Metaiodobenzylguanidine scintigraphy of cardiac sympathetic innervation

Metaiodobenzylguanidine (MIBG), a noradrenaline analogue,labelled with radioactive iodine I-123 is used for assessingpre-synaptic activity of the myocardial adrenergic system. Thepaper describes the mechanism of myocardial I-123-MIBG uptakeand the relevant examination methods. It also refers to thenecessity of standardising acquisition methods and assessmentcriteria in order to improve comparability of results, especiallynumerical results, originating from various countries and centres.Although first introduced as a cardiological diagnostic procedure30 years ago, I-123-MIBG myocardial scintigraphy continues tobe mostly applied as a research method, even though its diagnosticand/or prognostic importance, especially in the case ofheart failure, has been widely reported. The recently publishedresults of two extensive retrospective works and a major prospective,multi-centre international ADMIRE-HF study confirmedthat I-123-MIBG scintigraphy has a high independent prognosticvalue in evaluating patients with heart failure. Abnormalmyocardial I-123-MIBG uptake can also be indicative of higherrisk of ventricular arrhythmias and sudden cardiac death inpatients with heart failure. I-123-MIBG myocardial scintigraphyalso seems to have considerable potential for the detection anddifferentiation of neurodegenerative diseases.