Brain parenchyma sonography discriminates Parkinson's disease and atypical parkinsonian syndromes
Brain parenchyma sonography discriminates Parkinson's disease and atypical parkinsonian syndromes
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DOI：
10.1212/wnl.60.1.74
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发表时间：
2003-01-14
期刊：
影响因子：
9.9
通讯作者：
Dressler, D
中科院分区：
文献类型：
--
作者：
Walter, U;Niehaus, L;Dressler, D
目标：探讨脑实质超声（BPS）在鉴别特发性帕金森病（IPD）和非典型帕金森综合征（APS）中的应用。研究方法：25例APS患者，9例进行性核上性麻痹（PSP）和16例多系统萎缩（MSA），以及25例年龄匹配的IPD患者根据标准化方案进行了BPS前瞻性研究。结果如下：25例IPD患者中有24例（96%）表现出黑质（SN）的强回声，但23例APS患者中只有2例（9%）表现出强回声（Mann-Whitney U检验，p < 0.001）。在这2例APS患者中，SN高回声仅为中度，而其余21例APS患者SN回声正常。SN高回声检测IPD的特异性为96%，敏感性为91%。如果SN强回声明显，则可以排除APS，因为IPD的阳性预测值为100%。22例APS患者中有17例（77%）发现豆状核强回声，但22例IPD患者中仅5例（23%）发现豆状核强回声（Mann-Whitney U检验，p < 0.001）。尾状核和丘脑的回声以及第三脑室和侧脑室前角的宽度不能区分IPD和APS。2例PSP患者由于骨窗不足而无法评估。结论：BPS是一种新的、无创的鉴别IPD和APS的方法。因此，BPS可能成为帕金森病的标准检查。
Objective: To study the use of brain parenchyma sonography (BPS) in discriminating between patients with idiopathic PD (IPD) and atypical parkinsonian syndromes (APS). Methods: Twenty-five patients with APS, 9 with progressive supranuclear palsy (PSP) and 16 with multiple-system atrophy (MSA), and 25 age-matched patients with IPD were prospectively studied with BPS according to a standardized protocol. Results: Twenty-four of the 25 (96%) IPD patients exhibited hyperechogenicity of the substantia nigra (SN) but only 2 of 23 (9%) APS patients (Mann-Whitney U test, p < 0.001). In those two APS patients, SN hyperechogenicity was moderate only, whereas the remaining 21 APS patients had normal SN echogenicity. The specificity of SN hyperechogenicity in detection of clinically diagnosed IPD patients was 96%, and the sensitivity was 91%. If SN hyperechogenicity was marked, APS could be excluded because of a positive predictive value of 100% for IPD. Nucleus lentiformis hyperechogenicity was found in 17 of 22 (77%) APS patients but in only 5 of 22 (23%) IPD patients (Mann-Whitney U test, p < 0.001). Nucleus caudatus and thalamus echogenicity and widths of the third ventricle and of the frontal horns of the lateral ventricles did not discriminate between IPD and APS. Two patients with PSP could not be assessed because of an insufficient bone window. Conclusions: BPS is a novel and noninvasive method to differentiate highly specifically between IPD and APS. Therefore, BPS might become a standard investigation in parkinsonian disorders.