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Araújo NC, Suassuna JHR, Fernandes RDCL. Transcranial sonography depicts a larger substantia nigra echogenic area in renal transplant patients on calcineurin inhibitors than on rapamycin. BMC Nephrol 2022; 23:108. [PMID: 35300603 PMCID: PMC8931960 DOI: 10.1186/s12882-022-02741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After kidney transplantation neurologic manifestations may develop, including Parkinson's disease (PD). An enlarged substantia nigra (SN) by transcranial sonography has been recognized as a marker of PD. METHODS In renal transplant recipients (RTRs = 95) and controls (n = 20), measurement of mesencephalon, SN, third ventricle, spleen and carotid intima-media thickness (cIMT) and middle cerebral artery (MCA), kidney and spleen arteries Doppler resistive index (RI) were performed. RESULTS RTRs had larger SN, third ventricle and cIMT and higher renal RI than controls. The SN was larger in the CNIs group than in controls and rapamycin group, while the third ventricle was similar between patients but larger than in controls. In RTRs, SN showed a direct linear correlation with spleen and the third ventricle with age, cIMT and RI of the MCA, kidney and spleen. In CNIs group the SN correlated positively with age and cIMT, while the third ventricle reproduced RTRs correlations. Rapamycin group showed a direct linear relationship between the third ventricle and age and RI of the MCA, kidney and spleen; SN showed no correlations. CONCLUSION RTRs on CNIs present a larger SN area than on rapamycin, probably due to the antiproliferative effect of rapamycin. This finding might be relevant when interpreting TCS in RTRs.
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Affiliation(s)
- Nordeval Cavalcante Araújo
- Division of Nephrology, University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro-RJ, 20551-030, Brazil.
| | - José Hermógenes Rocco Suassuna
- Division of Nephrology, University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro-RJ, 20551-030, Brazil
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Mašková J, Školoudík D, Štofaniková P, Ibarburu V, Kemlink D, Zogala D, Trnka J, Krupička R, Šonka K, Růžička E, Dušek P. Comparative study of the substantia nigra echogenicity and 123I-Ioflupane SPECT in patients with synucleinopathies with and without REM sleep behavior disorder. Sleep Med 2020; 70:116-123. [PMID: 32403038 DOI: 10.1016/j.sleep.2020.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/16/2020] [Accepted: 02/14/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Hyperechogenicity of the substantia nigra (SN) and abnormal dopamine transporter-single-photon emission computed tomography (DAT-SPECT) are biomarkers commonly used in the assessment of prodromal synucleinopathy. Our goals were as follows: (1) to compare echogenicity of SN in idiopathic rapid eye movement (REM) behavior disorder (iRBD), Parkinson's disease (PD) without RBD (PD-noRBD), PD with RBD (PD + RBD), and control subjects; and (2) to examine association between SN degeneration assessed by DAT-SPECT and SN echogenicity. PATIENTS/METHODS A total of 61 subjects with confirmed iRBD were examined using Movement Disorders Society-unified PD rating scale (MDS-UPDRS), TCS (transcranial sonography) and DAT-SPECT. The results were compared with 44 patients with PD (25% PD + RBD) and with 120 age-matched healthy subjects. RESULTS AND CONCLUSION The abnormal SN area was found in 75.5% PD, 23% iRBD and 7.3% controls. Median SN echogenicity area in PD (0.27 ± 0.22 cm2) was higher compared to iRBD (0.07 ± 0.07 cm2; p < 0.0001) and controls (0.05 ± 0.03 cm2; p < 0.0001). SN echogenicity in PD + RBD was not significantly different from PD-noRBD (0.30 vs. 0.22, p = 0.15). Abnormal DAT-SPECT was found in 16 iRBD (25.4%) and 44 PD subjects (100%). No correlation between the larger SN area and corresponding putaminal binding index was found in iRBD (r = -0.13, p = 0.29), nor in PD (r = -0.19, p = 0.22). The results of our study showed that: (1) SN echogenicity area in iRBD was higher compared to controls, but the hyperechogenicity was present only in a minority of iRBD patients; (2) SN echogenicity and DAT-SPECT binding index did not correlate in either group; and (3) SN echogenicity does not differ between PD with/without RBD.
