Okawa Masae, Miwa Hideto, Kajimoto Yoshinori, Hama Kiwa, Morita Shuhei, Nakanishi Ichiro, Kondo Tomoyoshi
Department of Neurology, Wakayama Medical University.
Intern Med. 2007;46(18):1527-31. doi: 10.2169/internalmedicine.46.0271. Epub 2007 Sep 14.
There is growing interest in the use of transcranial sonography (TCS) of the substantia nigra (SN) in patients with Parkinson's disease (PD), as it has been reported that SN hyperechogenicity may be present in about 90% of PD patients. However, TCS of the SN has not been applied in Japanese patients, and its clinical potential has not been determined.
TCS of the SN was performed in patients with PD, progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and essential tremor (ET), and age-matched controls. Ultrasound images of the SN were assessed using semi-qualitative estimation criteria by two investigators unaware of clinical diagnosis.
SN hyperechogenicity was observed in approximately 83% of accessible SNs in Japanese PD patients. In comparison, SN hyperechogenicity was less frequently observed in healthy subjects or in patients with PSP, MSA, and ET. However, the rate of successful recording of the SN by TCS decreased prominently with advancing age, particularly in females.
The present study confirmed that TCS of the SN is potentially useful in the investigation of Japanese patients, and it provides a better differential diagnosis between PD and atypical parkinsonism. The recording failure of TCS in aged, particularly female subjects, may limit the clinical potential of TCS of the SN in Japanese patients.
帕金森病（PD）患者中，对使用经颅超声检查（TCS）检测黑质（SN）的兴趣日益浓厚，因为据报道约90%的PD患者可能存在SN高回声。然而，SN的TCS尚未应用于日本患者，其临床潜力也尚未确定。
对PD、进行性核上性麻痹（PSP）、多系统萎缩（MSA）和特发性震颤（ET）患者以及年龄匹配的对照组进行SN的TCS检查。由两名不知临床诊断情况的研究人员使用半定性评估标准对SN的超声图像进行评估。
在日本PD患者中，约83%可检测到的SN出现高回声。相比之下，健康受试者或PSP、MSA和ET患者中SN高回声的观察频率较低。然而，随着年龄增长，尤其是女性，TCS成功记录SN的比率显著下降。
本研究证实，SN的TCS在日本患者的检查中可能有用，并且它能更好地区分PD和非典型帕金森综合征。在老年受试者尤其是女性受试者中TCS记录失败，可能会限制SN的TCS在日本患者中的临床潜力。
