Skip to main content
SpringerLink
Log in

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

  • Review Article
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

Objective

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 123I-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between PD and other Parkinsonism.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Jost WH, Del Tredici K, Landvogt C, Braune S (2010) Importance of 123I-metaiodobenzylguanidine scintigraphy/single photon emission computed tomography for diagnosis and differential diagnostics of Parkinson syndromes. Neurodegener Dis 7:341–347

    Article  PubMed  CAS  Google Scholar 

  2. Treglia G, Cason E, Gabellini A, Giordano A, Fagioli G (2010) Recent developments in innervation imaging using iodine-123-metaiodobenzylguanidine scintigraphy in Lewy body diseases. Neurol Sci 31:417–422

    Article  PubMed  Google Scholar 

  3. Yamashina S, Yamazaki J (2007) Neuronal imaging using SPECT. Eur J Nucl Med Mol Imaging 34:939–950

    Article  PubMed  Google Scholar 

  4. Nakajima K, Yoshita M, Matsuo S, Taki J, Kinuya S (2008) Iodine-123-MIBG sympathetic imaging in Lewy-body diseases and related movement disorders. Q J Nucl Med Mol Imaging 52:378–387

    PubMed  CAS  Google Scholar 

  5. Rascol O, Schelosky L (2009) 123I-Metaiodobenzylguanidine scintigraphy in Parkinson’s disease and related disorders. Mov Disord 24(Suppl 2):732–741

    Article  Google Scholar 

  6. Treglia G, Cason E (2010) 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. J Neuroimaging. doi:10.1111/j.1552-6569.2010.00532.x (epub ahead of print)

  7. Hishikawa N, Hashizume Y, Yoshida M, Sobue G (2003) Clinical and neuropathological correlates of Lewy body disease. Acta Neuropathol (Berl) 105:341–350

    Google Scholar 

  8. Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31

    Article  PubMed  Google Scholar 

  9. Braune S, Reinhardt M, Schnitzer R, Riedel A, Lücking CH (1999) Cardiac uptake of [123I]MIBG separates Parkinson’s disease from multiple system atrophy. Neurology 53:1020–1025

    PubMed  CAS  Google Scholar 

  10. Salsone M, Bagnato A, Novellino F, Cascini GL, Paglionico S, Cipullo S, Morelli M, Pugliese P, Nicoletti G, Messina D, Condino F, Arabia G, Morgante L, Quattrone A (2009) Cardiac MIBG scintigraphy in primary progressive freezing gait. Parkinsonism Relat Disord 15:365–369

    Article  PubMed  Google Scholar 

  11. Hirayama M, Hakusui S, Koike Y, Ito K, Kato T, Ikeda M, Hasegawa Y, Takahashi A (1995) A scintigraphical qualitative analysis of peripheral vascular sympathetic function with meta-[123I]iodobenzylguanidine in neurological patients with autonomic failure. J Auton Nerv Syst 53:230–234

    Article  PubMed  CAS  Google Scholar 

  12. Druschky A, Hilz MJ, Platsch G, Radespiel-Tröger M, Druschky K, Kuwert T, Neundörfer B (2000) Differentiation of Parkinson’s disease and multiple system atrophy in early disease stages by means of I-123-MIBG-SPECT. J Neurol Sci 175:3–12

    Article  PubMed  CAS  Google Scholar 

  13. Orimo S, Ozawa E, Nakade S, Hattori H, Tsuchiya K, Taki K, Takahashi A (2003) [123I] meta-iodobenzylguanidine myocardial scintigraphy differentiates corticobasal degeneration from Parkinson’s disease. Intern Med 42:127–128

    Article  PubMed  Google Scholar 

  14. Courbon F, Brefel-Courbon C, Thalamas C, Alibelli MJ, Berry I, Montastruc JL, Rascol O, Senard JM (2003) Cardiac MIBG scintigraphy is a sensitive tool for detecting cardiac sympathetic denervation in Parkinson’s disease. Mov Disord 18:890–897

    Article  PubMed  Google Scholar 

  15. Saiki S, Hirose G, Sakai K, Kataoka S, Hori A, Saiki M, Kaito M, Higashi K, Taki S, Kakeshita K, Fujino S, Miaki M (2004) Cardiac 123I-MIBG scintigraphy can assess the disease severity and phenotype of PD. J Neurol Sci 220:105–111

