Abstract
Objective: To retrospectively evaluate the transcranial ultrasound (TCS) features in an initially undiagnosed population with clinical suspicion of idiopathic Parkinson disease and compare with follow-up clinical diagnosis.
Background: TCS was already well validated for PD diagnosis. It is important to evaluate the practical applicability of this test in a real clinical scenario in order to evaluate the reliability of its results to differentiate PD from the principal PD mimetics.
Design/Methods: We studied who presented at our outpatient clinic with initial clinical suspicion of PD, essential tremor (ET) or atypical parkinsonism (AP) and that performed TCS. All the exams were realized by the same examiner. The final clinical diagnosis was defined by a consensus of the assistant movement disorder specialist and another neurologist. We evaluated the test characteristics and accuracy using Bayesian methods
Results: 85 patients (60% man and 40% woman) with a mean age of 67 (17 – 88) y.o. were included. Final diagnosis was established in 65 (76%), 39 (60%) with PD, 11 (17%) with ET, 9 (14%) with AP and 6 (9%) with EPD. The PD patients had the highest SN values when compared to the other groups. SN hyperechogenicity (SN+) was defined as bigger than 20 mm, found in 95% (n=37) of the PD and in 12% (n=3) of non-PD. The TCS showed a sensibility of 93.4%, a specificity of 86,6% together with a PPV of 92.1% and a positive LR of 6.93 to differentiate PD from non-PD. The Bayesian ROC curve suggested an optimal SN cut-off value of 21.4 mm
Conclusions: The movement disorders expert clinical diagnosis for PD, the current gold standard is still too vulnerable. Therefore, complementary exams are urgently needed. This study demonstrates the practical efficacy of the TCS in differentiating PD from NPD (non-Parkinson’s) when the clinical diagnosis was initially not clarified.
Disclosure: Dr. Grippe has nothing to disclose. Dr. Allam has nothing to disclose. Dr. Brandao has nothing to disclose. Dr. Pereira has nothing to disclose. Dr. Aguilar has nothing to disclose. Dr. Cunha has nothing to disclose. Dr. Kessler has nothing to disclose.
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