Panic disorder has been associated with altered serotonin metabolism in the brainstem raphe. The aim of study was to evaluate the BR echogenicity on transcranial sonography (TCS) in panic disorder. A total of 96 healthy volunteers were enrolled in the "derivation" cohort, and 26 healthy volunteers and 26 panic disorder patients were enrolled in the "validation" cohort. TCS echogenicity of brainstem raphe and substantia nigra was assessed on anonymized images visually and by means of digitized image analysis. Significantly reduced brainstem raphe echogenicity was detected more frequently in panic disorder patients than in controls using both visual (68% vs. 31%) and digitized image analysis (52% vs. 12%). The optimal cut-off value of digitized brainstem raphe echogenicity indicated the diagnosis of panic disorder with a sensitivity of 64% and a specificity of 73%, and corresponded to the 30th percentile in the derivation cohort. Reduced brainstem raphe echogenicity was associated with shorter treatment duration, and, by trend, lower severity of anxiety. No relationship was found between echogenicity of brainstem raphe or substantia nigra and age, gender, severity of panic disorder, or severity of depression. Patients with panic disorder exhibit changes of brainstem raphe on TCS suggesting an alteration of the central serotonergic system.

• Klíčová slova
• Brainstem raphe, Panic disorder, Transcranial sonography,
• MeSH
• depresivní poruchy komplikace   diagnostické zobrazování   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový kmen diagnostické zobrazování   MeSH
• nuclei raphe diagnostické zobrazování   MeSH
• panická porucha komplikace   diagnostické zobrazování   MeSH
• senzitivita a specificita MeSH
• substantia nigra diagnostické zobrazování   MeSH
• ultrasonografie dopplerovská transkraniální metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Transcranial sonography is a highly sensitive noninvasive sonographic method for detection of early and specific echogenic changes in basal ganglia of patients with some neurodegenerative diseases. Transcranial sonography showed substantia nigra hyperechogenicity as a typical echo feature in idiopathic Parkinson disease and lenticular nucleus hyperechogenicity as a characteristic finding in atypical parkinsonian syndromes. Brain stem raphe hypoechogenicity or interruption has been shown to be highly prevalent in patients with unipolar depression as well as depression associated with certain neurodegenerative diseases. Transcranial sonography also revealed basal ganglia hyperechoic changes in movement disorders with trace metal accumulation such as Wilson disease, some entities of neurodegeneration with brain iron accumulation, as well as several forms of spinocerebellar ataxia. Transcranial sonography is a valuable neuro imaging method for early and differential diagnosis and follow-up of patients with neurodegenerative and psychiatric diseases.

• Klíčová slova
• basal ganglia echogenicity, neurodegenerative diseases, psychiatric diseases, transcranial sonography, ultrasound education,
• MeSH
• duševní poruchy diagnostické zobrazování   MeSH
• lidé MeSH
• neurodegenerativní nemoci diagnostické zobrazování   MeSH
• ultrasonografie dopplerovská transkraniální metody   MeSH
• vylepšení obrazu metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

