What is the value of transcranial ultrasound for diagnosing Parkinson’s disease?

Transcranial ultrasound may be a valuable tool for the diagnosis of Parkinson’s disease (PD) in patients with parkinsonism, possibly sparing the use of expensive imaging techniques. Prospective studies with longer follow-up and head-to-head studies comparing transcranial ultrasound with other diagnostic modalities are needed to further assess its value.

“Although MRI, PET, and scintigraphy are useful instruments for diagnostic purposes, there is a need for a complementary, more available, and cost-effective method to differentiate between PD, atypical parkinsonism (AP), and essential tremor (ET),” explained Dr Markus Stiehm (Skåne University Hospital, Sweden). The current retrospective study aimed to evaluate the diagnostic value of a substantia nigra-positive finding through transcranial ultrasound in patients with newly diagnosed parkinsonism [1].

The study included 72 patients with suspected parkinsonism who were referred for transcranial ultrasound. The findings from the initial test were compared with the final diagnosis after a long-term follow-up; the mean follow-up duration was 95.6 months. Dr Stiehm added that all final diagnoses were reviewed by an experienced neurologist and that nuclear imaging results could be analysed for this purpose.

The observed sensitivity of transcranial ultrasound for diagnosing PD versus non-PD appeared to be limited, at 73.21%. However, the specificity (87.50%) and positive predictive value (95.35%) were promising. “Transcranial ultrasound does not appear to be suitable as a single first-line diagnostic tool, due to the limited sensitivity,” argued Dr Stiehm. “It can however be regarded as a non-invasive, cost-effective, complementary diagnostic method, potentially sparing the use of expensive nuclear imaging techniques in some patients.” Large prospective studies with longer follow-up time are needed to gain further insights into the usefulness and reproducibility of transcranial ultrasound.

1. Stiehm M, et al. The diagnostic value of transcranial ultrasound in Swedish Parkinsonism patients: a retrospective cohort study including a long follow-up period. Late-breaking session 1, 10th EAN Congress, 29 June–2 July 2024, Helsinki, Finland.

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Posted on 25 July 2024