The Significance Of Transcranial Ultrasonography In Diagnosis Of Parkinson's Disease And The Correlation Between The Strong Echo Of The Substantia Nigra And The Clinical Characteristics

Part 1 The significance of Transcranial Ultrasonography in the diagnosis of Parkinson's DiseaseObjective To investigate the clinical significance of transcranial ultrasound(Transcranial sonography;TCS)in the diagnosis of Parkinson's disease(Parkinson's disease,PD).Methods From March 2017 to March 2018,105 patients with primary Parkinson's disease admitted to our hospital were selected as the study group,and 90 patients with essential tremor admitted to our hospital during the same period were selected as the control group.The subjects in both groups were examined by transcranial ultrasound.The echo intensity and area of cerebral nigra(Substantia nigra,SN)on both sides of the subjects were measured and recorded.And the ratio of bilateral nigra hyperechoic area to midbrain area(Ratio of total area of hyperechoic substantia nigra to total area of mesencephalon,S/M)was calculated.The SN echo area,total midbrain area,S/M ratio,SN echo intensity and SN high echo positive rate between the two groups were compared by SPSS20.0 statistical software.The optimal critical point of SN area and S/M ratio in the diagnosis of PD was analyzed by using the receiver operating characteristic curve(Receiver operating characteristic curve,ROC),and the corresponding diagnostic sensitivity,specificity,negative predictive value and positive predictive value were calculated.Results 1 There was no statistical difference in the total area of the midbrain of the two groups(P>0.05),but the area of SN strong echo and the ratio of S/M in the study group were significantly higher than those in the control group(P<0.05).2 The degree of SN echo intensity in the study group was higher than that of the control group(P<0.05).The hyperecho positive rate of SN in the study group was 81.90%,which was significantly higher than that of the control group(16.67%,P<0.05).3 The results of ROC curve analysis showed that the AUC area of SN hyperecho area was 0.816,and the best diagnostic threshold was 0.21cm2.At this time,the sensitivity,specificity,negative predictive value and positive predictive value of PD were 80.6%,73.2%,78.5%and 74.9%respectively.The AUC area of S/M in the diagnosis of PD was 0.845,and the best diagnostic threshold was 7.28%.At this time,the sensitivity,specificity,negative predictive value,positive predictive value of S/M were 85.1%,78.5%,80.2%,76.7%respectively.Conclusion Transcranial ultrasound can detect abnormal strong echo of midbrain nigra in patients with Parkinson's disease,and the operation method is simple and noninvasive,and the sensitivity and specificity of diagnosis are medium,which can provide some help for clinical screening and diagnosis of PD.Part 2:Correlation analysis between strong echo of substantia nigra and clinical features of patients with Parkinson's diseaseObjective To investigate the correlation between substantia nigra strong echo and clinical features in patients with Parkinson's disease(PD)during transcranial ultrasound(TCS),so as to improve the reference for clinical diagnosis.Methods From March 2017 to March 2018,105 patients with primary Parkinson's disease admitted to our hospital were selected as the study subjects.All patients were examined by transcranial ultrasound.According to the strong echoes of the substantia nigra,they were divided into strong substantia nigra echo group(n=86)and normal substantia nigra echo group(n=19).The general data such as sex,age,age of onset,course of disease,education level and family history of PD were collected.And the motor symptoms of the patients were evaluated by the third part of unified Parkinson's disease scale(Unified Parkinson's Disease Rating Scale,UPDRS-III)and Hoehen-Yahr stages.In addition,the non-motor symptoms was evaluated by the non-motor symptom questionnaire(Non-motor symptom questionnaire,NMSQ),the Scales for Outcomes in Parkinson's Disease-Autonomic questionnaire(the Scales for Outcomes in Parkinson's Disease-Autonomic questionnaire,SCOPA-AUT),Montreal cognitive assessment scale(Montreal Cognitive Assessment scale,MoCA),Hamilton depression Scale(Hamilton Depression Scale,HAMD),Hamilton anxietyscale(Hamilton Anxiety Scale,HAMA),Pittsburgh sleeping quality Index(Pittsburgh Sleep quality Index,PSQI)and olfactory disorder.The correlation between substantia nigra strong echo and clinical characteristics of patients with PD was analyzed by univariate and multivariate Logstic regression analysis.Results 1 The male/female ratio,age and onset age in the strong substantia nigra echo group were significantly higher than those in the normal substantia nigra echo group(P<0.05).The proportion of patients with smoking history in substantia nigra strong echo group was significantly lower than that in normal substantia nigra echo group(P<0.05).There was no significant difference in course of disease,educational level and family history of PD between the two groups(P>0.05).2 There was no significant difference in UPDRS-? score between the two groups(P>0.05).However,the proportion of H-Y stage)? in the strong substantia nigra echo group was significantly higher than that in the normal substantia nigra echo group(P<0.05).3 There was no significant difference in NMSQ,MoCA score,HAMD score,HAMA score and PSQI score between the two groups(P>0.05).The SCOPA-AUT score of the patients with strong substantia nigra echo was higher than that of the patients with normal substantia nigra echo,and there was a significant difference between the two groups(P<0.05).The proportion of olfactory disturbance in the group with strong substantia nigra echo was higher than that in the group with normal substantia nigra echo,and there was a significant difference between the two groups(P<0.05).4 Logstic analysis showed that sex(male),age of onset and olfactory disorders were risk factors for hyperechoic substantia nigra.Conclusion The positive rate of substantia nigra strong echo in male PD patients was higher than that in female patients.The positive rate of substantia nigra strong echo in PD patients with with late onset age and olfactory disorder are higher than that in patients with earlier onset age and no olfactory disorder.The possibility of strong echo of nigra in PD patients with smoking history is relatively low.There is no significant correlation between motor symptoms and strong echoes in nigra.However,the strong echo of substantia nigra may indicate that the autonomic nerve function of the patients is more serious.