The Clinical Application Of Transcranial Sonography In Patients With Parkinson’s Disease

Part Ⅰ The characters of substantia nigra on transcranialsonography in Parkinson’s disease patients with different clinicalfactorsObjective To explore the clinical value of substantia nigra(SN) in the diagnosis of Parkinson’s disease(PD) patients with different related factors.Methods Transcranial sonography(TCS) was performed in 136 PD and 100 healthy controls. The rates of hyperechogenicity of SN between the two groups were compared and further analyzed the relations between the laeger area of SN and related factors with PD patients.Results(1) The rate of hyperechogenicity of SN was higher in PD group(78.68%,107/136) than in controls(10.00, 10/100). Furthermore, the rate of hyperechogenicity of SN was more frequent in male both in PD group(88.64%, 78/88) and in controls(11.11%,8/72). When made the abnomal SN to predict PD, the sensitivity, specificity and accuracy were 78.68%, 90.00% and 83.47%, respectively.(2) The rate of SN hyperechogenicity was higher in late-onset PD(82.86%, 87/105)than in early-onset PD(64.52%, 20/31), significant difference was found between them(x2= 4.80, P = 0.02). Furthermore, the rate of hyperechogenicity of SN was higher in male PD patients with late-onset(91.18%, 62/68) than male PD patients with early-onset(75.00%,15/20), female PD patients with late-onset(67.57%, 25/37) and female PD patients with early-onset(45.45%, 5/11).(3) The rate of hyperechogenicity of SN was higher in PD with akinetic-rigid type(93.33, 56/60) than mixed type(78.57%, 22/28) and tremor dominant type(60.42%,29/48).(4) The mean area of the larger SN hyperechogenicity in male PD group was(0.45 ±0.16) cm2, and female PD group(0.41 ± 0.12) cm2; early-onset PD group(0.43 ± 0.16) cm2 and late onset PD group(0.45 ± 0.14) cm2; PD with akinetic-rigid type group(0.44 ± 0.11)cm2, tremor dominant type group(0.46 ± 0.16) cm2 and mixed type group(0.44 ± 0.20)cm2, there were no difference in the three groups, and also had no correlations with these factors(P > 0.05).Conclusions The rate of hyperechogenicity of SN is higher in PD than in control group, especially more frequent in PD patients with male, late-onset and akinetic-rigid type,which might afford evidence for the diagnosis of PD.Part Ⅱ Transcranial sonography in patients with Parkinson’sdisease and multiple system atrophyObjective To explore the application value of transcranial sonography(TCS) in the differential diagnosis between Parkinson’s disease(PD) and multiple system atrophy(MSA).Methods TCS was successfully performed in 45 PD, 29 MSA and 45 healthy controls. The echogenicity of the substantia nigra(SN) and lenticular nucleus(LN), the mesencephalic area and the width of the third ventricle among the three groups were analyzed.Results(1) Among the three groups, the hyperechogenicity of SN was marked in PD group(38/45, 84.44%) than in MSA group(4/29, 13.79%) and in controls(5/45,11.11%). However, the rate of hyperechogenicity of LN was highest in MSA group(23/29,79.31%) than in PD group(11/45, 24.44%) and in healthy controls(10/45, 22.22%).(2) The mean width of the third ventricle and the mesencephalic areas of the three groups were as follows: MSA group:(7.49 ± 3.09) mm and(4.31 ± 0.59) cm2, PD group:(5.94 ± 2.36) mm and(4.82 ± 0.84) cm2, healthy controls:(5.88 ± 2.43) mm and(4.79 ±0.79) cm2. There were significant differences among them(P < 0.05).(3) The mean area of the larger SN hyperechogenicity and the H-Y stage of PD patients were(0.46 ± 0.14) cm2 and(2.24 ± 0.91) stage, respectively. But there were no correlatoins between them(r = 0.05, P = 0.77), the same result was found in the relation between mesencephalic areas and age(r =-0.15, P = 0.11). But, the positive relationbetween the third ventricle and age in all subjects was found(r = 0.60, P < 0.05).Conclusion TCS can show the hyperechogenicity of SN in PD, the hyperechogenicity of LN with the wider third ventricle and the smaller mesencephalic area in MSA, which might be useful to distinguish MSA from PD.