Catecholamines influence myocardial ¹²³I MIBG uptake in neuroblastoma patients

Summary

Aim: Cardiac ¹²³I metaiodobenzylguanidine (MIBG) imaging can be influenced by several factors. We evaluated the relationship between catecholamine measurements and cardiac ¹²³I MIBG uptake in neuroblastoma patients. Patients, methods: 30 neuroblastoma patients were retrospectively assessed on cardiac ¹²³I MIBG uptake and urinary catecholamine dopamine and metabolites, homovanillic acid (HVA) and vanillylmandelic acid (VMA). Cardiac ¹²³I MIBG uptake was quantified by heart-to-mediastinum (H/M) ratios, which were calculated into standard deviation scores (SDS) using age-specific reference values. Results: In 17 (57%) and 12 patients (40%) H/M ratio measurements were below –1.0 and –2.0 SDS at diagnosis. A significant inverse correlation between the average of urine metabolites HVA and VMA, and H/M ratio SDS was observed (r -.39, p = 0.04). Furthermore, there was a significant correlation between the urinary catecholamine metabolite HVA and H/M ratio SDS (r -.40, p = 0.04). Conclusion: Routine calculation of H/M ratios in ¹²³I MIBG scintigrams of neuroblastoma patients is not helpful because it will not identify cardiac ventricular dysfunction in this patient category. A low H/M ratio on ¹²³I MIBG scintigraphy is explained by increased cathecholamine levels secreted by neuroblastoma tumours.

Zusammenfassung

Ziel: Myokardiale ¹²³I-Metaiodbenzylguanidin-( MIBG)-Szintigraphie kann durch verschiedene Faktoren beeinflusst werden. Wir untersuchten die Beziehung zwischen der Menge von Katecholaminen und myokardialer ¹²³I-MIBG-Aufnahme bei Neuroblastom-Patienten. Patienten, Methoden: Bei 30 Neuroblastom- Patienten wurden retrospektiv eine myokardiale ¹²³I-MIBG-Aufnahme sowie das Katecholamin Dopamin und dessen Metaboliten, Homovanillinsäure (HVA) und Vanillinmandelsäure (VMA) im Urin beurteilt. Die myokardiale ¹²³I-MIBG-Aufnahme wurde mit dem Herz-/Mediastinum (H/M)-Quotienten quantifiziert und mit altersspezifischen Referenzwerten als Z-Score-Wert (SDS) ausgedrückt. Ergebnisse: Bei 17 (57%) Patienten war der H/M-Quotient unter –1.0 und bei 12 Patienten (40%) unter –2.0 SDS bei Diagnosestellung. Er wurde sowohl eine inverse Korrelation zwischen der durchschnittlichen Menge der Urin-Katecholamin-Metaboliten HVA und VMA und dem H/M-Quotienten SDS (r – .39, p = 0,04) als auch eine inverse Korrelation zwischen dem Urin-Katecholamine HVA und dem H/M-Quotienten SDS (r -.40, p = 0.04) beobachtet. Schlussfolgerung: Als Routineanalyse wird der H/M-Quotient eines myokardialen ¹²³I-MIBG-Szintigramms in Neuroblastom-Patienten nicht empfohlen, weil es eine kardiale Dysfunktion zum Zeitpunkt der Diagnose nicht identifizieren kann. Ein niedriger H/M-Quotient eines ¹²³I-MIBGSzintigramms wird durch die erhöhte Katecholaminausschüttung des Neuroblastom- Tumors verursacht.

Keywords

Metaiodobenzylguanidine - neuroblastoma - catecholamine - cardiac imaging

Schlüsselwörter

Metaiodbenzylguanidin - Neuroblastom - Katecholamine - Herzdiagnostik

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