municipal sewerage.

Science.gov (United States)

Fenner, F D; Martin, J E

1997-08-01

Behavior of 131I activity in primary sludge at the Ann Arbor, Michigan, Municipal Waste Water Treatment Plant was studied in relation to known radioiodine therapy events at the University of Michigan Hospital complex. The principal compounds administered are Na131I, which has widespread use, and meta (131I) iodobenzylguanidine (MIBG), which is a compound unique to the University of Michigan, although labeled antibodies and other forms are also used in therapy and research. The objectives of the study were to determine the environmental fate of such discharges and to determine radiation exposures to workers and the public when sludges are incinerated. Approximately 17% of the MIBG activity administered in a therapy was found in the primary sludge, whereas only 1.1% of the Na131I was in sludge. When land applied, the short half life of 131I in the sludge presents few radiological health concerns; however, incineration, which is done in winter months, is assumed to release organically bound 131I to the atmosphere. Radiation doses due to incineration of sludge containing measured concentrations were calculated for a maximally exposed worker to be 1.7 microSv (0.17 mrem) of which 0.48 microSv (0.048 mrem) was due to a 2-d upset condition. For a more typically exposed worker, and a member of the public, the committed effective dose equivalents were 1.2 microSv (0.12 mrem) and 0.06 microSv (0.006 mrem), respectively, for a 22-wk incineration period with release of all radioiodine in the sludge. Transport time to the treatment plant for radioiodine was found to be much longer than that of normal sewage, possibly due to organic material in sewer lines that absorb iodine. The residence time of radioiodine in the sewer also appears to be longer than expected; whether other radioactive materials are held up the same way is not known but chemical form is surely a factor.

Assessment of inferior wall in 123I-metaiodobenzylguanidine myocardial SPECT in diabetic patients

International Nuclear Information System (INIS)

Fukumoto, Yoshihiro; Kuroda, Yasuhisa; Ohta, Jun; Osono, Ken; Saitou, Miyoko; Suzuki, Mituaki; Nakajima, Toshiki

1994-01-01

A phantom experiment and a clinical assessment have been made with the purpose of investigating the causes of low accumulation and deficiency of the inferior wall in 123 I-metaiodobenzylguanidine (MIBG) myocardial SPECT and the method for its evaluation. By the phantom experiment, assessments were made regarding (1) influence of the liver positioned adjacently; and (2) involvement of absorption and attenuation of the inferior wall. For the clinical assessment, 84 patients with diabetes in whom no abnormality was observed by exercise myocardial SPECT ( 201 TlCl) and 5 cases of inferior myocardial infarction (OMI group) were adopted as subjects. The inferior walls were evaluated as visually deficient because of the adjacently-positioned liver, but no low value was exhibited by quantitative evaluation. By pulmonary mediastinal phantom (-), improvement of the inferior wall was observed visually and quantitatively, compared with pulmonary mediastinal phantom (+). By quantitative evaluation, the patients were classified into normal MIBG group (N group); segmentally deficient group (S group); and non-accumulated group (DH group). In addition, S group was classified by severity score into those from S 1 to S 4 groups. No significant difference was observed in Relative Regional Uptake (RRU) in the inferior wall between S 4 group and OMI group. To sum up, we considered the causes for low accumulation and deficiency of the inferior wall, (1) adjacently-positioned liver; (2) absorption and attenuation; and (3) the lesion itself. Visual evaluation is not sufficient as the evaluating method. Quantitative evaluation becomes necessary. (author)

Cardiac abnormalities in diabetic patients with mutation in the mitochondrial tRNA Leu(UUR)Gene

International Nuclear Information System (INIS)

Ueno, Hiroshi; Shiotani, Hideyuki

1999-01-01

An A-to-G transition at position 3243 of the mitochondrial DNA is known to be a pathogenic factor for mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), diabetes and cardiomyopathy. This mutation causes dysfunction of the central nervous system in MELAS. Because the heart, as well as the brain and nervous system, is highly dependent on the energy produced by mitochondrial oxidation, these tissues are more vulnerable to mitochondrial defects. Cardiac abnormalities were assessed in 10 diabetic patients associated with this mutation using echocardiography and 123 I-metaiodobenzylguanidine (MIBG) scintigraphy, and compared with 19 diabetic patients without the mutation. Duration of diabetes, therapy, control of blood glucose and diabetic complications, such as diabetic retinopathy and nephropathy, were not different between the 2 groups. Diabetic patients with the mutation had a significantly thicker interventricular septum (16.8±3.7 vs 11.0±1.6 mm, p 0.05). In conclusion, left ventricular hypertrophy with or without abnormal wall motion and severely reduced MIBG uptake may be characteristic in diabetic patients with a mutation in the mitochondrial tRNA Leu(UUR) gene. (author)

Relationship between left ventricular diastolic function and myocardial sympathetic denervation measured by {sup 123}I-meta-iodobenzylguanidine imaging in Anderson-Fabry disease

Energy Technology Data Exchange (ETDEWEB)

Spinelli, Letizia; Giudice, Caterina Anna; Imbriaco, Massimo; Trimarco, Bruno; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Pellegrino, Teresa [Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Pisani, Antonio; Riccio, Eleonora [University Federico II, Department of Public Health, Naples (Italy); Salvatore, Marco [IRCCS SDN, Naples (Italy)

2016-04-15

Whether cardiac sympathetic nervous function abnormalities may be present in patients with Anderson-Fabry disease (AFD) remains unexplored. We investigated the relationship between left ventricular (LV) function and cardiac sympathetic nervous function in patients with AFD. Twenty-five patients (12 men, mean age 43 ± 13 years) with genetically proved AFD and preserved LV ejection fraction and ten age and gender-matched control subjects underwent speckle tracking echocardiography and {sup 123}I-meta-iodobenzylguanidine (MIBG) imaging from which early and late heart to mediastinum (H/M) ratios and myocardial washout rate values were calculated. In AFD patients, a significant correlation between late H/M ratio and LV mass index (r = -61, p = 0.001), left atrial volume (r = -0.72, p < 0.001), systolic pulmonary artery pressure (r = -0.75, p < 0.001), and early diastolic untwisting rate (r = -0.66, p < 0.001) was found. Ten AFD patients exhibited a late H/M ratio below two fold standard deviation of control subjects (≤1.75). Patients showing late H/M ratio ≤ 1.75 had significantly higher LV mass index, relative wall thickness, left atrial volume and systolic pulmonary artery pressure, lower systolic longitudinal strain and an early diastolic untwisting rate compared to patients with late H/M ratio > 1.75. At multivariable linear regression analysis, early diastolic untwisting rate was the only independent predictor of late H/M ratio ≤ 1.75 (odds ratio 1.15, 95 % confidence interval 1.07-1.31, p < 0.05). The present findings provide the first demonstration of a cardiac sympathetic derangement in AFD patients with preserved LV ejection fraction, which is mostly related to LV diastolic dysfunction. (orig.)

