Abstract：
OBJECTIVE: Transcranial brain parenchyma sonography (TCS) has been recommended as a tool for the early and differential diagnosis of Parkinson\'s disease (PD) in German and European clinical guidelines. Still, the brain structures to be examined for the diagnostic questions and the requirements for being a qualified investigator were not specified in detail. These issues have now been addressed in the 2023 update of the clinical guideline on PD by the German Society of Neurology (DGN).
METHODS: The recommendations were based on a systematic literature review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS: Three diagnostic questions were defined: (1) What is the accuracy of TCS in the differential diagnosis of PD versus atypical and secondary Parkinsonian syndromes? (2) What is the accuracy of TCS in the differential diagnosis of PD versus essential tremor? (3) What is the accuracy of TCS in the diagnosis of PD in persons with typical early symptoms, compared with the diagnosis established by clinical follow-up? The brain structures to be assessed and the level of recommendation were formulated for these questions. The training requirements for being regarded as qualified TCS investigator were stipulated by the responsible medical societies (German Society of Ultrasound in Medicine, DEGUM; German Society for Clinical Neurophysiology and Functional Imaging, DGKN). Finally, the recommendations for these diagnostic questions reached strong consensus (each ≥ 97%) of the guideline committee. Here, the details of review and recommendations are presented.
CONCLUSIONS: The updated guideline clarifies the diagnostic uses and limitations of TCS in PD.
METHODS: The recommendations were based on a systematic literature review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS: Three diagnostic questions were defined: (1) What is the accuracy of TCS in the differential diagnosis of PD versus atypical and secondary Parkinsonian syndromes? (2) What is the accuracy of TCS in the differential diagnosis of PD versus essential tremor? (3) What is the accuracy of TCS in the diagnosis of PD in persons with typical early symptoms, compared with the diagnosis established by clinical follow-up? The brain structures to be assessed and the level of recommendation were formulated for these questions. The training requirements for being regarded as qualified TCS investigator were stipulated by the responsible medical societies (German Society of Ultrasound in Medicine, DEGUM; German Society for Clinical Neurophysiology and Functional Imaging, DGKN). Finally, the recommendations for these diagnostic questions reached strong consensus (each ≥ 97%) of the guideline committee. Here, the details of review and recommendations are presented.
CONCLUSIONS: The updated guideline clarifies the diagnostic uses and limitations of TCS in PD.
摘要：
目的：在德国和欧洲临床指南中，经颅脑实质超声检查（TCS）已被推荐为帕金森病（PD）的早期和鉴别诊断工具。尽管如此，没有详细说明诊断问题需要检查的大脑结构以及成为合格研究者的要求.现在，这些问题已在德国神经病学会（DGN）2023年更新的PD临床指南中得到解决。
方法：建议基于PRISMA（系统评价和荟萃分析的首选报告项目）指南的系统文献综述。
结果：定义了三个诊断问题：（1）TCS在PD与非典型和继发性帕金森综合征的鉴别诊断中的准确性如何？（2）TCS在PD与特发性震颤的鉴别诊断中的准确性如何？（3）TCS在具有典型早期症状的人中诊断PD的准确性如何，与临床随访确定的诊断相比？针对这些问题制定了要评估的大脑结构和推荐水平。被视为合格的TCS研究者的培训要求由负责任的医学学会（德国医学超声学会，德国临床神经生理学和功能成像学会，DGKN）。最后,这些诊断问题的建议在指南委员会达成了强烈共识(各≥97%).这里,详细的审查和建议。
结论：更新的指南阐明了TCS在PD中的诊断用途和局限性。
方法：建议基于PRISMA（系统评价和荟萃分析的首选报告项目）指南的系统文献综述。
结果：定义了三个诊断问题：（1）TCS在PD与非典型和继发性帕金森综合征的鉴别诊断中的准确性如何？（2）TCS在PD与特发性震颤的鉴别诊断中的准确性如何？（3）TCS在具有典型早期症状的人中诊断PD的准确性如何，与临床随访确定的诊断相比？针对这些问题制定了要评估的大脑结构和推荐水平。被视为合格的TCS研究者的培训要求由负责任的医学学会（德国医学超声学会，德国临床神经生理学和功能成像学会，DGKN）。最后,这些诊断问题的建议在指南委员会达成了强烈共识(各≥97%).这里,详细的审查和建议。
结论：更新的指南阐明了TCS在PD中的诊断用途和局限性。
