Fortschr Neurol Psychiatr 2010; 78: S25-S30
DOI: 10.1055/s-0029-1245167
Workshop

© Georg Thieme Verlag KG Stuttgart · New York

Stellenwert der Hirnparenchym-Sonografie in der Differenzial- und Frühdiagnose des Parkinson-Syndroms

Transcraniel Ultrasound in the Differential Diagnosis of Parkinson’s DiseaseD. Woitalla1 , H. Braak2 , K. Del. Tredici2 , W. Fogel3 , J. Hagenah4 , W. Oertel5 , D. Berg6
  • 1Neurologische Universitätsklinik der Ruhr-Universität Bochum im St. Josef Hospital (Direktor: Prof. Dr. R. Gold)
  • 2Klinische Neuroanatomie, Universitätsklinikum Ulm (Direktor: Prof. Dr. A. C. Ludolph)
  • 3Deutsche Klinik für Diagnostik, Wiesbaden (Direktor: Prof. Dr. W. Jost)
  • 4Medizinische Universität zu Lübeck, Klinik für Neurologie (Direktor: Prof. Dr. D. Kömpf)
  • 5Klinik für Neurologie und Poliklinik der Philipps-Universität Marburg (Direktor: Prof. Dr. W. Oertel)
  • 6Abteilung Neurodegeneration und Hertie Institut für klinische Hirnforschung, Universitätsklinikum Tübingen (Direktor: Prof. Dr. T. Gasser)
Further Information

Publication History

Publication Date:
01 March 2010 (online)

Zusammenfassung

Die transkranielle sonografische Untersuchung des Hirnparenchyms stellt einen wichtigen Baustein in der Diagnose und Differenzialdiagnose des Parkinson-Syndroms dar. Bei bis zu 90 % der Parkinson-Patienten ist eine Hyperechogenität der Substantia nigra nachweisbar. Insbesondere in der Frühdiagnose, d. h. bei noch wenig ausgeprägtem klinischen Befund, und in der Differenzialdiagnose zur Multisystematrophie vom Parkinson-Typ (MSA-P) und zur progressiven supranukleären Paralyse (PSP) kann sie wertvolle ergänzende Informationen liefern. Aufgrund der Prävalenz von ca. 10 % in der Normalbevölkerung ist der Nachweis einer Hyperechogenität jedoch nur im Kontext der klinischen Untersuchung anzuwenden. Unterschiedliche Studien weisen darauf hin, dass bei einzelnen Gesunden mit diesem Ultraschallmerkmal eine Vulnerabilität des nigrostriatalen Systems vorliegen kann. Die genaue Bedeutung der Hyperechogenität bei gesunden Personen ist noch Gegenstand der Forschung.

Abstract

Imaging of the brain structure with transcraniel ultrasound has become an important tool for the diagnosis and differential diagnosis of Parkinson's Disease. In up to 90 % of parkinsonian patients abnormal echogenity of the substantia nigra could be demonstrated. Particularly in the early diagnosis in subjects with only very mild extrapyramidal features and in the differential diagnosis to other neurodegenerative disorders with parkinsonian features, such as the parkinsonian variant of multisystematrophy (MSA-P) and progressive supranuclear paralysis (PSP) ultrasound has a high diagnostic yield. Because of a prevalence of about 10 % in the normal population, the evidence of an abnormal echogenity of the substantia nigra has to be interpreted carefully in the context of a clinical examination. Although there are a number of studies indicating that in some of these subjects a vulnerability of the nigrostriatal system can be found, the meaning of an abnormal echogenicity of the substantia nigra in the healthy population needs to be further elucidated in already ongoing research projects.

