Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
J Parkinsons Dis. 2022;12(4):1115-1123. doi: 10.3233/JPD-213012.
Essential tremor (ET) and the tremor of Parkinson's disease (PD) are the most common tremors encountered in clinical practice. Especially in early disease stages, discrimination between the tremors of ET and PD can be challenging.
The aim of this study was to evaluate the diagnostic accuracy of transcranial sonography (TCS) of the substantia nigra echogenicity for differential diagnosis of PD versus ET.
A systematic PubMed search identified 512 studies. Sensitivity and specificity of substantia nigra hyperechogenicity was estimated. Data synthesis was carried applying a random effects bivariate binomial model. To assess study quality and risk of bias, the QUADAS-2 tool was used.
Eighteen studies were suitable for analysis including 1,264 PD and 824 ET patients. The meta analysis showed a pooled sensitivity and specificity for TCS in the differential diagnosis of PD versus ET of 84.6% (95% CI, 79.4-88.6%) and 83.9% (95% CI, 78.4-88.2%), respectively. Furthermore, we found nearly similar results in sensitivity and specificity comparing TCS and DaTSCAN in a subgroup-analysis of three studies using both diagnostic tools including 107 patients with PD and 62 patients with ET. The QUADAS-2 toolbox revealed a high risk of bias regarding the methodological quality of patient selection.
Substantia nigra hyperechogenicity yield high diagnostic accuracy for the discrimination of PD from ET. TCS is a low cost, widely available, non-invasive marker without radiation Therefore, a diagnostic algorithm based on presence or absence of substantia nigra hyperechogenicity is highly warranted.
特发性震颤（ET）和帕金森病（PD）震颤是临床实践中最常见的震颤。特别是在疾病早期，区分 ET 和 PD 的震颤具有挑战性。
本研究旨在评估黑质超声回声强度对 PD 与 ET 鉴别诊断的准确性。
系统地检索了 PubMed 数据库，共识别出 512 项研究。评估了黑质高回声的敏感性和特异性。应用随机效应二项式模型进行数据综合。使用 QUADAS-2 工具评估研究质量和偏倚风险。
18 项研究适合进行分析，共纳入 1264 例 PD 和 824 例 ET 患者。Meta 分析显示，TCS 在 PD 与 ET 鉴别诊断中的敏感性和特异性分别为 84.6%（95%CI，79.4-88.6%）和 83.9%（95%CI，78.4-88.2%）。此外，我们在使用两种诊断工具的三项研究的亚组分析中发现，TCS 和 DaTSCAN 的敏感性和特异性结果相似，该亚组分析共纳入 107 例 PD 患者和 62 例 ET 患者。QUADAS-2 工具提示在患者选择的方法学质量方面存在高偏倚风险。
黑质高回声对 PD 和 ET 的鉴别具有较高的诊断准确性。TCS 是一种成本低、广泛应用、无辐射的非侵入性标志物。因此，基于黑质高回声的存在与否建立诊断算法是非常有必要的。
