The specificity and sensitivity of transcranial ultrasound in the differential diagnosis of Parkinson's disease: a prospective blinded study
The specificity and sensitivity of transcranial ultrasound in the differential diagnosis of Parkinson's disease: a prospective blinded study
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DOI：
10.1016/s1474-4422(08)70067-x
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发表时间：
2008-05-01
期刊：
影响因子：
48
通讯作者：
Berg, Daniela
中科院分区：
文献类型：
--
作者：
Gaenslen, Alexandra;Unmuth, Barbara;Berg, Daniela
背景特发性帕金森病(IPD)的特点是经颅超声(TCS)发现黑质(SN)回声增强。初步的回顾性研究结果表明，这一超声征象是IPD的特异性征象，有助于将其与非典型帕金森综合征(APS)相鉴别；然而，这些早期研究是在疾病分期较晚且已知临床诊断的患者中进行的。我们的目的是确定TCS在帕金森综合征早期的诊断价值，因为临床症状往往不能做出明确的诊断。方法在这项前瞻性的盲法研究中，60名首次出现临床症状但仍不清楚的帕金森综合征患者进行了TCS检查。调查人员对临床调查结果、超声检查结果和调查时的诊断都是盲目的。每3个月随访1次，对患者的临床症状进行评估和再评估。对不能确定临床诊断的患者进行了拉氯普利PET或多巴胺转运体单光子发射计算机断层扫描(SPECT)，或两者兼而有之。结果在38名患者中，临床诊断不能建立在基线水平。在12个月时，39名患者被临床归类为IPD。与终点诊断相比，基线时TCS的敏感性为90.7%，特异性为82.4%，对IPD的阳性预测值为92.9%，分类准确率为88.3%，是一种易于实施、无创、廉价的技术，有助于帕金森综合征的早期鉴别诊断。在临床上常规使用TCS可以使疾病特异性治疗更早开始。
Background Increased echogenicity of the substantia nigra (SN), as determined by transcranial sonography (TCS), is characteristic of idiopathic Parkinson's disease (iPD). The results of initial retrospective studies indicate that this ultrasound sign is specific for iPD and can help to differentiate it from atypical parkinsonian syndromes (aPS); however, these early studies were done in patients with later disease stages and known clinical diagnosis. We aimed to determine the diagnostic value of TCS in the early stages of parkinsonian syndromes, when the clinical symptoms often do not enable a definite diagnosis to be made.Methods 60 patients who presented with the first, but still unclear, clinical symptoms of parkinsonism had TCS in this prospective blinded study. Investigators were blinded to the results of the clinical investigations, the ultrasound findings, and the diagnosis at time of investigation. The patients were followed-up every 3 months for 1 year to assess and re-evaluate the clinical symptoms. The patients in whom a clinical diagnosis could not be made with certainty were investigated with raclopride PET or dopamine transporter single-photon emission computed tomography (SPECT), or both.Findings A clinical diagnosis of parkinsonism could not be established at baseline in 38 patients. At 12 months, 39 patients were clinically categorised as having iPD. Compared with endpoint diagnosis, the sensitivity of TCS at baseline was 90.7% and the specificity was 82.4%; the positive predictive value of TCS for iPD was 92.9% and the classification accuracy was 88.3%.Interpretation TCS is an easy to implement, non-invasive, and inexpensive technique that could help in the early differential diagnosis of parkinsonian syndromes. The routine use of TCS in the clinic could enable disease-specific therapy to be started earlier.Funding Michael J Fox Foundation for Parkinson's Research.