经颅超声成像诊断帕金森病的临床应用价值

Diagnositic value of trascranial sonography in detection of Parkinson disease

目的探讨经颅超声成像(TCS)测量黑质(SN)高回声的面积与双侧黑质高回声总面积/中脑总面积(S/M)诊断帕金森病(PD)的临床价值。方法对92例PD患者(PD组)和98名健康人(健康对照组)进行TCS检查,分别测量中脑及SN高回声面积,计算S/M比值。比较PD组和健康对照组受检者中脑面积、SN高回声面积以及S/M的差异,采用受试者操作特性(ROC)曲线计算两种指标最佳临界点诊断PD的敏感度及特异度,同时计算联合应用2种指标诊断PD的敏感度和特异度。结果 PD组患者SN高回声面积、S/M分别为(0.34±0.27)cm2和(12.15±4.57)%,健康对照组受检者上述指标分别为(0.14±0.08)cm2和(6.37±3.30)%,2组比较差异均有统计学意义(t=82.68、100.83,P均<0.01)。ROC曲线示,SN高回声面积的最佳临界点为0.20 cm2,其敏感度及特异度分别为80.40%、74.50%;S/M的最佳临界点为7.52%,其敏感度及特异度分别为89.10%、63.30%;当2种指标联合应用时,其敏感度及特异度分别为80.40%、78.60%。结论 TCS快速、便捷、可重复性强,是PD的重要筛查工具。SN高回声面积≥0.20 cm2且S/M>7.52%联合应用是诊断PD的最佳指标。

Objective To evaluate the clinical value of trascranial sonography (TCS) in measuring hyperechogenic substantia nigra ( SN) area and area ratio of SN to midbrain ( S/M) for the diagnosis of Parkinson′s disease( PD).Methods A total of 109 PD patients ( PD group) and 115 normal controls (control group) underwent TCS.The area of midbrain and SN and the area ratio of S/M were measured and compared between PD group and control group .Statistical analysis of the two parameters in predicting PD was performed with receive operating characteristic ( ROC) curves.The sensitivity and specificity of each parameter and their combination were calculated .Results The hyperechogenic SN area and S/M were (0.34 ±0.27)cm 2 and (12.15 ±4.57)%in PD group,whereas (0.14 ±0.08)cm 2 and (6.37 ±3.30)%in control group respectively .The difference between the two groups was statistically significant (t=82.68, 100.83,both P<0.01).ROC analysis showed that using the cut-off of 0.20 cm 2 for SN hyperechogenicity, the sensitivity and specificity were 80.40%and 74.50%.With the cut-off of 7.52%for S/M,the sensitivity and specificity were 89.10% and 63.30%.By using the combination of SN hyperechogenicity≥0.20 cm 2 and S/M>7.52%,the sensitivity was 80.4%and the specificity was 78.6%.Conclusions TCS is a fast, convenient,effective and useful tool for screening PD .The combination of the SN area and S/M provided the best diagnostic parameters.