INTRODUCTION: Wilson's disease (WD) is a hereditary disorder caused by ATP7B mutations resulting in systemic copper accumulation. WD may manifest as early-adulthood parkinsonism; and atypical cases may be difficult to distinguish from early-onset Parkinson's disease (EO-PD), a neurodegenerative disorder with onset ≤40 years of age. The aim of our study was to compare transcranial sonography (TCS)-magnetic resonance fusion imaging in WD and EO-PD and examine whether TCS can provide clinically useful information. METHODS: We examined 22 WD, 16 EO-PD, and 24 healthy control subjects. We measured echogenicity and determined presence of MRI signal changes in T2-weighted images in the substantia nigra (SN) and lentiform nucleus (NL). TCS with the capability of magnetic resonance fusion and Virtual Navigator was used. The echogenicity indices of SN and NL were processed using digital image analysis to eliminate subjective evaluation errors. RESULTS: Mean SN echogenicity index in EO-PD (39.8 ± 5.9 [SD]) was higher compared to WD (28.0 ± 4.6, p < 0.0001) and control subjects (28.8 ± 4.9, p < 0.0001). Mean NL echogenicity index was higher in WD (117.5 ± 37.0) compared to EO-PD (61.6 ± 5.4, p < 0.0001) and control subjects (54.9 ± 11.2, p < 0.0001). The SN hyperechogenicity had sensitivity 93.8%, and specificity 90.9%, while the NL hyperechogenicity had sensitivity 95.5% and specificity 93.8% for differentiation of WD and EO-PD. NL hyperechogenicity was more pronounced in WD subjects with putaminal MRI T2 hyperintensity (p < 0.05) but was also present in subjects without MRI abnormality. CONCLUSIONS: There are distinct TCS findings in WD and EO-PD complementary to MRI that can be utilized as highly sensitive and specific biomarkers of these disorders.

• Klíčová slova
• Copper, Early-onset Parkinson's disease, MRI, Transcranial sonography, Wilson's disease,
• MeSH
• biologické markery MeSH
• corpus striatum diagnostické zobrazování   MeSH
• dospělí MeSH
• hepatolentikulární degenerace diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie normy   MeSH
• multimodální zobrazování MeSH
• Parkinsonova nemoc diagnostické zobrazování   MeSH
• senzitivita a specificita MeSH
• ultrasonografie dopplerovská transkraniální normy   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery 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
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový kmen diagnostické zobrazování   MeSH
• Parkinsonova nemoc diagnostické zobrazování   MeSH
• počítačové zpracování obrazu * MeSH
• senioři MeSH
• spánková kost diagnostické zobrazování   MeSH
• substantia nigra diagnostické zobrazování   MeSH
• ultrasonografie dopplerovská transkraniální * MeSH
• zdraví dobrovolníci pro lékařské studie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The primary aim of this study was to assess whether there exists a relationship between lumbar cerebrospinal fluid (CSF) pressure and intracranial blood flow velocities as measured by transcranial Doppler sonography (TCD) in children with scaphocephaly. Another aim was to compare pre- and postoperative TCD. Using a transducer, lumbar CSF pressure (LP) was assessed in 21 children with scaphocephaly. TCD was performed, and the pulsatility index (PI) and the resistance index (RI) were obtained before and after cranioplasty. In 17 children LP was higher than the reference values. No significant differences were found in PI and RI indices before and after cranioplasty. LP values were significantly higher in children older than 6 months. There was no association between LP and PI and RI indices. In children with scaphocephaly a higher LP can be expected with age. Moreover, TCD is not a reliable tool in predicting abnormal LP values.

• MeSH
• arteriae cerebrales patofyziologie   MeSH
• dítě MeSH
• intrakraniální tlak fyziologie   MeSH
• kraniosynostózy mozkomíšní mok   diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• mozek krevní zásobení   MeSH
• neparametrická statistika MeSH
• předškolní dítě MeSH
• rychlost toku krve fyziologie   MeSH
• tlak mozkomíšního moku fyziologie   MeSH
• ultrasonografie dopplerovská transkraniální metody   MeSH
• věkové rozložení MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Transcranial sonography (TCS) of the brain parenchyma in patients with movement and other neurodegenerative disorders has developed with increasing dynamics during the past two decades. The specific advantages of TCS are the different visualization of brain structures compared to other neuroimaging methods due to the different physical imaging principle, high-resolution imaging of echogenic deep brain structures, on-time dynamic imaging with high resolution in time, relatively low costs of technical equipment, wide availability, short investigation time, noninvasivity, mobility and bedside availability, and little corruption by patients' movements. TCS proved sensitive and reliable in detecting disease-specific alterations of brainstem structures and basal ganglia in various movement disorders. Here, we give an overview on the technical requirements and recommendations on the standardized application of TCS of deep brain structures in movement disorders. We discuss methodological potentials and limitations of TCS, its validity, and future developments.

