title: Substantia nigra echogenicity and imaging of striatal dopamine transporters in Parkinson's disease: a cross-sectional study.
abstract: Approximately 10% of patients with a presumed diagnosis of Parkinson's disease (PD) remain misdiagnosed despite recent advances in neuroimaging. The current study addresses the use of transcranial sonography and single-photon emission computed tomography (SPECT) using (99m)Tc-TRODAT-1 to evaluate the echogenicity of the substantia nigra (SN) and the density of striatal presynaptic dopamine transporters, respectively, in a sample of 20 PD patients (13 males and 7 females) and 9 healthy subjects. The median age of the PD patients was 62 years. The median age at disease onset was 56 years, and the median disease duration was 5 years. The SN echogenic area was larger in PD patients than healthy subjects. The cut-off value of 0.22 cm(2) for the SN echogenic area was associated with 100% sensitivity and 78% specificity for the diagnosis of PD. Striatal and putaminal (99m)Tc-TRODAT-1 binding was lower in PD patients than healthy subjects. The cut-off value of 0.90 for the striatal (99m)Tc-TRODAT-1 binding was associated with 100% sensitivity and an 89% specificity for the diagnosis of PD, and the cut-off value of 0.76 for putaminal (99m)Tc-TRODAT-1 binding was associated with an 85% sensitivity and an 89% specificity. The size of the SN echogenic area did not correlate with the degree of striatal (99m)Tc-TRODAT-1 binding in PD patients. In conclusion, both SN hyperechogenicity and decreased striatal or putaminal (99m)Tc-TRODAT-1 binding constitute surrogate markers for differentiating PD patients from healthy individuals with a slightly higher diagnostic specificity of (99m)Tc-TRODAT-1 SPECT.
authors.affiliation: Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil. Electronic address: edsonshu@hotmail.com.
authors.forename: Edson
authors.initials: E
authors.lastname: Bor-Seng-Shu
authors.affiliation: Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Jose Luiz
authors.initials: JL
authors.lastname: Pedroso
authors.affiliation: Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Andre C
authors.initials: AC
authors.lastname: Felicio
authors.affiliation: Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
authors.forename: Daniel Ciampi
authors.initials: DC
authors.lastname: de Andrade
authors.affiliation: Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Braga-Neto
authors.affiliation: Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Ilza Rosa
authors.initials: IR
authors.lastname: Batista
authors.affiliation: Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Orlando Graziani Povoas
authors.initials: OG
authors.lastname: Barsottini
authors.affiliation: Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Vanderci
authors.initials: V
authors.lastname: Borges
authors.affiliation: Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Henrique Ballalai
authors.initials: HB
authors.lastname: Ferraz
authors.affiliation: Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
authors.forename: Ming Chi
authors.initials: MC
authors.lastname: Shih
authors.affiliation: Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Bressan
authors.affiliation: Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
authors.forename: Luiz Augusto Franco
authors.initials: LA
authors.lastname: de Andrade
authors.affiliation: Department of Neurology, University of Rostock, Rostock, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Walter
mesh_terms: D000328:Adult; D000368:Aged; D003342:Corpus Striatum / Q000000981:diagnostic imaging / Q000378:metabolism*; D003430:Cross-Sectional Studies; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013378:Substantia Nigra / Q000000981:diagnostic imaging / Q000378:metabolism; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D050483:Dopamine Plasma Membrane Transport Proteins; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D014326:Tropanes; C104196:technetium Tc 99m TRODAT-1
keywords: Dopamine transporter; Parkinson's disease; SPECT; Substantia nigra echogenicity; Transcranial sonography