经颅超声诊断帕金森病

目的 探讨经颅超声(TCS)诊断帕金森病(PD)的临床应用价值。方法 随机选取478例临床确诊的神经变性疾病患者(病例组),根据诊断标准分为PD、帕金森叠加综合征、继发性帕金森综合征及原发性震颤亚组;另选取同期124名正常志愿者作为对照组。应用TCS盲法测量黑质(SN)高回声面积,比较各组SN高回声阳性率及SN高回声面积差异,计算TCS诊断PD的敏感度及特异度。对PD亚组患者进行急性多巴反应试验,比较SN高回声阳性率与多巴反应试验阳性率的差异。结果 TCS的中脑显示率为81.72%(492/602),剔除中脑显示不清者后,病例组入组389例,其中PD患者170例,对照组103名。PD亚组SN高回声阳性率和SN高回声面积均明显高于其余各组(P均<0.01)。TCS诊断PD的敏感度为81.76%(139/170),特异度为77.64%(250/322)。PD亚组多巴反应阳性率与SN高回声阳性率差异无统计学意义(P>0.01)。结论 SN高回声为PD的典型TCS特征,对于诊断PD具有重要应用价值。     

中脑黑质回声应用于帕金森病早期诊断的临床意义

目的 探讨经颅超声（TCS）中脑黑质回声用于帕金森病（PD）早期诊断的临床意义。方法 选取2018年1月至2020年10月在浙江省中医院确诊的PD患者69例作为观察组,收集PD患者的TCS中脑黑质回声资料以及性别、年龄、发病年龄等临床资料,另选取同期在本院行TCS检查的特发性震颤（ET）患者15例作为对照组,比较两组的脑黑质回声情况,统计分析观察组中脑黑质回声增强（SN+）与SN正常或减低（SN-）患者的性别、年龄、发病年龄以及病程差异。结果 PD患者中脑黑质可出现高信号,其中男性及老年患者的SN阳性率更高,PD患者比ET患者SN阳性率更高。结论 TCS检查黑质回声特点对PD的早期诊断具有一定意义,有助于与ET的鉴别诊断,还具有无创、经济、方便的优点。     

经颅超声在帕金森病诊断与黑质回声及临床特征相关性研究

目的探讨经颅超声(TCS)检查中脑黑质(SN)高回声对帕金森病(PD)临床应用价值,分析其与临床分期、运动症状严重程度的相关性。方法选取145例帕金森病患者,另有96例健康成年人作为对照组,行TCS检查,测量SN高回声的面积,并计算双侧SN高回声总面积与中脑部面积比值(S/M),面积≥0.20 cm~2和(或)S/M≥7%时,视为阳性(SN+),分析两组SN高回声的差异;将PD组分为PDSN+组和PDSN-组,采用H-Y分期和UPDRSⅢ部分评分评定患者病情严重程度,分析两组患者临床特征的差异。结果 PD组的SN+占比、SN高回声面积、S/M比值均高于对照组;SN高回声IV级和V级组的阳性预测值高于SN高回声Ⅲ级组,有统计学差异(P0.05);TCS诊断PD的灵敏度为61%、特异度为85%,阳性预测值为85%;PDSN+组与PDSN-组比较,患者年龄、性别、病程、UPDRSⅢ部分评分、H-Y分期均无显著性差异(P0.05)。结论 TCS可辅助诊断PD,但SN高回声的面积和S/M比值与PD患者疾病分期和运动症状严重程度无关。     

经颅超声在早期帕金森病鉴别诊断中的应用进展

黑质经颅超声(TCS)检查对帕金森病(PD)的诊断具有重要价值。TCS已被推荐用于测定第三脑室宽度、PD的早期诊断与鉴别诊断、深部脑刺激(DBS)术后电极位置管理等,随着研究的不断深入及操作流程的日益规范,TCS较高的阳性预测值及其廉价、便利、无创等特点,使有望常规应用于PD的早期诊断与鉴别诊断。     

