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Research Article Volume 13 Issue 1
The relation between Parkinson’s disease and cardiac sympathetic innervation: role of 123 I-MIBG Scintigraphy
Sameh Mostafa Azab, Ashraf Anas Zytoon, Safaa Aboelkasem Mohamed Soliman, Teisuke Hashimoto, Shaimaa Yaihya Abdel Raouf, Shrief R. Abd El-Khalek
Received: January 26, 2026 | Published: February 27, 2026
Citation: Azab SM, Zytoon AA, Soliman SAM, et al. The relation between Parkinson’s disease and cardiac sympathetic innervation: role of 123 I-MIBG Scintigraphy. Int J Radiol Radiat Ther. 2026;13(1):22-32. DOI: 10.15406/ijrrt.2026.13.00449
Abstract
Background: Cardiac ¹²³I metaiodobenzylguanidine (¹²³IMIBG) scintigraphy is used for early detection of Parkinson’s disease (PD) and distinguishing it from Multiple System Atrophy (MSA). This study aimed to evaluate the role of ¹²³I MIBG in the differential diagnosis of parkinsonian syndromes and to assess the relationships between myocardial MIBG uptake and age, and disease severity. Methods: This case-control study evaluated 124 participants (62 participants with PD, 32 participants had other neurological disease and 30 participants were negative served as controls) referred to the Nuclear Medicine Department, Dokkyo Medical University, Japan, who underwent ¹²³I MIBG myocardial scintigraphy. A Receiver Operating Characteristic (ROC) test was performed to determine the best cut-off value for MIBG early and MIBG delayed as well as Heart washout rate and H/M. Results: There was no significant difference (relationship) between the variables (MIBG. early, MIBG.delayed, Heart washout rate, H/M washout rate values) and Modified Hoehn and Yahr (H.Y .). MIBG early (2.12) AUC 0.684 with sensitivity 90%, specificity 60%, accuracy 69.5% and MIBG delayed (1.98) AUC 0.753 with sensitivity 90%, specificity 68%, accuracy 75% as diagnostic tool for distinguishing between Parkinson’s participants and controls. Heart washout rate (22.1) AUC 0.817 with sensitivity 90%, specificity 70%, accuracy 84% and H/M washout rate (18.6) AUC 0.837 with sensitivity 90%, specificity 80%, accuracy 87% as diagnostic tool for distinguishing between Parkinson’s participants and controls. MIBG early (2.39) AUC 0.813 with sensitivity 87.5%, specificity 71%, accuracy 76.6% and MIBG delayed (2.31) AUC 0.878 with sensitivity 96.9%, specificity 71%, accuracy 79.8% as diagnostic tool for distinguishing between Parkinson’s participants and other neurological diseases. Heart washout rate (25.57) AUC 0.812 with sensitivity 82.3%, specificity 68.7%, accuracy 77.7% and H/M washout rate (28.35) AUC 0.873 with sensitivity 82.3%, specificity 84.4%, accuracy 83% as diagnostic tool for distinguishing between Parkinson’s participants and other neurological diseases. Conclusions: MIBG early and MIBG delayed as well as Heart washout rate and H/M washout rate are diagnostic tool to distinguish Parkinson’s participants and controls also, in distinguish Parkinson’s participants and other neurological diseases .Incorporating these parameters could enhance the accuracy of PD diagnosis, particularly in clinical scenarios where concurrent cardiac disease may confound the diagnosis.
Keywords: Parkinson’s disease, ¹²³I MIBG scintigraphy, multiple system atrophy, progressive supranuclear palsy, heart-to-mediastinum, washout rates, sympathetic nervous system
©2026 Azab, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.