Specificity of transcranial sonography in parkinson spectrum disorders in comparison to degenerative cognitive syndromes

Abstract

BackgroundHyperechogenicity of the substantia nigra (SN+), detected by transcranial sonography (TCS), was reported as a characteristic finding in Parkinson's disease (PD), with high diagnostic accuracy values, when compared mainly to healthy controls or essential tremor (ET) group. However, some data is accumulating that the SN + could be detected in other neurodegenerative and even in non-neurodegenerative disorders too. Our aim was to estimate the diagnostic accuracy of TCS, mainly focusing on the specificity point, when applied to a range of the parkinsonian disorders, and comparing to the degenerative cognitive syndromes.MethodsA prospective study was carried out at the Hospital of Lithuanian University of Health Sciences from January until September 2011. Initially, a TCS and clinical examination were performed on 258 patients and 76 controls. The General Electric Voluson 730 Expert ultrasound system was used. There were 12.8% of cases excluded with insufficient temporal bones, and 4.3% excluded with an unclear diagnosis. The studied sample consisted of the groups: PD (n = 71, 33.2%), ET (n = 58, 27.1%), PD and ET (n = 10, 4.7%), atypical parkinsonian syndromes (APS) (n = 3, 1.4%), hereditary neurodegenerative parkinsonism (HDP) (n = 3, 1.4%), secondary parkinsonism (SP) (n = 23, 10.8%), mild cognitive impairment (MCI) (n = 33, 15.4%), dementia (n = 13, 6.1%), and control (n = 71).ResultsThere were 80.3% of PD patients at stages 1 & 2 according to Hoehn and Yahr. At the cut-off value of 0.20 cm2 of the SN+, the sensitivity for PD was 94.3% and the specificity - 63.3% (ROC analysis, AUC 0.891), in comparison to the rest of the cohort. At the cut-off value of 0.26 cm2, the sensitivity was 90% and the specificity 82.4%.The estimations for the lowest specificity for PD, in comparison to the latter subgroups (at the cut-off values of 0.20 cm2 and 0.26 cm2, respectively) were: 0% and 33.3% to APS, 33.3% and 66.7% to HDP, 34.8% and 69.6% to SP, 55.2% and 82.8% to ET, 75% and 91.7% to dementia.ConclusionsThe high sensitivity of the test could be employed as a valuable screening tool. But TCS is more useful as a supplementary diagnostic method, due to the specificity values not being comprehensive.

Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review

“…(Von der Weid,2001; Langer et al,2002; Hill et al,2004; Spiegler et al,2006; Mahone et al,2007; Aukema et al,2009; Kadan-Lottick et al,2009; Kadan-Lottick et al,2010; Robinson et al,2010; Daams et al,2012; Krawczuk-Rybak et al,2012; Edelmann et al,2013; Genschaft et al,2013; Krull et al,2013; Lewis et al,2013; Ross et al,2013; Schuitema et al,2013; Edelmann et al,2014; Elalfy et al,2014) There were only 4 longitudinal studies that evaluated survivors’ neurocognitive changes from active treatment to post-treatment survivorship phase. (Kingma et al,2001; Harila et al,2009; Halsey et al,2011; Lewis et al,2013) Most studies focused on a pure sample of survivors who received chemotherapy-only treatment protocols while others included separate populations of ALL survivors who received CRT(Kingma et al,2001; Von der Weid,2001; Langer et al,2002; Spiegler et al,2006; Harila et al,2009; Kadan-Lottick et al,2010; Halsey et al,2011; Krull et al,2011; Daams et al,2012; Krull et al,2013; Schuitema et al,2013; Edelmann et al,2014) or patients of other cancer types.…”

