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This study aimed to further evaluate TCS for clinical diagnosis of PD, and to explore the association between sonographic manifestations and visual hallucinations (VH). A total of 226 subjects including 141 PD patients and 85 controls were recruited. All participants received TCS. A series of rating scales to evaluate motor and non-motor symptoms were performed in PD patients. Results showed that 172 subjects were successfully assessed by TCS. The area of SN was greater in PD patients than that in controls (<jats:italic>P<\/jats:italic>&lt; 0.001). As receiver-operating characteristic (ROC) curve analysis showed, the best cutoff value for the larger SN echogenicity size was 23.5 mm<jats:sup>2<\/jats:sup>(sensitivity 70.3%, specificity 77.0%). Patients with VH had larger SN area (<jats:italic>P<\/jats:italic>= 0.019), as well as higher Non-Motor Symptoms Scale (NMSS) scores (<jats:italic>P<\/jats:italic>= 0.018). Moreover, binary logistic regression analysis indicated that SN hyperechogenicity (odds ratio = 4.227,<jats:italic>P<\/jats:italic>= 0.012) and NMSS scores (odds ratio = 0.027,<jats:italic>P<\/jats:italic>= 0.042) could be the independent predictors for VH. In conclusion, TCS can be used as an auxiliary diagnostic tool for Parkinson\u2019s disease. Increased SN echogenicity is correlated with VH in Parkinson\u2019s disease, possibly because the brain stem is involved in the mechanism in the onset of VH. Further studies are needed to confirm these findings.<\/jats:p>","DOI":"10.1007\/s10072-019-04110-z","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T02:02:26Z","timestamp":1574388146000},"page":"661-667","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Increased substantia nigra echogenicity correlated with visual hallucinations in Parkinson\u2019s disease: a Chinese population-based study"],"prefix":"10.1007","volume":"41","author":[{"given":"Ting","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Qin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongsheng","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Na","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingnian","family":"Ni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianqing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hufang","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoqing","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingqing","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuekai","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangzhu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongyan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1607-5897","authenticated-orcid":false,"given":"Jinzhou","family":"Tian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,11,22]]},"reference":[{"key":"4110_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/2047-9158-1-5","volume":"1","author":"AJ Stoessl","year":"2012","unstructured":"Stoessl AJ (2012) Neuroimaging in the early diagnosis of neurodegenerative disease. 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