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Sample records for metaiodobenzylguanidine

  1. 131I Metaiodobenzylguanidine scintigraphy

    International Nuclear Information System (INIS)

    Izumi, Motomori; Morimoto, Isao; Yamashita, Shunichi; Hirayu, Hideshi; Nagataki, Shigenobu

    1988-01-01

    A newly developed radiopharmaceutical agent, 131 I-metaiodobenzylguanidine ( 131 I-MIBG) has been reported to be very useful for locating pheochromocytoma and to be specific for pheochromocytoma and safe for humans. The first 131 I-MIBG scintiscanning in Japan which has been carried out in our clinic and the analysis of clinical experience of 131 I-MIBG scanning in Japan are presented

  2. Merkel cell carcinoma and iodine-131 metaiodobenzylguanidine scan

    International Nuclear Information System (INIS)

    Castagnoli, A.; Biti, G.; De Cristofaro, M.T.R.; Papi, M.G.; Ferri, P.; Magrini, S.M.; Bianchi, S.

    1992-01-01

    Two cases of Merkel cell carcinoma, a neuroendocrine neoplasia of the skin, investigated with iodine, 131 metaiodobenzylguanidine ( 131 I-mIBG) scintigraphy, are reported. Uptake in the tumor was evident only in 1 case. The possible diagnostic and therapeutic role of 131 I-mIBG in patients with this rare neoplasm is discussed. (orig.)

  3. Merkel cell carcinoma and iodine-131 metaiodobenzylguanidine scan

    Energy Technology Data Exchange (ETDEWEB)

    Castagnoli, A.; Biti, G.; De Cristofaro, M.T.R.; Papi, M.G. (Florence Univ. (Italy). Dipt. di Fisiopatologia); Ferri, P. (Florence Univ. (Italy). U.O. Medicina Nuclear USL 10D); Magrini, S.M. (Florence Univ. (Italy). U.O. Radioterapia USL 10D); Bianchi, S. (Florence Univ. (Italy). Ist. di Anatomia Patologica)

    1992-10-01

    Two cases of Merkel cell carcinoma, a neuroendocrine neoplasia of the skin, investigated with iodine, 131 metaiodobenzylguanidine ({sup 131}I-mIBG) scintigraphy, are reported. Uptake in the tumor was evident only in 1 case. The possible diagnostic and therapeutic role of {sup 131}I-mIBG in patients with this rare neoplasm is discussed. (orig.).

  4. [(123)I]metaiodobenzylguanidine and [(111)In]octreotide uptake in begnign and malignant pheochromocytomas

    NARCIS (Netherlands)

    E. van der Harst (Erwin); E.P. Krenning (Eric); D.J. Kwekkeboom (Dirk Jan); F.T.B. Bosman (Fré); H.A. Bruining (Hajo); H.J. Bonjer (Jaap); S.W.J. Lamberts (Steven); F. Boomsma (Frans); Th. Stijnen (Theo); W.W. de Herder (Wouter); R.R. de Krijger (Ronald); A.H. van den Meiracker (Anton)

    2001-01-01

    textabstractSelecting the appropriate approach for resection and follow-up of pheochromocytomas (PCCs) is highly dependent upon reliable localization and exclusion of multifocal, bilateral, or metastatic disease. Metaiodobenzylguanidine (MIBG) scintigraphy was

  5. Meta-iodobenzylguanidine synthesis and labelling with iodine-131

    International Nuclear Information System (INIS)

    Miranda, J.; Herrera, J.; Robles, A.; Caballero, J.; Portilla, A.; Ticona, L.

    1997-01-01

    Meta-iodo-benzylguanidine (MIBG) synthesis is carried out through m-iodo benzylamine condensation and subsequent formation of the hemisulfate salt. The synthesized product is characterized and identified by IR spectroscopy and m.p. determination. Acute toxicity tests conducted in mice demonstrated that the synthesized product is not toxic. MIBG hemisulfate labelling methods with I-131 is carried out by nucleophilic isotopic exchange; the reaction is catalyzed with cooper sulfate in the presence of ammonium sulfate at temperatures ranging between 140 and 150 o C . Biological distribution tests in wistar rats present an average value of 1,54% of injected dose/organ gram in suprarenal glands. These values show promise for the application of this radiopharmaceutical in radiodiagnosis of suprarenal tumors and procurement of adrenal medulla, myocardium and salivary gland images

  6. Radionuclide therapy of Sipple syndrome using iodine-131 metaiodobenzylguanidine

    International Nuclear Information System (INIS)

    Furusawa, Mitsuhiro; Shimomura, Osamu; Tomiguchi, Seiji; Hirota, Yoshihisa; Takahashi, Mutsumasa; Yamauchi, Jyoji; Iwaoka, Daisuke; Satoh, Tatsuo

    1992-01-01

    A 40-years-old female who had lung and liver metastases from malignant pheochromocytoma was treated with 3.7 GBq 131 I-MIBG (metaiodobenzylguanidine). After the treatment, 131 I-MIBG showed increased uptake in the metastatic lesions of the lung and liver. The size of tumor was no significant change on CT and MRI, but the intensity of liver metastases decreased gradually on MRI. Prior to the treatment, the levels of adrenaline and noradrenaline were high. One to three days after treatment, the level of these laboratory data further increased, but they gradually decreased in 1 to 3 months. These changes may be due to necrosis of tumor tissue. (author)

  7. 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)

  8. Transcapillary transport of metaiodobenzylguanidine (MIBG) in isolated rat heart

    International Nuclear Information System (INIS)

    DeGrado, Timothy R.; Wang Shuyan

    1998-01-01

    A better understanding of transcapillary transport for tracer metaiodobenzylguanidine (MIBG) is desirable for development of tracer kinetic models that yield meaningful estimates of neuronal uptake function from tissue radioactivity time courses. This study utilized a multiple-indicator approach in Langendorff-perfused rat hearts to define transport mechanisms and determine the capillary permeability-surface area (PSc) over a broad range of flow (F). Multiple injections within the same heart at different flows allowed characterization of the PSc/F relationship within the same heart. The coefficient of variation of E for multiple injections within the same hearts at constant flow was 6±2% (3 to 6 injections in 9 hearts). In 10 hearts (4 to 6 injections per heart), flow was varied between 2.0-16.5 mL/min. PSc was found to be nearly proportional to flow in each heart (r=0.88±0.14; slope = 0.23±0.10; intercept = 11±7 mL/min/g dry). Tissue hypoxia at low flows, as evidenced by enhanced lactate production, did not appear to influence the PSc/F relationship. Pharmacologic blockade of uptake-1 and uptake-2 had negligible affect on E or PSc as compared with flow-matched controls, although tissue retention was markedly reduced. The results show PSc of MIBG to be nearly proportional to flow but independent of specific neuronal and extraneuronal transport mechanisms and tissue hypoxia. The results are consistent with a passive diffusion process across the capillary endothelial barrier. The increase in PSc with increasing flow could reflect capillary recruitment and/or enhanced capillary permeability

  9. 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

  10. 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.

  11. Standardization of I-123-meta-iodobenzylguanidine myocardial sympathetic activity imaging: phantom calibration and clinical applications

    NARCIS (Netherlands)

    Nakajima, Kenichi; Verschure, Derk O.; Okuda, Koichi; Verberne, Hein J.

    2017-01-01

    Purpose Myocardial sympathetic imaging with I-123-meta-iodobenzylguanidine (I-123-mIBG) has gained clinical momentum. Although the need for standardization of I-123-mIBG myocardial uptake has been recognized, the availability of practical clinical standardization approaches is limited. The need for

  12. 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.

  13. Meta-iodobenzylguanidine inhibits complex I and III of the respiratory chain in the human cell line Molt-4

    NARCIS (Netherlands)

    Cornelissen, J.; Wanders, R. J.; van Gennip, A. H.; van den Bogert, C.; Voûte, P. A.; van Kuilenburg, A. B.

    1995-01-01

    In this paper we report the effects of meta-iodobenzylguanidine (MIBG), a structural analogue of norepinephrine, on cell proliferation and several parameters related to mitochondrial respiration in Molt-4 cells. In micromolar concentrations, MIBG completely inhibited the proliferation of Molt-4

  14. 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

  15. Asymmetry of cardiac [123I] meta-iodobenzyl-guanidine scans in patients with ventricular tachycardia and a "clinically normal" heart.

    OpenAIRE

    Gill, J S; Hunter, G J; Gane, J; Ward, D E; Camm, A J

    1993-01-01

    OBJECTIVE--Patients with exercise induced ventricular tachycardia associated with a "clinically normal" heart may have an abnormality of the regional distribution of the cardiac sympathetic nerve supply. In this study the regional distribution of the myocardial nerve supply in patients with ventricular tachycardia (VT) and control subjects was examined by [123] meta-iodobenzylguanidine (MIBG) scanning. PATIENTS AND DESIGN--Eight patients with exercise induced VT and seven patients with VT unr...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  18. Effect of adrenergic receptor ligands on metaiodobenzylguanidine uptake and storage in neuroblastoma cells

    Energy Technology Data Exchange (ETDEWEB)

    Babich, J.W. [Division of Nuclear Medicine, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (United States)]|[Department of Radiology, Harvard Medical School, Boston, Massachusetts (United States); Graham, W. [Division of Nuclear Medicine, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (United States); Fischman, A.J. [Division of Nuclear Medicine, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (United States)]|[Department of Radiology, Harvard Medical School, Boston, Massachusetts (United States)

    1997-05-01

    The effects of adrenergic receptor ligands on uptake and storage of the radiopharmaceutical [{sup 125}I]metaiodobenzylguanidine (MIBG) were studied in the human neuroblastoma cell line SK-N-SH. For uptake studies, cells were with varying concentrations of {alpha}-agonist (clonidine, methoxamine, and xylazine), {alpha}-antagonist (phentolamine, tolazoline, phenoxybenzamine, yohimbine, and prazosin), {beta}-antagonist (propranolol, atenolol), {beta}-agonist (isoprenaline and salbutamol), mixed {alpha}/{beta} antagonist (labetalol), or the neuronal blocking agent guanethidine, prior to the addition of [{sup 125}I]MIBG (0.1 {mu}M). The incubation was continued for 2 h and specific cell-associated radioactivity was measured. For the storage studies, cells were incubated with [{sup 125}I]MIBG for 2 h, followed by replacement with fresh medium with or without drug (MIBG, clonidine, or yohimbine). Cell-associated radioactivity was measured at various times over the next 20 h. Propanolol reduced [{sup 125}I]MIBG uptake by approximately 30% (P<0.01) at all concentrations tested, most likely due to nonspecific membrane changes. In conclusion, the results of this study establish that selected adrenergic ligands can significantly influence the pattern of uptake and storage of MIBG in cultured neuroblastoma cells, most likely through inhibition of uptake or through noncompetitive inhibition. The potential inplications of these findings justify further study. (orig./VHE). With 4 figs., 1 tab.

  19. Iodine-131 in breast milk following administration of 131I Meta-Iodobenzylguanidine

    International Nuclear Information System (INIS)

    Bibbo, G.; Munn, C.; Cain, T.

    2000-01-01

    Full text: Samples of breast milk from a lactating patient, injected with 18.9 MBq of [ 131 I] Meta-Iodobenzylguanidine (MIBG) to localise a possible phaeochromocytomas, have been collected for 140h after administration of the radiopharmaceutical. From each of the collected samples, radioactivity from 1 ml of milk was counted in a NaI crystal well counter: The recorded counts were then compared with the counts of a known reference 131 I source. The specific concentration of the radioactivity secreted in the milk increased reaching a peak at 13h after the administration of the radiopharmaceutical and then decreased exponentially with an effective half time of 16h. Dosimetry calculations indicated that for the infant to receive an effective dose 131 I ingested), breast feeding needed to be suspended for at least 40h. However, the thyroid dose (assuming the infant thyroid has a mass of 1.5g and an uptake of 70%) would be about 24 mSv. To limit the thyroid dose to 131 'I from ICRP 72 for a three-month-old infant; fed 140ml of milk per feed every 4h (6 feeds/day) with the first feed occurring 3h after the administration of the radiopharmaceutical. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  20. 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)

  1. 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)

  2. Iodine-131 Metaiodobenzylguanidine Therapy for Neuroblastoma: Reports So Far and Future Perspective

    Directory of Open Access Journals (Sweden)

    Daiki Kayano

    2015-01-01

    Full Text Available Neuroblastoma, which derives from neural crest, is the most common extracranial solid cancer in childhood. The tumors express the norepinephrine (NE transporters on their cell membrane and take in metaiodobenzylguanidine (MIBG via a NE transporter. Since iodine-131 (I-131 MIBG therapy was firstly reported, many trails of MIBG therapy in patients with neuroblastoma were performed. Though monotherapy with a low dose of I-131 MIBG could achieve high-probability pain reduction, the objective response was poor. In contrast, more than 12 mCi/kg I-131 MIBG administrations with or without hematopoietic cell transplantation (HCT obtain relatively good responses in patients with refractory or relapsed neuroblastoma. The combination therapy with I-131 MIBG and other modalities such as nonmyeloablative chemotherapy and myeloablative chemotherapy with HCT improved the therapeutic response in patients with refractory or relapsed neuroblastoma. In addition, I-131 MIBG therapy incorporated in the induction therapy was proved to be feasible in patients with newly diagnosed neuroblastoma. To expand more the use of MIBG therapy for neuroblastoma, further studies will be needed especially in the use at an earlier stage from diagnosis, in the use with other radionuclide formations of MIBG, and in combined use with other therapeutic agents.

  3. 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.)

  4. 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

  5. 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.

  6. 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)

  7. 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

  8. 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)

  9. 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)

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

    NARCIS (Netherlands)

    Bleeker, Gitta; Schoot, Reineke A.; Caron, Huib N.; de Kraker, Jan; Hoefnagel, Cees A.; van Eck, Berthe L.; Tytgat, Godelieve A.

    2013-01-01

    In the treatment of patients with high-risk neuroblastoma, different doses of (131)I-metaiodobenzylguanidine ((131)I-MIBG) are administered at different time points during treatment. Toxicity, mainly haematological (thrombocytopenia), from (131)I-MIBG therapy is known to occur in extensively

  11. Impact of mediastinal, liver and lung (123)I-metaiodobenzylguanidine ( (123)I-MIBG) washout on calculated (123)I-MIBG myocardial washout

    NARCIS (Netherlands)

    Verberne, Hein J.; Somsen, G. Aernout; Povinec, Pavol; van Eck-Smit, Berthe L. F.; Jacobson, Arnold F.

    2009-01-01

    PURPOSE: In planar (123)I-metaiodobenzylguanidine ((123)I-MIBG) myocardial imaging mediastinum (M) activity is often used as a background correction in calculating "washout" (WO). However, the most likely sources for counts that might produce errors in estimating myocardial (Myo) activity are lung

  12. Long-term follow-up of the thyroid gland after treatment with 131I-Metaiodobenzylguanidine in children with neuroblastoma: importance of continuous surveillance

    NARCIS (Netherlands)

    Clement, S. C.; van Eck-Smit, B. L. F.; van Trotsenburg, A. S. P.; Kremer, L. C. M.; Tytgat, G. A. M.; van Santen, H. M.

    2013-01-01

    Thyroid dysfunction has been reported in up to 52% of patients 1.4 years after treatment with (131) I-Metaiodobenzylguanidine (MIBG) in children with neuroblastoma (NBL), despite the use of potassium-iodide (KI). Our aim was to investigate if the incidence and severity of thyroid damage increases in

  13. The development of meta-iodobenzylguanidine analogues for the therapy of neuroendocrine and other tumours

    International Nuclear Information System (INIS)

    Vaidyanathan, G.; Zalutsky, M.R.

    2001-01-01

    Radioiodinated meta-iodobenzylguanidine (MIBG) has been extensively used in the diagnosis and therapy of neuroendocrine tumours such as neuroblastoma. We have developed a no-carrier-added synthesis (n.c.a.) for MIBG as well as other analogues which may improve clinical utility. In SK-N-SH human neuroblastoma cells in vitro, the uptake of n.c.a. [ 131 I]MIBG remained constant over a 2-3-log activity concentration range. In contrast, the uptake of [ 131 I]MIBG prepared by an exchange radioiodination (ex-[ 131 I]MIBG) steadily decreased over the same range demonstrating the saturability of uptake under these conditions. Similar differences in uptake were seen in normal mouse heart and adrenals, the normal target tissues for MIBG. While no advantage of n.c.a [ 131 I]MIBG over ex-[ 131 I]MIBG was seen in athymic mice hosting SK-N-SH neuroblastoma xenografts, higher tumour uptake and tumour-to-normal tissue ratios were observed when SK-N- BE(2C) xenografts were used. Since neuroblastoma is often associated with micrometastases, an MIBG analogue labelled with the -particle emitting 211 At could be advantageous. A method has been developed for the efficient synthesis of meta-[ 211 At]astatobenzylguanidine (MABG). A number of in vitro assays and tissue distribution studies showed that MABG is an excellent analogue of MIBG. From clonogenic assays using SK-N-SH neuroblastoma cells, it was calculated that the D 0 value for MABG (215 Bq/ml) was more than 1000-fold lower than that of n.c.a. [ 131 I]MIBG. A 18 F-labelled analogue of MIBG, 4-[ 18 F]fluoro-3-iodobenzylguanidine ([ 18 F]FIBG), has been prepared and is shown to have a higher uptake in SK-N-SH cells than MIBG. Because it may be an invaluable tool in combination with [ 18 F]FIBG, a method has been developed for the synthesis of its radioiodinated analogue, [ 131 I]FIBG. It was shown that SK-N-SH cells retained FIBG to a significantly higher degree than MIBG over a 3-day period, suggesting that [ 131 I]FIBG may deliver

  14. 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)

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

    International Nuclear Information System (INIS)

    De Rosa, Anna; De Leva, Maria Fulvia; Maddaluno, Gennaro; Filla, Alessandro; De Michele, Giuseppe; Pappata, Sabina; Pellegrino, Teresa; Fiumara, Giovanni; Carotenuto, Raffaella; Cuocolo, Alberto; Petretta, Mario

    2013-01-01

    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 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 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 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 123 I-MIBG cardiac imaging could become a useful tool for analysing the pathophysiology of SCA2. (orig.)

  16. 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)

  17. 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)

  18. 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.)

  19. Persistent positive metaiodobenzylguanidine scans after autologous peripheral blood stem cell transplantation may indicate maturation of stage 4 neuroblastoma.

    Science.gov (United States)

    Okamoto, Yasuhiro; Kodama, Yuichi; Nishikawa, Takuro; Rindiarti, Almitra; Tanabe, Takayuki; Nakagawa, Shunsuke; Yoshioka, Takako; Takumi, Koji; Kaji, Tatsuru; Kawano, Yoshifumi

    2017-04-01

    Metaiodobenzylguanidine (MIBG) scans are sensitive testing tools for neuroblastoma. Persistent positive MIBG scans in patients with stage 3 neuroblastoma have previously been found to indicate maturation rather than regression. We assessed the significance of this finding in stage 4 neuroblastoma in the present study. Fifteen consecutive pediatric patients with stage 4 neuroblastoma treated between 2004 and 2014 at the Kagoshima University Hospital were retrospectively examined. Treatment involved a combination of multiagent chemotherapy, resection, autologous peripheral blood stem cell transplantation (PBSCT), radiotherapy, and maintenance therapy with retinoic acid. The MIBG uptake in each patient during treatment was assessed using a Curie score. The 5-year event-free and overall survival rates in 15 patients were 38.9% and 58.7%, respectively. Four patients with persistent positive MIBG scans who underwent autologous PBSCT but experienced decreased 123 I-MIBG uptake during the clinical course survived without progression, and their event-free survival (EFS) was significantly superior to that of patients who showed negative MIBG scans after PBSCT (5-year EFS rate: 18.2%, p = 0.0176). Therefore, persistent positive MIBG scans with gradually decreased uptake after PBSCT do not always indicate neuroblastoma progression, and may instead indicate tumor maturation in some selected cases, if not all cases, of stage 4 neuroblastoma.

  20. 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)

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  2. 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)

  3. Washout rate of {sup 123}I-metaiodobenzylguanidine increased by posture change or exercise in normal volunteers

    Energy Technology Data Exchange (ETDEWEB)

    Yano, Takashi; Yamabe, Hiroshi; Yokoyama, Mitsuhiro [Kobe Univ. (Japan). School of Medicine

    1999-04-01

    {sup 123}I-metaiodobenzylguanidine (MIBG) imaging detects sympathetic nerve function in the heart. The present study was conducted to clarify whether posture change or exercise affects {sup 123}I-MIBG kinetics in normal volunteers. Seven subjects underwent three {sup 123}I-MIBG studies, i.e., supine protocol, sitting protocol and exercise protocol. Planar {sup 123}I-MIBG images were obtained at 15 minutes, 1 hour and 4 hours after injection of {sup 123}I-MIBG. The washout rate (WR) from 15 minutes to 1 hour in the supine position in all subjects was similar for all three protocols, whereas the WR from 1 hour to 4 hours was significantly augmented in the sitting protocol and the exercise protocol as compared to the supine protocol (p<0.05 and p<0.01). The serum concentration of noradrenaline was significantly increased from the baseline to the 4 hour sampling in the sitting protocol and the exercise protocol (both p<0.01), but was not altered in the supine protocol. The WR from 1 hour to 4 hours significantly correlated with the noradrenaline concentration in 4 hour sampling (r=0.59, p<0.01). It also significantly correlated with an increase in the noradrenaline concentration from the baseline to the 4 hour sampling (r=0.53, p<0.05). It is concluded that posture change or exercise affects the WR of {sup 123}I-MIBG in normal healthy subjects. (author)

  4. Washout rate of [sup 123]I-metaiodobenzylguanidine increased by posture change or exercise in normal volunteers

    Energy Technology Data Exchange (ETDEWEB)

    Yano, Takashi; Yamabe, Hiroshi; Yokoyama, Mitsuhiro (Kobe Univ. (Japan). School of Medicine)

    1999-04-01

    [sup 123]I-metaiodobenzylguanidine (MIBG) imaging detects sympathetic nerve function in the heart. The present study was conducted to clarify whether posture change or exercise affects [sup 123]I-MIBG kinetics in normal volunteers. Seven subjects underwent three [sup 123]I-MIBG studies, i.e., supine protocol, sitting protocol and exercise protocol. Planar [sup 123]I-MIBG images were obtained at 15 minutes, 1 hour and 4 hours after injection of [sup 123]I-MIBG. The washout rate (WR) from 15 minutes to 1 hour in the supine position in all subjects was similar for all three protocols, whereas the WR from 1 hour to 4 hours was significantly augmented in the sitting protocol and the exercise protocol as compared to the supine protocol (p<0.05 and p<0.01). The serum concentration of noradrenaline was significantly increased from the baseline to the 4 hour sampling in the sitting protocol and the exercise protocol (both p<0.01), but was not altered in the supine protocol. The WR from 1 hour to 4 hours significantly correlated with the noradrenaline concentration in 4 hour sampling (r=0.59, p<0.01). It also significantly correlated with an increase in the noradrenaline concentration from the baseline to the 4 hour sampling (r=0.53, p<0.05). It is concluded that posture change or exercise affects the WR of [sup 123]I-MIBG in normal healthy subjects. (author)

  5. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  7. Lung uptake of /sup 131/I-metaiodobenzylguanidine in sheep. An in vivo measurement of pulmonary metabolic function

    Energy Technology Data Exchange (ETDEWEB)

    Slosman, D.O.; Donath, A.; Morel, D.R.; Mo Costabella, P.M.

    1988-05-01

    Circulating biogenic amines are known to be cleared by the mammalian lung. Their lung uptake is considered as an indicator of pulmonary endothelial integrity. Unfortunately, their use as markers of pulmonary metabolic function in human pathology is precluded by their biological effects and by the type of radiolabeling (/sup 3/H and /sup 14/C), making them harmful for repeat injections and unfit for scintigraphy. Metaiodobenzylguanidine (MIBG) is structurally related to the neuron blocking agent guanethidine, devoid of significant biological effects, and has been shown to be extracted by the same active sodium dependent, saturable transport as norepinephrine in perfused rat lungs in vitro. We studied the single pass lung extraction of /sup 131/I-MIBG in five awake and five anaesthetised sheep using the standard double indicator dilution technique with /sup 99m/Tc-human serum albumin (HSA) as an intravascular reference tracer. Intravenous bolus injection of increasing doses of MIBG up to 400 nmol resulted in a significant (F ratio = 7.778, P < 0.0001) dose dependent decrease of MIGB extraction in both awake and anaesthetised sheep, without significant differences of extraction values between the two groups. For the 10 sheep, the averaged percentage single pass pulmonary uptake of MIBG at the peak of the dilution curve decreased from 32%+-3% (mean +- SE, n=27 measurements) with 20 nmol to 18%+-2% (n=32) with 400 nmol. Estimates of the apparent Michaelis-Menten constant (K/sub m/) averaged 2+-1.2 ..mu..Mol (n=7), whereas estimates of the apparent maximum velocity of removal (V/sub max/) was 1.1+-0.5 ..mu..mol/min (n=7). In contrast to intersubject variability, the pharmacokinetic parameters showed little intra subject variation. No correlation was found between MIBG extraction, K/sub m/ or V/sub max/ values and hemodynamic or gas exchange parameters.

  8. 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)

  9. 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.)

  10. Disease stage classification in hypertrophic cardiomyopathy by dual analysis of iodine-123-labeled metaiodobenzylguanidine and thallium-201 myocardial scintigraphies

    Energy Technology Data Exchange (ETDEWEB)

    Hiasa, Go [Ehime Univ., Matsuyama (Japan). School of Medicine

    2001-08-01

    Many patients with hypertrophic cardiomyopathy (HCM) gradually changes from typical myocardial hypertrophy to dilated cardiomyopathy-like features. However, it is difficult to estimate the disease stage in HCM. To determine the disease stage, dual analysis of iodine-123-labeled metaiodobenzylguanidine ({sup 123}I-MIBG) and thallium-201 ({sup 201}Tl) myocardial scintigraphies were performed in 108 HCM patients. According to the scintigraphic distribution patterns, patients were divided into three groups. Group A (n=15): normal distributions of both {sup 123}I-MIBG and {sup 201}Tl, group B (n=71): normal {sup 201}Tl and low {sup 123}I-MIBG patterns, group C (n=22): low distributions of both scintigraphies. The decrease in {sup 201}Tl uptake was observed in only group C. Concerning {sup 123}I-MIBG, heart-to-mediastinum ratio (H/M) and washout rate (WOR) had good correlations with left ventricular systolic functions. H/M was decreased and WOR was increased in order of C, B and A groups. Left ventricular diastolic function reflected by isovolumic relaxation time was longer in group B than in group A. Attenuated left ventricular hypertrophy, enlarged left ventricular volumes, impaired left ventricular functions and serious clinical symptoms were observed in only group C. Myocardial sympathetic abnormalities in group B may be mainly due to myocardial hypertrophy, and those in group C may be due to myocardial injury. Dual analysis of {sup 123}I-MIBG and {sup 201}Tl scintigraphies may be useful to classify disease stages of HCM. (author)

  11. 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)

  12. 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

  13. A Family with Von Hippel-Lindau Syndrome: The Findings of Indium-111 Somatostatin Receptor Scintigraphy, Iodine-123 Metaiodobenzylguanidine Scintigraphy and Single Photon Emission Computerized Tomography

    Directory of Open Access Journals (Sweden)

    Pelin Arıcan

    2017-02-01

    Full Text Available Von Hippel-Lindau syndrome (VHLS is an autosomal dominant hereditary familial disorder characterized by development of malignant and benign neoplasms. Differential diagnosis of the adrenal and pancreatic masses are difficult in patients with VHLS. Iodine-123 metaiodobenzylguanidine (I-123 MIBG and indium-111 somatostatin receptor scintigraphies (In-111 SRS have important roles in the differential diagnosis of adrenal and pancreatic masses in those patients. In this case report, we present the findings of I-123 MIBG single-photon emission computerized tomography (SPECT/CT and In-111 SRS SPECT/CT in three members of a family with VHLS. In case 1, a residual neuroendocrine tumor (NET was detected in the head of pancreas on In-111 SRS SPECT/CT images. In case 2 and 3, I-123 MIBG SPECT/CT confirmed the adrenal masses as pheochromocytoma, and the extra-adrenal mass as NET, before surgery. We thought that In-111 SRS and I-123 MIBG scan might be helpful in the routine work up of VHLS patients for diagnostic and therapeutic purposes. Hybrid SPECT/CT system may improve diagnostic accuracy of planar images since it assesses morphologic and functional information together.

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

    Science.gov (United States)

    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.

  15. 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.)

  16. Cardiac sympathetic dysfunction in an athlete's heart detected by 1''2''3I-metaiodobenzylguanidine scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Matsuo, Shinro; Nakamura, Yasuyuki; Takahashi, Masayuki; Matsui, Toshiki; Kusukawa, Junya; Yoshida, Shintaro; Hamamoto, Hajime; Kinoshita, Masahiko [Shiga Univ. of Medical Sciences, Otsu (Japan)

    2001-05-01

    The athlete's heart is commonly characterized by an increase in left ventricular mass because of an increase in the left ventricular diastolic cavity dimensions or wall thickness or both. Endurance exercise also induces numerous cardiovascular adaptations, including increased vagal tone. However, the sympathetic function has not yet been precisely elucidated, so the present study evaluated cardiac sympathetic nerve function from metaiodobenzylguanidine (MIBG) images obtained 15 and 180 min after the injection of {sup 123}I-MIBG at a dose of 111MBq. The ratio of heart/mediastinum count (H/M) and the washout rates of {sup 123}I-MIBG (WR) were calculated in 25 consecutive patients who were athletes (aged 52{+-}13 years) and 23 normal subjects. There was a significant difference in the H/M between the athletic and normal hearts (2.3{+-}0.3 vs 2.6{+-}0.3, p<0.01, Scheffe's test). An increased WR was observed in the athletes group when compared with the normal group (34{+-}4 vs 28{+-}3, p<0.01), and there was a significant correlation between WR and the left ventricular mass index (r=0.578, p<0.01). Prolonged exercise training may alter cardiac sympathetic nerve function, which can be detected by MIBG imaging. (author)

  17. Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability

    Energy Technology Data Exchange (ETDEWEB)

    Scholte, Arthur J.H.A.; Schuijf, Joanne D.; Delgado, Victoria; Kok, Jurriaan A.; Bus, Mieke T.J.; Maan, Arie C.; Wall, Ernst E. van der; Bax, Jeroen J. [Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, PO Box 9600, Leiden (Netherlands); Stokkel, Marcel P.; Dibbets-Schneider, Petra [Leiden University Medical Center, Nuclear Medicine, Leiden (Netherlands); Kharagitsingh, Antje V. [Medisch Centrum Haaglanden, Department of Internal Medicine, The Hague (Netherlands)

    2010-09-15

    The purpose of this study was to evaluate the prevalence of cardiac autonomic neuropathy (CAN) in a cohort of patients with type 2 diabetes, truly asymptomatic for coronary artery disease (CAD), using heart rate variability (HRV) and {sup 123}I-metaiodobenzylguanidine ({sup 123}I-mIBG) myocardial scintigraphy. The study group comprised 88 patients with type 2 diabetes prospectively recruited from an outpatient diabetes clinic. In all patients myocardial perfusion scintigraphy, CAN by HRV and {sup 123}I-mIBG myocardial scintigraphy were performed. Two or more abnormal tests were defined as CAN-positive (ECG-based CAN) and one or fewer as CAN-negative. CAN assessed by {sup 123}I-mIBG scintigraphy was defined as abnormal if the heart-to-mediastinum ratio was <1.8, the washout rate was >25%, or the total defect score was >13. The prevalence of CAN in patients asymptomatic for CAD with type 2 diabetes and normal myocardial perfusion assessed by HRV and {sup 123}I-mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, {sup 123}I-mIBG scintigraphy showed CAN. The current study revealed a high prevalence of CAN in patients with type 2 diabetes. Secondly, disagreement between HRV and {sup 123}I-mIBG scintigraphy for the assessment of CAN was observed. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Fujii, Tadashige [Shinshu Univ., Matsumoto, Nagano (Japan). School of Allied Medical Sciences; Tanaka, Masao; Yazaki, Yoshikazu; Kitabayashi, Hiroshi; Koizumi, Tomonori; Sekiguchi, Morie; Gomi, Tsutomu; Yano, Kesato; Itoh, Atsuko

    1997-11-01

    {sup 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)

  19. 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)

  20. 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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  1. Noninvasive screening for pheochromocytoma in patients with an incidentally discovered adrenal mass. Usefulness of provocative test with metoclopramide and {sup 131}I-metaiodobenzylguanidine scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yokoyama, Hiroshi; Tsuji, Yuji [Fukuoka Univ. (Japan). School of Medicine

    1999-10-01

    Pheochromocytoma accounts for approximately 25% of incidentally discovered adrenal masses. Certain diagnostic procedures (e.g., adrenal arteriography, needle biopsy of an adrenal mass), anesthesia and abdominal surgery may cause a sudden release of catecholamines from a pheochromocytoma and induce paroxysmal attacks of hypertension. In addition, pheochromocytoma is well known to cause unsuspected operating room deaths. Therefore, we must carefully separate this functioning neoplasm from other types of adrenal masses. In this study, we compared the results of noninvasive tests including assay of urinary catecholamines and their metabolites, a provocative pharmacologic test using metoclopramide (MCP test), and {sup 131}I-metaiodobenzylguanidine (MlBG) scintigraphy to screen for pheochromocytoma in 10 consecutive patients with an incidentally discovered adrenal mass (6 pheochromocytomas and 4 non-functioning adrenocortical adenomas). We measured the 24-hour urinary excretion of catecholamines, metanephrines and vanillyl mandelic acid in all 10 patients; 5 were positive, 4 were negative and 1 was false-negative (sensitivity=83%, specificity=100%). The MCP test was performed in 7 patients; 3 were positive, 3 were negative and 1 was false-negative (sensitivity=75%, specificity=100%). MIBG scintigraphy was performed in 7 patients; 4 were positive, 1 was negative and 2 were false-negative (sensitivity=67%, specificity=100%). According to these results, all patients with an incidentally discovered adrenal mass should undergo a determination of the 24-hour urinary excretion of catecholamines and their metabolites, including metanephrines. If this urine assay is negative, other noninvasive tests including the MCP test and MIBG scintigraphy should be considered in selected patients with radiographic characteristics of pheochromocytoma. (author)

  2. 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.)

  3. Investigation of the relationship between regression of hypertensive cardiac hypertrophy and improvement of cardiac sympathetic nervous dysfunction using iodine-123 metaiodobenzylguanidine myocardial imaging

    International Nuclear Information System (INIS)

    Morimoto, Satoshi; Terada, Koji; Keira, Natsuya; Satoda, Masahiko; Inoue, Keiji; Tatsukawa, Hirotaka; Katoh, Shuji; Ida, Kazunori; Sugihara, Hiroki; Takeda, Kazuo; Nakagawa, Masao

    1996-01-01

    Although many theories exist on the subject, the mechanisms responsible for a reduction of hypertensive cardiac hypertrophy in response to antihypertensive therapy are still unclear. In order to investigate the relationship between regression of hypertensive cardiac hypertrophy and cardiac nervous function, we studied ten patients with untreated essential hypertension (six men and four women, 62±12 years old). Both echocardiography and iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging were performed before and after antihypertensive therapy. Left ventricular mass (LVM) was significantly reduced in conjunction with the reduction of blood pressure following treatment. MIBG myocardial images showed that the heart-to-mediastinum activity ratio (H/M) was significantly increased while the washout ratio was significantly decreased. Patients were divided into two groups according to the ratio of the LVM values before and after therapy (LVM ratio). Patients with an LVM ratio of less than 0.75 were classified as group A and those with values higher than 0.75 as group B. Neither the change in blood pressure nor the length of treatment was significantly different between these two groups. On the other hand, both the increase in H/M and the decrease in the washout ratio were significantly greater in group A than in group B. These results indicate that an improvement in cardiac sympathetic nervous function may be related to the regression of hypertensive cardiac hypertrophy. Increasing the subject base in these studies and a more precise analysis of the relevance of the data obtained from MIBG myocardial images are recommended to clarify how changes in cardiac sympathetic nervous function relate to the regression of hypertensive cardiac hypertrophy. (orig.)

