ReviewTranscranial brain parenchyma sonography in movement disorders: State of the art
Introduction
For many y, the intact skull was regarded as an insurmountable problem to obtaining high-resolution sonographic images of the adult brain. However, after first attempts in the 1970s and 1980s (Berland et al 1988, Furuhata 1989, Kamphuisen et al 1972), transcranial sonography (TCS) of the brain parenchyma has developed with increasing dynamics. Today’s modern ultrasound systems allow high-resolution TCS of the brain structures. In comparison with conventional neuroimaging methods such as CT and MRI, advantages of TCS are low costs, short investigation times, noninvasiveness, unlimited repeatability, bedside availability and lower dependency on patient’s compliance. Disadvantages are dependency on acoustic temporal bone windows, which accounts for missing or only partial accessibility of 10% to 20% of patients (Becker and Berg 2001), and dependency on examiner’s skills. An important argument in favor of TCS is that the physical principle (a reflection of ultrasound waves at interfaces with diverse acoustic impedances) differs from other imaging methods and thereby delivers new and complementary findings.
In recent y, TCS has been proven to be reliable and useful in detecting basal ganglia alterations in several movement disorders. Pathbreaking was the finding of increased echogenicity of substantia nigra in Parkinson’s disease (PD) (Becker et al. 1995a). Since then, characteristic TCS findings have been reported for other movement disorders such as idiopathic dystonia and Huntington’s disease (Naumann et al 1996, Postert et al 1999). TCS findings led to new insights and pathophysiological concepts, especially in PD and dystonia (Becker and Berg 2001). In the clinical setting, use of TCS for early recognition and differential diagnosis of neurodegenerative disorders is promising. This necessitates methodological standardization and definition of clinical applications.
On May 11, 2004, on the occasion of the Ninth Meeting of the European Society of Neurosonology and Cerebral Hemodynamics (ESNCH) in Wetzlar, Germany, the ESNCH sponsored a workshop to develop a standardized procedure of TCS in neurodegenerative diseases. This paper presents the consensus findings on application of TCS in movement disorders resulting from the workshop and reviews the main studies that led to their development.
Section snippets
Methods
To achieve consensus on application of TCS in movement disorders in adults, the chairs of the planned consensus meeting (D.B., U.W.) at first searched the Medline database for all research papers in this field that have been published until end of year 2003, including TCS studies of healthy adults. For this, the keywords “sonography” and “ultrasound” were combined sequentially with each of the following keywords: “substantia nigra,” “brainstem raphe,” “cerebellum,” “lenticular nucleus” and
Evaluation of TCS studies and issues to be standardized
Database research detected 11 reports on substantia nigra (SN) TCS (Becker et al 1995a, Berg et al 1999a, Berg et al 2001a, Berg et al 2001b, Berg et al 2001c, Berg et al 2002, Jabs et al 2001, Postert et al 1999, Ruprecht-Dorfler et al 2003, Walter et al 2002, Walter et al 2003), four on brainstem raphe (BR) TCS (Becker et al 1994, Becker et al 1995b, Becker et al 1997a, Berg et al 1999b), seven on lenticular nucleus (LN) TCS (Becker et al 1997b, Becker et al 2002, Berg et al 2000a, Naumann et
References (49)
- et al.
Echogenicity of the brainstem raphe in patients with major depression
Psychiatry Res
(1994) - et al.
Reduced echogenicity of brainstem raphe specific to unipolar depression: a transcranial color-coded real-time sonography study
Biol Psychiatry
(1995) - et al.
Iron accumulation of the substantia nigra in rats visualized by ultrasound
Ultrasound Med Biol
(1999) - et al.
Echogenicity of substantia nigra determined by transcranial ultrasound correlates with severity of parkinsonian symptoms induced by neuroleptic therapy
Biol Psychiatry
(2001) - et al.
Screening for mutations of the ferritin light and heavy genes in Parkinson’s disease patients with hyperechogenicity of the substantia nigra
Neurosci Lett
(2003) - et al.
Transcranial sonography of the brain parenchyma: comparison of B-mode imaging and tissue harmonic imaging
Ultrasound Med Biol
(2000) - et al.
Echogenicity of the substantia nigra in relatives of patients with sporadic Parkinson’s disease
NeuroImage
(2003) - et al.
Copper genes are not implicated in the pathogenesis of focal dystonia
Neurology
(2002) - et al.
Neuroimaging in basal ganglia disorders: Perspectives for transcranial ultrasound
Mov Disord
(2001) - et al.
Degeneration of substantia nigra in chronic Parkinson’s disease visualized by transcranial color-coded real-time sonography
Neurology
(1995)
Parkinson’s disease and depression: evidence for an alteration of the basal limbic system detected by transcranial sonography
J Neurol Neurosurg Psychiatry
Comparison of transcranial sonography, magnetic resonance imaging, and single photon emission computed tomography findings in idiopathic spasmodic torticollis
Mov Disord
Increased tissue copper and manganese content of the lentiform nucleus in primary adult-onset dystonia
Ann Neurol
Evidence for disturbances of copper metabolism in dystoniaFrom the image towards a new concept
Neurology
Evidence for shoulder girdle dystonia in selected patients with cervical disc prolapse
Mov Disord
Differentiation of Parkinson’s disease and atypical parkinsonian syndromes by transcranial ultrasound
J Neurol Neurosurg Psychiatry
Vulnerability of the nigrostriatal system as detected by transcranial ultrasound
Neurology
Depression in Parkinson‘s disease: brainstem midline alteration on transcranial sonography and magnetic resonance imaging
J Neurol
The basal ganglia in haemochromatosis
Neuroradiology
Differences of echogenicity and T2 relaxation time of the nucleus lentiformis in MSA and PSP as compared to Parkinson’s disease
Mov Disord
Changes of copper transporting proteins and ceruloplasmin in the lentiform nuclei in primary adult-onset dystonia
Ann Neurol
Relationship of substantia nigra echogenicity and motor function in elderly subjects
Neurology
Echogenicity of the substantia nigra in Parkinson’s disease and its relation to clinical findings
J Neurol
Echogenicity of the substantia nigra: Association with increased iron content and marker for susceptibility to nigrostriatal injury
Arch Neurol
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