The Clinical Application Value Of Transcranial Sonography In Diagnosis Of Multiple System Atrophy With Predominant Parkinsonism And Parkinson’s Disease

ObjectiveTo study the use of substantia nigra(SN)and the third ventricle(TV)in differenting Parkinson,s disease(PD)from multiple system atrophy with predominant parkinsonism(MSA-P)in different age groups.MethodsEighteen early onset MSA-P patients(EOMSA-P,onset age<50 years),twenty-eight early onset PD patients(EOPD,onset age<50 years),forty late onset MSA-P patients(LOMSA-P,onset age≥50 years),fifty late onset PD patients(LOPD,onset age≥50 years)were enrolled in this study.All the patients were follow up for at last 2 years to confirm the initial diagnoses.Analyzed the characteristics of transcranial sonography(TCS)images,parameters include the rate of high echogenic SN,the classification of high echogenic SN,the area of high echogenic SN,and the width of TV.The echo of SN was divided into five leves,Ⅰ was hypoechoic,Ⅱ was normal,When the brightness of the SN was ranked as Ⅲeven above and the area of high SN>0.20 cm2 was classif1ed as pathologic.ResultsThe rate of high echogenic SN has no meaningful heterogeneity between EOPD and EOMSA-P(53.6%vs 33.3%,P=0.13):there has no significant distribution differences of echoic grades between them(Z=-1.43,P=0.15);the area of high echogenic SN M(Q)was 0.30(0.37)cm2 in EOPD and 0.44(0.16)cm2 in EOMSA-P,there also has no significant differences between them(Z=-1.28,P=0.20).The rate of high echogenic SN in LOPD was significantly higher than that in LOMSA-P(78.0%vs20.0%,P<0.05),using the area of high echogenic SN>0.20cm2 as criterion,it could discriminat PD from MSA-P with sensitivity of 78.0%,specificity of 80.0%,and posi-tive predictive value of 83.0%;there has significant distribution differences of echoic grades between them(Z=-4.92,P<0.01);the area of high echogenic SN M(Q)was 0.47(0.23)cm2 in LOPD and 0.48(0.15)cm2 in LOMSA-P,but there has no significant differences of SN hyperechogenicity areas between them(Z=-0.81,P=0.42).The rate of high echogenic SN in LOPD was significantly higher than that in EOPD(78.0%vs 53.6%,P=0.02),but there has no significant distribution differences of echoic grades between them(Z=-1.77,P=0.08),there has no significant differences of SN hyperechogenicity areas between them(Z=-1.69,P=0.09).There was no correlation between SN hyperechogenicity and Hoehn-Yahr staging(r=0.03,P=0.78)in PD.The width(mean±SD)of the TV was 0.51±0.13cm in EOMSA-P,0.44±0.17cm in EOPD,no statistical significant difference between them;The width(mean±SD)of the TV was 0.71±0.19cm in LOMSA-P,0.60±0.22cm in LOPD,no statistical significant difference between them.There has significant differences between the width of EOPD and LOPD(t=-5.51,P<0.01)).The relationship between the width of TV and age was positive in PD group(r=0.46,P<0.01)and in MSA-P group(r=0.54,P<0.01).ConclusionsThe rate of high echogenic SN and SN echoic grade could hlep to differential diagnosis of PD and MSA-P when disease onset at 50 years or older,using the area of high echogenic SN>0.2cm2 as criterion,it could discriminat PD from MSA-P with sensitivity of 78.0%,specificity of 80.0%,and positive predictive value of 83.0%.but when disease onset younger than 50 years,it could not.