Echogenicity of Brain Structures in Huntington’s Disease Patients Evaluated by Transcranial Sonography – Magnetic Resonance Fusion Imaging using Virtual Navigator and Digital Image Analysis

Abstract

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.

Zusammenfassung

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.

Keywords

Head/Neck - Neurology - Physics and Technology

Publication History

Received: 07 November 2022

Accepted after revision: 29 March 2023

Article published online:
24 May 2023

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