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Chinese Journal of Medical Ultrasound (Electronic Edition) ›› 2025, Vol. 22 ›› Issue (10): 944-954. doi: 10.3877/cma.j.issn.1672-6448.2025.10.007

• Head and Neck Ultrasound • Previous Articles    

Transcranial sonography-magnetic resonance fusion imaging reveals spatial characteristics of substantia nigra hyperechogenicity in Parkinson's disease

Chao Hou1,2, Jizhu Xia2, Mingxing Li1,(), Wen He2, Wei Zhang2   

  1. 1 Department of Ultrasound, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
    2 Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
  • Received:2025-05-14 Online:2025-10-01 Published:2025-12-24
  • Contact: Mingxing Li

Abstract:

Objective

To explore the spatial characteristics of substantia nigra hyperechogenicity (SNH) in Parkinson's disease (PD) via transcranial sonography (TCS)-magnetic resonance (MR) fusion imaging.

Methods

Inpatients who were diagnosed with PD in Beijing Tiantan Hospital, Capital Medical University and underwent TCS-MR fusion imaging were prospectively enrolled from November 2023 to October 2024. For fusion images, three dual-sided planes were selected: substantia nigra (SN) 1 (the plane with the largest area of the red nucleus), SN2 (the plane with the largest area of SNH), and SN3 (the plane where the red nucleus is just out of view). ImageJ was used to outline the regions of interest (ROIs) on the fusion images based on the spatial relationships of the coordinates. We recorded the location of SNH in nuclei, calculated echogenicity and pixel values for each ROI, and analyzed the spatial features of SNH.

Results

A total of 164 patients [average age (63.70 ± 7.65) years; 65.24% (107/164) male] with PD were included. SNH could be observed in nuclei beyond the SN, including the red nuclei, the dorsal band of the SN, and the ventral tegmental area. Among 109 cases of left-sided SNH, 18 were localized solely within the SN, 17 were found in the dorsal band of the SN, and the remaining 74 involved at least two nuclei. Conversely, on the right side, 18 out of 79 SNH cases were situated in the SN, 15 in the dorsal band of the SN, and 46 involved two or more nuclei. Two orientations of SNH were identified: medial-lateral (where the long diameter of the SNH is parallel to the long axis of the SN) and anterior-posterior (where the long diameter of the SNH is perpendicular to the long axis of the SN). A total of 66 cases of left SNH exhibited a medial-lateral orientation, while 43 followed an anterior-posterior orientation. On the right side, 62 cases showed a medial-lateral orientation, and 17 were oriented anterior-posteriorly. Compared to those with a medial-lateral orientation, the left SNH cases with an anterior-posterior orientation were characterized by younger age, longer disease duration, higher Hoehn-Yahr stage, narrower third ventricular width, larger SNH area, and a greater proportion of postural instability (P<0.05). Additionally, statistically significant differences were observed in the caudal and rostral distribution, as well as in the nuclei distribution of SNH between the two orientations (P<0.001).

Conclusion

In PD, SNH can extend beyond the SN and has two orientations: medial-lateral and anterior-posterior. The anterior-posterior orientation of the left SNH may reflect a more severe disease state.

Key words: Transcranial sonography, Magnetic resonance imaging, Fusion imaging, Parkinson's disease, Substantia nigra hyperechogenicity

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