Staging and Functional Characterization of Pheochromocytoma and Paraganglioma by 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography

Science.gov (United States)

Timmers, Henri J. L. M.; Chen, Clara C.; Carrasquillo, Jorge A.; Whatley, Millie; Ling, Alexander; Eisenhofer, Graeme; King, Kathryn S.; Rao, Jyotsna U.; Wesley, Robert A.; Adams, Karen T.

2012-01-01

Background Pheochromocytomas and paragangliomas (PPGLs) are rare tumors of the adrenal medulla and extra-adrenal sympathetic chromaffin tissues; their anatomical and functional imaging are critical to guiding treatment decisions. This study aimed to compare the sensitivity and specificity of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) for tumor localization and staging of PPGLs with that of conventional imaging by [123I]-metaiodobenzylguanidine single photon emission CT (123I-MIBG SPECT), CT, and magnetic resonance imaging (MRI). Methods A total of 216 patients (106 men, 110 women, aged 45.2 ± 14.9 years) with suspected PPGL underwent CT or MRI, 18F-FDG PET/CT, and 123I-MIBG SPECT/CT. Sensitivity and specificity were measured as endpoints and compared by the McNemar test, using two-sided P values only. Results Sixty (28%) of patients had nonmetastatic PPGL, 95 (44%) had metastatic PPGL, and 61 (28%) were PPGL negative. For nonmetastatic tumors, the sensitivity of 18F-FDG was similar to that of 123I-MIBG but less than that of CT/MRI (sensitivity of 18F-FDG = 76.8%; of 123I-MIBG = 75.0%; of CT/MRI = 95.7%; 18F-FDG vs 123I-MIBG: difference = 1.8%, 95% confidence interval [CI] = −14.8% to 14.8%, P = .210; 18F-FDG vs CT/MRI: difference = 18.9%, 95% CI = 9.4% to 28.3%, P < .001). The specificity was 90.2% for 18F-FDG, 91.8% for 123I-MIBG, and 90.2% for CT/MRI. 18F-FDG uptake was higher in succinate dehydrogenase complex– and von Hippel–Lindau syndrome–related tumors than in multiple endocrine neoplasia type 2 (MEN2) related tumors. For metastases, sensitivity was greater for 18F-FDG and CT/MRI than for 123I-MIBG (sensitivity of 18F-FDG = 82.5%; of 123I-MIBG = 50.0%; of CT/MRI = 74.4%; 18F-FDG vs 123I-MIBG: difference = 32.5%, 95% CI = 22.3% to 42.5%, P < .001; CT/MRI vs 123I-MIBG: difference = 24.4%, 95% CI = 11.3% to 31.6%, P < .001). For bone metastases, 18F-FDG was more sensitive than CT/MRI (sensitivity of 18

Alteration of myocardial metaiodobenzylguanidine uptake after treatment of phaeochromocytoma and neuroblastoma

Energy Technology Data Exchange (ETDEWEB)

Suga, Kazuyoshi; Ogasawara, Nobuhiko; Ariga, Misako; Motoyama, Kazumi; Hara, Akiko; Kume, Norihiko; Matsunaga, Naofumi [Department of Radiology, Yamaguchi University School of Medicine, Ube, Yamaguchi (Japan)

2000-05-01

The relationships between changes in myocardial uptake of metaiodobenzylguanidine (MIBG) and those in circulating catecholamines and cardiac function after treatment of phaeochromocytoma and neuroblastoma were evaluated. Iodine-123 or iodine-131 MIBG scintigraphy was performed before and after surgical resection and/or chemotherapy for primary tumours in nine patients with phaeochromocytoma and 13 patients with neuroblastoma. Changes in myocardial MIBG uptake after treatment were estimated by the heart-to-upper mediastinum (H/M) uptake ratios on the images obtained 24 h after MIBG injection, which were compared with serum levels of noradrenaline (NA) and adrenaline (A). Cardiac function was assessed by echocardiography, with measurements of the left ventricular ejection fraction (LVEF). Before treatment, eight patients with phaeochromocytoma and three with neuroblastoma showed poor myocardial MIBG uptake, with highly elevated circulating NA and A. Echocardiography, however, did not show cardiac dysfunction in these patients with the exception of two patients with phaeochromocytoma. With normalization of NA and A levels after treatment, all of these patients except for the two with persistent cardiac dysfunction showed restoration of myocardial MIBG uptake. The H/M ratios increased significantly after treatment in both patient groups, i.e. with phaeochromocytoma and with neuroblastoma (P<0.0001 and P<0.05, respectively), and these ratios correlated inversely with circulating NA and A before and after treatment. By contrast, there was no significant correlation between H/M ratios and LVEF in these two groups. These results indicate that suppression of myocardial MIBG uptake usually may not be related to cardiac dysfunction and may be reversible following normalization of excess catecholamine levels after treatment in patients with neuroadrenergic tumours. However, the suppression may persist in the presence of catecholamine-induced cardiac dysfunction. The assessment

Iodine-123 (123I) is promising radiopharmaceutical in the radionuclide diagnostics

International Nuclear Information System (INIS)

Tazhedinov, I.T.

