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Background <p><sup>123</sup>I-MIBG has been shown to visualize impaired cardiac neuronal function, but data of this imaging modality in patients with acute myocarditis are scarce. Nonetheless, an association with reduced cardiac function has been observed previously. The aim of this study was to establish and evaluate semi-quantitative and quantitative parameters in <sup>123</sup>I-MIBG scintigraphy and SPECT/CT in patients with acute myocarditis and identify associations with left ventricular ejection fraction (LVEF) and biomarkers.</p> Methods <p>Eight patients with acute myocarditis and a gender and age-matched control group who underwent <sup>123</sup>I-MIBG scintigraphy and SPECT/CT were retrospectively analysed. Semi-quantitative Heart-to-Mediastinum (<i>H</i>/<i>M</i>) ratio and washout rate were calculated, additionally SPECT/CT system calibration and a whole-heart-segmentation were used for absolute quantification of tracer uptake. ROC analysis for the prediction of acute myocarditis and correlation of imaging parameters with LVEF and serological biomarkers was performed.</p> Results <p>Seven patients (87.5%) showed visually decreased tracer uptake. Planar imaging parameters showed significant differences compared to the control group (e.g. <i>H</i>/<i>M</i> ratio 1.6 ± 0.3 vs. 2.3 ± 0.8, <i>p</i> &lt; 0.05), as well as multiple quantitative parameters e.g. SUVmean (1.7 ± 0.5 vs. 3.0 ± 1.0; <i>p</i> &lt; 0.01). Additionally, correlation between imaging parameters and LVEF (e.g. SUVmax <i>r</i> = 0.85, <i>p</i> &lt; 0.01) and NT-proBNP (e.g. <i>H</i>/<i>M</i> <i>r</i> = − 0.88, <i>p</i> &lt; 0.05) was observed.</p> Conclusion <p><sup>123</sup>I-MIBG visualizes impairment of cardiac neuronal function in patients with acute myocarditis and is associated with reduced ejection fraction and elevated NT-proBNP. We could establish an absolute quantification approach that could offer novel diagnostic opportunities for disease assessment and risk stratification, which will be focused on further studies.</p>

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Quantitative evaluation of 123I-MIBG imaging in patients with myocarditis: impairment of cardiac neuronal function revisited

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月17日

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  • Lukas Kessler,
  • Stephan Settelmeier,
  • Kim M. Pabst,
  • Tugce Telli,
  • Zohreh Varasteh,
  • Pedro Fragoso Costa,
  • Walter Jentzen,
  • Francesco Barbato,
  • Hubertus Hautzel,
  • Stephan Himmen,
  • Christoph Rischpler,
  • Tienush Rassaf,
  • Ken Herrmann,
  • David Kersting

摘要

Background

123I-MIBG has been shown to visualize impaired cardiac neuronal function, but data of this imaging modality in patients with acute myocarditis are scarce. Nonetheless, an association with reduced cardiac function has been observed previously. The aim of this study was to establish and evaluate semi-quantitative and quantitative parameters in 123I-MIBG scintigraphy and SPECT/CT in patients with acute myocarditis and identify associations with left ventricular ejection fraction (LVEF) and biomarkers.

Methods

Eight patients with acute myocarditis and a gender and age-matched control group who underwent 123I-MIBG scintigraphy and SPECT/CT were retrospectively analysed. Semi-quantitative Heart-to-Mediastinum (H/M) ratio and washout rate were calculated, additionally SPECT/CT system calibration and a whole-heart-segmentation were used for absolute quantification of tracer uptake. ROC analysis for the prediction of acute myocarditis and correlation of imaging parameters with LVEF and serological biomarkers was performed.

Results

Seven patients (87.5%) showed visually decreased tracer uptake. Planar imaging parameters showed significant differences compared to the control group (e.g. H/M ratio 1.6 ± 0.3 vs. 2.3 ± 0.8, p < 0.05), as well as multiple quantitative parameters e.g. SUVmean (1.7 ± 0.5 vs. 3.0 ± 1.0; p < 0.01). Additionally, correlation between imaging parameters and LVEF (e.g. SUVmax r = 0.85, p < 0.01) and NT-proBNP (e.g. H/M r = − 0.88, p < 0.05) was observed.

Conclusion

123I-MIBG visualizes impairment of cardiac neuronal function in patients with acute myocarditis and is associated with reduced ejection fraction and elevated NT-proBNP. We could establish an absolute quantification approach that could offer novel diagnostic opportunities for disease assessment and risk stratification, which will be focused on further studies.