Myocardial 123I-MIBG scintigraphy for differentiation of Lewy bodies disease from FTD

Clinical distinction between Lewy bodies disease (LBD) and frontotemporal dementia (FTD) is sometimes difficult. Nigrostriatal dopaminergic degeneration occurs in both LBD and FTD, limiting helpfulness of DAT imaging to differentiate these forms of dementia. Several studies have emphasized the usefulness of myocardial scintigraphy with 123Metaiodobenzylguanidine (123I-MIGB) in assessing the sympathetic nerve terminals in LBD demonstrating that cardiac 123I-MIGB uptake is decreased in patients with this disease.We investigated the role of cardiac 123I-MIBG scintigraphy in differentiating patients with LBD from those with FTD. Clinical diagnosis of LBD and FTD was determined according to established consensus criteria. Nine patients with LBD (1 possible and 8 probable), 6 patients with FTD, and 16 control subjects were involved in the study.The heart to mediastinum ratio (H/M) of 123I-MIBG uptake was markedly reduced in all patients with LBD (H/M early: 1.25 ± 0.12; delayed: 1.14 ± 0.13) whereas it was normal in patients with FTD (H/M early: 1.86 ± 0.20; delayed: 1.80 ± 0.23) and in controls (H/M early: 1.91 ± 0.17; delayed: 1.99 ± 0.19), suggesting that cardiac 123I-MIBG scintigraphy can help distinguish patients with LBD from those with FTD.