2003-01-01

In the paper some advantages of the radiopharmaceuticals with 123 I against 99m Tc preparations are shown. It is noted that the 123 I is the most favourable among cyclotron radionuclides for radionuclide diagnostics by it nuclear-physical characteristics. With application of 123 I it is possible to attain a significant progress in the thyroid examination. 123 I labelled preparations should have a high bond strength providing the high information valuation of examinations

Role of interleukin-6 levels in cardiovascular autonomic dysfunction in type 2 diabetic patients

Energy Technology Data Exchange (ETDEWEB)

Shinohara, Tetsuji; Takahashi, Naohiko; Kakuma, Tetsuya; Hara, Masahide; Yoshimatsu, Hironobu [Oita University, Department of Internal Medicine 1, Faculty of Medicine, Yuhu, Oita (Japan); Yufu, Kunio; Anan, Futoshi; Nakagawa, Mikiko; Saikawa, Tetsunori [Oita University, Department of Cardiovascular Science, Oita (Japan)

2008-09-15

Increased serum interleukin-6 (IL-6) levels are associated with an increased risk of cardiovascular disease, and cardiovascular autonomic dysfunction is associated with high mortality in type 2 diabetic patients. However, the relationship between IL-6 levels and cardiovascular autonomic dysfunction has not been fully elucidated. The aim of this study was to determine whether serum IL-6 levels are associated with cardiovascular autonomic dysfunction in type 2 diabetic patients. Eighty type 2 diabetic patients who did not have organic heart disease were categorized into a high IL-6 group (>2.5 pg/ml, n= 0, age 59{+-}12 years) or a non-high IL-6 group (<2.5 pg/ml, n=40, 61{+-}12 years). Cardiac autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations and {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy. The body mass index values (BMI), fasting insulin levels and homeostasis model assessment index values were higher in the high IL-6 group than in the non-high IL-6 group (p<0.01). Early and delayed {sup 123}I-MIBG myocardial uptake values were lower (p<0.01), and the percent washout rate of {sup 123}I-MIBG was higher (p<0.05) in the high IL-6 group than in the non-high IL-6 group. Furthermore, multiple regression analysis revealed that the IL-6 level was independently predicted by the BMI and the myocardial uptake of {sup 123}I-MIBG during the delayed phase. The results indicate that elevated IL-6 levels are associated with depressed cardiovascular autonomic function and obesity in type 2 diabetic patients. (orig.)

Differentiated Thyroid Carcinoma After I-131-MIBG Treatment for Neuroblastoma During Childhood: Description of the First Two Cases

NARCIS (Netherlands)

van Santen, Hanneke M.; Tytgat, Godelieve A. M.; van de Wetering, Marianne D.; van Eck-Smit, Berthe L. F.; Hopman, Saskia M. J.; van der Steeg, Alida F.; Nieveen van Dijkum, Els J. M.; van Trotsenburg, A. S. Paul

2012-01-01

Background: It is well known that the thyroid gland is sensitive to the damaging effects of irradiation (X-radiation or I-131(-)). For this reason, during exposure to I-131-metaiodobenzylguanidine (MIBG) in children with neuroblastoma (NBL), the thyroid gland is protected against radiation damage by

Updating the procedure for metaiodobenzylguanidine labelling with iodine radioisotopes employed in industrial production.

Science.gov (United States)

Franceschini, R; Mosca, R; Bonino, C

1991-01-01

The classical procedure used for the preparation of [125I]- and [131I]metaiodobenzylguanidine (MIBG) is the solid-phase isotopic exchange between MIBG and radioiodide. This reaction requires 1.5 hours at 160 degrees C to obtain maximum total labelling yields of 75-80%. Recently, the importance of rapid procedures for the preparation of 123I-MIBG has been highlighted. A highly efficient procedure for the industrial production of 123I-MIBG using ascorbic acid, tin sulfate and copper sulfate pentahydrate in 0.01 M sulfuric acid is reported. Sequential radio-TLC analysis of the labelling mixture shows that the labelling yield reaches 98% within 45 min at 100 degrees C. The specific activity of the 123I-MIBG produced in this manner is on the order of 100 Ci/mmol.

Relevance of 123I-BMIPP delayed scintigraphic imaging for patients with angina pectoris ? a pilot study

OpenAIRE

Koyama, Kohei; Akashi, Yoshihiro J.; Kida, Keisuke; Suzuki, Kengo; Ishibashi, Yuki; Musha, Haruki; Banach, Maciej

2011-01-01

Introduction The study was designed to clarify the role of 123I-?-methyl-iodophenylpentadecanoic acid (123I-BMIPP) in the evaluation of myocardial fatty acid metabolism in patients with stable angina pectoris (AP) before and after percutaneous coronary intervention (PCI). Material and methods Ten controls (mean age: 70.4 ?10.5 years) and 12 patients with AP (mean age: 67.4 ?11.6 years) and single vessel coronary artery disease participated in the radionuclide cardiac study. Scintigraphic imag...

Role of 131-1 MIBG Therapy in the Treatment of Advanced Neuroblastoma

International Nuclear Information System (INIS)

Riad, R.; Kotb, M.; Omar, W.; Zaher, A.; Khalafalla, Kh.; Fawzy, M.; Ebeid, E.; El-Wakil, M.

2009-01-01

Introduction: Neuroblastoma, a neoplasm of the sympathetic nervous system, is the second most extra-cranial malignant solid tumor of childhood. Many therapeutic strategies has evolved over the last 20 years, based upon work by international cooperative groups and smaller cohort studies. Novel therapies to improve initial disease response and treatment of minimal residual disease are required to improve survival for these children with high-risk neuroblastoma. Radio-labeled MIBG therapy has been tried in the treatment of advanced stage 3 and 4 neuroblastoma in an attempt to improve patients outcome. The use of radio-labeled MIBG to treat neuroblastoma has arisen from the high sensitivity and specificity of in-vivo MIBG imaging for detection of primary and metastatic tumors. Aim of the Work: To determine the impact of MIBG therapy on neuroblastoma patients outcome and its impact on their quality of life. Patients and Methods: Thirty pediatric patients with stage 4 pathologically proven neuroblastoma are included in this study. Eighteen of the study patients (60%) were males and 12 (40%) were females. All the patients had partially responsive tumor to first-line therapy + surgery. 131-1 Mibg doses ranged from 100 to 150 mCi with number of courses ranged from 1-7 according to response and toxicity. Results: Two patients achieved complete remission (CR) and were still disease-free after 64 and 69 months. Nine patients showed partial remission (PR) to 131-1 MIBG, all the nine patients were alive at 16-57 months (mean 30.6 months) among whom seven were alive with stable disease and two patients were alive with progressive disease (PD) at the end of study. Eighteen patients remained stable after 131-I MIBG therapy, among them six were alive with PD and four were alive with stable disease at the end of study, while the remaining eight patients died. The last patient developed PD and died within 15 months. The 5 years event free survival (EPS) was 48.2% and the overall

[A Phase 1 study of beta-methyl-p-(123I)-iodophenyl-pentadecanoic acid (123I-BMIPP)].

