ATROPHIC NERVE-FIBERS IN REGIONS OF REDUCED MIBG UPTAKE IN DOXORUBICIN CARDIOMYOPATHY

A myocardial MIBG-SPECT examination was conducted 2 wk after doxorubic in chemotherapy on a 52-yr-old woman without cardiac symptoms. Despite normal (TI)-T-201 scintigraphy, reduced MIBG uptake was detected in t he apical anterior, inferior and lateral segments of the left ventricl e. The patient died of congestive heart failure due to doxorubicin-ind uced cardiomyopathy 10 mo later. At necropsy, the left ventricle was m arkedly dilated and the apical anterior, inferior and lateral walls we re thin, stiff and whitish. Nerve fibers in the apical inferior wall w ere atrophic and markedly fibrotic where MIBG uptake was most reduced. Nerve fibers in the septum were normal where MIBG uptake had remained normal. The histologic findings correspond with the findings on the M IBG image. MIBG imaging may detect cardiac sympathetic denervation in doxorubicin-induced cardiomyopathy before cardiac symptoms are manifes t and cardiac function deteriorates.