Download PDF
Klinische Neurophysiologie 2010; 41(4): 253-257
DOI: 10.1055/s-0030-1263201
Originalia

© Georg Thieme Verlag KG Stuttgart · New York

Sonografie der Substantia nigra – Technik und klinische Implikationen

Sonography of the Substantia Nigra – Technique and Clinical RelevanceS. Mehnert1 , I. Reuter1 , E. Stolz1 , M. Kaps1
  • 1Neurologische Klinik der Justus-Liebig-Universität Gießen
Further Information

Publication History

Publication Date:
07 December 2010 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die transkranielle Parenchymsonografie (TCS) stellt eine wertvolle ergänzende Methode bei der Diagnostik von Bewegungsstörungen dar. Über 90% der Patienten mit idiopathischem Parkinson-Syndrom (IPS) weisen sonografisch eine Vergrößerung der Fläche der Substantia nigra (SN) auf. Dahingegen findet man nur bei bis zu 10% der Gesunden eine veränderte Echogenität der SN. Die SN-Hyperechogenität entspricht einem Suszeptibilitätsmarker für die Parkinson-Erkrankung, sie ist jedoch kein Verlaufsparameter der striatonigralen Degeneration. Bei der Differenzierung des IPS von atypischen Parkinson-Syndromen oder essentiellem Tremor ist neben der Echogenität der SN die Beurteilung der Echogenität des Nucleus lentiformis, des Nucleus caudatus und der Ventrikelweite hilfreich. In diesem Artikel werden die Methodik der Parenchymsonografie, ihr Stellenwert im Vergleich zu anderen bildgebenden Verfahren und ihre Anwendung bei der Differenzialdiagnostik von Bewegungsstörungen erläutert.

Abstract

In movement disorders transcranial ultrasound (TCS) represents an important diagnostic method. In more than 90% of patients with idiopathic Parkinson's disease (IPD) an increase of the echogenicity of the substantia nigra (SN) is found. In contrast, in healthy individuals a change of the SN echogenic signal is shown in only up to 10%. Whereas SN hyperechogenicity seems to disclose a susceptibility for IPD, it is not a marker for the progression of the disease. In the differential diagnosis of IPD and atypical Parkinsonian syndromes or essential tremor, additional sonografic parameters such as echogenicity of the nucleus lentiformis, nucleus caudatus and width of ventricles are useful. This article elucidates the methodological approach, its value in comparison with other diagnostic methods and its implementation in the diagnostic work-up of movement disorders.

Schlüsselwörter

transkranielle Sonografie - Substantia nigra - Parkinson - Bewegungsstörungen

Key words

transcranial sonography - substantia nigra - Parkinson's disease - movement disorder

