Meta-Iodobenzylguanidine Imaging: From Standardization to Mortality Risk Models in Heart Failure

123 I-meta-iodobenzylguanidine (MIBG) is a potent prognostic marker of chronic heart failure (CHF). However, inter-institutional variations due to methodological variations required minimization before 123 I-MIBG findings could be universally applied to the diagnosis, treatment and prognosis of CHF. Therefore, protocols including data acquisition, setting regions of interest for calculating heart-to-mediastinum ratios (HMR) and crosscalibration of HMR among institutions required standardization. A cross-calibration phantom was introduced to overcome institutional differences, and a large amount of experimental data were collected, which enabled multicenter comparisons and the creation of large-scale prognostic databases. Thereafter, cardiac mortality risk models to estimate shortand long-term (two and five years, respectively) mortality were created based on a standardized 123 I-MIBG HMR. The ability of these models to accurately determine prognosis is currently undergoing validation.