Ultrasound Evaluation of Substantia Nigra in Patients with Parkinsonian Syndromes

Authors: P. Bártová 1;  D. Školoudík 1,2;  T. Fadrná 1;  P. Ressner 3;  M. Bar 1;  R. Herzig 2;  P. Kaňovský 2
Authors‘ workplace: Neurologická klinika FNsP Ostrava 1;  Neurologická klinika LF UP a FN Olomouc 2;  Neurologické oddělení nemocnice Nový Jičín 3
Published in: Cesk Slov Neurol N 2007; 70/103(6): 653-657
Category: Original Paper

Předneseno formou přednášky na 16th Meeting of the European Neurological Society, Lausanne, Švýcarsko, 29. 5. 2006, 21. sjezdu Slovenských a českých mladých neurologů, Martin, Slovensko, 17. 2. 2006, 6. neurosonologických dnnech v Olomouci 5. 5. 2006 a formou posteru na 10th Congress of the European Federation of Neurological Societies, Glasgow, UK 4. 9. 2006 a 10th International Congress of Parkinsons disease and Movement Disorders, Kyoto, Japonsko 2. 11. 2006.


The hyperechogenic and extended area of the substantia nigra is detectable in more than 90 % of patients with Parkinson's disease (PD). However, its maximum rate of incidence in healthy population is 10 %. The objective of our study was to detect the rate of incidence of hyperechogenic or extended substantia nigra in patients with atypical Parkinsonian syndrome (APS).

Over 15 months, we performed transcranial sonography in 209 patients with PD, multisystem atrophy (MSA), vascular Parkinsonian syndrome (VPS) and essential tremor (ET). Both PD and healthy patients were selected for the control group.

Hyperechogenic SN was detected in 42.9 % patients with MSA, in 10 % with ET and in 18.2 % with VP. The rate of incidence of extended area of SN larger than 0.25 cm2 was 50 % for patients with MSA, 20 % for patients with VPS and 27.3 % for patients with ET. The rate of incidence of the hyperechogenic, extended area of SN was significantly higher in PD patients (84.7 %) and MSA patients (50 %) (p > 0.05) as compared with VPS patients (27.3 %), ET patients (20 %) and healthy volunteers (0 %).

The rate of incidence of hyperechogenic, extended area of SN is significantly higher in patients with PD and MSA. TCS detection of SN can be used as an additional method in differential diagnostics of PD and of atypical Parkinsonian syndromes.

Key words:
transcranial sonography – substantia nigra – multisystem atrophy – vascular parkinsonism – essential tremor


1. Behnke S, Berg D, Naumann M, Becker G. Differentiation of Parkinson’s disease and atypical parkinsonian syndromes by transcranial ultrasound. J Neurol Neurosurg Psychiatry 2005; 76: 423–425.

2. Walter U, Niehaus L, Probst T, Benecke R, Meyer BU, Dressler D. Brain parenchyma sonography discriminates Parkinson’s disease and atypical parkinsonian syndromes. Neurology 2003; 60: 74–77.

3. Schrag A, Good CD, Miszkiel K, Morris HR, Mathias CJ, Lees AJ et al. Differentiation of Atypical Parkinsonian Syndromes with Routine MRI. Neurology 2000; 54: 697–702.

4. Růžička E, Roth J, Kaňovský P, Sekyrová M, Urgošík D, Vladyka V. Parkinsonova nemoc a parkinsonské syndromy. Praha: Galén 2000: 118–165.

5. Gilman S, Low P, Quinn N, Albanese A, Ben-Shlomo Y, Fowler C et al. Consensus statement on the diagnosis of multiple system atrophy. American Autonomic Society and American Academy of Neurology. Clinical Auton Res 1998; 8: 359–362.

6. Brucke T, Asenbaum S, Pirker W, Djamshidian S, Wenger S, Wober C et al. Measurement of the Dopaminergic Degeneration in Parkinson’s Disease with [123I]-CIT and SPECT: Correlation with Clinical Findings and Comparison with Multiple System Atrophy and Progressive Supranuclear Palsy. J Neural Transmit 1997; 50(Suppl.): 9–24.

7. Booij J, Speelman JD, Horstink MW, Wolters EC. The Clinical Benefit of Imaging Striatal Dopamine Transporters with [123I]FP-CIT SPECT in Differentiating Patients with Presynaptic Parkinsonism from those with Other Forms of Parkinsonism. Eur J Nuclear Med 2001 Mar; 28: 266–272.

8. Asenbaum S, Pirker W, Angelberger P, Bencsits G, Pruckmayer M, Brucke T. [123I] beta-CIT and SPECT in Essential Tremor and Parkinson’s Disease. J Neural Transm 1998; 105: 1213–1228.

9. Becker G, Berg D. Neuroimaging in basal ganglia disorders: perspectives for transcranial ultrasound. Mov Disord 2001; 16: 23–32.

10. Berg D, Becker G, Zieler B, Tucha O, Hofman E, Preier M et al. Vulnerability of the nigrostriatal system as detected by transcranial ultrasound. Neurology 1999; 53: 1026–1031.

11. Becker G, Seufert J, Bogdahn U, Reichmann H, Reiners K. Degeneration of substantia nigra in chronic Parkinson´s disease visualized by transcranial color-coded real-time sonography. Neurology 1995; 45: 182–184.

12. Berg D, Grote C, Rausch WD, Maurer M, Wesemann W, Riederer P et al. Iron accumulation of the substantia nigra in rats visualized by ultrasound. Ultrasound Med Biol 1999; 25: 901–904.

13. Berg D, Roggendorf W, Schroder U, Klein R, Tatschner T, Benz P et al. Echogenicity of substantia nigra association with increased iron content and marker for susceptibility to nigrostriatal injury. Arch Neurol 2002; 59: 999–1005.

14. Ressner P, Školoudík D, Kaňovský P. Echogenita substantia nigra u Parkinsonovy nemoci - pilotní studie. Ces Slov Neurol N 2006; 102: 376–379.

15. Niehaus L, Savyer N, Weber U, Hertel R, Trottenberg T, Kupsch A. Brain parenchyma sonography in patients with essential tremor and Parkinson´s disease. Cerebrovasc Dis 2004; 17(Suppl 4): 3 [abstract].

16. Jankovic J. Essencial Tremor: clinical characteristics. Neurology 2000; 54 (Suppl 4): S21-S5.

17. Thanvi B, Lo N, Robinson T. Vascular parkinsonism - an important cause of parkinsonism in older people. Age and Ageing 2005; 34: 114–119.

18. Demirkiran M, Bozdemir H, Sarica Y. Vascular Parkinsonism: a distinct, heterogenous clinical entity. Acta Neurol Scand 2001; 104: 63–67.

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