Email updates

Keep up to date with the latest news and content from BMC Neurology and BioMed Central.

Open Access Research article

The predictive value of transcranial duplex sonography for the clinical diagnosis in undiagnosed parkinsonian syndromes: comparison with SPECT scans

Annemarie MM Vlaar1*, Tjerk de Nijs1, Marinus JPG van Kroonenburgh2, Werner H Mess3, Ania Winogrodzka1, Selma C Tromp4 and Wim EJ Weber1

Author Affiliations

1 Departments of neurology, university hospital Maastricht, The Netherlands

2 Department of nuclear medicine, university hospital Maastricht, The Netherlands

3 Department of clinical neurophysiology, university hospital Maastricht, The Netherlands

4 Department of clinical neurophysiology, St. Antonius hospital, Nieuwegein, The Netherlands

For all author emails, please log on.

BMC Neurology 2008, 8:42  doi:10.1186/1471-2377-8-42

Published: 9 November 2008

Abstract

Background

Transcranial duplex sonography (TCD) of the substantia nigra has emerged as a promising, non-invasive tool to diagnose idiopathic Parkinson's disease (IPD). However, its diagnostic accuracy in patients with undefined parkinsonism remains to be determined.

In this study we determined the predictive value of TCD for the clinical diagnosis in undiagnosed parkinsonian syndromes. Additionally we compared the predictive value of TCD with that of presynaptic and postsynaptic single photon emission computer tomography (SPECT) scans.

Methods

We studied 82 patients with an unclassified parkinsonian syndrome. All 82 patients were subjected to a TCD, 59 of them underwent a presynaptic SPECT scans and 32 underwent a postsynaptic SPECT scan.

We determined the diagnostic accuracy of TCD and SPECT scans in differentiating:

1) IPD patients from patients without nigrostriatal degeneration and 2) IPD patients from patients with atypical parkinsonian syndromes (APS).

To compare the diagnostic accuracy of TCD and SPECT scans, we used the clinical diagnosis after follow-up according to generally accepted clinical criteria as the gold standard. This clinical diagnosis was determined by a movement disorder specialist.

3) Finally, we ascertained the predictive value of the TCD for the SPECT result.

Results

The clinical diagnoses after follow-up resulted in 51 cases of IPD, 7 patients with APS and 17 patients without nigrostriatal degeneration. In total 7 patients remained undiagnosed.

1) The accuracy of TCD, assessed by sensitivity and specificity, to differentiate IPD patients from patients without nigrostriatal degeneration was 50% and 82% respectively.

For the presynaptic SPECT scans sensitivity was 97% and specificity 100%.

2) In differentiating IPD patients from APS patients, the sensitivity and specificity of TCD was 50% and 43% respectively. For presynaptic SPECT scans this was 97% and 0%. For the postsynaptic SPECT scans the sensitivity was 75% and the specificity 81%.

3) The positive predictive value (PPV) of an abnormal TCD for an abnormal presynaptic SPECT scan was 88%.

Conclusion

Presynaptic SPECT scanning has a higher predictive value for the clinical diagnosis than TCD. However, since the PPV of an abnormal TCD for parkinsonism with nigrostriatal degeneration is high, TCD might be used as screening tool, before ordering a presynaptic SPECT.