{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T06:01:28Z","timestamp":1793685688763,"version":"4.5.1"},"reference-count":51,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T00:00:00Z","timestamp":1653350400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPD"],"published-print":{"date-parts":[[2022,5,24]]},"abstract":"<jats:p>Background: Essential tremor (ET) and the tremor of Parkinson\u2019s disease (PD) are the most common tremors encountered in clinical practice. Especially in early disease stages, discrimination between the tremors of ET and PD can be challenging. Objective: The aim of this study was to evaluate the diagnostic accuracy of transcranial sonography (TCS) of the substantia nigra echogenicity for differential diagnosis of PD versus ET. Methods: A systematic PubMed search identified 512 studies. Sensitivity and specificity of substantia nigra hyperechogenicity was estimated. Data synthesis was carried applying a random effects bivariate binomial model. To assess study quality and risk of bias, the QUADAS-2 tool was used. Results: Eighteen studies were suitable for analysis including 1,264 PD and 824 ET patients. The meta analysis showed a pooled sensitivity and specificity for TCS in the differential diagnosis of PD versus ET of 84.6% (95% CI, 79.4\u201388.6%) and 83.9% (95% CI, 78.4\u201388.2%), respectively. Furthermore, we found nearly similar results in sensitivity and specificity comparing TCS and DaTSCAN in a subgroup-analysis of three studies using both diagnostic tools including 107 patients with PD and 62 patients with ET. The QUADAS-2 toolbox revealed a high risk of bias regarding the methodological quality of patient selection. Conclusion: Substantia nigra hyperechogenicity yield high diagnostic accuracy for the discrimination of PD from ET. TCS is a low cost, widely available, non-invasive marker without radiation Therefore, a diagnostic algorithm based on presence or absence of substantia nigra hyperechogenicity is highly warranted.<\/jats:p>","DOI":"10.3233\/jpd-213012","type":"journal-article","created":{"date-parts":[[2022,2,18]],"date-time":"2022-02-18T11:50:27Z","timestamp":1645185027000},"page":"1115-1123","source":"Crossref","is-referenced-by-count":28,"title":["Differentiating Parkinson\u2019s Disease from Essential Tremor Using Transcranial Sonography: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"12","author":[{"given":"Beatrice","family":"Heim","sequence":"first","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Peball","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Hammermeister","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atbin","family":"Djamshidian","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Krismer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Seppi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"key":"10.3233\/JPD-213012_ref1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s12883-018-1072-x","article-title":"Parkinson\u2019s Disease Diagnostic Observations (PADDO): Study rationale and design of a prospective cohort study for early differentiation of parkinsonism","volume":"18","author":"van Rumund","year":"2018","journal-title":"BMC Neurol"},{"key":"10.3233\/JPD-213012_ref2","doi-asserted-by":"crossref","first-page":"17013","DOI":"10.1038\/nrdp.2017.13","article-title":"Parkinson disease","volume":"3","author":"Poewe","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"10.3233\/JPD-213012_ref3","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1007\/s00702-017-1717-8","article-title":"Magnetic resonance imaging for the diagnosis of Parkinson\u2019s disease","volume":"124","author":"Heim","year":"2017","journal-title":"J Neural Transm (Vienna)"},{"key":"10.3233\/JPD-213012_ref4","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/bs.irn.2018.08.010","article-title":"Structural imaging in atypical parkinsonism","volume":"142","author":"Heim","year":"2018","journal-title":"Int Rev Neurobiol"},{"key":"10.3233\/JPD-213012_ref5","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S1474-4422(11)70214-9","article-title":"Advances in imaging in Parkinson\u2019s disease","volume":"10","author":"Stoessl","year":"2011","journal-title":"Lancet Neurol"},{"key":"10.3233\/JPD-213012_ref6","doi-asserted-by":"crossref","first-page":"117563","DOI":"10.1016\/j.jns.2021.117563","article-title":"Mild cognitive impairment, dementia and risk of mortality in essential tremor: A longitudinal prospective study of