• Daniel Richter, Dirk Woitalla, Siegfried Muhlack, Ralf Gold, Lars Tönges, and Christos Krogias.
• Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany.
• J Neuroimaging. 2017 Sep 1; 27 (5): 524-530.

Background And PurposeThe axial mesencephalic transcranial sonography plane is an established and sensitive diagnostic tool for the differentiation of Parkinson's disease and essential tremor. However, the substantia nigra can also be depicted in a second coronal examination plane, whose diagnostic value has not yet been evaluated. Furthermore, the M-mode tremor frequency determination represents another sonographic tool, which might yield additional diagnostic value.MethodsWe included patients with diagnosed Parkinson's disease (n = 31), essential tremor (n = 16), and healthy age-matched controls (n = 16). All were examined by transcranial sonography in the axial and coronal plane. Tremor frequencies were quantified by an M-mode tremor frequency determination examination protocol. A clinical assessment was conducted in all participants.ResultsThe utilization of a coronal examination plane improved the diagnostic strength in discriminating of Parkinson's disease from essential tremor and healthy controls. In combination with the determination of tremor frequency, best discriminative results were achieved (sensitivity, 90.3%; specificity, 96.9%). In the Parkinson's disease group, we found a significant positive correlation between hyposmia and coronal hyperechogenicity.ConclusionThe combined usage of coronal transcranial sonography and M-mode tremor frequency determination should be considered to improve diagnostic strength of sonographic techniques for the diagnosis of Parkinson's disease.Copyright © 2017 by the American Society of Neuroimaging.

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