脑黑质经颅超声在帕金森病及特发性震颤鉴别诊断的临床应用价值

Clinical Utility of Transcranial Sonographic Assessment of the Substantia Nigra in the Differential Diagnosis of Parkinson’s Disease and Essential Tremor

摘要: 目的：探讨脑黑质经颅超声(TCS)对特发性震颤(ET)及帕金森病(PD)鉴别诊断的临床应用价值。方法：回顾性纳入202例于本院诊断ET及PD且接受TCS检查的患者，其中PD患者114例，ET患者88例。计算并比较两组双侧SN高回声面积、双侧SN高回声面积与中脑总面积之比(SN高回声/中脑面积，S/M)及脑黑质回声分级，通过ROC曲线分析SN高回声面积及S/M诊断PD的效能。结果：两组患者TCS定量参数结果显示，PD患者SN高回声面积显著高于ET患者(0.34 ± 0.09比0.18 ± 0.06，P < 0.05)，中脑面积无显著差异，PD患者S/M显著高于ET患者(0.10 ± 0.02比0.07 ± 0.01，P < 0.05)。通过黑质强回声面积诊断PD的ROC曲线结果表明AUC为0.70 (95% CI: 0.60~0.78)，诊断灵敏度、特异度及准确性分别为74.38%、65.20%及68.01%，通过S/M诊断PD的ROC曲线结果表明AUC为0.65 (95% CI: 0.56~0.70)，诊断灵敏度、特异度及准确性分别为67.11%、60.98%及64.20%。结论：脑黑质TCS检查有助于发现脑黑质异常高回声，定量参数能够为PD与ET患者的鉴别诊断提供一定的辅助价值。

Abstract: Objective: To explore the clinical application value of transcranial sonography (TCS) of the substantia nigra (SN) in the differential diagnosis of essential tremor (ET) and Parkinson’s disease (PD). Methods: This retrospective study included 202 patients diagnosed with ET and PD at our hospital, who underwent TCS examination, comprising 114 PD patients and 88 ET patients. The bilateral SN hyperechogenicity area, the ratio of the bilateral SN hyperechogenicity area to the total midbrain area (SN hyperechogenicity/midbrain area, S/M), and the grading of SN echogenicity were calculated and compared between the two groups. The diagnostic efficacy of SN hyperechogenicity area and S/M in diagnosing PD was analyzed using receiver operating characteristic (ROC) curves. Results: The TCS quantitative parameters showed that the SN hyperechogenicity area in PD patients was significantly larger than in ET patients (0.34 ± 0.09 vs 0.18 ± 0.06, P < 0.05), while there was no significant difference in midbrain area between the two groups. The S/M ratio in PD patients was significantly higher than in ET patients (0.10 ± 0.02 vs 0.07 ± 0.01, P < 0.05). The ROC curve for diagnosing PD using the SN hyperechogenicity area showed an area under the curve (AUC) of 0.70 (95% CI: 0.60~0.78), with a diagnostic sensitivity, specificity, and accuracy of 74.38%, 65.20%, and 68.01%, respectively. The ROC curve for diagnosing PD using S/M showed an AUC of 0.65 (95% CI: 0.56~0.70), with a diagnostic sensitivity, specificity, and accuracy of 67.11%, 60.98%, and 64.20%, respectively. Conclusion: TCS of the substantia nigra is helpful in identifying abnormal SN hyperechogenicity. Quantitative parameters can provide significant reference value for the differential diagnosis between PD and ET patients.