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Título

ASSESSMENT OF CONCORDANCE BETWEEN ULTRA-PORTABLE ULTRASOUND EQUIPMENT AND A TRADITIONAL ONE FOR THE DIAGNOSIS OF PARKINSON’S DISEASE BY TRANSCRANIAL SONOGRAPHY

Resumo

Abstract
Introduction: The diagnosis of Parkinson's disease (PD) is clinical. Transcranial sonography (TCS) is used to assist in the diagnosis of PD, revealing an increase in echogenicity of the substantia nigra (SN) with an accuracy of 80-90%. With the advance in technology, ultrasound (US) equipment is becoming ever more portable, allowing the use of this method even in places with difficult access to traditional systems. There are still no studies to determine the accuracy of TCS performed on ultra-portable (UP) equipment within the field of PD.
Objective: To verify the accuracy of the Lumify (Philips Medical Systems) UP equipment by differentiating data from healthy control subjects and from patients with PD and assessing the concordance between measures obtained from this equipment and traditional equipment.
Methods: In this cross-sectional study, TCS was performed on 129 subjects, between September 2019 and July 2021, separated into two groups, one with healthy controls and the other with PD in the Outpatient Clinics for PD at the Hospital Universitário Gaffrée e Guinle da Universidade Federal do Estado do Rio de Janeiro / Empresa Brasileira de Serviços Hospitalares or in the Clinic for Movement Disorders at the Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. The tests were performed by insonation of the temporal bone window (TW) of healthy individuals and patients with PD. The parameters obtained in accordance with protocols established were: assessment of the quality of the TW and the size of the third ventricle. In addition to the measurement of the mesencephalon area and the SN hyperechogenicity, which, in the UP equipment, were performed by automatic measurement of an ellipse and, in the traditional one, by manual delineation of its borders.
Results: The accuracy of the UP equipment for the diagnosis of PD was 93%, with a sensitivity of 98.3% and specificity of 86.7%, with a cut-off point of the SN area >0.20 cm². The highest concordance was the assessment of the quality of the TW (Kappa index of 100% for the right TW and 83% for the left). The SN measurements presented with higher indices of concordance: ICC= 90% for the right SN and 93% for the left. The highest concordance between the systems was the measurement of the third ventricle (ICC 96%).
Conclusions: The UP ultrasound is an accurate tool for PD diagnosis, and could be a valuable, practical, fast, and great potential bedside method.

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Keywords: Ultra-portable transcranial ultrasound, Parkinson's disease, Substantia nigra.