Objective: This study aims to investigate the reliability of Transcranial Sonography (TCS) in the diagnosis of Parkinson’s Disease (PD) and its contribution to the differential diagnosis in atypical parkinsonism syndromes.

Background: Transcranial Sonography  (TCS) , which can be used to visualize the brainstem and subcortical brain structures, has begun to be seen as a remarkable method in movement disorders. Studies have reported that increased hyperechogenicity of Substansia Nigra (SN) detected by TCS has high sensitivity and specificity in the diagnosis of PD.

Method: 52 PD patients, 9 other parkinsonism patients ( 4 drug-induced parkinsonism, 2 multiple system atrophy, 1 progressive supranuclear palsy, 1 corticobasal degeneration, 1 vascular parkinsonism ) and 54 healthy individuals were included in the study and divided into 3 groups. SN of all individuals were evaluated by the same neurosonologist using TCS blindly applied to the diagnosis of the patient, and the hyperechogenic area was measured. The cut off value was determined as 0.24 cm². These measurements were compared between PD, other parkinsonism patients and healthy individuals. In addition, hyperechogenic areas were compared according to the PD subtypes (akinetic rigid, tremor dominant, postural instability), dominant disease side, disease severity and duration.

Results: SN hyperechogenic area values of the healthy group were lower than those of the patient groups, while the SN hyperechogenic areas of the PD group had the highest value. The specificity of TCS in the diagnosis of PD was 87.5, and its sensitivity was 73.3. Higher hyperechogenicity was observed in the akinetic rigid subtype. A low correlation in the same direction was found between disease age, UPDRS II and III score and hyperechogenicity. There was no relationship between disease side, disease duration, H&Y stage and hyperechogenicity in PD.

Conclusion: In this study, it has been shown that the determination of SN hyperechogenicity with TCS in PD has a diagnostic value and can be useful in differential diagnosis of atypical parkinsonism disorders. In order to benefit from TCS in the diagnosis of other parkinsonism; It was thought that evaluation of only the SN is insufficient, and it is necessary to evaluate the mesencephalon, other basal ganglia and the third ventricle.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-different-radiological-perspective-on-parkinsons-disease-and-parkinsonism-transcranial-sonography/