Science.gov (United States)

Torizuka, K; Yonekura, Y; Nishimura, T; Tamaki, N; Uehara, T; Ikekubo, K; Hino, M

1991-07-01

Phase 1 study of beta-methyl-p-(123I)-iodophenylpentadecanoic acid (123I-BMIPP), a new radiopharmaceutical developed for the evaluation of myocardial fatty acid metabolism, was performed in six normal volunteers to evaluate its biodistribution and safety. After intravenous injection of 111 MBq of 123I-BMIPP, the agent accumulated to the myocardium rapidly (5.4 +/- 0.6% at 1.5 hr after injection) and was washed-out slowly (5.1 +/- 0.4% at 3.0hr). 123I-BMIPP demonstrated no significant accumulation to any specific organs other than myocardium, liver and muscle. Myocardium was clearly visualized in the planar and SPECT images obtained 30 min and 3 hrs after injection. The absorption doses from 123I-BMIPP estimated by MIRD method were lower than those from 201Tl in all organs. Neither adverse reactions nor abnormal clinical laboratory findings were found in the safety evaluation. These results suggest 123I-BMIPP is a promising agent for evaluating myocardial fatty acid metabolism.

Optimizing Parkinson's disease diagnosis: the role of a dual nuclear imaging algorithm.

Science.gov (United States)

Langston, J William; Wiley, Jesse C; Tagliati, Michele

2018-01-01

The diagnosis of Parkinson's disease (PD) currently relies almost exclusively on the clinical judgment of an experienced neurologist, ideally a specialist in movement disorders. However, such clinical diagnosis is often incorrect in a large percentage of patients, particularly in the early stages of the disease. A commercially available, objective and quantitative marker of nigrostriatal neurodegeneration was recently provided by 123-iodine 123 I-ioflupane SPECT imaging, which is however unable to differentiate PD from a variety of other parkinsonian syndromes associated with striatal dopamine deficiency. There is evidence to support an algorithm utilizing a dual neuroimaging strategy combining 123 I-ioflupane SPECT and the noradrenergic receptor ligand 123 I-metaiodobenzylguanidine (MIBG), which assesses the post-ganglion peripheral autonomic nervous system. Evolving concepts regarding the synucleinopathy affecting the central and peripheral autonomic nervous systems as part of a multisystem disease are reviewed to sustain such strategy. Data are presented to show how MIBG deficits are a common feature of multisystem Lewy body disease and can be used as a unique feature to distinguish PD from atypical parkinsonisms. We propose that the combination of cardiac (MIBG) and cerebral 123 I-ioflupane SPECT could satisfy one of the most significant unmet needs of current PD diagnosis and management, namely the early and accurate diagnosis of patients with typical Lewy body PD. Exemplary case scenarios will be described, highlighting how dual neuroimaging strategy can maximize diagnostic accuracy for patient care, clinical trials, pre-symptomatic PD screening, and special cases provided by specific genetic mutations associated with PD.

Metabolism of 123I-FP-CIT in humans

International Nuclear Information System (INIS)

Tanaka, Akihiro; Okano, Kyoko; Tamagami, Hiroshi

1999-01-01

The metabolism of N-(3-fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl)nortropane ( 123 I) ( 123 I-FP-CIT) in healthy humans was studied. Plasma and urine samples, obtained after i.v. administration of 123 I-FP-CIT, were analyzed using the two-dimensional thin-layer chromatography technique. Eleven radiochemical components were detected in both plasma and urine, and four of them were the parent 123 I-FP-CIT and its metabolites, N-(3-fluoropropyl)-2β-carboxy-3β-(4-iodophenyl)nortropane ( 123 I) ( 123 I-acid), 2β-carboxy-3β-(4-iodophenyl)nortropane ( 123 I) ( 123 I-nor-acid) and 2β-carbomethoxy-3β-(4-iodophenyl)nortropane ( 123 I) ( 123 I-nor-CIT). These four identified radiochemical components occupied about 80% or more in ratio of the radiochemical components in the plasma and urine. In the metabolites of 123 I-FP-CIT, the high polar metabolites- 123 I-acid and 123 I-nor-acid-were found to be the major components, while lipophilic 123 I-nor-CIT was a minor component. Free iodide ( 123 I - ) was not found in the plasma or urine. Thus, the main metabolic reactions which 123 I-FP-CIT undergoes in humans seem to be hydrolysis of the ester bond and N-dealkylation. In vivo deiodination of 123 I-FP-CIT was found to be minimum. Current results suggest that the metabolites of 123 I-FP-CIT hardly influence evaluation of the dopamine transporter in the human brain. (author)

N-isopropyl-p-[I[sup 123

Energy Technology Data Exchange (ETDEWEB)

Tada, Hiroshi; Morooka, Keiichi; Arimoto, Kiyoshi; Matsuo, Takiko; Takagi, Kazue; Yanagawa, Etsuko (Toho Univ., Tokyo (Japan). School of Medicine)

