Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2010

Open Access 01-12-2010 | Research article

Transcranial sonography for diagnosis of Parkinson's disease

Authors: Sabine Mehnert, Iris Reuter, Karsten Schepp, Peter Maaser, Erwin Stolz, Manfred Kaps

Published in: BMC Neurology | Issue 1/2010

Login to get access

Abstract

Background

In idiopathic Parkinson's disease (IPD) transcranial sonography (TCS) represents an alternative diagnostic method to verify clinical diagnosis. Although the phenomenon of an increased echogenicity of the Substantia nigra (SN) is well known this method is still not widly used in the diagnostic workup. Until now reliability of this method is still a matter of debate, partly because data only existed from a few laboratories using the same ultrasound machine. Therefore our study was conducted to test the reliability of this method by using a different ultrasound device and examining a large population of control and IPD subjects by two examiners to calculate interobserver reliability.

Method

In this study echogenicity of SN was examined in 199 IPD patients and 201 control subjects. All individuals underwent a neurological assessment including Perdue pegboard test and Webster gait test. Using a Sonos 5500 ultrasound device area of SN was measured, echogenicity of raphe, red nuclei, thalamus, caudate and lenticular nuclei, width of third and lateral ventricle were documented.

Results

We found a highly characteristic enlargement of the SN echogenic signal in IPD. The cut-off value for the SN area was established using a ROC curve with a sensitivity of 95% corresponding to an area of SN of 0.2 cm2 and was found to be equivalent to the cut-off values of other studies using different ultrasound devices.

