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Does normal substantia nigra echogenicity make a difference in Parkinson’s disease diagnosis? A real clinical practice follow-up study

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Abstract

Objectives

Substantia nigra hyperechogenicity (SN+) detected by transcranial ultrasound (TUS) is useful for Parkinson’s disease (PD) diagnosis. Approximately 15% false negative results of unknown significance are reported. However, most TUS studies are transversal, and diagnosis of PD may change during follow-up.

Methods

Analysis of our prospective registry of TUS in clinical practice, selecting patients with sufficient bone window, to whom TUS was performed because of suspected PD, and a minimum of 3-year follow-up. Subjects were classified regarding SN echogenicity (SN+/SN−).

Results

172 patients (122 SN+, 50 SN−), mean age 71 years (25–90), were included. At the end of follow-up, PD diagnosis was retained by 91% SN+ vs. 54% SN− subjects (p < 0.0001), while final diagnosis of atypical parkinsonism (3%SN+ vs. 16%SN−, p:0.0059) was more frequent in SN−. Dopaminergic therapy response was associated with SN+ (88% SN+ vs. 50% SN−, p < 0.0001), as were abnormal DaTSCANs (90%SN+ vs. 56%SN−, p 0.0027). SN echogenicity had 80% sensitivity and 68% specificity for PD diagnosis, while SPECT had 91% and 73%, respectively. SN+ was the only baseline predictor of keeping PD diagnosis at the end of follow-up, with an odds ratio of 12 (95% CI 3–42) (p < 0.001).

Conclusions

In our sample of patients with suspected PD, SN hyperechogenicity predicted PD diagnosis in the long term with a high odds ratio. Conversely, a baseline normal SN echogenicity was associated with a poorer response to PD therapy and change to a different diagnosis from PD. Normal SN appears to be a caveat for clinicians to check for atypical parkinsonism features during follow-up.

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Correspondence to Araceli Alonso-Canovas.

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Approval of the institution Ethics Committee was obtained, as it was written informed consent from participants.

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Alonso-Canovas, A., Lopez-Sendon Moreno, J., Buisan, J. et al. Does normal substantia nigra echogenicity make a difference in Parkinson’s disease diagnosis? A real clinical practice follow-up study. J Neurol 265, 2363–2369 (2018). https://doi.org/10.1007/s00415-018-9006-5

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  • DOI: https://doi.org/10.1007/s00415-018-9006-5

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