• MeSH
• diferenciální diagnóza MeSH
• lidé MeSH
• pohybové poruchy diagnóza   diagnostické zobrazování   patofyziologie   MeSH
• prediktivní hodnota testů MeSH
• reprodukovatelnost výsledků MeSH
• ultrasonografie dopplerovská transkraniální metody   normy   trendy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Diagnosis of Parkinson's disease (PD) can be difficult in the early stages of the disease. The aim of the study described here was to assess the correlation between transcranial sonography (TCS) and (123)I-FP-CIT ([(123)I]ioflupane, N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-[(123)I]iodophenyl)nortropane) SPECT (single photon emission computed tomography) findings and the diagnosis of PD. A total of 49 patients were enrolled in the study: 29 patients with PD, 7 patients with other parkinsonian syndromes, 11 patients with essential tremor and 2 with psychogenic movement disorder. Substantia nigra echogenicity was measured using TCS. SPECT was performed using DaTSCAN ([(123)I]ioflupane). TCS and SPECT findings were correlated in 84% of patients, with κ = 0.62 (95% confidence interval: 0.38-0.86). TCS-measured substantia nigra echogenicity and SPECT-measured striatal binding ratio were negatively correlated (r = -0.326, p = 0.003). TCS/SPECT sensitivity, specificity and positive and negative predictive values for the diagnosis of PD were 89.7%/96.6%, 60.0%/70.0%, 76.5%/82.4% and 80.0%/93.3%, respectively. Both positive TCS and SPECT findings correlated significantly with the diagnosis of PD (κ = 0.52, 95% confidence interval: 0.27-0.76, and κ = 0.69, 95% confidence interval: 0.49-0.90, respectively).

• Klíčová slova
• Parkinson's disease, Parkinsonian syndromes, Single photon emission computed tomography, Substantia nigra, Transcranial sonography, [(123)I]ioflupane,
• MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• esenciální tremor diagnostické zobrazování   MeSH
• jednofotonová emisní výpočetní tomografie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• parkinsonské poruchy diagnostické zobrazování   MeSH
• prediktivní hodnota testů MeSH
• radiofarmaka MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• substantia nigra diagnostické zobrazování   MeSH
• tropany MeSH
• ultrasonografie dopplerovská transkraniální metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• 2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane MeSH Prohlížeč
• radiofarmaka MeSH
• tropany MeSH

Transcranial color-coded sonography (TCCS) monitoring of severe brain injury patients may reveal various pathological hemodynamic changes. According to changes in flow velocities in basal brain arteries, the presence of brain hyperemia, vasospasms, and oligemia can be detected. The study included a group of 20 patients with severe brain injury. TCCS measured flow velocities and ICP values were monitored on a daily basis in the course of a week after injury. In nearly 50 % of patients significant hemodynamic changes occurred. The most frequent pathological finding was hyperemia (31.8 %), followed by vasospasm (10.9 %) and oligemia (9.1 %). In 42.7 % of patients increased flow velocities were registered and only 9.1 % of records were within the normal range of values. The most substantial elevation in time-averaged mean velocity occurred from the second to the sixth day after injury. In a subgroup of patients with raised intracranial pressure 41.6 % of flow velocity (FV) measuring met the TCCS criteria for hyperemia compared with 26 % in a subgroup of patients without intracranial pressure (ICP) elevation. The study showed that hemodynamic changes after severe brain injury are relatively common findings and that TCCS is a useful bed-side tool for the monitoring of intracranial hemodynamic changes.