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Affiliation(s)
- J Mašková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic.
| | - D Školoudík
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic; Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - P Štofaniková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - V Ibarburu
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - D Kemlink
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - D Zogala
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - J Trnka
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - R Krupička
- Department of Biomedical Informatics, Czech Technical University in Prague, Faculty of Biomedical Engineering, Czech Republic
| | - K Šonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - E Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - P Dušek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic; Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
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Tao A, Chen G, Deng Y, Xu R. Accuracy of Transcranial Sonography of the Substantia Nigra for Detection of Parkinson's Disease: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:628-641. [PMID: 30612821 DOI: 10.1016/j.ultrasmedbio.2018.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Anyu Tao
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youbin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renfan Xu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Transcranial B-Mode Sonography in Movement Disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 143:179-212. [PMID: 30473195 DOI: 10.1016/bs.irn.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Applying a 2-4MHz probe at the temporal bone window transcranial B-mode sonography (TCS) enables the depiction of the brain parenchyma through the intact skull. Meanwhile it has been applied for the diagnosis and the differential diagnosis of movement disorders for decades. In the first part of this chapter, we summarize the technical requirements and describe the ultrasound method for optimal TCS examination. Imaging planes and the relevant structures are explained in detail. In the second part of the chapter, we focus on the role of substantia nigra hyperechogenicity for the diagnosis of Parkinson's disease (PD) and prodromal PD. In this part, we also mention the role of TCS in atypical and secondary Parkinsonian syndromes and other movement disorders. Summarizing all these information we explain how TCS can be helpful for the differential diagnosis of movement disorders. The current data show that TCS is an easily applicable and economic imaging method which can be used as an additional tool for the diagnosis of PD with a high sensitivity (>85%), specificity (>80%) and inter-rater reliability (>84%) as well as for the differential diagnosis of movement disorders. Lately, TCS has also been utilized in further areas such as the detection of individuals at risk for PD or the determination of electrode localization in patients with deep brain stimulation. An insufficient temporal bone window especially in the elderly and the necessity of an experienced investigator are limitations of this method.
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Grippe TC, Allam N, Brandão PRDP, Pereira DA, Cardoso FEC, Aguilar ACR, Kessler IM. Is transcranial sonography useful for diagnosing Parkinson's disease in clinical practice? ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:459-466. [PMID: 30066797 DOI: 10.1590/0004-282x20180067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Transcranial sonography (TCS) is an emerging ancillary examination for diagnosing Parkinson's disease (PD). OBJECTIVE To evaluate TCS features in patients with PD and its mimics, and establish their accuracy in predicting the final clinical diagnosis after follow-up. METHODS We retrospectively studied 85 patients with an initial clinical suspicion of PD, atypical parkinsonism or essential tremor, all of whom underwent TCS. Two specialists reviewed the follow-up clinical visit records and determined the final clinical diagnosis. The accuracy analysis of the TCS was determined using Bayesian statistical methods. RESULTS The finding of substantia nigra hyperechogenicity (> 20 mm2) showed high sensitivity (93.4%) and specificity (86.6%). The positive likelihood ratio showed 6.93-fold greater odds for diagnosing PD than an alternative condition when this finding was present. CONCLUSIONS This study revealed the practical usefulness of TCS in differentiating PD from its prevalent mimics when the clinical diagnosis was initially unclear.
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Affiliation(s)
- Talyta Cortez Grippe
- Universidade de Brasília, Faculdade de Medicina, Brasília DF, Brasil.,Hospital de Base do Distrito Federal, Centro de Referência em Parkinson e Distúrbios do Movimento, Brasília DF, Brasil
| | - Nasser Allam
- Hospital de Base do Distrito Federal, Centro de Referência em Parkinson e Distúrbios do Movimento, Brasília DF, Brasil
| | - Pedro Renato de Paula Brandão
- Hospital de Base do Distrito Federal, Centro de Referência em Parkinson e Distúrbios do Movimento, Brasília DF, Brasil.,Câmara dos Deputados, Departamento Médico, Brasília DF, Brasil
| | - Danilo Assis Pereira
- Instituto Brasileiro de Neuropsicologia e Ciências Cognitivas, Brasília DF, Brasil
| | - Francisco Eduardo Costa Cardoso
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brasil
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Fernandes RDCL, Rosso ALZD, Vincent MB, Araújo NC. Use of Gray-Level Histograms to Assess Substantia Nigra Echogenicity in Transcranial Sonography Images of Parkinson Disease Patients. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316667083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A substantial body of research has shown that Parkinson disease (PD) patients display an enlarged hyperechogenic substantia nigra (SN) by transcranial sonography (TCS). Nonetheless, the categorization of SN echogenicity is still subjective. A method is described to quantify SN echogenicity based on the gray-level histograms of digitized TCS images. In 31 PD patients and 57 controls, the gray-scale mean (GSM) of the SN, mesencephalon, and basal cisterns and their ratios were assessed using image-editing computer software. The GSM values were compared between the groups and correlated with age, SN area, and disease duration. The SN GSM was significantly higher in the PD group ( P < .05) with a positive correlation with age but not with disease duration. In this cohort of participants, mesencephalon echogenicity was found to increase with disease duration. These results would suggest quantitatively SN hyperechogenicity in PD. Quantifying SN echogenicity is feasible and might minimize subjectivity in PD diagnosis by TCS. The method has the potential to disclose subtle changes in other midbrain structures’ echogenicity engendered by the disease process as well.
