PURPOSE: Transcranial sonography (TCS) magnetic resonance (MR) fusion imaging and digital image analysis are useful tools for the evaluation of various brain pathologies. This study aimed to compare the echogenicity of predefined brain structures in Huntington's disease (HD) patients and healthy controls by TCS-MR fusion imaging using Virtual Navigator and digitized image analysis. MATERIALS AND METHODS: The echogenicity of the caudate nucleus (CN), substantia nigra (SN), lentiform nucleus (LN), insula, and brainstem raphe (BR) evaluated by TCS-MR fusion imaging using digitized image analysis was compared between 21 HD patients and 23 healthy controls. The cutoff values of echogenicity indices for the CN, LN, insula, and BR with optimal sensitivity and specificity were calculated using receiver operating characteristic analysis. RESULTS: The mean echogenicity indices for the CN (67.0±22.6 vs. 37.9±7.6, p<0.0001), LN (110.7±23.6 vs. 59.7±11.1, p<0.0001), and insula (121.7±39.1 vs. 70.8±23.0, p<0.0001) were significantly higher in HD patients than in healthy controls. In contrast, BR echogenicity (24.8±5.3 vs. 30.1±5.3, p<0.001) was lower in HD patients than in healthy controls. The area under the curve was 90.9%, 95.5%, 84.1%, and 81.8% for the CN, LN, insula, and BR, respectively. The sensitivity and specificity were 86% and 96%, respectively, for the CN and 90% and 100%, respectively, for the LN. CONCLUSION: Increased CN, LN, and insula echogenicity and decreased BR echogenicity are typical findings in HD patients. The high sensitivity and specificity of the CN and LN hyperechogenicity in TCS-MR fusion imaging make them promising diagnostic markers for HD.

UNLABELLED: ZIEL: Transkranielle Sonografie (TCS), Magnetresonanz-Fusionsbildgebung (MR-Fusionsbildgebung) und digitale Bildanalyse sind nützliche Werkzeuge für die Beurteilung verschiedener Hirnpathologien. Ziel dieser Studie war es, durch TCS-MR-Fusionsbildgebung mittels Virtual Navigator und digitaler Bildanalyse die Echogenität vordefinierter Hirnstrukturen bei Patienten mit der Huntington-Krankheit (HD) und gesunden Kontrollpersonen zu vergleichen. MATERIAL UND METHODEN: Die Echogenität des Nucleus caudatus (NC), der Substantia nigra (SN), des Nucleus lentiformis (NL), der Insula und der Hirnstamm-Raphe (BR), die mittels TCS-MR-Fusionsbildgebung und digitalisierter Bildanalyse bewertet wurde, wurde bei 21 Patienten mit Huntington-Krankheit und 23 gesunden Kontrollpersonen verglichen. Die Cutoff-Werte der Echogenitätsindizes für NC, NL, Insula und BR mit optimaler Sensitivität und Spezifität wurden mittels ROC-Analyse (Receiver Operating Characteristic Analyse) berechnet. ERGEBNISSE: Bei HD-Patienten im Vergleich zu gesunden Kontrollen waren die mittleren Echogenitätsindizes signifikant höher für den NC (67,0 ± 22,6 vs. 37,9 ± 7,6; p<0,0001), den NL (110,7 ± 23,6 vs. 59,7 ± 11,1; p<0,0001) und die Insula (121,7 ± 39,1 vs. 70,8 ± 23,0; p<0,0001). Im Gegensatz dazu war die BR-Echogenität bei HD-Patienten geringer als bei gesunden Kontrollpersonen (24,8 ± 5,3 vs. 30,1 ± 5,3; p<0,001). Die AUC betrug 90,9% für den NC, 95,5% für den NL, 84,1% für die Insula und 81,8% für die BR. Die Sensitivität und Spezifität betrugen 86% bzw. 96% für den NC und 90% bzw. 100% für den NL. SCHLUSSFOLGERUNG: Erhöhte Echogenität von NC, NL und Insula und verringerte BR-Echogenität sind typische Befunde bei HD-Patienten. Die hohe Sensitivität und Spezifität der Hyperechogenität von NC und NL in der TCS-MR-Fusionsbildgebung machen diese zu vielversprechenden diagnostischen Markern für HD.

• MeSH
• Adult MeSH
• Huntington Disease * diagnostic imaging   MeSH
• Image Interpretation, Computer-Assisted methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Brain * diagnostic imaging   MeSH
• Cerebral Cortex diagnostic imaging   MeSH
• Multimodal Imaging methods   MeSH
• Caudate Nucleus diagnostic imaging   MeSH
• Image Processing, Computer-Assisted methods   MeSH
• Reference Values MeSH
• ROC Curve MeSH
• Aged MeSH
• Sensitivity and Specificity MeSH
• Ultrasonography, Doppler, Transcranial methods   MeSH
• User-Computer Interface MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND AND PURPOSE: Increased echogenicity of the substantia nigra is a typical transcranial sonography finding in Parkinson disease. Experimental software for digital analysis of the echogenic substantia nigra area has been developed. The aim of this study was to compare the evaluation of substantia nigra echogenicity by using digital analysis with a manual measurement in patients with Parkinson disease and healthy volunteers. MATERIALS AND METHODS: One hundred thirteen healthy volunteers were enrolled in the derivation cohort, and 50 healthy volunteers and 30 patients with Parkinson disease, in the validation cohort. The substantia nigra was imaged from the right and left temporal bone window by using transcranial sonography. All subjects were examined twice by using different sonographic machines by an experienced sonographer. DICOM images of the substantia nigra were encoded; then, digital analysis and manual measurement of the substantia nigra were performed. The 90th percentile of the derivation cohort values was used as a cut-point for the evaluation of the hyperechogenic substantia nigra in the validation cohort. The Spearman coefficient was used for assessment of the correlation between both measurements. The Cohen κ coefficient was used for the assessment of the correlation between both measurements and Parkinson disease diagnosis. RESULTS: The Spearman coefficient between measurements by using different machines was 0.686 for digital analysis and 0.721 for manual measurement (P < .0001). Hyperechogenic substantia nigra was detected in the same 26 (86.7%) patients with Parkinson disease by using both measurements. Cohen κ coefficients for digital analysis and manual measurement were 0.787 and 0.762, respectively (P < .0001). CONCLUSIONS: The present study showed comparable results when measuring the substantia nigra features conventionally and by using the developed software.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Brain Stem diagnostic imaging   MeSH
• Parkinson Disease diagnostic imaging   MeSH
• Image Processing, Computer-Assisted * MeSH
• Aged MeSH
• Temporal Bone diagnostic imaging   MeSH
• Substantia Nigra diagnostic imaging   MeSH
• Ultrasonography, Doppler, Transcranial * MeSH
• Healthy Volunteers MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH