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Research ArticleBrain
Open Access

Transcranial Sonography of the Substantia Nigra: Digital Image Analysis

D. Školoudík, M. Jelínková, J. Blahuta, P. Čermák, T. Soukup, P. Bártová, K. Langová and R. Herzig
American Journal of Neuroradiology December 2014, 35 (12) 2273-2278; DOI: https://doi.org/10.3174/ajnr.A4049
D. Školoudík
aFrom the Faculty of Health Science (D.Š.), Palacký University Olomouc, Olomouc, Czech Republic
bDepartment of Neurology (D.Š., M.J., P.B.), University Hospital Ostrava, Ostrava, Czech Republic
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M. Jelínková
bDepartment of Neurology (D.Š., M.J., P.B.), University Hospital Ostrava, Ostrava, Czech Republic
cDepartment of Neurology (M.J.), Hospital, Karviná-Ráj, Karviná, Czech Republic
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J. Blahuta
dInstitute of Computer Science (J.B., P.Č., T.S.), Faculty of Philosophy and Science, Silesian University in Opava, Opava, Czech Republic
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P. Čermák
dInstitute of Computer Science (J.B., P.Č., T.S.), Faculty of Philosophy and Science, Silesian University in Opava, Opava, Czech Republic
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T. Soukup
dInstitute of Computer Science (J.B., P.Č., T.S.), Faculty of Philosophy and Science, Silesian University in Opava, Opava, Czech Republic
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P. Bártová
bDepartment of Neurology (D.Š., M.J., P.B.), University Hospital Ostrava, Ostrava, Czech Republic
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K. Langová
eDepartment of Biophysics (K.L.), Faculty of Medicine and Dentistry, Institute of Molecular and Translational Medicine, Palacký University, Olomouc, Czech Republic
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R. Herzig
fDepartment of Neurology (R.H.), Charles University Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic.
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    Fig 1.

    Transcranial sonography: brain stem with the substantia nigra imaged from a transtemporal approach, axial mesencephalic plane. 1) middle cerebral artery, 2) perimesencephalic cisterns, 3) substantia nigra, 4) fourth ventricle, and 5) brain raphe.

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    Fig 2.

    Placement of the region of interest (green) for digital analysis on the TCS brain stem images obtained from a healthy volunteer (A) and a patient with Parkinson disease (B).

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    Fig 3.

    The difference between the 90th percentile of the derivation cohort (red line; echogenicity index, 18.536) and the counted value in the validation cohort (black) measured by using machine 1. A, Normal echogenicity of the substantia nigra (echogenicity index, 11.760). B, Hyperechogenic substantia nigra (echogenicity index, 31.810).

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    Fig 4.

    The 90th percentile of the derivation cohort for the Esaote My Lab Twice (machine 1) and GE Healthcare Vivid 7 Pro (machine 2) machines.

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    Fig 5.

    Receiver operating characteristic curve for Parkinson disease diagnosis using manual measurement (blue) and digital analysis (red) of the substantia nigra for machine 1.

Tables

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    Table 1:

    Demographic data of the derivation and validation cohorts

    Derivation Cohort Healthy VolunteersValidation Cohort
    Healthy VolunteersPatients with PD
    No. of subjects1135030
    Mean age (yr)52.3 ± 13.154.1 ± 12.256.9 ± 10.5
    Male sex (No.) (%)58 (51.3)25 (50.0)19 (63.3)
    Median UPDRS-III (IQR, range)NANA29.5 (20.5–38.5; 12–47)
    Median Hoehn and Yahr stage (IQR, range)NANA2 (1–3; 1–3)
    L-DOPA therapy (No.) (%)NANA19 (63.3%)
    DA therapy (No.) (%)NANA15 (50.0)
    Mean of disease duration (mo) (range)NANA28.4 ± 12.0 (6–48)
    • Note:—DA indicates dopamine agonist; IQR, interquartile range; NA, not applicable; UPDRS, Unified Parkinson's Rating Scale.

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    Table 2:

    Correlations between manual measurement and digital analysis of substantia nigra echogenicity for both machines, between measurements performed using different machines, and between the right and left substantia nigra using both manual measurement and digital analysis

    CorrelationsSpearman CoefficientP Value
    Between manual measurement and digital analysis for My Lab Twice0.630<.0001
    Between manual measurement and digital analysis for Vivid Pro 70.553<.0001
    Between digital analysis using different machines0.686<.0001
    Between visual measurements using different machines0.721<.0001
    Between the right and left substantia nigra using digital analysis and My Lab Twice0.575<.0001
    Between the right and left substantia nigra using digital analysis and Vivid Pro 70.512.0001
    Between the right and left substantia nigra using manual measurement and My Lab Twice0.494.0003
    Between the right and left substantia nigra using manual measurement and Vivid Pro 70.631<.0001
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American Journal of Neuroradiology: 35 (12)
American Journal of Neuroradiology
Vol. 35, Issue 12
1 Dec 2014
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Cite this article
D. Školoudík, M. Jelínková, J. Blahuta, P. Čermák, T. Soukup, P. Bártová, K. Langová, R. Herzig
Transcranial Sonography of the Substantia Nigra: Digital Image Analysis
American Journal of Neuroradiology Dec 2014, 35 (12) 2273-2278; DOI: 10.3174/ajnr.A4049

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Transcranial Sonography of the Substantia Nigra: Digital Image Analysis
D. Školoudík, M. Jelínková, J. Blahuta, P. Čermák, T. Soukup, P. Bártová, K. Langová, R. Herzig
American Journal of Neuroradiology Dec 2014, 35 (12) 2273-2278; DOI: 10.3174/ajnr.A4049
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