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BACKGROUND AND PURPOSE:Increased echogenicity of the substantia nigra is a typical transcranial sonography finding in Parkinson disease. Experimental software for digital analysis of the echogenic substantia nigra area has been developed. The aim of this study was to compare the evaluation of substantia nigra echogenicity by using digital analysis with a manual measurement in patients with Parkinson disease and healthy volunteers.

Objective. The aim of this study was to assess the correlation between substantia nigra (SN) echogenic features and area and the clinical symptoms in patients with Parkinson disease (PD). Methods. Clinical examinations and transcranial sonographic evaluations of the SN were performed in 115 consecutive patients with PD. The presence of tremors, rigidity, bradykinesia, gait disorders, speech disorders, and hypomimia was evaluated according to the motor portion of the Unified Parkinson Disease Rating Scale. The Mann-Whitney U test, the Kruskal-Wallis test, analysis of variance, and multivariate analysis were applied when assessing statistical significance. Results. An enlarged and hyperechoic SN existed in 84.0% of patients with bilateral rigidity but in only 70.6% of patients with unilateral rigidity (P < .05). Similarly, 85.0% of patients with bilateral bradykinesia in comparison with 65.7% of patients with unilateral bradykinesia had an enlarged and hyperechoic SN (P < .05). A significant correlation was shown between the SN echogenicity and area (r = 0.705; P < .01). Conclusions. An enlarged and hyper echoic SN seems to be a marker of structural involvement of the SN in patients with PD. This structural involvement is expressed more in patients with bilateral rigidity and bradykinesia. Key words: bradykinesia; Parkinson disease; substantia nigra; transcranial sonography; tremor. Moreover, studies published so far have shown that TCS-detectable changes of SN echogenicity are not strictly specific only for PD, but they are also more frequent in other movement disorders than in the healthy population. [2][3][4]7,11 An enlarged and hyperechoic SN can be detected in 9% to 50% of patients with multiple system atrophy, [12][13][14] in 20% to 40% of patients with vascular parkinsonism, 15,16 in 90% of patients with corticobasal degeneration, 12,17 and in up to 97% of patients with Lewy body dementia.

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