脑黑质经颅超声在特发性震颤与帕金森病鉴别诊断中的应用研究

目的 探讨脑黑质经颅超声(TCS)在特发性震颤(ET)与帕金森病(PD)鉴别诊断中的应用成效。方法 回顾性选取60例ET及PD患者(ET组21例，PD组39例)。研究对象均接受脑黑质TCS检查，对比各组的脑黑质回声强度分布、脑黑质高回声率、脑黑质高回声面积及双侧脑黑质高回声总面积/脑黑质总面积(S/M)比值，分析脑黑质高回声面积及S/M值对PD的诊断效能。结果 PD组脑黑质高回声率显著高于ET组，左侧、右侧、较大侧、双侧脑黑质高回声面积及S/M值均显著高于ET组(P<0.05)。脑黑质高回声面积(左侧、右侧、较大侧及双侧)、S/M值诊断PD的曲线下面积(AUC)依次为0.798、0.785、0.862、0.865和0.857,较大侧脑黑质高回声面积对PD的诊断效能优于左侧和右侧(P<0.05)。结论 脑黑质TCS检查可发现脑黑质异常强回声，帮助临床从震颤人群中有效鉴别出ET和PD,提高震颤患者病因诊断的诊断准确度。     

经颅超声成像诊断帕金森病的临床应用价值

目的探讨经颅超声成像（TCS）测量黑质（SN）高回声的面积与双侧黑质高回声总面积/中脑总面积（S/M）诊断帕金森病（PD）的临床价值。方法对92例PD患者（PD组）和98名健康人（健康对照组）进行TCS检查,分别测量中脑及SN高回声面积,计算S/M比值。比较PD组和健康对照组受检者中脑面积、SN高回声面积以及S/M的差异,采用受试者操作特性（ROC）曲线计算两种指标最佳临界点诊断PD的敏感度及特异度,同时计算联合应用2种指标诊断PD的敏感度和特异度。结果PD组患者SN高回声面积、S/M分别为（0．34±0．27）cm 2和（12．15±4．57）％,健康对照组受检者上述指标分别为（0．14±0．08）cm2和（6．37±3．30）％,2组比较差异均有统计学意义（t＝82．68、100．83,P均＜0．01）。 ROC曲线示,SN高回声面积的最佳临界点为0．20 cm2,其敏感度及特异度分别为80．40％、74．50％;S/M的最佳临界点为7．52％,其敏感度及特异度分别为89．10％、63．30％;当2种指标联合应用时,其敏感度及特异度分别为80．40％、78．60％。结论TCS快速、便捷、可重复性强,是PD的重要筛查工具。 SN高回声面积≥0．20 cm 2且S/M＞7．52％联合应用是诊断PD的最佳指标。     

经颅彩色编码超声诊断帕金森综合征的临床价值

目的 探讨经颅彩色编码超声(TCCS)诊断帕金森综合征(PD)的价值。方法 选择52例PD患者(PD组)和50例健康人群(对照组)，经颞窗探查中脑区黑质(SN)的回声强度，对其进行分级，并测量SN强回声的面积及双侧黑质强回声/中脑面积(S/M)值。结果 TCCS显示SN出现强回声41 (/52, 78.8%)例，而对照组出现SN强回声为19 (24.0%)例，两组差异有统计学意义(X 2 = 4.766, P = 0.000)。PD组单侧SN强回声面积0.34±0.10 cm2，S/M为11±4%；对照组单侧SN强回声面积0.17±0.05 cm2，S/M为5±1%。PD组与对照组SN强回声面积及S/M均有明显统计学差异(t = 9.859, p = 0.000; t = 10.394, p = 0.000)。依据受试者工作特征曲线，以S/M为6.5%作为诊断PD临界值，其曲线下面积为0.964，敏感性为98.1%，特异性为84.6%；以单侧SN强回声面积0.215作为诊断PD的临界值，其曲线下面积为0.929，敏感性为88.5%，特异性为75.0%。结论 TCCS对于预测正常人群中罹患PD的风险及早期诊断PD具有重要临床应用价值。     