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 (1) 182-184
    CrossrefPubMedGoogle Scholar
  • 2 Berg D, Siefker C, Ruprecht-Dörfler P. et al . Relationship of substantia nigra echogenicity and motor function in elderly subjects.  Neurology. 2001;  56 (1) 13-17
    CrossrefPubMedGoogle Scholar
  • 3 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 (2) 191-196
    CrossrefPubMedGoogle Scholar
  • 4 Mehnert S, Reuter I, Schepp K. et al . Transcranial sonography for diagnosis of Parkinson's disease.  BMC Neurol. 2010;  10 9
    CrossrefPubMedGoogle Scholar
  • 5 Berg D, Godau J, Walter U. Transcranial sonography in movement disorders.  Lancet Neurol. 2008;  7 (11) 1044-1055
    CrossrefPubMedGoogle Scholar
  • 6 Walter U, Behnke S, Eyding J. et al . Transcranial brain parenchyma sonography in movement disorders: state of the art.  Ultrasound Med Biol. 2007;  33 (1) 15-25
    CrossrefPubMedGoogle Scholar
  • 7 Berg D, Becker G, Zeiler B. et al . Vulnerability of the nigrostriatal system as detected by transcranial ultrasound.  Neurology. 1999;  53 (5) 1026-1031
    CrossrefPubMedGoogle Scholar
  • 8 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 (6) 463-467
    CrossrefPubMedGoogle Scholar
  • 9 Prestel J, Schweitzer KJ, Hofer A. et al . Predictive value of transcranial sonography in the diagnosis of Parkinson's disease.  Mov Disord. 2006;  21 (10) 1763-1765
    CrossrefPubMedGoogle Scholar
  • 10 Vlaar AM, Bouwmans A, Mess WH. et al . Transcranial duplex in the differential diagnosis of parkinsonian syndromes: a systematic review.  J Neurol. 2009;  256 (4) 530-538
    CrossrefPubMedGoogle Scholar
  • 11 Puls I, Berg D, Mäurer M. et al . Transcranial sonography of the brain parenchyma: comparison of B-mode imaging and tissue harmonic imaging.  Ultrasound Med Biol. 2000;  26 (2) 189-194
    CrossrefPubMedGoogle Scholar
  • 12 Hughes AJ, Daniel SE, 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 (3) 181-184
    CrossrefPubMedGoogle Scholar
  • 13 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 (3) 383-385
    CrossrefPubMedGoogle Scholar
  • 14 Berg D, Roggendorf W, Schröder U. et al . Echogenicity of the substantia nigra: association with increased iron content and marker for susceptibility to nigrostriatal injury.  Arch Neurol. 2002;  59 (6) 999-1005
    CrossrefPubMedGoogle Scholar
  • 15 Hochstrasser H, Bauer P, Walter U. et al . Ceruloplasmin gene variations and substantia nigra hyperechogenicity in Parkinson disease.  Neurology. 2004;  63 (10) 1912-1917
    PubMedGoogle Scholar
  • 16 Walter U, Niehaus L, Probst T. et al . Brain parenchyma sonography discriminates Parkinson's disease and atypical parkinsonian syndromes.  Neurology. 2003;  60 (1) 74-77
    CrossrefPubMedGoogle Scholar
  • 17 Zecca L, Berg D, Arzberger T. et al . In vivo detection of iron and neuromelanin by transcranial sonography: a new approach for early detection of substantia nigra damage.  Mov Disord. 2005;  20 (10) 1278-1285
    CrossrefPubMedGoogle Scholar
  • 18 Behnke S, Schroeder U, Dillmann U. et al . Hyperechogenicity of the substantia nigra in healthy controls is related to MRI changes and to neuronal loss as determined by F-Dopa PET.  Neuroimage. 2009;  47 (4) 1237-1243
    CrossrefPubMedGoogle Scholar
  • 19 Jenner P, Schapira AH, Marsden CD. New insights into the cause of Parkinson's disease.  Neurology. 1992;  42 (12) 2241-2250
    PubMedGoogle Scholar
  • 20 Youdim MB, Ben-Shachar D, Riederer P. The possible role of iron in the etiopathology of Parkinson's disease.  Mov Disord. 1993;  8 (1) 1-12
    CrossrefPubMedGoogle Scholar
  • 21 Hagenah J, König IR, Sperner J. et al . Life-long increase of substantia nigra hyperechogenicity in transcranial sonography.  Neuroimage. 2010;  51 (1) 28-32
    CrossrefPubMedGoogle Scholar
  • 22 Berg D, Becker G. Perspectives of B-mode transcranial ultrasound.  Neuroimage. 2002;  15 (3) 463-473
    CrossrefPubMedGoogle Scholar
  • 23 Walter U, Klein C, Hilker R. et al . Brain parenchyma sonography detects preclinical parkinsonism.  Mov Disord. 2004;  19 (12) 1445-1449
    CrossrefPubMedGoogle Scholar
  • 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 (10) 1196-1202
    CrossrefPubMedGoogle Scholar
  • 25 Spiegel J, Hellwig D, Möllers MO. et al . Transcranial sonography and [123I]FP-CIT SPECT disclose complementary aspects of Parkinson's disease.  Brain. 2006;  129 (5) 1188-1893
    CrossrefPubMedGoogle Scholar
  • 26 Vlaar AM, Bouwmans A, Mess WH. et al . Transcranial duplex in the differential diagnosis of parkinsonian syndromes: a systematic review.  J Neurol. 2009;  256 (4) 530-538
    CrossrefPubMedGoogle Scholar
  • 27 Ebentheuer J, Canelo M, Trautmann E. et al . Substantia nigra echogenicity in progressive supranuclear palsy.  Mov Disord. 2010;  25 (6) 765-768
    PubMedGoogle Scholar
  • 28 Niehaus L, Savyer N, Weber U. Brain parenchyma sonography in patients with essential tremor and Parkinson's disease.  Cerebrovasc Dis. 2004;  17 (S 04) 3
    PubMedGoogle Scholar
  • 29 Stockner H, Sojer M, K KS. et al . Midbrain sonography in patients with essential tremor.  Mov Disord. 2007;  22 (3) 414-417
    CrossrefPubMedGoogle Scholar
  • 30 Postert T, Lack B, Kuhn W. et al . Basal ganglia alterations and brain atrophy in Huntington's disease depicted by transcranial real time sonography.  J Neurol Neurosurg Psychiatry. 1999;  67 (4) 457-462
    CrossrefPubMedGoogle Scholar
  • 31 Becker G, Naumann M, Scheubeck M. et al . Comparison of transcranial sonography, magnetic resonance imaging, and single photon emission computed tomography findings in idiopathic spasmodic torticollis.  Mov Disord. 1997;  12 (1) 79-88
    CrossrefPubMedGoogle Scholar
  • 32 Naumann M, Becker G, Toyka KV. et al . Lenticular nucleus lesion in idiopathic dystonia detected by transcranial sonography.  Neurology. 1996;  47 (5) 1284-1290
    CrossrefPubMedGoogle Scholar
  • 33 Walter U, Krolikowski K, Tarnacka B. et al . Sonographic detection of basal ganglia lesions in asymptomatic and symptomatic Wilson disease.  Neurology. 2005;  64 (10) 1726-1732
    CrossrefPubMedGoogle Scholar
  • 34 Okawa M, Miwa H, Kajimoto Y. et al . Transcranial sonography of substantia nigra in Japanese patients with Parkinson's disease or atypical Parkinsonism: clinical potential and limitations.  Intern Med. 2007;  46 (18) 1527-1531
    CrossrefPubMedGoogle Scholar

Korrespondenzadresse

Dr. S. Mehnert

Klinik für Neurologie

Universitätsklinikum Gießen

und Marburg GmbH

Standort Gießen

Am Steg 14

35392 Gießen

Email: sabine.schmidt@neuro.med.uni-giessen.de

      >