  4. Characteristics of regional sympathetic dysfunction in acutely ischemic myocardium assessed by 123I-metaiodobenzylguanidine imaging. Impairment of myocardial norepinephrine uptake or retention

    International Nuclear Information System (INIS)

    Ishida, Yoshio; Hirose, Yoshiaki; Maeno, Masakazu

    1995-01-01

    To characterize regional cardiac sympathetic dysfunction due to myocardial ischemia, we examined 123 I-metaiodobenzylguanidine (MIBG) myocardial distribution of initial 15-min and 4-hr delayed SPECT images in 14 patients with recent myocardial infarction (MI), 25 patients with vasospastic angina which was angiographically proven with elgonovine maleate (Gp VSAP) and 16 patients with chest pain syndrome and normal CAG findings (Gp CP). In those with MI, the study was serially done at 2 weeks after (Gp MI-1) and at 3 months after the onset of MI (Gp MI-2). We estimated regional tracer uptake in 20 segments of tomographic images by using a 4-point scoring system (0=normal, 1=mild, 2=moderate, 3=severe reduction) and calculated the total defect score (IDS). In all patients with MI, the area of reduced MIBG uptake was more extensive than the 201 Tl perfusion defect in the acute stage (Gp MI-1) indicating the presence of viable but denervated myocardial tissue. Also, the MIBG defect was persistently observed from initial (TDS: 24±13) to delayed imaging (TDS: 26±12). However, in the chronic stage (Gp MI-2), the initial MIBG uptake improved (TDS: 18 ±9) but the delayed uptake remained almost the same (TDS: 22±10) indicating high washout of MIBG from the ischemic myocardium. Fourteen in Gp VSAP and 14 in Gp CP showed the regional MIBG defect in the delayed image more extensively than in the initial image indicating high washout of MIBG in the involved myocardial regions. These results suggest that neuronal uptake of MIBG is impaired in the acute stage of MI although neuronal retention of MIBG is predominantly impaired in the chronic stage of MI or in Gps VSAP and CP. (author)

  5. Dosimetric results in treatments of neuroblastoma and neuroendocrine tumors with {sup 131}I-metaiodobenzylguanidine with implications for the activity to administer

    Energy Technology Data Exchange (ETDEWEB)

    Mínguez, Pablo, E-mail: pablo.minguezgabina@osakidetza.net [Department of Medical Radiation Physics, Lund University, Lund 22185, Sweden and Department of Medical Physics, Gurutzeta/Cruces University Hospital, Barakaldo 48903 (Spain); Flux, Glenn [Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton SM2 5PT (United Kingdom); Genollá, José; Guayambuco, Sonía; Delgado, Alejandro; Fombellida, José Cruz [Department of Nuclear Medicine, Gurutzeta/Cruces University Hospital, Barakaldo 48903 (Spain); Sjögreen Gleisner, Katarina [Department of Medical Radiation Physics, Lund University, Lund 22185 (Sweden)

    2015-07-15

    Purpose: The aim was to investigate whole-body and red marrow absorbed doses in treatments of neuroblastoma (NB) and adult neuroendocrine tumors (NETs) with {sup 131}I-metaiodobenzylguanidine and to propose a simple method for determining the activity to administer when dosimetric data for the individual patient are not available. Methods: Nine NB patients and six NET patients were included, giving in total 19 treatments as four patients were treated twice. Whole-body absorbed doses were determined from dose-rate measurements and planar gamma-camera imaging. For six NB and five NET treatments, red marrow absorbed doses were also determined using the blood-based method. Results: Dosimetric data from repeated administrations in the same patient were consistent. In groups of NB and NET patients, similar whole-body residence times were obtained, implying that whole-body absorbed dose per unit of administered activity could be reasonably well described as a power function of the patient mass. For NB, this functional form was found to be consistent with dosimetric data from previously published studies. The whole-body to red marrow absorbed dose ratio was similar among patients, with values of 1.4 ± 0.6–1.7 ± 0.7 (1 standard deviation) in NB treatments and between 1.5 ± 0.6 and 1.7 ± 0.7 (1 standard deviation) in NET treatments. Conclusions: The consistency of dosimetric results between administrations for the same patient supports prescription of the activity based on dosimetry performed in pretreatment studies, or during the first administration in a fractionated schedule. The expressions obtained for whole-body absorbed doses per unit of administered activity as a function of patient mass for NB and NET treatments are believed to be a useful tool to estimate the activity to administer at the stage when the individual patient biokinetics has not yet been measured.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  7. Estimated Internal and External Radiation Exposure of Caregivers of Patients With Pediatric Neuroblastoma Undergoing 131I Metaiodobenzylguanidine Therapy: A Prospective Pilot Study.

    Science.gov (United States)

    Han, Sangwon; Yoo, Seon Hee; Koh, Kyung-Nam; Lee, Jong Jin

    2017-04-01

    Current recommendations suggest that family members should participate in the care of children receiving in-hospital I metaiodobenzylguanidine (MIBG) therapy for neuroblastoma. The present study aimed to measure the external radiation exposure and estimate the internal radiation exposure of caregivers during the hospital stay for I MIBG therapy. Caregivers received radiation safety instructions and a potassium iodide solution for thyroid blockade before patient admission. External radiation exposure was determined using a personal pocket dosimeter. Serial 24-hour urine samples were collected from caregivers during the hospital stay. Estimated internal radiation exposure was calculated based on the urine activity. Twelve cases (mean age, 6.2 ± 3.5 years; range, 2-13 years) were enrolled. The mean administered activity was 233.3 ± 74.9 (range, 150.0-350.0) mCi. The mean external radiation dose was 5.8 ± 7.2 (range, 0.8-19.9) mSv. Caregivers of children older than 4 years had significantly less external radiation exposure than those of children younger than 4 years (1.9 ± 1.0 vs 16.4 ± 5.0 mSv; P = 0.012). The mean estimated internal radiation dose was 11.3 ± 10.2 (range, 1.0-29.8) μSv. Caregivers receive both external and internal radiation exposure while providing in-hospital care to children receiving I MIBG therapy for neuroblastoma. However, the internal radiation exposure was negligible compared with the external radiation exposure.

  8. Effects of aldose reductase inhibitor and vitamin B12 on myocardial uptake of iodine-123 metaiodobenzylguanidine in patients with non-insulin-dependent diabetes mellitus

    International Nuclear Information System (INIS)

    Utsunomiya, Keita; Narabayashi, Isamu; Tamura, Koji; Nakatani, Yuko; Saika, Yoshinori; Onishi, Satoshi; Kariyone, Shigeo

    1998-01-01

    This study was undertaken to examine the effects of aldose reductase inhibitor (ARI) and vitamin B 12 (VB12) on myocardial uptake of iodine-123 metaiodobenzylguanidine (MIBG) in patients with diabetic autonomic disorder. Myocardial scintigraphy using 123 I-MIBG was performed on 20 healthy volunteers (controls) and 56 patients with non-insulin-dependent diabetes mellitus (NIDDM), in order to obtain the heart/mediastinum ratio in the initial (HMi) and the delayed images (HMd), and the washout rate (%WR). Thirty-four of the 56 NIDDM patients could be diagnosed as having diabetic autonomic disorder by evaluating their scintigraphic findings in comparison with the controls. Seventeen of these 34 patients received 150 mg/day of epalrestat (ARI group) in three divided doses before meals, and the other 17 received 1.5 mg/day of mecobalamin (VB12 group) in three divided doses after meals, for 3-5 months. According to the presence or absence of clinical symptoms of autonomic or peripheral somatic nerve disorder, the patients were subclassified into four groups. group 1=patients, with autonomic symptoms or somatosensory disorder in the ARI group; group 2=patients without autonomic symptoms or somatosensory disorder in the ARI group; group 3=patients with autonomic symptoms or somatosensory disorder in the VB12 group; and group 4=patients without autonomic symptoms or somatosensory disorder in the VB12 group. After completion of the treatment, myocardial scintigraphy was performed again. Comparing the results obtained before and after the treatment, it was seen that ARI improved only the HMi in group 1 (P=0.046), whereas VB12 significantly improved HMi in the group 3 (P=0.018) and HMi, HMd and %WR in group 4 (P=0.043, P=0.018 and P=0.043, respectively). We conclude that VB12 is more efficacious than ARI in the treatment of diabetic cardiovascular autonomic disorder. (orig.)

  9. 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.)

  10. 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)

  11. 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.

  12. Long-term follow-up of the thyroid gland after treatment with 131I-Metaiodobenzylguanidine in children with neuroblastoma: importance of continuous surveillance.

    Science.gov (United States)

    Clement, S C; van Eck-Smit, B L F; van Trotsenburg, A S P; Kremer, L C M; Tytgat, G A M; van Santen, H M

    2013-11-01

    Thyroid dysfunction has been reported in up to 52% of patients 1.4 years after treatment with (131) I-Metaiodobenzylguanidine (MIBG) in children with neuroblastoma (NBL), despite the use of potassium-iodide (KI). Our aim was to investigate if the incidence and severity of thyroid damage increases in time. All long-term survivors of childhood NBL treated with (131) I-MIBG in the period 1989-1999 in our center (n = 16 of 43) were evaluated. During exposure to (131) I-MIBG, patients received 100 mg KI per day as thyroid protection. All MIBG images were evaluated for thyroid uptake of radio-iodine. Thyroid dysfunction was defined as a plasma thyrotropin concentration above the institutional age-related reference ranges (thyrotropin elevation, TE) or using thyroxine at last moment of follow-up. In all, ultrasound investigation of the thyroid was performed. Fifteen years after treatment with (131) I-MIBG, in 81% (n = 13) thyroid disorders were diagnosed. Eight survivors (50%) were treated with thyroxine. Thyroid nodules were found in nine survivors, of which two were diagnosed with papillary thyroid carcinoma. In 28% of (131) I-MIBG-images radio-iodine uptake in the thyroid gland was seen, but no correlation was found between thyroidal radio-iodine uptake and thyroid disorders. Despite protection with KI during exposure to (131) I-MIBG in childhood, the occurrence of thyroid disorders is high and increases in time. Continuous screening for thyroid dysfunction and nodules in these survivors is recommended. Other ways to protect the thyroid gland should be further evaluated. Copyright © 2013 Wiley Periodicals, Inc.

  13. 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

  14. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  17. 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

  18. Measurement of myocardial uptake rate and method of dual energy data acquisition in myocardial scintigraphy with sup 123 I-metaiodobenzylguanidine and sup 201 Tl-chloride, 2; Clinical studies in hypertrophic cardiomyopathy and hypertensive cardiomegaly

    Energy Technology Data Exchange (ETDEWEB)

    Higashino, Hiroshi (Ehime Univ., Shigenobu (Japan). School of Medicine)

    1991-06-01

    Myocardial scintigraphy was performed on 24 patients with hypertrophic cardiomyopathy (HCM), 5 with essential hypertension (EHT) and 7 normal controls at rest by means of simultaneous dual energy data acquisition following an intravenous injection of {sup 123}I-metaiodobenzylguanidine (MIGB) and {sup 201}Tl-chloride (Tl). The myocardial uptake rates of both tracers were measured in the planar images by taking into account the myocardial and pulmonary attenuation. The regional myocardial distributions of the tracers were also studied in the SPECT images. In planar images, the rate of loss of {sup 123}I-MIBG from the myocardium of HCM subjects was significantly higher than of control subjects 15 min to 3 hr after injection. No significant difference was observed from 3 hr to 5 hr and from the 5 hr to 21 hr periods. In the SPECT images, the rate of loss of {sup 123}I-MIBG from the myocardium of HCM subjects was significantly higher than of control subjects in all segments of myocardium through a 15 min to 5 hr observation period. The results suggested that the uptake-release mechanism of {sup 123}I-MIBG in the neuronal vesicles was impaired in HCM subjects in two different ways: (1) normal release in delayed phase associated with low uptake in early phase or (2) accelerated release in early phase. Moreover, the sympathetic dysfunction may spread through the all segments of myocardium of HCM subjects. The apical lesion showed an extremely high rate of loss up to 5 hr after injection in SPECT images. This was quite different from that of the septal lesion. This indicated that the apical lesion of HCM subjects may have a different sympathetic abnormality. In EHT subjects, no abnormal regional distribution of {sup 123}I-MIBG was observed. This suggested that the sympathetic innervation was maintained although an abnormal distribution of blood flow was frequently observed in {sup 201}Tl scintigraphy. (author).

  19. Usefulness of 123I-metaiodobenzylguanidine myocardial scintigraphy for predicting the effectiveness of β-blockers in patients with dilated cardiomyopathy from the standpoint of long-term prognosis

    International Nuclear Information System (INIS)

    Fujimoto, Shinichiro; Inoue, Aritomo; Hisatake, Shinji; Yamashina, Shohei; Yamashina, Hisayo; Nakano, Hajime; Yamazaki, Junichi

    2004-01-01

    The usefulness of 123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in predicting the effectiveness of β-blocker therapy in dilated cardiomyopathy (DCM) was investigated from the standpoint of long-term prognosis. The subjects were 53 DCM patients in whom β-blockers had been successfully introduced and used for 6 months or longer. When symptoms were stable before the introduction of β-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 β-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 β-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 β-blocker therapy are those with low early EXT and early SEV and high WR before β-blocker introduction regardless of LVEF values. (orig.)

  20. Clinical efficacy of efonidipine hydrochloride, a T-type calcium channel inhibitor, on sympathetic activities. Examination using spectral analysis of heart rate/blood pressure variabilities and 123I-Metaiodobenzylguanidine myocardial scintigraphy

    International Nuclear Information System (INIS)

    Harada, Kenji; Nomura, Masahiro; Nishikado, Akiyoshi; Uehara, Kouzoh; Nakaya, Yutaka; Ito, Susumu

    2003-01-01

    Dihydropyridine Ca antagonists cause reflex tachycardia related to their hypotensive effects. Efonidipine hydrochloride has inhibitory effects on T-type Ca channels, even as it inhibits reflex tachycardia. In the present study, the influence of efonidipine hydrochloride on heart rate and autonomic nervous function was investigated. Using an electrocardiogram and a tonometric blood pressure measurement, autonomic nervous activity was evaluated using spectral analysis of heart rate/systolic blood pressure variability. Three protocols were used: a single dose of efonidipine hydrochloride was administered orally to healthy subjects with resting heart rate values of 75 beats/min or more (high-heart rate (HR) group) and to healthy subjects with resting heart rate values less than 75 beats/min (low-HR group); efonidipine hydrochloride was newly administered to untreated patients with essential hypertension, and autonomic nervous activity was investigated after a 4-week treatment period; and patients with high heart rate values (≥75 beats/min) who had been treated with a dihydropyridine L-type Ca channel inhibitor for 1 month or more were switched to efonidipine hydrochloride and any changes in autonomic nervous activity were investigated. In all protocols, administration of efonidipine hydrochloride decreased the heart rate in patients with a high heart rate, reduced sympathetic nervous activity, and enhanced parasympathetic nervous activity. In addition, myocardial scintigraphy with 123 I-metaiodobenzylguanidine showed significant improvement in the washout rate and heart to mediastinum (H/M) ratio of patients who were switched from other dihydropyridine Ca antagonists to efonidipine hydrochloride. Efonidipine hydrochloride inhibits increases in heart rate and has effects on the autonomic nervous system. It may be useful for treating hypertension and angina pectoris, and may also have a cardiac protective function. (author)

  1. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    Rey, Cristina Rodriguez; Candil, Aida Ortega; Galvan, Eliseo Vano; Martin, Maria Nieves Cabrera; Delgado, Jose Luis Carreras

    2016-01-01

    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.

  4. Magnetic resonance imaging of metaiodobenzylguanidine scintigraphy for the demonstration of paragangliomas. Correlations and disparities

    Energy Technology Data Exchange (ETDEWEB)

    Gils, A.P.G. van (Dept. of Diagnostic Radiology and Nuclear Medicine, Leiden Univ. Hospital (Netherlands)); Erkel, A.R. van (Dept. of Diagnostic Radiology and Nuclear Medicine, Leiden Univ. Hospital (Netherlands)); Falke, T.H.M. (Dept. of Diagnostic Radiology and Nuclear Medicine, Leiden Univ. Hospital (Netherlands)); Pauwels, E.K.J. (Dept. of Diagnostic Radiology and Nuclear Medicine, Leiden Univ. Hospital (Netherlands))

    1994-03-01

    In this report, the performance of these two non-invasive imaging methods in the examination of paragangliomas is compared and the merits and deficits of the two techniques are discussed. Both techniques produce comparable results in the detection of functioning paragangliomas. MR imaging, however, also demonstrates tumours that do not take up MIBG. MR imaging does not involve the use of ionising radiation and is not hampered by medication. Moreover, MR imaging has a higher spatial resolution. Because of these merits it is concluded that for demonstration of paragangliomas, wholebody MR imaging is the preferred and initial method of investigation. MIBG scintigraphy, on the other hand, continues to be a reliable method for non-invasive detection of functioning paragangliomas. At present it is clearly faster in whole-body imaging than MRI and it is definitely patient-friendly (no claustrophobia). It could be reserved for cases where a strong suspicion of a functioning paraganglioma persists, despite normal MR imaging findings, and for cases where doubt exists about the functional activity of one or more multicentric tumours. MIBG scintigraphy must be used in the evaluation of patients referred for iodine-131 MIBG treatment. (orig./MG)

  5. 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).

  6. Metaiodobenzylguanidine total-body scintigraphy required for revealing occult neuroblastoma in opsoclonus-myoclonus syndrome

    NARCIS (Netherlands)

    Swart, Joost F.; de Kraker, Jan; van der Lely, Nico

    2002-01-01

    A girl aged 13 months presented with clinical features of subacute progressive ataxia leading to abasia, astasia, loss of unsupported sitting and apraxia. In addition, an opsoclonus, myoclonia and introvert behaviour developed. MRI of the brain, EEG, extensive tests of blood, urine and CSF showed no

  7. Radiochemical and biological control for metaiodobenzylguanidine (MIBG) labelled with 131I

    International Nuclear Information System (INIS)

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

    1988-01-01

    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 the tracer administration. (author) [pt

  8. 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

  9. {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 ATTR patients before signs of amyloidosis are evident on echocardiography. (orig.)

  10. 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.)

  11. 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.)

  12. 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.

  13. The significance of 201Tl/123I MIBG (metaiodobenzylguanidine) mismatched myocardial regions for predicting ventricular tachycardia in patients with idiopathic dilated cardiomyopathy

    International Nuclear Information System (INIS)

    Maeno, Masakazu; Ishida, Yoshio; Shimonagata, Tsuyoshi

    1993-01-01

    123 I-MIBG (MIBG) regional defects in myocardial regions with preserved 201 Tl (Tl) uptake have been observed in patients with idiopathic dilated cardiomyopathy (DCM). To evaluate whether the presence of Tl/MIBG mismatched regions is related to the occurrence of ventricular tachycardia (VT), we performed myocardial dual SPECT imaging with Tl (111 MBq) and MIBG (111 MBq) in 17 patients with DCM, 11 (Gp A) with and 6 (Gp B) without VT. Myocardial dual SPECT imaging was performed at 15 minutes after and 4 hours after the tracer injection. The regional tracer uptake was scored visually in 6 segments of the basal, middle, and apical short-axial images and in 2 apical segments of the midventricular vertical long-axial image by a four-point scoring system (0=normal, 1=moderate, 2=severe and 3=complete defect). Then, the severity of tracer maldistributions was assessed by the difference between total defect scores (TDSs) of Tl and MIBG (ΔTDS). TDS was not different between Gps A and B in both Tl and MIBG images. However, ΔTDS was larger in Gp A than in Gp B (13.5±6.5 vs. 5.8±3.0, p<0.05). Also, the number of segments with the mismatched tracer uptake was larger in Gp A than in Gp B (12.5±3.0 vs. 8.3±1.5, p<0.01). In the electrophysiologic study, we found that the fractionated area corresponded to the mismatched region in 3 of 5 patients in Gp A. These results suggest that regional sympathetic denervation is a possible factor which provocates VT, and myocardial dual SPECT imaging with Tl and MIBG is a useful method for predicting VT in patients with DCM. (author)

  14. 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)

  15. A case of cardiac sudden death related to abnormality of sympathetic nervous disturbance detected by {sup 123}I-metaiodobenzylguanidine (MIBG)

    Energy Technology Data Exchange (ETDEWEB)

    Igarashi, Masaki; Matsukawa, Seishirou; Morishita, Takeshi [Toho Univ., Tokyo (Japan). School of Medicine

    1996-11-01

    A case of cardiac sudden death was reported. A female, 64 years old patient with multiple myeloma had been treated with total dose of 790 mg of adriamycin. Although treadmill examination, dobutamine-loaded cardiac echography and thallium-loaded myocardial scintigraphy gave normal findings, Holter ECG revealed bigeminy and discontinuous ventricular tachycardia. Mexiletine was not tolerated. {sup 123}I-MIBG image gave deficit of lateral to posterior wall and increased washing rate of 65%. At 36 days after hospitalization, the ventricular tachycardia changed to fatal fibrillation. The sympathetic nervous disturbance detected by the enhanced washing rate of {sup 123}I-MIBG might have participated in the death. (K.H.)

  16. Mechanisms of uptake of norepinephrine (NE) and Meta-iodobenzylguanidine (MIBG) into cultured bovine adrenomedullary cells: Evidence for uptake-one

    International Nuclear Information System (INIS)

    Tobes, M.C.; Jaques, S. Jr.; Sisson, J.C.; Wieland, D.M.

    1984-01-01

    The nature of the sodium-dependent and sodium-independent uptake systems for NE and MIBG were studied in cultured bovine adrenomedullary cells, a model system exhibiting uptake mechanisms analogous to those in human pheochromocytomas. At concentrations ≤1.0μM, uptake of NE and MIBG was primarily by the sodium-dependent system; at higher concentrations, ≥ 20 μM, uptake of both agents was predominantly by the sodium-independent pathway. Desmethylimipramine (DMI) inhibited the sodium-dependent uptake of 0.5 and 20.0 μM NE (IC-50 = 0.05 and 1.0 μM, respectively) and the sodium-dependent uptake of 0.5 μM MIBG(IC-50 of 0.05 μM). However, at 0.5 and 20 μM, NE and MIBG, the sodium-independent uptake was 100 to 1000 fold less sensitive to the inhibitory effects of DMI. Cocaine, an Uptake-one inhibitor structurally unrelated to DMI, inhibited the sodium-dependent and independent NE and MIBG uptake in a pattern similar to DMI. DMI was a competitive inhibitor of sodium-dependent NE and MIBG uptake but not of sodium-independent uptake. Similarly, NE and MIBG were competitive inhibitors of each other when uptake occurred by the sodium-dependent pathway but not when uptake occurred by the sodium-independent pathway. The sodium-dependent pathway is a saturable, energy-dependent system which is inhibited by classical Uptake-one inhibitors. The sodium-independent uptake system may represent a diffusion mechanism. Consistent with these in vitro results, scintiscans of pheochromocytomas with [I-131]MIBG have been altered in vivo by DMI-like drugs and, therefore, appear to reflect Uptake-one

  17. Long-term efficacy of current thyroid prophylaxis and future perspectives on thyroid protection during {sup 131}I-metaiodobenzylguanidine treatment in children with neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Clement, S.C. [University of Amsterdam, Department of Pediatric Endocrinology, Emma Children' s Hospital, Academic Medical Center, PO box 22660, Amsterdam (Netherlands); University of Amsterdam, Department of Pediatric Oncology, Emma Children' s Hospital, Academic Medical Center, Amsterdam (Netherlands); Rijn, R.R. van [University of Amsterdam, Department of Radiology, Emma Children' s Hospital, Academic Medical Center, Amsterdam (Netherlands); Eck-Smit, B.L.F. van [University of Amsterdam, Department of Nuclear Medicine, Academic Medical Center, Amsterdam (Netherlands); Trotsenburg, A.S.P. van [University of Amsterdam, Department of Pediatric Endocrinology, Emma Children' s Hospital, Academic Medical Center, PO box 22660, Amsterdam (Netherlands); Caron, H.N.; Tytgat, G.A.M. [University of Amsterdam, Department of Pediatric Oncology, Emma Children' s Hospital, Academic Medical Center, Amsterdam (Netherlands); Santen, H.M. van [Wilhelmina Children' s Hospital, University Medical Center Utrecht, Department of Pediatric Endocrinology, Utrecht (Netherlands)

    2015-04-01

    Treatment with {sup 131}I-MIBG is associated with significant thyroid damage. This study was undertaken to investigate the long-term efficacy of current thyroid prophylaxis, to explore the relationship between thyroid dysfunction and thyroid volume after exposure to {sup 131}I-MIBG and to evaluate the possible negative effects of {sup 131}I{sup -} on the parathyroid glands. Of 81 long-term surviving patients with neuroblastoma treated with {sup 131}I-MIBG during the period 1999-2012, 24 were finally evaluated. Patients received thyroxine (T4), methimazole and potassium iodide as thyroid protection. In all patients (para)thyroid function was evaluated and ultrasound investigation of the (para)thyroid gland(s) was performed. Thyroid dysfunction was defined as a plasma thyrotropin concentration >5.0 mU/L (thyrotropin elevation, TE) or as the use of T4 at the time of follow-up. Hyperparathyroidism was defined as a serum calcium concentration above the age-related reference range in combination with an inappropriately high parathyroid hormone level. At a median follow-up of 9.0 years after {sup 131}I-MIBG treatment, thyroid disorders were seen in 12 patients (50 %; 9 with TE, 5 with a thyroid nodule and 1 patient was subsequently diagnosed with differentiated thyroid carcinoma). No significant risk factors for the occurrence of thyroid damage could be identified. In 14 of 21 patients (67 %) in whom thyroid volume could be determined, the volume was considered small (<-2SD) for age and gender. Patients treated with T4 at the time of follow-up had significantly smaller thyroid volumes for age than patients without T4 treatment (p = 0.014). None of the patients was diagnosed with hyperparathyroidism. Thyroid protection during treatment with {sup 131}I-MIBG needs attention and must be further improved, as thyroid disorders are still frequently seen despite current thyroid prophylaxis. Reduced thyroid volume in neuroblastoma survivors may be related to previous {sup 131}I-MIBG therapy or current T4 treatment. No deleterious effects of {sup 131}I-MIBG on the parathyroid glands could be found. (orig.)

  18. Long-term efficacy of current thyroid prophylaxis and future perspectives on thyroid protection during 131I-metaiodobenzylguanidine treatment in children with neuroblastoma

    International Nuclear Information System (INIS)

    Clement, S.C.; Rijn, R.R. van; Eck-Smit, B.L.F. van; Trotsenburg, A.S.P. van; Caron, H.N.; Tytgat, G.A.M.; Santen, H.M. van

    2015-01-01

    Treatment with 131 I-MIBG is associated with significant thyroid damage. This study was undertaken to investigate the long-term efficacy of current thyroid prophylaxis, to explore the relationship between thyroid dysfunction and thyroid volume after exposure to 131 I-MIBG and to evaluate the possible negative effects of 131 I - on the parathyroid glands. Of 81 long-term surviving patients with neuroblastoma treated with 131 I-MIBG during the period 1999-2012, 24 were finally evaluated. Patients received thyroxine (T4), methimazole and potassium iodide as thyroid protection. In all patients (para)thyroid function was evaluated and ultrasound investigation of the (para)thyroid gland(s) was performed. Thyroid dysfunction was defined as a plasma thyrotropin concentration >5.0 mU/L (thyrotropin elevation, TE) or as the use of T4 at the time of follow-up. Hyperparathyroidism was defined as a serum calcium concentration above the age-related reference range in combination with an inappropriately high parathyroid hormone level. At a median follow-up of 9.0 years after 131 I-MIBG treatment, thyroid disorders were seen in 12 patients (50 %; 9 with TE, 5 with a thyroid nodule and 1 patient was subsequently diagnosed with differentiated thyroid carcinoma). No significant risk factors for the occurrence of thyroid damage could be identified. In 14 of 21 patients (67 %) in whom thyroid volume could be determined, the volume was considered small (<-2SD) for age and gender. Patients treated with T4 at the time of follow-up had significantly smaller thyroid volumes for age than patients without T4 treatment (p = 0.014). None of the patients was diagnosed with hyperparathyroidism. Thyroid protection during treatment with 131 I-MIBG needs attention and must be further improved, as thyroid disorders are still frequently seen despite current thyroid prophylaxis. Reduced thyroid volume in neuroblastoma survivors may be related to previous 131 I-MIBG therapy or current T4 treatment. No deleterious effects of 131 I-MIBG on the parathyroid glands could be found. (orig.)

  19. 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)

  20. Long-term efficacy of current thyroid prophylaxis and future perspectives on thyroid protection during I-131-metaiodobenzylguanidine treatment in children with neuroblastoma

    NARCIS (Netherlands)

    Clement, S. C.; van Rijn, R. R.; van Eck-Smit, B. L. F.; van Trotsenburg, A. S. P.; Caron, H. N.; Tytgat, G. A. M.; van Santen, H. M.

    2015-01-01

    Purpose Treatment with I-131-MIBG is associated with significant thyroid damage. This study was undertaken to investigate the long-term efficacy of current thyroid prophylaxis, to explore the relationship between thyroid dysfunction and thyroid volume after exposure to I-131-MIBG and to evaluate the

  1. {sup 123}I-metaiodobenzylguanidine accumulation in a urinoma and cortex of an obstructed kidney after surgical resection of an abdominal neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Moralidis, Efstratios; Arsos, Georgios; Karakatsanis, Constantinos [Hippokration Hospital, Department of Nuclear Medicine, Aristotelian University, Thessaloniki (Greece); Papakonstantinou, Eugenia; Koliouskas, Dimitrios [Hippokration Hospital, Department of Paediatric Oncology, Thessaloniki (Greece); Badouraki, Maria [Hippokration Hospital, Department of Radiology, Division of Pediatric Radiology, Thessaloniki (Greece)

    2008-01-15

    Surgical ureteric injury is rare and often unsuspected for a long time. We present a child in whom an abdominal neuroblastoma was completely excised, but during surgery the left ureter was transected and anastomosed. One month later, during postoperative disease staging, abnormal {sup 123}I-MIBG accumulation was observed in the left renal cortex and the left side of the abdomen. These findings were consistent with acute total obstruction and urinoma formation and were subsequently confirmed by renography and MRI. Despite treatment efforts, a significant amount of left renal mass and function were lost over the following months. These unusual findings are new additions to the literature regarding potential false-positive interpretations of {sup 123}I-MIBG scans. (orig.)

  2. Long-term efficacy of current thyroid prophylaxis and future perspectives on thyroid protection during I-131-metaiodobenzylguanidine treatment in children with neuroblastoma

    NARCIS (Netherlands)

    Clement, S. C.; van Rijn, R. R.; van Eck-Smit, B. L. E.; van Trotsenburg, A. S. P.; Caron, H. N.; Tytgat, G. A. M.; van Santen, H. M.|info:eu-repo/dai/nl/238668959

    Purpose Treatment with I-131-MIBG is associated with significant thyroid damage. This study was undertaken to investigate the long-term efficacy of current thyroid prophylaxis, to explore the relationship between thyroid dysfunction and thyroid volume after exposure to I-131-MIBG and to evaluate the

  3. Combining 123I-metaiodobenzylguanidine SPECT/CT and 18F-FDG PET/CT for the assessment of brown adipose tissue activity in humans during cold exposure

    NARCIS (Netherlands)

    Admiraal, Wanda M.; Holleman, Frits; Bahler, Lonneke; Soeters, Maarten R.; Hoekstra, Joost B.; Verberne, Hein J.

    2013-01-01

    Brown adipose tissue (BAT) has become a focus of research in the hope of finding a new target to fight obesity. Metabolic BAT activity can be visualized with (18)F-FDG PET/CT. Furthermore, the sympathetic innervation of BAT can be visualized with the radiolabeled norepinephrine analog

  4. Cardiac sympathetic imaging with mIBG in cirrhosis and portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Mortensen, Christian; Bendtsen, Flemming

    2012-01-01

    Autonomic and cardiac dysfunction is frequent in cirrhosis and includes increased sympathetic nervous activity, impaired heart rate variability (HRV), and baroreflex sensitivity (BRS). Quantified (123)I-metaiodobenzylguanidine (mIBG) scintigraphy reflects cardiac noradrenaline uptake, and in pati......Autonomic and cardiac dysfunction is frequent in cirrhosis and includes increased sympathetic nervous activity, impaired heart rate variability (HRV), and baroreflex sensitivity (BRS). Quantified (123)I-metaiodobenzylguanidine (mIBG) scintigraphy reflects cardiac noradrenaline uptake...

  5. 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, respectively. Prazosin, urapidil, and metoprolol were as effective as treatment with other adrenergic drugs in lowering cardiac uptake of {sup 99m}Tc-FBPBAT. Uptake reduction was more pronounced in myocardium than in other adrenergic-rich organs, including the lung, spleen, kidney, and adrenals, suggesting that the {sup 99m}Tc-FBPBAT uptake in myocardium specifically reflects a high degree of {alpha}{sub 1}/{beta}{sub 1}-receptor binding to cardiac adrenergic neurons. In comparison, reduction of cardiac and pulmonary uptake of {sup 123}I-MIBG was effective after pretreatment of rats with desipramine and reserpine, confirming distinct neuronal binding sites for {sup 99m}Tc-FBPBAT and {sup 123}I-MIBG. {sup 99m}Tc-FBPBAT was excreted via urine and to a lower degree via feces. Urine analysis 6 hours p.i. revealed that more than 40% of the total excreted radioactivity was unmetabolized {sup 99m}Tc-FBPBAT. In conclusion, the uptake of {sup 99m}Tc-FBPBAT in rat myocardium specifically reflects binding to cardiac adrenergic neurons. The {sup 99m}Tc-FBPBAT uptake appears to be predominantly mediated via the {alpha}{sub 1}/{beta}{sub 1}-adrenoceptor pathway. These data indicate that {sup 99m}Tc-FBPBAT, like {sup 123}I-MIBG, may be suitable for mapping cardiac adrenergic innervation by SPET, especially for {alpha}{sub 1}/{beta}{sub 1}-adrenoceptors as target in numerous heart diseases.

  6. Circumvention of glucocorticoid resistance in childhood leukemia.

    Science.gov (United States)

    Haarman, E G; Kaspers, G J L; Pieters, R; Rottier, M M A; Veerman, A J P

    2008-09-01

    In this study, we determined if in vitro resistance to prednisolone and dexamethasone could be circumvented by cortivazol or methylprednisolone, or reversed by meta-iodobenzylguanidine in pediatric lymphoblastic and myeloid leukemia. As there were strong correlations between the LC50 values (drug concentration inducing 50% leukemic cell kill, LCK) of the different glucocorticoids and median prednisolone/methylprednisolone, prednisolone/dexamethasone and prednisolone/cortivazol LC50 ratios did not differ between the leukemia subtypes, we conclude that none of the glucocorticoids had preferential anti-leukemic activity. Meta-iodobenzylguanidine however, partially reversed glucocorticoid resistance in 19% of the lymphoblastic leukemia samples.

  7. Beneficial effects of metoprolol on myocardial sympathetic function: Evidence from a randomized, placebo-controlled study in patients with congestive heart failure

    NARCIS (Netherlands)

    de Milliano, Paul A. R.; de Groot, Andre C.; Tijssen, Jan G. P.; van Eck-Smit, Berthe L. F.; van Zwieten, Pieter A.; Lie, Kong I.

    2002-01-01

    BACKGROUND: We sought to investigate whether beta-blockers exert a presynaptic effect in the myocardium as measured by 123I-metaiodobenzylguanidine. METHODS: The study comprised 59 patients with congestive heart failure, New York Heart Association class II or III, and left ventricular ejection

  8. 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:

  9. Use of 6-[18F]-fluorodopamine positron emission tomography (PET) as first-line investigation for the diagnosis and localization of non-metastatic and metastatic phaeochromocytoma (PHEO).

    NARCIS (Netherlands)

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

    2009-01-01

    OBJECTIVE: Imaging modalities available for the localization of phaeochromocytoma (PHEO) include computed tomography (CT), magnetic resonance imaging (MRI), [(123)I]- or [(131)I]-labelled metaiodobenzylguanidine ((123/131)I-MIBG) scintigraphy and 6-[(18)F]-fluorodopamine ((18)F-FDA) positron

  10. East and Central African Journal of Surgery Volume 15 Number 2 ...

    African Journals Online (AJOL)

    DELL

    Despite this, CTS is still preferred over MRI because of lack of anatomical information. Metaiodobenzylguanidine scan (MIBG) is a good functional test and surveys the whole body but has high false negative rate (29%) for extra-adrenal pheochromocytomas than pheochromocytomas4. Positron emission tomography (PET) ...

  11. 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

  12. REDUCTION OF INTRATUMORAL PH BY THE MITOCHONDRIAL INHIBITOR M-IODOBENZYLGUANIDINE AND MODERATE HYPERGLYCEMIA

    NARCIS (Netherlands)

    KUIN, A; SMETS, L; VOLK, T; PAANS, A; ADAMS, G; ATEMA, A; JAHDE, E; MAAS, A; RAJEWSKY, MF; VISSER, G; WOOD, P

    1994-01-01

    The interstitial pH of RIF-1 tumors was selectively lowered by i.p. administration of the mitochondrial inhibitor meta-iodobenzylguanidine (MIBG; 40-100 mg/kg), supported by sustained moderate hyperglycemia (plasma glucose concentration, 14 mM) in rats or by a single i.p. bolus injection of glucose

  13. The use of both diagnostic and therapeutic MIBG in neuroblastoma patients

    NARCIS (Netherlands)

    Bleeker, G.

    2014-01-01

    Neuroblastoma is the most common extra-cranial malignant solid tumour of childhood. It is an embryonic tumour derived from the sympathetic adrenal lineage of the neural crest. Distant metastases are present at diagnosis in 50% of the patients. Metaiodobenzylguanidine (MIBG) is a compound

  14. MIBG causes oxidative stress and up-regulation of anti-oxidant enzymes in the human neuroblastoma cell line SK-N-BE(2c)

    NARCIS (Netherlands)

    Cornelissen, J.; van Kuilenburg, A. B.; Voûte, P. A.; van Gennip, A. H.

    1997-01-01

    We report the effects of meta-iodobenzylguanidine (MIBG), a neuroblastoma-seeking agent, on cell proliferation and several oxidative stress-related parameters in the human neuroblastoma cell line SK-N-BE(2c). MIBG inhibited the proliferation of this cell line in micromolar concentrations.

  15. 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...

  16. A comparison of targeting of neuroblastoma with mIBG and anti L1-CAM antibody mAb chCE7: therapeutic efficacy in a neuroblastoma xenograft model and imaging of neuroblastoma patients

    NARCIS (Netherlands)

    Hoefnagel, C. A.; Rutgers, M.; Buitenhuis, C. K.; Smets, L. A.; de Kraker, J.; Meli, M.; Carrel, F.; Amstutz, H.; Schubiger, P. A.; Novak-Hofer, I.

    2001-01-01

    Iodine-131 labelled anti L1-CAM antibody mAb chCE7 was compared with the effective neuroblastoma-seeking agent 131I-labelled metaiodobenzylguanidine (MIBG) with regard to (a) its therapeutic efficacy in treating nude mice with neuroblastoma xenografts and (b) its tumour targeting ability in

  17. 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

  18. Scintigraphic localization of pheochromocytomas using 131 I-meta-iodobenzylguanidine. Comparison with computerized tomography

    International Nuclear Information System (INIS)

    Charbonnel, B.; Coornaert, S.; Tellier, J.L.; Peltier, P.; Chatal, J.F.

