The predictive power of transcranial sonography in movement disorders: a longitudinal cohort study

Abstract

Transcranial sonography (TCS) is a noninvasive, easily performed, and commonly available neuroimaging technique useful for the study of brain parenchyma in movement disorders. This tool has been increasingly used in the diagnosis of Parkinson's disease and atypical parkinsonism. The aim of the study was to evaluate the applicability of this technique as supportive tool in the early diagnosis of movement disorders. We performed TCS on 315 individuals which were diagnosed as healthy controls or affected by idiopathic Parkinson's disease, monogenetic subtypes of Parkinson's disease, atypical parkinsonism, and Dementia with Lewy bodies. Five TCS diagnostic patterns were defined on the basis of substantia nigra's and lenticular nuclei's echogenicity. TCS evaluations were performed by two blinded neuro-sonographers. Clinical diagnosis on all individuals was performed at baseline and at 4-year follow-up. The concordance rate between TCS patterns and clinical diagnosis and the specificity of TCS pattern to discriminate each group of individuals were compared at baseline and at follow-up. The concordance rate between TCS patterns and clinical diagnosis of all individuals was 84% at baseline and increased at follow-up (91%) significantly (p = 0.01). The specificity of TCS pattern in the comparison between patients diagnosed as affected by idiopathic Parkinson's disease and atypical parkinsonism showed a significant increase at follow-up (p = 0.03). Our study strongly confirms the role of TCS as a noninvasive and cost-effective tool in early diagnosis of movement disorders.

Increased substantia nigra echogenicity correlated with visual hallucinations in Parkinson’s disease: a Chinese population-based study

“…As a noninvasive technique, transcranial sonography (TCS) is potentially useful for the diagnosis of PD by showing the structural changes in substantia nigra (SN). Even though previous studies have proved that the specificity was 88.2-85% and the sensitivity was 84-94.9% in diagnostic accuracy of TCS in PD patients [3,4], and the concordance rate between TCS patterns and PD diagnosis increased from 87 to 95% in a 4year follow-up [5]. Still, the data based on Chinese population need to be supplemented.…”

Lentiform Nucleus Hyperechogenicity in Parkinsonian Syndromes: A Systematic Review and Meta-Analysis with Consideration of Molecular Pathology

“…After assessing the abstracts, 135 articles were excluded. The remaining 15 [7,12,[15][16][17][18][19][20][21][22][23][24][25][26][27] articles were included in our meta-analysis. These 15 articles provided the data of overall 1330 patients with a sufficient bone window subdivided into 1091 PD and 239 aPS (MSA-P and PSP) patients.…”

“…A hyperechogenic lentiform nucleus frequently occurs in MSA-P and PSP, while it is an uncommon feature in PD. Additionally, the prevalence of LN hyperechogenicity in the healthy population is assumed to be low (7.9% for marked LN hyperechogenicity), but studies specifically targeting this question are lacking [19,28]. Until today, the distinction of PD from MSA-P and PSP is not always easy, especially in early disease.…”

Comparison between a handheld ultrasound device and a traditional ultrasound for performing transcranial sonography in patients with Parkinson's disease

“…Transcranial sonography (TCS) is a neuroimaging technique used to obtain and evaluate images of the cerebral parenchyma in movement disorders through B‐mode and assess the blood flow velocities of the intracranial vessels through Doppler mode (Brisson et al., 2021; Monaco et al., 2018). This is an ultrasonographic technique used to detect abnormalities in the echogenicity of substantia nigra (SN), thalamus, lenticular nuclei, red nuclei, the continuation of the median raphe nucleus, and ventricular diameters and assesses vascular reactivity (Brisson et al., 2021; Monaco et al., 2018; Walter et al., 2008). The main limitation of TCS is the lack of bone window, which could vary between 5% and 44% of the population, according to Brisson, Santos et al (2021), depending on various factors, including, sex, age, and ethnicity.…”