Objective: To investigate relation between the clinical features and the standardized heart to mediastinum (H/M) ratio by cardiac metaiodobenzylguanidine (MIBG) imaging in patients with Parkinson’s disease (PD).

Background: Recently a calibration phantom method for the standardization of H/M ratio by different SPECT machines has been developed (Nakajima et al. Eur J Nucl Med Mol Imaging 39:113-119, 2012).

Methods: A multicenter cross-sectional study participating 6 hospitals. The subjects were 99 PD patients (age; 71.9±7.9 years old, PD disease duration; 5.7±4.4 years, mean±SD). We examined their clinical/neurological features and the standardized H/M ratio by cardiac MIBG imaging.

Results: There was no difference in the H/M ratio between the male and the female. The H/M ratio was significantly lower in the patients older than 65 years than the younger patients (1.60±0.51 vs.1.40±0.35, P=0.0426). The H/M ratio had no relation with their disease duration. The H/M ratio was lower in the patients whose motor symptom was severe (UPDRS part III 7 items ≥12 points) than the milder patients (1.50±0.38 vs.1.37±0.38, P=0.0034). The H/M ratio was lower in the patients with Hoehn and Yahr stage ≥III than the patients with Hoehn and Yahr stage ≤II (1.59±0.46 vs.1.38±0.34, P=0.0124). The several items in UPDRS part III were related to the H/M ratio; “finger taps” (normal or mildly impaired (≤1point) 1.51±0.36 vs. impaired (≥2points) 1.36±0.39, P<0.0001),”arising from chair” (1.50±0.37 vs.1.36±0.39, P=0.0125),”gait” (1.52±0.40 vs.1.37±0.35, P=0.0096),”posture” (1.54±0.40 vs.1.38±0.37, P=0.0033) and “severity of postural stability” (1.54±0.44 vs.1.38±0.34, P=0.0318). The presence of tremor, rigidity or dyskinesia was not related to the H/M ratio. The patients with wearing-off showed lower H/M ratio than the patients without it (1.49±0.41 vs.1.37±0.33, P=0.0410). As for the autonomic dysfunction, the patients with incontinence showed lower H/M ratio than the patients without it (1.47±0.40 vs.1.25±0.19, P=0.0116).

Conclusions: The H/M ratio is higher in the patients who was younger than 65 years, or without akinesia or postural instability or wearing-off or incontinence. Summing up, cardiac MIBG imaging remains at higher levels in the early stage compared to the late stage of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/relation-between-the-clinical-features-and-the-standardized-heart-to-mediastinum-ratio-in-cardiac-metaiodobenzylguanidine-imaging-in-patients-with-parkinsons-disease-a-multicenter-cross-sectional-st/