    1984-01-01

    Meta-iodobenzylguanidine was synthesized, radiolabelled with I 131 or I 123 and injected to 28 controls and 7 patients totalizing 13 foci of pheochromocytoma. The tumour was located in one adrenal gland in 3 cases, in both adrenal glands in 1 case, and between the aorta and the vena cava in 1 case; 2 were malignant with metastases. Scintigraphy was negative in all controls, whereas all pheochromocytomas were clearly demonstrated 24 h after injection, except one regarded as non functional due to necrosis. By comparison, CT readily showed the tumour in 7 cases, showed it only thanks to scintigraphic guidance in 4 cases and failed in 2 cases. It is concluded that scintigraphy with meta-iodo-benzylguanidine provides a safe and reliable means of locating a wide range of pheochromocytomas [fr

  19. Radio active's risk assessment and management following the death of a patient who received a therapeutic dose of iodine-131 as part of a treatment by radioimmunotherapy; Evaluation et gestion du risque radioactif suite au deces d'un patient ayant recu une dose therapeutique d'iode-131 dans le cadre d'un traitement en radiotherapie metabolique

    Energy Technology Data Exchange (ETDEWEB)

    Djoumessi, C.F.; Prunier, C.; Baulieu, J.L.; Besnard, J.C. [CHU de Tours, Service de Medecine Nucleaire, 37 - Tours (France); Djoumessi, C.F.; Bramoulle, C. [CHRU de Tours, Unite de Radiophysique, Clinique d' Oncologie et de Radiotherapie, 37 - Tours (France)

    2009-07-15

    A patient treated with meta-iodobenzylguanidine (Mibg) marked with iodine-131 for malignant pheochromocytoma died three hours after injection. To minimize radioactive risks, the decision to keep the remains for sixteen days was taken. This paper presents the levels of exposure of different persons involved in the care of the patient since his hospitalization until his funeral and the measures taken to prevent radioactive spread and contamination. (authors)

  20. Intraoperative localization of recurrent medullary carcinoma of the thyroid using indium-111 pentetreotide and a nuclear surgical probe

    Energy Technology Data Exchange (ETDEWEB)

    Waddington, W.A. (Inst. of Nuclear Medicine, Univ. Coll., London Medical School (United Kingdom)); Kettle, A.G. (Dept. of Nuclear Medicine, Kent and Canterbury Hospital, Canterbury (United Kingdom)); Heddle, R.M. (Dept. of Surgery, Kent and Canterbury Hospital, Canterbury (United Kingdom)); Coakley, A.J. (Dept. of Nuclear Medicine, Kent and Canterbury Hospital, Canterbury (United Kingdom))

    1994-04-01

    A patient with recurrent medullary thyroid cancer in the neck in whom previous surgery for recurrence had been undertaken with only partial success had the diseased tissue localized preoperatively by indium-111 pentetreotide. Scanning with technetium-99m V dimercaptosuccinic acid and iodine-123 metaiodobenzylguanidine failed to localize the tumor. Utilization of a nuclear surgical probe after preoperative [sup 111]In pentetreotide allowed accurate surgical localization of the tumour tissue. (orig.)

  1. An Unusual Case of Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Kristin N. Fiorino

    2011-01-01

    Full Text Available A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA, which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment.

  2. Localization of a pheochromocytoma using I-123 MIBG adrenal scintigraphy.

    Directory of Open Access Journals (Sweden)

    Shirkare S

    1994-04-01

    Full Text Available In a patient with the clinical diagnosis of pheochromocytoma, the localization of the tumor is essential for planning treatment. Recently, we have performed I-123 metaiodobenzylguanidine (MIBG adrenal scintigraphy in a patient presenting with a history of paroxysmal hypertension. Scintigraphy accurately located an ectopic unilateral pheochromocytoma. The scintigraphic diagnosis was confirmed by surgery and a diagnosis of ectopic unilateral pheochromocytoma was made by histopathological examination. This case report illustrates the specific diagnosis of pheochromocytoma by I-123 MIBG scintigraphy which is especially useful when other diagnostic procedures are equivocal.

  3. An efficient batch preparation of high specific activity [123I] and [124I] mIBG

    International Nuclear Information System (INIS)

    Amartey, J.K.; Al-Jammaz, I.; Lambrecht, R.M.

    2001-01-01

    The increasing demand for radiolabeled metaiodobenzylguanidine (mIBG) prompted the need to obtain the radiopharmaceutical by a reliable, routine and simple synthetic method for batch production. The production of mIBG labeled with either 123 I or 124 I has been optimized by modifying literature methods that involve solid-state exchange reaction on 'cold' mIBG facilitated by ammonium sulfate. The radiochemical yield and purity of radioiodinated mIBG generally exceeded 80 and 98%, respectively, with specific activity of >50 mCi/mg

  4. An unusual case of gastrointestinal bleeding.

    Science.gov (United States)

    Fiorino, Kristin N; Lestini, Brian; Nichols, Kim E; Anupindi, Sudha A; Maqbool, Asim

    2011-01-01

    A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA), which showed an 8 cm well-defined retroperitoneal vascular mass. (123)Iodine metaiodobenzylguanidine ((123)MIBG) scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI) bleeding and highlights the utility of CTA and (123)MIBG in evaluation and treatment.

  5. An Unusual Case of Gastrointestinal Bleeding

    Science.gov (United States)

    Fiorino, Kristin N.; Lestini, Brian; Nichols, Kim E.; Anupindi, Sudha A.; Maqbool, Asim

    2011-01-01

    A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA), which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG) scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI) bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment. PMID:22606522

  6. Primary diagnosis of multiple pheochromocytomas in the brother of a MEN-2 patient by simultaneous MIBG scintigraphy and low-dose computed tomography

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Petersen, Claus Leth

    2002-01-01

    Metaiodobenzylguanidine (MIBG) scintigraphy is a well-established functional imaging method for localizing pheochromocytomas. However, the morphologic information revealed on the scintigram is often too sparse and thus, accordingly, supplemental computed tomography (CT) or magnetic resonance...... in both adrenal glands and one extra-adrenal pheochromocytoma located in the liver. The combined imaging ensured the final diagnosis without any need for further imaging. Based on the findings of this case, the authors believe that combined MIBG scintigraphy and low-dose CT is a promising future single...

  7. Carotid body paraganglioma metastatic to bone: report of two cases

    International Nuclear Information System (INIS)

    Kawai, A.; Healey, J.H.; Wilson, S.C.; Huvos, A.G.; Yeh, S.D.J.

    1998-01-01

    Two patients with carotid body paraganglioma developed bone metastases 3 and 6 years respectively after surgical excision of the primary tumors. Plain radiographs showed ill-defined metastatic lesions. Scintigram using radiolabeled metaiodobenzylguanidine, an analogue of noradrenaline that is taken up by neurosecretary granules, showed an abnormal accumulation in the corresponding metastatic lesion. Histologically, nests of epithelioid cells with clear cytoplasm and pyknotic nuclei and abundant collagen fibers were observed within destroyed trabeculae. Treatment including external radiation and surgery provided pain relief and early local disease control. (orig.)

  8. 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

  9. Radiopharmaceuticals for diagnosis and treatment: Progress report for the period November 1, 1968 through July 1, 1987

    International Nuclear Information System (INIS)

    Kuhl, D.E.

    1987-07-01

    This project has been directed to the evolution of labeled chemicals useful for nuclear medical imaging to trace adrenal functions and localizing tumors in the neuroendocrine system. A major success was the introduction of 131 I-metaiodobenzylguanidine (MIBG). The uptake of radiolabeled precursors of epinephrine was explored. The uptake and excretion of five C-14 labeled precursors of epinephrine was studied in dogs. The adrenal medulla uptake of C-14 dopamine exceeded that of all other precursors. During the initial attempts to synthesize a successful adrenal medulla imaging agent, the concentration of C-14 dopamine in the human neuroblastoma was found to be considerably greater than in the normal human adrenal medulla. Radioiodinated bretylium analog was prepared that images the dog adrenal medulla. This effort was rapidly followed by the synthesis of original compounds with structural similarities to both norepinephrine and the adrenergic neuronal blocking agent, guanethidine; these latter agents demonstrating greater adrenal medulla specificity than the bretylium analogs. One of these guanidine derivatives, 131 I-metaiodobenzylguanidine (MIBG) has permitted the first successful diagnostic imaging of human adrenal medullary hyperplasia and of pheochromocytomas (including metastasized carcinoma) which could not be localized by any existing methodologies

  10. Adult Neuroblastoma Complicated by Increased Intracranial Pressure: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Patrick L. Stevens

    2014-01-01

    Full Text Available Neuroblastoma is the third most commonly occurring malignancy of the pediatric population, although it is extremely rare in the adult population. In adults, neuroblastoma is often metastatic and portends an extremely poor overall survival. Our case report documents metastatic neuroblastoma occurring in a healthy 29-year-old woman whose course was complicated by an unusual presentation of elevated intracranial pressures. The patient was treated with systemic chemotherapy, I131 metaiodobenzylguanidine (MIBG radiotherapy, and autologous stem cell transplant (SCT. Unfortunately the patient’s response to therapy was limited and she subsequently died. We aim to review neuroblastoma in the context of increased intracranial pressure and the limited data of neuroblastoma occurring in the adult population, along with proposed treatment options.

  11. Misleading diagnosis of retroperitoneal actinomycosis

    Energy Technology Data Exchange (ETDEWEB)

    Berchtenbreiter, C.; Bruening, R.; Reiser, M. [Inst. of Diagnostic Radiology, University Hospital Grosshadern, Ludwig Maximilians University, Munich (Germany); Auernhammer, A. [Medical Clinic II, Univ. Hospital Grosshadern, Ludwig Maximilians University, Munich (Germany)

    1999-07-01

    A 34-year-old woman presented with a left-sided suprarenal space-occupying lesion on sonography. Culture of material obtained during sonographic-guided puncture of the retroperitoneal lesion yielded a mixed flora of Actinomyces and Peptostreptococcus. Initially, a misleading diagnosis of an adrenal pheochromocytoma was initiated by highly positive metaiodobenzylguanidine scintigraphy after chemical chemistry vanillylmandelic acid (VMA) test showed elevated values for adrenaline and its derivatives. Retroperitoneal actinomycosis with yet unproven spread into thoracic and cervical compartments is a particular unusual presentation of an infection with these organisms. Because it may mimic subacute infections or malignant masses in terms of clinical and laboratory findings, radiological diagnosis of this entity may be difficult. The diagnosis was based on results of culture and the response of the patient to long-term penicillin-derivate therapy after surgical drainage of the suprarenal abscess formation. (orig.)

  12. Acute type A aortic dissection in a patient with paraganglioma.

    Science.gov (United States)

    Dos Santos Borrego, Andreia; Carrilho Ferreira, Pedro; Pinto, Fausto J

    2017-10-01

    Acute aortic dissection is the most common acute aortic syndrome. It is more prevalent in males and in the elderly, and has a high mortality. Hypertension is the main risk factor. Diagnosis is based on clinical features, laboratory tests and imaging exams. Treatment is usually surgical, although in some cases an endovascular approach is an alternative. Paraganglioma is an uncommon neuroendocrine tumor. Most produce catecholamines, and so usually manifest with hypertensive crisis, palpitations, headache and sweating. This tumor is diagnosed by measurement of plasma or urinary catecholamines and by computed tomography, magnetic resonance imaging and 123 I-metaiodobenzylguanidine (MIBG) scintigraphy. Surgery is the only potentially curative treatment. Copyright © 2017 Sociedade Portuguesa de Cardiologia. All rights reserved.

  13. Cardiac 123I-MIBG uptake in de novo Brazilian patients with Parkinson's disease without clinically defined dysautonomia

    Directory of Open Access Journals (Sweden)

    Marco Antonio Araujo Leite

    2014-06-01

    Full Text Available Myocardial scintigraphy with meta-iodo-benzyl-guanidine (123I cMIBG has been studied in Parkinson's disease (PD, especially in Asian countries, but not in Latin America. Most of these studies include individuals with PD associated to a defined dysautonomia. Our goal is to report the cardiac sympathetic neurotransmission in de novo Brazilian patients with sporadic PD, without clinically defined dysautonomia. We evaluated retrospectively a series of 21 consecutive cases with PD without symptoms or signs of dysautonomia assessed by the standard bedside tests. This number was reduced to 14 with the application of exclusion criteria. 123I cMIBG SPECT up-take was low or absent in all of them and the heart/mediastinum ratio was low in 12 of 14. We concluded that 123I cMIBG has been able to identify cardiac sympathetic neurotransmission disorder in Brazilian de novo PD patients without clinically defined dysautonomia.

  14. Positron tomographic imaging of tumors using monoclonal antibodies. Final progress report, April 15, 1989--October 31, 1995

    Energy Technology Data Exchange (ETDEWEB)

    Zalutsky, M.R.

    1997-02-01

    The overall objective of this research is to develop methods for utilizing positron emission tomography (PET) to increase the clinical potential of radiolabeled monoclonal antibodies (MAbs). Enhancement of MAb tumor localization by hyperthermia also was proposed. Studies were to have been performed with both {sup 18}F and {sup 124}I; however, the lack of its availability (until quite recently) prevented experiments with {sup 124}I. Instead, two additional lines of inquiry were initiated in which they utilized aspects of the radiofluorination chemistries originally developed for MAbs for labeling chemotactic peptides and meta-iodobenzylguanidine (MIBG) analogues with {sup 18}F. This final report summarizes the original specific aims and the main research accomplishments in studies of mouse, dog and human models.

  15. What factors do relate with plasma B type natriuretic peptide levels? A study by nuclear cardiology

    Energy Technology Data Exchange (ETDEWEB)

    Oshima, Keita; Sarai, Masayoshi; Sato, Takahisa [Fujita Health Univ., Toyoake, Aichi (Japan). School of Medicine] [and others

    2002-02-01

    To find clinical factors relating with plasma B type natriuretic peptide levels (BNP), early and delayed imagings at rest were done in 104 patients with heart diseases (66 males/38 females, mean age of 65.4 y) after the intravenous injection of 111 MBq of {sup 123}I-MIDI (metaiodobenzylguanidine). Myocardial SPECT synchronized with electrocardiography was also done after 600 MBq of {sup 123}I-MIDI injection. In the same day, BNP was measured. Images were taken with ADAC gamma camera VERTEX-plus of 2-detector type. Log BNP was found related with age, H/M(D) (heart/mediastinum count ratio, delayed) and BMI (body mass index) as well as EF (left ventricular ejection fraction) and since the correlation was more significant than BNP, log BNP was considered to be a more sensitive measure. (K.H.)

  16. Pheochromocytoma of the urinary bladder - a case report

    Directory of Open Access Journals (Sweden)

    Marić Predrag

    2016-01-01

    Full Text Available Introduction. Pheochromocytoma of the urinary bladder is a rare tumor and presents less than 0.06% of all urinary bladder tumors. Case report. We presented a 49-year-old female patient with a history of daily paroxysmal hypertension accompanied with flushing of the face and upper chest, palpitations and excessive sweating prior to micturition. Ultrasonography reported a 3 cm bladder wall tumor. The 131I-metaiodobenzylguanidine (131I-MIBG scan showed a pathological isotope accumulation in the projection of the bladder. The patient underwent a partial cystectomy. One year following the operation the patient was normotensive and without recurrence. Conclusion. The most efficient treatment option for bladder pheochromocytoma is surgical resection. The most important fact in the diagnostics is suspicion on this rare condition.

  17. Scintigraphic assessment of cardiac adrenergic innervation in patients with essential hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Fujiwara, Y.; Hamada, M.; Shigematsu, Y.; Sumimoto, T.; Hamamoto, K.; Hiwada, K. (2nd Department of Internal Medicine, Ehime University School of Medicine (Japan))

    1991-01-01

    To assess the regional cardiac adrenergic innervation in patients with essential hypertension (EHT), simultaneous iodine-123 metaiodobenzylguanidine ((123I)MIBG) and thallium-201 (201Tl) myocardial imagings were performed in five patients with EHT, seven patients with hypertrophic cardiomyopathy (HCM), and seven normal subjects. Short axial images at rest were divided into five segments: anterior, septal, posterior, lateral, and apical segments. Percent regional uptake (%RU) of 201Tl except the septal segment in patients with EHT showed no significant difference. However, the %RU of (123I)MIBG at posterior, lateral, and apical segments was significantly lower than that at anterior and septal segments in EHT. This intraimage heterogeneity of (123I)MIBG was also observed in HCM. These results suggest that there is a difference in regional adrenergic innervation of the left ventricle with myocardial hypertrophy.

  18. {sup 18}F-DOPA PET/CT for assessment of response to induction chemotherapy in a child with high-risk 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); Lopci, Egesta [Humanitas Clinical and Research Center, Nuclear Medicine Department, Rozzano, MI (Italy); Foppiani, Luca [Galliera Hospital, Internal Medicine and Endocrinology, Genoa (Italy); Morana, Giovanni [G. Gaslini Children' s Hospital, Department of Pathology and Radiology, Genoa (Italy); Conte, Massimo [G. Gaslini Children' s Hospital, Department of Hematology-Oncology, Genoa (Italy)

    2014-03-15

    Functional imaging plays a crucial role in the assessment of neuroblastoma. The evaluation of response to induction chemotherapy is a cornerstone in scheduling proper treatment management in patients affected by high-risk neuroblastoma. {sup 123}I-metaiodobenzylguanidine has been recognized as the radiopharmaceutical of choice in neuroblastoma assessment. To date, the clinical role of PET/CT in pediatric malignancy is not well established.{sup 18}F-DOPA-PET/CT has been recently used in neuroblastoma, and compared with {sup 123}I-MIBG-scan. Scant new data are available about the role of this tool in the evaluation of treatment response after induction chemotherapy. We investigate the role of {sup 18}F-DOPA-PET/CT in characterizing the response to induction chemotherapy in a child affected by high-risk-neuroblastoma, in whom the rare association of {sup 123}I-MIBG-negative primary tumor and MIBG-positive bone marrow metastases was observed. (orig.)

  19. 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)

  20. Primary pancreatic neuroblastoma presenting with opsoclonus–myoclonus syndrome

    Directory of Open Access Journals (Sweden)

    Samuel Galgano, MD

    2016-03-01

    Full Text Available Although neuroblastoma is a common solid organ malignancy in children, primary pancreatic neuroblastoma is a rare entity in children, with very few cases reported in the literature. The case discusses the presentation of a 21-month-old female presenting to the neurology clinic with ataxia and erratic eye movements. Our case illustrates the computed tomography, ultrasound, and scintigraphic findings of primary pancreatic neuroblastoma presenting as opsoclonus–myoclonus syndrome. Computed tomography and ultrasound demonstrated a vascular, enhancing mass in the pancreatic body clearly separate from the adrenal gland. Metaiodobenzylguanidine scan demonstrates focal intense uptake in the pancreatic body. The patient's diagnosis was confirmed with biopsy, and her malignancy responded well to conventional chemotherapy. The case is important in that it demonstrates the unusual imaging appearance of a primary pancreatic neuroblastoma.

  1. Isotopic Exchange Reaction Assisted with Cu (I) generated ''in situ'' For Synthesis of Ready-to-Use for on-the-spot Formulation of [131 I] Iodobenzyl Derivatives

    International Nuclear Information System (INIS)

    Abudaia, J.A.; Suliman, M.O.

    2007-01-01

    It has been examined that meta-Iodobenzylguanidine (m-IBG), para-Iodoamphetamine (p-IPA) and orth-Iodohippuric acid (o-IHA) are three commonly used Iodobenzyl derivative compounds, and can be formulated as Ready-to-Use Kits for on-the-spot labeling catalyzed with copper ion Cu+ (I) generated ''In Situ''. The labeling procedure efficiently has been established within 30 min of heating using an autoclave, 20 min. and 90 min. using dry heating block respectively. Isotopic exchange reaction with Iodine-131 radioactive of those three Ready-to-Use Kits has led to Radiochemical Purity ''RCP'' equals to 98%, > 98%, and almost 99%, and Radiochemical Yield ''RCY'' > 97%, >93% and > 98% respectively. Attention was paid to the Radiochemical Stability of those three Iodobenzyl derivatives for a period time of preservation at low temperature. As a result, this gave evidence that such Radiopharmaceuticals could be used as Ready-to-Use products at different times of preservations.

  2. Cytoplasmic aggregates of dynactin in iPSC-derived tyrosine hydroxylase-positive neurons from a patient with Perry syndrome.

    Science.gov (United States)

    Mishima, Takayasu; Ishikawa, Taizo; Imamura, Keiko; Kondo, Takayuki; Koshiba, Yasushi; Takahashi, Ryosuke; Takahashi, Jun; Watanabe, Akihiro; Fujii, Naoki; Tsuboi, Yoshio; Inoue, Haruhisa

    2016-09-01

    Perry syndrome is a rare autosomal dominant disorder clinically characterized by parkinsonism with depression/apathy, weight loss, and central hypoventilation. Eight mutations in DCTN1 gene have been reported. A novel disease model is required because the detailed pathogenesis remains unclear. To develop a novel model, we generated induced pluripotent stem cells (iPSCs) from a Perry syndrome patient with F52L mutation in DCTN1, and describe clinical and neuroimaging investigations. We differentiated iPSCs into tyrosine hydroxylase (TH)-positive neurons. Immunocytochemistry analyses of control and mutant were performed. The patient displayed levodopa responsive parkinsonism. Dopamine transporter single photon emission tomography showed markedly decreased uptake in the striatum, and metaiodobenzylguanidine cardiac scintigraphy also showed decreased uptake. Perry syndrome TH-positive neurons showed dynactin aggregates in cytoplasm. TH-positive neurons from Perry syndrome iPSCs recapitulated an aspect of the disease phenotype of Perry syndrome. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Adrenal pathology in childhood: a spectrum of disease

    Energy Technology Data Exchange (ETDEWEB)

    Paterson, Anne [Royal Belfast Hospital for Sick Children, 180 Falls Road, Belfast BT12 6BE (United Kingdom)

    2002-10-01

    Adrenal lesions in children may present with an asymptomatic adrenal mass lesion, an endocrinopathy, a hypertensive or metabolic crisis or a paraneoplastic syndrome. Some of the underlying disease processes remain localised within the adrenal gland or may develop into disseminated disease. The role of the radiologist is to confirm the adrenal location of a lesion and to document any other foci of disease. Ultrasound, CT, MR imaging and metaiodobenzylguanidine scintigraphy are the most commonly utilised imaging modalities for examining the adrenal glands and their pathologies in children. This paper reviews the spectrum of adrenal disease in childhood and presents the information as a series of radiological appearances: anomalies of adrenal shape, location, number and size, cystic adrenal masses, solid adrenal mass lesions, and adrenal calcifications are all examined. The radiological findings must always be interpreted in conjunction with the patient's age, the clinical history, the findings on physical examination and the available biochemical data. (orig.)

  4. Therapy with radionuclides

    International Nuclear Information System (INIS)

    Biersack, H.J.; Hotze, A.L.

    1992-01-01

    Radioiodine therapy of benign and malignant thyroid diseases is a well-established procedure in Nuclear Medicine. However, the therapeutic use of radioisotopes in other diseases is relatively unknown among our refering physicians. The therapeutic effects of intraarticular (rheumatoid arthritis) and intracavitary (pleural and peritoneal carcinosis) applications yields good results. The radiophosphorus therapy in polycythemia vera rubra has always to be considered as an alternative to chemotherapy. The use of analgetics may be reduced by pain therapy of bone metastasis by injection of bone-seeking beta emitters like Rh-186 HEDP. Other procedures like therapeutic application of meta-iodo-benzylguanidine in neuroblastoma and malignant pheochromocytoma resulted in at least remissions of the disease. Radioimmunotherapy needs further evaluation before it can be recommended as a routine procedure. (orig.) [de

  5. Myocardial adrenergic status in patients with idiopatic dilated cardiomyopathies and with chagas' disease studied by the myocardic scintillography with I-123-MIBG

    International Nuclear Information System (INIS)

    Freire, R.; Marinho, N.; Freitas, H.; Chizzola, P.; Buchpiguel, C.; Mansur, A.; Meneghetti, C.; Bocchi, E.

    1997-01-01

    Full text: Metaiodobenzylguanidine labeled with I-123 MIBG is a radiopharmaceutical used to study the cardiac adrenergic activity. The objective of this study was to test the hypothesis that congestive cardiac failure (CCF) patients with Chagas' disease etiology would have a scintillographic pattern of uptake of MIBG similar to that presented by patients with idiopatic dilated cardiomyopathies (IDCM). We studied 24 patients, 10 with Chagas' disease and 14 with IDMC.The results show that the presented alterations in the cardiac uptake of 15m and 4 h, in the turn over (wash out) and in the distribution (ratio heart/mediastinum), presented in the patients with Chagas' disease are similar (p=ns) to that found in the IDCM patients. Although the IDCM and Chagas' disease etiology are different, both courses with a decrease in the number of adrenergic receptors available at myocardial cell level, demonstrated by similarity in the presented scintillographic pattern

  6. 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)

  7. Unusual Presentation of Bladder Paraganglioma: Comparison of 131I MIBG SPECT/CT and 68Ga DOTANOC PET/CT

    International Nuclear Information System (INIS)

    Jain, Tarun Kumar; Basher, Rajender Kumar; Gupta, Nitin; Shukla, Jaya; Singh, Shrawan Kumar; Mittal, Bhagwant Rai

    2016-01-01

    Extraadrenal chromaffin cell-related tumors or paragangliomas are rare, especially in the bladder, accounting for less than 1% of cases. We report a 16-year-old boy who presented with hematuria and paroxysmal headache and was found to have a prostatic growth infiltrating the urinary bladder on anatomical imaging. Iodine-131 ( 131 I) metaiodobenzylguanidine (MIBG) whole-body scanning and subsequently gallium-68 ( 68 Ga) DOTANOC positron emission tomography/computed tomography (PET/CT) were performed. The MIBG scan revealed a non-tracer-avid soft-tissue mass, while DOTANOC PET/CT revealed a tracer-avid primary soft-tissue mass involving the urinary bladder and prostate with metastasis to the iliac lymph nodes. He underwent surgical management; histopathology of the surgical specimen revealed a bladder paraganglioma, whereas the prostate was found to be free of tumor

  8. Delayed autonomic neuropathy in a patient with diethylene glycol poisoning: a case report.

    Science.gov (United States)

    Kamada, Hiroki; Suzuki, Hideaki; Yamamoto, Saori; Nomura, Ryosuke; Kushimoto, Shigeki

    2017-07-01

    A 72-year-old man presented to our hospital after ingesting insecticide containing approximately 2 mL/kg diethylene glycol, which exceeded the lethal dose of 1 mL/kg. The patient recovered from critical symptoms on acute phase until day 3, but received artificial ventilation for muscle weakness secondary to sensorimotor neuropathy on days 11-54. Even after marked improvement from sensorimotor neuropathy, the patient continued to complain of orthostatic hypotension. Autonomic neuropathy was identified by positive result of a head-up tilt test, and reduction in coefficient of variation of R-R intervals and cardiac iodine-123-metaiodobenzylguanidine uptake for the assessment of cardiac sympathetic activity. The patient's symptoms fully recovered 2 years after the exposure to diethylene glycol. This case shows the first report of delayed autonomic neuropathy after recovery from severe sensorimotor neuropathy, and suggests the importance of continuous monitoring for late-onset neurological complications.

  9. Positron tomographic imaging of tumors using monoclonal antibodies. Final progress report, April 15, 1989--October 31, 1995

    International Nuclear Information System (INIS)

    Zalutsky, M.R.

    1997-02-01

    The overall objective of this research is to develop methods for utilizing positron emission tomography (PET) to increase the clinical potential of radiolabeled monoclonal antibodies (MAbs). Enhancement of MAb tumor localization by hyperthermia also was proposed. Studies were to have been performed with both 18 F and 124 I; however, the lack of its availability (until quite recently) prevented experiments with 124 I. Instead, two additional lines of inquiry were initiated in which they utilized aspects of the radiofluorination chemistries originally developed for MAbs for labeling chemotactic peptides and meta-iodobenzylguanidine (MIBG) analogues with 18 F. This final report summarizes the original specific aims and the main research accomplishments in studies of mouse, dog and human models

  10. Dosimetry for therapeutic treatment of neuroblastoma by 131I-mIBG

    International Nuclear Information System (INIS)

    Sudbrock, F.; Eschner, W.; Schmidt, M.; Schicha, H.

    2006-01-01

    Aim: targeted radiotherapies using iodine-131 meta-iodobenzylguanidin have long been in use for treatment of stage IV neuroblastoma but reliable dosimetric data are scarce. Method: this work presents an approach to determine the whole body exposure and tumour doses delivered during therapy. Dosimetric data are reported and discussed for six treatments carried out according to the trial protocol NB2004 as it is in use in our study in the last two years. Results: whole body exposures ore found to be in the range of 1.75 to 2.5 Gy whereas tumour doses vary between 15 and 55 Gy. Conclusion: the course of action prescribed by the trial protocol allows whole body exposure as well as tumour doses to be determined routinely. (orig.)

  11. Relationships between left ventricular sympathetic innervation and diastolic dysfunction: the role of myocardial innervation/perfusion mismatch.

    Science.gov (United States)

    Gimelli, Alessia; Liga, Riccardo; Avogliero, Francesco; Coceani, Michele; Marzullo, Paolo

    2016-12-27

    A possible relationship between cardiac sympathetic denervation and left ventricular (LV) diastolic dysfunction has been suggested. However, an evaluation of the interactions between myocardial adrenergic tone and LV perfusion and diastolic function is lacking. Seventy-two patients underwent 99m Tc-tetrofosmin/ 123 I-metaiodobenzylguanidine ( 123 I-MIBG) cardiac Cadmium-Zinc-Telluride (CZT) imaging. The summed rest score (SRS) and summed 123 I-MIBG score (SS-MIBG) were computed as measures of regional perfusion and innervation heterogeneities. LV segments showing an impaired innervation, despite a relatively preserved perfusion ( 99m Tc-tetrofosmin- 123 I-MIBG tracers' uptake ≥25%), were individuated (innervation/perfusion mismatch). The peak filling rate (PFR) was computed as a measure of LV diastolic function. Nineteen of the 72 (26%) patients presented a normal LV diastolic function, while 29 (40%) and 24 (34%) had a mild and overt diastolic dysfunction. Subjects with diastolic dysfunction showed more abnormal SRS and SS-MIBG values (P mismatch. A modest correlation between the extent of cardiac innervation/perfusion mismatch and PFR values was evident (R = -0.27, P = 0.029). On multivariate analysis, the extent of regional innervation/perfusion mismatch remained an independent predictor of overt LV diastolic abnormalities (P = 0.017). The burden of LV regions showing an innervation/perfusion mismatch associates with the occurrence of overt diastolic dysfunction.

  12. 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)

  13. Pheochromocytomas and secreting paragangliomas

    Directory of Open Access Journals (Sweden)

    Gimenez-Roqueplo Anne-Paule

    2006-12-01

    Full Text Available Abstract Catecholamine-producing tumors may arise in the adrenal medulla (pheochromocytomas or in extraadrenal chromaffin cells (secreting paragangliomas. Their prevalence is about 0.1% in patients with hypertension and 4% in patients with a fortuitously discovered adrenal mass. An increase in the production of catecholamines causes symptoms (mainly headaches, palpitations and excess sweating and signs (mainly hypertension, weight loss and diabetes reflecting the effects of epinephrine and norepinephrine on α- and β-adrenergic receptors. Catecholamine-producing tumors mimic paroxysmal conditions with hypertension and/or cardiac rhythm disorders, including panic attacks, in which sympathetic activation linked to anxiety reproduces the same signs and symptoms. These tumors may be sporadic or part of any of several genetic diseases: familial pheochromocytoma-paraganglioma syndromes, multiple endocrine neoplasia type 2, neurofibromatosis 1 and von Hippel-Lindau disease. Familial cases are diagnosed earlier and are more frequently bilateral and recurring than sporadic cases. The most specific and sensitive diagnostic test for the tumor is the determination of plasma or urinary metanephrines. The tumor can be located by computed tomography, magnetic resonance imaging and metaiodobenzylguanidine scintigraphy. Treatment requires resection of the tumor, generally by laparoscopic surgery. About 10% of tumors are malignant either at first operation or during follow-up, malignancy being diagnosed by the presence of lymph node, visceral or bone metastases. Recurrences and malignancy are more frequent in cases with large or extraadrenal tumors. Patients, especially those with familial or extraadrenal tumors, should be followed-up indefinitely.

  14. Pharmacologic manipulation to enhance diagnostic imaging in adrenal gland scintigraphy

    International Nuclear Information System (INIS)

    Gross, M.D.; Shapiro, B.

    1985-01-01

    Pharmacologic manipulation of adrenal gland function was first used to enhance the biochemical diagnosis of adrenal cortical and adrenal medullary disease. Scintigraphy depends on the specific adrenal accumulation of a radiopharmaceutical (ie, iodine 131 (/sup 131/I)-labelled 19-iodocholesterol [cortex], /sup 131/I-labeled 6β-iodomethylnorcholesterol [NP-59] [cortex], selenium 75 (/sup 75/Se)-labeled 6β-selenomethylnorcholesterol [cortex] or /sup 131/I-labeled metaiodobenzylguanidine [medulla], and the pattern and degree of radiotracer uptake can, like the biochemical parameters, be altered by pharmacologic manipulation to improve diagnostic accuracy. The relationship of alterations of cortical and medullary function to the accumulation of these radiopharmaceuticals has recently been demonstrated. The scintigraphic studies can be integrated with the other complementary tests of radiodiagnosis that demonstrate increased spatial resolution (computed tomography and ultrasound) but do not define organ function. This chapter focuses on the important pharmacologic manipulations that are used in the scintigraphic approach to the localization and functional characterization of the adrenal cortex and medulla

  15. 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)

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

    Energy Technology Data Exchange (ETDEWEB)

    Koyama, Keiko; Inoue, Tomio; Hasegawa, Akira; Oriuchi, Noboru; Okamoto, Eiichi; Tomaru, Yumi; Endo, Keigo [Gunma Univ., Maebashi (Japan). School of Medicine

    2001-08-01

    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)

  17. Autonomic failure mimicing dopamine agonist induced vertigo in a patient with macroprolactinoma.

    Science.gov (United States)

    Seiler, L; Braune, S; Borm, K; Magerkurth, C; Talazko, J; Peters, T; Reincke, M

    2002-10-01

    A 68-year-old man presented with general fatigue, increasing adynamia, weakness, vertigo and recurrent syncope. Six weeks earlier the diagnosis of a macroprolactinoma had been established based on a greatly elevated prolactin concentration (161 170 micro U/l) and MR-evidence of a 3.5 cm measuring pituitary mass. The patient had been started on cabergoline (1.5 mg weekly). Orthostatic hypotension due to the dopamine agonist was considered very likely and carbergoline therapy was stopped. However, there was no relief of the symptoms and further syncopes followed. Testing of blood pressure and heart rate regulation, selective testing of postganglionic cardiac neurons with [ 123 J] metaiodobenzylguanidine scintigraphy provided evidence of grossly impaired neurogenic cardiovascular regulation due to failure of postganglionic efferent sympathetic activity. This is characteristic for pure autonomic failure. The patient was treated symptomatically with high fluid intake, compression stockings, fludrohydrocortisone (0.1 mg o.d.s.), piroxicam (20 mg o.d.s.) and etilephrin (10 mg q.d.s.), which enabled him to cope with daily activities without syncope. This case shows that vertigo in a patient with macroprolactinoma is not always related to drug therapy but may be related to other causes.

  18. MIBG scintigraphy in differential diagnosis of Parkinsonism: a meta-analysis.

    Science.gov (United States)

    Treglia, Giorgio; Cason, Ernesto; Stefanelli, Antonella; Cocciolillo, Fabrizio; Di Giuda, Daniela; Fagioli, Giorgio; Giordano, Alessandro

    2012-02-01

    Differential diagnosis between Parkinson's disease (PD) and other Parkinsonism using clinical criteria or imaging methods is often difficult. The purpose of this study is to systematically review and meta-analyze published data about the diagnostic performance of myocardial innervation imaging using (123)I-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between PD and other Parkinsonism. A comprehensive computer literature search of studies published through March 2011 regarding MIBG scintigraphy in patients with PD and other Parkinsonism was performed in PubMed/MEDLINE and Embase databases. Only studies in which MIBG scintigraphy was performed for differential diagnosis between PD and other Parkinsonism were selected. Pooled sensitivity, pooled specificity and area under the ROC curve were calculated to measure the accuracy of MIBG scintigraphy in differential diagnosis between PD and other Parkinsonism. Nineteen studies comprising 1,972 patients (1,076 patients with PD, 117 patients with other Lewy body diseases and 779 patients with other diseases) were included in this meta-analysis. The pooled sensitivity of MIBG scintigraphy in detecting PD was 88% (95% CI 86-90%); the pooled specificity of MIBG scintigraphy in discriminating between PD and other Parkinsonism was 85% (95% CI 81-88%). The area under the ROC curve was 0.93. In patients with clinically suspected PD, myocardial innervation imaging demonstrated high sensitivity and specificity. MIBG scintigraphy is an accurate test in this setting. Nevertheless, possible causes of false-negative and false-positive results should be kept in mind when interpreting the scintigraphic results.

  19. Diagnostic performance of myocardial innervation imaging using MIBG scintigraphy in differential diagnosis between dementia with lewy bodies and other dementias: a systematic review and a meta-analysis.

