Influence of Antidepressant Use on I-MIBG Heart and Lung Uptakes in the Diagnosis of Lewy Body Disease

Overview

Journal Ann Nucl Med

Date 2022 Feb 20

PMID 35184216

Authors

Shinobu Adaniya

Miwako Takahashi

Keitaro Koyama

Kenichiro Ogane

Toshimitsu Momose

Affiliations

Soon will be listed here.

Abstract

Objective: The clinical significance of decreased physiological lung uptake of I-metaiodobenzylguanidine (MIBG) has not been well investigated. This study aimed to elucidate the association between a decrease in lung MIBG uptake with antidepressant intake and the myocardial MIBG uptake in patients who were clinically diagnosed with Lewy body disease (LBD) and patients who were diagnosed as not having LBD.

Methods: We retrospectively reviewed the heart and lung uptakes on 167 consecutive MIBG scans, antidepressant status, and clinical diagnosis of LBD. The images were visually classified into two groups: decreased lung uptake and preserved lung uptake. A semi-quantitative analysis was performed using the heart-to-mediastinum ratio (H/M), lung-to-mediastinum ratio (L/M), and myocardial washout rate (WR).

Results: All 17 patients with decreased lung uptake were on treated with antidepressants, while none of the 150 patients with preserved lung uptake were treated with any antidepressants. Of the 17 patients with decreased lung uptake, 6 patients were clinically diagnosed as LBD and other 11 were clinically diagnosed as non-LBD. There was not significant difference in early H/M, delayed H/M, and myocardial WR between the 11 non-LBD patients with decreased lung uptake and 83 non-LBD patients with preserved lung uptake (2.87 ± 0.69 vs. 2.89 ± 0.44, 3.09 ± 0.48 vs. 2.98 ± 0.59, and 21.8 ± 11.3% vs. 21.1 ± 12.5%, respectively). Moreover, in LBD patients, there were no significant differences in those values between six patients with decreased lung uptake and 67 patients with preserved lung uptake (1.68 ± 0.32 vs. 1.73 ± 0.42, 1.34 ± 0.21 vs. 1.54 ± 0.57, 46.2 ± 22.8% vs. 42.8 ± 21.3%, respectively).

Conclusions: Antidepressants probably blocked MIBG uptake in the lungs, and a decreased lung uptake was not significantly associated with heart uptake. A remarkable decrease in lung uptake can be a signal to check a patient's medication status.

Citing Articles

Value of multi-parameter I-MIBG scintigraphy in the differential diagnosis of Parkinson's disease.

Xue T, Cui Y, Kan Y, Wang G, Yang J EJNMMI Res. 2025; 15(1):7.

PMID: 39875667 PMC: 11775374. DOI: 10.1186/s13550-025-01197-8.

Iodine-123 Metaiodobenzylguanidine (I-123 MIBG) in Clinical Applications: A Comprehensive Review.

Chang M, Peng C, Chen C, Shih Y, Chen J, Tai Y Pharmaceuticals (Basel). 2025; 17(12.

PMID: 39770405 PMC: 11676292. DOI: 10.3390/ph17121563.

Cardiac 123I-Metaiodobenzylguanidine (MIBG) Scintigraphy in Parkinson's Disease: A Comprehensive Review.

Rissardo J, Caprara A Brain Sci. 2023; 13(10).

PMID: 37891838 PMC: 10605004. DOI: 10.3390/brainsci13101471.

Depression in dementia with Lewy bodies: a critical update.

Jellinger K J Neural Transm (Vienna). 2023; 130(10):1207-1218.

PMID: 37418037 DOI: 10.1007/s00702-023-02669-8.

References

Mitsui J, Saito Y, Momose T, Shimizu J, Arai N, Shibahara J . Pathology of the sympathetic nervous system corresponding to the decreased cardiac uptake in 123I-metaiodobenzylguanidine (MIBG) scintigraphy in a patient with Parkinson disease. J Neurol Sci. 2006; 243(1-2):101-4. DOI: 10.1016/j.jns.2005.11.034. View

Orimo S, Suzuki M, Inaba A, Mizusawa H . 123I-MIBG myocardial scintigraphy for differentiating Parkinson's disease from other neurodegenerative parkinsonism: a systematic review and meta-analysis. Parkinsonism Relat Disord. 2012; 18(5):494-500. DOI: 10.1016/j.parkreldis.2012.01.009. View

Takahashi M, Ikemura M, Oka T, Uchihara T, Wakabayashi K, Kakita A . Quantitative correlation between cardiac MIBG uptake and remaining axons in the cardiac sympathetic nerve in Lewy body disease. J Neurol Neurosurg Psychiatry. 2015; 86(9):939-44. DOI: 10.1136/jnnp-2015-310686. View

McKeith I, Boeve B, Dickson D, Halliday G, Taylor J, Weintraub D . Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017; 89(1):88-100. PMC: 5496518. DOI: 10.1212/WNL.0000000000004058. View

