Differentiation of Parkinson's disease and atypical parkinsonian syndromes by transcranial ultrasound

Behnke, Stefanie; Berg, Daniela; Naumann, Markus; Becker, Georg

doi:10.1136/jnnp.2004.049221

Cited by 156 publications

(122 citation statements)

References 14 publications

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“…Lenticular nucleus hyperechogenicity is frequently detected in brain disorders with an accumulation of iron, manganese, or copper, e. g. in Wilson's disease [14]. This finding is also present in 70 -90 % of patients with atypical Parkinsonian syndromes and supports, especially if combined with other TCS findings ( • " Table 3), their discrimination from PD [1, 30,31]. Caudate nucleus hyperechogenicity is often found in patients with Huntington's disease [38] and may support discrimination from other chorea disorders [unpublished data].…”

Section: Diagnostic Relevancementioning

confidence: 90%

“…For the differentiation of PD from atypical Parkinsonian syndromes, SN TCS should be combined with TCS of other brain structures ( • " Table 3), or with distinct clinical findings [1, 30 -33]. The combined presence of normal SN echogenicity and lenticular nucleus hyperechogenicity clearly discriminates atypical Parkinsonian syndromes from idiopathic PD [30,31]. In turn, the triad of SN hyperechogenicity, motor asymmetry and hyposmia is highly predictive for PD already at very early disease stages [32].…”

Section: Diagnostic Relevancementioning

confidence: 99%

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Transcranial Sonography (TCS) of Brain Parenchyma in Movement Disorders: Quality Standards, Diagnostic Applications and Novel Technologies

Walter

Školoudík

2014

Ultraschall in Med

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Transcranial B-mode sonography (TCS) of brain parenchyma is being increasingly used as a diagnostic tool in movement disorders. Compared to other neuroimaging modalities such as magnetic resonance imaging (MRI) and computed tomography, TCS can be performed today with portable machines and has the advantages of noninvasiveness and high resistance to movement artifacts. In distinct brain disorders TCS detects abnormalities that cannot be visualized or can only be visualized with significant effort with other imaging methods. In the field of movement disorders, TCS has been established mainly as a tool for the early and differential diagnosis of Parkinson?s disease. The postoperative position control of deep brain stimulation electrodes, especially in the subthalamic nucleus, can reliably and safely be performed with TCS.?The present update review summarizes the current methodological standards and defines quality criteria of adequate TCS imaging and assessment of diagnostically relevant deep brain structures such as substantia nigra, brainstem raphe, basal ganglia and ventricles. Finally, an overview is given on recent technological advances including TCS-MRI fusion imaging and upcoming technologies of digitized image analysis aiming at a more investigator-independent assessment of deep brain structures on TCS.

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Section: Diagnostic Relevancementioning

confidence: 90%

Section: Diagnostic Relevancementioning

confidence: 99%

Transcranial Sonography (TCS) of Brain Parenchyma in Movement Disorders: Quality Standards, Diagnostic Applications and Novel Technologies

Walter

Školoudík

2014

Ultraschall in Med

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“…Diffusion weighted imaging of the PUT is abnormal in MSA but does not sensitively detect PD [13,14], and nigral echogenicity may be increased in PD but does not sensitively detect MSA [15]. Neither approach therefore efficiently identifies central DA deficiency.…”

Section: Abstract or Phrasesmentioning

confidence: 99%

Biomarkers to detect central dopamine deficiency and distinguish Parkinson disease from multiple system atrophy