    Science.gov (United States)

    Treglia, Giorgio; Cason, Ernesto

    2012-04-01

    This study was designed to review the diagnostic performance of myocardial innervation imaging using iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between dementia with Lewy bodies (DLB) and other dementias. A comprehensive computer literature search of studies published through May 2010 regarding MIBG scintigraphy in patients with DLB was performed in PubMed/MEDLINE and Embase databases. Only studies in which MIBG scintigraphy was performed for differential diagnosis between DLB and other dementias were selected. Pooled sensitivity and specificity of MIBG scintigraphy were presented with a 95% confidence interval (CI). The area under the ROC curve was calculated to measure the accuracy of MIBG scintigraphy in differential diagnosis between Lewy body diseases and other dementias. Ultimately, we identified 8 studies comprising a total of 346 patients with dementia (152 patients with DLB and 194 patients with other dementias). The pooled sensitivity of MIBG scintigraphy in detection of DLB was 98% (95% CI, 94-100%); the pooled specificity of MIBG scintigraphy in differential diagnosis between DLB and other dementias was 94% (95% CI, 90-97%). The area under the ROC curve was .99. Myocardial innervation imaging with MIBG scintigraphy demonstrated high pooled sensitivity and specificity in patients with suspected DLB. MIBG scintigraphy is an accurate test for differential diagnosis between DLB and other dementias. Copyright © 2010 by the American Society of Neuroimaging.

  20. A longitudinal study of a family with adult-onset autosomal dominant leukodystrophy: Clinical, autonomic and neuropsychological findings.

    Science.gov (United States)

    Terlizzi, Rossana; Calandra-Buonaura, Giovanna; Zanigni, Stefano; Barletta, Giorgio; Capellari, Sabina; Guaraldi, Pietro; Donadio, Vincenzo; Cason, Ernesto; Contin, Manuela; Poda, Roberto; Tonon, Caterina; Sambati, Luisa; Gallassi, Roberto; Liguori, Rocco; Lodi, Raffaele; Cortelli, Pietro

    2016-02-01

    Adult-onset autosomal dominant leukodystrophy (ADLD) is a rare progressive neurological disorder caused by Lamin B1 duplication (LMNB1). Our aim was to investigate longitudinally the pattern of the autonomic dysfunction and the degree of neuropsychological involvement. Three related ADLD patients and one asymptomatic carrier of LMNB1 duplication underwent a standardized evaluation of autonomic nervous system, including cardiovascular reflexes, pharmacological testing, microneurography, skin biopsy, Metaiodobenzylguanidine scintigraphy and a complete neuropsychological battery. An early neurogenic orthostatic hypotension was detected in all patients and confirmed by a low rise in noradrenaline levels on Tilt Test. However infusion of noradrenaline resulted in normal blood pressure rise as well as the infusion of clonidine. At the insulin tolerance test the increase in adrenaline resulted pathological in two out three patients. Microneurography failed to detect muscle sympathetic nerve activity bursts. Skin biopsy revealed a poor adrenergic innervation, while cardiac sympathetic nerves were normal. None of ADLD patients showed a global cognitive deficit but a selective impairment in the executive functions. Autonomic disorder in ADLD involves selectively the postganglionic sympathetic system including the sympatho-adrenal response. Cognitive involvement consisting in an early impairment of executive tasks that might precede brain MR abnormalities. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. 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)

  2. [Radionuclide therapy of endocrine-related cancer].

    Science.gov (United States)

    Kratochwil, C; Giesel, F L

    2014-10-01

    This article gives an overview of the established radionuclide therapies for endocrine-related cancer that already have market authorization or are currently under evaluation in clinical trials. Radioiodine therapy is still the gold standard for differentiated iodine-avid thyroid cancer. In patients with bone and lung metastases (near) total remission is seen in approximately 50% and the 15-year survival rate for these patients is approximately 90%. In contrast to the USA, meta-iodobenzylguanidine (MIBG) therapy has market approval in Europe. According to the current literature, in the setting of advanced stage neuroblastoma and malignant pheochromocytoma or paraganglioma, radiological remission can be achieved in >30% and symptom control in almost 80% of the treated patients. Somatostatin receptor targeted radionuclide therapies (e.g. with DOTATATE or DOTATOC) demonstrated promising results in phase 2 trials, reporting progression-free survival in the range of 24-36 months. A first phase 3 pivotal trial for intestinal carcinoids is currently recruiting and another trial for pancreatic neuroendocrine tumors is planned. Radiopharmaceuticals based on glucagon-like peptide 1 (GLP1) or minigastrins are in the early evaluation stage for application in the treatment of insulinomas and medullary thyroid cancer. In general, radiopharmaceutical therapy belongs to the group of so-called theranostics which means that therapy is tailored for individual patients based on molecular imaging diagnostics to stratify target positive or target negative tumor phenotypes.

  3. Depicting medullary thyroid cancer recurrence: the past and the future of nuclear medicine imaging.

    Science.gov (United States)

    Skoura, Evangelia

    2013-10-01

    Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and medically challenging malignancy. Even if the extent of initial surgery is deemed adequate, the recurrence rate remains high, up to 50% in most series. Measurement of serum calcitonin is important in the follow-up of patients with MTC, and reliably reflects the existence of the disease. There is no single sensitive diagnostic imaging method to reveal all MTC recurrences or metastases. Conventional morphologic imaging methods (U/S, CT, and MRI) and several methods of nuclear medicine have been used for this purpose with variable accuracy. The main role of nuclear medicine imaging is the detection of residual or recurrent tumor in the postoperative follow-up. In this review we present the radiopharmaceuticals used in the diagnosis of MTC recurrence, and comparison among them. The most used radiopharmaceuticals labelled with γ emitters are: Metaiodobenzylguanidine (MIBG), labelled with (131)I or (123)I, (111)In-pentetreotide (Octreoscan), 99mTc-pentavalent dimercaptosuccinic acid ((99m)Tc(V)-DMSA), and (99m)Tc-EDDA/HYNIC-Tyr3-Octreotide ( Tektrotyd). The radiopharmaceuticals labelled with a positron-emitting radionuclide (β+), suitable for positron emission tomography (PET) imaging are: (18)F-fluorodeoxyglucose ((18)F-FDG), (18)F-fluorodihydroxyphenylalanine (18F-DOPA), and 68Ga-labelled somatostatin analogues (68Ga-DOTATATE or DOTATOC).

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

    International Nuclear Information System (INIS)

    Shinohara, Tetsuji; Takahashi, Naohiko; Kakuma, Tetsuya; Hara, Masahide; Yoshimatsu, Hironobu; Yufu, Kunio; Anan, Futoshi; Nakagawa, Mikiko; Saikawa, Tetsunori

    2008-01-01

    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 ( 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 123 I-MIBG myocardial uptake values were lower (p 123 I-MIBG was higher (p 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.)

  5. Nuclear medicine and multimodality imaging of pediatric neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Wolfgang Peter; Pfluger, Thomas [Ludwig-Maximilians-University of Munich, Department of Nuclear Medicine, Munich (Germany); Coppenrath, Eva [Ludwig-Maximilians-University of Munich, Department of Radiology, Munich (Germany)

    2013-04-15

    Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system and is metastatic or high risk for relapse in nearly 50% of cases. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for defining the adequate therapeutic choice. Tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor specific agent for imaging. MIBG imaging has several disadvantages, such as limited spatial resolution, limited sensitivity in small lesions and the need for two or even more acquisition sessions. Most of these limitations can be overcome with positron emission tomography (PET) using [F-18]2-fluoro-2-deoxyglucose [FDG]. Furthermore, new tracers, such as fluorodopa or somatostatin receptor agonists, have been tested for imaging neuroblastoma recently. However, MIBG scintigraphy and PET alone are not sufficient for operative or biopsy planning. In this regard, a combination with morphological imaging is indispensable. This article will discuss strategies for primary and follow-up diagnosis in neuroblastoma using different nuclear medicine and radiological imaging methods as well as multimodality imaging. (orig.)

  6. Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital

    International Nuclear Information System (INIS)

    Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

    2014-01-01

    Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments

  7. MIBG detection of hepatic neuroblastoma: correlation with CT, US and surgical findings

    International Nuclear Information System (INIS)

    Dessner, D.A.; DiPietro, M.A.; Shulkin, B.L.

    1993-01-01

    Metaiodobenzylguanidine (MIBG) imaging is used in the diagnosis, staging and follow-up of virtually every case of neuroblastoma seen at our institution. Normal sites of MIBG uptake include the liver and therefore difficulties have been predicted and encountered in the diagnosis of hepatic neuroblastoma due to inability to separate abnormally increased tracer deposition from normal hepatic activity. We reviewed every MIBG (I 123 and I 131 ) study performed at our pediatric hospital over a 4 year period encompassing 88 patients, 67 of whom had biopsy proven neuroblastoma. Hepatic findings on MIBG studies were compared with concurrent abdominal CT and US studies in all 67 patients. The clinical records of all patients with abnormal MIBG scans or abnormal CT or US studies of the liver were also reviewed. Eight patients were found to have abnormal liver findings on one or more imaging studies (MIBG, CT, or US). There were 3 true positive MIBG studies, one of which was an early study in a patient who later went on to have one of the false positive studies. Two patients had false positive MIBG scans for liver neuroblastoma MIBG failed to detect liver involvement in 4 patients. (orig.)

  8. Hepatic absorbed radiation dosimetry during I-131 metaiodobenzylguanadine (MIBG) therapy for refractory neuroblastoma

    International Nuclear Information System (INIS)

    Koral, Kenneth F.; Regan, Denise; Huberty, John P.; Frame, Bill; Matthay, Katherine K.; Maris, John M.; Normolle, Daniel; Yanik, Gregory A.

    2008-01-01

    To compare the prediction of therapeutic hepatic radiation-absorbed dose rates from tracer imaging plus a linearity assumption to estimation based on intra-therapy imaging in 131 I metaiodobenzylguanidine (MIBG) therapy of refractory neuroblastoma. Conjugate-view images of the liver were obtained before therapy for seven patients at seven times after a tracer infusion of 131 I MIBG and at three times after the therapy infusion. Measured liver activities were converted to dose-rate estimates. Three statistical models of the rates assuming double exponential dependences on time were examined. One of the three models allowed for a multiplicative correction to the therapeutic late-phase dose-rate amplitude. Results from that model: (1) the tracer prediction of the late-phase absorbed-dose-rate amplitude was a factor of 1.75 times the intra-therapy-estimated value, and (2) the difference between tracer prediction of the radiation-absorbed dose and intra-therapy estimation of it was statistically significant, and (3) the liver radiation-absorbed dose did not reach 30 Gy. A statistical modeling analysis finds that the radiation-absorbed dose after therapy appears to be lower than that which is predicted from the linear scaling with administered activity of the tracer radiation-absorbed dose. Hepatocyte toxicity is the most likely reason but it is not high enough to produce clinically observable results. (orig.)

  9. 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)

  10. Perianesthetic management of the first robotic partial cystectomy in bladder pheochromocytoma. A case report.

    Science.gov (United States)

    Pandey, R; Garg, R; Roy, K; Darlong, V; Punj, J; Kumar, A

    2010-04-01

    The authors report the perianesthetic considerations of a rare case of pheochromocytoma of the urinary bladder for which the first reported robotic partial cystectomy and ureteric reimplantation were performed. A 59-year-old male patient, known to be hypertensive, was posted for transurethral resection of a bladder tumor. In the operation room, after attaching the monitors, a subarachnoid block was given. Upon manipulation of the tumor, the blood pressure and heart rate increased markedly. A pheochromocytoma was suspected and was later confirmed by raised urine catecholamine levels and meta-iodobenzyl-guanidine scan. The patient was started on tablet prazosin and atenolol. After optimization, a robotic partial cystectomy was planned. In the operating room, an epidural catheter and a radial artery cannula were inserted. After the induction of anesthesia and the securing of the airway, surgery was started. After the insertion of the verres needle, pneumoperitoneum was created very slowly, and then the patient was positioned in 40 degrees Trendelenburg. Surges in arterial blood pressure (ABP) were managed with titrated doses of sodium nitroprusside and nitroglycerine and boluses of esmolol and labetalol. ABP drops postoperatively were managed with fluid and dopamine infusion. Robotic surgery is a safe alternative to the open technique for pheochromocytoma of the urinary bladder. Care should be taken during the positioning of the patient for robot placement and during pneumoperitoneum creation.

  11. The new techniques of scintigraphic imaging

    International Nuclear Information System (INIS)

    Chatal, J.F.

    1990-01-01

    The purpose of scintigraphic imaging is not to explore the morphology of an organ (or its abnormalities) but rather its functional and metabolic characteristics. It is thus important that a molecular structure (e.g., a hormonal receptor or an antigen) closely linked to the functional activity of an organ or tissue be targeted on its cell surface. Such diagnostic targeting requires the synthesis and labeling of a radiopharmaceutical substance specific for the receptor or antigen in question. It also requires a detection system adapted to count rates and signal-to-background ratios (generally moderate). The synthesis of new radiopharmaceutical agents, a critical stage for the future of nuclear medicine, is a long and often risky process in which success is difficult to foresee. Radiolabeling must be stable in vitro and in vivo, and the radiopharmaceutical must subsequently retain its capability of recognizing the targeted molecule. In endocrinology, the exemplary achievement in this direction has been the synthesis of 131 I-6-iodomethylnorcholesterol and 131 I-metaiodobenzylguanidine for functional scintigraphy of the adrenal cortex and medulla. Progress in detection equipment has been marked by the development of monophotonic tomoscintigraphy, using gamma cameras with a revolving head to obtain slices in different spatial planes showing the distribution in the organism of the injected radiopharmaceutical agent [fr

  12. (18)F-FDG-PET/CT, (123)I-MIBG and (99m)Tc-MDP whole-body scans, in detecting recurrence of an adult adrenal neuroblastoma.

    Science.gov (United States)

    Skoura, Evangelia; Oikonomopoulos, Georgios; Vasileiou, Spyridon; Kyprianou, Diogenis; Koumakis, Georgios; Datseris, Ioannis E

    2014-01-01

    Neuroblastoma is the most common extracranial solid malignancy in children, but is rare in adults. We report the case of a 33 year old man with recurrence of neuroblastoma, 2 years after the excision of the primary tumor in the right adrenal gland. The iodine-123-radioiodinated metaiodobenzylguanidine ((123)I-MIBG) and (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) bone scans and the fluorine-18-fluorodeoxyglucose-positron computed tomography ((18)F-FDG PET/CT) findings in this patient are presented. First, we applied (123)I-MIBG scintigraphy that detected increased uptake at the right adrenal gland region and probably at liver lesions and in several bones. Then, the (99m)Tc-MDP bone scan revealed also increased uptake of the radiopharmaceutical in bones, but there was a discrepancy between these two studies concerning the number and location of the lesions. Then, (18)F-FDG PET/CT scan was performed, which showed increased uptake of (18)F-FDG at the right adrenal gland region with extension to the liver and also in multiple bones. Additionally, an aortocaval lymph node was detected. In conclusion, this case indicated that (18)F-FDG PET/CT has defined the extent of the recurrence of neuroblastoma in a better way than (123)I-MIBG and (99m)Tc-MDP together.

  13. Does I-131-MIBG underestimate skeletal disease burden in neuroblastoma?

    Directory of Open Access Journals (Sweden)

    Barai Sukanta

    2004-10-01

    Full Text Available Background: Controversy persists as to the need for both MIBG and bone scanning in routine evaluation of neuroblastoma. Aim: To compare the efficacy of I-131- metaiodobenzylguanidine (MIBG scan against that of conventional Tc99m- methylene diphosphonate (MDP bone scan for the detection of skeletal deposition of neuroblastoma. Methods and Material: The study included 57 patients (36 boys, 21 girls: age range 1-14 years of neuroblastoma who underwent both bone scan with Tc99m-MDP and I-131-MIBG scan within 15 days of each other at presentation and during follow-up. Results: At presentation 11(19.2% patients had evidence of skeletal metastases on MDP scan against 7 patients who showed bony secondaries on MIBG scan. Of the 7 patients, with positive MIBG and MDP scans, MDP scan detected 11 sites whereas MIBG scan detected 7 sites. On follow-up study, 3 patients with initial abnormal MDP scan but normal MIBG scan, developed skeletal metastases detectable on MIBG scan, whereas 3 of the 46 patients who had normal MDP and MIBG scan at presentation; developed skeletal metastases detectable on MDP scan. MIBG scan was concordant in 2 of them but was normal in the third patient. Conclusion: I-131-MIBG underestimates skeletal disease burden in neuroblastoma. Therefore, Tc99m-MDP bone scan should remain a part of routine assessment of patients with neuroblastoma.

  14. Recent advances of MIBG imaging in cardiology

    International Nuclear Information System (INIS)

    Kosaka, Toshimitsu; Ito, Hiroshi

    2005-01-01

    The sympathetic nervous system plays an important role in the regulation of cardiovascular function both in healthy subjects and in patients with heart disease. Cardiac neurotransmission imaging allows in vivo noninvasive assessment of presynaptic storage, release and reuptake of neurotransmitters. Iodine-123 labeled metaiodobenzylguanidine (MIBG) is an analogue of the sympatholytic agent guanethidine and behaves in a manner that is similar to norepinephrine, a neurotransmitter of the sympathetic nervous system in the heart. Qualitative and quantitative assessment of MIBG uptake and washout kinetics has evaluated alterations of the cardiac sympathetic function in various heart diseases, such as cardiomyopathies, coronary artery disease, diabetic heart and arrhythmias. As reduced MIBG uptake has been related to the clinical indices of severity and prognosis, it can be used to evaluate the therapeutic effects on the cardiac sympathetic dysfunction. For example, angiotensin converting enzyme inhibitors and β-blockers which have been shown to improve functional capacity and prognosis in patients with heart failure, have been demonstrated to increase MIBG uptake and reduce its washout rate in these patients, indicating favorable effects on the sympathetic nervous system. Thus, MIBG imaging has become a promising noninvasive tool and a widely available modality for the assessment of prognosis and effects of medical therapy in various forms of cardiac pathology. The usefulness and recent advances of MIBG imaging in cardiology will be noted in this article. (author)

  15. Diffusion weighted imaging best discriminates PD from MSA-P: A comparison with tilt table testing and heart MIBG scintigraphy.

    Science.gov (United States)

    Köllensperger, Martin; Seppi, Klaus; Liener, Claudia; Boesch, Sylvia; Heute, Dirk; Mair, Katherina J; Mueller, Joerg; Sawires, Martin; Scherfler, Christoph; Schocke, Michael F; Donnemilier, Eveline; Virgolini, Irene; Wenning, Gregor K; Poewe, Werner

    2007-09-15

    Both diffusion weighted magnetic resonance imaging (DWI) of the basal ganglia and meta-iodobenzylguanidin (MIBG) scintigraphy of the heart have been reported useful in the differential diagnosis of patients with Parkinson's disease (PD) vs. the parkinson variant of multiple system atrophy (MSA-P). Their diagnostic value, however, has never been directly compared in patients with parkinsonism and autonomic dysfunction. We have studied 9 patients with PD and 9 patients with MSA-P matched for age and disease severity. Regional trace of the diffusion tensor values were determined in the putamina. Cardiac MIBG uptake was quantified by comparing regions of interest over heart and mediastinum Heart/Mediastinum (H/M) ratio. Furthermore, all patients underwent tilt testing. PD patients showed significantly lower H/M ratios than normal controls; however, there was considerable overlap between the two patient groups. We did not detect any significant differences of blood pressure response to passive tilt between the two patient groups. Sensitivity of MIBG scintigraphy versus DWI for the differentiation of MSA-P from PD was 55.6% vs. 100%, specificity 88.8% vs. 100%, and area under the curve 0.802 vs. 1.000. Our data suggest that DWI is superior to both tilt table testing and MIBG scintigraphy in the differential diagnosis of PD versus MSA-P. (c) 2007 Movement Disorder Society.

  16. 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.)

  17. 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.

  18. 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.

  19. Clinical significance of {sup 123}I-MIBG myocardial scintigraphy in patients with hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Ido, Akira; Hasebe, Naoyuki; Nakamura, Hideki [Asahikawa Medical Coll., Hokkaido (Japan)] [and others

    1997-09-01

    We studied the abnormality of myocardial sympathetic nervous system in patients with hypertrophic cardiomyopathy using {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in comparison with the parameters of other clinical examinations. In 50 patients with HCM, the heart to mediastinum {sup 123}I-MIBG uptake ratio (H/M) was significantly low and washout rate (WR) of {sup 123}I-MIBG was significantly high respectively compared with normal subjects (n=8). H/M was negatively correlated with serum norepinephrine level, wall thickness or left ventricle, left ventricular mass index, left ventricular end diastolic pressure respectively, and WR was positively correlated with those parameters respectively. On the other hand, LF/HF calculated by spectral analysis in holter electrocardiogram was positively correlated with H/M, and negatively correlated with WR. In HCM, H/M in patients with subjective symptoms was significantly lower than that without subjective symptoms, and WR in patients with paroxysmal atrial fibrillation was significantly higher than that without paroxysmal atrial fibrillation. This study revealed that H/M and WR reflected the severity and the difference of disease type in HCM. In conclusion, {sup 123}I-MIBG contributes to evaluating more details in diagnosis and pathophysiology of HCM. (author)

  20. Adaptive servo-ventilation therapy improves cardiac sympathetic nerve activity, cardiac function, exercise capacity, and symptom in patients with chronic heart failure and Cheyne-Stokes respiration.

    Science.gov (United States)

    Toyama, Takuji; Hoshizaki, Hiroshi; Kasama, Shu; Miyaishi, Yusuke; Kan, Hakuken; Yamashita, Eiji; Kawaguti, Ren; Adachi, Hitoshi; Ohsima, Shigeru

    2017-12-01

    Adaptive servo-ventilation (ASV) therapy has been reported to be effective for improving central sleep apnea (CSA) and chronic heart failure (CHF). The purpose of this study was to clarify whether ASV is effective for CSA, cardiac sympathetic nerve activity (CSNA), cardiac symptoms/function, and exercise capacity in CHF patients with CSA and Cheyne-Stokes respiration (CSR-CSA). In this study, 31 CHF patients with CSR-CSA and a left ventricular ejection fraction (LVEF) ≤ 40% were randomized into an ASV group and a conservative therapy (non-ASV) group for 6 month. Nuclear imagings with 123 I-Metaiodobenzylguanidine (MIBG) and 99m Tc-Sestamibi were performed. Exercise capacity using a specific activity scale (SAS) and the New York Heart Association (NYHA) class were evaluated. CSNA was evaluated by 123 I-MIBG imaging, with the delayed heart/mediastinum activity ratio (H/M), delayed total defect score (TDS), and washout rate (WR). The ASV group had significantly better (P improvement of CSR-CSA, CSNA, cardiac symptoms/function, and exercise capacity in CHF patients with CSR-CSA.

  1. Effectiveness of nocturnal home oxygen therapy to improve exercise capacity, cardiac function and cardiac sympathetic nerve activity in patients with chronic heart failure and central sleep apnea.

    Science.gov (United States)

    Toyama, Takuji; Seki, Ryotaro; Kasama, Shu; Isobe, Naoki; Sakurai, Shigeki; Adachi, Hitoshi; Hoshizaki, Hiroshi; Oshima, Shigeru; Taniguchi, Koichi

    2009-02-01

    Central sleep apnea, often found in patients with chronic heart failure (CHF), has a high risk of poor prognosis. This study involved 20 patients with CHF (left ventricular ejection fraction (LVEF) 5 times/h who were divided into 2 groups: 10 patients treated with nocturnal home oxygen therapy (HOT) and 10 patients without HOT (non-HOT). All patients had dilated cardiomyopathy and underwent overnight polysomnography, cardiopulmonary exercise testing, and nuclear cardiac examinations to evaluate AHI, exercise capacity according to the specific activity scale and oxygen uptake at anaerobic threshold and peak exercise (peak VO(2)). Cardiac function according to (99m)Tc-MIBI QGS, and the total defect score (TDS), H/M ratio and the washout rate (WR) on (123)I-metaiodobenzylguanidine (MIBG) imaging were calculated for all patients. As compared with the non-HOT group, the HOT group demonstrated a greater reduction in AHI (26.1+/-9.1 to 5.1+/-3.4), (123)I-MIBG TDS (31+/-8 to 25+/-9), and (123)I-MIBG WR (48+/-8% to 41+/-5%) and a greater increase in the specific activity scale (4.0+/-0.9 to 5.8+/-1.2 Mets), peak VO(2) (16.0+/-3.8 to 18.3+/-4.7 ml . min(-1) . kg(-1)), and LVEF (27+/-9% to 37+/-10%). HOT improves exercise capacity, cardiac function, and cardiac sympathetic nerve activity in patients with CHF and central sleep apnea.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  3. Diabetic cardiac autonomic dysfunction. Parasympathetic versus sympathetic

    Energy Technology Data Exchange (ETDEWEB)

    Uehara, Akihiko; Kurata, Chinori; Sugi, Toshihiko; Mikami, Tadashi; Shouda, Sakae [Hamamatsu Univ. School of Medicine, Shizuoka (Japan)

    1999-04-01

    Diabetic cardiac autonomic dysfunction often causes lethal arrhythmia and sudden cardiac death. {sup 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)

  4. Hypertensive crisis caused by electrocauterization of the adrenal gland during hepatectomy.

    Science.gov (United States)

    Doo, A Ram; Son, Ji-Seon; Han, Young-Jin; Yu, Hee Chul; Ko, Seonghoon

    2015-02-14

    Hypertensive crisis (i.e., systolic blood pressure over 300 mmHg) is very rare during operation except pheochromocytoma, but it can be a fatal and embarrassing to surgeons and anesthesiologists. The right adrenal gland can be electrocauterized during a right hemi-hepatectomy. We report a case of hypertensive crisis during right hemi-hepatectomy in which the right adrenal gland was stimulated by monopolar electrocautery in a patient with normal neuroendocrine function. A 73-year-old man with hepatocellular carcinoma was scheduled to undergo right hemi-hepatectomy. Three hours into the surgery, the patient's blood pressure increased abruptly from 100/40 to over 350/130 mmHg (the maximum measurement pressure of the monitor; 350 mmHg). The surgeon had cauterized the right adrenal gland using monopolar electrocautery to separate the liver from the adrenal gland immediately prior to the event. Approximately 3 minutes after suspending the operation, blood pressure returned to baseline levels. After the event, the operation was successfully completed without any complication. Hormonal studies and iodine-123 meta-iodobenzylguanidine scintigraphy revealed no neuroendocrine tumor such as a pheochromocytoma. Operations such as hepatectomy that stimulate the adrenal gland may lead to an unexpected catecholamine surge and result in hypertensive crisis, even if neuroendocrine function of the adrenal gland is normal.

  5. 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.

  6. Excessive blinking and ataxia in a child with occult neuroblastoma and voltage-gated potassium channel antibodies.

    LENUS (Irish Health Repository)

    Allen, Nicholas M

    2012-05-01

    A previously healthy 9-year-old girl presented with a 10-day history of slowly progressive unsteadiness, slurred speech, and behavior change. On examination there was cerebellar ataxia and dysarthria, excessive blinking, subtle perioral myoclonus, and labile mood. The finding of oligoclonal bands in the cerebrospinal fluid prompted paraneoplastic serological evaluation and search for an occult neural crest tumor. Antineuronal nuclear autoantibody type 1 (anti-Hu) and voltage-gated potassium channel complex antibodies were detected in serum. Metaiodobenzylguanidine scan and computed tomography scan of the abdomen showed a localized abdominal mass in the region of the porta hepatis. A diagnosis of occult neuroblastoma was made. Resection of the stage 1 neuroblastoma and treatment with pulsed corticosteroids resulted in resolution of all symptoms and signs. Excessive blinking has rarely been described with neuroblastoma, and, when it is not an isolated finding, it may be a useful clue to this paraneoplastic syndrome. Although voltage-gated potassium channel complex autoimmunity has not been described previously in the setting of neuroblastoma, it is associated with a spectrum of paraneoplastic neurologic manifestations in adults, including peripheral nerve hyperexcitability disorders.

  7. QUANTITATIVE APPROACH TO ASSIST NEUROBLASTOMA ASSESSMENT BY MEASURING I-123 mIBG UPTAKE IN SCINTIGRAPHIC IMAGES

    Directory of Open Access Journals (Sweden)

    Rafael Martínez-Díaz

    2015-03-01

    Full Text Available Whole-body 123I-Metaiodobenzylguanidine (mIBG scintigraphy is used as the primary image modality in neuroblastoma detection. It is the most sensitive and specific method for staging and response evaluation. Validated semi-quantitative scoring methods with low interobserver variability and high reproducibility have shown to be indispensable for the evaluation of response to therapy. However, low resolution, noise and acquisition difficulties, specially in children, make low definition scans. These facts increase observer dependent interpretations that limit assessment and complicate to put a scoring method successfully into practice. It is essential to have an objective and reliable measure of response to test the activity of therapies. In this paper we propose the use of a quantitative observer-independent measurement of the strength of uptake to be used as an additional tool for assisting the International Society of Paediatric Oncology Europe Neuroblastoma Group (SIOPEN semi-quantitative scoring method. This is the scoring method recommended by the SIOPEN Nuclear Medicine and Physics Committee, in collaborative work with the Children’s Oncology Group, as the standard one for acquiring and reporting diagnostic paediatric mIBG scans across Europe. Our proposed method is based on the ratio between the amount of specific uptake at tumours and the amount of non-specific uptake at SIOPEN anatomical sectors which has shown to be constant in all the scans of the patients.

  8. 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.

  9. Secretive and proliferative tumor profile helps to select the best imaging technique to identify postoperative persistent or relapsing medullary thyroid cancer.

    Science.gov (United States)

    Faggiano, A; Grimaldi, F; Pezzullo, L; Chiofalo, M G; Caracò, C; Mozzillo, N; Angeletti, G; Santeusanio, F; Lombardi, G; Colao, A; Avenia, N; Ferolla, P

    2009-03-01

    In patients with postoperative persistent medullary thyroid cancer (MTC), the tumor detection rate is generally low for most of the imaging techniques now available. The aim of this study was to investigate if the clinico-biological profile of the tumor may indicate which imaging technique to perform in order to identify postoperative persistent or relapsing MTC foci. Thirty-five consecutive MTC patients with detectable and progressively increasing postoperative serum concentrations of calcitonin were enrolled in the study. The detection rates of 18F-deoxy-d-glucose (FDG)-positron emission tomography (PET), somatostatin receptor scintigraphy (SRS), and 131I-metaiodobenzylguanidine scintigraphy (MIBG) were compared in relation with calcitonin and carcinoembryonic antigen serum concentrations, Ki-67 score and results of conventional imaging techniques (CIT). FDG-PET positivity was significantly associated with calcitonin serum concentrations >400 pg/ml and Ki-67 score >2.0% (P800 pg/ml (Ptechnique to use in the follow-up of patients with MTC. A Ki-67 score >2.0% suggests to perform a FDG-PET in addition to conventional imaging. Calcitonin secretion predicts both FDG-PET and SRS uptake but SRS positivity is generally found only in patients with well defined MTC lesions that are also detectable at the conventional imaging examination. MIBG outcome is not predicted by any clinico-biological factors here investigated.

  10. Body weight and dysautonomia in early Parkinson's disease.

    Science.gov (United States)

    Umehara, T; Nakahara, A; Matsuno, H; Toyoda, C; Oka, H

    2017-05-01

    Patients with Parkinson's disease (PD) begin to lose weight several years before diagnosis, which suggests weight variation is associated with some factor(s) that precede the onset of motor symptoms. This study aimed to investigate the association of autonomic nervous system with body weight in patients with PD. The subjects were 90 patients with early de novo PD. We examined the associations of body mass index (BMI) with sympathetic nervous activity reflected in orthostatic intolerance or cardiac uptake of 123 I-metaiodobenzylguanidine and parasympathetic nervous activity reflected in constipation or heart rate variability (HRV). Twelve patients (13.3%) were overweight (BMI>25 kg/m 2 ), 62 patients (68.9%) were normal-weight (18.5≦BMIDysautonomia and disease severity are closely related to body weight independently of age, sex, symptom duration, and motor subtype. Dysautonomia may play a partial role on weight variation in the early stage of PD. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Cardiovascular dysautonomia in de novo Parkinson's disease without orthostatic hypotension.

    Science.gov (United States)

    Oka, H; Toyoda, C; Yogo, M; Mochio, S

    2011-02-01

    Clinical symptoms of Parkinson's disease (PD) include not only motor distress, but also autonomic dysfunction. To study the characteristics of subclinical autonomic nervous dysfunction in de novo PD without orthostatic hypotension (OH). Autonomic nervous function including cardiac sympathetic gain was evaluated on the basis of cardiac radioiodinated metaiodobenzylguanidine (MIBG) uptake, the response to the Valsalva maneuver, and spectral analyses of the RR interval and blood pressure in 20 patients with de novo PD without OH. Decreased cardiac MIBG uptake was found even in patients with PD without OH. Hemodynamic studies using the Valsalva maneuver revealed that patients with PD without OH had preserved baroreceptor reflex sensitivity in phase II and phase IV. Blood pressures normally responded in early and late phase II, but not in phase IV. Blood pressure recovery time was slightly reduced in patients with PD without OH when compared with the value in controls. The low frequency component of the RR interval and systolic blood pressure and the ratio of RR-LF to RR-HF in de novo PD without OH were significantly reduced when compared with the control values, whereas the high frequency component of the RR interval did not differ significantly. These results show that latent cardiac and vasomotor sympathetic dysfunction but not parasympathetic dysfunction is already present in early stage de novo PD, even without orthostatic hypotension. © 2010 The Author(s). European Journal of Neurology © 2010 EFNS.

  12. Scintigraphic differentiation between two forms of primary dysautonomia early after onset of autonomic dysfunction: value of cardiac and pulmonary iodine-123 MIBG uptake

    Energy Technology Data Exchange (ETDEWEB)

    Reinhardt, M.J.; Juengling, F.D.; Krause, T.M. [Dept. of Nuclear Medicine, Freiburg University Hospital (Germany); Braune, S. [Dept. of Neurology, Freiburg University Hospital (Germany)

    2000-05-01

    Primary dysfunction of the autonomic nervous system can be observed in patients with Parkinson's disease and those with multiple system atrophy. However, the fate of the two diseases differs considerably and leads to different strategies for patient management. Differentiation of the two diseases currently requires a combination of several clinical and electrophysiological tests. First studies of myocardial innervation using iodine-123 metaiodobenzylguanidine (MIBG) indicated a possible role of scintigraphy for this purpose. An increase in the pulmonary uptake of {sup 123}I-MIBG has been reported in secondary dysautonomias. Whether sympathetic innervation of the lung is affected in primary dysautonomias is currently unknown. Therefore, cardiac and pulmonary uptake of {sup 123}I-MIBG was studied in 21 patients with Parkinson's disease, 7 patients with multiple system atrophy and 13 age- and sex-matched controls. Thoracic images were obtained in the anterior view 4 h after intravenous injection of 185 MBq {sup 123}I-MIBG, at which time the maximum neuronal uptake is reached. All patients with Parkinson's disease had significantly lower cardiac uptake of {sup 123}I-MIBG than patients with multiple system atrophy and controls. Sympathetic innervation of the lung was not affected in either disease. It is concluded that scintigraphy with {sup 123}I-MIBG appears to be a useful tool for differentiation between Parkinson's disease and multiple system atrophy early after onset of autonomic dysfunction. (orig.)

  13. Adrenal incidentaloma in neurofibromatosis type 1

    Directory of Open Access Journals (Sweden)

    Tančić-Gajić Milina

    2008-01-01

    Full Text Available INTRODUCTION Neurofibromatosis type 1 is one of the most common genetically transmitted diseases with a high index of spontaneous mutations and extremely varied and unpredictable clinical manifestations. It is diagnosed by the existence of certain clinical criteria. The presence of numerous localised cutaneous neurofibromas or a plexiform neurofibroma is virtually pathognomonic of neurofibromatosis type 1. The incidence of pheochromocytoma in neurofibromatosis type 1 is 0.1-5.7%. CASE OUTLINE A 56-year old female patient was admitted for further evaluation of incidental adrenal tumour previously diagnosed on computerized tomography (CT. She had previously unrecognized neurofibromatosis type 1 and a clinical picture which could remind of pheochromocytoma. None of the catecholamine samples in 24 hr urine indicated functionally active pheochromocytoma. Chromogranin A was moderately increased. Decision for operation was made after performing the image techniques. Adrenal incidentaloma had features of pheochromocytoma on abdominal magnetic resonance imaging (MRI, with positive 131I-MIBG (iodine 131-labelled metaiodobenzylguanidine scintigraphy. After being treated with phenoxybenzamine and propranolol, she was operated on. The pathohistological finding showed the case of left adrenal pheochromocytoma. CONCLUSION Detailed diagnostic procedure for pheochromocytoma should be performed with patients having neurofibromatosis type 1 and adrenal incidentaloma. Pheochromocytomas are rare tumours with fatal outcome if not duly recognized and cured.

  14. Validation of the mIBG skeletal SIOPEN scoring method in two independent high-risk neuroblastoma populations: the SIOPEN/HR-NBL1 and COG-A3973 trials.

