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Background  The heart-to-mediastinum ratio (HMR) obtained in myocardial sympathetic innervation imaging using  123 I-metaiodobenzylguanidine (MIBG) is used for heart failure or Lewy body diseases (LBD). Discovery NM/CT 670 CZT, a novel whole-body scanner, enables direct HMR measurements in planar images, in contrast to cardiac-dedicated CZT-based cameras which require specific post-processing reconstruction. We sought to investigate the clinical utility of the Discovery NM/CT 670 CZT for myocardial innervation imaging and the potential time reduction.    Results  Following preliminary phantom examinations,  123 I-MIBG planar imaging was performed in 36 patients with suspected or known LBD to measure HMRs with a collection time of 300 s. Images for different collection times were subsequently reframed using already acquired data, and changes in HMRs were evaluated.  The HMRs for patients with versus without clinically diagnosed LBD were 1.63 ± 0.08 versus 2.21 ± 0.08 at early phase ( p  < 0.001) and 1.54 ± 0.09 versus 2.08 ± 0.09 at delayed phase ( p  < 0.001). The difference of HMRs (300 s − other collection time) became greater as the collection time became shorter. There was good consistency in HMRs between the 300-s images (reference) and the 200-s (intra-class correlation (ICC) coefficients > 0.99), 100-s (ICC coefficients > 0.97), and 50-s (ICC coefficients > 0.89) images.    Conclusions  In planar images with a whole-body CZT-based camera, the HMRs of patients with LBD were significantly lower than those without. HMRs with the collection time of 50 s and longer showed good consistency with those of 300 s in the ICC analysis. These findings indicate a clinical utility of this novel scanner for HMR measurements and potential time reductions.    Electronic supplementary material  The online version of this article (10.1186/s13550-019-0491-z) contains supplementary material, which is available to authorized users.

High-speed scanning of planar images showing 123I-MIBG uptake using a whole-body CZT camera: a phantom and clinical study