Specificity and sensitivity of transcranial sonography of the substantia nigra in the diagnosis of Parkinson's disease: prospective cohort study in 196 patients.
Specificity and sensitivity of transcranial sonography of the substantia nigra in the diagnosis of Parkinson's disease: prospective cohort study in 196 patients.
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DOI：
10.1136/bmjopen-2013-002613
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发表时间：
2013
期刊：
影响因子：
2.9
通讯作者：
Weber WE
中科院分区：
文献类型：
--
作者：
Bouwmans AE;Vlaar AM;Mess WH;Kessels A;Weber WE
许多超声研究表明，黑质（SN+）中典型的回声增强区可以帮助诊断特发性帕金森病（IPD）。几乎所有这些研究都是回顾性的，涉及诊断明确且病程较长的患者。在这项研究中，经颅超声（TCS）的黑质的诊断准确性与未确诊的帕金森综合征的患者最近发作进行了评价。诊断准确性的前瞻性队列研究。荷兰两所教学医院的神经科门诊。196例连续患者，转诊至两个神经科门诊，分析临床不明确的帕金森综合征。在入选后2周内，所有患者还接受了TCS和123 I-碘氟烷单光子发射CT（FP-CIT SPECT）脑部扫描（n=176）。 2年后，由两名运动障碍专家神经科医生对患者进行重新检查，以进行最终临床诊断，作为我们研究的替代金标准。 241例患者中45例（18.67%）的颞窗不足。102例（52.0%）患者的最终临床诊断为IPD。24例（12.3%）诊断为非典型帕金森综合征（APS），其中多系统萎缩（MSA）8例（4.0%），进行性核上性麻痹（PSP）6例（3.1%），路易体痴呆6例（3.1%），皮质基底节变性4例（2%）。21例（10.7%）患者诊断为血管性帕金森综合征，20例（10.2%）原发性震颤，7例（3.6%）药物性帕金森综合征，22例（11.2%）患者无帕金森综合征，但有其他诊断。SN+诊断IPD的灵敏度为0.40（CI 0.30至0.50），特异性为0.61（CI 0.52至0.70）。据此，阳性预测值（PPV）为0.53，阴性预测值（NPV）为0.48。FP-CIT SPECT扫描诊断IPD的灵敏度和特异性分别为0.88（CI 0.1至0.95）和0.68（CI 0.58至0.76），PPV为0.75，NPV为0.84。TCS对早期帕金森病的诊断准确性不足以用于常规临床使用。NCT0036819
Numerous ultrasound studies have suggested that a typical enlarged area of echogenicity in the substantia nigra (SN+) can help diagnose idiopathic Parkinson's disease (IPD). Almost all these studies were retrospective and involved patients with well-established diagnoses and long-disease duration. In this study the diagnostic accuracy of transcranial sonography (TCS) of the substantia nigra in the patient with an undiagnosed parkinsonian syndrome of recent onset has been evaluated. Prospective cohort study for diagnostic accuracy. Neurology outpatient clinics of two teaching hospitals in the Netherlands. 196 consecutive patients, who were referred to two neurology outpatient clinics for analysis of clinically unclear parkinsonism. Within 2 weeks of inclusion all patients also underwent a TCS and a 123I-ioflupane Single Photon Emission CT (FP-CIT SPECT) scan of the brain (n=176). After 2 years, patients were re-examined by two movement disorder specialist neurologists for a final clinical diagnosis, that served as a surrogate gold standard for our study. Temporal acoustic windows were insufficient in 45 of 241 patients (18.67%). The final clinical diagnosis was IPD in 102 (52.0%) patients. Twenty-four (12.3%) patients were diagnosed with atypical parkinsonisms (APS) of which 8 (4.0%) multisystem atrophy (MSA), 6 (3.1%) progressive supranuclear palsy (PSP), 6 (3.1%) Lewy body dementia and 4 (2%) corticobasal degeneration. Twenty-one (10.7%) patients had a diagnosis of vascular parkinsonism, 20 (10.2%) essential tremor, 7 (3.6%) drug-induced parkinsonism and 22 (11.2%) patients had no parkinsonism but an alternative diagnosis. The sensitivity of a SN+ for the diagnosis IPD was 0.40 (CI 0.30 to 0.50) and the specificity 0.61 (CI 0.52 to 0.70). Hereby the positive predictive value (PPV) was 0.53 and the negative predictive value (NPV) 0.48. The sensitivity and specificity of FP-CIT SPECT scans for diagnosing IPD was 0.88 (CI 0.1 to 0.95) and 0.68 (CI 0.58 to 0.76) with a PPV of 0.75 and an NPV of 0.84. The diagnostic accuracy of TCS in early stage Parkinson's disease is not sufficient for routine clinical use. NCT0036819
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