Sonografie der Substantia nigra – Technik und klinische Implikationen

Zusammenfassung

Die transkranielle Parenchymsonografie (TCS) stellt eine wertvolle ergänzende Methode bei der Diagnostik von Bewegungsstörungen dar. Über 90% der Patienten mit idiopathischem Parkinson-Syndrom (IPS) weisen sonografisch eine Vergrößerung der Fläche der Substantia nigra (SN) auf. Dahingegen findet man nur bei bis zu 10% der Gesunden eine veränderte Echogenität der SN. Die SN-Hyperechogenität entspricht einem Suszeptibilitätsmarker für die Parkinson-Erkrankung, sie ist jedoch kein Verlaufsparameter der striatonigralen Degeneration. Bei der Differenzierung des IPS von atypischen Parkinson-Syndromen oder essentiellem Tremor ist neben der Echogenität der SN die Beurteilung der Echogenität des Nucleus lentiformis, des Nucleus caudatus und der Ventrikelweite hilfreich. In diesem Artikel werden die Methodik der Parenchymsonografie, ihr Stellenwert im Vergleich zu anderen bildgebenden Verfahren und ihre Anwendung bei der Differenzialdiagnostik von Bewegungsstörungen erläutert.

Abstract

In movement disorders transcranial ultrasound (TCS) represents an important diagnostic method. In more than 90% of patients with idiopathic Parkinson's disease (IPD) an increase of the echogenicity of the substantia nigra (SN) is found. In contrast, in healthy individuals a change of the SN echogenic signal is shown in only up to 10%. Whereas SN hyperechogenicity seems to disclose a susceptibility for IPD, it is not a marker for the progression of the disease. In the differential diagnosis of IPD and atypical Parkinsonian syndromes or essential tremor, additional sonografic parameters such as echogenicity of the nucleus lentiformis, nucleus caudatus and width of ventricles are useful. This article elucidates the methodological approach, its value in comparison with other diagnostic methods and its implementation in the diagnostic work-up of movement disorders.

Schlüsselwörter

transkranielle Sonografie - Substantia nigra - Parkinson - Bewegungsstörungen

Key words

transcranial sonography - substantia nigra - Parkinson's disease - movement disorder

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