Transcranial Sonography of the Substantia Nigra in Japanese Patients with Parkinson's Disease or Atypical Parkinsonism: Clinical Potential and Limitations

Okawa, Masae; Miwa, Hideto; Kajimoto, Yoshinori; Hama, Kiwa; Morita, Shuhei; Nakanishi, Ichiro; Kondo, Tomoyoshi

doi:10.2169/internalmedicine.46.0271

Cited by 81 publications

(62 citation statements)

References 17 publications

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“…Previous efforts have reported a 10%-20% rate of inadequate acoustic bone windows, especially in women and the elderly, in up to 59% of Asian old women 10 , and, perhaps, in patients with osteoporosis 1,8 . Although conclusions can only be drawn with caution, as the number of participants was rather small in this pilot study, only 10.8% of our participants lacked adequate bone windows.…”

Section: Discussionmentioning

confidence: 99%

Transcranial sonography as a diagnostic tool for Parkinson's disease: a pilot study in the city of Rio de Janeiro, Brazil

Fernandes

Rosso

Vincent

et al. 2011

Arq. Neuro-Psiquiatr.

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In Brazil there is no systematic study on Transcranial Sonography (TCS), a neuroimaging method that depicts echogenic deep brain structures using ultrasound. Objective: To establish the percentage of subjects with permissive temporal windows and to address the ability of TCS of the substantia nigra (SN) to distinguish parkinsonian patients in a Brazilian sample. Method: We performed TCS using the Acuson X300 (Siemens, Germany) in 37 individuals: 23 with Parkinson's disease (PD) and 14 healthy controls. Results: 10.8% of subjects had insufficient temporal acoustic bone windows. SN echogenic areas were larger in patients (mean±SD, 0.31±0.08cm2 ) compared to controls (mean±SD, 0.17±0.02cm 2 ). TCS accurately identified 88.2% of PD patients. Conclusion: A large proportion of Brazilians seem to be eligible for TCS. An expressive number of PD patients could be diagnosed by TCS based on an expanded SN echogenic area. However, the current data is preliminary and must be corroborated by larger studies. Key words: diagnostic imaging, ultrasonography, Parkinson's disease.A Ultrassonografia transcraniana como método diagnóstico para a doença de Parkinson: um estudo piloto na cidade do Rio de Janeiro, Brasil RESUMO No Brasil não há estudos sistemáticos sobre a Ultrassonografia Transcraniana (USTC), modalidade de neuroimagem que visualiza estruturas ecogênicas profundas do parênquima cerebral utilizando ultrassom. Objetivo: Determinar a porcentagem de indivíduos com janelas ósseas adequadas e a capacidade da USTC da substância negra (SN) de discernir pacientes parkinsonianos em amostra brasileira. Método: USTC realizada com equipamento AcusonX300 (Siemens, Germany) em 37 indivíduos: 23 com doença de Parkinson (DP) e 14 controles saudáveis. Resultados: 10,8% dos participantes apresentaram janelas acústicas temporais inadequadas. As áreas de ecogenicidade da SN foram maiores nos pacientes (média±desvio padrão, 0,31±0,08 cm 2 ) do que nos controles (média±desvio padrão, 0,17±0,02 cm 2 ). A USTC identificou 88,2% dos pacientes com DP. Conclusão: Grande proporção de brasileiros parece ser elegível para a realização de USTC. Um número expressivo dos pacientes com DP poderia ser diagnosticado com base no aumento da área ecogênica da SN. Contudo, esses dados preliminares devem ser corroborados com amostra mais numerosa. Palavras-Chave: diagnóstico por imagem, ultrassonografia, doença de Parkinson.

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Section: Discussionmentioning

confidence: 99%

Transcranial sonography as a diagnostic tool for Parkinson's disease: a pilot study in the city of Rio de Janeiro, Brazil

Fernandes

Rosso

Vincent

et al. 2011

Arq. Neuro-Psiquiatr.

