123I-MIBG myocardial scintigraphy in diabetic patients: Relationship with 201Tl uptake and cardiac autonomic function

被引:0
作者
Nagamachi S. [1 ]
Jinnouchi S. [1 ]
Kurose T. [1 ]
Ohnishi T. [1 ]
Flores II L.G. [1 ]
Nakahara H. [1 ]
Futami S. [1 ]
Tamura S. [1 ]
Matsukura S. [1 ]
机构
[1] Department of Radiology, Miyazaki Medical College, Miyazaki 889-1692, Kihara 5200, Kiyotakecho
关键词
!sup]123[!/sup]I-MIBG myocardial scintigraphy; Cardiac autonomic neuropathy; Diabetic myocardial damage; NIDDM;
D O I
10.1007/BF03164921
中图分类号
学科分类号
摘要
Purpose: To investigate the influence of diabetic myocardial damage (suspected myocardial damage; SMD) diagnosed by 201Tl-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) after 123I-MIBG injection. The heart to mediastinum uptake ratio (H/M) and washout ratio of 123I-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 the 201Tl image and the 123I-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 subgroup 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 autonomic 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 myocardial 123I-MIBG uptake might progress independently of SMD.
引用
收藏
页码:323 / 331
页数:8
相关论文
共 37 条
  • [1] Ewing D.J., Cambell I.W., Clarke B.F., The natural history of diabetic autonomic neuropathy, Q J Med, 49, pp. 95-108, (1980)
  • [2] Nagamachi S., Jinnouchi S., Nakahara H., Flores L.G., Ohnishi T., Hoshi H., Et al., <sup>123</sup>I-MIBG myocardial scintigraphy in diabetic patients: Relationship to autonomic neuropathy, Nucl Med Commu, 17, pp. 621-632, (1996)
  • [3] Mantysaari M., Kuikka J., Mustonene J., Tahvanainen K., Vanninen E., Lansimies E., Et al., Noninvasive detection of cardiac sympathetic nervous dysfunction in diabetic patients using [<sup>123</sup>I]metaiodobenzylguanidine, Diabetes, 41, pp. 1069-1075, (1992)
  • [4] Kim S.J., Lee J.D., Ryu Y.H., Jeon P., Shim Y.W., Yoo H.S., Et al., Evaluation of cardiac sympathetic neuronal integrity in diabetic patients using iodine-123 metaiodobenzyl guanidine, Eur J Nucl Med, 23, pp. 401-406, (1996)
  • [5] Katono E., Owada K., Takeda H., Techigawara M., Watanabe N., Maruyama Y., Usefulness of myocardial imaging by <sup>123</sup>I-MIBG in assessment of diabetic neuropathy, Jpn J Nucl Med, 30, pp. 1235-1239, (1993)
  • [6] Hattori N., Tamaki N., Hayashi T., Masuda I., Kudoh T., Tateno M., Et al., Regional abnormality of iodine-123-MIBG in diabetic hearts, J Nucl Med, 37, pp. 1985-1990, (1996)
  • [7] Dubois E.A., Kam K.L., Somsen G.A., Boer G.J., Bruin K., Batink H.D., Et al., Cardiac iodine-123 metaiodobenzylguanidine uptake in animals with diabetes mellitus and/or hypertension, Eur J Nucl Med, 23, pp. 901-908, (1996)
  • [8] Abe N., Kashiwagi A., Shigeta Y., Usefulness of cardiac <sup>125</sup>I-metaiodobenzylguanidine uptake for evaluation of cardiac sympathetic nerve abnormalities in diabetic rats, J Japan Diab Soc, 35, pp. 113-119, (1992)
  • [9] Matsuo S., Takahashi S., Yoshida S., Tohru I., Nakamura Y., Mitsunami K., Et al., Characteristics of regional sympathetic innervation in diabetic patients with silent myocardial ischemia assessed by <sup>123</sup>I-metaiodobenzyl guanidine imaging, Jpn J Nucl Med, 33, pp. 493-499, (1996)
  • [10] Langer A., Freeman M.R., Josse R.G., Armstrong P.W., Metaiodobenzylguanidine imaging in diabetes mellitus: Assessment of cardiac sympathetic denervation and its relation to autonomie dysfunction and silent myocardial ischemia, J am Coll Cardiol, 25, pp. 610-618, (1995)