PT - JOURNAL ARTICLE AU - Scott, Lynda A. AU - Kench, Peter L. TI - Cardiac Autonomic Neuropathy in the Diabetic Patient: Does <sup>123</sup>I-MIBG Imaging Have a Role to Play in Early Diagnosis? DP - 2004 Jun 01 TA - Journal of Nuclear Medicine Technology PG - 66--71 VI - 32 IP - 2 4099 - http://tech.snmjournals.org/content/32/2/66.short 4100 - http://tech.snmjournals.org/content/32/2/66.full SO - J. Nucl. Med. Technol.2004 Jun 01; 32 AB - Objectives: In diabetes, extended adrenergic receptor stimulation with hyperglycemia and insulin deficiency is associated with cardiac autonomic dysfunction. Clinically evident diabetic cardiac autonomic neuropathy (CAN) is associated with a poor prognosis. Research studies indicate that autonomic function tests, which are traditionally used to diagnose diabetic CAN, are less sensitive than 123I-metaiodobenzylguanidine (MIBG) imaging, particularly in the early stages of the disease. This established imaging technique makes use of the noradrenaline analog MIBG, which is radiolabeled with 123I to assess the noradrenaline uptake-1 mechanism of the sympathetic nervous system. Although scintigraphic studies indicate that long-standing cardiac autonomic dysfunction is permanent, some authors have shown partial reversibility with early metabolic intervention. 123I-MIBG imaging could therefore have an important clinical role to play in the early diagnosis and treatment monitoring of diabetic CAN. Methods: A PubMed/MEDLINE Internet search was performed using MIBG, diabetes, and cardiac autonomic neuropathy as key words. Conclusion: The general expense of 123I-MIBG imaging, together with the lack of commercial availability of this radiopharmaceutical in the United States, has limited the clinical use of this technique. As such, the clinical role of 123I-MIBG imaging in the early diagnosis of diabetic CAN has yet to be validated and defined in most regions of the world, and further study is required.