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Prolonged Lung Retention of Iodine-123-MIBG in Diabetic Patients

Mustafa Ünlü and Sabahat nanir

Departments of Nuclear Medicine, Gazi University Medical Faculty
Bayindir Medical Center, Ankara, Turkey

Correspondence: For correspondence or reprints contact: Sabahat nanir, MD, Bayindir Medical Centre, Department of Nuclear Medicine, TR-06520, Sogutozu, Ankara, Turkey.

ABSTRACT

Iodine-123-MIBG has been introduced as a biochemical marker in assessing pulmonary endothelial cell integrity and myocardial ß-adrenergic sympathetic innervation. The aim of this study was to evaluate ¹²³I-MIBG lung uptake in diabetic patients with and without coronary artery disease. Methods: Forty-four nonsmoking patients with normal respiratory function tests were included: 12 diabetics, 11 diabetics with coronary artery disease, 14 nondiabetic patients with coronary artery disease and 7 age-matched controls were imaged with ¹²³I-MIBG and ²⁰¹Tl scintigraphy. The lung retention of ¹²³I-MIBG, cardiac sympathetic innervation (heart-to-upper mediastinum ratio of ¹²³I-MIBG) and ²⁰¹Tl lung-to-heart ratio were determined in all cases. Results: In diabetics with coronary artery disease, significantly prolonged lung retention and decreased cardiac uptake of ¹²³I-MIBG were found. The lung retention of ¹²³I-MIBG was inversely correlated with the heart-to-upper mediastinum ratio in this group. Lung-to-heart ratios of ²⁰¹Tl were significantly increased in patients with coronary artery disease but there was no significant difference between diabetics and nondiabetics. Conclusion: Prolonged lung retention of ¹²³I-MIBG was associated with decreased cardiac sympathetic innervation in diabetic coronary artery disease patients. It seems that passive pulmonary congestion or cardiac dysfunction itself did not influence ¹²³I-MIBG lung uptake. Increased lung extraction of ¹²³I-MIBG is highly suggestive of ongoing pulmonary endothelial dysfunction together with ischemic events in diabetics.

Key Words: iodine-123-MIBG • Type II diabetes mellitus • pulmonary endothelium • sympathetic innervation

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