颅脑超声对帕金森病的诊断价值

目的 探索颅脑超声(TCS)对帕金森病(PD)的诊断价值.方法 对78例PD患者(PD组)和60名正常人(正常对照组)进行TCS检查,观察中脑回声,并测量中脑黑质回声增强的面积及与中脑面积的比值(S/M).将中脑黑质面积≥0.20 cm2和S/M≥7.00％诊断为PD,记为阳性,中脑黑质面积＜0.20 cm2或S/M＜7.00％记为阴性.结果 PD组78例中,阳性66例,阴性12例;正常对照组60名中,5名为阳性,55名为阴性(P＜0.005).TCS诊断PD的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为92.96％(66/71)、82.09％(55/67)、84.61％(66/78)、91.67％(55/60)、87.68％(121/138).结论 TCS对辅助诊断PD有一定价值.     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。     

不同临床亚表型帕金森病的经颅超声黑质影像学检查及其与铁代谢的相关性研究

目的通过分析姿势步态异常型与震颤型帕金森病(PD)患者的经颅超声检查(TCS)黑质(SN)区回声特征、血清铁代谢参数及二者相关性, 以探索SN回声变化的病理机制。方法回顾性纳入2019年1月至2021年12月在苏州大学附属第二医院帕金森病专科就诊的155例PD患者, 其中95例姿势步态异常型(姿势步态异常组), 60例震颤型(震颤组);选取同期性别和年龄相匹配的健康体检者49例作为对照组。对所有受检者进行TCS检查和血清铁代谢参数检测, 比较分析两组PD患者SN区回声变化特点及三组间铁代谢参数的差异;根据TCS结果分别将姿势步态异常组和震颤组细分为SN强回声阳性(SN+)亚组与SN强回声阴性(SN-)亚组, 比较各亚组间铁代谢参数的差异。分析姿势步态异常组和震颤组SN强回声与铁代谢参数的相关性。结果姿势步态异常组双侧SN强回声总面积、较大一侧SN强回声面积及SN强回声总面积与中脑面积的比值(S/M)大于震颤组(均P<0.01)。姿势步态异常组和震颤组血清铜蓝蛋白和转铁蛋白低于对照组(均P<0.001);姿势步态异常组血清铁蛋白低于震颤组和对照组(均P<0.01)。姿势...     

Diagnostic Performance of Transcranial Sonography for Evaluating Substantia Nigra Hyper-echogenicity in Patients with Parkinson's Disease

To determine the diagnostic performance of transcranial sonography (TCS) in assessing increased echogenic area of the substantia nigra (SN) in patients with Parkinson's disease (PD). Institutional review board approval was obtained for this retrospective study. A total of 278 PD patients (mean age: 64.7 ± 9.8 y, 100 women) and 300 healthy control patients (mean age: 63.6 ± 9.3 y, 97 women) were referred for TCS assessment of SN hyper-echogenicity (SN+) from June 2016 to December 2018. Two sonographers independently measured the sizes of the echogenic areas of the SN by TCS imaging in both PD patients and healthy controls. The diagnostic sensitivity, specificity and accuracy of TCS imaging were compared between PD patients and healthy controls. Inter-rater agreement was assessed with the Cohen's κ statistic. The sensitivity, specificity and accuracy of readers 1 and 2, respectively, for the identification of SN+ in TCS were 90.3% and 89.6% (251 and 249 of 278), 89.3% and 88.3% (268 and 265 of 300) and 89.8% and 88.9% (519 and 514 of 578). Inter-observer agreement was excellent (к = 0.84). The area under the receiver operating characteristic curve (AUC) for differentiation of PD patients from healthy controls was 0.92 for reader 1 and 0.91 for reader 2. Cutoff values of 0.20 and 0.21 cm² were derived from the assessments performed by readers 1 and 2, respectively. We defined 0.20 cm² as the optimal cutoff value because it had a higher AUC. TCS is a promising diagnostic technique and can be very helpful in differentiating PD patients from healthy individuals.     

