Walter U, Zach H, Liepelt-Scarfone I, Maetzler W
Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Deutschland.
Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich.
Nervenarzt. 2017 Apr;88(4):365-372. doi: 10.1007/s00115-017-0289-z.
The clinical diagnosis of idiopathic Parkinson's disease (iPD) can be challenging. In these cases, additional diagnostic methods are available that can help to improve diagnostic accuracy.
OBJECTIVES, MATERIAL AND METHODS: This article provides an overview of currently available and promising novel ancillary methods for the early and differential diagnosis of iPD.
Imaging tools, such as 1.5 Tesla magnetic resonance imaging (MRI) and computed tomography (CT) are mainly used for the differentiation between iPD and symptomatic parkinsonian syndromes (PS). High-resolution diffusion tensor imaging and iron and neuromelanin-sensitive high-field MRI sequences can become important in the future, particularly for earlier diagnosis. Transcranial B‑mode sonography of the substantia nigra and basal ganglia is established for early and differential diagnostics, especially in the combination of diagnostic markers but necessitates an adequately trained investigator and the use of validated digital image analysis instruments. DATScan can discriminate iPD from essential tremor, medication-induced parkinsonism and psychogenic movement disorder but not iPD from atypical PS. For the latter differential diagnosis, fluorodeoxyglucose positron emission tomography and myocardial metaiodobenzylguanidine scintigraphy can be helpful. Olfactory testing should preferably be used in combination with other diagnostic tests. Genetic, biochemical and histopathological tests are currently not recommended for routine use. Novel sensor-based techniques have a high potential to support clinical diagnosis of iPD but have not yet reached a developmental stage that is sufficient for clinical use. Novel sensor-based techniques have high potential to support clinical diagnosis of iPD, but have not yet reached a development stage that is sufficient for clinical use.
Ancillary diagnostic methods can support the early and differential diagnosis of iPD.
特发性帕金森病（iPD）的临床诊断可能具有挑战性。在这些情况下，可以采用其他诊断方法来提高诊断准确性。
目的、材料与方法：本文概述了目前可用于iPD早期诊断和鉴别诊断的、有前景的新型辅助方法。
成像工具，如1.5特斯拉磁共振成像（MRI）和计算机断层扫描（CT），主要用于区分iPD和症状性帕金森综合征（PS）。高分辨率扩散张量成像以及对铁和神经黑色素敏感的高场MRI序列未来可能会变得很重要，特别是对于早期诊断。经颅B型黑质和基底节超声检查已用于早期诊断和鉴别诊断，尤其是结合诊断标志物时，但需要有充分培训的研究人员并使用经过验证的数字图像分析仪器。DAT扫描可以区分iPD与特发性震颤、药物性帕金森综合征和精神性运动障碍，但不能区分iPD与非典型PS。对于后者的鉴别诊断，氟脱氧葡萄糖正电子发射断层扫描和心肌间碘苄胍闪烁显像可能会有帮助。嗅觉测试最好与其他诊断测试结合使用。目前不建议将基因、生化和组织病理学检测用于常规诊断。基于新型传感器的技术很有潜力支持iPD的临床诊断，但尚未达到足以用于临床的发展阶段。基于新型传感器的技术很有潜力支持iPD的临床诊断，但尚未达到足以用于临床的发展阶段。
辅助诊断方法可以支持iPD的早期诊断和鉴别诊断。
