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Mesencephalic area measured by transcranial sonography in the differential diagnosis of parkinsonism

机译：经颅超声检查中脑面积在帕金森病的鉴别诊断中的作用

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Background: Transcranial B-mode sonography (TCS) has become an important tool in the differential diagnosis of parkinsonism given that current technology enables an adequate assessment of brain structures. In this study we aimed at evaluating the usefulness of midbrain area measured by TCS in the differential diagnosis between Parkinson's Disease (PD) and Progressive Supranuclear Palsy (PSP). Methods: Patients with a diagnosis of PD or PSP according to current clinical criteria were recruited. PSP patients were classified as Richardson's syndrome and PSP-parkinsonism. TCS was performed and the mesencephalic area and third ventricle width were measured offline by an examiner blinded to clinical diagnosis. Results: TCS was performed in 60 patients (75% PD, 25% PSP). Eight patients (13,3%) had inadequate acoustic window. Patients with PSP had a smaller mesencephalic area (3.58cm2 vs 5.28cm2, p0.001). A mesencephalic area ≥4.27cm2 discriminates PD from PSP with a positive predictive value 100%. Patients with PSP also had a higher third ventricle diameter (8.84mm vs 5.11mm, p0.001). Within the PSP group patients with Richardson's syndrome had a wider third ventricle than patients with PSP-Parkinsonism phenotype (9.57mm vs 7mm, p=0.01), but no differences were found in the mesencephalic area between both phenotypes. Conclusions: Measurement of the mesencephalic area and the third ventricle width by TCS is a non-invasive, easily accessible technique that is useful in the differential diagnosis between PD and PSP, at least in the late stages of the disease.
机译：背景：鉴于目前的技术能够对大脑结构进行充分的评估，经颅B型超声（TCS）已成为帕金森病鉴别诊断的重要工具。在这项研究中，我们旨在评估TCS测量的中脑区域在帕金森氏病（PD）和进行性核上性麻痹（PSP）之间的鉴别诊断中的有用性。方法：招募根据当前临床标准诊断为PD或PSP的患者。 PSP患者被分类为Richardson综合征和PSP-帕金森病。进行了TCS，并由对临床诊断无知的检查员离线测量了中脑区域和第三脑室宽度。结果：60例患者进行了TCS（75％PD，25％PSP）。八名患者（13.3％）的声音窗口不足。 PSP患者的中脑面积较小（3.58cm2对5.28cm2，p <0.001）。中脑区域≥4.27cm2可以将PD与PSP区别开，阳性预测值为100％。 PSP患者的第三脑室直径也更大（8.84mm对5.11mm，p <0.001）。在PSP组中，与PSP-帕金森氏症表型相比，具有Richardson综合征的患者的第三脑室更宽（9.57mm对7mm，p = 0.01），但在两种表型之间的中脑区域均未发现差异。结论：TCS测量中脑区域和第三脑室宽度是一种非侵入性，易于使用的技术，至少在疾病晚期，可用于PD和PSP的鉴别诊断。

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