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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(07): 459-466
DOI: 10.1590/0004-282X20180067
ARTICLE

Is transcranial sonography useful for diagnosing Parkinson’s disease in clinical practice?

O ultrassom transcraniano é útil para o diagnóstico da doença de Parkinson na prática clínica?
Talyta Cortez Grippe
1   Universidade de Brasília, Faculdade de Medicina, Brasília DF, Brasil;
2   Hospital de Base do Distrito Federal, Centro de Referência em Parkinson e Distúrbios do Movimento, Brasília DF, Brasil;
,
Nasser Allam
2   Hospital de Base do Distrito Federal, Centro de Referência em Parkinson e Distúrbios do Movimento, Brasília DF, Brasil;
,
Pedro Renato de Paula Brandão
2   Hospital de Base do Distrito Federal, Centro de Referência em Parkinson e Distúrbios do Movimento, Brasília DF, Brasil;
3   Câmara dos Deputados, Departamento Médico, Brasília DF, Brasil;
,
Danilo Assis Pereira
4   Instituto Brasileiro de Neuropsicologia e Ciências Cognitivas, Brasília DF, Brasil;
,
Francisco Eduardo Costa Cardoso
5   Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brasil.
,
Ana Carolina Rodrigues Aguilar
2   Hospital de Base do Distrito Federal, Centro de Referência em Parkinson e Distúrbios do Movimento, Brasília DF, Brasil;
,
Iruena Moraes Kessler
1   Universidade de Brasília, Faculdade de Medicina, Brasília DF, Brasil;
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ABSTRACT

Transcranial sonography (TCS) is an emerging ancillary examination for diagnosing Parkinson’s disease (PD).

Objective To evaluate TCS features in patients with PD and its mimics, and establish their accuracy in predicting the final clinical diagnosis after follow-up.

Methods We retrospectively studied 85 patients with an initial clinical suspicion of PD, atypical parkinsonism or essential tremor, all of whom underwent TCS. Two specialists reviewed the follow-up clinical visit records and determined the final clinical diagnosis. The accuracy analysis of the TCS was determined using Bayesian statistical methods.

Results The finding of substantia nigra hyperechogenicity (> 20 mm2) showed high sensitivity (93.4%) and specificity (86.6%). The positive likelihood ratio showed 6.93-fold greater odds for diagnosing PD than an alternative condition when this finding was present.

Conclusions This study revealed the practical usefulness of TCS in differentiating PD from its prevalent mimics when the clinical diagnosis was initially unclear.

RESUMO

A ultrassonografia transcraniana (UTC) é um exame complementar para diagnóstico de doença de Parkinson (DP).

Objetivo Avaliar as características da UTC em pacientes com DP e seus diagnósticos diferenciais e estabelecer a precisão desse exame para o diagnóstico clínico de DP após seguimento.

Métodos Avaliou-se retrospectivamente 85 pacientes com suspeita clínica inicial de DP, parkinsonismo atípico (PA) ou tremor essencial (TE), todos submetidos a UTC. Um consenso de dois especialistas determinou o diagnóstico clínico final após revisar os registros médicos das consultas de seguimento. A precisão do UTC foi calculada usando métodos estatísticos Bayesianos.

Resultados O achado de hiperecogenicidade da substância negra (> 20 mm2) mostrou alta sensibilidade (93,4%) e especificidade (86,6%). A razão de verossimilhança positiva mostra 6.93 vezes mais chances de diagnosticar DP do que uma condição alternativa, se o achado estiver presente.

Conclusões Este estudo demonstra a utilidade prática do UTC na diferenciação de DP de condições clínicas similares quando o diagnóstico clínico é inicialmente pouco claro.

Parkinson’s disease - parkinsonian disorders - essential tremor - ultrasonography - diagnostic techniques and procedures
doença de Parkinson - transtornos parkinsonianos - tremor essencial - ultrassonografia - técnicas e procedimentos diagnósticos


Publikationsverlauf

Eingereicht: 30. Januar 2018

Angenommen: 20. April 2018

Artikel online veröffentlicht:
25. August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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