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Li DH, He YC, Liu J, Chen SD. Diagnostic Accuracy of Transcranial Sonography of the Substantia Nigra in Parkinson's disease: A Systematic Review and Meta-analysis. Sci Rep 2016; 6:20863. [PMID: 26878893 PMCID: PMC4754637 DOI: 10.1038/srep20863] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/08/2016] [Indexed: 11/20/2022] Open
Abstract
A large number of articles have reported substantia nigra hyperechogenicity in Parkinson’s disease (PD) and have assessed the diagnostic accuracy of transcranial sonography (TCS); however, the conclusions are discrepant. Consequently, this systematic review and meta-analysis aims to consolidate the available observational studies and provide a comprehensive evaluation of the clinical utility of TCS in PD. Totally, 31 studies containing 4,386 participants from 13 countries were included. A random effects model was utilized to pool the effect sizes. Meta-regression and sensitivity analysis were performed to explore potential heterogeneity. Overall diagnostic accuracy of TCS in differentiating PD from normal controls was quite high, with a pooled sensitivity of 0.83 (95% CI: 0.81–0.85) and a pooled specificity of 0.87 (95% CI: 0.85–0.88). The positive likelihood ratio, the negative likelihood ratio and diagnostic odds ratio were calculated 6.94 (95% CI: 5.09–9.48), 0.19 (95% CI: 0.16–0.23), and 42.89 (95% CI: 30.03–61.25) respectively. Our systematic review of the literature and meta-analysis suggest that TCS has high diagnostic accuracy in the diagnosis of PD when compared to healthy control.
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Affiliation(s)
- Dun-Hui Li
- Department of Neurology &Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Ya-Chao He
- Department of Neurology &Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Jun Liu
- Department of Neurology &Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Sheng-Di Chen
- Department of Neurology &Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
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Toomsoo T, Liepelt-Scarfone I, Kerner R, Kadastik-Eerme L, Asser T, Rubanovits I, Berg D, Taba P. Substantia Nigra Hyperechogenicity: Validation of Transcranial Sonography for Parkinson Disease Diagnosis in a Large Estonian Cohort. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:17-23. [PMID: 26589647 DOI: 10.7863/ultra.14.12069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/07/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Substantia nigra hyperechogenicity is a promising biomarker for Parkinson disease (PD). Substantia nigra hyperechogenicity has previously been established as a useful diagnostic criterion in several European and Asian patient cohorts. However, diagnostic cutoff values for substantia nigra hyperechogenicity remain unknown for most patient populations. This study validated the diagnostic accuracy of substantia nigra hyperechogenicity in a large cohort of patients with PD in Estonia. METHODS The study included 300 patients with PD from Estonia, representing 10% of the national PD patient population, and 200 healthy control participants. To define the optimal cutoff value in the PD cohort, data from a single assessment versus repetitive assessments by transcranial sonography were compared. With the use of 3 repetitive assessments, the diagnostic accuracy of the data was measured. In addition, calculations for percentile values were used to define substantia nigra hyperechogenicity among controls. RESULTS Our data showed that the multiassessment approach yielded higher diagnostic accuracy than a single assessment (P = .021). The highest diagnostic accuracy was achieved by using the measurement mean to define substantia nigra hyperechogenicity, which was 0.23 cm(2) (sensitivity, 88.7%; specificity, 92.2%), whereas single measurements detected PD with higher sensitivity (sensitivity, 93.2%; specificity, 85.1%). No significant difference was found between mean and median measurements (P= .18). CONCLUSIONS This study indicates the diagnostic merit of transcranial sonography in PD diagnosis in an additional population and demonstrates that transcranial sonography of the substantia nigra is a relevant and useful diagnostic tool for patients with PD.
