Digital Analysis Of Substantia Nigra Hyperechogenicity,And Sonographic Alterations Of Third Ventricular Width And Brain Raphe Nucleus In Parkinson's Disease

Part ?: Quantity detection of Substantia nigra hyperechogenicity based on digital image analysis for diagnosing Parkinson's diseaseObject: Increased echogenicity of the Substantia nigra(SN)has been widely recognized as marker of Parkinson's disease(PD).However,the diagnostic accuracy of transcranial sonography relies on the experience of doctor,and changes in substantia nigra echo cannot be quantified.We aimed to apply digital analysis to quantify hyperechogenicity of Substantia nigra,and explore its clinical value for diagnosis of PD.Method: The cross-sectional study which from November 2017 to October 2020 included 652 PD patients and 99 controls.Then,all subjects underwent transcranial sonography in Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology.Finally,we compare the diagnostic accuracy of Substantia nigra hyperechogenicity by using digital analysis with that in a manual measurement in PD.Furthermore,the Receiver operating characteristic curve(ROC)analysis was applied to explore diagnosis value in Parkinson's disease.Results: There are 482 subjects including 400 in the PD group and 82 in the healthy control group,from whose quantified results of Substantia nigra hyperechogenicity could be used for analysis.The ROC analysis showed that the authenticity Area Under Curve(AUC)of the quantified larger Substantia nigra hyperechoic region detection for diagnosing PD was0.858(95%CI:0.805-0.910),the sensitivity was 87.8%,and the specificity was 73.2%.What's more,among these PD patients,there is no correlation between larger Substantia nigra hyperechogenicity and age,age of onset,course of disease,non-motor symptoms,and motor symptoms(P>0.05).Conclusion: This is the first study applying digital analysis to quantify the changes in Substantia nigra hyperechogenicity.Then,the result shows that diagnostic accuracy for PD based on digital analysis is consistent with the level of experienced clinicians.This method may have broad application prospects in hospital in the future.Part ?: Third ventricular width by transcranial sonography are associated with cognitive impairment in Parkinson's diseaseObject : 25%-30% of PD patients suffer from cognitive impairment.However,information on neuroimaging method to predict cognitive impairment is limited.We aimed to explore whether third ventricular width could be as a biomarker in PD with cognitive impairment.Method:652 subjects with PD were recruited in Tongji hospital,174 of those completed transcranial sonography and extensive cognitive testing.Those subjects were divided into two groups(PD with/without cognitive impairment)according to the scores of MMSE and Mo CA respectively.Then,we performed ROC analysis and Cox model analysis in order to explore the diagnosis and predictive value of third ventricular width based on transcranial sonography in PD patients with cognitive impairment.Result: Third ventricular width is negatively correlated with the total scores of MMSE and Mo CA,especially the item of memory.ROC analysis shows that the cut-offs of third ventricular width for the prediction of PD patients with cognitive impairment is 4.75 mm,and the AUC is 0.742(95%CI:0.660-0.824),the sensitivity is 62.7%,and the specificity is 75.6%.Among PD patients without cognitive impairment,the adjusted hazard ratios for cognitive impairment of the group with dilated third ventricle(?4.75mm)was 7.975(95%CI:1.609-39.532)comparing to the non-dilated third ventricle group(<4.75mm),during 21.5(18.0,26.0)months follow-up.Conclusion: Third ventricular width based on transcranial sonography emerged as an independent predictor of long-term cognitive impairment in PD patients.Part ?: Relationship between sonographic alter of midbrain raphe nucleus and serum metal and non?motor symptoms in patients with Parkinson?s diseaseObjective: To explore the relationship between the changes of midbrain raphe nucleus echo and blood trace metals,non?motor symptoms in patients with Parkinson?s disease(PD).Methods: A total of 177 patients with PD were recruited from Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from November 2017 to December 2019,who completed a series of non?motor symptoms scales,transcranial sonography,and the measurement of serum metal.All subjects divided into two groups according to the continuity instituation of raphe nucleus echo.The difference of trace metals in peripheral blood and the scores of non?motor symptoms were analyzed.Results: The serum iron level of PD patients in the continuous echo of raphe nucleus group [15.33(11.30,18.93)?mol/L] is higher than that of the discontinuous group [12.52(4.15,16.00)?mol/L,P=0.022],so is the scores of Scale for Outcomes in PD for Autonomic Symptoms [34.00(28.00,39.00)vs 31.00(26.25,36.00),P=0.041].There is no significant difference in the level of serum copper,hemoglobin,ceruloplasmin,and the scores of MDSUPDRS,PDSS,PDQ39,HAMD and HAMA between the two groups(P>0.05).Conclusion: There are significant differences in serum iron levels and the scores of SCOPA?AUT between the two groups,but no difference in depression,sleep,and daily living ability.