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Metaiodobenzylguanidine scintigraphy in pulmonary and cardiac disease

van Kroonenburgh, Marinusa,b; Mostard, Remyb,c; Vöö, Stefana,b

Current Opinion in Pulmonary Medicine: September 2010 - Volume 16 - Issue 5 - p 511–515
doi: 10.1097/MCP.0b013e32833b1e1f
Interstitial lung disease: Edited by Marjolein Drent

Purpose of review Nuclear medicine techniques have the capacity to investigate neuronal dysfunction at the synapse level. For instance, metaiodobenzylguanidine (MIBG) shows a similar uptake, storage and release as norepinephrine. Intravenously injected radiolabeled MIBG is able to reflect neuronal damage induced by inflammation and tumors. The purpose of this review is to evaluate the results and the limitation of these neuronal imaging techniques in patients with pulmonary and cardiac diseases and to give an opinion about the clinical value of these new diagnostic tools.

Recent findings MIBG neuronal images of the lungs and heart can show heterogeneous distribution patterns with either diminished or increased MIBG uptake and/or washout. These changes reflect changes in endothelial integrity, neuronal innervations and clearance of norepinephrine. Interest in the role of neurotransmitter involvement and the relation between endothelial cell integrity and vascularization is growing and of utmost importance to understand the effect on pathophysiology of diseases.

Summary At this moment, there is no added clinical value to routinely use MIBG scanning of the lungs and the heart. This is partly due to the many unresolved questions such as what actually happens and which factors influence MIBG uptake and washout under normal physiological circumstances. But the technique, if standardized and when dynamic time acquisition is performed with the latest equipment, such as PET and single photon emission computed tomography–computed tomography (SPECT–CT), has a tremendous potential. It can unravel upto now unknown relationships between innervation, vascularization and endothelial integrity. Other diagnostic tools such as MRI and CT do not have this capacity, so the future looks bright for these new neuronal imaging techniques.

aDepartment of Nuclear Medicine, the Netherlands

bILD Care Center, Maastricht University Medical Centre, Maastricht, the Netherlands

cDepartment of Respiratory Medicine, Atrium Medical Centre, Heerlen, the Netherlands

Correspondence to Marinus van Kroonenburgh, MD, PhD, Department of Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands Tel: +31 43 3874746; fax: +31 43 3876746; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.