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
- 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
- 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
- 4
Mehnert S, Reuter I, Schepp K. et al .
Transcranial sonography for diagnosis of Parkinson's disease.
BMC Neurol.
2010;
10
9
- 5
Berg D, Godau J, Walter U.
Transcranial sonography in movement disorders.
Lancet Neurol.
2008;
7
(11)
1044-1055
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 19
Jenner P, Schapira AH, Marsden CD.
New insights into the cause of Parkinson's disease.
Neurology.
1992;
42
(12)
2241-2250
- 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
- 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
- 22
Berg D, Becker G.
Perspectives of B-mode transcranial ultrasound.
Neuroimage.
2002;
15
(3)
463-473
- 23
Walter U, Klein C, Hilker R. et al .
Brain parenchyma sonography detects preclinical parkinsonism.
Mov Disord.
2004;
19
(12)
1445-1449
- 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
- 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
- 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
- 27
Ebentheuer J, Canelo M, Trautmann E. et al .
Substantia nigra echogenicity in progressive supranuclear palsy.
Mov Disord.
2010;
25
(6)
765-768
- 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
- 29
Stockner H, Sojer M, K KS. et al .
Midbrain sonography in patients with essential tremor.
Mov Disord.
2007;
22
(3)
414-417
- 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
- 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
- 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
- 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
- 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
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
