title: Transcranial Parenchymal Sonographic Findings in Patients With Cerebral Small Vessel Disease: A Preliminary Study.
abstract: OBJECTIVE
  Patients with cerebral small vessel disease often present with various motor, cognitive, and emotional changes, including gait disturbances, parkinsonism, and depression. Substantia nigra hyperechogenicity, brain stem raphe hypoechogenicity, ventricle diameters, and sonographic characteristics of other brain structures on transcranial sonography have been increasingly used as biomarkers in a range of neurologic diseases. We aimed to explore the frequency and clinical correlates of transcranial sonographic findings in symptomatic patients with small vessel disease.
  
  
  METHODS
  In a cross-sectional study, neurologic, cognitive, and emotional statuses and transcranial sonographic and magnetic resonance imaging findings were compared between 102 patients with small vessel disease and 45 healthy age- and sex-matched control participants.
  
  
  RESULTS
  Compared to healthy controls, small vessel disease cases had more frequent brain stem raphe hypoechogenicity (55.9% versus 11.1%; P < .0001), substantia nigra hyperechogenicity (30.4% versus 11.1%; P = .022), and enlarged third ventricles (P < .0001). Substantia nigra hyperechogenicity correlated with gait disturbances, extrapyramidal features, and cognitive impairment. Brain stem raphe hypoechogenicity was associated with the diagnosis of depression. Enlargement of the third and lateral ventricles was more frequent in patients with cognitive impairment. Pathologic substantia nigra hyperechogenicity and enlarged ventricles were associated with the severity of cerebral ischemic lesions.
  
  
  CONCLUSIONS
  Transcranial sonography shows pathologic findings in a substantial number of patients with small vessel disease, probably reflecting disruption of frontostriatal pathways.
authors.affiliation: Faculty of Medicine, University of Belgrade, Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia. aleksandra3003@yahoo.com.
authors.forename: Aleksandra M
authors.initials: AM
authors.lastname: Pavlović
authors.affiliation: Faculty of Medicine, University of Belgrade, Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Pekmezović
authors.affiliation: Faculty of Medicine, University of Belgrade, Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Zagorka
authors.initials: Z
authors.lastname: Jovanović
authors.affiliation: Faculty of Medicine, University of Belgrade, Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Tamara Svabic
authors.initials: TS
authors.lastname: Medjedović
authors.affiliation: Faculty of Medicine, University of Belgrade, Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Nikola
authors.initials: N
authors.lastname: Veselinović
authors.affiliation: Faculty of Medicine, University of Belgrade, Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Melanie C
authors.initials: MC
authors.lastname: Norton
authors.affiliation: Faculty of Medicine, University of Belgrade, Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Nada
authors.initials: N
authors.lastname: Sternić
mesh_terms: D000328:Adult; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*
keywords: neurosonology; small-vessel disease; transcranial parenchymal sonography; vascular cognitive impairment; vascular depression; white matter hyperintensities