    Science.gov (United States)

    Ladenstein, Ruth; Lambert, Bieke; Pötschger, Ulrike; Castellani, Maria-Rita; Lewington, Valerie; Bar-Sever, Zvi; Oudoux, Aurore; Śliwińska, Anna; Taborska, Katerina; Biassoni, Lorenzo; Yanik, Gregory A; Naranjo, Arlene; Parisi, Marguerite T; Shulkin, Barry L; Nadel, Helen; Gelfand, Michael J; Matthay, Katherine K; Park, Julie R; Kreissman, Susan G; Valteau-Couanet, Dominique; Boubaker, Ariane

    2018-02-01

    Validation of the prognostic value of the SIOPEN mIBG skeletal scoring system in two independent stage 4, mIBG avid, high-risk neuroblastoma populations. The semi-quantitative SIOPEN score evaluates skeletal meta-iodobenzylguanidine (mIBG) uptake on a 0-6 scale in 12 anatomical regions. Evaluable mIBG scans from 216 COG-A3973 and 341 SIOPEN/HR-NBL1 trial patients were reviewed pre- and post-induction chemotherapy. The prognostic value of skeletal scores for 5-year event free survival (5 yr.-EFS) was tested in the source and validation cohorts. At diagnosis, both cohorts showed a gradual non-linear increase in risk with cumulative scores. Several approaches were explored to test the relationship between score and EFS. Ultimately, a cutoff score of ≤3 was the most useful predictor across trials. A SIOPEN score ≤ 3 pre-induction was found in 15% SIOPEN patients and in 22% of COG patients and increased post-induction to 60% in SIOPEN patients and to 73% in COG patients. Baseline 5 yr.-EFS rates in the SIOPEN/HR-NBL1 cohort for scores ≤3 were 47% ± 7% versus 26% ± 3% for higher scores at diagnosis (p  3 after induction have very poor outcomes and should be considered for alternative therapeutic strategies.

  15. Molecular imaging of brown adipose tissue in health and disease

    International Nuclear Information System (INIS)

    Bauwens, Matthias; Wierts, Roel; Brans, Boudewijn; Royen, Bart van; Backes, Walter; Bucerius, Jan; Mottaghy, Felix

    2014-01-01

    Brown adipose tissue (BAT) has transformed from an interfering tissue in oncological 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) to an independent imaging research field. This review takes the perspective from the imaging methodology on which human BAT research has come to rely on heavily. This review analyses relevant PubMed-indexed publications that discuss molecular imaging methods of BAT. In addition, reported links between BAT and human diseases such as obesity are discussed, and the possibilities for imaging in these fields are highlighted. Radiopharmaceuticals aiming at several different biological mechanisms of BAT are discussed and evaluated. Prospective, dedicated studies allow visualization of BAT function in a high percentage of human subjects. BAT dysfunction has been implicated in obesity, linked with diabetes and associated with cachexia and atherosclerosis. Presently, 18 F-FDG PET/CT is the most useful tool for evaluating therapies aiming at BAT activity. In addition to 18 F-FDG, other radiopharmaceuticals such as 99m Tc-sestamibi, 123 I-metaiodobenzylguanidine (MIBG), 18 F-fluorodopa and 18 F-14(R,S)-[ 18 F]fluoro-6-thia-heptadecanoic acid (FTHA) may have a potential for visualizing other aspects of BAT activity. MRI methods are under continuous development and provide the prospect of functional imaging without ionizing radiation. Molecular imaging of BAT can be used to quantitatively assess different aspects of BAT metabolic activity. (orig.)

  16. Molecular imaging of brown adipose tissue in health and disease

    Energy Technology Data Exchange (ETDEWEB)

    Bauwens, Matthias [MUMC, Department of Medical Imaging, Division of Nuclear Medicine, Maastricht (Netherlands); Maastricht University, Research School NUTRIM, Maastricht (Netherlands); Wierts, Roel; Brans, Boudewijn [MUMC, Department of Medical Imaging, Division of Nuclear Medicine, Maastricht (Netherlands); Royen, Bart van; Backes, Walter [MUMC, Department of Medical Imaging, Division of Radiology, Maastricht (Netherlands); Bucerius, Jan [MUMC, Department of Medical Imaging, Division of Nuclear Medicine, Maastricht (Netherlands); Uniklinikum Aachen, Division of Nuclear Medicine, Aachen (Germany); Maastricht University, Research School CARIM, Maastricht (Netherlands); Mottaghy, Felix [MUMC, Department of Medical Imaging, Division of Nuclear Medicine, Maastricht (Netherlands); Uniklinikum Aachen, Division of Nuclear Medicine, Aachen (Germany)

    2014-04-15

    Brown adipose tissue (BAT) has transformed from an interfering tissue in oncological {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET) to an independent imaging research field. This review takes the perspective from the imaging methodology on which human BAT research has come to rely on heavily. This review analyses relevant PubMed-indexed publications that discuss molecular imaging methods of BAT. In addition, reported links between BAT and human diseases such as obesity are discussed, and the possibilities for imaging in these fields are highlighted. Radiopharmaceuticals aiming at several different biological mechanisms of BAT are discussed and evaluated. Prospective, dedicated studies allow visualization of BAT function in a high percentage of human subjects. BAT dysfunction has been implicated in obesity, linked with diabetes and associated with cachexia and atherosclerosis. Presently, {sup 18}F-FDG PET/CT is the most useful tool for evaluating therapies aiming at BAT activity. In addition to {sup 18}F-FDG, other radiopharmaceuticals such as {sup 99m}Tc-sestamibi, {sup 123}I-metaiodobenzylguanidine (MIBG), {sup 18}F-fluorodopa and {sup 18}F-14(R,S)-[{sup 18}F]fluoro-6-thia-heptadecanoic acid (FTHA) may have a potential for visualizing other aspects of BAT activity. MRI methods are under continuous development and provide the prospect of functional imaging without ionizing radiation. Molecular imaging of BAT can be used to quantitatively assess different aspects of BAT metabolic activity. (orig.)

  17. Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital.

    Science.gov (United States)

    Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

    2014-10-01

    Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments.

  18. A case of neonatal neuroblastoma

    International Nuclear Information System (INIS)

    Nounaka, Osamu; Gotoh, Toshiaki; Takahashi, Kazuaki; Koyanagi, Tomohiko; Kakizaki, Hidehiro; Nakanishi, Shoichiro.

    1987-01-01

    A two-day-old male infant was referred to us for probable neuroblastoma, because of upper abdominal mass and positive urinary vanillylmandelic acid (VMA). Primary site of neuroblastoma was not found, but clinically IV-S stage neuroblastoma was strongly suspected, so 131 I-metaiodobenzylguanidine (MIBG) scan was performed. RI accumulation was found near the left adrenal region. Thus laparotomy was performed and left adrenal was resected. Liver biopsy was also performed. Microscopically multiple in situ foci of neuroblastoma cells were found in the left adrenal and tumor involvement was also seen in the liver. Skin and bone marrow metastasis were ruled out. Minimal chemotherapy was intended but abandoned soon because of possible spontaneous regression of stage IV-S neuroblastoma. Thereafter liver has been getting smaller and the patient has been doing well. Urinary VMA and homovanillic acid (HVA) per creatinine, which were used for follow-up, have also normalized after 3 months. Treatment of stage IV-S neuroblastoma and early diagnosis by 131 I-MIBG scan were reviewed. (author)

  19. Salvage treatment after r-interferon α-2a in advanced neuroendocrine tumors

    International Nuclear Information System (INIS)

    Zilembo, N.; Buzzoni, R.; Bajetta, E.; Di Bartolomeo, M.; De Braud, F.; Castellani, R.; Maffioli, L.; Celio, L.; Villa, E.; Lorusso, V.; Fosser, V.; Buzzi, F.

    1993-01-01

    The use of interferon (IFN) in neuroendocrine advanced tumors has achieved control of hormonal symptoms but low objective tumor response rate. In patients resistant to, or failing on, IFN a second line treatment may be required. Seventeen patients having received recombinant IFN α-2a as last treatment entered the study. There were 12 carcinoids, 3 medullary thyroid carcinomas, one Merkel cell carcinoma, and one neuroendocrine pancreatic tumor. Two different treatments were used: one radiometabolic therapy with metaiodobenzylguanidine (MIBG) in 3 patients with high MIBG uptake and one polychemotherapy regimen, including streptozotocin 500 mg/m 2 intravenously days 1, 2, 3 and epirubicin 75 mg/m 2 intravenously day 1, in the remaining 14 patients. Stable disease with relief of symptoms and tumor marker reduction was obtained in two patients receiving MIGB therapy, whereas the third patient had progressive disease. In the chemotherapy group only one partial response was obtained and neither tumor marker reduction nor subjective improvement were seen. Our second-line treatment was not especially effective but may be considered for rapidly progressive and/or symptomatic disease. The radiometabolic therapy appears promising in symptomatic patients with small tumor burden whereas our chemotherapy regimen appears ineffective. (orig.)

  20. (CT, MRI, USG) radiological diagnostics of neuroendocrine tumors

    International Nuclear Information System (INIS)

    Cwikla, J.; Furmanek, M.; Walecki, J.; Sankowski, A.; Pawlowska-Detko, A.

    2007-01-01

    Neuroendocrine tumors (NET) consists of a heterogeneneous group of neoplasma, that are able to express cell membrane neuroamine uptake mechanisms and/or specific receptors, which can be used in the localization and treatment of these tumours. Conventionally NETs may present with a wide variety of functional or nonfuctional endocrinesyndromes and may be familial and have other associated tumors, also they have different histology and prognosis. They originate from endocrine glands such as the pituitary, the parathyroids, and the neuroendocrine) adrenal, as well as endocrine islets within glandular tissue (thyroid or pancreatic) and cells dispersed between exocrine cells, such as endocrine cells of the digestive system (gastroenteropancreatic GEP-NET0 and respiratory tracts. GEp-NET are the the most common including more 70% of all NETs. Imaging modalities and assessment of specific tumors markers offers high sensitivity in establishing the diagnosis and can also have pronostic significance. One of most important single imaging techniques in terms of initial identification and staging o GET-NET are CT and somatostatin receptor scintigraphy (SRS). Other investigation like magnetic resonance imaging (MRI), endoscopic (EUS) are used for the precise localization of GEP-NET. Another techniques including functional approach 123 I MIBG (meta-iodobenzylguanidine scintigraphy) and FDG PET.Important using of imaging approach is monitoring of response on treatment. (author)

  1. Update on Modern Management of Pheochromocytoma and Paraganglioma

    Directory of Open Access Journals (Sweden)

    Jacques W. M. Lenders

    2017-06-01

    Full Text Available Despite all technical progress in modern diagnostic methods and treatment modalities of pheochromocytoma/paraganglioma, early consideration of the presence of these tumors remains the pivotal link towards the best possible outcome for patients. A timely diagnosis and proper treatment can prevent the wide variety of potentially catastrophic cardiovascular complications. Modern biochemical testing should include tests that offer the best available diagnostic performance, measurements of metanephrines and 3-methoxytyramine in plasma or urine. To minimize false-positive test results particular attention should be paid to pre-analytical sampling conditions. In addition to anatomical imaging by computed tomography (CT or magnetic resonance imaging, new promising functional imaging modalities of photon emission tomography/CT using with somatostatin analogues such as 68Ga-DOTATATE (68Ga-labeled DOTA(0-Tyr(3-octreotide will probably replace 123I-MIBG (iodine-123-metaiodobenzylguanidine in the near future. As nearly half of all pheochromocytoma patients harbor a mutation in one of the 14 tumor susceptibility genes, genetic testing and counseling should at least be considered in all patients with a proven tumor. Post-surgical annual follow-up of patients by measurements of plasma or urinary metanephrines should last for at least 10 years for timely detection of recurrent or metastatic disease. Patients with a high risk for recurrence or metastatic disease (paraganglioma, young age, multiple or large tumors, genetic background should be followed up lifelong.

  2. Update on Modern Management of Pheochromocytoma and Paraganglioma.

    Science.gov (United States)

    Lenders, Jacques W M; Eisenhofer, Graeme

    2017-06-01

    Despite all technical progress in modern diagnostic methods and treatment modalities of pheochromocytoma/paraganglioma, early consideration of the presence of these tumors remains the pivotal link towards the best possible outcome for patients. A timely diagnosis and proper treatment can prevent the wide variety of potentially catastrophic cardiovascular complications. Modern biochemical testing should include tests that offer the best available diagnostic performance, measurements of metanephrines and 3-methoxytyramine in plasma or urine. To minimize false-positive test results particular attention should be paid to pre-analytical sampling conditions. In addition to anatomical imaging by computed tomography (CT) or magnetic resonance imaging, new promising functional imaging modalities of photon emission tomography/CT using with somatostatin analogues such as ⁶⁸Ga-DOTATATE (⁶⁸Ga-labeled DOTA(0)-Tyr(3)-octreotide) will probably replace ¹²³I-MIBG (iodine-123-metaiodobenzylguanidine) in the near future. As nearly half of all pheochromocytoma patients harbor a mutation in one of the 14 tumor susceptibility genes, genetic testing and counseling should at least be considered in all patients with a proven tumor. Post-surgical annual follow-up of patients by measurements of plasma or urinary metanephrines should last for at least 10 years for timely detection of recurrent or metastatic disease. Patients with a high risk for recurrence or metastatic disease (paraganglioma, young age, multiple or large tumors, genetic background) should be followed up lifelong. Copyright © 2017 Korean Endocrine Society.

  3. Usefulness of 123I-MIBG and 123I-BMIPP myocardial scintigraphy for detecting coronary artery disease and for evaluating left ventricular function

    International Nuclear Information System (INIS)

    Toyama, Takuji; Suzuki, Yasushi; Tsukagoshi, Joichi

    1995-01-01

    We evaluated the diagnostic value of 123 I-metaiodobenzylguanidine (MIBG) and 123 I-labeled beta-methyliodophenyl pentadecanoic acid (BMIPP) myocardial SPECTs for evaluating coronary artery disease and left ventricular function, in comparison with the diagnostic value of 201 Tl (Tl) SPECT. For forty-nine patients with coronary artery disease, resting MIBG and BMIPP SPECTs were performed to detect coronary artery stenosis, compared with the diagnostic value of exercise Tl. Left ventricular ejection fraction and regional wall motion were compared with the total US (TUS) and regional US (RUS) of resting MIBG and BMIPP SPECTs, and in turn, compared with resting Tl SPECT. The sensitivity of resting BMIPP SPECT for detecting coronary artery stenosis was lower, and the specificity of resting MIBG SPECT was lower than the other two methods. The accuracy of resting MIBG SPECT for evaluating coronary lesions was nearly the same as the accuracy of exercise Tl, but higher than that of BMIPP SPECT. Left ventricular ejection fraction was well correlated with TUS of resting MIBG SPECT (r=0.80), resting BMIPP SPECT (r=0.77), and resting Tl SPECT (r=0.68). Regional wall motion was most correlated with RUS of resting BMIPP SPECT, compared with that of resting Tl and MIBG SPECTs. These data suggest that resting MIBG SPECT is useful for detecting coronary artery disease and that resting BMIPP SPECT is valuable in evaluating regional left ventricular function. (author)

  4. The usefulness of I-131 MIBG scintigraphy in extra-adrenal lesions of pheochromocytoma

    International Nuclear Information System (INIS)

    Kubo, Atsushi; Nakayama, Toshitake; Nishiguchi, Iku; Hashimoto, Teisuke; Kunieda, Etsuo; Hashimoto, Shozo

    1988-01-01

    I-131 metaiodobenzylguanidine (MIBG) scintigraphy has been performed in 55 patients with suspected pheochromocytomas, from January, 1984. I-131 MIBG scintigraphy was performed after 0.5 mCi was injected intravenously over 20 to 30 seconds. Whole body image and/or spot images of head, chest, posterior midabdomen and lower anterior abdomen were obtained 4, 24, 48 and occasionally 72 hours later by means of Toshiba GCA-90 B gamma camera with a high-energy, parallelhole collimator interfaced to a data processor. Thyroid uptake of I-131 was blocked by Lugol solution several drops per day, beginning two days before the tracer injection. 13 extra-adrenal lesions of 3 matastatic pheochromocytomas and 2 extra-adrenal pheochromocytomas could be detected by I-131 MIBG scintigraphy. Extensive bone, liver, lung and lymph nodes metastases were demonstrated by I-131 MIBG scintigraphy in 3 patients with metastatic pheochromocytomas. In 1 of 2 patients with extra-adrenal pheochromocytoma, an abnormal concentration of I-131 MIBG was observed in anterior middle mediastinum proved to be mediastinal ectopic pheochromocytoma, and in another patient it was seen in the region of visceral paraganglia, while X-ray CT failed to demonstrate the tumors in both patients. Thus I-131 MIBG scintigraphy has proved to be safe, specific and noninvasive, and it has been of considerable value, especially in the location of extra-adrenal pheochromocytoma and metastatic pheochromocytoma. (author)

  5. Interest of MIBG scintigraphy in screening for pheochromocytoma in patients with medullary thyroid carcinoma

    International Nuclear Information System (INIS)

    Bonnin, F.; Lumbroso, J.; Schlumberger, M.; Megnigbeto, A.; Tenenbaum, F.; Leclere, J.; Travagli, J.P.; Gardet, P.; Parmentier, C.

    1995-01-01

    Adrenal medullary disease (AMD) is clinically silent in most patients with medullary thyroid carcinoma (MTC). During 16 years, a series of 174 MTC patients was screened yearly for AMD. Metaiodobenzylguanidine (MIBG) scans were performed in 54 cases (21 at diagnosis and 33 during the follow up of MTC) either systematically (43 cases) or in patients with biological or ultrasonographic signs of AMD (11 cases). AMD was discovered in ten patients: five patients were already known to have a type II multiple endocrine neoplasia (MEN-2); in five patients previously considered as having either a sporadic (four cases) or a familial type of isolated MTC (one case), the occurrence of AMD led to diagnose a MEN-2 a syndrome. In three cases, AMD was bilateral. MIBG scan were performed in nine of the ten patients with AMD. No false positive MIBG scan was observed in the series. All patients with positive MIBG scan had either elevated excretion of catecholamines and derivates. MIBG scan had a sensitivity of 0.9 and specificity of 1. MIBG should not be used as a screening test. In particular, MIBG scan should not be performed systematically neither at diagnosis nor during follow-up. But, in cases with suspicion of AMD, it provides important complementary functional information. (authors). 15 refs., 3 tabs., 2 figs

  6. 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.)

  7. 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)

  8. 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.)

  9. A combination of P wave electrocardiography and plasma brain natriuretic peptide level for predicting the progression to persistent atrial fibrillation: comparisons of sympathetic activity and left atrial size.

    Science.gov (United States)

    Akutsu, Yasushi; Kaneko, Kyouichi; Kodama, Yusuke; Miyoshi, Fumito; Li, Hui-Ling; Watanabe, Norikazu; Asano, Taku; Tanno, Kaoru; Suyama, Jumpei; Namiki, Atsuo; Gokan, Takehiko; Kobayashi, Youichi

    2013-11-01

    Development of atrial fibrillation (AF) is complexly associated with electrical and structural remodeling and other factors every stage of AF development. We hypothesized that P wave electrocardiography with an elevated brain natriuretic peptide (BNP) level would be associated with the progression to persistence from paroxysmal AF. P wave electrocardiography such as a maximum P wave duration (MPWD) and dispersion by 12-leads ECG, heart/mediastinum (H/M) ratio by delayed iodine-123 metaiodobenzylguanidine scintigraphic imaging, left ventricular ejection fraction (LVEF), and left atrial dimension (LAD) by echocardiography, and plasma BNP level were measured to evaluate the electrical and structural properties and sympathetic activity in 71 patients (mean ± standard deviation, age: 67 ± 13 years, 63.4 % males) with idiopathic paroxysmal AF. Over a 12.9-year follow-up period, AF developed into persistent AF in 30 patients. A wider MPWD (>129 ms) (p = 0.001), wider P wave dispersion (>60 ms) (p = 0.001), LAD enlargement (>40 mm) (p = 0.001), higher BNP level (>72 pg/mL) (p = 0.002), lower H/M ratio (≤2.7) (p = 0.025), and lower LVEF (≤60 %) (p = 0.035) were associated with the progression to persistent AF, and the wide MPWD was an independently powerful predictor of the progression to persistent AF with a hazard ratio (HR) of 5.49 [95 % confidence interval (CI) 2.38-12.7, p < 0.0001] after adjusting for potential confounding variables, such as age and sex. The combination of wide MPWD and elevated BNP level was additive and incremental prognostic power with 13.3 [2.16-13, p < 0.0001]. The wide MPWD with elevated BNP level was associated with the progression to persistent AF.

  10. 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)

  11. Pheochromocytoma and Paraganglioma: Current Functional and Future Molecular Imaging

    International Nuclear Information System (INIS)

    Blanchet, Elise M.; Martucci, Victoria; Pacak, Karel

    2012-01-01

    Paragangliomas are neural crest-derived tumors, arising either from chromaffin sympathetic tissue (in adrenal, abdominal, intra-pelvic, or thoracic paraganglia) or from parasympathetic tissue (in head and neck paraganglia). They have a specific cellular metabolism, with the ability to synthesize, store, and secrete catecholamines (although most head and neck paragangliomas do not secrete any catecholamines). This disease is rare and also very heterogeneous, with various presentations (e.g., in regards to localization, multifocality, potential to metastasize, biochemical phenotype, and genetic background). With growing knowledge, notably about the pathophysiology and genetic background, guidelines are evolving rapidly. In this context, functional imaging is a challenge for the management of paragangliomas. Nuclear imaging has been used for exploring paragangliomas for the last three decades, with MIBG historically as the first-line exam. Tracers used in paragangliomas can be grouped in three different categories. Agents that specifically target catecholamine synthesis, storage, and secretion pathways include: 123 and 131I-metaiodobenzylguanidine (123/131I-MIBG), 18F-fluorodopamine (18F-FDA), and 18F-fluorodihydroxyphenylalanine (18F-FDOPA). Agents that bind somatostatin receptors include 111In-pentetreotide and 68Ga-labeled somatostatin analog peptides (68Ga-DOTA-TOC, 68Ga-DOTA-NOC, 68Ga-DOTA-TATE). The non-specific agent most commonly used in paragangliomas is 18F-fluorodeoxyglucose (18F-FDG). This review will first describe conventional scintigraphic exams that are used for imaging paragangliomas. In the second part we will emphasize the interest in new PET approaches (specific and non-specific), considering the growing knowledge about genetic background and pathophysiology, with the aim of understanding how tumors behave, and optimally adjusting imaging technique for each tumor type.

  12. Cardiac {sup 123}I-MIBG scintigraphy in patients with Parkinson`s disease

    Energy Technology Data Exchange (ETDEWEB)

    Orimo, Satoshi [Kanto Central Hospital, Tokyo (Japan)

    1997-08-01

    We discuss the cardiac {sup 123}I-MIBG ({sup 123}I-metaiodobenzylguanidine) scintigraphy in patients with Parkinson`s disease (PD) based on our results, and examine the clinical significance in lowering MIBG storage. Thirty-four patients with PD without diabetes millitus or heart failure, presenting normal cardiac thallium scintigraphy, were examined. They included 13 male and 21 female, aged from 52 to 83 (average age 70.1) and their morbid period was between 0.25 and 19 years (agerage 4.9 years). Ten patients with age-matched disease control were chosen. They contained 5 male and 5 female, aged from 59 to 77 (average age 70.7), suffering from headache, vertigo, cerebral infarction, etc. PD patients group and the age-matched control group were compared with the normal control group. In PD patients, MIBG storage was significantly lowered on the initial and the late images in comparison with the disease and neurological control groups, and the wash-out rate was enhanced. There was negative correlation or the expected tendency of correlation between MIBG storage and the clinical severity. MIBG storage was lowered with longer morbid period. Anti-Parkinson drugs had no apparent effects on MIBG storage. The detection rate of abnormality by cardiac MIBG scintigraphy was clearly higher than that by the sympathetic skin response, and some patients who had no sign on the sympathetic skin response showed the lowering of MIBG storage. The possibility of the failure of the norepinephrine transporter system was indicated as the main cause for the lowering of MIBG storage. (K.H.)

  13. Cardiac 123I-MIBG scintigraphy in patients with Parkinson's disease

    International Nuclear Information System (INIS)

    Orimo, Satoshi

    1997-01-01

    We discuss the cardiac 123 I-MIBG ( 123 I-metaiodobenzylguanidine) scintigraphy in patients with Parkinson's disease (PD) based on our results, and examine the clinical significance in lowering MIBG storage. Thirty-four patients with PD without diabetes millitus or heart failure, presenting normal cardiac thallium scintigraphy, were examined. They included 13 male and 21 female, aged from 52 to 83 (average age 70.1) and their morbid period was between 0.25 and 19 years (agerage 4.9 years). Ten patients with age-matched disease control were chosen. They contained 5 male and 5 female, aged from 59 to 77 (average age 70.7), suffering from headache, vertigo, cerebral infarction, etc. PD patients group and the age-matched control group were compared with the normal control group. In PD patients, MIBG storage was significantly lowered on the initial and the late images in comparison with the disease and neurological control groups, and the wash-out rate was enhanced. There was negative correlation or the expected tendency of correlation between MIBG storage and the clinical severity. MIBG storage was lowered with longer morbid period. Anti-Parkinson drugs had no apparent effects on MIBG storage. The detection rate of abnormality by cardiac MIBG scintigraphy was clearly higher than that by the sympathetic skin response, and some patients who had no sign on the sympathetic skin response showed the lowering of MIBG storage. The possibility of the failure of the norepinephrine transporter system was indicated as the main cause for the lowering of MIBG storage. (K.H.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  16. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  18. Evaluation of the utility of99mTc-MDP bone scintigraphy versus MIBG scintigraphy and cross-sectional imaging for staging patients with neuroblastoma.

    Science.gov (United States)

    Gauguet, Jean-Marc; Pace-Emerson, Tamara; Grant, Frederick D; Shusterman, Suzanne; DuBois, Steven G; Frazier, A Lindsay; Voss, Stephan D

    2017-11-01

    Accurate staging of neuroblastoma requires multiple imaging examinations. The purpose of this study was to determine the relative contribution of 99m Tc-methylene diphosphonate (MDP) bone scintigraphy (bone scan) versus metaiodobenzylguanidine scintigraphy (MIBG scan) for accurate staging of neuroblastoma. A medical record search by the identified patients with neuroblastoma from 1993 to 2012 who underwent both MIBG and bone scan for disease staging. Cross-sectional imaging was used to corroborate the scintigraphy results. Clinical records were used to correlate imaging findings with clinical staging and patient management. One hundred thirty-two patients underwent both MIBG and bone scan for diagnosis. All stage 1 (n = 12), 2 (n = 8), and 4S (n = 4) patients had a normal bone scan with no skeletal MIBG uptake. Six of 30 stage 3 patients had false (+) bone scans. In the 78 stage 4 patients, 58/78 (74%) were both skeletal MIBG(+)/bone scan (+). In 56 of the 58 cases, skeletal involvement detected with MIBG was equal to or greater than that detected by bone scan. Only 3/78 had (-) skeletal MIBG uptake and (+) bone scans; all 3 had other sites of metastatic disease. Five of 78 had (+) skeletal MIBG with a (-) bone scan, while 12/78 had no skeletal involvement by either MIBG or bone scan. In no case did a positive bone scan alone determine a stage 4 designation. In the staging of neuroblastoma, 99m Tc-MDP bone scintigraphy does not identify unique sites of disease that affect disease stage or clinical management, and in the majority of cases bone scans can be omitted from the routine neuroblastoma staging algorithm. © 2017 Wiley Periodicals, Inc.

  19. Optimization of liposomal topotecan for use in treating neuroblastoma.

    Science.gov (United States)

    Chernov, Lina; Deyell, Rebecca J; Anantha, Malathi; Dos Santos, Nancy; Gilabert-Oriol, Roger; Bally, Marcel B

    2017-06-01

    The purpose of this work was to develop an optimized liposomal formulation of topotecan for use in the treatment of patients with neuroblastoma. Drug exposure time studies were used to determine that topotecan (Hycamtin) exhibited great cytotoxic activity against SK-N-SH, IMR-32 and LAN-1 neuroblastoma human cell lines. Sphingomyelin (SM)/cholesterol (Chol) and 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC)/Chol liposomes were prepared using extrusion methods and then loaded with topotecan by pH gradient and copper-drug complexation. In vitro studies showed that SM/Chol liposomes retained topotecan significantly better than DSPC/Chol liposomes. Decreasing the drug-to-lipid ratio engendered significant increases in drug retention. Dose-range finding studies on NRG mice indicated that an optimized SM/Chol liposomal formulation of topotecan prepared with a final drug-to-lipid ratio of 0.025 (mol: mol) was better tolerated than the previously described DSPC/Chol topotecan formulation. Pharmacokinetic studies showed that the optimized SM/Chol liposomal topotecan exhibited a 10-fold increase in plasma half-life and a 1000-fold increase in AUC 0-24 h when compared with Hycamtin administered at equivalent doses (5 mg/kg). In contrast to the great extension in exposure time, SM/Chol liposomal topotecan increased the life span of mice with established LAN-1 neuroblastoma tumors only modestly in a subcutaneous and systemic model. The extension in exposure time may still not be sufficient and the formulation may require further optimization. In the future, liposomal topotecan will be assessed in combination with high-dose radiotherapy such as 131 I-metaiodobenzylguanidine, and immunotherapy treatment modalities currently used in neuroblastoma therapy. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  20. 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.)

  1. Radiation Therapy to the Primary and Postinduction Chemotherapy MIBG-Avid Sites in High-Risk Neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Mazloom, Ali; Louis, Chrystal U.; Nuchtern, Jed; Kim, Eugene; Russell, Heidi; Allen-Rhoades, Wendy; Krance, Robert; Paulino, Arnold C., E-mail: apaulino@mdanderson.org

    2014-11-15

    Purpose: Although it is generally accepted that consolidation therapy for neuroblastoma includes irradiation of the primary site and any remaining metaiodobenzylguanidine (MIBG)-avid metastatic sites, limited information has been published regarding the efficacy of this approach. Methods and Materials: Thirty patients with high-risk neuroblastoma were treated at 1 radiation therapy (RT) department after receiving 5 cycles of induction chemotherapy and resection. All patients had at least a partial response after induction therapy, based upon international neuroblastoma response criteria. The primary sites were treated with 24 to 30 Gy whereas the MIBG-avid metastatic sites were treated with 24 Gy. RT was followed by high-dose chemotherapy with autologous stem cell rescue and 6 months of cis-retinoic acid. Results: The 5-year progression-free survival (PFS) and overall survival (OS) rates were 48% and 59%, respectively. The 5-year locoregional control at the primary site was 84%. There were no differences in locoregional control according to degree of primary surgical resection. The 5-year local control rate for metastatic sites was 74%. The 5-year PFS rates for patients with 0, 1, 2, and >3 postinduction MIBG sites were 66%, 57%, 20%, and 0% (P<.0001), respectively, whereas 5-year OS rates were 80%, 57%, 50%, and 0%, respectively (P<.0001). Conclusions: RT to the primary site and postinduction MIBG-positive metastatic sites was associated with 84% and 74% local control, respectively. The number of MIBG-avid sites present after induction chemotherapy and surgery was predictive of progression-free and overall survival.

  2. Role of I-MIBG cardiac scintigraphy in diagnosing Parkinson's disease: a case study

    International Nuclear Information System (INIS)

    Freeborn, Adam; Mathers, Dawn

    2009-01-01

    Full text: A 49-year-old male presented with a two year history of progressively worsening akinetic rigid syndrome. After a number of non-specific findings on PET, MRI and CT scans of the brain, a clinical diagnosis was made of Parkinson's disease, and treatment with Sinemet was commenced. The patient's symptoms, however, were not sufficiently relieved and a change in medication was considered. However, after much persistence from the patient and his family in seeking a number of neurological opinions, a 12J[-metaiodobenzylguanidine (MIBG) cardiac study was requested to attempt to confirm the diagnosis of Parkinson's disease. The patient's medication was ceased for seven days prior to the study, and the patient was pre-treated with IO ml of potassium iodide one hour prior to '231-MIBG administration, to protect the thyroid. 185MBq of '231 M IBG was administered intravenously and planar and SPECT images of the chest were acquired at fifteen minutes and three hours post injection. A heart-to-mediastinum (H-to-M) ratio was calculated at both fifteen minutes and three hours post injection, to quantify the cardiac uptake of the tracer. The images demonstrated reduced uptake on the early images (H-to-M ratio of 0.75 [normal value - 1.52]) and further reduced uptake on the delayed images (H-to-M ratio of 0.68). This reduced cardiac uptake is associated with Parkinson's disease, and provided sufficient evidence to confirm the initial clinical suspicion. As a result, the patient's medication dosage is currently being reviewed, with more invasive therapies being considered.

  3. 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.)

  4. 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.

  5. Effect of Switching from Cilnidipine to Azelnidipine on Cardiac Sympathetic Nerve Function in Patients with Heart Failure Preserved Ejection Fraction.

    Science.gov (United States)

    Kiuchi, Shunsuke; Hisatake, Shinji; Kabuki, Takayuki; Oka, Takashi; Dobashi, Shintaro; Fujii, Takahiro; Ikeda, Takanori

    2018-01-27

    Cardiac sympathetic nerve activity is known to play a key role in the development and progression of heart failure (HF). Azelnidipine, an L-type calcium channel blocker (CCB), inhibits the sympathetic nerve activity of the central system. In contrast, cilnidipine, an N-type CCB, inhibits the sympathetic nerve activity of the peripheral system. CCBs are recommended as class IIa in patients with HF preserved ejection fraction (HFpEF); however, there are no comparative data on the difference in effect of cilnidipine and azelnidipine in patients with HFpEF and hypertension. We investigated the difference in effect of azelnidipine compared with cilnidipine in patients with HFpEF. Twenty-four consecutive HF patients who received angiotensin II type1a receptor blocker and beta blocker from April 2013 to January 2015 were enrolled. Cilnidipine was switched to azelnidipine during the follow-up period. Blood pressures, heart rate, blood tests, echocardiography, and 123 I-metaiodobenzylguanidine (MIBG) cardiac-scintigraphy were measured before and after 6 months from azelnidipine administration. B-type natriuretic peptide tended to decrease after switching to azelnidipine; however, there were no significant differences between the pre-state and post-state (pre-state: 118.5 pg/mL and post-state: 78.4 pg/mL, P = 0.137). Other laboratory findings, including catecholamine, also did not change significantly. In echocardiography, there were no significant differences in systolic and diastolic functions at the pre-state and post-state. As for MIBG, there were no significant changes in heart/mediastinum ratio. However, washout rate was significantly reduced (pre-state: 42.9 and post-state: 39.6, P = 0.030). Azelnidipine improved the dysfunction of cardiac sympathetic nerve activity compared with cilnidipine in patients with HFpEF.

  6. 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.

  7. Synchronous bilateral pheochromocytomas and paraganglioma with novel germline mutation in MAX: a case report.

    Science.gov (United States)

    Shibata, Masahiro; Inaishi, Takahiro; Miyajima, Noriyuki; Adachi, Yayoi; Takano, Yuko; Nakanishi, Kenichi; Takeuchi, Dai; Noda, Sumiyo; Aita, Yuichi; Takekoshi, Kazuhiro; Kodera, Yasuhiro; Kikumori, Toyone

    2017-12-28

    Recent advance of genetic testing has contributed to the diagnosis of hereditary pheochromocytoma and paraganglioma (PPGL). The clinical characteristics of hereditary PPGL are varying among the types of mutational genes. It is still difficult to specify the pathognomonic symptoms in the case of rare genetic mutations. Here, we report the case of synchronous bilateral pheochromocytomas and paraganglioma with novel MYC associated factor X (MAX) gene mutation. A 24-year-old female had hyperhidrosis and hypertension. Her urine test showed high normetanephrine and vanillylmandelic acid. Enhanced computed tomography revealed three enhanced masses in right adrenal gland, left adrenal gland, and left renal hilus. She was diagnosed with PPGL. Because 123 I-metaiodobenzylguanidine scintigraphy indicated the accumulations in the left adrenal gland mass and the left renal hilus mass and not in the right adrenal gland mass, we performed laparoscopic left adrenalectomy and extirpation of the left renal hilus mass to preserve the right adrenocortical function. However, her symptoms recurred shortly after the operation presumably due to unveiling of the activity of the right pheochromocytoma. Following right adrenalectomy as the second operation, the catecholamine levels declined to normal range. Her genetic testing indicated the novel germline mutation in MAX gene (c.70_73 del AAAC/p.Lys24fs*40). MAX germline mutation is recently identified as a rare cause of hereditary PPGL. The deletion mutation in MAX gene in this patient has never reported before. In the case of bilateral pheochromocytomas, the surgical indication should be decided considering each patient's genetic background. Due to the possibility for other types of malignant tumors, close follow-up is essential for MAX mutation carriers.

