Diagnostic value of transcranial sonography and ultrasound fusion imaging for the detection and treatment of Parkinson’s disease

Transcranial sonography and MRI - fusion ultrasound can serve as a screening tool for detecting the preclinical stage and differential diagnosis of Parkinson's disease, as well as a tool for monitoring the treatment process and deep brain stimulation.

Transcranial B-mode sonography (TCS) is a non-invasive neuroimaging  method that allows high resolution imaging of deep brain structures.  The classical TCS finding of substantia nigra hyperechogenicity (SN) is widely acknowledged as a diagnostic tool for the  idiopatic Parkinson disease (PD)  in the guidlines of the European neurological societies (EAN, MDS-ES).

A growing number of longitudinal studies suggest that TCS of SN may serve as a screening tool for selection subjects at risc of developing PD and even predict parkinsonism-dominant phenotypes in several hereditary disorders. Novel technologies for automatically detected brain structures such as a combination of pre-registered magnetic resonance imaging (MRI) with real-time transcranial ultrasound, known as ultrasound fusion imaging, are beeing widely tested for the accurate detection of SN microstructure  ,as well as insular and hyppocampal structures. The application of this method is used for the intra- and postoperative localisation of electrodes for deep brain stimulation for the treatment of PD and  dystonia.


Key points:

  • Parkinson's disease
  • transcranial sonography
  • substantia nigra
  • magnetic resonance -transcranial ultrasound fusion imaging
  • deep brain stimulation



TCS applications: which are in the guidlines? Which are in the pipelines? Uwe Walter, abstracts of the 24th Meeting of the European Society of Neurosonology and Cerebral Hemodynamics joint meeting with Neurosonology Research Group, Linz, 5-7 April, 2019 ,p. 47

Sonographic alteration of substantia nigra is related to parkinsonism-predominant course of X-linked dystonia-parkinsonism  Uwe Walte, R L Rosales, A Rocco, A Domingo,   et al.,Parkinsonism & Related Disorders 37 · January 2017

Transcranial Sonography (TCS) of Brain Parenchyma in Movement Disorders: Quality Standards, Diagnostic Applications and Novel Technologies U. Walter1,D.Školoudík   Ultraschall in Med 2014; 35: 322–331

Magnetic resonance-tran scranial ultrasound fusion imaging: A novel tool for brain electrode Walter U, Müller JU, Rösche J, Kirsch M, Grossmann A, Benecke R, Wittstock M, Wolters A   Mov Disord. 2016 Mar;31(3):302-9.