Toomsoo Toomas, Liepelt-Scarfone Inga, Berg Daniela, Kerner Riina, Pool Allan-Hermann, Kadastik-Eerme Liis, Rubanovits Inna, Asser Toomas, Taba Pille
Center of Neurology, East Tallinn Central Hospital, Tallinn, Estonia.
Department of Neurodegeneration, Center of Neurology, Hertie Institute of Clinical Brain Research and German Center of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany.
Ultrasound Med Biol. 2019 Jan;45(1):122-128. doi: 10.1016/j.ultrasmedbio.2018.09.018. Epub 2018 Oct 26.
Substantia nigra (SN) hyper-echogenicity (SN+) describes an enlargement (>90th percentile) of the area of echogenicity at the anatomic site of the SN in the midbrain detected by transcranial sonography. This ultrasound sign has proven to be a valuable marker supporting the clinical diagnosis of Parkinson's disease (PD). Although there is considerable variation in the extent of echogenic signals at the anatomic site of the SN among PD patients, previous work suggests that SN+ is a stable marker throughout the course of the disease. The present study focused on two aspects: (i) determining whether SN+ values differ between the sides, mirroring the asymmetric character of the disease; and (ii) determining whether age has an influence on SN echogenicity. This cross-sectional study included 300 PD patients and 200 healthy controls. SN+ was measured planimetrically by transcranial sonography. Echogenicity was analyzed separately for onset and non-onset sides, with onset side defined as the SN contralateral to the side of the body that first manifested PD-related motor impairment. Age of the patients and healthy controls at study time was used for correlation. We found that the onset SN+ contralateral to the side of initial motor symptoms was on average 17.6% larger than its counterpart. However, we also found that contrary to the control group, where an increase in age was associated with an increase in size of SN+, age of PD patients was associated with a decline in size of the onset SN+. Furthermore, SN measured at the onset side of PD patients correlated significantly with patient age and Hoehn and Yahr stage, a scale that grades PD severity, although this was not the case for the non-onset side. The present study indicates that changes in SN echogenicity have a different dynamic depending on the onset side of the disease. The age at study time had a significantly negative effect on the size of onset SN+, the effect on the non-onset side was non-significant. We conclude that for appropriate PD analysis, onset SN+ is a more important marker than the average of both sides of SN. Furthermore, we found that among healthy controls, the size of SN+ increases with age.
黑质（SN）高回声（SN+）是指经颅超声检测到的中脑SN解剖部位的回声区域增大（>第90百分位数）。这一超声征象已被证明是支持帕金森病（PD）临床诊断的一个有价值的标志物。尽管PD患者中SN解剖部位的回声信号范围存在相当大的差异，但先前的研究表明，SN+在疾病过程中是一个稳定的标志物。本研究聚焦于两个方面：（i）确定SN+值在两侧之间是否存在差异，以反映疾病的不对称特征；（ii）确定年龄是否对SN回声有影响。这项横断面研究纳入了300例PD患者和200名健康对照。通过经颅超声以平面测量法测量SN+。分别对发病侧和非发病侧的回声进行分析，发病侧定义为与首次出现PD相关运动障碍的身体一侧对侧的SN。将患者和健康对照在研究时的年龄用于相关性分析。我们发现，与最初运动症状一侧对侧的发病SN+平均比其对应侧大17.6%。然而，我们还发现，与对照组不同，在对照组中年龄增加与SN+大小增加相关，而PD患者的年龄与发病SN+大小下降相关。此外，在PD患者发病侧测量的SN与患者年龄和Hoehn-Yahr分期（一种评估PD严重程度的量表）显著相关，尽管在非发病侧并非如此。本研究表明，SN回声的变化根据疾病的发病侧具有不同的动态变化。研究时的年龄对发病SN+大小有显著的负面影响，对非发病侧的影响不显著。我们得出结论，对于适当的PD分析，发病SN+比SN两侧的平均值是一个更重要的标志物。此外，我们发现，在健康对照中，SN+的大小随年龄增加。
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