Comparative diagnostic sensitivity of the substantia nigra transcranial sonography and salivary gland biopsy in patients with Parkinson’s disease

Parkinsons disease is a chronic neurodegenerative disease, the diagnosis of which remains challenging at the early stages, although clinical diagnostic criteria are developed. The diagnostic accuracy is only 58% for patients at early Parkinsons disease stages. The sensitivity and specificity of transcranial sonography of the substantia nigra used for Parkinsons disease verification is about 85% and 71%, respectively. It has been shown that the aggregates of -synuclein in the nerve fibers in major salivary glands may be seen in Parkinsons disease patients. The availability of the salivary glands for morphological study made it possible to investigate the approaches of the in vivo histological diagnosis of Parkinsons disease based on the detection of -synuclein aggregates in the nerve fibers innervating the glands. Aim: To evaluate and compare the sensitivity of transcranial sonography of the substantia nigra and sublingual salivary gland biopsy. Materials and methods: Six patients with clinically verified Parkinsons disease were enrolled. Evaluation of the neurological state using special scales, transcranial sonography of the substantia nigra and sublingual salivary gland biopsy was performed. Results: Mean age of patients was 59 [58; 60.7] years, mean disease duration period was 5 [3; 7.75] years and the mean HoehnYahr stage was 2.25 [2; 2.5]. Hyperechogenicity of the substantia nigra was found in 3 of 6 patients and the substantia nigra sensitivity was shown to be 50%. Sublingual salivary gland biopsy was positive for -synuclein in 6 of 6 patients and the sensitivity of method was shown to be 100%. No adverse events after biopsy were registered. Conclusion: The sensitivity of sublingual salivary gland biopsy was higher than those of transcranial sonography of the substantia nigra, which indicates the prospect of using the biopsy method as a more sensitive diagnostic tool in Parkinsons disease (1 table, bibliography: 19 refs)

Transcranial Sonography in the Diagnosis of Pituitary Tumor—A Direct Comparison With MRI

BackgroundTranscranial sonography (TCS) is a convenient tool for detecting certain brain diseases, such as brain tumors. Few studies have reported on the use of TCS in the area of Sella turcica. The accuracy and repeatability of Sella turcica with or without pituitary tumor is not clear.PurposeThis study aimed to investigate the feasibility and accuracy of TCS to measure the size of Sella turcica according to the measurement in MRI and determine its diagnostic performance in individuals with pituitary tumor.Materials and MethodsIn this cross-sectional comparative study, healthy volunteers and patients with pituitary tumor were enrolled for examination of TCS and MRI between October 2020 and July 2021. The transverse diameter (D1, cm) of Sella turcica and the volume of the pituitary tumor were measured by TCS and MRI, respectively, and compared by using Student’s t-test or Mann–Whitney test, using the receiver operating characteristic (ROC) curve to analyze the diagnostic value of D1 in TCS for pituitary tumor.ResultsA total of 75 healthy volunteers and 51 patients with pituitary tumor were evaluated. In healthy volunteers, the mean D1 was 1.30 ± 0.35 (range, 0.82–3.22) by TCS and 1.32 ± 0.29 (range, 0.94–3.02) by MRI (P = 0.054). In patients with pituitary tumor, the mean D1 was 2.0 ± 0.65 (range, 0.90–3.48) by TCS and 2.42 ± 1.0 (range, 0.80–4.70) by MRI (P = 0.000). The median measurement volume was 4.41 and 6.59 cm3 in TCS and MR, respectively (P = 0.000). The mean D1 was 1.31 ± 0.35 in healthy volunteers and 2.0 ± 0.65 cm in patients with pituitary tumor (P = 0.000). In the ROC curve analysis, the area under the curve was 0.836, and the optimal cutoff value (1.56) exhibited a sensitivity and specificity of 67.31 and 88.0%, respectively.ConclusionThe consistency between the two imaging technologies performed well in D1 measurement, while the volume of the pituitary tumor was smaller as assessed by TCS than by MRI. D1 in TCS had good diagnostic performance in pituitary tumor.

Transcranial Sonography with Clinical and Demographic Characteristics to Predict Cognitive Impairment in PD: A Longitudinal Study

Background Parkinson’s disease (PD) is a neurodegenerative disease second only to Alzheimer’s disease and is clinically characterized by a series of motor and non-motor symptoms. The latter often appear before motor symptoms, while cognitive impairment mostly occurs within a few years after the diagnosis of PD. We Aimed to predict the risk factors of cognitive impairment in PD patients based on transcranial sonography, clinical symptoms, and demographic characteristics. Independent-sample t-test was used for continuous data, and chi-square test was used for countable data. According to the occurrence time of cognitive impairment (CI), 172 PD patients were divided into non-CI (N-CI, n=48), CI at the first treatment (F-CI, n=58), and CI at the last treatment (L-CI, n=66). The age of onset, first treatment and smoking history of CI patients were significantly different from those with N-CI. When age of first treatment ≥61 years was considered the boundary value to diagnose CI, the sensitivity and specificity were 77.40% and 66.70%, respectively. At the first treatment, there was significant difference in depression between F-CI and N-CI. At the last treatment, the cumulative and new or aggravated hypomnesia of L-CI was significantly more than that of N-CI. There was significant difference in TCS grading between the first- and last treatment in L-CI. Depression, sexual dysfunction, and olfactory dysfunction were independent risk factors for CI during the last treatment, while memory impairment was an independent risk factor for CI during the entire treatment. The sensitivity and specificity of predicting CI in PD patients were 81.80% and 64.60%, respectively. The older the age of onset and treatment of PD patients, the more likely they were to have CI. Hypomnesia, depression, sexual dysfunction, and olfactory dysfunction can be used as independent risk factors to predict CI in PD patients.

