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Ultraschall Med 2014; 35(04): 322-331
DOI: 10.1055/s-0033-1356415
Review
© Georg Thieme Verlag KG Stuttgart · New York

Transcranial Sonography (TCS) of Brain Parenchyma in Movement Disorders: Quality Standards, Diagnostic Applications and Novel Technologies

Transkranielle Sonografie (TCS) des Hirnparenchyms bei Bewegungsstörungen: Qualitätsstandards, diagnostische Anwendungen und neue Technologien
U. Walter
1   Department of Neurology, University of Rostock
,
D. Školoudík
2   Department of Neurology, Palacký University Olomouc, Ostrava University and University Hospital Ostrava
› Author Affiliations
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Publication History

16 April 2013

22 November 2013

Publication Date:
24 April 2014 (online)

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Abstract

Transcranial B-mode sonography (TCS) of brain parenchyma is being increasingly used as a diagnostic tool in movement disorders. Compared to other neuroimaging modalities such as magnetic resonance imaging (MRI) and computed tomography, TCS can be performed today with portable machines and has the advantages of noninvasiveness and high resistance to movement artifacts. In distinct brain disorders TCS detects abnormalities that cannot be visualized or can only be visualized with significant effort with other imaging methods. In the field of movement disorders, TCS has been established mainly as a tool for the early and differential diagnosis of Parkinson’s disease. The postoperative position control of deep brain stimulation electrodes, especially in the subthalamic nucleus, can reliably and safely be performed with TCS. The present update review summarizes the current methodological standards and defines quality criteria of adequate TCS imaging and assessment of diagnostically relevant deep brain structures such as substantia nigra, brainstem raphe, basal ganglia and ventricles. Finally, an overview is given on recent technological advances including TCS-MRI fusion imaging and upcoming technologies of digitized image analysis aiming at a more investigator-independent assessment of deep brain structures on TCS.

Zusammenfassung

Die transkranielle B-Bild-Sonografie (TCS) tiefer Hirnstrukturen wird zunehmend als diagnostisches Instrument bei Bewegungsstörungen eingesetzt. Im Vergleich zu anderen Bildgebungsverfahren wie Magnetresonanztomografie (MRT) und Computertomografie liegen die Vorteile der TCS in der hohen Mobilität bis hin zum heute möglichen Einsatz tragbarer Geräte, der gesundheitlichen Unbedenklichkeit und der geringen Störbarkeit durch Patientenbewegungen. Bei bestimmten Hirnerkrankungen detektiert die TCS abnorme Befunde, die mit anderen Verfahren nicht oder nur mit hohem Aufwand darstellbar sind. Im Bereich der Bewegungsstörungen hat sich die TCS hauptsächlich als Instrument zur Früh- und Differenzialdiagnose des idiopathischen Parkinson-Syndroms etabliert. Die postoperative Positionskontrolle von Tiefenhirnstimulations-Sonden, insbesondere im Nucleus subthalamicus, kann zuverlässig und unschädlich mittels TCS durchgeführt werden. Die vorliegende aktuelle Übersicht fasst die gegenwärtigen methodischen Standards zusammen und definiert Qualitätskriterien für eine adäquate Bildgebung und Befundung diagnostisch relevanter tiefer Hirnstrukturen wie Substantia nigra, Hirnstamm-Raphe, Basalganglien und Hirnventrikel. Schließlich wird ein Überblick über aktuelle technologische Entwicklungen inklusive der TCS-MRT-Fusions-Bildgebung und aufkommender Technologien zur digitalen Bildanalyse gegeben, die das Ziel einer geringeren Untersucher-Abhängigkeit bei der Beurteilung tiefer Hirnstrukturen mittels TCS verfolgen.

Key words

basal ganglia - brain - ultrasound - movement disorders - TCS
 

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