• Mitsuhiro Yoshita, Heii Arai, Hiroyuki Arai, Tetsuaki Arai, Takashi Asada, Hiroshige Fujishiro, Haruo Hanyu, Osamu Iizuka, Eizo Iseki, Kenichi Kashihara, Kenji Kosaka, Hirotaka Maruno, Katsuyoshi Mizukami, Yoshikuni Mizuno, Etsuro Mori, Kenichi Nakajima, Hiroyuki Nakamura, Seigo Nakano, Kenji Nakashima, Yoshiyuki Nishio, Satoshi Orimo, Miharu Samuraki, Akira Takahashi, Junichi Taki, Takahiko Tokuda, Katsuya Urakami, Kumiko Utsumi, Kenji Wada, Yukihiko Washimi, Junichi Yamasaki, Shouhei Yamashina, and Masahito Yamada.
• Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8640, Japan; Department of Neurology, Hokuriku National Hospital, Nanto, Toyama 939-1893, Japan.
• Plos One. 2015 Jan 1; 10 (3): e0120540.

Background And PurposeDementia with Lewy bodies (DLB) needs to be distinguished from Alzheimer's disease (AD) because of important differences in patient management and outcome. Severe cardiac sympathetic degeneration occurs in DLB, but not in AD, offering a potential system for a biological diagnostic marker. The primary aim of this study was to investigate the diagnostic accuracy, in the ante-mortem differentiation of probable DLB from probable AD, of cardiac imaging with the ligand 123I-meta-iodobenzylguanidine (MIBG) which binds to the noradrenaline reuptake site, in the first multicenter study.MethodsWe performed a multicenter study in which we used 123I-MIBG scans to assess 133 patients with clinical diagnoses of probable (n = 61) or possible (n = 26) DLB or probable AD (n = 46) established by a consensus panel. Three readers, unaware of the clinical diagnosis, classified the images as either normal or abnormal by visual inspection. The heart-to-mediastinum ratios of 123I-MIBG uptake were also calculated using an automated region-of-interest based system.ResultsUsing the heart-to-mediastinum ratio calculated with the automated system, the sensitivity was 68.9% and the specificity was 89.1% to differentiate probable DLB from probable AD in both early and delayed images. By visual assessment, the sensitivity and specificity were 68.9% and 87.0%, respectively. In a subpopulation of patients with mild dementia (MMSE ≥ 22, n = 47), the sensitivity and specificity were 77.4% and 93.8%, respectively, with the delayed heart-to-mediastinum ratio.ConclusionsOur first multicenter study confirmed the high correlation between abnormal cardiac sympathetic activity evaluated with 123I-MIBG myocardial scintigraphy and a clinical diagnosis of probable DLB. The diagnostic accuracy is sufficiently high for this technique to be clinically useful in distinguishing DLB from AD, especially in patients with mild dementia.

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