1992-09-01

We studied the clinical usefulness of I[sup 123]-IMP SPECT in 50 pediatric patients with CNS disorders, which were categorized into the convulsive disorder group (n=20), the cerebrovascular disorder group (n=10), the acute encephalopathy or CNS infection group (n=10), the metabolic or degenerative disorder group (n=6), the congenital abnormality group (n=2) and the migraine group (n=2). The findings obtained were compared with those of cranial CT. I[sup 123]-IMP SPECT revealed abnormal findings in 45 out of the 50 patients (90%), although cranial CT showed abnormal findings in only 24 patients (48%). This difference was statistically significant (p<0.01). In all groups except the migraine, we could find abnormal findings in more than 90% of the patients. Out of 28 patients without focal findings on the initial CT scanning. I[sup 123]-IMP SPECT showed focal abnormalities in 26 patients (93%). Moreover in many patients with focal neurological abnormalities, we found focal abnormalities of I[sup 123]-IMP SPECT related with neurological abnormalities of the patients. From these findings, we think I[sup 123]-IMP SPECT might be superior to CT scanning in examining a localized lesion. It was found that in many patients with focal abnormalities in CT scanning, I[sup 123]-IMP SPECT showed larger abnormalities in CT scanning. By using I[sup 123]-IMP SPECT we might be able to study the blood perfusional state surrounding the abnormal area shown by CT. In 3 patients with acute cerebrovascular disorders, I[sup 123]-IMP SPECT revealed abnormal findings 3 to 11 days earlier than cranial CT. I[sup 123]-IMP SPECT might be useful for early recognition of the pathological state. From these experiences, we concluded that I[sup 123]-IMP SPECT was useful for studying the pathophysiology of CNS disorders in children. (author).

The effect of cisplatin pretreatment on the accumulation of MIBG by neuroblastoma cells in vitro.

Science.gov (United States)

Armour, A; Cunningham, S H; Gaze, M N; Wheldon, T E; Mairs, R J

1997-01-01

[131I]meta-iodobenzylguanidine ([131I]MIBG) provides a means of selectively delivering radiation to neuroblastoma cells and is a promising addition to the range of agents used to treat neuroblastoma. As MIBG is now being incorporated into multimodal approaches to therapy, important questions arise about the appropriate scheduling and sequencing of the various agents employed. As the ability of neuroblastoma cells to actively accumulate MIBG is crucial to the success of this therapy, the effect of chemotherapeutic agents on this uptake capacity needs to be investigated. We report here our initial findings on the effect of cisplatin pretreatment on the neuroblastoma cell line SK-N-BE (2c). After treating these cells with therapeutically relevant concentrations of cisplatin (2 microM and 20 microM), a stimulation in uptake of [131I]MIBG was observed. Reverse transcription-polymerase chain reaction (RT-PCR) analysis demonstrated that this effect was due to increased expression of the noradrenaline transporter. These results suggest that appropriate scheduling of cisplatin and [131I]MIBG may lead to an increase in tumour uptake of this radiopharmaceutical with consequent increases in radiation dose to the tumour.

Cardiac metabolism of 15 (p-I-123 phenyl-) pentadecanoic acid after intracoronary tracer application

Energy Technology Data Exchange (ETDEWEB)

Reske, S.N.; Reichmann, K.; Knopp, R.; Winkler, C.; Koischwitz, D.; Machulla, H.J.; Simon, H.

1984-05-01

Myocardial turnover of ..omega..-(p/sup 123/I-Phenyl-) pentadecanoic acid and release of its metabolites into the coronary sinus and peripheral blood has been studied in patients with coronary artery and valvular heart disease. After intracoronary tracer injection myocardial extraction fractions of 45-53% in control subjects were observed. In patients with coronary artery disease (CAD) normal to reduced values (34-61%) were established. Hydrophilic catabolites of I-PPA, probably p/sup 123/I-benzoic and -hippuric acid as well as small amounts of the non-metabolized tracer were found in coronary sinus and peripheral blood. Myocardial tracer uptake and clearance patterns were clearly different in normal myocardium when compared to that obtained in patients with CAD. Thus, evaluation of myocardial I-PPA metabolism might provide a new diagnostic tool for assessment of integrity of the heart's muscular metabolic function.

Multicurie, transportable, integrally shielded 123Xe → 123I generator and processing system for high-purity iodine-123 production

International Nuclear Information System (INIS)

Lagunas-Solar, M.C.; Thibeau, H.L.; Goodart, C.E.; Little, F.E.; Navarro, N.J.; Hartnett, D.E.

1985-01-01

An integrally shielded 123 Xe → 123 I generator system has been designed and tested under production conditions for its suitability as a multicurie handling device from which to produce radiopharmaceutical-quality high-purity no-carrier-added (NCA) 123 I. The 123 Xe → 123 I generator system is expected to provide an alternative to current techniques and to increase the availability and reliability of high-purity 123 I made via the 127 I(p,5n) 123 Xe → 123 I nuclear reaction. The generator system is based on the Crocker Nuclear Laboratory's continuous-flow production system which has been operating since 1974 for the multicurie production of 123 I. The generator system, which consists of an integrally shielded xenon trap and separate loading and processing apparatuses, is simple and reliable to operate, can be adapted to computerized control, and provides a safe working environment for the repeated handling of multicurie amounts of Xe-I radioactivities

Utility of thallium-201 and iodine-123 metaiodobenzylguanidine in the scintigraphic detection of neuroendocrine neoplasia

International Nuclear Information System (INIS)

Montravers, F.; Coutris, G.; Sarda, L.; Mensch, B.; Talbot, J.N.

1993-01-01

In order to determine whether the association of the two markers is able to improve the detection of neuroendocrine lesions, 137 sctinigraphic examinations using MIBG and thallium were performed in 101 patients referred for suspicion or follow-up of neuroendocrine tumours. Thallium chloride was first injected (1 MBq/kg), images being acquired about 20 min after injection; 123 I-MIBG (4 MBq/kg) was then injected and images acquired 5 and 24 h later. In patients with phaeochromocytoma or neuroblastoma, thallium scintigraphy appeared of little help since no tumoural site was discovered by thallium accumulation alone. In contrast, thallium examination seemed of interest in the detection of paraganglioma and MTC, the association of the two radiopharmaceuticals increasing the number of detected sites. (orig./MTG)

Interleucina 1β correlaciona-se com MIBG e parâmetros do exercício, na insuficiência cardíaca?

