Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147, Rostock, Germany.
Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany.
J Neurol. 2024 Dec;271(12):7387-7401. doi: 10.1007/s00415-024-12502-1. Epub 2024 Jul 4.
Transcranial brain parenchyma sonography (TCS) has been recommended as a tool for the early and differential diagnosis of Parkinson's disease (PD) in German and European clinical guidelines. Still, the brain structures to be examined for the diagnostic questions and the requirements for being a qualified investigator were not specified in detail. These issues have now been addressed in the 2023 update of the clinical guideline on PD by the German Society of Neurology (DGN).
The recommendations were based on a systematic literature review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
Three diagnostic questions were defined: (1) What is the accuracy of TCS in the differential diagnosis of PD versus atypical and secondary Parkinsonian syndromes? (2) What is the accuracy of TCS in the differential diagnosis of PD versus essential tremor? (3) What is the accuracy of TCS in the diagnosis of PD in persons with typical early symptoms, compared with the diagnosis established by clinical follow-up? The brain structures to be assessed and the level of recommendation were formulated for these questions. The training requirements for being regarded as qualified TCS investigator were stipulated by the responsible medical societies (German Society of Ultrasound in Medicine, DEGUM; German Society for Clinical Neurophysiology and Functional Imaging, DGKN). Finally, the recommendations for these diagnostic questions reached strong consensus (each ≥ 97%) of the guideline committee. Here, the details of review and recommendations are presented.
The updated guideline clarifies the diagnostic uses and limitations of TCS in PD.
经颅脑实质超声（TCS）已被德国和欧洲临床指南推荐为早期鉴别诊断帕金森病（PD）的一种工具。然而，对于诊断问题需要检查的脑结构以及合格研究者的要求，并未在细节上加以具体说明。德国神经病学会（DGN）在 2023 年更新的 PD 临床指南中解决了这些问题。
该建议是基于 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行的系统文献回顾。
确定了三个诊断问题：（1）TCS 在鉴别诊断 PD 与非典型和继发性帕金森综合征方面的准确性如何？（2）TCS 在鉴别诊断 PD 与特发性震颤方面的准确性如何？（3）与临床随访确定的诊断相比，TCS 在诊断具有典型早期症状的 PD 患者中的准确性如何？针对这些问题，制定了评估脑结构和推荐级别。负责医学协会（德国超声医学学会，DEGUM；德国临床神经生理学和功能影像学学会，DGKN）规定了被视为合格 TCS 研究者的培训要求。最终，指南委员会对这些诊断问题的建议达成了强烈共识（每项≥97%）。在这里，我们呈现了审查和建议的详细信息。
更新后的指南阐明了 TCS 在 PD 中的诊断用途和局限性。
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