“…(Von der Weid,2001; Langer et al,2002; Hill et al,2004; Spiegler et al,2006; Mahone et al,2007; Aukema et al,2009; Kadan-Lottick et al,2009; Kadan-Lottick et al,2010; Robinson et al,2010; Daams et al,2012; Krawczuk-Rybak et al,2012; Edelmann et al,2013; Genschaft et al,2013; Krull et al,2013; Lewis et al,2013; Ross et al,2013; Schuitema et al,2013; Edelmann et al,2014; Elalfy et al,2014) There were only 4 longitudinal studies that evaluated survivors’ neurocognitive changes from active treatment to post-treatment survivorship phase. (Kingma et al,2001; Harila et al,2009; Halsey et al,2011; Lewis et al,2013) Most studies focused on a pure sample of survivors who received chemotherapy-only treatment protocols while others included separate populations of ALL survivors who received CRT(Kingma et al,2001; Von der Weid,2001; Langer et al,2002; Spiegler et al,2006; Harila et al,2009; Kadan-Lottick et al,2010; Halsey et al,2011; Krull et al,2011; Daams et al,2012; Krull et al,2013; Schuitema et al,2013; Edelmann et al,2014) or patients of other cancer types. (Aukema et al,2009; Kadan-Lottick et al,2010) The majority of the included studies had sample sizes between 10 to 50 subjects,(Kingma et al,2001; Langer et al,2002; Hill et al,2004; Mahone et al,2007; Aukema et al,2009; Harila et al,2009; Daams et al,2012; Krawczuk-Rybak et al,2012; Edelmann et al,2013; Genschaft et al,2013; Schuitema et al,2013; Edelmann et al,2014) with the exception of 4 studies with a larger cohort of more than 100 subjects(Von der Weid,2001; Kadan-Lottick et al,2010; Halsey et al,2011; Krull et al,2013) and 3 studies with less than 10 subjects.…”

“…(Kingma et al,2001; Harila et al,2009; Halsey et al,2011; Lewis et al,2013) Most studies focused on a pure sample of survivors who received chemotherapy-only treatment protocols while others included separate populations of ALL survivors who received CRT(Kingma et al,2001; Von der Weid,2001; Langer et al,2002; Spiegler et al,2006; Harila et al,2009; Kadan-Lottick et al,2010; Halsey et al,2011; Krull et al,2011; Daams et al,2012; Krull et al,2013; Schuitema et al,2013; Edelmann et al,2014) or patients of other cancer types. (Aukema et al,2009; Kadan-Lottick et al,2010) The majority of the included studies had sample sizes between 10 to 50 subjects,(Kingma et al,2001; Langer et al,2002; Hill et al,2004; Mahone et al,2007; Aukema et al,2009; Harila et al,2009; Daams et al,2012; Krawczuk-Rybak et al,2012; Edelmann et al,2013; Genschaft et al,2013; Schuitema et al,2013; Edelmann et al,2014) with the exception of 4 studies with a larger cohort of more than 100 subjects(Von der Weid,2001; Kadan-Lottick et al,2010; Halsey et al,2011; Krull et al,2013) and 3 studies with less than 10 subjects. (Lewis et al,2012; Lewis et al,2013; Ross et al,2013) Most the studies reported survivors’ mean duration of time since diagnosis, which ranged between 5 and 22 years.…”

Usefulness of Cardiac MIBG Scintigraphy, Olfactory Testing and Substantia Nigra Hyperechogenicity as Additional Diagnostic Markers for Distinguishing between Parkinson’s Disease and Atypical Parkinsonian Syndromes

“…In addition, hyperechogenicity of the SN on transcranial sonography (TCS) has been more frequently observed in patients with PD than in those with MSA or PSP [12, 13]. Taken together, these observations suggest that utilizing a combination of these batteries in addition to clinical assessment would be useful to achieve a correct diagnosis of PD.…”

Achados de ultrassonografia transcraniana na doença de Parkinson e no tremor essencial: relato de casos

“…The limitations of this method include dependence on the temporal acoustic bone window and low specificity, which would place it in the category of screening methods (10) . Some Brazilian studies have already confirmed the validity of TCS findings for the diagnosis of movement disorders among us (6,12) .…”