Substantia nigra echogenicity correlated with clinical features of Parkinson's disease Hai-Yan Zhou a, 1 , Qian Sun a, 1 , Yu-Yan Tan a , Yun-Yun Hu b , Wei-Wei Zhan b , Dun-Hui Li a , Ying Wang a , Qin Xiao a , Jun Liu a, ** , Sheng-Di Chen a, * a Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China b Department of Ultrasonography, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China article info Article history: Received 8 August 2015 Received in revised form 21 January 2016 Accepted 21 January 2016 Keywords: Parkinson's disease Transcranial sonography Substantia nigra Disease severity Chinese abstract Background: Transcranial sonography can display structural alterations in the substantia nigra (SN) of patients with Parkinson's disease (PD), and is considered to be a potential useful tool for the diagnosis of PD. The aim of this study was to assess the correlation between SN echogenicity and clinical features in Chinese patients with PD. Methods: A total of 420 subjects including 290 patients with PD and 130 controls were recruited from the neurological clinic or the community. Transcranial sonographic evaluations of the SN were per- formed in all subjects, and motor and non-motor symptoms were thoroughly assessed by a series of rating scales in PD patients. Results: Two hundred and one patients were successfully assessed by transcranial sonography. SN hyperechogenicity was found to be associated with male sex (p ¼ 0.004), higher scores on the Unified Parkinson's Disease Rating Scale (UPDRS) part II (p ¼ 0.001) and autonomic symptoms scores (p ¼ 0.003). Moreover, regression analysis revealed that UPDRS part II scores (odds ratio ¼ 1.141, p < 0.001) and gender (odds ratio ¼ 2.409, p ¼ 0.007) could be the independent predictors for SN hyperechogenicity; in addition, among all items of UPDRS part II, speech, dressing, hygiene, and turning in bed and adjusting bed clothes significantly correlated with SN hyperechogenicity. Conclusions: This is the first report suggesting the correlation between SN echogenicity and UPDRS part II, and we conclude that increased SN echogenicity might reflect more severe disease disability or poorer medical response. © 2016 Published by Elsevier Ltd. 1. Introduction Parkinson's disease (PD) is the second most common neurode- generative disorder and is associated with the progressive loss of dopaminergic neurons in the substantia nigra (SN). Transcranial sonography (TCS) is a convenient and noninvasive diagnostic technique that allows imaging of the brain parenchyma in two- dimensional black and white slices. TCS can display specific structural changes in the SN of PD patients, and hyperechogenicity in the anatomical area of the SN is believed to be a marker of PD [1,2]. Based on fluorodopa positron emission tomography (PET) studies, enlarged hyperechogenic size of the SN is considered to be associated with functional impairment of the nigrostriatal system [3]. Previous studies have suggested that SN hyperechogenicity (SNþ) is associated with the disease severity, although the findings are conflicting [2,4e8]. To date, TCS data from Chinese patients with PD are limited [9,10]. Our study aimed to evaluate the corre- lation of the sonographic findings with the clinical features in Chinese PD patients including motor and non-motor characteristics. 2. Subjects and methods 2.1. Subjects From March 2014 to May 2015, two hundred and ninety patients * Corresponding author. Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. ** Corresponding author. Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. E-mail addresses: jly0520@hotmail.com (J. Liu), chen_sd@medmail.com (S.-D. Chen). 1 These authors made an equal contribution to this work. Contents lists available at ScienceDirect Parkinsonism and Related Disorders journal homepage: www.elsevier.com/locate/parkreldis http://dx.doi.org/10.1016/j.parkreldis.2016.01.021 1353-8020/© 2016 Published by Elsevier Ltd. Parkinsonism and Related Disorders xxx (2016) 1e6 Please cite this article in press as: H.-Y. Zhou, et al., Substantia nigra echogenicity correlated with clinical features of Parkinson's disease, Parkinsonism and Related Disorders (2016), http://dx.doi.org/10.1016/j.parkreldis.2016.01.021