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Evaluation of Probable or Possible Dementia with Lewy Bodies Using ¹²³I-IMP Brain Perfusion SPECT, ¹²³I-MIBG, and ^99mTc-MIBI Myocardial SPECT

¹ Department of Radiology, Fujita Health University, Toyoake, Japan; ² Department of Psychiatry, Fujita Health University, Toyoake, Japan; ³ Department of Cardiology, Fujita Health University, Toyoake, Japan; and ⁴ St. Marianna Medical Institute, Kawasaki, Japan

View larger version (141K): [in this window] [in a new window]   FIGURE 1.  123I-MIBG images in early and delayed phase in 2 patients with probable DLB. Patient 1 shows low 123I-MIBG uptake in both images (H/M ratio: early, 1.33; delayed, 1.14). In contrast, patient 10 shows normal uptake in both images (H/M ratio: early, 2.05; delayed, 2.04).

View larger version (37K): [in this window] [in a new window]   FIGURE 2.  Representative 3D-SSP images of DLB (patient 8), 2 patients who demonstrated mild occipital hypoperfusion (patients 6 and 10), and group analysis between probable DLB group and healthy control subjects. 3D-SSP images of patient 6 show moderate reduction in frontal, parietal, and temporal lobes and mild-to-moderate reduction in precuneus and posterior cingulate gyrus, but mild reduction of occipital lobe, and primary sensorimotor cortex is spared so that this reduction pattern is considered as likely AD. 3D-SSP images of patient 8 show typical findings of DLB with occipital hypoperfusion. 3D-SSP images of patient 10 show heterogeneous reduction of entire brain cortex so that this reduction pattern is considered as not likely to be DLB pattern. 3D-SSP images of group comparison between the probable DLB group and healthy control subjects clearly demonstrated a reduction in parietotemporal, occipital cortex, posterior cingulated, and precuneus perfusion. RT.LAT = right lateral; LT.LAT = left lateral; SUP = superior; INF = inferior; ANT = anterior; POST = posterior; RT.MED = right medial; LT.MED = left medial.

View larger version (46K): [in this window] [in a new window]   FIGURE 3.  3D-SSP images of 4 patients with possible DLB and group analysis between possible DLB group and healthy control subjects. 3D-SSP images of patient 13 show moderate reduction in frontal and temporal lobe, but not other regions, so this reduction pattern is considered as likely frontotemporal lobe dementia. 3D-SSP images of patient 18 show typical reduction pattern of DLB. 3D-SSP images of patients 19 and 21 show severe reduction in frontal, parietal, and temporal lobes and mild-to-moderate reduction in precuneus and posterior cingulate gyrus, and primary sensorimotor cortex is spared so that this reduction pattern is considered as AD, but patient 19 shows unilateral mild occipital hypoperfusion on left side. 3D-SSP images of group comparison between possible DLB group and healthy control subjects show no significant reduction. RT.LAT = right lateral; LT.LAT = left lateral; SUP = superior; INF = inferior; ANT = anterior; POST = posterior; RT.MED = right medial; LT.MED = left medial.

View larger version (11K): [in this window] [in a new window]   FIGURE 4.  Mean early H/M ratio (1.52 ± 0.21) and delayed H/M ratio (1.32 ± 0.25) in probable DLB group were significantly lower than those in possible DLB group (early: 2.11 ± 0.45, P = 0.004; delayed: 2.03 ± 0.66, P = 0.012) and control group (early: 2.72 ± 0.53, P = 0.002; delayed: 2.74 ± 0.75, P = 0.004), respectively. NS = not significant.

View larger version (7K): [in this window] [in a new window]   FIGURE 5.  There was no significant difference between probable DLB group (LVEF: 71.0% ± 9.15%) and possible DLB group (LVEF: 74.7% ± 8.14%, P = 0.35) and control group (LVEF: 69.5% ± 11.52%, P = 0.79), respectively. NS = not significant.