    Article  PubMed  Google Scholar 

  16. Matsui H, Udaka F, Oda M, Kubori T, Nishinaka K, Kameyama M (2005) Metaiodobenzylguanidine (MIBG) scintigraphy at various parts of the body in Parkinson’’s disease and multiple system atrophy. Auton Neurosci 119:56–60

    Article  PubMed  Google Scholar 

  17. Lee PH, Kim JS, Shin DH, Yoon SN, Huh K (2006) Cardiac 123I-MIBG scintigraphy in patients with drug induced Parkinsonism. J Neurol Neurosurg Psychiatry 77:372–374

    Article  PubMed  CAS  Google Scholar 

  18. Shin DH, Lee PH, Bang OY, Joo IS, Huh K (2006) Clinical implications of cardiac-MIBG SPECT in the differentiation of Parkinsonian syndromes. J Clin Neurol 2:51–57

    Article  PubMed  Google Scholar 

  19. Lee PH, Yeo SH, Kim HJ, Youm HY (2006) Correlation between cardiac 123I-MIBG and odor identification in patients with Parkinson’s disease and multiple system atrophy. Mov Disord 21:1975–1977

    Article  PubMed  Google Scholar 

  20. Lee PH, Yeo SH, Yong SW, Kim YJ (2007) Odour identification test and its relation to cardiac 123I-metaiodobenzylguanidine in patients with drug induced Parkinsonism. J Neurol Neurosurg Psychiatry 78:1250–1252

    Article  PubMed  Google Scholar 

  21. Yamashita F, Hirayama M, Nakamura T, Takamori M, Hori N, Uchida K, Hama T, Sobue G (2010) Pupillary autonomic dysfunction in multiple system atrophy and Parkinson’s disease: an assessment by eye-drop tests. Clin Auton Res 20:191–197

    Article  PubMed  Google Scholar 

  22. Marini C, Bandettini di Poggio M, Pomposelli E, Marchese R, Nobili F, Morbelli SD, Villa G, Abbruzzese G, Sambuceti G (2010) Whole body and cardiac metaiodobenzylguanidine kinetics in Parkinson disease and multiple system atrophy: implications for the diagnostic role of imaging. Clin Nucl Med 35:311–316

    Article  PubMed  Google Scholar 

  23. Tateno F, Sakakibara R, Kishi M, Ogawa E, Terada H, Ogata T, Haruta H (2011) Sensitivity and specificity of metaiodobenzylguanidine (MIBG) myocardial accumulation in the diagnosis of Lewy body diseases in a movement disorder clinic. Parkinsonism Relat Disord. doi:10.1016/jparkreldis.2011.02.001 (epub ahead of print)

  24. Fröhlich I, Pilloy W, Vaillant M, Diederich NJ (2010) Myocardial MIBG scintigraphy: a useful clinical tool? A retrospective study in 50 Parkinsonian patients. Neurol Sci 31:403–406

    Article  PubMed  Google Scholar 

  25. Ishibashi K, Saito Y, Murayama S, Kanemaru K, Oda K, Ishiwata K, Mizusawa H, Ishii K (2010) Validation of cardiac (123)I-MIBG scintigraphy in patients with Parkinson’s disease who were diagnosed with dopamine PET. Eur J Nucl Med Mol Imaging 37:3–11

    Article  PubMed  Google Scholar 

  26. Chung EJ, Lee WY, Yoon WT, Kim BJ, Lee GH (2009) MIBG scintigraphy for differentiating Parkinson’s disease with autonomic dysfunction from Parkinsonism-predominant multiple system atrophy. Mov Disord 24:1650–1655

    Article  PubMed  Google Scholar 

  27. Novellino F, Arabia G, Bagnato A, Cascini GL, Salsone M, Nicoletti G, Messina D, Morelli M, Paglionico S, Giofrè L, Restuccia A, Torchia G, Condino F, Quattrone A (2009) Combined use of DAT-SPECT and cardiac MIBG scintigraphy in mixed tremors. Mov Disord 24:2242–2248