Association Between Asymmetry of Substantia Nigra Hyperechogenicity and Clinical Characteristics in Different Parkinson Disease Subtypes: A 5-Year Follow-up Study

Our study focused on three aspects to determine whether bilateral substantia nigra hyperechogenicity (SN+) is asymmetrical, whether the asymmetry of SN+ is related to the clinical features and whether there is variation in SN+ asymmetry during the progression of Parkinson disease (PD). This follow-up study included 234 patients with PD, who were divided into tremor PD (TD, n = 67) and non-tremor PD (NTD, n = 167) groups based on the Unified Parkinson's Disease Rating Scale (UPDRS) Part III. All participants underwent transcranial sonography (TCS) and clinical assessment. In both the TD and NTD groups, the initial SN+ was larger than the non-initial SN+. The initial SN+ was associated with Hoehn and Yahr (H&Y) stage, PD duration and initial UPDRS III, and the SN+ asymmetry index was associated with motor asymmetry index in the TD group. In the NTD group, the initial SN+ was associated only with initial UPDRS III. After a 5-year follow-up, the area of SN+ on both sides was gradually inclining to symmetry in the NTD group. Our study determined that SN+ asymmetry could reflect asymmetrical characteristics of PD. Furthermore, we inferred that the dynamic change in SN+ asymmetry might reflect a dynamic change in motor asymmetry in the NTD group.     

Quantitative Transcranial Sonography Evaluation of Substantia Nigra Hyperechogenicity Is Useful for Predicting Levodopa-Induced Dyskinesia in Parkinson Disease

Levodopa-induced dyskinesia (LID) is a common motor complication in Parkinson disease (PD). Abnormal substantia nigra hyperechogenicity (SN+), detected by transcranial sonography (TCS), plays an important role in the differential diagnosis of PD. The purpose of this study was to investigate the predictive performance of quantitative SN+ evaluations for LID. Five hundred sixty-two individuals were included in our analysis, and 198 individuals were followed up. These individuals were divided into two groups at baseline: the PD with LID (PD+LID) group and the PD without LID (PD-LID) group. The association between total hyperechogenic area of the SN on both sides (SN_T) and LID was analyzed by binary logistic analysis. A binary logistic regression model including SN_T was applied to establish a model for discriminating LID. At baseline, 105 (18.7%) individuals were diagnosed with LID. The PD+LID group had a longer disease duration, shorter education duration, higher levodopa equivalent doses, greater disease severity and larger SN_T. A model combining clinical features and SN_T was further established with better efficiency (area under the receiver operating characteristic curve = 0.839). One hundred ninety-eight individuals were followed up; individuals with a larger SN_T and a higher predicted probability were more likely to develop LID in our follow-up. Our study determined that quantitative TCS evaluation of SN echogenicity is useful in predicting LID in PD.     

Accuracy of Transcranial Sonography of the Substantia Nigra for Detection of Parkinson's Disease: A Systematic Review and Meta-analysis

A systematic review and meta-analysis were conducted to evaluate the diagnostic accuracy of substantia nigra hyper-echogenicity by transcranial sonography (TCS) for the diagnosis of Parkinson's disease (PD). PubMed, Embase and the Cochrane Library were electronically searched from inception to June 2018 for all relevant studies. The methodological quality of each study was evaluated by two independent reviewers, who used the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Articles reporting information sufficient to calculate the sensitivity and specificity of TCS to diagnose PD were included. Statistical analysis included data pooling, heterogeneity testing, sensitivity analyses and forest meta-regression. Thirty-nine studies (3123 participants with PD) were analyzed. The pooled sensitivity and specificity of TCS were 0.84 (95% confidence interval: 0.81–0.87) and 0.85 (0.80–0.88), respectively, for differentiating PD from normal controls or participants with other parkinsonian syndromes. In the secondary outcome, PD participants exhibited a significant increase in substantia nigra areas than either normal controls (0.14 [0.12–0.16], p < 0.0001) or participants with other parkinsonian syndromes (0.11 [0.08–0.13], p < 0.0001). This meta-analysis revealed the high diagnostic performance of TCS in differentiating patients with PD from both normal controls and participants with other parkinsonian syndromes.     

