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Involvement of pulmonary endothelial cell injury in the pathogenesis of pulmonary fibrosis: clinical assessment by 123I-MIBG lung scintigraphy

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Abstract

Purpose

Pulmonary microvascular endothelial injury may be involved in the pathogenesis of pulmonary fibrosis (PF). The aim of this study was to evaluate the pulmonary vascular status in patients with PF by lung scintigraphic assessment of 123I-metaiodobenzylguanidine (123I-MIBG), which reflects latent endothelial cell lesions.

Methods

We assessed lung 123I-MIBG kinetics and clinical indices in 23 PF patients and 16 controls. Mean uptake ratios of lung to mediastinum (L/M) were calculated in anterior planar images at 30 (early image) and 270 (delayed image) min after intravenous injection of 123I-MIBG. The pulmonary mean washout rate (WR) of 123I-MIBG was also calculated.

Results

The L/M ratio in early images, but not in delayed images, was significantly lower in the PF patients than in the controls (L/Mearly 1.41±0.14 vs 1.53±0.10, p<0.01; L/Mdelayed 1.28±0.10 vs 1.33±0.07, p=NS). WR was significantly reduced in the PF patients compared with the controls (28.6%±3.1% vs 34.2%±5.1%, p<0.001). In the study subjects (PF patients plus controls) there were significant relationships between lung WR of 123I-MIBG and other diagnostic parameters for the severity of PF, such as vital capacity (r=0.625, p<0.0001), total lung capacity (r=0.691, p<0.0001), carbon monoxide diffusing capacity (r=0.622, p<0.0001), serum angiotensin-converting enzyme activity (r=0.422, p<0.01), carbohydrate antigen KL-6 levels (r=−0.495, p<0.01) and surfactant protein-D levels (r=−0.461, p<0.01). When control subjects were excluded, similar significant correlations were observed between WR and %TLC (r=0.508, p<0.05), DLCO (r=0.593, p<0.01) and serum ACE activity (r=0.515, p<0.05) in the PF patients.

Conclusion

These results suggest that endothelial cell injury plays a significant role in the pathogenesis of PF, and that lung WR of 123I-MIBG, which is a specific marker of endothelial damage, can serve as a novel diagnostic tool to evaluate the functional severity of PF.

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Acknowledgements

This study was supported in part by grants-in-aid for Scientific Research (Nos. 11557044 and 13770295) from the Ministry of Education, Culture, Sports, Science and Technology, Japan.

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Authors and Affiliations

  1. First Department of Internal Medicine, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan

    Noriaki Takabatake, Tsuyoshi Arao, Makoto Sata, Shuichi Abe, Sumito Inoue, Yasuchika Takeishi & Isao Kubota

  2. Department of Laboratory Medicine, Yamagata University School of Medicine, Yamagata, Japan

    Yoko Shibata

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  1. Noriaki Takabatake
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Correspondence to Noriaki Takabatake.

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Takabatake, N., Arao, T., Sata, M. et al. Involvement of pulmonary endothelial cell injury in the pathogenesis of pulmonary fibrosis: clinical assessment by 123I-MIBG lung scintigraphy. Eur J Nucl Med Mol Imaging 32, 221–228 (2005). https://doi.org/10.1007/s00259-004-1663-1

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  • DOI: https://doi.org/10.1007/s00259-004-1663-1

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