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Affiliation(s)
- Toomas Toomsoo
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Inga Liepelt-Scarfone
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Riina Kerner
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Liis Kadastik-Eerme
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Toomas Asser
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.).
| | - Inna Rubanovits
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Daniela Berg
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
| | - Pille Taba
- Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia (T.T., I.R.); Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany (I.L.-S., D.B.); Statistics Estonia, Tallinn, Estonia (R.K.); and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia (L.K.-E., T.A., P.T.)
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Alonso-Cánovas A, López-Sendón JL, Buisán J, deFelipe-Mimbrera A, Guillán M, García-Barragán N, Corral I, Matute-Lozano MC, Masjuan J, Martínez-Castrillo JC, Walter U. Sonography for diagnosis of Parkinson disease-from theory to practice: a study on 300 participants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2069-2074. [PMID: 25425362 DOI: 10.7863/ultra.33.12.2069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Hyperechogenicity of the substantia nigra on transcranial sonography is used for diagnosing Parkinson disease (PD). Cutoff values for the substantia nigra echogenic area, defining substantia nigra hyperechogenicity, vary among ultrasound systems from different manufacturers. In this study we wanted to determine the cutoff criterion for a Toshiba (Tokyo, Japan) system and to assess its diagnostic value. METHODS Three hundred participants (controls, n = 138; patients with PD, n = 105; and patients with essential tremor, n = 57) underwent transcranial sonography following a standardized protocol. RESULTS The substantia nigra was assessable in 92.7% of all participants. The substantia nigra echogenic area (larger of bilateral measurements) was larger in patients with PD (mean ± SD, 0.24 ± 0.05 cm(2)) than controls (0.14 ± 0.05 cm(2); P < .001) and patients with essential tremor (0.14 ± 0.04 cm(2); P < .001). Substantia nigra echogenicity was larger in male participants (0.20 ± 0.07 cm(2)) than female participants (0.15 ± 0.06 cm(2); P< .001). Age did not correlate with substantia nigra echogenicity in any group. Frontal horn width was larger and lenticular nucleus hyperechogenicity and a discontinuous raphe were more frequent in the PD group than the other groups. On multivariate analysis, only substantia nigra hyperechogenicity was associated with the diagnosis of PD. The 90th-percentile substantia nigra echogenic area in the control group, which defined marked substantia nigra hyperechogenicity, also represented the optimum cutoff value for discrimination of PD from non-PD participants on receiver operating characteristic curve analysis (area under the curve, 0.913; Youden index, 0.73). This cutoff value (≥0.21 cm(2), larger of bilateral measurements) yielded sensitivity of 83% and specificity of 90% for the diagnosis of PD. CONCLUSIONS Transcranial sonography shows good diagnostic validity for diagnosis of PD when implemented according to a strictly standardized protocol.
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Affiliation(s)
- Araceli Alonso-Cánovas
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.).
| | - José Luis López-Sendón
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Javier Buisán
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Alicia deFelipe-Mimbrera
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Marta Guillán
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Nuria García-Barragán
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Iñigo Corral
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - María Consuelo Matute-Lozano
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Jaime Masjuan
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Juan Carlos Martínez-Castrillo
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
| | - Uwe Walter
- Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain (A.A.-C., J.L.L.-S., J.B., A.d.-M., M.G., N.G.-B., I.C., M.C.M.-L., J.M., J.C.M.-C.); and Department of Neurology, University of Rostock, Rostock, Germany (U.W.)
