Myocardial iodine-labeled metaiodobenzylguanidine 123 uptake relates to age

doi:10.1016/S1071-3581(95)80023-9

Journal of Nuclear Cardiology

Volume 2, Issue 2, March–April 1995, Pages 126-132

https://doi.org/10.1016/S1071-3581(95)80023-9 Get rights and content

Background ¹²³I-labeled metaiodobenzylguanidine (¹²³I-MIBG) is used increasingly toassess cardiac adrenergic neuron function. Few studies have reported data on myocardial MIBG uptake in relation to age, with contradictory results. This study reports the results of myocardial MIBG studies in untreated patients with cancer to assess the influence of age on myocardial MIBG uptake.

Methods and Results Thirty-nine patients with cancer enrolled in a study to assess the effectof doxorubicin administration on adrenergic neuron function underwent baseline studies with ¹²³I-MIBG before chemotherapy. None of the patients had a history of neuropathy, previous cardiac disease, or previous chemotherapy or mediastinal radiotherapy. Myocardial MIBG uptake was quantified by a heart/mediastinal ratio (HMR) 4 hours after intravenous administration of 5 mCi ¹²³I-MIBG. The mean age of patients was 38 years, ranging from 16 to 75 years. Ten patients were below 20 years, 13 patients were between 20 and 40 years, six patients were between 40 and 60 years, and 10 patients were greater than 60 years of age. Myocardial ¹²³I-MIBG uptake was observed in all patients, with a mean HMR of 1.85±0.29 (range 1.31 to 2.62). HMR correlated with age (r=−0.6264; p<0.001). A decrease in ¹²³I-MIBG uptake with aging was observed. The mean HMR of patients of less than 20 years was 2.07, of patients between 20 and 40 years 1.89, of patients between 40 and 60 years 1.83, and of patients greater than 60 years 1.56. The best separation was observed comparing patients who were greater than 60 years (mean MHR 1.56±0.16; range 1.31 to 1.78) with patients who were less than 60 years of age (mean HMR 1.95±0.;24; range 1.56 to 2.62; p=0.003).

Conclusions Myocardial ¹²³I-MIBG uptake relates to age. A decrease in myocardial MIBGuptake is observed with aging, especially in those patients over 60 years of age. The influence of age on myocardial MIBG uptake has to be taken into account when studies are designed to assess cardiac adrenergic neuron function with ¹²³I-MIBG. (J Nucl Cardiol 1995;2:126–32.)

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Simultaneous assessment of myocardial perfusion and adrenergic innervation in patients with heart failure by low-dose dual-isotope CZT SPECT imaging
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In patients with heart failure (HF) sequential imaging studies have demonstrated a relationship between myocardial perfusion and adrenergic innervation. We evaluated the feasibility of a simultaneous low-dose dual-isotope ¹²³I/^99mTc-acquisition protocol using a cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) camera.
Thirty-six patients with HF underwent simultaneous low-dose ¹²³I-metaiodobenzylguanidine (MIBG)/^99mTc-sestamibi gated CZT-SPECT cardiac imaging. Perfusion and innervation total defect sizes and perfusion/innervation mismatch size (defined by ¹²³I-MIBG defect size minus ^99mTc-sestamibi defect size) were expressed as percentages of the total left ventricular (LV) surface area. LV ejection fraction (EF) significantly correlated with perfusion defect size (P < .005), innervation defect size (P < .005), and early (P < .05) and late (P < .01) ¹²³I-MIBG heart-to-mediastinum (H/M) ratio. In addition, late H/M ratio was independently associated with reduced LVEF (P < .05). Although there was a significant relationship (P < .001) between perfusion and innervation defect size, innervation defect size was larger than perfusion defect size (P < .001). At multivariable linear regression analysis, ¹²³I-MIBG washout rate (WR) correlated with perfusion/innervation mismatch (P < .05).
In patients with HF, a simultaneous low-dose dual-isotope ¹²³I/^99mTc-acquisition protocol is feasible and could have important clinical implications.
Feasibility of myocardial PET imaging using a benzylguanidine analog: meta-(3-[18F]fluoropropyl)benzylguanidine ([18F]mFPBG)
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Citation Excerpt :
Therefore, [123I]mIBG single photon emission computed tomography (SPECT) imaging can distinguish between regional adrenergic denervation and perfusion defects, unlike SPECT myocardial perfusion imaging (MPI) [11,12]. Such differences are particularly important in older adults, who exhibit lower uptake of [123I]mIBG in the posterior inferior wall [13]. Investigation of cardiac sympathetic nervous innervation with [123I]mIBG SPECT allows for the evaluation of ischemia in areas of myocardial infarction (MI) and adjacent non-infarcted regions, as earlier damage to sympathetic neurons, rather than to cardiac myocytes, may account for some degree of ischemia.
Global and regional sympathetic activity in the heart can be evaluated using [¹²³I]meta-iodobenzylguanidine ([¹²³I]mIBG) imaging. However, [¹²³I]mIBG is associated with low image spatial resolution and sensitivity in cardiac imaging. We investigated the capability of an F-18-labeled mIBG derivative, meta-(3-[¹⁸F]fluoropropyl)benzylguanidine ([¹⁸F]mFPBG), for identifying ischemic and viable myocardium in a rat model of myocardial infarction.
The ex vivo biodistribution and in vivo metabolic stability of [¹⁸F]mFPBG were investigated in Sprague–Dawley rats. Selective cardiac adrenergic activation was confirmed via a blocking experiment involving pretreatment with desipramine (2 mg kg⁻¹), followed by the administration of [¹⁸F]mFPBG. Imaging properties of [¹⁸F]mFPBG were compared with those of traditional cardiac imaging radiotracers ([¹²³I]mIBG and [^99mTc]MIBI) in a rat model of myocardial infarction. Non-invasive image-based measurements of infarct sizes were then compared with histological findings by using Bland–Altman analysis.
The differences in infarct sizes determined using histological analysis and [¹⁸F]mFPBG PET were −2.55 ± 4.99% (range: −12.33 to 7.22), −2.35 ± 3.32% (range: −8.87 to 4.16), and −3.15 ± 6.16% (range: −15.24 to 8.93) at 5, 20, and 40 min, respectively. Furthermore, [¹⁸F]mFPBG PET was superior to traditional imaging methods in assessing the degree of ischemia in areas of myocardial infarction, as well as the actual infarct size.
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¹: Supported by grant DGICYT PB93-1016.

