Cardiac MIBG Scintigraphy in Neurodegenerative Parkinsonism: Limitations in Clinical Practice

Reduced cardiac uptake on ¹²³Iodine-metaiodobenzylguanidine (MIBG) scintigraphy is a valuable tool for differentiating neurodegenerative parkinsonism but interpretation can be difficult due to comorbidities and drug-tracer interactions.

This study investigated factors limiting the clinical applicability of MIBG scintigraphy in everyday clinical practice.

Patient records (2021-2022) were retrospectively reviewed, independent of whether MIBG scintigraphy was performed, for comorbidities and concomitant medication confounding its interpretation.

Six hundred ninety five patients (640 Parkinson's disease, 22 multiple system atrophy, 33 progressive supranuclear palsy) were included. Factors potentially influencing cardiac MIBG binding were present in 55.3% with 18.1% exhibiting multiple factors. Medications with known drug-tracer interactions were found in 46.9% and comorbidities associated with reduced cardiac MIBG uptake in 20.9%.

The clinical utility of MIBG scintigraphy is frequently restricted by medications and comorbidities highlighting the need of careful planning in clinical practice.