Ding Chang Wei, Wang Cai Shan, Zhao Ping, Chen Ming Lei, Zhang Ying Chun, Liu Chun Feng
Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 San Xiang Road, Suzhou, 215004, China.
Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Acta Neurol Belg. 2024 Dec;124(6):1875-1884. doi: 10.1007/s13760-024-02547-4. Epub 2024 Jul 22.
This study explored the characteristics of muscle stiffness of lower gastrocnemius in resting and exercise states in patients with postural instability gait difficulty (PIGD) and tremor dominant (TD) Parkinson's disease patients using shear wave elastography (SWE).
75 PD patients from the Department of Parkinson's Disease Center in the Hospital from September 2021 to December 2022 were prospectively included, including 44 patients with PIGD and 31 with TD. In the same period, 40 healthy subjects matching gender and age were included as the control group. SWE was used to detect Young's modulus of both sides (right and left, R- and L-) of the lateral head of the gastrocnemius in resting (YM1) and exerciser states (YM2) in all participants and the absolute difference Young's modulus between resting and exercise state (ΔYM) was calculated.
R-YM2 and R-ΔYM were the highest in the normal controls, followed by the TD group, and lowest in the PIGD group. There were no differences in L-YM2 and L-ΔYM between the PIGD group and the TD group (all p > 0.05), but they were lower than those in the normal control group (all p < 0.05). In addition, R-YM2 and R-ΔYM were negatively correlated with disease duration and UPDRS III scores in the PIGD group (all p < 0.05). R-ΔYM has the highest value in the differential diagnosis of PIGD and TD patients. The area under the receiver operating characteristic curve (ROC) curve is 0.812 (95%CI, 0.730-0.893), and the diagnostic threshold is 120.5 Kpa with a sensitivity of 63.6%, a specificity of 90.1%, a positive predictive of 80%, and a negative predictive value of 80%.
Shear wave elastography is a sensitive ultrasound method for evaluating muscle strength in patients with PIGD and TD. It also provides a new biological indicator to distinguish between different phenotypes of patients with PD.
本研究采用剪切波弹性成像（SWE）技术，探究姿势不稳步态障碍（PIGD）型和震颤为主（TD）型帕金森病患者在静息和运动状态下腓肠肌下部肌肉硬度的特征。
前瞻性纳入2021年9月至2022年12月在我院帕金森病中心就诊的75例帕金森病患者，其中PIGD型44例，TD型31例。同期纳入40例性别和年龄匹配的健康受试者作为对照组。采用SWE检测所有参与者腓肠肌外侧头两侧（右侧和左侧，R-和L-）在静息状态（YM1）和运动状态（YM2）下的杨氏模量，并计算静息和运动状态之间杨氏模量的绝对差值（ΔYM）。
正常对照组的R-YM2和R-ΔYM最高，其次是TD组，PIGD组最低。PIGD组和TD组之间的L-YM2和L-ΔYM无差异（均p>0.05），但均低于正常对照组（均p<0.05）。此外，PIGD组的R-YM2和R-ΔYM与病程和UPDRS III评分呈负相关（均p<0.05）。R-ΔYM在PIGD和TD患者的鉴别诊断中具有最高值。受试者工作特征曲线（ROC）下面积为0.812（95%CI，0.730-0.893），诊断阈值为120.5 Kpa，敏感性为63.6%，特异性为90.1%，阳性预测值为80%，阴性预测值为80%。
剪切波弹性成像是评估PIGD和TD患者肌肉力量的一种敏感超声方法。它还为区分帕金森病患者的不同表型提供了一种新的生物学指标。