  8. Effectiveness of nocturnal home oxygen therapy to improve exercise capacity, cardiac function and cardiac sympathetic nerve activity in patients with chronic heart failure and central sleep apnea

    International Nuclear Information System (INIS)

    Toyama, Takuji; Seki, Ryotaro; Isobe, Naoki; Sakurai, Shigeki; Adachi, Hitoshi; Hoshizaki, Hiroshi; Oshima, Shigeru; Taniguchi, Koichi; Kasama, Shu

    2009-01-01

    Central sleep apnea, often found in patients with chronic heart failure (CHF), has a high risk of poor prognosis. This study involved 20 patients with CHF (left ventricular ejection fraction (LVEF) 5 times/h who were divided into 2 groups: 10 patients treated with nocturnal home oxygen therapy (HOT) and 10 patients without HOT (non-HOT). All patients had dilated cardiomyopathy and underwent overnight polysomnography, cardiopulmonary exercise testing, and nuclear cardiac examinations to evaluate AHI, exercise capacity according to the specific activity scale and oxygen uptake at anaerobic threshold and peak exercise (peak VO 2 ). Cardiac function according to 99m Tc-methoxyisobutylisonitrile (MIBI) QGS, and the total defect score (TDS), H/M ratio and the washout rate (WR) on 123 I-metaiodobenzylguanidine (MIBG) imaging were calculated for all patients. As compared with the non-HOT group, the HOT group demonstrated a greater reduction in AHI (26.1±9.1 to 5.1±3.4), 123 I-MIBG TDS (31±8 to 25±9), and 123 I-MIBG WR (48±8% to 41±5%) and a greater increase in the specific activity scale (4.0±0.9 to 5.8±1.2 Mets), peak VO 2 (16.0±3.8 to 18.3±4.7 ml·min -1 ·kg -1 ), and LVEF (27±9% to 37±10%). HOT improves exercise capacity, cardiac function, and cardiac sympathetic nerve activity in patients with CHF and central sleep apnea. (author)

  9. Likelihood of Bone Recurrence in Prior Sites of Metastasis in Patients With High-Risk Neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Polishchuk, Alexei L. [Department of Radiation Oncology, University of California at San Francisco School of Medicine and UCSF Benioff Children' s Hospital, San Francisco, California (United States); Li, Richard [Division of Radiation Oncology, Dana Farber/Boston Children' s Cancer and Blood Disorders Center, Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Hill-Kayser, Christine [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Little, Anthony [Division of Oncology, Children' s Hospital of Philadelphia, Philadelphia, Pennsylvania (United States); Hawkins, Randall A. [Department of Radiology, University of California at San Francisco School of Medicine and UCSF Benioff Children' s Hospital, San Francisco, California (United States); Hamilton, Jeffrey; Lau, Michael [Department of Radiation Oncology, University of California at San Francisco School of Medicine and UCSF Benioff Children' s Hospital, San Francisco, California (United States); Tran, Hung Chi [Division of Hematology/Oncology, Children' s Hospital of Los Angeles, Los Angeles, California (United States); Strahlendorf, Caron [Division of Hematology and Oncology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia (Canada); Lemons, Richard S. [Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah (United States); Weinberg, Vivian [Department of Radiation Oncology, University of California at San Francisco School of Medicine and UCSF Benioff Children' s Hospital, San Francisco, California (United States); Matthay, Katherine K.; DuBois, Steven G. [Department of Pediatrics, University of California at San Francisco School of Medicine and UCSF Benioff Children' s Hospital, San Francisco, California (United States); and others

    2014-07-15

    Purpose/Objectives: Despite recent improvements in outcomes, 40% of children with high-risk neuroblastoma will experience relapse, facing a guarded prognosis for long-term cure. Whether recurrences are at new sites or sites of original disease may guide decision making during initial therapy. Methods and Materials: Eligible patients were retrospectively identified from institutional databases at first metastatic relapse of high-risk neuroblastoma. Included patients had disease involving metaiodobenzylguanidine (MIBG)-avid metastatic sites at diagnosis and first relapse, achieved a complete or partial response with no more than one residual MIBG-avid site before first relapse, and received no total body irradiation or therapy with {sup 131}I-MIBG before first relapse. Anatomically defined metastatic sites were tracked from diagnosis through first relapse to determine tendency of disease to recur at previously involved versus uninvolved sites and to assess whether this pattern was influenced by site irradiation. Results: Of 159 MIBG-avid metastatic sites identified among 43 patients at first relapse, 131 (82.4%) overlapped anatomically with the set of 525 sites present at diagnosis. This distribution was similar for bone sites, but patterns of relapse were more varied for the smaller subset of soft tissue metastases. Among all metastatic sites at diagnosis in our subsequently relapsed patient cohort, only 3 of 19 irradiated sites (15.8%) recurred as compared with 128 of 506 (25.3%) unirradiated sites. Conclusions: Metastatic bone relapse in neuroblastoma usually occurs at anatomic sites of previous disease. Metastatic sites identified at diagnosis that did not receive radiation during frontline therapy appeared to have a higher risk of involvement at first relapse relative to previously irradiated metastatic sites. These observations support the current paradigm of irradiating metastases that persist after induction chemotherapy in high-risk patients. Furthermore

  10. Scintigraphic evaluation of regional myocardial sympathetic activity in patients with hypertrophic cardiomyopathy. Comparison between asymmetrical hypertrophic cardiomyopathy and apical hypertrophy

    Energy Technology Data Exchange (ETDEWEB)

    Eno, Shin; Takeo, Eiichiro; Sasaki, Satoshi; Matsuda, Keiji; Fujii, Hideaki; Kanazawa, Ikuo [Chugoku Rosai General Hospital, Kure, Hiroshima (Japan)

    1998-02-01

    Using {sup 123}I-MIBG (metaiodobenzylguanidine) and {sup 201}Tl imagings, an examination concerning the relation between the hypertrophic region and its sympathetic nervous function was done. Subjects were 12 normal adults (4 males and 8 females, mean age 61.3 yr), 13 patients with asymmetrical hypertrophic cardiomyopathy (10 males and 3 females, 63.9 yr) and 13 patients with apical hypertrophy (9 males and 4 females, 67.2 yr). The SPECT apparatus was Toshiba two-gated gamma camera GCA 7200A. At 20 min and 3 hr after intravenous injection of 111 MBq of {sup 123}I-MIBG, myocardial SPECT and planar images were obtained with collimator LEHR under following conditions: photoelectric peak 159 KeV, window width 20%, matrix size 64 x 64 (256 x 256 for the planar image), step angle 6deg, 40 sec/step and 180deg for 1 camera. In another day, {sup 201}Tl SPECT and planar imagings were performed 10 min after intravenous injection of 111 MBq of {sup 201}Tl for the photoelectric peak 72 KeV under similar conditions to above. SPECT images were reconstructed using Butterworth filter and Shepp and Logan filter. Images were examined for the defect score, myocardium/mediastinum ratio, whole heart washout rate and regional washout rate. In the asymmetrical hypertrophic myopathy, abnormal sympathetic nerve function was recognized on the regions regardless of their disease severity while in the apical hypertrophy, abnormality was restricted on the apical region. Therefore, the two diseases were found different from each other from the aspect of sympathetic nerve functions. (K.H.)

  11. 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)

  12. Validation of cardiac {sup 123}I-MIBG scintigraphy in patients with Parkinson's disease who were diagnosed with dopamine PET

    Energy Technology Data Exchange (ETDEWEB)

    Ishibashi, Kenji [Tokyo Medical and Dental University, Department of Neurology and Neurological Science, Graduate School, Tokyo (Japan); Tokyo Metropolitan Institute of Gerontology, Positron Medical Center, Tokyo (Japan); Saito, Yuko [Tokyo Metropolitan Geriatric Hospital, Department of Pathology, Tokyo (Japan); Tokyo Metropolitan Institute of Gerontology, Department of Neuropathology, Tokyo (Japan); Murayama, Shigeo [Tokyo Metropolitan Institute of Gerontology, Department of Neuropathology, Tokyo (Japan); Kanemaru, Kazutomi [Tokyo Metropolitan Geriatric Hospital, Department of Neurology, Tokyo (Japan); Oda, Keiichi; Ishiwata, Kiichi; Ishii, Kenji [Tokyo Metropolitan Institute of Gerontology, Positron Medical Center, Tokyo (Japan); Mizusawa, Hidehiro [Tokyo Medical and Dental University, Department of Neurology and Neurological Science, Graduate School, Tokyo (Japan)

    2010-01-15

    The aim of this study was to evaluate the diagnostic potential of cardiac {sup 123}I-labelled metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy in idiopathic Parkinson's disease (PD). The diagnosis was confirmed by positron emission tomography (PET) imaging with {sup 11}C-labelled 2{beta}-carbomethoxy-3{beta}-(4-fluorophenyl)-tropane ({sup 11}C-CFT) and {sup 11}C-raclopride (together designated as dopamine PET). Cardiac {sup 123}I-MIBG scintigraphy and dopamine PET were performed for 39 parkinsonian patients. To estimate the cardiac {sup 123}I-MIBG uptake, heart to mediastinum (H/M) ratios in early and delayed images were calculated. On the basis of established clinical criteria and our dopamine PET findings, 24 patients were classified into the PD group and 15 into the non-PD (NPD) group. Both early and delayed images showed that the H/M ratios were significantly lower in the PD group than in the NPD group. When the optimal cut-off levels of the H/M ratio were set at 1.95 and 1.60 in the early and delayed images, respectively, by receiver-operating characteristic analysis, the sensitivity of cardiac {sup 123}I-MIBG scintigraphy for the diagnosis of PD was 79.2 and 70.8% and the specificity was 93.3 and 93.3% in the early and delayed images, respectively. In the Hoehn and Yahr 1 and 2 PD patients, the sensitivity decreased by 69.2 and 53.8% in the early and delayed images, respectively. In early PD cases, cardiac {sup 123}I-MIBG scintigraphy is of limited value in the diagnosis, because of its relatively lower sensitivity. However, because of its high specificity for the overall cases, cardiac {sup 123}I-MIBG scintigraphy may assist in the diagnosis of PD in a complementary role with the dopaminergic neuroimaging. (orig.)

  13. Validation of cardiac 123I-MIBG scintigraphy in patients with Parkinson's disease who were diagnosed with dopamine PET

    International Nuclear Information System (INIS)

    Ishibashi, Kenji; Saito, Yuko; Murayama, Shigeo; Kanemaru, Kazutomi; Oda, Keiichi; Ishiwata, Kiichi; Ishii, Kenji; Mizusawa, Hidehiro

    2010-01-01

    The aim of this study was to evaluate the diagnostic potential of cardiac 123 I-labelled metaiodobenzylguanidine ( 123 I-MIBG) scintigraphy in idiopathic Parkinson's disease (PD). The diagnosis was confirmed by positron emission tomography (PET) imaging with 11 C-labelled 2β-carbomethoxy-3β-(4-fluorophenyl)-tropane ( 11 C-CFT) and 11 C-raclopride (together designated as dopamine PET). Cardiac 123 I-MIBG scintigraphy and dopamine PET were performed for 39 parkinsonian patients. To estimate the cardiac 123 I-MIBG uptake, heart to mediastinum (H/M) ratios in early and delayed images were calculated. On the basis of established clinical criteria and our dopamine PET findings, 24 patients were classified into the PD group and 15 into the non-PD (NPD) group. Both early and delayed images showed that the H/M ratios were significantly lower in the PD group than in the NPD group. When the optimal cut-off levels of the H/M ratio were set at 1.95 and 1.60 in the early and delayed images, respectively, by receiver-operating characteristic analysis, the sensitivity of cardiac 123 I-MIBG scintigraphy for the diagnosis of PD was 79.2 and 70.8% and the specificity was 93.3 and 93.3% in the early and delayed images, respectively. In the Hoehn and Yahr 1 and 2 PD patients, the sensitivity decreased by 69.2 and 53.8% in the early and delayed images, respectively. In early PD cases, cardiac 123 I-MIBG scintigraphy is of limited value in the diagnosis, because of its relatively lower sensitivity. However, because of its high specificity for the overall cases, cardiac 123 I-MIBG scintigraphy may assist in the diagnosis of PD in a complementary role with the dopaminergic neuroimaging. (orig.)

  14. Clinical significance of pretreatment FDG PET/CT IN MOBG-avid pediatric neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Seo Young; Kim, Yong Il; Cheon, Gi Jeong; Kang, Keon Wook; Chung, June Key; Lee, Dong Soo; Kang, Hyoung Jin; Shin, Hee Young [Seoul National University Hospital, Seoul (Korea, Republic of); Kim, E. Edmund [Seoul National University, Seoul (Korea, Republic of); Rahim, Muhammad Kashif [Nishtar Medical College and Hospital, Multan (Pakistan)

    2017-06-15

    {sup 18}F-fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging is well known to have clinical significance in the initial staging and response evaluation of the many kinds of neoplasms. However, its role in the pediatric neuroblastoma is not clearly defined. In the present study, the clinical significance of FDG-PET/computed tomography (CT) in 123I- or 131I-metaiodobenzylguanidine (MIBG)-avid pediatric neuroblastoma was investigated. Twenty patients with neuroblastoma who undertook pretreatment FDG PET/CT at our institute between 2008 and 2015 and showed MIBG avidity were retrospectively enrolled in the present study. Clinical information—including histopathology, and serum markers—and several PET parameters—including SUVmax of the primary lesion (Psuv), target-to-background ratio (TBR), metabolic tumor volume (MTV), and coefficient of variation (CV)—were analyzed. The prognostic effect of PET parameters was evaluated in terms of progression-free survival (PFS). Total 20 patients (4.5 ± 3.5 years) were divided as two groups by disease progression. Six patients (30.0 %) experienced disease progression and one patient (5.0 %) died during follow-up period. There were not statistically significant in age, stage, MYCN status, primary tumor size, serum lactate dehydrogenase (LDH), neuron-specific enolase (NSE), and ferritin level between two groups with progression or no progression. However, Psuv (p = 0.017), TBR (p = 0.09), MTV (p = 0.02), and CV (p = 0.036) showed significant differences between two groups. In univariate analysis, PFS was significantly associated with Psuv (p = 0.021) and TBR (p = 0.023). FDG-PET parameters were significantly related with progression of neuroblastoma. FDG-PET/CT may have the potential as a valuable modality for evaluating prognosis in the patients with MIBG-avid pediatric neuroblastoma.

  15. 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

  16. 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.)

  17. 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

  18. Cardiac Sympathetic Hyperactivity after Chemotherapy: Early Sign of Cardiotoxicity?

    International Nuclear Information System (INIS)

    Guimarães, Sarita Lígia Pessoa de Melo Machado; Brandão, Simone Cristina Soares; Andrade, Luciana Raposo; Maia, Rafael José Coelho; Markman Filho, Brivaldo

    2015-01-01

    Chemotherapy with anthracyclines and trastuzumab can cause cardiotoxicity. Alteration of cardiac adrenergic function assessed by metaiodobenzylguanidine labeled with iodine-123 ( 123 I-mIBG) seems to precede the drop in left ventricular ejection fraction. To evaluate and to compare the presence of cardiovascular abnormalities among patients with breast cancer undergoing chemotherapy with anthracyclines and trastuzumab, and only with anthracycline. Patients with breast cancer were analyzed clinical, laboratory, electrocardiographic and echocardiographic and cardiac sympathetic activity. In scintigraphic images, the ratio of 123 I-mIBG uptake between the heart and mediastinum, and the washout rate were calculated. The variables were compared between patients who received anthracyclines and trastuzumab (Group 1) and only anthracyclines (Group 2). Twenty patients, with mean age 57 ± 14 years, were studied. The mean left ventricular ejection fraction by echocardiography was 67.8 ± 4.0%. Mean washout rate was 28.39 ± 9.23% and the ratio of 123 I-mIBG uptake between the heart and mediastinum was 2.07 ± 0.28. Of the patients, 82% showed an increased in washout rate, and the ratio of 123 I-mIBG uptake between the heart and mediastinum decreased in 25%. Concerning the groups, the mean washout rate of Group 1 was 32.68 ± 9.30% and of Group 2 was 24.56 ± 7.72% (p = 0,06). The ratio of 123 I-mIBG uptake between the heart and mediastinum was normal in all patients in Group 2, however, the Group 1, showed 50% the ratio of 123 I-mIBG uptake between the heart and mediastinum ≤ 1.8 (p = 0.02). In women with breast cancer undergoing chemotherapy, assessment of cardiac sympathetic activity with 123 I-mIBG appears to be an early marker of cardiotoxicity. The combination of chemotherapy showed higher risk of cardiac adrenergic hyperactivity

  19. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  1. 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.)

  2. Evolution of a pheochromocytoma.

    Science.gov (United States)

    Magill, Steven B; Fritsche, Claire M; Klinger, Dean E; Tector, Alfred J; Shaker, Joseph L

    2006-01-01

    To present a case that demonstrates the evolution of a pheochromocytoma over a several-year period and to emphasize the importance of a thorough work-up for pheochromocytoma in patients with neurofibromatosis type 1 (NF1) and hypertension. We review the long-term clinical, biochemical, and imaging findings in a man with a complex medical history of hypertension, NF1, and cardiomyopathy. A 44-year-old man, with a well-documented history of headaches, hypertension, and NF1, was referred for evaluation of a right adrenal enlargement. He had developed cardiomyopathy and undergone an evaluation for cardiac transplantation. Initial computed tomography revealed subtle asymmetry in the upper right adrenal gland. Biochemical studies for pheochromocytoma yielded equivocal findings, with a 1.5-fold elevation in the urinary norepinephrine and near-normal urinary metanephrine level. Because 131I-metaiodobenzylguanidine imaging showed no tracer uptake in the area of the right adrenal gland, the patient was thought not to have a pheochromocytoma. The patient eventually underwent cardiac transplantation and did well. On reassessment 3 1/2 years later, he was found to have a larger right adrenal mass. The second endocrine evaluation demonstrated substantial elevation in the urinary metanephrine level, and the patient underwent laparoscopic right adrenalectomy to remove the tumor (3.5 by 3.0 by 2.5 cm), which proved to be a pheochromocytoma. This case shows that a pheochromocytoma can be difficult to diagnose and can evolve to become a large, biochemically active tumor. It is imperative that patients with an adrenal tumor undergo periodic reevaluation to ensure that the tumor remains stable in size. If the tumor enlarges, further biochemical testing is warranted.

  3. Determination of the Heart-to-Mediastinum Ratio of123I-MIBG Uptake Using Dual-Isotope (123I-MIBG/99mTc-Tetrofosmin) Multipinhole Cadmium-Zinc-Telluride SPECT in Patients with Heart Failure.

    Science.gov (United States)

    Blaire, Tanguy; Bailliez, Alban; Ben Bouallegue, Fayçal; Bellevre, Dimitri; Agostini, Denis; Manrique, Alain

    2018-02-01

    The aim of this retrospective study was to compare the heart-to-mediastinum ratio (HMR) of 123 I-metaiodobenzylguanidine ( 123 I-MIBG) uptake obtained using a multipinhole cadmium-zinc-telluride (CZT) camera with that obtained using conventional planar imaging. Methods: Forty consecutive heart failure patients underwent planar acquisition 4 h after 123 I-MIBG injection (191 ± 41 [mean ± SD] MBq). To localize the heart using the CZT camera, 99m Tc-tetrofosmin (358 ± 177 MBq) was administered and dual-isotope acquisition was performed. The HMRs were calculated with conventional planar imaging (HMR planar ), with anterior reprojection images using the CZT camera (HMR reproj ), and with transaxial reconstructed images using the CZT camera (HMR transaxial ). In a phantom study, we estimated a linear model fitting the CZT camera data to the planar data, and we applied it to provide corrected CZT camera-determined HMRs in patients (cHMR reproj and cHMR transaxial ). Results: Thirty-four men and 6 women (71 ± 9 y old) with ischemic (22 patients) and nonischemic (18 patients) heart failure completed the study. For 22 of the 40 patients (55%), the New York Heart Association classification was class II and the ejection fraction was 35% ± 9%. HMR reproj (1.12 ± 0.19) and HMR transaxial (1.35 ± 0.34) were lower than HMR planar (1.44 ± 0.14) ( P isotope ( 123 I and 99m Tc) acquisition on a multipinhole CZT camera was feasible in patients with heart failure. However, this determination should be performed using transaxial reconstructed images and linear correction based on phantom data acquisitions. © 2018 by the Society of Nuclear Medicine and Molecular Imaging.

  4. Clinical application of cardiac SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Shigeyuki [Yokohama Rosai Hospital (Japan)

    1999-07-01

    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 {sup 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 {sup 201}Tl. Quantitative assessment of {sup 99m}Tc MIBI uptake reflect the degree of viability. {sup 123}I-Metaiodobenzylguanidine (MIBG), an analog of norepinephrine, has been used for scintigraphic assessment of regional cardiac adrenergic innervation. Cardiac sympathetic denervation, assessed by {sup 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. {sup 23}I-BMIPP ({rho}-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, {sup 99m}Tc perfusion agents, {sup 123}I-MIBG and {sup 23}I-BMIPP and in associated clinical

  5. 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.)

  6. 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)

  7. Cardiac Sympathetic Hyperactivity after Chemotherapy: Early Sign of Cardiotoxicity?

    Energy Technology Data Exchange (ETDEWEB)

    Guimarães, Sarita Lígia Pessoa de Melo Machado [Pós-Graduação em Ciências da Saúde da Universidade Federal de Pernambuco (PGCS-UFPE), Recife, PE (Brazil); Hospital Agamenon Magalhães (HAM), Recife, PE (Brazil); Brandão, Simone Cristina Soares, E-mail: simonecordis@yahoo.com.br [Pós-Graduação em Ciências da Saúde da Universidade Federal de Pernambuco (PGCS-UFPE), Recife, PE (Brazil); Andrade, Luciana Raposo [Hospital Santa Joana, Recife, PE (Brazil); Maia, Rafael José Coelho [Pós-Graduação em Ciências da Saúde da Universidade Federal de Pernambuco (PGCS-UFPE), Recife, PE (Brazil); Hospital Agamenon Magalhães (HAM), Recife, PE (Brazil); Markman Filho, Brivaldo [Pós-Graduação em Ciências da Saúde da Universidade Federal de Pernambuco (PGCS-UFPE), Recife, PE (Brazil)

    2015-09-15

    Chemotherapy with anthracyclines and trastuzumab can cause cardiotoxicity. Alteration of cardiac adrenergic function assessed by metaiodobenzylguanidine labeled with iodine-123 ({sup 123}I-mIBG) seems to precede the drop in left ventricular ejection fraction. To evaluate and to compare the presence of cardiovascular abnormalities among patients with breast cancer undergoing chemotherapy with anthracyclines and trastuzumab, and only with anthracycline. Patients with breast cancer were analyzed clinical, laboratory, electrocardiographic and echocardiographic and cardiac sympathetic activity. In scintigraphic images, the ratio of {sup 123}I-mIBG uptake between the heart and mediastinum, and the washout rate were calculated. The variables were compared between patients who received anthracyclines and trastuzumab (Group 1) and only anthracyclines (Group 2). Twenty patients, with mean age 57 ± 14 years, were studied. The mean left ventricular ejection fraction by echocardiography was 67.8 ± 4.0%. Mean washout rate was 28.39 ± 9.23% and the ratio of {sup 123}I-mIBG uptake between the heart and mediastinum was 2.07 ± 0.28. Of the patients, 82% showed an increased in washout rate, and the ratio of {sup 123}I-mIBG uptake between the heart and mediastinum decreased in 25%. Concerning the groups, the mean washout rate of Group 1 was 32.68 ± 9.30% and of Group 2 was 24.56 ± 7.72% (p = 0,06). The ratio of {sup 123}I-mIBG uptake between the heart and mediastinum was normal in all patients in Group 2, however, the Group 1, showed 50% the ratio of {sup 123}I-mIBG uptake between the heart and mediastinum ≤ 1.8 (p = 0.02). In women with breast cancer undergoing chemotherapy, assessment of cardiac sympathetic activity with {sup 123}I-mIBG appears to be an early marker of cardiotoxicity. The combination of chemotherapy showed higher risk of cardiac adrenergic hyperactivity.

  8. 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.)

  9. 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)

  10. Early diagnosis of and surgical strategy for adrenal medullary disease in MEN II gene carriers

    Energy Technology Data Exchange (ETDEWEB)

    Jansson, S.; Tisell, L.E.; Fjaelling, M.L.; Lindberg, S.; Jacobsson, L.; Zachrisson, B.F.

    1988-01-01

    Sixteen multiple endocrine neoplasia type II (MEN II) gene carriers--12 who had undergone thyroidectomy because of medullary carcinoma of the thyroid and 4 whose thyroid glands had been removed because of C cell hyperplasia--were examined for the presence of pheochromocytomas. No patient had sought medical advice for pheochromocytoma symptoms. Fourteen patients had MEN IIa syndromes, one patient had a MEN IIb and another patient had a mixed syndrome of von Recklinghausen's neurofibromatosis and MEN II. Eight patients had undergone unilateral adrenalectomy for pheochromocytoma 11 +/- 4 years before. The patients underwent clinical examination, determination of the urinary excretion of catecholamines and metabolites, and /sup 131/I-metaiodobenzylguanidine (/sup 131/I-MIBG) and CAT scans. /sup 131/I-MIBG scanning was performed with images 1, 4, and 7 days after the radionuclide injection. In seven of eight patients who had undergone unilateral adrenalectomies, the /sup 131/I-MIBG scans showed accumulation of the radionuclide in the remaining adrenal gland. Bilateral adrenal accumulation of the radionuclide was demonstrated in seven of eight MEN IIa gene carriers who had not undergone adrenalectomy. Five patients, two of whom had undergone adrenalectomy, were found to have unilateral pheochromocytomas less than 2 cm in diameter. Only one of these five patients had an elevated excretion of urinary catecholamines. Between day 4 and day 7 after /sup 131/I-MIBG injection, adrenal glands with pheochromocytomas increased their relative accumulation of the radionuclide significantly more (p less than 0.02) than did adrenal glands without any demonstrable pheochromocytomas. All the pheochromocytomas were viewed by means of CAT scans.

  11. Relationships between cardiac innervation/perfusion imbalance and ventricular arrhythmias: impact on invasive electrophysiological parameters and ablation procedures

    Energy Technology Data Exchange (ETDEWEB)

    Gimelli, Alessia [Fondazione Toscana Gabriele Monasterio, Pisa (Italy); Menichetti, Francesca; Soldati, Ezio; Liga, Riccardo; Vannozzi, Andrea; Bongiorni, Maria Grazia [University Hospital of Pisa, Cardio-Thoracic and Vascular Department, Pisa (Italy); Marzullo, Paolo [Fondazione Toscana Gabriele Monasterio, Pisa (Italy); CNR, Institute of Clinical Physiology, Pisa (Italy)

    2016-12-15

    To assess the relationship between regional myocardial perfusion and sympathetic innervation parameters at myocardial scintigraphy and intra-cavitary electrophysiological data in patients with ventricular arrhythmias (VA) submitted to invasive electrophysiological study and ablation procedure. Sixteen subjects underwent invasive electrophysiological study with electroanatomical mapping (EAM) followed by trans-catheter ablations of VA. Before ablation all patients were studied with a combined evaluation of regional myocardial perfusion and sympathetic innervation by means of tomographic {sup 99m}Tc-tetrofosmin and {sup 123}I- metaiodobenzylguanidine cadmium-zinc-telluride (CZT) scintigraphies, respectively. Off-line spatial co-registration of CZT perfusion and innervation data with the three-dimensional EAM reconstruction was performed in every patient. CZT revealed the presence of myocardial scar in 55 (20 %) segments. Of the viable myocardial segments, 131 (60 %) presented a preserved adrenergic innervation, while 86 (40 %) showed a significantly depressed innervation (i.e. innervation/perfusion mismatch). On EAM, the invasively measured intra-cavitary voltage was significantly lower in scarred segments than in viable ones (1.7 ± 1.5 mV vs. 4.0 ± 2.2 mV, P < 0.001). Interestingly, among the viable segments, those showing an innervation/perfusion mismatch presented a significantly lower intra-cavitary voltage than those with preserved innervation (1.9 ± 2.5 mV vs. 4.7 ± 2.3 mV, P < 0.001). Intra-cardiac ablation was performed in 63 (23 %) segments. On multivariate analysis, after correction for scar burden, the segments showing an innervation/perfusion mismatch remained the most frequent ablation targets (OR 5.6, 95 % CI 1.5-20.8; P = 0.009). In patients with VA, intra-cavitary electrical abnormalities frequently originate at the level of viable myocardial segments with depressed sympathetic innervation that frequently represents the ultimate ablation target

  12. 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.)

  13. [Hereditary pheochromocytoma--a family affected by von Hippel-Lindau disease].

    Science.gov (United States)

    Mertl, J; Rovný, A; Krepelová, A; Prásek, J

    2003-07-01

    The authors present a case of a 37 year old male (proband) with a 13 year history of progressive sight impairment leading to blindness and a 4 year history of a mild hypertension. He was incidentally found to have large adrenal tumors after an ultrasound kidney examination. The tumors were confirmed with CT scan and magnetic resonance imaging. A bilateral pheochromocytoma was biochemically demonstrated and successfully removed. The eye diagnosis of angiomatosis retinae von Hippel-Lindau was ascertained after a search of the patient files in other medical departments, which led to a family screening. Proband's brother, having hypertension and a history of a cerebellar astrocytoma operation, was also diagnosed with CT scan to have a bilateral pheochromocytoma. Unfortunately, at the same time he was found to have a large irremovable neuroendocrine pancreatic carcinoma, which caused complications and his eventual death. Both proband and his brother were affected by the same CGG(Arg167)->CAG(Gln) mutation in the exon 3 of the VHL gene. Other living and examined family members were not affected, which was confirmed by negative genetic testing. One year after the pheochromocytoma operation, proband was diagnosed to have a retroperitoneal tumor left to the aorta, clinically silent, with slightly and non-constantly elevated urine norepinephrine and normetanephrine. Metaiodobenzylguanidine scintigraphy showed that it was a paraganglioma. The old CT and magnetic resonance picture review demonstrated that the tumor had already been present at the time of the operation. It was surgically removed and histologically verified. It is a pity that proband had not been sent by his ophthalmologist for an endocrine examination when the eye diagnosis was determined. Affection of the family would have been discovered earlier, and proband's brother might have possibly been saved.

  14. Pheochromocytoma presenting as recurrent urinary tract infections : a case report

    Directory of Open Access Journals (Sweden)

    MEntee Gerard P

    2011-01-01

    Full Text Available Abstract Introduction Pheochromocytomas are rare, potentially fatal, neuroendocrine tumors of the adrenal medulla or extra-adrenal paraganglia. Their clinical presentation varies greatly from the classic triad of episodic headache, diaphoresis and tachycardia to include a spectrum of non-specific symptomatology. Case presentation A 43-year-old Caucasian woman was referred to us from primary care services with a three-month history of recurrent urinary tract infections on a background of hypertension, latent autoimmune diabetes of adulthood and autoimmune hypothyroidism. At 38 years she required insulin therapy. Despite medication compliance and dietary control, she reported a recent history of increased insulin requirements and uncontrolled hypertension with concomitant recurrent urinary tract infections. A renal ultrasound examination, to rule out underlying renal pathology, revealed an incidental 8cm right adrenal mass of both solid and cystic components. A subsequent computed tomography of her abdomen and pelvis confirmed a solid heterogeneous mass consistent with a pheochromocytoma. There were no other features suggestive of multiple endocrine neoplasia. Urinary collection over 24 hours revealed grossly elevated levels of catecholamines and metabolites. Following an open right adrenalectomy, our patient's insulin requirements were significantly reduced and her symptoms resolved. Two weeks post-operatively, an iodine-131-metaiodobenzylguanidine scintigraphy was negative for residual tumor and metastatic disease. Urinary catecholamine and metabolite concentrations were within the normal range at a follow-up six months later. Conclusion Pheochromocytoma is a rare catecholamine-producing tumor requiring a high index of suspicion for early diagnosis. Our case report serves to highlight the importance of considering pheochromocytoma as a differential diagnosis in the atypical setting of recurrent urinary tract infections and concomitant autoimmune

  15. Abnormal thermography in Parkinson's disease.

    Science.gov (United States)

    Antonio-Rubio, I; Madrid-Navarro, C J; Salazar-López, E; Pérez-Navarro, M J; Sáez-Zea, C; Gómez-Milán, E; Mínguez-Castellanos, A; Escamilla-Sevilla, F

    2015-08-01

    An autonomic denervation and abnormal vasomotor reflex in the skin have been described in Parkinson's disease (PD) and might be evaluable using thermography with cold stress test. A cross-sectional pilot study was undertaken in 35 adults: 15 patients with PD and abnormal [(123)I]-metaiodobenzylguanidine cardiac scintigraphy and 20 healthy controls. Baseline thermography of both hands was obtained before immersing one in cold water (3 ± 1 °C) for 2 min. Continuous thermography was performed in: non-immersed hand (right or with lesser motor involvement) during immersion of the contralateral hand and for 6 min afterward; and contralateral immersed hand for 6 min post-immersion. The region of interest was the dorsal skin of the third finger, distal phalanx. PD patients showed a lower mean baseline hand temperature (p = 0.037) and greater thermal difference between dorsum of wrist and third finger (p = 0.036) and between hands (p = 0.0001) versus controls, regardless of the motor laterality. Both tests evidenced an adequate capacity to differentiate between groups: in the non-immersed hand, the PD patients did not show the normal cooling pattern or final thermal overshoot observed in controls (F = 5.29; p = 0.001), and there was an AUC of 0.897 (95%CI 0.796-0.998) for this cooling; in the immersed hand, thermal recovery at 6 min post-immersion was lesser in patients (29 ± 17% vs. 55 ± 28%, p = 0.002), with an AUC of 0.810 (95%CI 0.662-0.958). PD patients reveal abnormal skin thermal responses in thermography with cold stress test, suggesting cutaneous autonomic dysfunction. This simple technique may be useful to evaluate autonomic dysfunction in PD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Regional heterogeneity in cardiac sympathetic innervation in acute myocardial infarction: relationship with myocardial oedema on magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Gimelli, Alessia; Masci, Pier Giorgio; Pasanisi, Emilio Maria; Lombardi, Massimo [Fondazione CNR/Regione Toscana, Pisa (Italy); Liga, Riccardo; Grigoratos, Chrysanthos [University Hospital of Pisa, Pisa (Italy); Marzullo, Paolo [Fondazione CNR/Regione Toscana, Pisa (Italy); Institute of Clinical Physiology, CNR, Pisa (Italy)

    2014-09-15

    To assess the relationships between myocardial structure and function on cardiac magnetic resonance (CMR) imaging and sympathetic tone on {sup 123}I-metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy early after myocardial infarction (MI). Ten patients underwent {sup 123}I-MIBG and {sup 99m}Tc-tetrofosmin rest cadmium zinc telluride scintigraphy 4 ± 1 days after MI. The segmental left ventricular (LV) relative radiotracer uptake of both {sup 99m}Tc-tetrofosmin and early {sup 123}I-MIBG was calculated. The day after scintigraphy, on CMR imaging, the extent of ischaemia-related oedema and of myocardial fibrosis (late gadolinium enhancement, LGE) was assessed. Accordingly, the extent of oedema and LGE was evaluated for each segment and segmental wall thickening determined. Based on LGE distribution, LV segments were categorized as ''infarcted'' (56 segments), ''adjacent'' (66 segments) or ''remote'' (48 segments). Infarcted segments showed a more depressed systolic wall thickening and greater extent of oedema than adjacent segments (p < 0.001) and remote segments (p < 0.001). Interestingly, while uptake of {sup 99m}Tc-tetrofosmin was significantly depressed only in infarcted segments (p < 0.001 vs. both adjacent and remote segments), uptake of {sup 123}I-MIBG was impaired not only in infarcted segments (p < 0.001 vs. remote) but also in adjacent segments (p = 0.024 vs. remote segments). At the regional level, after correction for {sup 99m}Tc-tetrofosmin and LGE distribution, segmental {sup 123}I-MIBG uptake (p < 0.001) remained an independent predictor of ischaemia-related oedema. After acute MI the regional impairment of sympathetic tone extends beyond the area of altered myocardial perfusion and is associated with myocardial oedema. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  18. Olfactory dysfunction and cardiovascular dysautonomia in Parkinson's disease.

    Science.gov (United States)

    Oka, Hisayoshi; Toyoda, Chizuko; Yogo, Makiko; Mochio, Soichiro

    2010-06-01

    Several studies have reported that olfactory dysfunction is an early neuropathological manifestation of Parkinson's disease (PD). Reduced cardiac meta-iodobenzylguanidine ((123)I-MIBG) uptake may be one of the earliest signs of PD. We studied the relation of olfactory dysfunction to cardiovascular dysautonomia in patients with PD. The study group comprised 66 patients with PD (70.5 years) and 26 controls (70.3 years) for olfactory assessment, 21 controls (72.1 years) for cardiac (123)I-MIBG scintigraphy and heart rate variability (HRV), assessed using the coefficient of variation for RR intervals (HRV), and 23 controls (69.2 years) for orthostatic blood pressure response. Olfactory function was assessed by the odor stick identification test Japan (OSIT-J), and cardiovascular autonomic function was evaluated by (123)I-MIBG scintigraphy of the heart, the fall in orthostatic blood pressure, and HRV. Patients with PD had a significantly lower OSIT-J score than did the controls (4.1 +/- 3.0 vs. 9.9 +/- 1.7, p = 0.001). The OSIT-J score was unrelated to variables other than gender, including age, disease duration, motor score on the unified Parkinson's disease rating scale, score on the mini-mental state examination, motor phenotype, visual hallucinations, and dopaminergic medication on multiple regression and logistic regression analyses. The OSIT-J score was related to the heart/mediastinum ratio of cardiac (123)I-MIBG uptake, the fall in orthostatic blood pressure, and HRV, after adjustment for other clinical variables. Olfactory dysfunction in PD was, thus, significantly related to both cardiac sympathetic and parasympathetic dysfunction, as well as vascular sympathetic dysfunction. As non-motor symptoms of PD, olfactory dysfunction and autonomic network failure appear to be closely related in PD.

  19. Diffuse occipital hypometabolism on [18 F]-FDG PET scans in patients with idiopathic REM sleep behavior disorder: prodromal dementia with Lewy bodies?

    Science.gov (United States)

    Fujishiro, Hiroshige; Iseki, Eizo; Murayama, Norio; Yamamoto, Ryoko; Higashi, Shinji; Kasanuki, Koji; Suzuki, Masaru; Arai, Heii; Sato, Kiyoshi

    2010-09-01

    Previous longitudinal studies have revealed that specific patterns on [(18) F]-fluoro-d-glucose (FDG) positron emission tomography (PET) scans in patients with amnesic mild cognitive impairment can predict Alzheimer's disease (AD). However, the significance of particular patterns on [(18) F]-FDG PET scans in prodromal patients with dementia with Lewy bodies (DLB) remains unclear. Based on the prevailing evidence that rapid eye movement (REM) sleep behavior disorder (RBD) often precedes the onset of DLB, [(18) F]-FDG PET scans of nine non-demented patients reporting recurrent nocturnal dream-enactment behavior in our memory clinic were compared with the normative database using three-dimensional stereotactic surface projection (3D-SSP) images. All patients underwent clinical and neuropsychological examinations as well as cardiac [(123) I]-metaiodobenzylguanidine ([(123) I]-MIBG) scintigraphy. Four patients were found to have diffuse areas of reduced cerebral metabolic rate of glucose (CMRglc), predominantly in the occipital lobe, which is the preferentially affected region in DLB patients. In contrast, five patients showed no such occipital hypometabolism; instead, these five patients showed hypometabolism in the left anterior cingulate gyrus (Broadmann area (BA) 24), right frontal lobe (BA 32) and right anterior temporal lobe (BA 38), which are the preferentially affected regions in Parkinson's disease rather than DLB. The extent of the reduction in CMRglc in the left occipital lobe was correlated with scores on the Bender Gestalt Test, which reflects visuospatial ability, but not with global cognitive measures. All patients showed reduced cardiac [(123) I]-MIBG levels, consistent with underlying Lewy body disease. These variations in [(18) F]-FDG PET scans raise the possibility that the specific pattern of CMRglc reduction may predict developing DLB in patients with idiopathic RBD. Further follow-up studies are needed, particularly on patients with diffuse

  20. Assessment of the efficacy of early phase parameters by (123)I-MIBG dynamic imaging for distinguishing Lewy body-related diseases from Parkinson's syndrome.