Signs of neuroinflammation outweigh neurodegeneration as predictors for early conversion to MS

Background The pathophysiological mechanisms underlying multiple sclerosis include both inflammatory and degenerative processes. We aimed to study and compare markers of neuroinflammation and neurodegeneration in patients with first presentation of demyelinating disorder and to prospectively identify which of the studied markers serve as predictors for early conversion to multiple sclerosis. Thus, 42 patients with first clinical manifestations suggestive of demyelinating disease were included in a prospective study. Subjects underwent thorough history taking and clinical evaluation. Laboratory studies involved analysis of cerebrospinal fluid (CSF) and serum chitinase 3-like 1 levels. Brain imaging included MRI and ultrasonographic assessment. Results T1 black holes, elevated oligoclonal bands (OCB), high baseline T2 lesion load, and enhanced MRI lesions were significantly higher in patients with 1st attack multiple sclerosis. Significantly higher CSF-OCB and serum chitinase 3-like 1 protein was detected in patients with multiple sclerosis (MS) compared to clinically isolated syndrome, and higher levels in MS convertors than non-convertors. Cognitive dysfunction evaluated by MoCA test and brain atrophy assessed using transcranial sonography did not show significant difference among the studied groups. Logistic regression analysis showed that heavy T2 lesion load served as the only predictor of conversion to MS. Conclusion Early conversion to MS after first attack of demyelination is related to detection of signs of neuroinflammation rather than neurodegeneration.

Role of the nigrosome 1 absence as a biomarker in amyotrophic lateral sclerosis

Introduction The absence of nigrosome 1 on brain MRI and the hyperechogenicity of substantia nigra (SNh) by transcranial sonography are two useful biomarkers in the diagnosis of parkinsonisms. We aimed to evaluate the absence of nigrosome 1 in amyotrophic lateral sclerosis (ALS) and to address its meaning. Methods 136 ALS patients were recruited, including 16 progressive muscular atrophy (PMA) and 22 primary lateral sclerosis (PLS) patients. The SNh area was measured planimetrically by standard protocols. The nigrosome 1 status was qualitatively assessed by two blind evaluators in susceptibility weight images of 3T MRI. Demographic and clinical data were collected and the C9ORF72 expansion was tested in all patients. Results Nigrosome 1 was absent in 30% of ALS patients (36% of PLS, 29% of classical ALS and 19% of PMA patients). There was no relationship between radiological and clinical laterality, nor between nigrosome 1 and SNh area. Male sex (OR = 3.63 [1.51, 9.38], p = 0.005) and a higher upper motor neuron (UMN) score (OR = 1.10 [1.02, 1.2], p = 0.022) were independently associated to nigrosome 1 absence, which also was an independent marker of poor survival (HR = 1.79 [1.3, 2.8], p = 0.013). Conclusion In ALS patients, the absence of nigrosome 1 is associated with male sex, UMN impairment and shorter survival. This suggests that constitutional factors and the degree of pyramidal involvement are related to the substantia nigra involvement in ALS. Thus, nigrosome 1 could be a marker of a multisystem degeneration, which in turn associates to poor prognosis.

Raphe Nuclei Echogenicity and Diameter of Third Ventricle in Schizophrenia Measured by Transcranial Sonography

Introduction: Serotonergic system hyperactivity at 5-HT2A receptors on glutamate neurons in the cerebral cortex is one of the pathways that is theoretically linked to psychosis. In addition to neurotransmitter dysfunction, volumetric studies revealed loss of cortical gray matter and ventricular enlargement in patients with schizophrenia, although there is no case-control research on patients with schizophrenia in order to evaluate echogenicity of RN or DTV. To address these issues, the present study assessed midbrain raphe nuclei (RN) as the main source of brain serotonin and diameter of third ventricle (DTV) as an index of atrophy by transcranial sonography (TCS) in a group of patients with schizophrenia. Methods: 30 patients with schizophrenia and 30 controls were assessed by TCS for RN echogenicity and DTV. TCS was done through temporal bone window via a phased-array ultrasound using 2.5 MHz transducer in depth of 14-16 cm. RN echogenicity assessed by a semi-quantitative visual scale and DTV was measured in thalamic plane. Results: 23 patients (76.5%) and 15 (50 %) controls showed hypoechogenicity of RN which was marginally significant (p=0.06). DTV was in average larger in the patient’s group (0.388 cm vs 0.234 cm, p<0.001). Conclusion: Increased DTV in the patients with schizophrenia is consistent with previous neuroimaging findings. However, marginally lower echogenicity of midbrain RN on TCS in schizophrenia is a new finding that supports the serotonin hypothesis of schizophrenia.