Session Information
Date: Monday, June 20, 2016
Session Title: Parkinsonism, MSA, PSP (secondary and parkinsonism-plus)
Session Time: 12:30pm-2:00pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: The aim of this study was to determine the diagnostic accuracy of cardiac 123I-metaiodobenzylguanidine (MIBG)-SPECT and CT co-registration in discriminating the Parkinson variant of multiple system atrophy (MSA-P) from Parkinson´s disease (PD).
Background: Cardiac 123I-MIBG SPECT imaging of the heart provides a measure of cardiac sympathetic innervation and has been used extensively as an additional pointer in differentiating PD from atypical Parkinsonian disorders including MSA. However, much less is known about the diagnostic value of 123I-MIBG-SPECT and low-dose-CT co-registration. Latter approach allows attenuation correction of SPECT images and fusion of the anatomic details from CT and the functional information from SPECT.
Methods: We conducted a prospective study including 16 PD and 7 MSA-P patients. Patients were matched for age and motor disability. All patients underwent thoracic 123I-MIBG SPECT/CT imaging. Disease severity was assessed using the Hoehn&Yahr, UMSARS and UPDRS scales. Data are presented as mean ± SD. Statistical analyses were performed using Fishers Exact Test, Student´s T-test and Wilcoxon Mann Whitney U test as appropriate.
Results: Mean age at examination was 65 years ± 2.2 years in PD and 65 years ± 3.0 in MSA-P patients, mean disease duration was 7.0 ± 0.7 years in PD and 4.0 ± 1.1 years in MSA. Total UMSARS score in MSA was 46.3 ± 3.6 (UMSARS I 22.7 ± 1.9; UMSARS II 23.7 ± 1.4 and global disability scale 3 ± 0.4). Total UPDRS score in PD was 72 ± 2.2 (UPDRS I 12 ± 1.1; UPDRS II 17 ± 1.1; UPDRS III 38 ± 2.1; UPDRS IV 6 ± 1.1). We detected a significant difference in cardiac uptake of 123I-MIBG between PD and MSA patients: 88% of PD patients had a pathological finding on 123I-MIBG SPECT CT imaging whereas only 43% of MSA patients showed abnormal cardiac sympathetic innervation (p=0.045). The corresponding odds ratio for a diagnosis of MSA was 9.3. Sensitivity and specificity were 57% and 88%, respectively.
Conclusions: In our cohort, MSA-P patients showed more frequently a reduced cardiac sympathetic innervation than previously reported. This finding is most likely due to the more detailed 123I-MIBG SPECT CT imaging approach used in our study. Nevertheless, the presence of normal cardiac sympathetic innervation strongly supports a diagnosis of MSA-P.
To cite this abstract in AMA style:
C. Kaindlstorfer, F. Krismer, A. Fanciulli, S. Eschlböck, M. Nocker, S. Bösch, K. Mair, C. Scherfler, A. Djamshidian-Tehrani, C. Uprimny, E. Donnemiller, I. Virgolini, K. Seppi, W. Poewe, G. Wenning. Diagnostic value of cardiac 123I-MIBG SPECT and CT co-registration in PD and MSA-P [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/diagnostic-value-of-cardiac-123i-mibg-spect-and-ct-co-registration-in-pd-and-msa-p/. Accessed June 14, 2025.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-value-of-cardiac-123i-mibg-spect-and-ct-co-registration-in-pd-and-msa-p/