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@ARTICLE{Stiehm:283119,
      author       = {Stiehm, M. and Nilsson, C. and Skogar, Ö and Walter, U.},
      title        = {{T}he diagnostic value of transcranial sonography in
                      {S}wedish parkinsonism patients: {A} retrospective cohort
                      study with long-term follow-up.},
      journal      = {Clinical parkinsonism $\&$ related disorders},
      volume       = {13},
      issn         = {2590-1125},
      address      = {Amsterdam},
      publisher    = {Elsevier},
      reportid     = {DZNE-2026-00015},
      pages        = {100411},
      year         = {2025},
      abstract     = {Although transcranial sonography (TCS) assessing
                      hyperechogenic substantia nigra (SN+) as biomarker for
                      Parkinsońs disease (PD) has been introduced elsewhere, the
                      clinical relevance and accuracy in a Swedish population is
                      still unknown.This retrospective single-center study
                      included 74 patients with predominantly early-stage
                      parkinsonism at first visit who had been examined by TCS
                      from 2013 to 2017 to determine the SN+ biomarker status in
                      relation to PD, atypical parkinsonian disorders (APS),
                      essential tremor (ET) and vascular/secondary/ unspecified
                      parkinsonism, with the aim of long-term follow-up to confirm
                      the clinical diagnosis. The cut-off value for SN+ was
                      regarded as the 90 $\%$ percentile of SN echogenicity in a
                      local healthy cohort (here, 0.23 cm2).In 2024, the mean
                      follow-up time was 95 months. Three patients (4 $\%)$
                      without transcranial bone were excluded. SN+ was found in
                      38/51 patients with finally diagnosed PD and 4/20 patients
                      with other final clinical diagnoses (p < 0.001). Sensitivity
                      was moderate (75 $\%)$ whereas specificity and the positive
                      predictive value were higher (80 $\%$ and 90 $\%,$
                      respectively). SN area measurements (most abnormal side)
                      were significantly different in PD-patients compared to
                      non-PD patients (n = 63; 0.28 ± 0.09 [95 $\%$ CI:
                      0.25-0.30] cm2 vs. 0.23 ± 0.10 [0.18-0.29] cm2, p
                      0.035).After a follow-up of up to 8 years, to maximize
                      diagnostic certainty, our findings support the use of TCS as
                      a valuable add-on tool in PD diagnostics in a Swedish
                      patient population, already in the early stage of disease
                      but not for screening.},
      keywords     = {Essential tremor (Other) / Hyperechogenicity (Other) /
                      Movement disorders (Other) / Parkinsonism (Other) /
                      Parkinsońs disease (Other) / Substantia nigra (Other) /
                      Transcranial sonography (Other) / Ultrasound (Other)},
      cin          = {AG Storch},
      ddc          = {610},
      cid          = {I:(DE-2719)5000014},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41479687},
      pmc          = {pmc:PMC12754217},
      doi          = {10.1016/j.prdoa.2025.100411},
      url          = {https://pub.dzne.de/record/283119},
}