• MeSH
• časové faktory MeSH
• intrakraniální tlak MeSH
• intrakraniální vazospazmus etiologie   MeSH
• klinické kódování MeSH
• lidé MeSH
• mozkový krevní oběh MeSH
• následné studie MeSH
• poranění mozku komplikace   diagnostické zobrazování   MeSH
• rychlost toku krve MeSH
• ultrasonografie dopplerovská transkraniální * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Acute occlusion of cervical or intracranial arteries is the most common cause of ischemic stroke (IS). The aims of the current study were to compare the occurrence of acute pathologic findings in intracranial arteries using transcranial color-coded sonography (TCCS) and computed tomographic angiography (CTA) performed within 3 hours of IS onset and to assess the correlation between the vascular findings on admission and the patient's clinical state on admission and 3 months after the IS. Forty-five consecutive patients with an acute IS were included in the prospective study during an 18-month period. All patients underwent CTA and TCCS within the first 3 hours of symptom onset. A high rate of pathologic findings in the intracranial circulation was found (70.9% in CTA and 77.4% in TCCS examinations). The CTA and TCCS findings with respect to the intracranial arteries were consistent in 87.1% of cases (Cohen's kappa, .797). The sensitivity, specificity, and positive and negative predictive values achieved with TCCS in patients with middle cerebral artery main stem occlusion were 92.3%, 94.4%, and 92.3% and 94.4%, respectively. There was no correlation between the patient's clinical status on admission and 3 months after the onset of the IS and the CTA or the TCCS findings (P > .1 in all cases). A substantial agreement was found between TCCS and CTA in the detection of pathologic findings in intracranial vessels in acute stroke patients. Both methods can be used for this purpose.

• MeSH
• cévní mozková příhoda diagnostické zobrazování   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mozková angiografie metody   MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• ultrasonografie dopplerovská barevná metody   MeSH
• ultrasonografie dopplerovská transkraniální metody   MeSH
• výběr pacientů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

OBJECTIVE: To analyze the feasibility and advantages of transcranial doppler sonography (TCD) for monitoring and optimization of selective cerebral perfusion (SCP) in aortic arch surgery. METHODS: From April 2013 to April 2014, nine patients with extensive aortic pathology underwent surgery under moderate hypothermic cardiac arrest with unilateral antegrade SCP under TCD monitoring in our institution. Adequate sonographic window and visualization of circle of Willis were to be confirmed. Intraoperatively, a cerebral cross-filling of the contralateral cerebral arteries on the unilateral SCP was to be confirmed with TCD. If no cross-filling was confirmed, an optimization of the SCP was performed via increasing cerebral flow and increasing PCO2. If not successful, the SCP was to be switched to bilateral perfusion. Air bubble hits were recorded at the termination of SCP. RESULTS: A sonographic window was confirmed in all patients. Procedural success was 100%. The mean operative time was 298 ± 89 minutes. Adequate cross-filling was confirmed in 8 patients. In 1 patient, inadequate cross-filling was detected by TCD and an optimization of cerebral flow was necessary, which was successfully confirmed by TCD. There was no conversion to bilateral perfusion. Extensive air bubble hits were confirmed in 1 patient, who suffered a postoperative stroke. The 30-day mortality rate was 0. Conclusion: The TCD is feasible for cerebral perfusion monitoring in aortic surgery. It enables a confirmation of adequacy of cerebral perfusion strategy or the need for its optimization. Documentation of calcific or air-bubble hits might add insight into patients suffering postoperative neurological deficits.

• MeSH
• aneurysma hrudní aorty diagnóza   patofyziologie   chirurgie   MeSH
• aorta thoracica diagnostické zobrazování   chirurgie   MeSH
• arteriae cerebrales diagnostické zobrazování   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový krevní oběh fyziologie   MeSH
• následné studie MeSH
• peroperační monitorování metody   normy   MeSH
• regionální krevní průtok fyziologie   MeSH
• retrospektivní studie MeSH
• studie proveditelnosti MeSH
• ultrasonografie dopplerovská transkraniální metody   MeSH
• výkony cévní chirurgie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH