Myocardial adrenergic innervation by SPECT with I123-MIBG

What is it?

This examination uses a substance (MIBG) similar to catecholamines, normally produced by the adrenals, at a dosage without pharmacological effects and labelledwith a radioactive part consisting of radio-iodine (I123). MIGB SPECT allows the measurement of cardiac sympathetic catecholaminergic innervation. The result of this examination guides the physician to a more correct diagnosis and a better therapeutic option.  

When is this exam indicated?

The examination with I123-MIGB, which includes a TOMOGRAPHIC study and/or early PLANAR ACQUISITIONS, a few minutes after administration, and late four hours after inoculation, allows to evaluate the cardiac sympathetic innervation and is therefore recommended for patients with Parkinson's disease, dementia with Lewy bodies, Parkinsonism, when the differential diagnosis has not been reached after an 18F-FDG PET examination.

  • Parkinson's disease
  • Parkinsonism
  • Lewy Body Dementia

How is it performed?

Upon the doctor's advice, it is recommended to suspend tricyclic antidepressants (7-21 days), sympathomimetics (7-14), labetalol (21 days), reserpine and bretylium (7-14), calcium channel blockers (14 days), antipsychotics (21-28 days) and beta-blockers (48 hours). In the days preceding the examination it is advisable to avoid food containing vanillin or other substances similar to catecholamines (coffee, tea, chocolate, nuts, bananas, pineapples). Fasting of at least 8 hours is required. The duration of the examination is about 4-5 hours. Before the examination it is necessary to drink a solution of potassium perchlorate dissolved in water in order to protect the thyroid from eventual free Iodine not bound to the radiopharmaceutical.  After the injection the patient will acquire early results and then wait 4 hours for later results. The examination is performed while the patient is lying on the SPECT couch and remains motionless with arms extended above the head for about 20 minutes.

 

The duration of the examination is about 120 minutes, including 90 minutes of waiting in a quiet room, after the radiopharmaceutical has been administered. This procedure provides optimal distribution in the brain tissue, followed by a 20 minute image acquisition by PET tomograph.

Contraindications

Pregnancy

Lactation (suspension of breastfeeding for 24 h)

Inability of the patient to be cooperative during the procedure.

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