Directory of Open Access Journals (Sweden)

Leandro Rocha Messias

2013-05-01

Full Text Available FUNDAMENTO: Na insuficiência cardíaca, níveis de interleucina 1β (IL 1β se associam a prognóstico. A atividade adrenérgica cardíaca avaliada através da cintilografia com metiodobenzilguanidina (I123 MIBG e parâmetros do exercício são importantes preditores de prognóstico. A relação entre essas variáveis não está bem definida. OBJETIVO: Avaliar associação entre níveis de IL 1β com parâmetros do exercício e do I123 MIBG. MÉTODOS: Estudo observacional transversal, com avaliação de 25 pacientes consecutivos com insuficiência cardíaca e fração de ejeção menor que 45%, através de: dosagem de IL 1β; parâmetros do I123 MIBG [relação coração/mediastino precoce e tardia, taxa de washout (WO]; e teste ergométrico em esteira pelo protocolo de Rampa. RESULTADOS: Separados em dois grupos pelos níveis de IL 1β (normal vs. elevado, o grupo com níveis aumentados apresentava menor reserva de duplo produto (RDP, menor capacidade funcional (CF e recuperação mais lenta da frequência cardíaca no 1º (RFC 1º e 2º minuto (RFC 2º, e maior WO. Na análise univariada, todas as variáveis se correlacionaram com a IL 1β; RDP: r = 0,203, p = 0,024; CF: r = 0,181, p = 0,034; RFC 1º: r = 0,182, p = 0,034; RFC 2º: r = 0,204, p = 0,023; WO: r = 0,263, p = 0,009. Na multivariada, apenas a WO permaneceu com correlação significativa (r2 = 0,263, p = 0,009. CONCLUSÃO: A hipertonia adrenérgica foi o principal determinante dos níveis de IL 1β, demonstrando que a atividade simpática excessiva influencia a atividade inflamatória sistêmica. As variáveis do teste ergométrico não foram capazes de identificar pacientes com níveis elevados de IL 1β.

Striatal uptake of I-123-β-CIT and I-123-IBZM in patients with extrapyramidal symptoms

International Nuclear Information System (INIS)

Bettin, S.; Kaempfer, I.; Seese, A.; Schaefer, A.; Reuter, M.; Loessner, J.; Dietrich, J.; Wagner, A.; Knapp, W.H.

1997-01-01

Aim: This pilot study deals with the question whether characteristic changes in local cerebral dopamine transporter function and D 2 -receptor binding capacity can be shown with SPET, in idiopathic Parkinson syndrome (IPS) and secondary Parkinson syndrome (SPS). Methods: In 16 patients (6 with IPS, 6 with SPS except Wilsons's disease, and 4 with Wilson's disease) SPET studies were performed using I-123-β-CIT and I-123-IBZM and a dual-head gamma camera. Images were obtained 20-24 h and 2 h post injection, respectively. For semiquantitative analysis count density ratios of basal ganglia (BG) and cerebellum (CER) were determined for I-123-β-CIT and ratios between BG and medial frontal cortex (MFC) for I-123-IBZM. Results: The BG/CER ratio in the I-123-β-CIT studies averaged 3.04±0.83 in IPS and 7.73±3.28 in SPS (p [de

Cardiac retention of PET neuronal imaging agent LMI1195 in different species: Impact of norepinephrine uptake-1 and -2 transporters

International Nuclear Information System (INIS)

Yu, Ming; Bozek, Jody; Kagan, Mikhail; Guaraldi, Mary; Silva, Paula; Azure, Michael; Onthank, David; Robinson, Simon P.

2013-01-01

Introduction: Released sympathetic neurotransmitter norepinephrine (NE) in the heart is cleared by neuronal uptake-1 and extraneuronal uptake-2 transporters. Cardiac uptake-1 and -2 expression varies among species, but the uptake-1 is the primary transporter in humans. LMI1195 is an NE analog labeled with 18 F for PET evaluation of cardiac neuronal function. This study investigated the impact of cardiac neuronal uptake-1 associated with different species on LMI1195 heart uptake. Methods: Cardiac uptake-1 was blocked by desipramine, a selective uptake-1 inhibitor, and sympathetic neuronal denervation was induced by 6-hydroxydopamine, a neurotoxin, in rats, rabbits and nonhuman primates (NHP). Tissue biodistribution and cardiac imaging of LMI1195 and 123 I-metaiodobenzylguanidine (MIBG) were performed. Results: In rats, uptake-1 blockade did not alter LMI1195 heart uptake compared to the control at 60-min post injection [1.41 ± 0.07 vs. 1.47 ± 0.23 % injected dose per gram tissue (%ID/g)]. In contrast, LMI1195 heart uptake was reduced by 80% in uptake-1 blocked rabbits. In sympathetically denervated rats, LMI1195 heart uptake was similar to the control (2.18 ± 0.40 vs. 2.58 ± 0.76 %ID/g). However, the uptake decreased by 79% in denervated rabbits. Similar results were found in MIBG heart uptake in rats and rabbits with uptake-1 blockade. Consistently, LMI1195 cardiac imaging showed comparable myocardial activity in uptake-1 blocked or sympathetically denervated rats to the control, but marked activity reduction in uptake-1 blocked or denervated rabbits and NHPs. Conclusions: LMI1195 is retained in the heart of rabbits and NHPs primarily via the neuronal uptake-1 with high selectivity and can be used for evaluation of cardiac sympathetic denervation. Similar to the human, the neuronal uptake-1 is the dominant transporter for cardiac retention of NE analogs in rabbits and NHPs, but not in rats

N-isopropyl-p-[I123] iodoamphetamine single photon emission computed tomography (I123-IMP SPECT) and child neurology

International Nuclear Information System (INIS)

Tada, Hiroshi; Morooka, Keiichi; Arimoto, Kiyoshi; Matsuo, Takiko; Takagi, Kazue; Yanagawa, Etsuko