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Journal of Nuclear Cardiology

References (30)

Heterogeneity of the human myocardial sympathetic innervation: in vivo demonstration by iodine-labeled meta-iodobenzylguanidine scintigraphy

Am Heart J

Iodine-123-meta-iodobenzylguanidine scintigraphy: a noninvasive method to demonstrate myocardial adrenergic nervous system disintegrity in patientswith idiopathic dilated cardiomyopathy

J Am Coll Cardiol

Transient alterations in cardiac performance after a six-hour race

Am J Cardiol

Catecholamine excretion andcardiac stores of norepinephrine in congestive heart failure

Am J Med

Effects of aging on asynchronous left ventricular regional function and global ventricular filling in normal human subjects

J Am Coll Cardiol

Age related changes in normal human hearts during the first 10 decades of life, part II (maturity): a quantitative anatomic study of 765 specimens from subjects 20 to 99 years old

Mayo Clin Proc

Meta-iodobenzylguanidine as an index of the adrenergic nervous system integrity and function

J Nucl Med

Meta-iodobenzylguanidine to map scintigraphically the adrenergic nervous system in man

J Nucl Med

Radiolabeled adrenergic neuron-blocking agents: adrenomedullary imaging with (I-125)iodobenzylguanidine

J Nucl Med

Heart imaging in the diagnosis of pheochromocytoma and assessment of catecholamine uptake

J Nucl Med

Myocardial imaging with a radioiodinated norepinephrine storage analog

J Nucl Med

Role of transmitter uptake mechanisms in synaptic neurotransmission

Br J Pharmacol

The role of uptake in the extraneuronal metabolism of catecholamines in the isolated rat heart

Br J Pharmacol

Iodine-131 metaiodobenzylguanidine intra- and extravesicular accumulation in the rat heart

J Nucl Med

Scintigraphic assessment of MIBG uptake in globally denervated human and canine hearts: implications for clinical studies

J Nucl Med

Cited by (77)

Adrenergic signaling in cardiovascular aging

Simultaneous assessment of myocardial perfusion and adrenergic innervation in patients with heart failure by low-dose dual-isotope CZT SPECT imaging

Feasibility of myocardial PET imaging using a benzylguanidine analog: meta-(3-[<sup>18</sup>F]fluoropropyl)benzylguanidine ([<sup>18</sup>F]mFPBG)

<sup>123</sup>I-MIBG imaging in heart failure: impact of comorbidities on cardiac sympathetic innervation

Autopsy Validation of the Diagnostic Accuracy of <sup>123</sup>I-Metaiodobenzylguanidine Myocardial Scintigraphy for Lewy Body Disease

Autonomic nervous system activity in primary Raynaud's phenomenon: Heart rate variability, plasma catecholamines and [<sup>123</sup>I]MIBG heart scintigraphy

Original articleMyocardial iodine-labeled metaiodobenzylguanidine 123 uptake relates to age1

Am Heart J

J Am Coll Cardiol

Am J Cardiol

Am J Med

J Am Coll Cardiol

Mayo Clin Proc

Meta-iodobenzylguanidine as an index of the adrenergic nervous system integrity and function

J Nucl Med

Meta-iodobenzylguanidine to map scintigraphically the adrenergic nervous system in man

J Nucl Med

Radiolabeled adrenergic neuron-blocking agents: adrenomedullary imaging with (I-125)iodobenzylguanidine

J Nucl Med

Heart imaging in the diagnosis of pheochromocytoma and assessment of catecholamine uptake

J Nucl Med

Myocardial imaging with a radioiodinated norepinephrine storage analog

J Nucl Med

Role of transmitter uptake mechanisms in synaptic neurotransmission

Br J Pharmacol

The role of uptake in the extraneuronal metabolism of catecholamines in the isolated rat heart

Br J Pharmacol

Iodine-131 metaiodobenzylguanidine intra- and extravesicular accumulation in the rat heart

J Nucl Med

Scintigraphic assessment of MIBG uptake in globally denervated human and canine hearts: implications for clinical studies

J Nucl Med

Original article
Myocardial iodine-labeled metaiodobenzylguanidine 123 uptake relates to age1