OBJECTIVES: Substantia nigra hyperechogenicity (SN+) detected by transcranial ultrasound (TUS) is useful for Parkinson's disease (PD) diagnosis. Approximately 15% false negative results of unknown significance are reported. However, most TUS studies are transversal, and diagnosis of PD may change during follow-up. METHODS: Analysis of our prospective registry of TUS in clinical practice, selecting patients with sufficient bone window, to whom TUS was performed because of suspected PD, and a minimum of 3-year follow-up. Subjects were classified regarding SN echogenicity (SN+/SN-). RESULTS: 172 patients (122 SN+, 50 SN-), mean age 71 years (25-90), were included. At the end of follow-up, PD diagnosis was retained by 91% SN+ vs. 54% SN- subjects (p < 0.0001), while final diagnosis of atypical parkinsonism (3%SN+ vs. 16%SN-, p:0.0059) was more frequent in SN-. Dopaminergic therapy response was associated with SN+ (88% SN+ vs. 50% SN-, p < 0.0001), as were abnormal DaTSCANs (90%SN+ vs. 56%SN-, p 0.0027). SN echogenicity had 80% sensitivity and 68% specificity for PD diagnosis, while SPECT had 91% and 73%, respectively. SN+ was the only baseline predictor of keeping PD diagnosis at the end of follow-up, with an odds ratio of 12 (95% CI 3-42) (p < 0.001). CONCLUSIONS: In our sample of patients with suspected PD, SN hyperechogenicity predicted PD diagnosis in the long term with a high odds ratio. Conversely, a baseline normal SN echogenicity was associated with a poorer response to PD therapy and change to a different diagnosis from PD. Normal SN appears to be a caveat for clinicians to check for atypical parkinsonism features during follow-up.
OBJECTIVES: Substantia nigra hyperechogenicity (SN+) detected by transcranial ultrasound (TUS) is useful for Parkinson's disease (PD) diagnosis. Approximately 15% false negative results of unknown significance are reported. However, most TUS studies are transversal, and diagnosis of PD may change during follow-up. METHODS: Analysis of our prospective registry of TUS in clinical practice, selecting patients with sufficient bone window, to whom TUS was performed because of suspected PD, and a minimum of 3-year follow-up. Subjects were classified regarding SN echogenicity (SN+/SN-). RESULTS: 172 patients (122 SN+, 50 SN-), mean age 71 years (25-90), were included. At the end of follow-up, PD diagnosis was retained by 91% SN+ vs. 54% SN- subjects (p < 0.0001), while final diagnosis of atypical parkinsonism (3%SN+ vs. 16%SN-, p:0.0059) was more frequent in SN-. Dopaminergic therapy response was associated with SN+ (88% SN+ vs. 50% SN-, p < 0.0001), as were abnormal DaTSCANs (90%SN+ vs. 56%SN-, p 0.0027). SN echogenicity had 80% sensitivity and 68% specificity for PD diagnosis, while SPECT had 91% and 73%, respectively. SN+ was the only baseline predictor of keeping PD diagnosis at the end of follow-up, with an odds ratio of 12 (95% CI 3-42) (p < 0.001). CONCLUSIONS: In our sample of patients with suspected PD, SN hyperechogenicity predicted PD diagnosis in the long term with a high odds ratio. Conversely, a baseline normal SN echogenicity was associated with a poorer response to PD therapy and change to a different diagnosis from PD. Normal SN appears to be a caveat for clinicians to check for atypical parkinsonism features during follow-up.
Authors: Philipp Mahlknecht; Heike Stockner; Michael Nocker; Stefan Kiechl; Johann Willeit; Christoph Scherfler; Martin Sojer; Arno Gasperi; Gregorio Rungger; Werner Poewe; Klaus Seppi Journal: Mov Disord Date: 2012-06-14 Impact factor: 10.338
Authors: A Berardelli; G K Wenning; A Antonini; D Berg; B R Bloem; V Bonifati; D Brooks; D J Burn; C Colosimo; A Fanciulli; J Ferreira; T Gasser; F Grandas; P Kanovsky; V Kostic; J Kulisevsky; W Oertel; W Poewe; J-P Reese; M Relja; E Ruzicka; A Schrag; K Seppi; P Taba; M Vidailhet Journal: Eur J Neurol Date: 2013-01 Impact factor: 6.089
Authors: Pierpaolo Turcano; Michelle M Mielke; Keith A Josephs; James H Bower; Joseph E Parisi; Bradley F Boeve; Rodolfo Savica Journal: Mov Disord Date: 2017-08-26 Impact factor: 10.338
Authors: Stefanie Lerche; Klaus Seppi; Stefanie Behnke; Inga Liepelt-Scarfone; Jana Godau; Philipp Mahlknecht; Alexandra Gaenslen; Kathrin Brockmann; Karin Srulijes; Heiko Huber; Isabel Wurster; Heike Stockner; Stefan Kiechl; Johann Willeit; Arno Gasperi; Klaus Fassbender; Werner Poewe; Daniela Berg Journal: J Neurol Date: 2013-11-05 Impact factor: 4.849
Authors: Alexandra Gaenslen; Barbara Unmuth; Jana Godau; Inga Liepelt; Adriana Di Santo; Katherine Johanna Schweitzer; Thomas Gasser; Hans-Jürgen Machulla; Matthias Reimold; Kenneth Marek; Daniela Berg Journal: Lancet Neurol Date: 2008-04-03 Impact factor: 44.182
Authors: Sven R Suwijn; Caroline Jm van Boheemen; Rob J de Haan; Gerrit Tissingh; Jan Booij; Rob Ma de Bie Journal: EJNMMI Res Date: 2015-03-17 Impact factor: 3.138
Authors: Angela E P Bouwmans; Annemarie M M Vlaar; Werner H Mess; Alfons Kessels; Wim E J Weber Journal: BMJ Open Date: 2013-04-02 Impact factor: 2.692