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123I-MIBG myocardial scintigraphy in diabetic patients: Relationship with201Tl uptake and cardiac autonomic function

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Abstract

Purpose

To investigate the influence of diabetic myocardial damage (suspected myocardial damage; SMD) diagnosed by201T1-SPECT and diabetic cardiac autonomic neuropathy (AN) on myocardial MIBG uptake in patients with non-insulin-dependent diabetes mellitus (NIDDM).

Subjects and Methods

Eighty-seven diabetic patients divided into four subgroups: 23 with SMD (+) AN (+); 19 with SMD (+) AN (−); 27 with SMD (−) AN (+); 18 with SMD (−) AN (−), and 10 controls were studied. Both planar and SPECT images were taken at 30 minutes (early) and 3 hours (delayed) after123I-MIBG injection. The heart to mediastinum uptake ratio (H/M) and washout ratio of123I-MIBG (WR) were obtained from both planar images. On SPECT images, the total uptake score (TUS) was obtained by the 5 point score method by dividing the myocardium into 20 segments on visual analysis. Similarly, the difference between the201Tl image and the123I-MIBG image in TUS was taken as the difference in the total uptake score (ΔTUS) representing cardiac sympathetic denervation without SMD.

Results

On both early and delayed planar images, the mean H/M value in the subgroups of diabetic patients was significantly lower in the SMD (+) AN (+) group than in the control group, but among those subgroups, there was statistically significant difference between the SMD (+) AN (+) and SMD (−) AN (−) groups only on the delayed images. Regarding the WR value, there was no statistically significant difference among subjects. On SPECT image analysis, the diabetic sub-group with AN or SMD had statistically significant lower values for TUS than those of the control group. Among diabetics, there was a statistically significant differences between SMD [+] AN [+] and SMD [−] AN [−] on both early and delayed images. Similarly, the SMD [+] AN [−] group also had significantly lower values than those of SMD [−] AN [−] on early images. Regarding ΔTUS, there was a statistically significant differences between AN [+] subgroups and controls. Similarly, the mean value for ΔTUS was much higher in AN [+] subgroups than in AN [−] subgroups with or without SMD in diabetes mellitus.

Conclusion

123I-MIBG myocardial uptake is affected by both SMD and cardiac autonomie neuropathy. Based on the finding that ΔTUS was much higher in AN [+] subgroups and there was no statistically significant difference between SMD [+] AN [+] and SMD [−] AN [+] subgroups, a decrease in myocardial123I-MIBG uptake might progress independently of SMD.

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Authors and Affiliations

  1. Department of Radiology, Miyazaki Medical College, Kihara 5200, Kiyotakecho, 889-1692, Miyazaki, Japan

    Shigeki Nagamachi, Seishi Jdmnouchi, Takashi Ohnishi, Leo G. Flores, Hiroshi Nakahara, Shigemi Futami & Shozo Tamura

  2. Third Department of Internal Medicine, Miyazaki Medical College, Japan

    Takeshi Kurose & Shigeru Matsukura

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  1. Shigeki Nagamachi
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  2. Seishi Jdmnouchi
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  3. Takeshi Kurose
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Nagamachi, S., Jdmnouchi, S., Kurose, T. et al. 123I-MIBG myocardial scintigraphy in diabetic patients: Relationship with201Tl uptake and cardiac autonomic function. Ann Nucl Med 12, 323–331 (1998). https://doi.org/10.1007/BF03164921

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  • DOI: https://doi.org/10.1007/BF03164921

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