Authors: O. Lang 1,2,3; D. Šuhajová Do 2; M. Bejtic 2; V. Kamírová 2; M. Lang 2 Authors‘ workplace: Kardiologická klinika, 3. LF UK Praha 1; Institut nukleární medicíny, PMCD s. r. o., Praha 2; Oddělení nukleární medicíny, ON Příbram, ČR 3 Published in: NuklMed 2026;15:5-9 Category: Review Article
Myocardial sympathetic innervation evaluation is usually performed in patients with heart failure, ischemic heart disease and cardiomyopathy. 123I-MIBG (meta-iodo-benzyl-guanidin) is used as an indicator. It is an analogue of adrenergic antagonist guanethidine, it has the same chemical structure as a norepinephrine. It is an ideal tool for assessment of postganglionic presynaptic sympathetic nervous system in the myocardium.
There is a group of neurodegenerative disorders caused by protein accumulation in neurons; these are called proteinopathy. Two types are usually distinguished: tauopathy and alpha-synucleinopathy. Both leads to neurodegeneration with subsequent disorder of neuronal transmission. Impairment of nigrostriatal system in the brain clinically appears as a parkinsonism, involvement of the cardiac sympathetic nervous system can manifest as an increased tendency to arrythmias and sudden cardiac death. Parkinsonism includes a large number of heterogeneous clinical entities, like tremor, bradykinesia, difficulty in walking and balancing, rigidity, stiffness, and cognitive impairment. These symptoms can occur both in Parkinson´s disease and in other parkinsonian disorders and in different types of dementia. The cause of some of them is but other than neurodegeneration. Its differentiation is important from the point of view of rational treatment but difficult from the clinical picture even using magnetic resonance imaging.
Nuclear medicine procedures have potential to detect neurodegeneration both in striatum and in myocardium. 123I-ioflupane (DaTSCAN) is used to detect striatal disorder, 123I-MIBG myocardial neurodegeneration. If the patient with parkinsonism has striatal disorder but normal myocardial innervation, it is not Parkinson´s disease but some other type of parkinsonism. On the other hand, if there is simultaneous disorder of both striatum and myocardium, it is Parkinson´s disease.
Nuclear medicine procedures are widely used as biomarkers in a large number of neurodegenerative diseases not only of myocardium but also of brain. In fact, combination of these two procedures can determine correct diagnosis in more than 90 % of patients with clinical parkinsonian syndromes.
differential diagnosis – parkinsonism – neurodegeneration – MIBG – DaTSCAN
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