Department of Neurology, Justus-Liebig University of Giessen, Giessen, Germany.
BMC Neurol. 2010 Jan 21;10:9. doi: 10.1186/1471-2377-10-9.
In idiopathic Parkinson's disease (IPD) transcranial sonography (TCS) represents an alternative diagnostic method to verify clinical diagnosis. Although the phenomenon of an increased echogenicity of the Substantia nigra (SN) is well known this method is still not widly used in the diagnostic workup. Until now reliability of this method is still a matter of debate, partly because data only existed from a few laboratories using the same ultrasound machine. Therefore our study was conducted to test the reliability of this method by using a different ultrasound device and examining a large population of control and IPD subjects by two examiners to calculate interobserver reliability.
In this study echogenicity of SN was examined in 199 IPD patients and 201 control subjects. All individuals underwent a neurological assessment including Perdue pegboard test and Webster gait test. Using a Sonos 5500 ultrasound device area of SN was measured, echogenicity of raphe, red nuclei, thalamus, caudate and lenticular nuclei, width of third and lateral ventricle were documented.
We found a highly characteristic enlargement of the SN echogenic signal in IPD. The cut-off value for the SN area was established using a ROC curve with a sensitivity of 95% corresponding to an area of SN of 0.2 cm2 and was found to be equivalent to the cut-off values of other studies using different ultrasound devices.
Our study shows that TCS is a reliable and highly sensitive tool for differentiation of IPD patients from individuals without CNS disorders.
在特发性帕金森病（IPD）中，经颅超声（TCS）是一种替代的诊断方法，可以验证临床诊断。尽管黑质（SN）回声增强的现象众所周知，但这种方法在诊断工作中仍未广泛应用。到目前为止，这种方法的可靠性仍然存在争议，部分原因是只有少数使用相同超声仪器的实验室存在数据。因此，我们的研究旨在通过使用不同的超声设备，由两名检查者对大量的对照组和 IPD 患者进行检查，以计算观察者间的可靠性，从而测试这种方法的可靠性。
本研究共纳入 199 名 IPD 患者和 201 名对照组患者。所有患者均接受了神经学评估，包括珀德钉板测试和韦伯斯特步态测试。使用 Sonos 5500 超声设备测量 SN 的面积，记录纹状体、红核、丘脑、尾状核和壳核的回声强度、第三脑室和外侧脑室的宽度。
我们发现 IPD 患者的 SN 回声信号特征性增大。使用 ROC 曲线确定了 SN 面积的截断值，其敏感性为 95%，对应的 SN 面积为 0.2cm2，与使用不同超声设备的其他研究的截断值相当。
我们的研究表明，TCS 是一种可靠且高度敏感的工具，可用于区分 IPD 患者和无中枢神经系统疾病的个体。
