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Iodine-123 MIBG Scanning for cardiac/mediastinum: New tool for diagnosing dementia

       There are currently about 260,000 dementia patients in Taiwan. According to the estimation of the Taiwan Dementia Society, there are at least 10,000 new cases added annually. As Taiwan has now entered the era of aging society, it is estimated that the number of dementia patients in Taiwan will grow to 930,000 individuals in about 40 years. The proper care of dementia begins with accurate diagnosis and assessment of the condition. Amongst dementia patients, about 60-70% are Alzheimer’s patients; 20 to 30% are vascular dementia (VaD), and the remaining 10% are the less common Dementia with Lewis Bodies (DLB) and Parkinson’s disease (PDD). In Japan, the diagnosis of dementia can achieve accuracy as high as 86% with cerebral perfusion scanning (ECD Brain SPECT) and the use of eZIS software; the system can also be used for diagnosis of VaD; the amyloid imaging with cerebral PET scanning is currently the most accurate diagnostic tool for Alzheimer’s disease imaging; however, the use of this technique in Taiwan has yet to be approved by the Ministry of Health and Welfare (MOHW).

       This test is recommended by neurologists after performing a series of assessments and suspecting the presence of DLB or PDD. The I-123 MIBG is currently available only through special application with the MOHW, and must be purchased from Japan. The domestic development of an I-123 MIBG system by the Institute of Nuclear Energy Research is currently proceeding. Completion of this system is expected in one to two years, and will drive down the cost of this test.

       A noteworthy feature of I-123 MIBG is its capability to simultaneously examine the cardiac/mediastinum ratio and adrenal glands of patients with malignant hypertension and suspected pheochromocytoma. Who would have known that a cardiac scan can also detect the presence of dementia? This is just one of the important future applications of nuclear medicine on the diagnosis and classification of dementia.