Goldstein¹,

Holmes²,

Bentho³

et al. 2008

Parkinsonism & Related Disorders

146

115

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Objective-Biomarkers are increasingly important to diagnose and test treatments of neurodegenerative diseases such as Parkinson disease (PD). This study compared neuroimaging, neurochemical, and olfactory potential biomarkers to detect central dopamine (DA) deficiency and distinguish PD from multiple system atrophy (MSA).Methods-In 77 PD, 57 MSA, and 87 control subjects, radioactivity concentrations in the putamen (PUT), caudate (CAU), occipital cortex (OCC), and substantia nigra (SN) were measured 2 hours after 6-[ 18 F]fluorodopa injection, septal myocardial radioactivity measured 8 minutes after 6-[ 18 F] fluorodopamine injection, CSF and plasma catechols assayed, or olfaction tested (University of Pennsylvania Smell Identification Test (UPSIT)). Receiver operating characteristic curves were constructed, showing test sensitivities at given specificities.Results-PUT:OCC, CAU:OCC, and SN:OCC ratios of 6-[ 18 F]fluorodopa-derived radioactivity were similarly low in PD and MSA (p<0.0001, p<0.0001, p=0.003 compared to controls), as were CSF dihydroxyphenylacetic acid (DOPAC) and DOPA concentrations (p<0.0001 each). PUT:SN and PUT:CAU ratios were lower in PD than in MSA (p=0.004; p=0.005). CSF DOPAC correlated positively with PUT:OCC ratios (r=0.61, p<0.0001). Myocardial 6-[ 18 F]fluorodopamine-derived radioactivity distinguished PD from MSA (83% sensitivity at 80% specificity, 100% sensitivity among patients with neurogenic orthostatic hypotension (NOH)). Only PD patients were anosmic; only MSA patients had normal olfaction (61% sensitivity at 80% specificity).Conclusions-PD and MSA feature low PUT:OCC ratios of 6-[ 18 F]fluorodopa-derived radioactivity and low CSF DOPAC and DOPA concentrations, cross-validating the neuroimaging and neurochemical approaches but not distinguishing the diseases. PUT:SN and PUT:OCC ratios of Corresponding author: David S. Goldstein, MD PhD, Clinical Neurocardiology Section, NINDS, NIH, 10 Center Drive MSC-1620, Building 10 Room 6N252, Bethesda, MD 20892-1620 USA, Phone: 301-496-2103, Fax: 301-402-0180, Blackberry: 301-675-1110 goldsteind@ninds.nih.gov. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Loss of sense of smell in PD has been associated with neuroimaging evidence of both central DA deficiency [22] and cardiac noradrenergic denervation [23]. Decreased olfaction also can occur in MSA [24,25], and it has been unclear how efficiently olfactory testing separates PD from MSA. NIH Public AccessThe main purpose of this study was to identify biomarkers that detect central DA deficiency and distinguish PD from MSA. Because of the impo...

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“…Recent studies reported increased SN echogenicity in 91-100% of PD patients, with boundary enlargements between 0.20-0.25 cm 2 depending on the specific ultrasound system used [8][9][10][11] . In contrast, a hyperechogenic enlarged SN is detectable in only 8-14% of healthy volunteers [8][9][10][11] . Some apparently healthy volunteers with positive TCS finding will later developed symptoms of PD (ref.…”

Section: Introductionmentioning

confidence: 99%

“…In addition to these imaging modalities, changes in the size and structure of the substantia nigra (SN) can be detected by transcranial sonography (TCS) (ref. [7][8][9][10][11] ).…”

Section: Introductionmentioning

confidence: 99%

A new program for highly reproducible automatic evaluation of the substantia nigra from transcranial sonographic images

Blahuta¹,

Soukup²,

Jelínková³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims. Recent studies report increased echogenicity of the substantia nigra (SN) in patients with Parkinson's disease (PD) using transcranial sonography (TCS). However, the main limitation to TCS is its dependence on the sonographer's experience. Experimental software for quantitative evaluation of the echogenic SN area was thus developed by us. The aim of this study was to test the reliability of the data using developed B-Mode Assist software in patients with parkinsonism and in healthy volunteers. Methods. The SN was imaged from the right temporal bone window in mesencephalic plane using TCS. DICOM images of SN were saved, converted into JPEG format, encoded and processed. Two observers performed 3 automatic evaluations of the SN area (measurements of SN area in each gray scale intensity inside the region of interest) by counting the standard deviation of all 6 measurements using developed software. The average value of all 3 measurements of each observer was used for computing Cohen's kappa coefficient to determine inter-observer correlations. Cohen's kappa coefficients as an intra-observer correlation for observer 1 and observer 2 were counted from the first 2 measurements of both observers. Results. In total, 92 images were evaluated using this software. The mean of the standard deviations was 3.87; Cohen's kappa for intra-observer agreement of two observers were 0.947, and 0.943, resp.; Cohen's kappa for inter-observers agreement was 0.880. The agreement between visual and automatic detection of SN pathology was in 97.8% images. The sensitivity, specificity, positive and negative predictive values of automatic measurement were 100, 96.2, 95.1, 100%, resp. Conclusions. The results show very reliable measurement of SN features using designed application with "almost perfect" inter-observer and intra-observer agreements.

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Differentiation of Parkinson's disease and atypical parkinsonian syndromes by transcranial ultrasound

Cited by 156 publications

References 14 publications

Transcranial Sonography (TCS) of Brain Parenchyma in Movement Disorders: Quality Standards, Diagnostic Applications and Novel Technologies

Transcranial Sonography (TCS) of Brain Parenchyma in Movement Disorders: Quality Standards, Diagnostic Applications and Novel Technologies

Biomarkers to detect central dopamine deficiency and distinguish Parkinson disease from multiple system atrophy

A new program for highly reproducible automatic evaluation of the substantia nigra from transcranial sonographic images

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