Roles of cardiac sympathetic neuroimaging in autonomic medicine.
David S GoldsteinWilliam P CheshirePublished in: Clinical autonomic research : official journal of the Clinical Autonomic Research Society (2018)
Sympathetic neuroimaging is based on the injection of compounds that either radiolabel sites of the cell membrane norepinephrine transporter (NET) or that are taken up into sympathetic nerves via the NET and radiolabel intra-neuronal catecholamine storage sites. Detection of the radioactivity is by planar or tomographic radionuclide imaging. The heart stands out among body organs in terms of the intensity of radiolabeling of sympathetic nerves, and virtually all of sympathetic neuroimaging focuses on the left ventricular myocardium. The most common cardiac sympathetic neuroimaging method worldwide is 123I-metaiodobenzylguanidine (123I-MIBG) scanning. 123I-MIBG scanning is used routinely in Europe and East Asia in the diagnostic evaluation of neurogenic orthostatic hypotension (nOH), to distinguish Lewy body diseases (e.g., Parkinson disease with orthostatic hypotension (OH), pure autonomic failure) from non-Lewy body diseases (e.g., multiple system atrophy) and to distinguish dementia with Lewy bodies from Alzheimer's disease. In the USA, 123I-MIBG scanning has been approved by the Food and Drug Administration for the evaluation of pheochromocytoma and some forms of heart failure-but not for the above-mentioned differential diagnoses. Positron emission tomographic methods based on imaging agents such as 18F-dopamine are categorized as research tools, despite more than a quarter century of clinical experience with these modalities. Considering that 123I-MIBG scanning is available at most academic medical centers in the USA, cardiac sympathetic neuroimaging by this methodology merits consideration as an autonomic test, especially in patients with nOH.
Keyphrases
- parkinson disease
- left ventricular
- high resolution
- heart failure
- deep brain stimulation
- drug administration
- heart rate variability
- electron microscopy
- heart rate
- spinal cord injury
- hypertrophic cardiomyopathy
- cardiac resynchronization therapy
- mild cognitive impairment
- acute myocardial infarction
- mitral valve
- high intensity
- cognitive impairment
- photodynamic therapy
- percutaneous coronary intervention
- cognitive decline
- loop mediated isothermal amplification
- transcatheter aortic valve replacement
- cerebral ischemia