    Article  PubMed  Google Scholar 

  28. Sawada H, Oeda T, Yamamoto K, Kitagawa N, Mizuta E, Hosokawa R, Ohba M, Nishio R, Yamakawa K, Takeuchi H, Shimohama S, Takahashi R, Kawamura T (2009) Diagnostic accuracy of cardiac metaiodobenzylguanidine scintigraphy in Parkinson disease. Eur J Neurol 16:174–182

    Article  PubMed  CAS  Google Scholar 

  29. Miyamoto T, Miyamoto M, Suzuki K, Nishibayashi M, Iwanami M, Hirata K (2008) 123I-MIBG cardiac scintigraphy provides clues to the underlying neurodegenerative disorder in idiopathic REM sleep behavior disorder. Sleep 31:717–723

    PubMed  Google Scholar 

  30. Nagamachi S, Wakamatsu H, Kiyohara S, Fujita S, Futami S, Tamura S, Nakazato M, Yamashita S, Arita H, Nishii R, Kawai K (2008) Usefulness of rCBF analysis in diagnosing Parkinson’s disease: supplemental role with MIBG myocardial scintigraphy. Ann Nucl Med 22:557–564

    Article  PubMed  Google Scholar 

  31. Köllensperger M, Seppi K, Liener C, Boesch S, Heute D, Mair KJ, Mueller J, Sawires M, Scherfler C, Schocke MF, Donnemilier E, Virgolini I, Wenning GK, Poewe W (2007) Diffusion weighted imaging best discriminates PD from MSA-P: a comparison with tilt table testing and heart MIBG scintigraphy. Mov Disord 22:1771–1776

    Article  PubMed  Google Scholar 

  32. Kashihara K, Ohno M, Kawada S, Okumura Y (2006) Reduced cardiac uptake and enhanced washout of 123I-MIBG in pure autonomic failure occurs conjointly with Parkinson’s disease and dementia with Lewy bodies. J Nucl Med 47:1099–1101

    PubMed  CAS  Google Scholar 

  33. Kim JS, Lee PH, Lee KS, Park JW, Kim YI, Chung YA, Kim SH, Kim SH, Kim J, Choi YY, Kim HT (2006) Cardiac [123I]metaiodobenzylguanidine scintigraphy for vascular Parkinsonism. Mov Disord 21:1990–1994

    Article  PubMed  Google Scholar 

  34. Lee PH, Kim JW, Bang OY, Joo IS, Yoon SN, Huh K (2006) Cardiac 123I-MIBG scintigraphy in patients with essential tremor. Mov Disord 21:1235–1238

    Article  PubMed  Google Scholar 

  35. Nagayama H, Hamamoto M, Ueda M, Nagashima J, Katayama Y (2005) Reliability of MIBG myocardial scintigraphy in the diagnosis of Parkinson’s disease. J Neurol Neurosurg Psychiatry 76:249–251

    Article  PubMed  CAS  Google Scholar 

  36. Reinhardt MJ, Jüngling FD, Krause TM, Braune S (2000) Scintigraphic differentiation between two forms of primary dysautonomia early after onset of autonomic dysfunction: value of cardiac and pulmonary iodine-123 MIBG uptake. Eur J Nucl Med 27:595–600

    Article  PubMed  CAS  Google Scholar 

  37. Takatsu H, Nagashima K, Murase M, Fujiwara H, Nishida H, Matsuo H, Watanabe S, Satomi K (2000) Differentiating Parkinson disease from multiple-system atrophy by measuring cardiac iodine-123 metaiodobenzylguanidine accumulation. JAMA 284:44–45

    Article  PubMed  CAS  Google Scholar 

  38. Taki J, Nakajima K, Hwang EH, Matsunari I, Komai K, Yoshita M, Sakajiri K, Tonami N (2000) Peripheral sympathetic dysfunction in patients with Parkinson’s disease without autonomic failure is heart selective and disease specific. Eur J Nucl Med 27:566–573

    Article  PubMed  CAS  Google Scholar 

  39. Orimo S, Ozawa E, Nakade S, Sugimoto T, Mizusawa H (1999) (123)I-metaiodobenzylguanidine myocardial scintigraphy in Parkinson’s disease. J Neurol Neurosurg Psychiatry 67:189–194

