The Analysis Of Transcranial Sonography Imaging Characteristics In Parkinson’s Disease

Part I The analysis of transcranial sonography imaging characteristics in Parkinson’s disease and essential tremorObjective To determine the validity of transcranial sonography(TCS) in the differential diagnosis of Parkinson’s disease(PD) and essential tremor(ET).Methods TCS was performed in 110 patients with PD, 30 patients with ET and 110 normal controls in a blind manner. The echo signal intensity of the substantia nigra(SN) was classified into grade Ⅰ-Ⅴ for semi-quantitative analysis. When the echo intensity was grade Ⅲ or more, it was deemed as abnormal, the area of the SN hyperechogenicity would be measured and its ratio to the area of the whole midbrain(S/M) would be calculated. Then the high echogenicity of lenticular nucleus and the width of the third ventricle were measured.Results(1) Semi-quantitative analysis: the ratio of the persons with the SN was grade Ⅲ or more was greater(85.45%, 100/110) in PD group than in ET group(13.33%, 4/30, x2 = 58.38, P < 0.001) and in normal controls(10.00%, 11/110, x2 = 125.51, P < 0.001). However, there was no difference between ET and controls.(2) Quantitative analysis: the median and quartile range of the area of SN hyperechogenicity and S/M were greater in PD group [0.54(0.58), 0.11(0.90)] than in ET group [0.00(0.04),0.00(0.015)], H = 42.56, 42.02 and in normal controls [0.00(0.00), 0.00(0.00)], H = 121.93,121.46, both P < 0. 01, respectively, there was no difference between ET and controls.(3) Using the area of hyperechogenicity ≥ 0.20 cm2 or S/M ≥ 7% as a cut off for predicting PD, the accuracy were 80%(88/110)、85.45%(94/110), respectively, no significant difference was found between them(P > 0. 05).(4) There were no differences in the ratio of abnormal lenticular nucleus and the width of the third ventricle in three groups, P > 0. 05, respectively.Conclusions TCS might find the specific hyperechogenicity of SN in PD patients, providing useful information to distinguish PD from ET.Part Ⅱ The analysis of transcranial sonography imaging characteristics in Parkinson’s disease with depressionObjective: Transcranial sonography(TCS) can be used to detective the change of mesencephalic brainstem raphe(BR). The purpose of our study was to assess the TCS imaging characteristics of BR in depression patients with or without Parkinson’s disease(PD) and the correlation between BR echogenicity and depression severity.Methods: TCS was performed in patients with PD, depression with PD, depression only and controls. Using the red nucleus as an internal standard, the BR was rated semi-quantitatively from grades 1 to 4 with grades 1-3 determined as abnormal. The depression individuals with or without PD were classified into mild depression, moderate depression and severe depression on Hamilton Depression Rating Scale(HAMD-17) and on Beck,s Depression Inventory(BDI-21). The abnormal substantia nigra, the abnormal lenticular nucleus and the width of the third ventricle were measured too.Results:(1) The rate of abnormal BR(≤ grade 3) was significantly higher in patients with both depression and PD(85%, 34/40) or patients with depression only(87.5%, 35/40), which were higher than the rate in patients with PD(10%, 4/40) and in control(5%, 2/40), P < 0.05, respectively.(2) TCS of the raphe in most patients with mild depression scored grade 3(15/28 in depression, 18/28 in depression with PD) while those with moderate depression scored grade 2-3(6/6 in depression, 6/6 in depression with PD), and most with severe depression scored grade 1(6/6 in depression, 5/6 in depression with PD).(3) There was a significant correlation between the BR echogenicity score and depression severity in depression patients with or without PD(P < 0.001).(4) There were no differences in the ratio of abnormal lenticular nucleus and the width of the third ventricle in four groups, P > 0.05, respectively.(5) The most ratio of abnormal substantia nigra existed in the depression with PD group(32/40) and PD group(30/40), which were more higher than the depression(4/40) and controls group(4/40), P = 0.00.Conclusions: TCS provided a good tool for assessing depression. There was a significant correlation between BR echogenicity and depression severity.