1992-01-01

We studied the clinical usefulness of I 123 -IMP SPECT in 50 pediatric patients with CNS disorders, which were categorized into the convulsive disorder group (n=20), the cerebrovascular disorder group (n=10), the acute encephalopathy or CNS infection group (n=10), the metabolic or degenerative disorder group (n=6), the congenital abnormality group (n=2) and the migraine group (n=2). The findings obtained were compared with those of cranial CT. I 123 -IMP SPECT revealed abnormal findings in 45 out of the 50 patients (90%), although cranial CT showed abnormal findings in only 24 patients (48%). This difference was statistically significant (p 123 -IMP SPECT showed focal abnormalities in 26 patients (93%). Moreover in many patients with focal neurological abnormalities, we found focal abnormalities of I 123 -IMP SPECT related with neurological abnormalities of the patients. From these findings, we think I 123 -IMP SPECT might be superior to CT scanning in examining a localized lesion. It was found that in many patients with focal abnormalities in CT scanning, I 123 -IMP SPECT showed larger abnormalities in CT scanning. By using I 123 -IMP SPECT we might be able to study the blood perfusional state surrounding the abnormal area shown by CT. In 3 patients with acute cerebrovascular disorders, I 123 -IMP SPECT revealed abnormal findings 3 to 11 days earlier than cranial CT. I 123 -IMP SPECT might be useful for early recognition of the pathological state. From these experiences, we concluded that I 123 -IMP SPECT was useful for studying the pathophysiology of CNS disorders in children. (author)

Renal function study using I-123-OIH

International Nuclear Information System (INIS)

Yamashita, Masato; Osaka, Yosio; Aikawa, Ichiro

1989-01-01

Twenty-eight renal function studies were performed in 24 patients with renal diseases with I-123 orthoiodohippurate (I-123 OIH). Neither side effects nor abnormal laboratory values were attributable to I-123 OIH. Imaging with Tc-99m diethylene triaminepentaacetic acid (DTPA) was also performed in 20 patients within one week after I-123 imaging. Findings with I-123 OIH and Tc-99m DTPA were similar in all except for two patients. The two patients had received cadaveric renal transplantation. One patient presented with acute tubular necrosis and the other with chronic renal rejection. In these patients, I-123 imaging showed vascular stricture and Tc-99m imaging showed a decreased glomerular function. Because I-123 OIH and Tc-99m DTPA had different pharmacodynamics, combined use of the two imaging agents may be useful in evaluating renal rejection or acute tubular necrosis. (N.K.)

The elimination rate of 123I-heptadecanoic acid after intracoronary and intravenous administration

International Nuclear Information System (INIS)

Visser, F.C.; Eenige, M.J. van; Wall, E.E. van der; Engelen, C.J. van; Cock, C.C. de; Roos, J.P.; Westera, G.; Lingen, A. van; Hollander, W. den; Heidendal, G.A.K.

1985-01-01

When calculating the elimination rate of radioactivity after the administration of radioiodinated heptadecanoic acid ( 123 I-HDA), background correction is necessary due to the high level of background activity. In the present study, the subtraction method of Freundlieb et al. was investigated by comparing the half-time values of the elimination rate after intravenous (i.v.) and intracoronary (i.c.) injection. In the latter case, no background correction was necessary. Six patients undergoing cardiac catheterization were studied. Scintigraphy was performed after the injection of 123 I-HDA into the left coronary artery and after i.v. injection. Half-time values are calculated from regions of interest drawn over myocardium perfused by the left-anterior descending branch (LAD) and the left circumflex artery (LCX). In the LAD region, the mean half-time value in the i.c. study was 22 min, while in the corrected i.v. study, the mean value was 27 min. In the LCX region, the half-time values were 24 and 33 min, respectively. The background-subtraction procedure proposed by Freundlieb et al. for i.v.-injected 123 I-HDA is incomplete, as it resulted in half-time values that were higher than those of the i.c. study. (orig.)

Prognostic value of {sup 18}F-DOPA PET/CT at the time of recurrence in patients affected by neuroblastoma

Energy Technology Data Exchange (ETDEWEB)

Piccardo, Arnoldo [Galliera Hospital, Nuclear Medicine Unit, Genoa (Italy); E.O. Ospedali Galliera, Department of Nuclear Medicine, Genoa (Italy); Puntoni, Matteo [Galliera Hospital, Clinical Trial Research Unit, Genoa (Italy); Lopci, Egesta; Fanti, Stefano [Sant' Orsola-Malpighi Hospital, Nuclear Medicine Unit, Bologna (Italy); Conte, Massimo; Sorrentino, Stefania; Garaventa, Alberto [G. Gaslini Children' s Hospital, Department of Hematology-Oncology, Genoa (Italy); Foppiani, Luca [Galliera Hospital, Internal Medicine, Genoa (Italy); Morana, Giovanni [G. Gaslini Children' s Hospital, Department of Pathology and Radiology, Genoa (Italy); Naseri, Mehrdad; Villavecchia, Giampiero [Galliera Hospital, Nuclear Medicine Unit, Genoa (Italy); Cistaro, Angelina [IRMET, PET Centre, Turin (Italy)

2014-06-15

The aim of this study was to investigate the relationship between {sup 123}I-metaiodobenzylguanidine (MIBG) scan semi-quantification and a new {sup 18}F-DOPA positron emission tomography (PET)/CT score in patients with suspected or documented neuroblastoma (NB) relapse and to assess the association between these two parameters and progression-free survival (PFS)/overall survival (OS). We analysed 24 NB patients who had undergone {sup 123}I-MIBG and {sup 18}F-DOPA PET/CT scans at the time of suspected relapse, after applying a proper scoring system for each scan. In time-to-event analyses, the score distributions were regarded as continuous and were categorized in tertiles and medians. We used Kaplan-Meier curves and Cox proportional hazard models for PFS and OS in order to estimate the independent prognostic impact of {sup 123}I-MIBG and {sup 18}F-DOPA PET/CT scans. The {sup 123}I-MIBG and {sup 18}F-DOPA scores were highly and positively correlated (Spearman's rho = 0.8, p < 0.001). Over a median follow-up of 14 months (range 6-82), 12 cases of disease progression and 6 deaths occurred. Multivariate Cox models showed a higher risk of disease progression [hazard ratio (HR) 17.0, 95 % confidence interval (CI) 2.7-109] in NB patients with {sup 123}I-MIBG score > 3 (3rd tertile) and an even higher risk (HR:37.2, 95 % CI 2.4-574) in those with {sup 18}F-DOPA whole-body metabolic burden (WBMB) >7.5 (median), after adjustment for all main clinical/pathological factors considered. Kaplan-Meier analyses showed a significant association with OS (log-rank p = 0.01 and p = 0.03 for {sup 123}I-MIBG and {sup 18}F-DOPA WBMB, respectively). Our results confirm the good agreement between {sup 18}F-DOPA PET/CT and {sup 123}I-MIBG scan in patients affected by NB relapse. In time-to-event analyses, {sup 123}I-MIBG scan and {sup 18}F-DOPA PET/CT scores were independently and significantly associated with disease progression. (orig.)

