Objective: To compare the MIBG uptake in the major salivary gland between progressive supranuclear palsy/corticobasal syndrome (PSP/CBS) and Parkinson’s disease (PD).

Background: ¹²³I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a useful tool to differentiate PD from PSP/CBS, and it has recently been demonstrated that the major salivary sympathetic denervation might be found in PD. However, little is known about the MIBG uptake in the major salivary between PD and other parkinsonian syndromes.

Method: We recruited patients with PSP/CBS, PD and non-PD controls to compare the MIBG uptake in the major salivary glands in addition to the myocardium. Head and chest planar images were scanned in the early and delayed phase, and we calculated the MIBG uptake ratios in parotid/mediastinum (P/M), submandibular/mediastinum (S/M) and heart/mediastinum (H/M), respectively, using a quantitative semi-automatic method. Additionally, we compared the MIBG uptake in the parotid glands, submandibular glands and the myocardium among three groups. Furthermore, we evaluated the disease sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in the combination of the major salivary glands and the myocardium.

Results: Fifteen patients with PSP/CBS, age and disease duration-matched 72 with PD and 30 with controls were enrolled in the present study. MIBG uptakes in early (p = 0.003) and delayed (p = 0.002) P/M, delayed (p = 0.037) S/M and early (p < 0.001) and delayed (p < 0.001) H/M were significantly reduced in PD, compared to PSP/CBS. Between PD and controls, MIBG uptakes in early and delayed P/M, S/M and H/M were significantly reduced in PD (all were p < 0.001). While MIBG uptake in P/M, S/M and H/M in PSP/CBS was equivalent to those of controls. When delayed P/M and S/M or delayed H/M were reduced, diagnostic accuracy for the combination of the major salivary glands and the myocardium between PSP/CBS and PD was as follows: sensitivity was 91.7%, specificity was 80%, PPV was 95.7% and NPV was 66.7%, respectively.

Conclusion: MIBG uptakes in the major salivary glands in PD were significantly reduced, compared to PSP/CBS and controls. The combination of MIBG uptake in the major salivary glands and the myocardium might contribute to high disease diagnostic sensitivity and show the wide distribution of Lewy pathology in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-the-mibg-uptake-in-the-major-salivary-glands-between-progressive-supranuclear-palsy-corticobasal-syndrome-and-parkinsons-disease/