    Article  PubMed  CAS  Google Scholar 

  40. Satoh A, Serita T, Seto M, Tomita I, Satoh H, Iwanaga K, Takashima H, Tsujihata M (1999) Loss of 123I-MIBG uptake by the heart in Parkinson’s disease: assessment of cardiac sympathetic denervation and diagnostic value. J Nucl Med 40:371–375

    PubMed  CAS  Google Scholar 

  41. Yoshita M (1998) Differentiation of idiopathic Parkinson’s disease from striatonigral degeneration and progressive supranuclear palsy using iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. J Neurol Sci 155:60–67

    Article  PubMed  CAS  Google Scholar 

  42. Verberne HJ, Brewster LM, Somsen GA, van Eck-Smit BL (2008) Prognostic value of myocardial 123I-metaiodobenzylguanidine (MIBG) parameters in patients with heart failure: a systematic review. Eur Heart J 29:1147–1159

    Article  PubMed  Google Scholar 

  43. King AE, Mintz J, Royall DR (2011) Meta-analysis of (123) I-MIBG cardiac scintigraphy for the diagnosis of Lewy body-related disorders. Mov Disord. doi:10.1002/mds.23659

  44. Solanki KK, Bomanji J, Moyes J, Mather SJ, Trainer PJ, Britton KE (1992) A pharmacological guide to medicines which interfere with the biodistribution of radiolabelled meta-iodobenzylguanidine (MIBG). Nucl Med Commun 13:513–521

    Article  PubMed  CAS  Google Scholar 

  45. Orimo S, Kanazawa T, Nakamura A, Uchihara T, Mori F, Kakita A, Wakabayashi K, Takahashi H (2007) Degeneration of cardiac sympathetic nerve can occur in multiple system atrophy. Acta Neuropathol 113:81–86

    Article  PubMed  Google Scholar 

  46. Sakata K, Iida K, Mochizuki N, Ito M, Nakaya Y (2009) Physiological changes in human cardiac sympathetic innervation and activity assessed by 123I-Metaiodobenzylguanidine (MIBG) imaging. Circ J 73:310–315

    Article  PubMed  Google Scholar 

  47. Braune S (2001) The role of cardiac metaiodobenzylguanidine uptake in the differential diagnosis of Parkinsonian syndromes. Clin Auton Res 11:351–355

    Article  PubMed  CAS  Google Scholar 

  48. Flotats A, Carrió I, Agostini D, Le Guludec D, Marcassa C, Schäfers M, Somsen GA, Unlu M, Verberne HJ, EANM Cardiovascular Committee; European Council of Nuclear Cardiology (2010) Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular Committee and the European Council of Nuclear Cardiology. Eur J Nucl Med Mol Imaging 37:1802–1812

    Article  PubMed  Google Scholar 

  49. Muxí A, Paredes P, Navales I, Valldeoriola F, Gaig C, Lomeña F, de la Cerda A, Solà O, Domenech B, Tolosa E, Pons F (2011) Diagnostic cutoff points for (123)I-MIBG myocardial scintigraphy in a Caucasian population with Parkinson’s disease. Eur J Nucl Med Mol Imaging 38:1139–1146

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

The Authors are grateful to Professor Guido Galli for his statistical support and Ms. Barbara Muoio for her technical support.

Conflicts of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Institute of Nuclear Medicine, Policlinico Gemelli, Catholic University of the Sacred Heart, Largo Gemelli 8, 00168, Rome, Italy

    Giorgio Treglia, Antonella Stefanelli, Fabrizio Cocciolillo, Daniela Di Giuda & Alessandro Giordano

  2. Nuclear Medicine Unit, Maggiore Hospital, Bologna, Italy

    Ernesto Cason & Giorgio Fagioli

Authors
  1. Giorgio Treglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ernesto Cason
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonella Stefanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabrizio Cocciolillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniela Di Giuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giorgio Fagioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alessandro Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giorgio Treglia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Treglia, G., Cason, E., Stefanelli, A. et al. MIBG scintigraphy in differential diagnosis of Parkinsonism: a meta-analysis. Clin Auton Res 22, 43–55 (2012). https://doi.org/10.1007/s10286-011-0135-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-011-0135-5

Keywords

Search

Navigation