Conclusions

Our study shows that TCS is a reliable and highly sensitive tool for differentiation of IPD patients from individuals without CNS disorders.
Appendix
Available only for authorised users
Literature
1.
Becker G, Seufert J, Bogdahn U, Reichmann H, Reiners K: Degeneration of substantia nigra in chronic Parkinson's disease visualized by transcranial color-coded real-time sonography. Neurology. 1995, 45: 182-184.CrossRefPubMed
2.
Berg D, Becker G, Zeiler B, Tucha O, Hofmann E, Preier M, Benz P, Jost W, Reiners K, Lange KW: Vulnerability of the nigrostriatal system as detected by transcranial ultrasound. Neurology. 1999, 53: 1026-1031.CrossRefPubMed
3.
Berg D, Siefker C, Ruprecht-Dorfler P, Becker G: Relationship of substantia nigra echogenicity and motor function in elderly subjects. Neurology. 2001, 56: 13-17.CrossRefPubMed
4.
Berg D, Roggendorf W, Schroder U, et al: Echogenicity of the substantia nigra: association with increased iron content and marker for susceptibility to nigrostriatal injury. Arch Neurol. 2002, 56: 999-1005. 10.1001/archneur.59.6.999.CrossRef
5.
Jabs BE, Berg D, Merschdorf U, Bartsch AJ, Pfuhlmann B: Differences in substantia nigra echogenicity of nosological subtypes within the schizophrenic spectrum. A preliminary transcranial ultrasound study. Neuropsychobiology. 2001, 44 (4): 183-186. 10.1159/000054940.CrossRefPubMed
6.
Postert T, Lack B, Kuhn W, et al: Basal ganglia alterations and brain atrophy in Huntington's disease depicted by transcranial real time sonography. J Neurol Neurosurg Psychiatry. 1999, 67: 457-462. 10.1136/jnnp.67.4.457.CrossRefPubMedPubMedCentral
7.
Ruprecht-Dörfler P, Berg D, Tucha O, Benz P, Meier-Meitinger M, Alders GL, Lange KW, Becker G: Echogenicity of the substantia nigra in relatives of patients with sporadic Parkinson's disease. Neuroimage. 2003, 18 (2): 416-422. 10.1016/S1053-8119(02)00035-6.CrossRefPubMed
8.
Walter U, Wittstock M, Benecke R, Dressler D: Substantia nigra echogenicity is normal in non-extrapyramidal cerebral disorders but increased in Parkinson's disease. J Neural Transm. 2002, 109: 191-196. 10.1007/s007020200015.CrossRefPubMed
9.
Walter U, Niehaus L, Probst T, Benecke R, Meyer BU, Dressler D: Brain parenchyma sonography discriminates Parkinson's disease and atypical parkinsonian syndromes. Neurology. 2003, 60 (1): 74-77.CrossRefPubMed
10.
Okawa M, Miwa H, Kajimoto Y, Hama K, Morita S, Nakanishi I, Kondo T: Transcranial sonography of substantia nigra in Japanese patients with Parkinson's disease or atypical Parkinsonism: clinical potential and limitations. Intern Med. 2007, 46 (18): 1527-31. 10.2169/internalmedicine.46.0271.CrossRefPubMed
11.
Vlaar AM, de Nijs T, van Kroonenburgh MJ, Mess WH, Winogrodzka A, Tromp SC, Weber WE: The predictive value of transcranial duplex sonography for the clinical diagnosis in undiagnosed parkinsonian syndromes: comparison with SPECT scans. BMC Neurol. 2008, 8: 42-10.1186/1471-2377-8-42.CrossRefPubMedPubMedCentral
12.
Hagenah J M, König I R, Becker B, Hilker R, Kasten M, Hedrich K, Pramstaller P P, Klein C, Seidel G: Substantia nigra hyperechogenicity correlates with clinical status and number of Parkin mutated alleles. J Neurol. 2007, 254: 1407-1413. 10.1007/s00415-007-0567-y.CrossRefPubMed
13.
Hagenah J M, Becker B, Bruggemann N, Djarmati A, Lohmann K, Sprenger A, Klein C, Seidel G: Transcranial sonography findings in a large family with homozygous and heterozygous PINK1 mutations. J Neurol Neurosurg Psychiatry. 2008, 79: 1071-1074. 10.1136/jnnp.2007.142174.CrossRefPubMed
14.
Hughes AJ, Daniel SE, Kilford L, Lees AJ: Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992, 55 (3): 181-184. 10.1136/jnnp.55.3.181.CrossRefPubMedPubMedCentral
15.
Fahn S, Elton RL, Members of the UPDRS Development Committee: The Unified Parkinson's Disease Rating Scale. Recent developments in Parkinson's disease. Edited by: Fahn S, Marsden CD, Calne DB, Goldstein M. 1987, Florham Park, NJ: Macmillan Health Care Information, 2: 153-163. 293-304.
16.
Webster DD: Critical analysis of the disability in Parkinson's disease. Mod Treat. 1968, 5: 257-282.PubMed
17.
Vingerhoets FJ, Schulzer M, Calne DB, Snow BJ: Which clinical sign of Parkinson's disease best refelcts the nigrostriatal lesion?. Ann Neurol. 1997, 41 (1): 58-64. 10.1002/ana.410410111.CrossRefPubMed
18.
Maschke M, Gomez CM, Tuite PJ, et al: Dysfunction of the basal ganglia, but not the cerebellum, impairs kinaesthesia. Brain. 2003, 126: 2312-22. 10.1093/brain/awg230.CrossRefPubMed
19.
Hobson DE, Lang AE, Martin WR, et al: Excessive daytime sleepiness ans sudden onset sleep in Parkinson disease: a survey by the Canadian Movement Disorders Group. JAMA. 2002, 287: 455-63. 10.1001/jama.287.4.455.CrossRefPubMed
20.
Parkin SG, Gregory RP, Scott R, et al: Unilateral and bilateral palidotomy for idiopathic Parkinson's disease: a case series of 115 paients. Mov Disord. 2002, 17: 682-92. 10.1002/mds.10186.CrossRefPubMed
21.
Walter U, Behnke S, Eyding J, Niehaus L, Postert T, Seidel G, Berg D: Transcranial brain parenchyma sonography in movement disorders: state of the art. Ultrasound Med Biol. 2007, 33 (1): 15-25. 10.1016/j.ultrasmedbio.2006.07.021.CrossRefPubMed
22.
Prestel J, Schweitzer KJ, Hofer A, Gasser T, Berg D: Predictive value of transcranial sonography in the diagnosis of Parkinson's disease. Mov Dis. 2006, 21 (10): 1763-1765. 10.1002/mds.21054.CrossRef
Metadata
Title
Transcranial sonography for diagnosis of Parkinson's disease
Authors
Sabine Mehnert
Iris Reuter
Karsten Schepp
Peter Maaser
Erwin Stolz
Manfred Kaps
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2010
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-10-9

Other articles of this Issue 1/2010

BMC Neurology 1/2010 Go to the issue

Research article

Differential effects of pre and post-payment on neurologists' response rates to a postal survey

Case report

Cerebral toxoplasmosis in Acquired Immunodeficiency Syndrome (AIDS) patients also provides unifying pathophysiologic hypotheses for Holmes tremor

Research article

Saliva levels of Abeta1-42 as potential biomarker of Alzheimer's disease: a pilot study

Study protocol

Modified constraint-induced movement therapy or bimanual occupational therapy following injection of Botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: a randomised controlled trial methods paper

Study protocol

Design and baseline characteristics of the ParkFit study, a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patients

Research article

Prevalence and pattern of cognitive impairment in rural and urban populations from Northern Portugal