Low Dose I-131 MIBG therapy as an adjunct for bone pain palliation in pediatric patients with end-stage neuroblastoma: a pilot study

International Nuclear Information System (INIS)

Pascual, Thomas; Herbert, Anthony; Howman-Giles, Robert

2009-01-01

Full text: Objective: This study describes the initial experience in the use of low-dose 1-131 MIBG in patients with metastaticl refractory Neuroblastoma given at 18.5 Mbql Kg (0.5 mCi/Kg )to (1) achieve disease palliation (i.e., pain I symptom control) and improvement in the quality of life, through subjective response from patient/carers and (2) allow day-admission to minimize hospital stay providing more quality time between the patients and carers. Methods: Patients with refractory and metastatic Neuroblastoma whose primary treatment goal at that particular stage is pain palliation were given low-dose 1-131 M IBG at a dose of 18.5 Mbql Kg ( 0.5 mCil Kg)l. Assessment of subjective pain relief following 1-131 MIBG was done through interviews from hospital visits of the patient and home visits by the team. Results: Four patients underwent Low-Dose 1-131 MIBG Therapy for pain palliation between May 2007- March 2008. Median age was 5.75 years old and median total dose given was 539 Mbql patient (14.5 mCil patient). All patients at a cenain time had relief from disease pain allowing them to communicate with family and participate in physical activities not priyiledged before. Observations gathered from carersl parents revealed that the overall quality-of-life improved after the 1-131 MIBG therapy with concurrent pain medication protocol. Conclusion: This initial I pilot study described achievement of disease palliation (i.e., pain and symptom control) and improvement in the quality of life of Stage IV Neuroblastoma patients and allows day-admissions providing more quality time between the patient and the family and reduces patient anxiety.

Radioiodinated tracers for myocardial imaging

International Nuclear Information System (INIS)

Kulkarni, P.V.; Corbett, J.R.

1990-01-01

Recent advances in the efficient production of high purity radioiodine (123I) and new efficient radiolabeling techniques have allowed the development of new classes of cardiovascular radiopharmaceuticals. These include 123I-labeled fatty acids to assess myocardial metabolism, 123I-metaiodobenzylguanidine (MIBG) for myocardial neuronal activity, labeled monoclonal antibodies for myocardial necrosis, and labeled lipoproteins for receptor concentration. 123I-labeled fatty acids and MIBG are under clinical investigation with encouraging results. 123I- and 111In-labeled fragments of monoclonal antibodies to myosin have been used for imaging myocardial necrosis in humans. The development of radiotracers for imaging of cholinergic and adrenergic receptors is still in the experimental stage. Recent advances in imaging instrumentation and radiopharmaceuticals have resulted in cardiac imaging applications beyond blood pool ventriculography, perfusion, and infarct-avid imaging. Developments of radioiodine (123I)-labeled agents promise to play an important role in the assessment of myocardial metabolism, neuronal activity, and receptor concentration. The chemistry of iodine is well defined compared with that of 99mTc; therefore, iodine isotopes are well suited for labeling biologically important molecules. Among the iodine isotopes, 123I has nearly ideal nuclear properties for nuclear medical applications with a 13.3-hour half-life (T1/2) and 159 keV gamma emission (83%). Despite the nearly ideal chemical and nuclear properties of 123I, the widespread application of 123I-based radiopharmaceuticals in clinical practice has been limited by high production costs (123I is produced in a cyclotron), relatively limited availability, and the presence of undesirable radionuclidic impurities (124I, T1/2 = 4.2 days; 125I, T1/2 = 60 days; 126I, T1/2 = 13.1 days). 77 references

Effect of low dose 131I-MIBG therapy in metastatic neural crest tumors: Evaluation by RECIST and quality of life questionnaire

International Nuclear Information System (INIS)

Basu, S.; Joseph, J.K.

2004-01-01

Full text: The primary aim of 131I-MIBG therapy in advanced metastatic or recurrent neural crest tumors is palliation i.e. disease control and improvement of health related quality of life. No clear guidelines regarding the dosage and schedule of 131I-MIBG therapy in neural crest tumors exist at present. In general, a fixed dose of 100-300 mCi has been suggested for each therapy. We share our experience of 131I-MIBG therapy in various subgroups of neural crest tumors and discuss the response assessed by the RECIST and the quality of life questionnaire. A total number of 14 patients were treated with indigenously produced 131I-MIBG, which was administered as continuous intravenous infusion over a period of 2-4 hours. Patient isolation according to guidelines set by the national regulatory authority and thyroid blockade with Lugol's iodide were strictly adhered to. Antihypertensive measures were undertaken in case of pheochromocytoma and paraganglioma to prevent effects of catecholamine release during or following 131I-MIBG infusion. The primaries included neuroblastoma (n=7), pheochromocytoma (n=5) and paraganglioma (n=2). The cases of neuroblastoma included patients with progressive disease where the conventional chemotherapy had failed, while those of pheochromocytoma and paraganglioma were cases with recurrent / metastatic disease following surgery. In cases of multiple therapies, the minimum interval between two consecutive therapies was 12 weeks. Regular renal and haematological profiles were monitored in all the cases. Response to therapy was assessed by RECIST. The findings of 131I-MIBG scintigraphy were incorporated with CT scan in assessing the target lesions. Biochemical response was evaluated by 24 hours urinary VMA estimation. The quality of life status was evaluated by the conventional questionnaire. A total of 27 therapies were administered in 14 patients. In five treated cases of pheochromocytoma, three received multiple therapies. Follow up results

Rapid clearance of iodine-131 MIBG from the heart and liver of patients with adrenergic dysfunction and pheochromocytoma