Beach T, Adler C, Sue L, Vedders L, Lue L, White Iii C . Multi-organ distribution of phosphorylated alpha-synuclein histopathology in subjects with Lewy body disorders. Acta Neuropathol. 2010; 119(6):689-702. PMC: 2866090. DOI: 10.1007/s00401-010-0664-3. View

Gelpi E, Navarro-Otano J, Tolosa E, Gaig C, Compta Y, Rey M . Multiple organ involvement by alpha-synuclein pathology in Lewy body disorders. Mov Disord. 2014; 29(8):1010-8. DOI: 10.1002/mds.25776. View

Taki J, Nakajima K, Hwang E, Matsunari I, Komai K, Yoshita M . Peripheral sympathetic dysfunction in patients with Parkinson's disease without autonomic failure is heart selective and disease specific. taki@med.kanazawa-u.ac.jp. Eur J Nucl Med. 2000; 27(5):566-73. DOI: 10.1007/s002590050544. View

Reinhardt M, Jungling F, Krause T, Braune S . Scintigraphic differentiation between two forms of primary dysautonomia early after onset of autonomic dysfunction: value of cardiac and pulmonary iodine-123 MIBG uptake. Eur J Nucl Med. 2000; 27(5):595-600. DOI: 10.1007/s002590050548. View

Matsui H, Udaka F, Oda M, Kubori T, Nishinaka K, Kameyama M . Metaiodobenzylguanidine (MIBG) scintigraphy at various parts of the body in Parkinson's disease and multiple system atrophy. Auton Neurosci. 2005; 119(1):56-60. DOI: 10.1016/j.autneu.2005.03.003. View

10.

Adaniya S, Takahashi M, Koyama K, Ogane K, Momose T . Two Cases of Decreased 123I-Metaiodobenzylguanidine Lung Uptake in Metaiodobenzylguanidine Scintigraphy While Taking Selective Serotonin Reuptake Inhibitor/Serotonin Noradrenaline Reuptake Inhibitor. Clin Nucl Med. 2020; 46(4):329-331. PMC: 7938912. DOI: 10.1097/RLU.0000000000003451. View

11.

Postuma R, Berg D, Stern M, Poewe W, Olanow C, Oertel W . MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2015; 30(12):1591-601. DOI: 10.1002/mds.26424. View

12.

Nakajima K, Okuda K, Yoshimura M, Matsuo S, Wakabayashi H, Imanishi Y . Multicenter cross-calibration of I-123 metaiodobenzylguanidine heart-to-mediastinum ratios to overcome camera-collimator variations. J Nucl Cardiol. 2014; 21(5):970-8. PMC: 4167440. DOI: 10.1007/s12350-014-9916-2. View

13.

Blom T, Meinsma R, Rutgers M, Buitenhuis C, Dekken-Van den Burg M, van Kuilenburg A . Selective serotonin reuptake inhibitors (SSRIs) prevent meta-iodobenzylguanidine (MIBG) uptake in platelets without affecting neuroblastoma tumor uptake. EJNMMI Res. 2020; 10(1):78. PMC: 7343696. DOI: 10.1186/s13550-020-00662-w. View

14.

Suhara T, Sudo Y, Yoshida K, Okubo Y, Fukuda H, Obata T . Lung as reservoir for antidepressants in pharmacokinetic drug interactions. Lancet. 1998; 351(9099):332-5. DOI: 10.1016/S0140-6736(97)07336-4. View

15.

Rapport M, Green A, PAGE I . Crystalline Serotonin. Science. 1948; 108(2804):329-30. DOI: 10.1126/science.108.2804.329. View

16.

Junod A . Uptake, metabolism and efflux of 14 C-5-hydroxytryptamine in isolated perfused rat lungs. J Pharmacol Exp Ther. 1972; 183(2):341-55. View

17.

Strum J, Junod A . Radioautographic demonstration of 5-hydroxytryptamine- 3 H uptake by pulmonary endothelial cells. J Cell Biol. 1972; 54(3):456-67. PMC: 2200290. DOI: 10.1083/jcb.54.3.456. View

18.

Nicholas T, Strum J, Angelo L, Junod A . Site and mechanism of uptake of 3H--norepinephrine by isolated perfused rat lungs. Circ Res. 1974; 35(5):670-80. DOI: 10.1161/01.res.35.5.670. View

19.

GILLIS C, Greene N, Cronau L, Hammond G . Pulmonary extraction of 5-hydroxytryptamine and norepinephrine before and after cardiopulmonary bypass in man. Circ Res. 1972; 30(6):666-74. DOI: 10.1161/01.res.30.6.666. View

20.

Slosman D, Polla B, Donath A . 123I-MIBG pulmonary removal: a biochemical marker of minimal lung endothelial cell lesions. Eur J Nucl Med. 1990; 16(8-10):633-7. DOI: 10.1007/BF00998161. View