    Science.gov (United States)

    Shiiba, Takuro; Nishii, Ryuichi; Sasaki, Masayuki; Kihara, Yasushi; Tsuruta, Kazuhito; Maeda, Masaji; Morishita, Junji

    2015-02-01

    The aim of this study was to assess the efficacy of early phase washout rate (early WR) and area under the time-activity curve (AUTAC) by (123)I-metaiodobenzylguanidine (MIBG) dynamic chest imaging for distinguishing Lewy body-related diseases (LBRD) from Parkinson's syndrome (PS) and reducing examination time. Sixty-two patients with suspected LBRD who underwent (123)I-MIBG dynamic imaging in early phase were retrospectively selected. The early WR and AUTAC were calculated from (123)I-MIBG dynamic data of the heart. We evaluated the relationships between proposed and conventional parameters by using Spearman's rank correlation coefficient. Differences in parameters between LBRD and PS groups were tested for statistical significance using the Mann-Whitney U test. The diagnostic performance of all parameters for distinguishing LBRD from PS was assessed in terms of receiver operating characteristic (ROC) analysis. Additionally, combination diagnostic performance and concordance rate between early phase parameters and late H/M ratio by kappa statistics were also assessed. The early WR and AUTAC showed a positive and negative correlation with conventional parameters. Both the early WR and AUTAC of LBRD group were significantly distinguishable from those of the PS group (p < 0.001). Area under the ROC curve of the early WR (0.98) was greater than that of AUTAC (0.91). The diagnostic performance of combination of the early phase parameters was 93 % sensitivity and 100 % specificity. Moreover, the early phase parameters showed excellent agreement with late H/M ratio (k = 0.93). The early WR and AUTAC showed high performance for distinguishing LBRD from PS, and the combination diagnosis with early H/M ratio and early WR contribute to improve the diagnostic performance. Thus, these parameters would be useful for reducing the examination time of myocardial (123)I-MIBG scintigraphy to diagnose LBRD.

  1. MIBG avidity correlates with clinical features, tumor biology, and outcomes in neuroblastoma: A report from the Children's Oncology Group.

    Science.gov (United States)

    DuBois, Steven G; Mody, Rajen; Naranjo, Arlene; Van Ryn, Collin; Russ, Douglas; Oldridge, Derek; Kreissman, Susan; Baker, David L; Parisi, Marguerite; Shulkin, Barry L; Bai, Harrison; Diskin, Sharon J; Batra, Vandana; Maris, John M; Park, Julie R; Matthay, Katherine K; Yanik, Gregory

    2017-11-01

    Prior studies suggest that neuroblastomas that do not accumulate metaiodobenzylguanidine (MIBG) on diagnostic imaging (MIBG non-avid) may have more favorable features compared with MIBG avid tumors. We compared clinical features, biologic features, and clinical outcomes between patients with MIBG nonavid and MIBG avid neuroblastoma. Patients had metastatic high- or intermediate-risk neuroblastoma and were treated on Children's Oncology Group protocols A3973 or A3961. Comparisons of clinical and biologic features according to MIBG avidity were made with chi-squared or Fisher exact tests. Event-free (EFS) and overall (OS) survival compared using log-rank tests and modeled using Cox models. Thirty of 343 patients (8.7%) had MIBG nonavid disease. Patients with nonavid tumors were less likely to have adrenal primary tumors (34.5 vs. 57.2%; P = 0.019), bone metastases (36.7 vs. 61.7%; P = 0.008), or positive urine catecholamines (66.7 vs. 91.0%; P < 0.001) compared with patients with MIBG avid tumors. Nonavid tumors were more likely to be MYCN amplified (53.8 vs. 32.6%; P = 0.030) and had lower norepinephrine transporter expression. Patients with MIBG nonavid disease had a 5-year EFS of 50.0% compared with 38.7% for patients with MIBG avid disease (P = 0.028). On multivariate testing in high-risk patients, MIBG avidity was the sole adverse prognostic factor for EFS identified (hazard ratio 1.77; 95% confidence interval 1.04-2.99; P = 0.034). Patients with MIBG nonavid neuroblastoma have lower rates of adrenal primary tumors, bone metastasis, and catecholamine secretion. Despite being more likely to have MYCN-amplified tumors, these patients have superior outcomes compared with patients with MIBG avid disease. © 2017 Wiley Periodicals, Inc.

  2. Validation of Postinduction Curie Scores in High-Risk Neuroblastoma: A Children's Oncology Group and SIOPEN Group Report on SIOPEN/HR-NBL1.

    Science.gov (United States)

    Yanik, Gregory A; Parisi, Marguerite T; Naranjo, Arlene; Nadel, Helen; Gelfand, Michael J; Park, Julie R; Ladenstein, Ruth L; Poetschger, Ulrike; Boubaker, Ariane; Valteau-Couanet, Dominique; Lambert, Bieke; Castellani, Maria-Rita; Bar-Sever, Zvi; Oudoux, Aurore; Kaminska, Anna; Kreissman, Susan G; Shulkin, Barry L; Matthay, Katherine K

    2018-03-01

    A semiquantitative 123 I-metaiodobenzylguanidine ( 123 I-MIBG) scoring method (the Curie score, or CS) was previously examined in the Children's Oncology Group (COG) high-risk neuroblastoma trial, COG A3973, with a postinduction CS of more than 2 being associated with poor event-free survival (EFS). The validation of the CS in an independent dataset, International Society of Paediatric Oncology European Neuroblastoma/High-Risk Neuroblastoma 1 (SIOPEN/HR-NBL1), is now reported. Methods: A retrospective analysis of 123 I-MIBG scans obtained from patients who had been prospectively enrolled in SIOPEN/HR-NBL1 was performed. All patients exhibited 123 I-MIBG-avid, International Neuroblastoma Staging System stage 4 neuroblastoma. 123 I-MIBG scans were evaluated at 2 time points, diagnosis ( n = 345) and postinduction ( n = 330), before consolidation myeloablative therapy. Scans of 10 anatomic regions were evaluated, with each region being scored 0-3 on the basis of disease extent and a cumulative CS generated. Cut points for outcome analysis were identified by Youden methodology. CSs from patients enrolled in COG A3973 were used for comparison. Results: The optimal cut point for CS at diagnosis was 12 in SIOPEN/HR-NBL1, with a significant outcome difference by CS noted (5-y EFS, 43.0% ± 5.7% [CS ≤ 12] vs. 21.4% ± 3.6% [CS > 12], P 2], P < 0.0001). The postinduction CS maintained independent statistical significance in Cox models when adjusted for the covariates of age and MYCN gene copy number. Conclusion: The prognostic significance of postinduction CSs has now been validated in an independent cohort of patients (SIOPEN/HR-NBL1), with a postinduction CS of more than 2 being associated with an inferior outcome in 2 independent large, cooperative group trials. © 2018 by the Society of Nuclear Medicine and Molecular Imaging.

  3. Nuclear medicine applications for neuroendocrine tumors.

    Science.gov (United States)

    Chatal, J F; Le Bodic, M F; Kraeber-Bodéré, F; Rousseau, C; Resche, I

    2000-11-01

    Sensitive, specific radiopharmaceuticals are available for scintigraphic diagnosis and internal radiotherapy of neuroendocrine tumors. (123)I-MIBG (metaiodobenzylguanidine) scintigraphy is the examination of choice for visualizing tumor sites of pheochromocytoma. In the event of malignant pheochromocytoma or carcinoid tumor, this examination allows assessment of the presence or absence of tumor uptake and can guide radiotherapy with (131)I-MIBG. The peptides secreted by neuroendocrine tumors can be radiolabeled for targeting of their specific receptors. Scintigraphy using a (111)In-labeled somatostatin analog (octreotide) is the examination of choice for diagnosis of the spread of gastroenteropancreatic and carcinoid tumors, as it is more sensitive than morphologic imaging techniques. It can also guide radiotherapy performed with the same pharmaceutical vector. These same two agents (MIBG and octreotide) can be used therapeutically by replacing (123)I with (131)I and (111)In by (90)Y. A transient palliative effect is obtained for a variable number of tumors (most often large ones) that take up the radiopharmaceutic agent well. There is general consensus that, for relatively radioresistant solid tumors, this type of radiotherapy is efficient only in the event of small tumor targets (a few millimeters in diameter) whose uptake is maximal, allowing more homogeneous distribution than that achieved with large tumors. Thus for optimal control of the disease it is recommended first to use scintigraphic imaging to confirm that the tumor takes up the radiopharmaceutical agent in question ((123)I-MIBG or (111)In-octreotide) and then reduce the tumor burden surgically before injecting high therapeutic activity (possibly with reinjection of peripheral stem cells). This treatment can be repeated three times every 3 months before evaluating the response. In these conditions, internal radiotherapy can be beneficial or even determinant for controlling disease progression.

  4. Patterns of Relapse in High-Risk Neuroblastoma Patients Treated With and Without Total Body Irradiation

    International Nuclear Information System (INIS)

    Li, Richard; Polishchuk, Alexei; DuBois, Steven; Hawkins, Randall; Lee, Stephanie W.; Bagatell, Rochelle; Shusterman, Suzanne; Hill-Kayser, Christine; Al-Sayegh, Hasan; Diller, Lisa; Haas-Kogan, Daphne A.; Matthay, Katherine K.; London, Wendy B.

    2017-01-01

    Purpose: External beam radiation therapy to initial sites of disease may influence relapse patterns in high-risk neuroblastoma. However, the effect of systemic irradiation by use of total body irradiation (TBI) on anatomic patterns of relapse has not previously been investigated. Methods and Materials: We retrospectively analyzed patients receiving definitive treatment of high-risk neuroblastoma with subsequent relapse in bony metastatic sites, with a date of relapse between January 1, 1997, and December 31, 2012. Anatomic sites of disease, defined by metaiodobenzylguanidine (MIBG) avidity, were compared at diagnosis and at first relapse. The Fisher exact test was performed to compare relapse in initially involved sites between patients treated with and without TBI. Results: Seventy-four patients with a median age at diagnosis of 3.5 years (range, 0.3-15.3 years) had relapse in 227 sites of MIBG-avid metastatic disease, with a median time to relapse of 1.8 years. Of the 227 sites of first relapse, 154 sites (68%) were involved at diagnosis. When we compared relapse patterns in patients treated with and without TBI, 12 of 23 patients (52%) treated with TBI had relapse in ≥1 previously MIBG-avid site of disease whereas 40 of 51 patients (78%) treated without TBI had relapse in ≥1 previously MIBG-avid site of disease (P=.03). Conclusions: Patients treated with systemic irradiation in the form of TBI were significantly less likely to have relapse in prior sites of disease. These findings support further investigation into the role of radiopharmaceutical therapies in curative multimodality therapy.

  5. Patterns of Relapse in High-Risk Neuroblastoma Patients Treated With and Without Total Body Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Li, Richard [Harvard Medical School, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Polishchuk, Alexei [School of Medicine, University of California San Francisco, San Francisco, California (United States); DuBois, Steven [Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Hawkins, Randall [School of Medicine, University of California San Francisco, San Francisco, California (United States); Lee, Stephanie W. [Brigham and Women' s Hospital, Boston, Massachusetts (United States); Bagatell, Rochelle [Children' s Hospital of Philadelphia, Philadelphia, Pennsylvania (United States); Shusterman, Suzanne [Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Hill-Kayser, Christine [Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Al-Sayegh, Hasan [Brigham and Women' s Hospital, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Diller, Lisa [Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Haas-Kogan, Daphne A. [Harvard Medical School, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Matthay, Katherine K. [School of Medicine, University of California San Francisco, San Francisco, California (United States); London, Wendy B. [Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); and others

    2017-02-01

    Purpose: External beam radiation therapy to initial sites of disease may influence relapse patterns in high-risk neuroblastoma. However, the effect of systemic irradiation by use of total body irradiation (TBI) on anatomic patterns of relapse has not previously been investigated. Methods and Materials: We retrospectively analyzed patients receiving definitive treatment of high-risk neuroblastoma with subsequent relapse in bony metastatic sites, with a date of relapse between January 1, 1997, and December 31, 2012. Anatomic sites of disease, defined by metaiodobenzylguanidine (MIBG) avidity, were compared at diagnosis and at first relapse. The Fisher exact test was performed to compare relapse in initially involved sites between patients treated with and without TBI. Results: Seventy-four patients with a median age at diagnosis of 3.5 years (range, 0.3-15.3 years) had relapse in 227 sites of MIBG-avid metastatic disease, with a median time to relapse of 1.8 years. Of the 227 sites of first relapse, 154 sites (68%) were involved at diagnosis. When we compared relapse patterns in patients treated with and without TBI, 12 of 23 patients (52%) treated with TBI had relapse in ≥1 previously MIBG-avid site of disease whereas 40 of 51 patients (78%) treated without TBI had relapse in ≥1 previously MIBG-avid site of disease (P=.03). Conclusions: Patients treated with systemic irradiation in the form of TBI were significantly less likely to have relapse in prior sites of disease. These findings support further investigation into the role of radiopharmaceutical therapies in curative multimodality therapy.

  6. Plasma norepinephrine is an independent predictor of adverse cerebral and cardiovascular events in type 2 diabetic patients without structural heart disease.

    Science.gov (United States)

    Yufu, Kunio; Okada, Norihiro; Ebata, Yuki; Murozono, Yukichi; Shinohara, Tetsuji; Nakagawa, Mikiko; Takahashi, Naohiko

    2014-09-01

    Resting plasma norepinephrine (NE) level was reportedly related to high mortality in patients with heart failure. The current study investigated whether resting NE could predict long-term major adverse cerebral and cardiovascular events (MACCEs) in Japanese type 2 diabetic patients without heart disease. We evaluated resting NE in 95 patients with type 2 diabetes who did not have severe complications. Based on the ROC curves, high NE was defined as ≥333pg/ml. Accurate follow-up information during a mean of 3.6±1.9 years was obtained in 27 high NE patients (13 female, mean age 64±12 years) and 68 low NE patients (29 female, 60±12 years). The Kaplan-Meier curves revealed that MACCE-free ratio was significantly lower in the high NE patients than in the low NE patients (log-rank 10.3, p=0.0013). Cox proportional hazards regression analysis revealed that female gender (hazard ratio 7.75), low baroreflex sensitivity (hazard ratio 6.66), and high NE (hazard ratio 5.40) were independently associated with the incidence of MACCE. Our results suggest that resting NE is comparably useful to identify the high-risk patients for MACCE to baroreflex sensitivity in type 2 diabetic patients. The results also suggest that pathogenic sympathetic activation leading to MACCE may be identified by the assessment of resting NE, more easily and less expensively compared to cardiac iodine 123 metaiodobenzylguanidine scintigraphy in this population. Copyright © 2014. Published by Elsevier Ltd.

  7. Meta[{sup 131}I]iodobenzylguanidine therapy for patients with metastatic and unresectable pheochromocytoma and paraganglioma

    Energy Technology Data Exchange (ETDEWEB)

    Goldsby, Robert E. [Division of Pediatric Oncology, Department of Pediatrics, University of California, San Francisco, CA 94143-0106 (United States); Fitzgerald, Paul A. [Division of Endocrinology, Department of Medicine, University of California, San Francisco, CA 94143-1222 (United States)], E-mail: paul.fitzgerald@ucsf.edu

    2008-08-15

    Introduction: Pheochromocytomas (PHEOs) and paragangliomas (PGLs) are tumors that can exhibit a malignant behavior. Targeted radiotherapy with {sup 131}I-metaiodobenzylguanidine ({sup 131}I-MIBG) has proven useful in patients with unresectable, metastatic and/or relapsed disease. Methods: We review the literature and our experience at UCSF to highlight important characteristics of PHEO/PGL and the use of {sup 131}I-MIBG in the treatment of this disease. Results: These tumors are rare, with a diagnosed incidence of only two to four cases per million annually; 40% are discovered at autopsy. Clinical manifestations are caused by excess secretion of catecholamines, although some PGLs are nonsecretory. Approximately 25% of patients with PHEO/PGLs have an underlying genetic predisposition. The risk of a germline mutation is higher in children. Diagnostic evaluation should include serial determinations of fractionated metanephrines and serum chromogranin A. Staging requires both {sup 123}I-MIBG and full-body magnetic resonance imaging or {sup 18}FDG-PET scanning. The primary treatment for PHEO/PGL is resection. Patients may be candidates for treatment with {sup 131}I-MIBG if they have unresectable or metastatic tumors that are avid for MIBG. Such patients usually respond to this targeted radioisotope therapy and many achieve a durable remission. Myelosuppression is a dose-related side effect that can be treated with transfusions or autologous hematopoietic stem cells. Late side effects can include infertility, myelodysplasia and second cancers. Conclusions: Treatment with {sup 131}I-MIBG can be considered for patients if surgery is not feasible. There are significant risks associated with this treatment, but the majority of patients will respond. Treatment with {sup 131}I-MIBG should be done at institutions with experience in delivering targeted radiotherapeutics.

  8. Hypertension complicating {sup 131}I-meta-iodobenzylguanidine therapy for neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Kosmin, Michael A.; Cork, Nicholas J.; Gaze, Mark N. [University College London Hospitals NHS Foundation Trust, Department of Oncology, London (United Kingdom); Bomanji, Jamshed B. [University College London Hospitals NHS Foundation Trust, Department of Nuclear Medicine, London (United Kingdom); Shankar, Ananth [University College London Hospitals NHS Foundation Trust, Department of Paediatric Oncology, London (United Kingdom)

    2012-04-15

    Radiolabelled meta-iodobenzylguanidine (mIBG), used as targeted therapy for neuroblastoma, is known to have effects on blood pressure (BP). In this study we audited BP changes in patients receiving {sup 131}I-mIBG therapy for neuroblastoma to identify BP-related adverse events (AE) and possible predictive factors. Between 2003 and 2010, 50 patients with neuroblastoma received 110 {sup 131}I-mIBG administrations. BP measurements before and after administration were compared with age- and sex-matched centile values. AE were analysed, and possible predisposing factors identified. This population had a baseline BP distribution higher than that of their age- and sex-matched peers, with 16% of preadministration systolic BP values above the 95th centile. Changes in BP after administration showed an approximately normal distribution with similar numbers of reduced and increased values. Four AE, all related to hypertension, occurred with one patient having generalized seizures. One AE was immediate, others occurred between 20 and 25 h after administration. No significant association between AE and patient age or sex was demonstrated. However, a significant association between AE and high preadministration BP was shown, both above the 90th centile (p = 0.0022) and above the 95th centile (p = 0.0135). Clinically relevant hypertension following {sup 131}I-mIBG therapy affected less than 5% of administrations, but was more common in those patients with preexisting hypertension. As hypertensive episodes may occur many hours after treatment, close monitoring of BP needs to be continued for at least 48 h after administration of {sup 131}I-mIBG. (orig.)

  9. 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.)

  10. 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)

  11. Clinical use of nuclear cardiology in the assessment of heart failure

    International Nuclear Information System (INIS)

    Han Lei; Shi Hongcheng

    2011-01-01

    Nuclear cardiology is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays an important role in their assessment and management. Quantitative gated single positron emission computed tomography is used to assess quantitatively cardiac volume, left ventricular ejection fraction, stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging can not only identify nonischemic heart failure and ischemic heart failure, but also demonstrate myocardial viability. Diastolic heart failure also termed as heart failure with a preserved left ventricular ejection fraction is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate and time to peak filling rate. With newer techniques such as three-dimensional, quantitative gated single positron emission computed tomography can assess movement of the left ventricle, and wall thickening evaluation aids its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using 123 I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using 123 I-15-(p-iodophenyl) 3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to improve heart failure diagnosis. Nuclear cardiology techniques contribute significantly to identifying patients with heart failure and to guiding their management decisions. (authors)

  12. Vorinostat increases expression of functional norepinephrine transporter in neuroblastoma in vitro and in vivo model systems

    Science.gov (United States)

    More, Swati S.; Itsara, Melissa; Yang, Xiaodong; Geier, Ethan G.; Tadano, Michelle K.; Seo, Youngho; VanBrocklin, Henry F.; Weiss, William A.; Mueller, Sabine; Haas-Kogan, Daphne A.; DuBois, Steven G.; Matthay, Katherine K.; Giacomini, Kathleen M.

    2011-01-01

    Purpose Histone deacetylase (HDAC) inhibition causes transcriptional activation or repression of several genes that in turn can influence the biodistribution of other chemotherapeutic agents. Here, we hypothesize that the combination of vorinostat, a HDAC inhibitor, with 131I-metaiodobenzylguanidine (MIBG) would lead to preferential accumulation of the latter in neuroblastoma (NB) tumors via increased expression of the human norepinephrine transporter (NET). Experimental Design In vitro and in vivo experiments examined the effect of vorinostat on the expression of NET, an uptake transporter for 131I-MIBG. Human NB cell lines (Kelly and SH-SY-5Y) and NB1691luc mouse xenografts were employed. The upregulated NET protein was characterized for its effect on 123I-MIBG biodistribution. Results Preincubation of NB cell lines, Kelly and SH-SY-5Y, with vorinostat caused dose-dependent increases in NET mRNA and protein levels. Accompanying this was a corresponding dose-dependent increase in MIBG uptake in NB cell lines. Four-fold and 2.5 fold increases were observed in Kelly and SH-SY-5Y cells, respectively, pre-treated with vorinostat in comparison to untreated cells. Similarly, NB xenografts, created by intravenous tail vein injection of NB1691-luc, and harvested from nude mice livers treated with vorinostat (150 mg/kg i.p.) showed substantial increases in NET protein expression. Maximal effect of vorinostat pretreatment in NB xenografts on 123I-MIBG biodistribution was observed in tumors that exhibited enhanced uptake in vorinostat treated (0.062 ± 0.011 μCi/(mg tissue-dose injected)) versus untreated mice (0.022 ± 0.003 μCi/(mg tissue-dose injected); p vorinostat treatment can enhance NB therapy with 131I-MIBG. PMID:21421857

  13. Intensified external-beam radiation therapy improves the outcome of stage 4 neuroblastoma in children > 1 year with residual local disease

    International Nuclear Information System (INIS)

    Simon, T.; Hero, B.; Berthold, F.; Bongartz, R.; Mueller, R.P.; Schmidt, M.

    2006-01-01

    Background and purpose: in neuroblastoma, the value of radiation therapy in high-intensive first-line treatment protocols is still not exactly known but radiation-associated long-term effects need to be considered. The impact of external-beam radiation therapy (EBRT) on event-free (EFS) and overall survival (OS) of stage 4 neuroblastoma patients of the NB97 trial was analyzed. Patients and methods: the authors retrospectively analyzed data of 110 stage 4 neuroblastoma patients ≥ 1 year who underwent induction therapy and high-dose chemotherapy with stem cell transplantation without relapse. Intensified local EBRT (36 Gy) of the residual tumor volume was reserved for patients with residual viable tumor documented by MRI and corresponding metaiodobenzylguanidine (MIBG) uptake. Results: 13 patients who received EBRT for local residual disease had similar outcome (3-year EFS 85 ± 10%, 3-year OS 92 ± 7%) as 74 patients without any MIBG residual (3-year EFS 61 ± 6%, 3-year OS 75 ± 6%). Outcome was worse in 23 children without EBRT to residual primary (3-year EFS 25 ± 10%, 3-year OS 51 ± 11%). Separate analysis of 14 patients with isolated localized residual disease found far better outcome of eight patients with EBRT (3-year EFS 100%, 3-year OS 100%) compared to six patients without EBRT (3-year EFS 20 ± 18%, 3-year OS 20 ± 18%). Multivariate analysis identified EBRT as influential on EFS (hazard ratio 0.27) and OS (hazard ratio 0.17) in addition to MYCN amplification and presence of primary tumor site MIBG residual. Conclusion: EBRT appeared effective in high-intensive treatment of stage 4 neuroblastoma. It seems to compensate the disadvantage of incomplete response to induction chemotherapy. These retrospective results need confirmation by a prospective randomized trial. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  15. Use of myocardial tomo-scintigraphy by 123I - MIBG in right ventricle arrhythmia-gen dysplasia

    International Nuclear Information System (INIS)

    Agostini, D.; Manrique, A.; Darlas, Y.; Loiselet, P.; Scanu, P.; Grollier, G.; Potier, J.C.; Bouvard, G.

    1997-01-01

    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 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 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 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, 123 I - MIBG allows the detecting of presence of a sympathetic dys-innervation of left ventricle in patients afflicted with RVAD

  16. 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

  17. Diagnostic tools for REM sleep behavior disorder.

    Science.gov (United States)

    Neikrug, Ariel B; Ancoli-Israel, Sonia

    2012-10-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by loss of muscle atonia during REM sleep that results in motor behaviors. Diagnosis of RBD involves a clinical interview in which history of dream enactment behaviors is elicited and a subsequent overnight polysomnography (PSG) evaluation to assess for REM sleep without atonia (RWA) and/or observe motor behaviors during REM sleep. Therefore, the nature of RBD diagnosis involves both subjective and objective measurements that attempt to qualify and quantify the different diagnostic sub-criteria. The primary aim of the current study was to identify and summarize the available clinical measurements that have been used for RBD assessment. Two major online databases (MEDLINE and PsycInfo) were searched for articles developing, validating, or evaluating psychometric properties of the RBD diagnostic criteria or methods used for diagnosis. Studies of adult subjects (18 years or more) that included sufficient psychometric data for validation were included. Fifty-eight studies were found to meet review criteria. The objective measurements for assessment of RBD reviewed included visual electromyographic (EMG) scoring methods, computerized EMG scoring methods, cardiac (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy, actigraphy, behavioral classification and video analysis. Subjective measurements of RBD included interviews and questionnaires. Sleep history may be sufficient for diagnosis of RBD in some populations. However, PSG is necessary for a definitive diagnosis. EMG scoring methods vary in definition used and there is no single accepted approach to scoring muscle activity. Additional validation studies are required for establishing cutoff scores for the different methods. Questionnaires were shown to be appropriate screening tools, yet further validation in different populations is necessary. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Comparison of {sup 18}F-dopa PET/CT and {sup 123}I-MIBG scintigraphy in stage 3 and 4 neuroblastoma: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Piccardo, Arnoldo [Galliera Hospital, Nuclear Medicine Unit, Genoa (Italy); E.O. Ospedali Galliera, Department of Nuclear Medicine, Genoa (Italy); Lopci, Egesta; Nanni, Cristina; Fanti, Stefano [Sant' Orsola-Malpighi Hospital, Nuclear Medicine Unit, Bologna (Italy); Conte, Massimo; Garaventa, Alberto; Sorrentino, Stefania [G. Gaslini Hospital, Medical and Pediatric Oncology Division, Genoa (Italy); Foppiani, Luca [Endocrinology, Galliera Hospital, Genoa (Italy); Altrinetti, Vania; Bianchi, Pietro; Cabria, Manlio; Villavecchia, Giampiero [Galliera Hospital, Nuclear Medicine Unit, Genoa (Italy); Cistaro, Angela [PET Centre, IRMET, Turin (Italy); Pession, Andrea [S. Orsola-Malpighi Hospital, Department of Pediatric Oncohematology, Bologna (Italy); Puntoni, Matteo [Galliera Hospital, Scientific Directorate - Clinical Trial Research Unit, Genoa (Italy)

    2012-01-15

    {sup 18}F-Dopa positron emission tomography (PET)/CT has proved a valuable tool for the assessment of neuroendocrine tumours. So far no data are available on {sup 18}F-dopa utilization in neuroblastoma (NB). Our aim was to evaluate the role of {sup 18}F-dopa PET/CT in NB and compare its diagnostic value with that of {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy in patients affected by stage 3-4 NB. We prospectively evaluated 28 paired {sup 123}I-MIBG and {sup 18}F-dopa PET/CT scans in 19 patients: 4 at the time of the NB diagnosis and 15 when NB relapse was suspected. For both imaging modalities we performed a scan-based and a lesion-based analysis and calculated sensitivity, specificity and accuracy. The standard of reference was based on clinical, imaging and histological data. NB localizations were confirmed in 17 of 19 patients. {sup 18}F-Dopa PET/CT and {sup 123}I-MIBG scintigraphy properly detected disease in 16 (94%) and 11 (65%), respectively. On scan-based analysis, {sup 18}F-dopa PET/CT showed a sensitivity and accuracy of 95 and 96%, respectively, while {sup 123}I-MIBG scanning showed a sensitivity and accuracy of 68 and 64%, respectively (p < 0.05). No significant difference in terms of specificity was found. In 9 of 28 paired scans (32%) PET/CT results influenced the patient management. We identified 156 NB localizations, 141 of which were correctly detected by {sup 18}F-dopa PET/CT and 88 by MIBG. On lesion-based analysis, {sup 18}F-dopa PET/CT showed a sensitivity and accuracy of 90% whereas {sup 123}I-MIBG scintigraphy showed a sensitivity and accuracy of 56 and 57%, respectively (p < 0.001). No significant difference in terms of specificity was found. In our NB population {sup 18}F-dopa PET/CT displayed higher overall accuracy than {sup 123}I-MIBG scintigraphy. Consequently, we suggest {sup 18}F-dopa PET/CT as a new opportunity for NB assessment. (orig.)

  19. Vascular time-activity variation in patients undergoing {sup 123}I-MIBG myocardial scintigraphy: implications for quantification of cardiac and mediastinal uptake

    Energy Technology Data Exchange (ETDEWEB)

    Verberne, Hein J.; Eck-Smit, Berthe L.F. van [University of Amsterdam, Department of Nuclear Medicine, room F2-238, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands); Verschure, Derk O. [University of Amsterdam, Department of Nuclear Medicine, room F2-238, Academic Medical Center, PO Box 22700, Amsterdam (Netherlands); Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands); Somsen, G.A. [Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands); Cardiology Centers of the Netherlands, Amsterdam (Netherlands); Jacobson, Arnold F. [GE Healthcare, Cardiac Center of Excellence, Princeton, NJ (United States)

    2011-06-15

    For the quantification of cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) uptake, the mediastinum is commonly used as a reference region reflecting nonspecific background activity. However, variations in the quantity of vascular structures in the mediastinum and the rate of renal clearance of {sup 123}I-MIBG from the blood pool may contribute to increased interindividual variation in uptake. This study examined the relationship between changes in heart (H) and mediastinal (M) counts and the change in vascular {sup 123}I-MIBG activity, including the effect of renal function. Fifty-one subjects with ischemic heart disease underwent early (15 min) and late (4 h) anterior planar images of the chest following injection of {sup 123}I-MIBG. Vascular {sup 123}I-MIBG activity was determined from venous blood samples obtained at 2 min, 15 min, 35 min, and 4 h post-injection. From the vascular clearance curve of each subject, the mean blood counts/min per ml at the time of each acquisition and the slope of the clearance curve were determined. Renal function was expressed as the estimated creatinine clearance (e-CC) and the estimated glomerular filtration rate (e-GFR). Relations between H and M region of interest (ROI) counts/pixel, vascular activity, and renal function were then examined using linear regression. Changes in ROI activity ratios between early and late planar images could not be explained by blood activity, the slope of the vascular clearance curves, or estimates of renal function. At most 3% of the variation in image counts could be explained by changes in vascular activity (p = 0.104). The e-CC and e-GFR could at best explain approximately 1.5% of the variation in the slopes of the vascular clearance curve (p = 0.194). The change in measured H and M counts between early and late planar {sup 123}I-MIBG images is unrelated to intravascular levels of the radiopharmaceutical. This suggests that changes in M counts are primarily due to decrease in soft tissue

  20. Efeito do carvedilol a curto prazo na atividade simpática cardíaca pela cintilografia com 123I-MIBG Effects of short-term carvedilol on the cardiac sympathetic activity assessed by 123I-MIBG scintigraphy

    Directory of Open Access Journals (Sweden)

    Sandra Marina Ribeiro de Miranda

    2010-03-01

    Full Text Available FUNDAMENTO: Alterações autonômicas na insuficiência cardíaca estão associadas a um aumento da morbimortalidade. Vários métodos não invasivos têm sido empregados para avaliar a função simpática, incluindo a imagem cardíaca com 123I-MIBG. OBJETIVO: Avaliar a atividade simpática cardíaca, por meio da cintilografia com 123I-MIBG, antes e após três meses de terapia com carvedilol em pacientes com insuficiência cardíaca com fração de ejeção do VE BACKGROUND: Autonomic alterations in heart failure are associated with an increase in morbimortality. Several noninvasive methods have been employed to evaluate the sympathetic function, including the Meta-Iodobenzylguanidine (123I-MIBG scintigraphy imaging of the heart. OBJECTIVE: to evaluate the cardiac sympathetic activity through 123I-MIBG scintigraphy, before and after three months of carvedilol therapy in patients with heart failure and left ventricular ejection fraction (LVEF < 45%. PATIENTS AND METHODS: Sixteen patients, aged 56.3 ± 12.6 years (11 males, with a mean LVEF of 28% ± 8% and no previous use of beta-blockers were recruited for the study. Images of the heart innervation were acquired with 123I-MIBG, and the serum levels of catecholamines (epinephrine, dopamine and norepinephrine were measured; the radioisotope ventriculography (RIV was performed before and after a three-month therapy with carvedilol. RESULTS: Patients' functional class showed improvement: before the treatment, 50% of the patients were FC II and 50% were FC III. After 3 months, 7 patients were FC I (43.8% and 9 were FC II (56.2%, (p = 0.0001. The mean LVEF assessed by RIV increased from 29% to 33% (p = 0.017. There was no significant variation in cardiac adrenergic activity assessed by 123I-MIBG (early and late resting images and washout rate. No significant variation was observed regarding the measurement of catecholamines. CONCLUSION: The short-term treatment with carvedilol promoted the clinical

  1. Impact of concomitant medication use on myocardial 123I-mIBG imaging results in patients with heart failure.

    Science.gov (United States)

    Jacobson, Arnold F; White, Susan; Travin, Mark I; Tseng, Carol

    2017-02-01

    Medications that interfere with sympathetic neuronal norepinephrine uptake and storage, such as neuropsychiatrics (NP) and sympathomimetic amines, are most likely to affect cardiac uptake of iodine-123 metaiodobenzylguanidine (I-mIBG). The present study examined these and other medications reported to affect I-mIBG uptake using measurements of cardiac I-mIBG uptake on the heart failure (HF) patients in the ADMIRE-HF extension (X) study. Baseline concomitant medications taken by the 961 HF patients were categorized into five groups: calcium channel blockers, NP medications, β agonists and sympathomimetics, α antagonists, and other antihypertensives. NP medications were further subcategorized into those expected to have high and low impact on norepinephrine transporter (NET) function. Myocardial I-mIBG heart/mediastinum (H/M) uptake ratios on 4 h planar images were compared among the groups. Impact of medication group on the prognostic value of the H/M ratio for all-cause (AC) and cardiac death during a median 2-year follow-up was also examined. A total of 283 (29%) patients were using at least one calcium channel blocker, NP medication, or β agonist or sympathomimetic. These patients had a lower mean H/M ratio than the other study patients (1.42±0.20 vs. 1.45±0.20; P=0.022). However, the 2-year AC mortality rates in the two groups were the same [11.3% (95% confidence interval: 7.5-15.2%) vs. 11.8% (95% confidence interval: 9.2-14.4%)]. In terms of medication categories, there were no significant differences in the mean H/M ratios between patients who did and did not use NP medications, β agonists, calcium channel blockers, and α antagonists. Across all categories, patients with H/M ratio greater than or equal to 1.60 had lower AC and cardiac mortality. Patients using higher potency (for NET inhibition) NP medications had significantly lower H/M ratio values, but the prognostic significance of H/M ratio greater than or equal to 1.60 was unchanged. Only a

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

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, T.J.; Lee, J.D. [Division of Nuclear Medicine, Department of Diagnostic Radiology, Yonsei University Medical College, Seoul (Korea); Research Institute of Radiological Science, Yonsei University Medical College, Seoul (Korea); Ha, J.-W. [Cardiology Division, Yonsei Cardiovascular Center, Yonsei University Medical College, Seoul (Korea); Yang, W.I.; Cho, S.H. [Department of Pathology, Yonsei University Medical College, Seoul (Korea)

    2000-06-01

    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). {sup 131}I-MIBG uptake of the left ventricular wall (24 ROIs) was measured by autoradiography. {sup 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<0.05). The serum NA level also showed no statistical difference until 4 weeks and was significantly increased in the 8-week group (P<0.05). MIBG uptake was decreased in the 6- and 8-week groups (P<0.05), and was closely correlated with the reduction in the number of nerve fibres on PGP 9.5 stain. Myocyte damage was seen only in the 8-week group. Neuronal population and the {sup 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

  3. Radiopharmaceutical development and clinical needs

    International Nuclear Information System (INIS)

    Vieira, M.R.

