目的探讨经颅超声成像（TCS）测量黑质（SN）高回声的面积与双侧黑质高回声总面积/中脑总面积（S/M）诊断帕金森病（PD）的临床价值。方法对92例PD患者（PD组）和98名健康人（健康对照组）进行TCS检查，分别测量中脑及SN高回声面积，计算S/M比值。比较PD组和健康对照组受检者中脑面积、SN高回声面积以及S/M的差异，采用受试者操作特性（ROC）曲线计算两种指标最佳临界点诊断PD的敏感度及特异度，同时计算联合应用2种指标诊断PD的敏感度和特异度。结果PD组患者SN高回声面积、S/M分别为（0．34±0．27）cm 2和（12．15±4．57）％，健康对照组受检者上述指标分别为（0．14±0．08）cm2和（6．37±3．30）％，2组比较差异均有统计学意义（t＝82．68、100．83，P均＜0．01）。 ROC曲线示，SN高回声面积的最佳临界点为0．20 cm2，其敏感度及特异度分别为80．40％、74．50％；S/M的最佳临界点为7．52％，其敏感度及特异度分别为89．10％、63．30％；当2种指标联合应用时，其敏感度及特异度分别为80．40％、78．60％。结论TCS快速、便捷、可重复性强，是PD的重要筛查工具。 SN高回声面积≥0．20 cm 2且S/M＞7．52％联合应用是诊断PD的最佳指标。%Objective To evaluate the clinical value of trascranial sonography (TCS) in measuring hyperechogenic substantia nigra ( SN) area and area ratio of SN to midbrain ( S/M) for the diagnosis of Parkinson′s disease( PD).Methods A total of 109 PD patients ( PD group) and 115 normal controls (control group) underwent TCS.The area of midbrain and SN and the area ratio of S/M were measured and compared between PD group and control group .Statistical analysis of the two parameters in predicting PD was performed with receive operating characteristic ( ROC) curves.The sensitivity and specificity of each parameter and their combination were calculated .Results The hyperechogenic SN area and S/M were (0.34 ±0.27)cm 2 and (12.15 ±4.57)%in PD group,whereas (0.14 ±0.08)cm 2 and (6.37 ±3.30)%in control group respectively .The difference between the two groups was statistically significant (t=82.68, 100.83,both P<0.01).ROC analysis showed that using the cut-off of 0.20 cm 2 for SN hyperechogenicity, the sensitivity and specificity were 80.40%and 74.50%.With the cut-off of 7.52%for S/M,the sensitivity and specificity were 89.10% and 63.30%.By using the combination of SN hyperechogenicity≥0.20 cm 2 and S/M>7.52%,the sensitivity was 80.4%and the specificity was 78.6%.Conclusions TCS is a fast, convenient,effective and useful tool for screening PD .The combination of the SN area and S/M provided the best diagnostic parameters.
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