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- Title
Does normal substantia nigra echogenicity make a difference in Parkinson’s disease diagnosis? A real clinical practice follow-up study.
- Authors
Alonso-Canovas, Araceli; Lopez-Sendon Moreno, Jose Luis; Buisan, Javier; Sainz de la Maza, Susana; Costa-Frossard, Lucienne; Garcia-Ribas, Guillermo; de Felipe-Mimbrera, Alicia; Matute-Lozano, Maria Consuelo; Zarza Sanz, Beatriz; Toledano Delgado, Rafael; Corral, Iñigo; Masjuan, Jaime; Martinez-Castrillo, Juan Carlos
- Abstract
Objectives: Substantia nigra hyperechogenicity (SN+) detected by transcranial ultrasound (TUS) is useful for Parkinson’s disease (PD) diagnosis. Approximately 15% false negative results of unknown significance are reported. However, most TUS studies are transversal, and diagnosis of PD may change during follow-up.Methods: Analysis of our prospective registry of TUS in clinical practice, selecting patients with sufficient bone window, to whom TUS was performed because of suspected PD, and a minimum of 3-year follow-up. Subjects were classified regarding SN echogenicity (SN+/SN−).Results: 172 patients (122 SN+, 50 SN−), mean age 71 years (25-90), were included. At the end of follow-up, PD diagnosis was retained by 91% SN+ vs. 54% SN− subjects (p < 0.0001), while final diagnosis of atypical parkinsonism (3%SN+ vs. 16%SN−, p:0.0059) was more frequent in SN−. Dopaminergic therapy response was associated with SN+ (88% SN+ vs. 50% SN−, p < 0.0001), as were abnormal DaTSCANs (90%SN+ vs. 56%SN−, p 0.0027). SN echogenicity had 80% sensitivity and 68% specificity for PD diagnosis, while SPECT had 91% and 73%, respectively. SN+ was the only baseline predictor of keeping PD diagnosis at the end of follow-up, with an odds ratio of 12 (95% CI 3-42) (p < 0.001).Conclusions: In our sample of patients with suspected PD, SN hyperechogenicity predicted PD diagnosis in the long term with a high odds ratio. Conversely, a baseline normal SN echogenicity was associated with a poorer response to PD therapy and change to a different diagnosis from PD. Normal SN appears to be a caveat for clinicians to check for atypical parkinsonism features during follow-up.
- Subjects
SUBSTANTIA nigra; ULTRASONIC imaging; PARKINSON'S disease; DIAGNOSIS; PATIENTS
- Publication
Journal of Neurology, 2018, Vol 265, Issue 10, p2363
- ISSN
0340-5354
- Publication type
Article
- DOI
10.1007/s00415-018-9006-5