Medical Student Research Committee (MSRC), Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institute, Stockholm, Sweden.
Parkinsonism Relat Disord. 2017 Sep;42:1-11. doi: 10.1016/j.parkreldis.2017.06.006. Epub 2017 Jun 15.
Studies have suggested that the majority of patients with Parkinson's disease have abnormal ultrasound hyperechogenicity of the substantia nigra, and that this may be useful in diagnosis. We performed a systematic review and meta-analysis to evaluate diagnostic value of substantia nigra ultrasound to differentiate Parkinson's disease from atypical parkinsonism and from essential tremor. We systematically searched PubMed and EMBASE for relevant studies published until November 2016. Eligible articles were screened, data were extracted and study quality was scored by two independent reviewers. We applied random effect models to calculate pooled estimates for the prevalence of hyperechogenicity in each condition. For final meta-analysis, 71 articles with a total number of 5730 participants (idiopathic Parkinson's disease: 4494, atypical parkinsonism: 594, essential tremor: 642) were included. The pooled prevalence rate of hyperechogenicity was 84% (95 %CI 80-87%) in idiopathic Parkinson's disease, 28% (95% CI 20-36%) in atypical parkinsonism and 15% (95% CI 7-23%) in essential tremor. Based on our meta-analysis, substantia nigra hyperechogenecity has 75% (95% CI: 60-86%) sensitivity and 70% (95% CI: 55-81%) specificity to differentiate idiopathic Parkinson's disease from atypical parkinsonism. Sensitivity and specificity to distinguish idiopathic Parkinson's disease from essential tremor was calculated as 78% (95% CI: 69-85%) and 85% (95% CI: 77-91%), respectively. Findings from our meta-analysis showed that transcranial sonography can provide useful information to differentiate idiopathic Parkinson's disease from mimicking movement disorders, although sensitivity and specificity are suboptimal, particularly for differentiating from atypical parkinsonism.
研究表明，大多数帕金森病患者的黑质超声表现为高回声异常，这可能有助于诊断。我们进行了系统评价和荟萃分析，以评估黑质超声区分帕金森病与非典型帕金森病和特发性震颤的诊断价值。我们系统地检索了 PubMed 和 EMBASE 数据库，以获取截至 2016 年 11 月发表的相关研究。由两名独立的评审员筛选合格的文章、提取数据并对研究质量进行评分。我们应用随机效应模型计算每种情况下高回声的患病率的合并估计值。对于最终的荟萃分析，纳入了 71 篇文章，共计 5730 名参与者（特发性帕金森病：4494 名，非典型帕金森病：594 名，特发性震颤：642 名）。特发性帕金森病患者黑质高回声的总体患病率为 84%（95%CI 80-87%），非典型帕金森病患者为 28%（95%CI 20-36%），特发性震颤患者为 15%（95%CI 7-23%）。根据我们的荟萃分析，黑质高回声对区分特发性帕金森病与非典型帕金森病的敏感性为 75%（95%CI：60-86%），特异性为 70%（95%CI：55-81%）。特发性帕金森病与特发性震颤之间的敏感性和特异性分别计算为 78%（95%CI：69-85%）和 85%（95%CI：77-91%）。我们的荟萃分析结果表明，经颅超声检查可为区分特发性帕金森病与类似运动障碍的疾病提供有用的信息，尽管敏感性和特异性都不理想，特别是在区分非典型帕金森病时。
