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      Cross calibration of 123I-meta-iodobenzylguanidine heart-to-mediastinum ratio with D-SPECT planogram and Anger camera

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          Cardiac 123I- meta-iodobenzylguanidine (MIBG) uptake is quantified using the heart-to-mediastinum ratio (HMR) with an Anger camera. The relationship between HMR determined using D-SPECT with a cadmium–zinc–telluride detector and an Anger camera is not fully understood. Therefore, the present study aimed to define this relationship using images derived from a phantom and from patients.


          Cross-calibration phantom studies using an Anger camera with a low-energy high-resolution (LEHR) collimator and D-SPECT, and clinical 123I-MIBG studies proceeded in 40 consecutive patients (80 studies). In the phantom study, a conversion coefficient (CC) was defined based on phantom experiments and applied to the Anger camera and the D-SPECT detector. The HMR was calculated using anterior images with the Anger camera and anterior planograms with D-SPECT. First, the HMR from D-SPECT was cross-calibrated to the Anger camera, and then, the HMR from both cameras were converted to the medium-energy general-purpose collimator condition (CC 0.88; ME88 condition). The relationship between HMR and corrected and uncorrected methods was examined. A 123I-MIBG washout rate was calculated using both methods with and without background subtraction.


          Based on the phantom experiments, the CC of the Anger camera with an LEHR collimator and of D-SPECT using an anterior planogram was 0.55 and 0.63, respectively. The original HMR from the Anger camera and D-SPECT was 1.76 ± 0.42 and 1.86 ± 0.55, respectively ( p < 0.0001). After D-SPECT HMR was converted to the Anger camera condition, the corrected D-SPECT HMR became comparable to the values under the Anger camera condition (1.75 ± 0.48, p = n. s.). When the HMR measured using the two cameras were converted under the ME88 condition, the average standardized HMR from the Anger camera and D-SPECT became comparable (2.21 ± 0.65 vs. 2.20 ± 0.75, p = n. s.). After standardization to the ME88 condition, a systematic difference in the linear regression lines disappeared, and the HMR from both the Anger (StdHMR Anger) and D-SPECT (StdHMR DSPECT) became comparable. Additional correction using a regression line further improved the relationship between both HMR [StdHMR DSPECT = 0.09 + 0.98 × StdHMR Anger ( R 2 = 0.91)]. The washout rate closely correlated with and without background correction between both methods ( R 2 = 0.83 and 0.65, respectively).


          The phantom-based conversion method is applicable to D-SPECT and enables the common application of HMR irrespective of D-SPECT and the Anger camera.

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          Most cited references 29

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          Myocardial iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure. Results of the prospective ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study.

          The ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study prospectively evaluated iodine-123 meta-iodobenzylguanidine ((123)I-mIBG) imaging for identifying symptomatic heart failure (HF) patients most likely to experience cardiac events. Single-center studies have demonstrated the poorer prognosis of HF patients with reduced (123)I-mIBG myocardial uptake, but these observations have not been validated in large multicenter trials. A total of 961 subjects with New York Heart Association (NYHA) functional class II/III HF and left ventricular ejection fraction (LVEF) or =1.60 was 0.40 (p or =1.60 and 37% for H/M <1.60; hazard ratios for individual event categories were as follows: HF progression, 0.49 (p = 0.002); arrhythmic events, 0.37 (p = 0.02); and cardiac death, 0.14 (p = 0.006). Significant contributors to the multivariable model were H/M, LVEF, B-type natriuretic peptide, and NYHA functional class. (123)I-mIBG imaging also provided additional discrimination in analyses of interactions between B-type natriuretic peptide, LVEF, and H/M. ADMIRE-HF provides prospective validation of the independent prognostic value of (123)I-mIBG scintigraphy in assessment of patients with HF. (Meta-Iodobenzylguanidine Scintigraphy Imaging in Patients With Heart Failure and Control Subjects Without Cardiovascular Disease, NCT00126425; Meta-Iodobenzylguanidine [123I-mIBG] Scintigraphy Imaging in Patients With Heart Failure and Control Subjects Without Cardiovascular Disease, NCT00126438).
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            Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular Committee and the European Council of Nuclear Cardiology.

             Ignasi Carrió,  ,   (2010)
            This proposal for standardization of (123)I-metaiodobenzylguanidine (iobenguane, MIBG) cardiac sympathetic imaging includes recommendations for patient information and preparation, radiopharmaceutical, injected activities and dosimetry, image acquisition, quality control, reconstruction methods, attenuation, scatter and collimator response compensation, data analysis and interpretation, reports, and image display. The recommendations are based on evidence coming from original or scientific studies whenever possible and as far as possible reflect the current state-of-the-art in cardiac MIBG imaging. The recommendations are designed to assist in the practice of performing, interpreting and reporting cardiac sympathetic imaging. The proposed standardization does not include clinical indications, benefits or drawbacks of cardiac sympathetic imaging, and does not address cost benefits or cost effectiveness; however, clinical settings of potential utility are mentioned. Standardization of MIBG cardiac sympathetic imaging should contribute to increasing its clinical applicability and integration into current nuclear cardiology practice.
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              ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers.


                Author and article information

                [1 ]ISNI 0000 0001 2308 3329, GRID grid.9707.9, Department of Nuclear Medicine, , Kanazawa University, ; 13-1 Takara-machi, Kanazawa, 920-8641 Japan
                [2 ]ISNI 0000 0004 0642 3012, GRID grid.459889.1, PET Imaging Center, , Public Central Hospital of Matto Ishikawa, ; Hakusan, Japan
                [3 ]ISNI 0000 0001 0265 5359, GRID grid.411998.c, Department of Physics, , Kanazawa Medical University, ; Uchinada, Kahoku, Japan
                [4 ]ISNI 0000 0004 0642 3012, GRID grid.459889.1, Department of Cardiology, , Public Central Hospital of Matto Ishikawa, ; Hakusan, Japan
                [5 ]Department of Neurology, Hokuriku National Hospital, Nanto, Japan
                ORCID:, +81-76-265-2333 ,
                Ann Nucl Med
                Ann Nucl Med
                Annals of Nuclear Medicine
                Springer Japan (Tokyo )
                8 July 2017
                8 July 2017
                : 31
                : 8
                : 605-615
                28689357 5622915 1191 10.1007/s12149-017-1191-2
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funded by: Grants-in-Aid for Scientific Research
                Award ID: 15K09947
                Award Recipient :
                Original Article
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                © The Japanese Society of Nuclear Medicine 2017


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