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“…A number of studies demonstrated good sensitivity and specificity of TCS for the differentiation of PD and aPS. In independent studies, it could be shown that SN hyperechogenicity is only rarely found in MSA-P and in not more than one third of PSP patients [25][26][27][28] . In addition to SN echogenicity, also LN echogenicity and the width of the third ventricle ( fig.…”

Section: Tcs In the Differential Diagnosis Of Pdmentioning

confidence: 99%

Place Value of Transcranial Sonography in Early Diagnosis of Parkinson’s Disease

Berg

Gaenslen²

2010

Neurodegener Dis

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Transcranial B-mode sonography (TCS) is a relatively new method which has been proven to be helpful in the diagnosis of Parkinson’s disease (PD). Due to the underlying physical principles, supplementary information to other neuroimaging methods can be derived. Substantia nigra (SN) hyperechogenicity is the characteristic feature of idiopathic PD, which can help in the differentiation of atypical parkinsonian syndromes like multiple system atrophy or progressive supranuclear palsy. Besides, the quick ‘look into the brain’ can easily visualize an enlargement of the ventricular system, alterations of the basal ganglia like increased contents of calcium or trace metals, or a missing brain stem raphe, typically seen in depressive disorders, and can therefore give further diagnostic hints for symptomatic parkinsonian syndromes. Many studies indicate that SN hyperechogenicity constitutes a stable marker, irrespective of the disease stage. In a prospective study of patients with very first signs of yet unclear parkinsonism, a high predictive value of TCS for the diagnosis of PD could be proven. Moreover, there is accumulating evidence that SN hyperechogenicity could play a role in the premotor diagnosis of PD. In this review, the additional diagnostic value of TCS in the early diagnosis of PD as well as limitations of the method are being discussed.

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“…In particular at later stages -but also in the onset early in the course of the disease [13] -TCS was reported to discriminate IPD from MSA-P and PSP [2,57], with a high sensitivity and specificity [23,26,61]. This was applied and calculated using the frequency and the distribution of TCS abnormalities of the substantia nigra, lenticular nucleus and third ventricle (Figure 2 A-B) ( Figure 3) [23,25,26].…”

Section: Tcs In Apsmentioning

confidence: 99%

“…This was applied and calculated using the frequency and the distribution of TCS abnormalities of the substantia nigra, lenticular nucleus and third ventricle (Figure 2 A-B) ( Figure 3) [23,25,26]. More specifically a pooled analysis of several studies [13,23,25,29,61] including 500 patients with adequate assessability on TCS, of whom 353 had definite PD, 86 had probable or possible MSA-P, and 61 had probable or possible PSP, has shown that hyperechogenicity of the SN and normal echogenicity of the basal ganglia has a positive predictive value of 91% for IPD [24]; normal echogenic SN combined with LN hyperechogenicity indicated MSA-P or PSP (sensitivity59%-specificity100%; positive predictive value 100%); normal echogenic SN indicated MSA-P rather than IPD (sensitivity 90%-specificity 98%; positive predictive value 86%); third-ventricle dilatation of more than 10 mm in combination with LN hyperechogenicity indicated PSP rather than IPD (sensitivity 84%-specificity 98%; positive predictive value 89%). In parkinsonism with an age at onset younger than 60 years, normal echogenic SN alone indicated MSA or PSP (sensitivity 75%-specificity 100%; positive predictive value 100%) [23].…”

Section: Tcs In Apsmentioning

confidence: 99%

See 1 more Smart Citation

Update on Transcranial Sonography Applications in Movement Disorders

Godani¹,

Canavese²,

Sette³

et al. 2014

J Diagn Imaging Ther

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Over the past 20 years transcranial B-mode sonography (TCS) of brain parenchyma is being increasingly used as a diagnostic tool in movement disorders. The most widely recognised finding for movement disorders has been an increase in echogenicity of the substantia nigra, an area of the midbrain that is affected in idiopathic Parkinson's disease (IPD). This finding has enabled a reliable diagnosis of IPD with high predictive values. Other sonographic features -such as hypoechogenicity of the brainstem raphe and hyperechogenicity of the lentiform nucleus -might help to increase the differential diagnosis of IPD and other movement disorders. In comparison with other neuroimaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT), TCS can currently be performed with portable machines and has the advantages of non-invasiveness with 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. This present update summarizes the current methodological standards and defines the assessment of diagnostically relevant deep brain structures such as substantia nigra, brainstem raphe, basal ganglia and ventricles

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Transcranial Sonography of the Substantia Nigra in Japanese Patients with Parkinson's Disease or Atypical Parkinsonism: Clinical Potential and Limitations

Abstract: Objective There is growing interest in the use of transcranial sonography (TCS)

Cited by 81 publications

References 17 publications

Transcranial sonography as a diagnostic tool for Parkinson's disease: a pilot study in the city of Rio de Janeiro, Brazil

Transcranial sonography as a diagnostic tool for Parkinson's disease: a pilot study in the city of Rio de Janeiro, Brazil

Place Value of Transcranial Sonography in Early Diagnosis of Parkinson’s Disease

Update on Transcranial Sonography Applications in Movement Disorders

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