Literatur

  • 1 Becker G, Seufert J, Bogdahn U. et al . Degeneration of substantia nigra in chronic Parkinson’s disease visualized by transcranial color-coded real-time sonography.  Neurology. 1995;  45 182-184
  • 2 Kolevski G, Petrov I, Petrova V. Transcranial sonography in the evaluation of Parkinson disease.  J Ultrasound Med. 2007;  26 509-512
  • 3 Ressner P, Skoloudik D, Hlustik P. et al . Hyperechogenicity of the substantia nigra in Parkinson’s disease.  J Neuroimaging. 2007;  17 164-167
  • 4 Berg D. Disturbance of iron metabolism as a contributing factor to SN hyperechogenicity in Parkinson’s disease: implications for idiopathic and monogenetic forms.  Neurochem Res. 2007;  32 1646-1654
  • 5 Walter U, Kanowski M, Kaufmann J. et al . Contemporary ultrasound systems allow high-resolution transcranial imaging of small echogenic deep intracranial structures similarly as MRI: a phantom study.  Neuroimage. 2008;  40 551-558
  • 6 Puls I, Berg D, Maurer M. et al . Transcranial sonography of the brain parenchyma: comparison of B-mode imaging and tissue harmonic imaging.  Ultrasound Med Biol. 2000;  26 189-194
  • 7 Kern R, Perren F, Kreisel S. et al . Multiplanar transcranial ultrasound imaging: standards, landmarks and correlation with magnetic resonance imaging.  Ultrasound Med Biol. 2005;  31 311-315
  • 8 Walter U, Behnke S, Eyding J. et al . Transcranial brain parenchyma sonography in movement disorders: state of the art.  Ultrasound Med Biol. 2007;  33 15-25
  • 9 Berg D, Godau J, Walter U. Transcranial sonography in movement disorders.  Lancet Neurol. 2008;  7 1044-1055
  • 10 Berg D, Becker G, Zeiler B. et al . Vulnerability of the nigrostriatal system as detected by transcranial ultrasound.  Neurology. 1999;  53 1026-1031
  • 11 Berg D, Siefker C, Ruprecht-Dorfler P. et al . Relationship of substantia nigra echogenicity and motor function in elderly subjects.  Neurology. 2001;  56 13-17
  • 12 Walter U, Wittstock M, Benecke R. et al . Substantia nigra echogenicity is normal in non-extrapyramidal cerebral disorders but increased in Parkinson’s disease.  J Neural Transm. 2002;  109 191-196
  • 13 Huang Y W, Jeng J S, Tsai C F. et al . Transcranial imaging of substantia nigra hyperechogenicity in a Taiwanese cohort of Parkinson’s disease.  Mov Disord. 2007;  22 550-555
  • 14 Kim J Y, Kim S T, Jeon S H. et al . Midbrain transcranial sonography in Korean patients with Parkinson’s disease.  Mov Disord. 2007;  22 1922-1926
  • 15 Berg D, Siefker C, Becker G. Echogenicity of the substantia nigra in Parkinson’s disease and its relation to clinical findings.  J Neurol. 2001;  248 684-689
  • 16 Schweitzer K J, Hilker R, Walter U. et al . Substantia nigra hyperechogenicity as a marker of predisposition and slower progression in Parkinson’s disease.  Mov Disord. 2006;  21 94-98
  • 17 Prestel J, Schweitzer K J, Hofer A. et al . Predictive value of transcranial sonography in the diagnosis of Parkinson’s disease.  Mov Disord. 2006;  21 1763-1765
  • 18 Berg D, Jabs B, Merschdorf U. et al . Echogenicity of substantia nigra determined by transcranial ultrasound correlates with severity of parkinsonian symptoms induced by neuroleptic therapy.  Biol Psychiatry. 2001;  50 463-467
  • 19 Spiegel J, Hellwig D, Mollers M O. et al . Transcranial sonography and [123I] FP-CIT SPECT disclose complementary aspects of Parkinson’s disease.  Brain. 2006;  129 1188-1193
  • 20 Walter U, Dressler D, Wolters A. et al . Transcranial brain sonography findings in clinical subgroups of idiopathic Parkinson’s disease.  Mov Disord. 2007;  22 48-54
  • 21 Berg D, Merz B, Reiners K. et al . Five-year follow-up study of hyperechogenicity of the substantia nigra in Parkinson’s disease.  Mov Disord. 2005;  20 383-385
  • 22 Behnke S, Double K L, Duma S. et al . Substantia nigra echomorphology in the healthy very old: Correlation with motor slowing.  Neuroimage. 2007;  34 1054-1059
  • 23 Haehner A, Hummel T, Hummel C. et al . Olfactory loss may be a first sign of idiopathic Parkinson’s disease.  Mov Disord. 2007;  22 839-842
  • 24 Sommer U, Hummel T, Cormann K. et al . Detection of presymptomatic Parkinson’s disease: combining smell tests, transcranial sonography, and SPECT.  Mov Disord. 2004;  19 1196-1202
  • 25 Unger M M, Moller J C, Stiasny-Kolster K. et al . Assessment of idiopathic rapid-eye-movement sleep behavior disorder by transcranial sonography, olfactory function test, and FP-CIT-SPECT.  Mov Disord. 2008;  23 596-599
  • 26 Becker G, Becker T, Struck M. et al . Reduced echogenicity of brainstem raphe specific to unipolar depression: a transcranial color-coded real-time sonography study.  Biol Psychiatry. 1995;  38 180-184
  • 27 Okawa M, Miwa H, Kajimoto Y. et al . Transcranial sonography of the substantia nigra in Japanese patients with Parkinson’s disease or atypical parkinsonism: clinical potential and limitations.  Intern Med. 2007;  46 1527-1531
  • 28 Walter U, Niehaus L, Probst T. et al . Brain parenchyma sonography discriminates Parkinson’s disease and atypical parkinsonian syndromes.  Neurology. 2003;  60 74-77
  • 29 Walter U, Dressler D, Probst T. et al . Transcranial brain sonography findings in discriminating between parkinsonism and idiopathic Parkinson disease.  Arch Neurol. 2007;  64 1635-1640
  • 30 Behnke S, Berg D, Naumann M. et al . Differentiation of Parkinson’s disease and atypical parkinsonian syndromes by transcranial ultrasound.  J Neurol Neurosurg Psychiatry. 2005;  76 423-425
  • 31 Walter U, Dressler D, Wolters A. et al . Sonographic discrimination of corticobasal degeneration vs progressive supranuclear palsy.  Neurology. 2004;  63 504-509
  • 32 Walter U, Dressler D, Wolters A. et al . Sonographic discrimination of dementia with Lewy bodies and Parkinson’s disease with dementia.  J Neurol. 2006;  253 448-454
  • 33 Hughes A J, Daniel S E, Kilford L. et al . Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases.  J Neurol Neurosurg Psychiatry. 1992;  55 181-184

PD Dr. med. Dirk Woitalla

St. Josef Hospital, Neurologische Universitätsklinik

Gudrunstr. 56

44791 Bochum

Email: d.woitalla@elis-stiftung.de

    >