Transcranial Sonography and I-FP-CIT Single Photon Emission Computed Tomography in Movement Disorders

Diagnosis of Parkinson's disease (PD) can be difficult in the early stages of the disease. The aim of the study described here was to assess the correlation between transcranial sonography (TCS) and ¹²³I-FP-CIT ([¹²³I]ioflupane, N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-[¹²³I]iodophenyl)nortropane) SPECT (single photon emission computed tomography) findings and the diagnosis of PD. A total of 49 patients were enrolled in the study: 29 patients with PD, 7 patients with other parkinsonian syndromes, 11 patients with essential tremor and 2 with psychogenic movement disorder. Substantia nigra echogenicity was measured using TCS. SPECT was performed using DaTSCAN ([¹²³I]ioflupane). TCS and SPECT findings were correlated in 84% of patients, with κ = 0.62 (95% confidence interval: 0.38–0.86). TCS-measured substantia nigra echogenicity and SPECT-measured striatal binding ratio were negatively correlated (r = –0.326, p = 0.003). TCS/SPECT sensitivity, specificity and positive and negative predictive values for the diagnosis of PD were 89.7%/96.6%, 60.0%/70.0%, 76.5%/82.4% and 80.0%/93.3%, respectively. Both positive TCS and SPECT findings correlated significantly with the diagnosis of PD (κ = 0.52, 95% confidence interval: 0.27–0.76, and κ = 0.69, 95% confidence interval: 0.49–0.90, respectively).     

Effect of Age on Substantia Nigra Hyper-echogenicity in Parkinson's Disease Patients and Healthy Controls

Substantia nigra (SN) hyper-echogenicity (SN+) describes an enlargement (>90th percentile) of the area of echogenicity at the anatomic site of the SN in the midbrain detected by transcranial sonography. This ultrasound sign has proven to be a valuable marker supporting the clinical diagnosis of Parkinson's disease (PD). Although there is considerable variation in the extent of echogenic signals at the anatomic site of the SN among PD patients, previous work suggests that SN+ is a stable marker throughout the course of the disease. The present study focused on two aspects: (i) determining whether SN+ values differ between the sides, mirroring the asymmetric character of the disease; and (ii) determining whether age has an influence on SN echogenicity. This cross-sectional study included 300 PD patients and 200 healthy controls. SN+ was measured planimetrically by transcranial sonography. Echogenicity was analyzed separately for onset and non-onset sides, with onset side defined as the SN contralateral to the side of the body that first manifested PD-related motor impairment. Age of the patients and healthy controls at study time was used for correlation. We found that the onset SN+ contralateral to the side of initial motor symptoms was on average 17.6% larger than its counterpart. However, we also found that contrary to the control group, where an increase in age was associated with an increase in size of SN+, age of PD patients was associated with a decline in size of the onset SN+. Furthermore, SN measured at the onset side of PD patients correlated significantly with patient age and Hoehn and Yahr stage, a scale that grades PD severity, although this was not the case for the non-onset side. The present study indicates that changes in SN echogenicity have a different dynamic depending on the onset side of the disease. The age at study time had a significantly negative effect on the size of onset SN+, the effect on the non-onset side was non-significant. We conclude that for appropriate PD analysis, onset SN+ is a more important marker than the average of both sides of SN. Furthermore, we found that among healthy controls, the size of SN+ increases with age.