    1998-01-01

    The use of radionuclides for medical applications has continued to grow at a very rapid pace. The use of radiotracers for nuclear medicine imaging and for radiotherapy of cancer as well as certain benign disorders is firmly established as an important clinical modality. Over the past ten years, nuclear medicine has experienced an evolution towards functional studies and novel therapeutic approaches. New radionuclides are required for these applications. In the developmental stages, each new isotope has to go through a phase of careful scrutiny and evaluation, and practical concerns related to the cost of production and availability must be addressed. The development of 18 F-labeled radiopharmaceuticals has opened a completely new area of investigation. Research on bioconjugates (this term includes radiolabeled antibodies, peptides, receptor-specific and other bioactive molecules) has experienced rapid growth because of the promise of a number of these ''bioactive molecules'' to serve as selective carriers of radionuclides for tumor-associated and other specific antigens/receptors ''in vivo''. The new concept of nuclear medicine, particularly when applied to the field of oncology is directed towards the physiological mechanisms and the study of molecular disfunctions. The search for new radiopharmaceuticals thus aims at studying tumors at a tissue and molecular level. Examples of this new approach are scans utilizing the following substances: -guanethidine and noradrenaline analogues such as meta-iodo-benzyl-guanidine labeled with iodine-131 or iodine-123 aimed at targeting neuroendocrine cells and their secretory granules; -various monoclonal antibodies directed at different tumor types, both for diagnostic and therapeutic purposes. Radioimmunotherapy is considered particularly suited for treatment of tumors not easily amenable to surgery and for the treatment of small disseminated lesions; -somatostatin analogs tagged with indium-111 or more recently with Yttrium

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Directory of Open Access Journals (Sweden)

    Leandro Rocha Messias

    2016-01-01

    Full Text Available Abstract Background: 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. Objectives: To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Methods: 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 (VO2. After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. Results: 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 VO2 and 123I-MIBG scintigraphic parameters. Conclusion: 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.

  6. Effects of adding intravenous nicorandil to standard therapy on cardiac sympathetic nerve activity and myocyte dysfunction in patients with acute decompensated heart failure

    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; Funada, Ryuichi; Takama, Noriaki; Koitabashi, Norimichi; Kurabayashi, Masahiko [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Ichikawa, Shuichi [Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Suzuki, Yasuyuki; Matsumoto, Naoya [Nihon University School of Medicine, Department of Cardiology, Tokyo (Japan); Sato, Yuichi [Health Park Clinic, Department of Imaging, Takasaki, Gunma (Japan)

    2015-04-01

    Nicorandil, an adenosine triphosphate-sensitive potassium channel opener, improves cardiac sympathetic nerve activity (CSNA) in ischemic heart disease or chronic heart failure. However, its effects on CSNA and myocyte dysfunction in acute heart failure (AHF) remain unclear. We investigated the effects of adding intravenous nicorandil to standard therapy on CSNA and myocyte dysfunction in AHF. We selected 70 patients with mild to moderate nonischemic AHF who were treated with standard conventional therapy soon after admission. Thirty-five patients were assigned to additionally receive intravenous nicorandil (4-12 mg/h; group A), whereas the remaining patients continued their current drug regimen (group B). Delayed total defect score (TDS), delayed heart to mediastinum count (H/M) ratio, and washout rate (WR) were determined by {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy within 3 days of admission and 4 weeks later. High sensitivity troponin T (hs-TnT) level was also measured at the same time points. After treatment, MIBG scintigraphic parameters significantly improved in both groups. However, the extent of the changes in these parameters in group A significantly exceeded the extent of the changes in group B [TDS -11.3 ± 4.3 in group A vs -4.0 ± 6.0 in group B (p < 0.01); H/M ratio 0.31 ± 0.16 vs 0.14 ± 0.16 (p < 0.01); WR -13.8 ± 7.8 % vs -6.1 ± 8.9 % (p < 0.01)]. The hs-TnT level decreased significantly from 0.052 ± 0.043 to 0.041 ± 0.033 ng/ml (p < 0.05) in group A, but showed no significant change in group B. Moreover, in both groups, no relationships between the extent of changes in MIBG parameters and hs-TnT level were observed. Adding intravenous nicorandil to standard therapy provides additional benefits for CSNA and myocyte dysfunction over conventional therapy alone in AHF patients. Furthermore, the mechanisms of improvement in CSNA and myocyte dysfunction after nicorandil treatment in AHF patients were distinct. (orig.)

  7. Use of 131I-MIBG: Tygerberg experience

    International Nuclear Information System (INIS)

    Canha, S.M. de; Swart, G.E.; Riet, F.A.D. van

    2004-01-01

    Full text: 131I-metaiodobenzylguanidine (131I-MIBG) is actively taken up by neurosecretory granules in the cytoplasm of tumour cells derived from the neural crest. It is therefore a useful treatment modality for tumours that concentrate 131I-MIBG. A retrospective analysis of 19 patients treated with 131I-MIBG in our hospital from 1987-2002 was done to determine its use and efficacy. The median age was 4.2 years with a range of 1.3 - 69.9 years. Thirteen (68.4%) of the patients were male and six were female. Records of 4 patients were missing. Rare indications for 131I-MIBG treatments were paraganglioma of the bladder, medullary carcinoma of the thyroid and pheochromocytoma. The majority of the patients had neuroblastoma - stage IV or recurrent disease. One patient with stage III neuroblastoma presented with spinal cord compression and was given a single dose of 131I-MIBG after surgical decompression. The aim of treatment was curative in 3 cases (15%), palliative in 13 (65%) and in 20% it was unknown. A total of 51 131I-MIBG injections were administered with an average of 3 treatments per patient. The average dose given per injection was 3796 MBq and the median interval between injections was 5 weeks. MIBG was generally well tolerated with only nausea and vomiting reported in some patients. The patients were monitored by their symptoms, full blood counts and diagnostic MIBG scans. In those cases where accurate records were kept-10 patients (52.6%) demonstrated a benefit and 5 cases (26.3%) did not. The latter experienced no palliation of their symptoms and disease progression was demonstrated during follow-up diagnostic MIBG scans. The symptoms that were palliated were hematuria (paraganglioma of bladder), proptosis (orbital metastasis in neuroblastoma), spinal cord compression and pain (soft tissue and bone). Record keeping and the availability of 131I-MIBG were the main problems encountered. On 02/04/2002, the 131I-MIBG produced locally became unstable and the

  8. 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.)

  9. Effects of Spinal Cord Stimulation on Cardiac Sympathetic Nerve Activity in Patients with Heart Failure.

    Science.gov (United States)

    Naar, Jan; Jaye, Deborah; Linde, Cecilia; Neužil, Petr; Doškář, Petr; Málek, Filip; Braunschweig, Frieder; Lund, Lars H; Mortensen, Lars; Linderoth, Bengt; Lind, Göran; Bone, Dianna; Scholte, Arthur J; Kueffer, Fred; Koehler, Jodi; Shahgaldi, Kambiz; Lang, Otto; Ståhlberg, Marcus

    2017-05-01

    Spinal cord stimulation (SCS) reduces sympathetic activity in animal models of heart failure with reduced ejection fraction (HF) but limited data exist of SCS in patients with HF. The aim of the present study was to test the primary hypothesis that SCS reduces cardiac sympathetic nerve activity in HF patients. Secondary hypotheses were that SCS improves left ventricular function and dimension, exercise capacity, and clinical variables relevant to HF. HF patients with a SCS device previously participating in the DEFEAT-HF trial were included in this crossover study with 6-week intervention periods (SCS-ON and SCS-OFF). SCS (50 Hz, 210-μs pulse duration, aiming at T2-T4 segments) was delivered for 12 hours daily. Indices of myocardial sympathetic neuronal function (heart-to-mediastinum ratio, HMR) and activity (washout rate, WR) were assessed using 123 I-metaiodobenzylguanidine (MIBG) scintigraphy. Echocardiography, exercise testing, and clinical data collection were also performed. We included 13 patients (65.3 ± 8.0 years, nine males) and MIBG scintigraphy data were available in 10. HMR was not different comparing SCS-ON (1.37 ± 0.16) and SCS-OFF (1.41 ± 0.21, P = 0.46). WR was also unchanged comparing SCS-ON (41.5 ± 5.3) and SCS-OFF (39.1 ± 5.8, P = 0.30). Similarly, average New York Heart Association class (2.4 ± 0.5 vs 2.3 ± 0.6, P = 0.34), quality of life score (24 ± 16 vs 24 ± 16, P = 0.94), and left ventricular dimension and function as well as exercise capacity were all unchanged comparing SCS-ON and SCS-OFF. In patients with HF, SCS (12 hours daily, targeting the T2-T4 segments of the spinal cord) does not appear to influence cardiac sympathetic neuronal activity or function as assessed by MIBG scintigraphy. © 2017 Wiley Periodicals, Inc.

  10. Radioiodinated phenylalkyl malonic acid derivatives as pH-sensitive SPECT tracers.

    Directory of Open Access Journals (Sweden)

    Matthias Bauwens

    Full Text Available INTRODUCTION: In vivo pH imaging has been a field of interest for molecular imaging for many years. This is especially important for determining tumor acidity, an important driving force of tumor invasion and metastasis formation, but also in the process of apoptosis. METHODS: 2-(4-[(123I]iodophenethyl-2-methylmalonic acid (IPMM, 2-(4-[(123I]iodophenethyl-malonic acid (IPM, 2-(4-[(123I]iodobenzyl-malonic acid (IBMM and 4-[(123I]iodophthalic acid (IP were radiolabeled via the Cu(+ isotopic nucleophilic exchange method. All tracers were tested in vitro in buffer systems to assess pH driven cell uptake. In vivo biodistribution of [(123I]IPMM and [(123I]IPM was determined in healthy mice and the pH targeting efficacy in vivo of [(123I]IPM was evaluated in an anti-Fas monoclonal antibody (mAb apoptosis model. In addition a mouse RIF-1 tumor model was explored in which tumor pH was decreased from 7.0 to 6.5 by means of induction of hyperglycemia in combination with administration of meta-iodobenzylguanidine. RESULTS: Radiosynthesis resulted in 15-20% for iodo-bromo exchange and 50-60% yield for iodo-iodo exchange while in vitro experiments showed a pH-sensitive uptake for all tracers. Shelf-life stability and in vivo stability was excellent for all tracers. [(123I]IPMM and [(123I]IPM showed a moderately fast predominantly biliary clearance while a high retention was observed in blood. The biodistribution profile of [(123I]IPM was found to be most favorable in view of pH-specific imaging. [(123I]IPM showed a clear pH-related uptake pattern in the RIF-1 tumor model. CONCLUSION: Iodine-123 labeled malonic acid derivates such as [(123I]IPM show a clearly pH dependent uptake in tumor cells both in vitro and in vivo which allows to visualize regional acidosis. However, these compounds are not suitable for detection of apoptosis due to a poor acidosis effect.

  11. Radionuclide therapy of endocrine-related cancer; Nuklearmedizinische Therapie endokriner Tumoren

    Energy Technology Data Exchange (ETDEWEB)

    Kratochwil, C.; Giesel, F.L. [Universitaetsklinikum Heidelberg, Abteilung Nuklearmedizin, Heidelberg (Germany)

    2014-10-15

    This article gives an overview of the established radionuclide therapies for endocrine-related cancer that already have market authorization or are currently under evaluation in clinical trials. Radioiodine therapy is still the gold standard for differentiated iodine-avid thyroid cancer. In patients with bone and lung metastases (near) total remission is seen in approximately 50 % and the 15-year survival rate for these patients is approximately 90 %. In contrast to the USA, meta-iodobenzylguanidine (MIBG) therapy has market approval in Europe. According to the current literature, in the setting of advanced stage neuroblastoma and malignant pheochromocytoma or paraganglioma, radiological remission can be achieved in > 30 % and symptom control in almost 80 % of the treated patients. Somatostatin receptor targeted radionuclide therapies (e.g. with DOTATATE or DOTATOC) demonstrated promising results in phase 2 trials, reporting progression-free survival in the range of 24-36 months. A first phase 3 pivotal trial for intestinal carcinoids is currently recruiting and another trial for pancreatic neuroendocrine tumors is planned. Radiopharmaceuticals based on glucagon-like peptide 1 (GLP1) or minigastrins are in the early evaluation stage for application in the treatment of insulinomas and medullary thyroid cancer. In general, radiopharmaceutical therapy belongs to the group of so-called theranostics which means that therapy is tailored for individual patients based on molecular imaging diagnostics to stratify target positive or target negative tumor phenotypes. (orig.) [German] Dieser Artikel gibt einen Ueberblick ueber die etablierten sowie weitere vielversprechende, aktuell im Rahmen von Studien eingesetzte nuklearmedizinische Therapiemoeglichkeiten diverser endokrinologischer Neoplasien. Die Radiojodtherapie ist unveraendert die Therapie der Wahl beim differenzierten, jodspeichernden Schilddruesenkarzinom. Im metastasierten Stadium sind in ca. 50 % der Faelle noch

  12. {sup 18}F-Fluorodihydroxyphenylalanine vs other radiopharmaceuticals for imaging neuroendocrine tumours according to their type

    Energy Technology Data Exchange (ETDEWEB)

    Balogova, Sona [Comenius University and St. Elisabeth Institute, Department of Nuclear Medicine, Bratislava (Slovakia); Hopital Tenon, AP-HP and Universite Pierre et Marie Curie, Department of Nuclear Medicine, Paris (France); Talbot, Jean-Noel; Michaud, Laure; Huchet, Virginie; Kerrou, Khaldoun; Montravers, Francoise [Hopital Tenon, AP-HP and Universite Pierre et Marie Curie, Department of Nuclear Medicine, Paris (France); Nataf, Valerie [Hopital Tenon, AP-HP, Department of Radiopharmacy, Paris (France)

    2013-06-15

    6-Fluoro-({sup 18}F)-L-3,4-dihydroxyphenylalanine (FDOPA) is an amino acid analogue for positron emission tomography (PET) imaging which has been registered since 2006 in several European Union (EU) countries and by several pharmaceutical firms. Neuroendocrine tumour (NET) imaging is part of its registered indications. NET functional imaging is a very competitive niche, competitors of FDOPA being two well-established radiopharmaceuticals for scintigraphy, {sup 123}I-metaiodobenzylguanidine (MIBG) and {sup 111}In-pentetreotide, and even more radiopharmaceuticals for PET, including fluorodeoxyglucose (FDG) and somatostatin analogues. Nevertheless, there is no universal single photon emission computed tomography (SPECT) or PET tracer for NET imaging, at least for the moment. FDOPA, as the other PET tracers, is superior in diagnostic performance in a limited number of precise NET types which are currently medullary thyroid cancer, catecholamine-producing tumours with a low aggressiveness and well-differentiated carcinoid tumours of the midgut, and in cases of congenital hyperinsulinism. This article reports on diagnostic performance and impact on management of FDOPA according to the NET type, emphasising the results of comparative studies with other radiopharmaceuticals. By pooling the results of the published studies with a defined standard of truth, patient-based sensitivity to detect recurrent medullary thyroid cancer was 70 % [95 % confidence interval (CI) 62.1-77.6] for FDOPA vs 44 % (95 % CI 35-53.4) for FDG; patient-based sensitivity to detect phaeochromocytoma/paraganglioma was 94 % (95 % CI 91.4-97.1) for FDOPA vs 69 % (95 % CI 60.2-77.1) for {sup 123}I-MIBG; and patient-based sensitivity to detect midgut NET was 89 % (95 % CI 80.3-95.3) for FDOPA vs 80 % (95 % CI 69.2-88.4) for somatostatin receptor scintigraphy with a larger gap in lesion-based sensitivity (97 vs 49 %). Previously unpublished FDOPA results from our team are reported in some rare NET, such as

  13. Cardiac Dysautonomia Predicts Long-Term Survival in Hereditary Transthyretin Amyloidosis After Liver Transplantation.

    Science.gov (United States)

    Algalarrondo, Vincent; Antonini, Teresa; Théaudin, Marie; Chemla, Denis; Benmalek, Anouar; Lacroix, Catherine; Castaing, Denis; Cauquil, Cécile; Dinanian, Sylvie; Eliahou, Ludivine; Samuel, Didier; Adams, David; Le Guludec, Dominique; Slama, Michel S; Rouzet, François

    2016-12-01

    This study sought to compare techniques evaluating cardiac dysautonomia and predicting the risk of death of patients with hereditary transthyretin amyloidosis (mATTR) after liver transplantation (LT). mATTR is a multisystemic disease involving mainly the heart and the peripheral nervous system. LT is the reference treatment, and pre-operative detection of high-risk patients is critical. Cardiovascular dysautonomia is commonly encountered in ATTR and may affect patient outcome, although it is not known yet which technique should be used in the field to evaluate it. In a series of 215 consecutive mATTR patients who underwent LT, cardiac dysautonomia was assessed by a dedicated clinical score, time-domain heart rate variability, 123 -meta-iodobenzylguanidine heart/mediastinum ( 123 -MIBG H/M) ratio on scintigraphy, and heart rate response to atropine (HRRA). Patient median age was 43 years, 62% were male and 69% carried the Val30Met mutation. Cardiac dysautonomia was documented by at least 1 technique for all patients but 6 (97%). In univariate analysis, clinical score, 123 -MIBG H/M ratio and HRRA were associated with mortality but not heart rate variability. The 123 -MIBG H/M ratio and HRRA had greater area under the curve (AUC) of receiver-operating characteristic curves than clinical score and heart rate variability (AUC: 0.787, 0.748, 0.656, and 0.523, respectively). Multivariate score models were then built using the following variables: New York Heart Association functional class, interventricular septum thickness, and either 123- MIBG H/M ratio (S MIBG ) or HRRA (S atropine ). AUC of S MIBG and S atropine were greater than AUC of univariate models, although nonsignificantly (AUC: 0.798 and 0.799, respectively). Predictive powers of S MIBG , S atropine , and a reference clinical model (AUC: 0.785) were similar. Evaluation of cardiac dysautonomia is a valuable addition for predicting survival of mATTR patients following LT. Among the different techniques that

  14. Early Detection and Treatment of Neuroblastic Tumor with Opsoclonus-Myoclonus Syndrome Improve Neurological Outcome: A Review of Five Cases at a Single Institution in Japan.

    Science.gov (United States)

    Takama, Yuichi; Yoneda, Akihiro; Nakamura, Tetsuro; Nakaoka, Tatsuo; Higashio, Atsushi; Santo, Kenji; Kuki, Ichiro; Kawawaki, Hisashi; Tomiwa, Kiyotaka; Hara, Junichi

    2016-02-01

    Opsoclonus-myoclonus syndrome (OMS) is a paraneoplastic neurological disorder associated with neuroblastic tumor (NT) in childhood. Half of patients have neurological sequelae after the neurological and oncological treatment. We reviewed the neurological and oncological outcomes of NT with OMS, and discussed whether the treatment of NT would contribute to improving the neurological prognosis. We retrospectively assessed NT patients with OMS from January 2001 to December 2013 at a single institution in Japan. Demographic data, neurological and oncological status, histopathology, treatments, prognosis, and diagnosis and treatment timing were retrospectively reviewed from the records. The timings assessed were the interval between OMS onset and NT detection, initial NT therapy, and initial OMS therapy, the interval between NT therapy and OMS remission, and duration of OMS. A total of 73 patients with NT were treated during the study period, and 5 of 73 patients were diagnosed as having NT with OMS. The median age at onset of OMS was 22 months (range, 18-30 months). The median age at detection of NT was 29 months (range, 21-33 months). Three of five cases showed no uptake on meta-iodobenzylguanidine scintigraphy. The tumor histopathology was neuroblastoma in two patients, ganglioneuroblastoma in two patients, and ganglioneuroma in one patient. Primary resection was performed in three cases. All patients survived. Two of five cases presented with atypical neurological symptoms without opsoclonus. The initial neurological therapy was started within a mean of 20 days (range, 3-76 days) from the onset of OMS in all cases. Four patients received intravenous immunoglobulin, and one with persistent neurological problems received rituximab. Neurological symptoms resolved in three cases. The mean interval between the onset of OMS and the detection of NT in case without neurological sequelae was 57 days (range, 25-113 days), while in case with neurological sequelae it was 365

  15. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

  16. The impact of acquisition time of planar cardiac {sup 123}I-MIBG imaging on the late heart to mediastinum ratio

    Energy Technology Data Exchange (ETDEWEB)

    Dimitriu-Leen, Aukelien C.; Veltman, Caroline E.; Bax, Jeroen J.; Scholte, Arthur J.H.A. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Gimelli, Alessia [Fondazione Toscana/CNR Gabriele Monasterio, Pisa (Italy); Al Younis, Imad [VieCuri, Department of Nuclear Medicine, Venlo (Netherlands); Verberne, Hein J. [Academic Medical Center, Department of Nuclear Medicine, Amsterdam (Netherlands); Wolterbeek, Ron [Leiden University Medical Center, Department of Medical Statistics and Bio-informatics, Leiden (Netherlands); Zandbergen-Harlaar, Silvia [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands)

    2016-02-15

    The aim of this study was to investigate whether performing the late cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) scan earlier than 4 h post-injection (p.i.) has relevant impact on the late heart to mediastinum ratio (H/M ratio) in patients with heart failure (HF). Forty-nine patients with HF (median left ventricular ejection fraction of 31 %, 51 % ischaemic HF) referred for cardiac {sup 123}I-MIBG scintigraphy were scanned at 15 min (early) p.i. and at 1, 2, 3 and 4 h (late) p.i. of {sup 123}I-MIBG. Late H/M ratios were calculated and evaluated using a linear mixed model with the mean late H/M ratio at 4 h p.i. as a reference. A difference in late H/M ratios of more than 0.10 between the different acquisition times in comparison with the late H/M ratio at 4 h p.i. was considered as clinically relevant. Statistically significant mean differences were observed between the late H/M ratios at 1, 2 and 3 h p.i. compared with the late H/M ratio at 4 h p.i. (0.09, 0.05 and 0.02, respectively). However, the mean differences did not exceed the cut-off value of 0.10. On an individual patient level, compared to the late H/M ratio at 4 h p.i., the late H/M ratios at 1, 2 and 3 h p.i. differed more than 0.10 in 24 (50 %), 9 (19 %) and 2 (4 %) patients, respectively. Variation in acquisition time of {sup 123}I-MIBG between 2 and 4 h p.i. does not lead to a clinically significant change in the late H/M ratio. An earlier acquisition time seems to be justified and may warrant a more time-efficient cardiac {sup 123}I-MIBG imaging protocol. (orig.)

  17. 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

  18. 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

  19. Long-term outcomes of {sup 131}Iodine mIBG therapy in metastatic gastrointestinal pancreatic neuroendocrine tumours: single administration predicts non-responders

    Energy Technology Data Exchange (ETDEWEB)

    Mulholland, Nicola; Chakravartty, Riddhika; Devlin, Lindsey; Kalogianni, Eleni; Corcoran, Ben; Vivian, Gillian [King' s College Hospital, Department of Nuclear Medicine, London (United Kingdom)

    2015-12-15

    {sup 131}Iodine (I131)-metaiodobenzylguanidine (mIBG) is a radionuclide-based treatment option for metastatic gastrointestinal-pancreatic neuroendocrine tumours (GEP NET). This study aimed at identifying prognostic indicators of long-term outcome based on initial evaluation following a first mIBG treatment (7400 MBq) in a patient cohort with such tumours, with a secondary aim of evaluating progression-free survival (PFS) and overall survival (OS) following mIBG therapy. Retrospective review of the hospital records was performed to identify a cohort of 38 adult patients who underwent {sup 131}Iodine-mIBG therapy over a 9-year period for metastatic GEP NETs and neuroendocrine tumours with an unknown primary. Treatment response was evaluated based on radiological criteria (RECIST1.1), biochemical markers [serum Chromogranin A (CgA)/urinary 5HIAA] and symptomatic response at clinical follow-up, all evaluated at 3-6 months from first mIBG treatment. Progression-free survival (PFS) and overall survival (OS) from the first mIBG treatment were recorded. At 3-6 months following a single mIBG therapy, 75 %, 67 %, and 63 % of patients showed either a partial response (PR) or stable disease (SD) on radiological, biochemical, and symptomatic criteria, respectively. Complete response (CR) was not seen in any patient. OS from the date of diagnosis and from the first therapy was 8 years +/-1.1 (95 % CI 5.7 to 10.2 years) and 4 years+/-0.69 (95 % CI 2.6-5.3 years), respectively. Twenty-nine percent of patients were alive at 10 years. Significant survival advantage was seen in patients with SD/PR as compared to those who had progressive disease (PD) for each of these three criteria. Biochemical, radiological (RECIST 1.1) and symptomatic assessment of disease status at 3 to 6 months after first I131-mIBG therapy stratifies patients with a poor prognosis. This can be used to identify patients who may benefit from alternative strategies of treatment. (orig.)

  20. Preparation of 123l and 131l mlBG by ascorbate reduction: A faster, safer method

    International Nuclear Information System (INIS)

    Baker, R.J.

    1997-01-01

    Full text: Meta-iodobenzylguanidine labelled with 123 l or 131 l has been prepared in a number of hospital radiopharmacies by the method of van Dormalen and Janssen (Method 1), which uses a copper catalysed exchange reaction accomplished by heating at 140 degree C in a heavy walled glass vial. The product is purified by passage through a small anion exchange column to remove unreacted iodine. More recently, the method of Rossouw (Method 2) has become available which utilizes ascorbic acid and copper (II) ions to effect the iodination at 100 deg C. Since the latter method has a number of potential advantages, the object of this work was to compare the results obtained from each method under conditions of routine preparation. Analysis of preparations using Method 1 gave the following results: 131 l, yield 89.3 ± 10.4% (n = 54); 123 l, yield 85.5 ± 10.6% (n = 5). The radiochemical purity was determined by both chromatography on Whatman No.1 / butanol, acetic acid, water (60:15:25) and cellulose acetate electrophoresis with the following results (mean values from both techniques): 131 l-mlBG 99.8 ± 0.1%; 131 l- iodine 0.2 ± -0.1%. For 123 l, 123 l-mlBG 99.2 ± 0.2%; 123 l-iodine 0.6 ± 0.2%. When prepared by Method 2, the results were: 131 I, yield 86.0 ± 9.8% (n = 5); 123 l, yield 97.0 ± 5.0% (n = 6). Radiochemical analyses were as follows: 131 l-mlBG 98.9 ± 0.1%; 131 l-iodine 1.0 ± 0.2%. For 123 l, 123 l-mlBG 97.8 ± 0.7%; 123 l-iodine 2.1 ± 0.6%. It is concluded that although Method 2 resulted in products of slightly lower purity, the small increase in free iodide for both radionuclides can be tolerated in view of the routine use of thyroid blockade with Lugol's solution. This method is much preferred as it removes the risk of explosion during the heating step. It is also considerably faster and reduces the chance of spillage as there is no need for passage through an anion exchange column. Both the 123 l and 131 l products show equivalent biodistribution

  1. 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

  2. Nuclear Medicine in Pediatric and Adolescent Tumors.

    Science.gov (United States)

    Kiratli, Pınar Özgen; Tuncel, Murat; Bar-Sever, Zvi

    2016-07-01

    Nuclear medicine has an important role in the management of many cancers in pediatric age group with multiple imaging modalities and radiopharmaceuticals targeting various biological uptake mechanisms. 18-Flourodeoxyglucose is the radiotracer of choice especially in patients with sarcoma and lymphoma. (18)FDG-PET, for sarcoma and lymphomas, is proved to be superior to conventional imaging in staging and therapy response. Although studies are limited in pediatric population, (18)FDG-PET/CT has found its way through international guidelines. Limitations and strengths of PET imaging must be noticed before adapting PET imaging in clinical protocols. Established new response criteria using multiple parameters derived from (18)FDG-PET would increase the accuracy and repeatability of response evaluation. Current data suggest that I-123 metaiodobenzylguanidine (MIBG) remains the tracer of choice in the evaluation of neuroblastoma (NB) because of its high sensitivity, specificity, diagnostic accuracy, and prognostic value. It is valuable in determining the response to therapy, surveillance for disease recurrence, and in selecting patients for I-131 therapy. SPECT/CT improves the diagnostic accuracy and the interpretation confidence of MIBG scans. (18)FDG-PET/CT is an important complementary to MIBG imaging despite its lack of specificity to NB. It is valuable in cases of negative or inconclusive MIBG scans and when MIBG findings underestimate the disease status as determined from clinical and radiological findings. F-18 DOPA is promising tracer that reflects catecholamine metabolism and is both sensitive and specific. F-18 DOPA scintigraphy provides the advantages of PET/CT imaging with early and short imaging times, high spatial resolution, inherent morphologic correlation with CT, and quantitation. Regulatory and production issues currently limit the tracer's availability. PET/CT with Ga-68 DOTA appears to be useful in NB imaging and may have a unique role in selecting

  3. 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

  4. Clinical and pathological study on early diagnosis of Parkinson's disease and dementia with Lewy bodies

    International Nuclear Information System (INIS)

    Orimo, Satoshi

    2008-01-01

    [ 123 I] Meta-iodobenzylguanidine (MIBG) myocardial scintigraphy has been used to evaluate postganglionic cardiac sympathetic innervation in heart diseases and some neurological disorders. To see clinical usefulness of MIBG myocardial scintigraphy to differentiate Parkinson's disease (PD) and dementia with Lewy bodies (DLB) from related movement disorders and Alzheimer disease (AD), we performed MIBG myocardial scintigraphy in patients with these disorders. Cardiac uptake of MIBG is specifically reduced in PD and DLB, and this imaging approach is a sensitive diagnostic tool that possibly differentiates PD and DLB from related movement disorders and AD. To see pathological basis of the reduced cardiac uptake of MIBG in Lewy body disease, we immunohistichemically examined cardiac tissues from patients with PD, DLB, related movement disorders and AD using antibodies against tyrosine hydroxylase (TH) and phosphorylated neurofilament (NF). Not only TH- but also NF-immunoreactive (ir) axons in the epicardial nerve fascicles were markedly decreased in Lewy body disease, namely cardiac sympathetic denervation, which accounts for the reduced cardiac uptake of MIBG in Lewy body disease. Patients with PD and DLB have Lewy bodies (LBs) in the nervous system, whereas patients with multiple system atrophy (MSA), progressive supranuclear palsy, corticobasal degeneration, parkin-associated PD and AD have no LBs in the nervous system. Even in patients with MSA, cardiac sympathetic denervation was associated with the presence of LBs. Therefore, cardiac sympathetic denervation is closely related to the presence of LBs in a wide range of neurodegenerative processes. Taken together, we conclude that the reduced cardiac uptake of MIBG is a potential biomarker for the presence of LBs. Because α-synuclein is one of the key molecules in the pathogenesis of PD, we further investigate how α-synuclein aggregates are involved in degeneration of the cardiac sympathetic nerve in PD. We

  5. Simplified Quantification and Acquisition Protocol of123I-mIBG Dynamic SPECT.

    Science.gov (United States)

    Wu, Jing; Gallezot, Jean-Dominique; Lu, Yihuan; Ye, Qing; Liu, Hui; Esserman, Denise A; Kyriakides, Tassos C; Thorn, Stephanie; Hashemi Zonouz, Taraneh; Liu, Yi-Hwa; Lampert, Rachel; Sinusas, Albert J; Carson, Richard E; Liu, Chi

    2018-02-23

    Previous studies have demonstrated the feasibility of absolute quantification of dynamic 123 I-metaiodobenzylguanidine ( 123 I-mIBG) single photon emission computed tomography (SPECT) imaging in human. This work reports on simplified quantification of dynamic 123 I-mIBG SPECT using practical protocols with shortened acquisition time and voxel-by-voxel parametric imaging. Methods: Twelve healthy human volunteers underwent five 15-min dynamic SPECT scans at 0, 15, 90, 120 and 180 min after 123 I-mIBG injection using a Discovery NM/CT 570c scanner. List-mode SPECT data were binned into 29 frames and reconstructed with corrections for attenuation, scatter and decay. Population-based blood-to-plasma correction and metabolite correction were applied to the image-derived input function. The likelihood estimation in graphical analysis (LEGA) technique was used as a simplified model to obtain volume of distribution (VT) values, which were compared to those obtained with the reversible two-tissue (2T) compartment model. Three simplified protocols were evaluated with 2T and LEGA, using a 30-min scan started with tracer injection plus a 15-min scan at 90, 120 or 180 min post-injection. Voxel-by-voxel LEGA fitting was applied to the aligned dynamic images using both the full dataset and the simplified protocols. Results: Correlation (y=0.955x+0.547, R2=0.997) and Bland-Altman plot (mean difference=-0.8 mL/cm 3 , 95% limits of agreement=[-2.5, 1.0] mL/cm 3 , normal VT range: 29.0 ± 12.4 mL/cm 3 ) showed that LEGA can be used as a simplified model of 2T for 123 I-mIBG. High quality VT parametric images can be obtained with LEGA. Region of interest (ROI) modeling and parametric imaging results were in excellent agreement in terms of correlation (y=0.999x-1.026, R2=0.982) and Bland-Altman plot (mean difference=-1.0 mL/cm 3 , 95% limits of agreement=[-4.2, 2.1] mL/cm 3 ). Reasonable correlations of VT values between all the simplified protocols and the full protocol (five 15-min

  6. Peripheral sympathetic dysfunction in patients with Parkinson's disease without autonomic failure is heart selective and disease specific

    International Nuclear Information System (INIS)

    Taki, Junichi; Nakajima, Kenichi; Hwang, Eui-Hyo; Matsunari, Ichiro; Tonami, Norihisa; Komai, Kiyonobu; Yoshita, Mitsuhiro; Sakajiri, Kenichi

    2000-01-01

    The study was undertaken to investigate by means of iodine-123-labelled metaiodobenzylguanidine (MIBG) scintigraphy the peripheral sympathetic function in patients with Parkinson's disease (PD) without autonomic failure and in patients with related neurodegenerative diseases with parkinsonism. Seventy patients (33 men and 37 women, mean age 63±9.7 years) with parkinsonism and ten control subjects underwent MIBG scintigraphy. Of these 70 patients, 41 were diagnosed as having idiopathic PD, 9 multiple system atrophy (MSA), 6 progressive supranuclear palsy (PSP) and 2 corticobasal degeneration (CBD); the remaining 12 were diagnosed as having neurodegenerative disease with parkinsonism (P-nism) that did not meet the diagnostic criteria of any specific disease. Cardiac planar and tomographic imaging studies and subsequent whole-body imaging were performed 20 min and 3 h after the injection of 111 MBq MIBG. The early MIBG heart to mediastinum (H/M) ratio in PD (1.61±0.29) was significantly lower than that in the control group (2.24±0.14, P<0.01), P-nism (2.15±0.31, P<0.01), MSA (2.08±0.31, P<0.05) and PSP (2.30±0.24, P<0.01). The delayed H/M ratio in PD (1.47±0.34) was also significantly lower than that in the control group (2.37±0.14, P<0.01), P-nism (2.13±0.38, P<0.01), PSP (2.36±0.36, P<0.01) and MSA (2.17±0.36, P<0.01). In patients with PD, early and delayed H/M ratios were significantly decreased in disease stages I, II and III (established using the Hoehn and Yahr criteria) as compared with control subjects, and there were no significant differences among the stages. Only PD showed a significantly higher washout rate (WR) than that in the control subjects (27%±8.0% vs 11%±4.2%, P<0.01). Early and delayed uptake ratios of the lung, parotid gland, thyroid gland, liver and femoral muscles in each of the patient groups were not significantly different from those in control subjects. Only the early and delayed uptake ratios of the lower leg muscles in MSA

  7. Equivalent Dose Rate 1 Meter from Neuroendocrine Tumor Patients Exiting the Nuclear Medicine Department After Undergoing Imaging.

    Science.gov (United States)

    Zhang-Yin, Jules; Dirand, Anne-Sophie; Sasanelli, Myriam; Corrégé, Gwenaelle; Peudon, Aude; Kiffel, Thierry; Nataf, Valérie; Clerc, Jérôme; Montravers, Françoise; Talbot, Jean-Noël

    2017-08-01

    123 I-metaiodobenzylguanidine (MIBG) and 111 In-pentetrotide SPECT have been used for functional imaging of neuroendocrine tumors (NETs) for the last 2 decades. More recently, PET/CT imaging with 18 F-FDG, 18 F-fluorodihydroxyphenylalanine (FDOPA), and 68 Ga somatostatin-receptor ligands in NETs has been expanding. A literature search could find no direct measurements of the dose rate from NET patients exiting the nuclear medicine department after undergoing PET/CT with 18 F-FDOPA or 68 Ga-DOTATOC, a somatostatin analog. Methods: We measured the dose rates from 93 NET patients on leaving the department after undergoing PET/CT or SPECT/CT in our centers. In total, 103 paired measurements of equivalent dose rate at 1 m (EDR-1m) from the sternum and urinary bladder were obtained. The detector faced the sternum or bladder and was 1 m away from and directly in front of the patient. The practice for exiting the department differed according to whether the patient had been referred for PET/CT or for SPECT/CT. PET/CT patients were discharged after imaging, whereas SPECT/CT patients left the department earlier, just after radiopharmaceutical injection. Results: The median administered activity was 122 MBq in 53 68 Ga-DOTATOC PET/CT studies, 198 MBq in 15 18 F-FDOPA PET/CT studies, and 176 MBq in 13 18 F-FDG PET/CT studies. The corresponding median EDR-1m was 4.8, 9.5, and 8.8 μSv/h, respectively, facing the sternum, and 5.1, 10.1, and 9.5 μSv/h, respectively, facing the bladder. The median administered activity was 170 MBq in 12 111 In-pentetreotide SPECT/CT studies and 186 MBq in 10 123 I-MIBG SPECT/CT studies. The corresponding median EDR-1m was 9.4, and 4.9 μSv/h, respectively, at the level of the sternum, and 9.3 and 4.7 μSv/h, respectively, at the level of the bladder. The EDR-1m was less than 20 μSv/h in all patients. Thus, when exiting the nuclear medicine department, the NET patients injected with 68 Ga-DOTATOC or 123 I MIBG emitted an average EDR-1m roughly

  8. 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