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Roles of cardiac sympathetic neuroimaging in autonomic medicine

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Abstract

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.

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Funding

The research reported here was indeed supported by the Division of Intramural Research of the NINDS and the NIH. Since we’re intramural, there isn’t a grant number. There is a Project Number. Please refer to the Project Number.

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  1. Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological, Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike MSC-1620, Building 10, Room 8N260, Bethesda, MD, 20892-1620, USA

    David S. Goldstein

  2. Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA

    William P. Cheshire Jr.

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  1. David S. Goldstein
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Correspondence to David S. Goldstein.

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Goldstein, D.S., Cheshire, W.P. Roles of cardiac sympathetic neuroimaging in autonomic medicine. Clin Auton Res 28, 397–410 (2018). https://doi.org/10.1007/s10286-018-0547-6

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