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Sanzaro E, Iemolo F, Duro G, Malferrari G. A new assessment tool for Parkinson disease: the nigral lesion load obtained by transcranial sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1635-1640. [PMID: 25154946 DOI: 10.7863/ultra.33.9.1635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES A sonographic method that provides for the measurement of a single frozen image and ignores the remaining portions of the midbrain has been used recently as a biological marker of Parkinson disease. We propose a new approach to evaluating the midbrain: obtaining the nigral lesion load, with which it is possible to acquire an estimate of the real damage to the substantia nigra. METHODS We studied 60 patients with Parkinson disease and classified them according to the Hoehn and Yahr scale (Neurology 1967; 17:427-442). Magnetic resonance imaging of the brain, ioflupane-labeled single-photon emission computed tomography, and technetium Tc 99m-labeled single-photon emission computed tomography were performed. Assessment of the midbrain parenchyma was performed with transcranial sonography to quantify the extent of hyperechoic signals on 2 different scans (upper and lower substantia nigra). RESULTS In 90% of patients (54), we found pathologic hyperechoic substantia nigra signals (>0.25 cm(2)). These data were similar to those described previously by other authors. However, the sum of the values obtained from each measurement (total of 4 per patient) showed that patients with severe disease had larger nigral lesion loads. In most cases, the study showed impairment of the nigrostriatal dopaminergic system when the hyperechoic pattern was more pronounced. CONCLUSIONS Transcranial sonography is a useful tool for Parkinson disease workup. A single measurement of substantia nigra echogenicity may be insufficient for an optimal definition of the stage of the disease. A study of the entire midbrain may deliver more information than a single measurement.
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Affiliation(s)
- Enzo Sanzaro
- Department of Neurology, Hospital of Vittoria, Ragusa, Italy (E.S., F.I.); National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy (F.I., G.D.); and Department of Neurology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.M.).
| | - Francesco Iemolo
- Department of Neurology, Hospital of Vittoria, Ragusa, Italy (E.S., F.I.); National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy (F.I., G.D.); and Department of Neurology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.M.)
| | - Giovanni Duro
- Department of Neurology, Hospital of Vittoria, Ragusa, Italy (E.S., F.I.); National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy (F.I., G.D.); and Department of Neurology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.M.)
| | - Giovanni Malferrari
- Department of Neurology, Hospital of Vittoria, Ragusa, Italy (E.S., F.I.); National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy (F.I., G.D.); and Department of Neurology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.M.)
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Bor-Seng-Shu E, Pedroso JL, Felicio AC, Ciampi de Andrade D, Teixeira MJ, Braga-Neto P, Batista IR, Barsottini OGP, Borges V, Ferraz HB, Shih MC, Bressan RA, de Andrade LAF, Walter U. Substantia nigra echogenicity and imaging of striatal dopamine transporters in Parkinson's disease: A cross-sectional study. Parkinsonism Relat Disord 2014; 20:477-81. [DOI: 10.1016/j.parkreldis.2014.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 01/03/2014] [Accepted: 01/11/2014] [Indexed: 10/25/2022]
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Bor-Seng-Shu E, Pedroso JL, Andrade DCD, Barsottini OGP, Andrade LAFD, Barbosa ER, Teixeira MJ. Transcranial sonography in Parkinson's disease. EINSTEIN-SAO PAULO 2013; 10:242-6. [PMID: 23052464 DOI: 10.1590/s1679-45082012000200022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 05/25/2012] [Indexed: 11/22/2022] Open
Abstract
Transcranial sonography has become a useful tool in the differential diagnosis of parkinsonian syndromes. This is a non-invasive, low cost procedure. The main finding on transcranial sonography in patients with idiopathic Parkinson's disease is an increased echogenicity of the mesencephalic substantia nigra region. This hyperechogenicity is present in more than 90% of cases, and reflects a dysfunction in the dopaminergic nigrostriatal pathway. This study discussed how the hyperechogenicity of the substantia nigra may facilitate the differential diagnosis of parkinsonian syndromes.
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Affiliation(s)
- Edson Bor-Seng-Shu
- Division of Clinical Neurosurgery, Universidade de São Paulo, São Paulo, SP, Brazil
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Fernandes RDCL, Rosso ALZD, Vincent MB, Bahia PRV, Resende CMC, Araujo NC. Achados de ultrassonografia transcraniana na doença de Parkinson e no tremor essencial: relato de casos. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000600014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A ultrassonografia transcraniana tem sido objeto de investigação como ferramenta diagnóstica em neurologia nos últimos anos. Ela permite boa visualização de estruturas cerebrais situadas na linha média, sítio frequente de anormalidades nas doenças do movimento. Relatamos os casos de pacientes com a doença de Parkinson e o tremor essencial em que a ultrassonografia transcraniana foi capaz de sugerir o diagnóstico.
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Pedroso JL, Bor-Seng-Shu E, Braga-Neto P, Teixeira MJ, Barsottini OGP. Transcranial sonography: Brazilian experience. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:313-4. [DOI: 10.1590/s0004-282x2012000400021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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