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Accuracy of Cardiac Innervation Scintigraphy for Mild Cognitive Impairment With Lewy Bodies

Lookup NU author(s): Dr Gemma Roberts, Dr Rory Durcan, Dr Paul Donaghy, Dr Sarah Lawley, Dr Joanna Ciafone, Dr Calum Hamilton, Dr Sean Colloby, Dr Michael Firbank, Dr Louise Allan, Nicola Barnett, Sally Barker, Dr Tamir Ali, Dr George Petrides, Professor John-Paul Taylor, Professor John O'Brien, Professor Alan Thomas

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


Abstract

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.OBJECTIVE: To provide evidence that cardiac I-123-metaiodobenzylguanidine sympathetic innervation imaging (MIBG) scintigraphy differentiates probable mild cognitive impairment with Lewy bodies (MCI-LB) from mild cognitive impairment due to Alzheimer disease (MCI-AD), we scanned patients with MCI and obtained consensus clinical diagnoses of their MCI subtype. We also performed baseline FP-CIT scans to compare the accuracy of MIBG and FP-CIT. METHODS: We conducted a prospective cohort study into the accuracy of cardiac MIBG scintigraphy in the diagnosis of MCI-LB. Follow-up clinical assessment was used to diagnose MCI-AD (no core features of MCI-LB and normal FP-CIT), probable MCI-LB (2 or more core features, or 1 core feature with abnormal FP-CIT), or possible MCI-LB (1 core feature or abnormal FP-CIT). For the comparison between MIBG and FP-CIT, only core clinical features were used for diagnosis. RESULTS: We recruited 95 people with mild cognitive impairment. Cardiac MIBG was abnormal in 22/37 probable and 2/15 possible MCI-LB cases and normal in 38/43 MCI-AD cases. The sensitivity in probable MCI-LB was 59% (95% confidence interval [CI], 42%-75%), specificity 88% (75%-96%), and accuracy 75% (64%-84%). The positive likelihood ratio was 5.1 and negative likelihood ratio 0.46. With symptom-only diagnoses, the accuracies were 79% for MIBG (95% CI, 68%-87%) and 76% for FP-CIT (95% CI, 65%-85%). CONCLUSIONS: Cardiac MIBG appears useful in early disease, with an abnormal scan highly suggestive of MCI-LB. Validation in a multicenter setting is justified. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that cardiac MIBG distinguishes MCI-LB from MCI-AD.


Publication metadata

Author(s): Roberts G, Durcan R, Donaghy PC, Lawley S, Ciafone J, Hamilton CA, Colloby SJ, Firbank MJ, Allan L, Barnett N, Barker S, Howe K, Ali T, Petrides GS, Lloyd J, Taylor J-P, O'Brien J, Thomas AJ

Publication type: Article

Publication status: Published

Journal: Neurology

Year: 2021

Volume: 96

Issue: 23

Pages: e2801-e2811

Print publication date: 08/06/2021

Online publication date: 21/04/2021

Acceptance date: 11/03/2021

Date deposited: 28/06/2021

ISSN (print): 028-3878

ISSN (electronic): 1526-632X

Publisher: American Academy of Neurology

URL: https://doi.org/10.1212/WNL.0000000000012060

DOI: 10.1212/WNL.0000000000012060

PubMed id: 33883238


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