title: Transcranial color-coded sonography helps differentiation between idiopathic Parkinson's disease and vascular parkinsonism.
abstract: BACKGROUND
  Recently, transcranial color-coded sonography (TCCS) has been found to have a diagnostic value in patients with idiopathic Parkinson's disease (IPD), which displays increased hyperechogenicity at the substantia nigra (SN).
  
  
  OBJECTIVE
  To use TCCS, to assess the difference in SN hyperechogenicity and intracranial hemodynamics among subjects with IPD, vascular parkinsonism (VP) and controls.
  
  
  METHODS
  Eighty IPD and 30 VP patients, and 60 controls were recruited into this study. The hyperechogenicity area at the SN and midbrain were calculated by encircling the outer circumference from the ipsilateral temporal window, using TCCS in each subject. The hemodynamics of intracranial large arteries, including flow velocity and pulsatility index (PI), were also measured.
  
  
  RESULTS
  The presence of SN hyperechogenicity was significantly higher in the IPD patients than in the VP patients and controls (84% vs. 20% & 5%, respectively, p < 0.001). In IPD patients, the SN hyperechogenicity was correlated with the neurological severity and disease duration. Twenty-five (66.7%) VP patients had obvious vascular abnormality, as seen in TCCS study. The mean PI was significantly more elevated in the VP patients than those in the IPD patients and controls (all p < 0.05), but there was no significant difference of flow velocities among the VP, IPD patients and controls.
  
  
  CONCLUSIONS
  TCCS, combining B-mode imaging for SN echogenicity and trancranial Doppler for intracranial hemodynamics, is a useful diagnostic tool in the differentiation between IPD and VP. These findings also suggest that multiple subcortical vascular lesions may damage the basal ganglia and thalamocortical circuit and result in parkinsonism features in VP patients.
authors.affiliation: Department of Neurology, Cardinal Tien Hospital, Taipei, Taiwan.
authors.forename: Chung-Fen
authors.initials: CF
authors.lastname: Tsai
authors.forename: Ruey-Meei
authors.initials: RM
authors.lastname: Wu
authors.forename: Yu-Weng
authors.initials: YW
authors.lastname: Huang
authors.forename: Li-Ling
authors.initials: LL
authors.lastname: Chen
authors.forename: Ping-Keung
authors.initials: PK
authors.lastname: Yip
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
mesh_terms: D000368:Aged; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010302:Parkinson Disease, Secondary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013378:Substantia Nigra / Q000000981:diagnostic imaging; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*