elders","volume":"428","author":"Delgado","year":"2021","journal-title":"J Neurol Sci"},{"key":"10.3233\/JPD-213012_ref7","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jclinepi.2009.06.005","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"62","author":"Moher","year":"2009","journal-title":"J Clin Epidemiol"},{"key":"10.3233\/JPD-213012_ref8","first-page":"529","article-title":"QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"Whiting","year":"2011","journal-title":"AnnIntern Med"},{"key":"10.3233\/JPD-213012_ref9","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1002\/jrsm.1439","article-title":"Graphical enhancements to summary receiver operating characteristic plots to facilitate the analysis and reporting of meta-analysis of diagnostic test accuracy data","volume":"12","author":"Patel","year":"2021","journal-title":"Res Synth Methods"},{"key":"10.3233\/JPD-213012_ref10","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12874-019-0724-x","article-title":"Development of an interactive web-based tool to conduct and interrogate meta-analysis of diagnostic test accuracy studies: MetaDTA","volume":"19","author":"Freeman","year":"2019","journal-title":"BMC Med Res Methodol"},{"key":"10.3233\/JPD-213012_ref11","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.1002\/sim.942","article-title":"A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations","volume":"20","author":"Rutter","year":"2001","journal-title":"Stat Med"},{"key":"10.3233\/JPD-213012_ref12","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1111\/ene.13988","article-title":"Substantia nigra hyperechogenicity in essential tremor and Parkinson\u2019s disease: A longitudinal study","volume":"26","author":"Cardaioli","year":"2019","journal-title":"Eur J Neurol"},{"key":"10.3233\/JPD-213012_ref13","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1590\/0004-282x20180067","article-title":"Is transcranial sonography useful for diagnosing Parkinson\u2019s disease in clinical practice?","volume":"76","author":"Grippe","year":"2018","journal-title":"Arq Neuropsiquiatr"},{"key":"10.3233\/JPD-213012_ref14","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1471-2377-12-12","article-title":"Specificity of transcranial sonography in parkinson spectrum disorders in comparison to degenerative cognitive syndromes","volume":"12","author":"Lau\u010dkait\u0117","year":"2012","journal-title":"BMC Neurol"},{"key":"10.3233\/JPD-213012_ref15","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1471-2377-14-54","article-title":"Ultrasonographic (TCS) and clinical findings in overlapping phenotype of essential tremor and Parkinson\u2019s disease (ET-PD)","volume":"14","author":"Lau\u010dkait\u0117","year":"2014","journal-title":"BMC Neurol"},{"key":"10.3233\/JPD-213012_ref16","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1600-0404.2008.01056.x","article-title":"Distinguishing Parkinson\u2019s disease and essential tremor with transcranial sonography","volume":"119","author":"Budisic","year":"2009","journal-title":"Acta Neurol Scand"},{"key":"10.3233\/JPD-213012_ref17","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1111\/jon.12441","article-title":"Coronal transcranial sonography and M-mode tremor frequency determination in Parkinson\u2019s disease and essential tremor","volume":"27","author":"Richter","year":"2017","journal-title":"J Neuroimaging"},{"key":"10.3233\/JPD-213012_ref18","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.nrl.2014.03.010","article-title":"Diagnostic value of combined assessment of olfaction and sustantia nigra hyperechogenicity for Parkinson\u2019s disease","volume":"30","author":"L\u00f3pez Hern\u00e1ndez","year":"2015","journal-title":"Neurologia"},{"key":"10.3233\/JPD-213012_ref19","doi-asserted-by":"crossref","first-page":"2069","DOI":"10.7863\/ultra.33.12.2069","article-title":"Sonography for diagnosis of Parkinson disease-from theory to practice: A study on 300 participants","volume":"33","author":"Alonso-C\u00e1novas","year":"2014","journal-title":"J Ultrasound Med"},{"key":"10.3233\/JPD-213012_ref20","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1016\/j.ultrasmedbio.2014.05.014","article-title":"Transcranial sonography and (123)I-FP-CIT single photon emission computed tomography in movement disorders","volume":"40","author":"B\u00e1rtov\u00e1","year":"2014","journal-title":"Ultrasound Med Biol"},{"key":"10.3233\/JPD-213012_ref21","first-page":"S28","article-title":"Transcranial sonography on Parkinson\u2019s disease and essential tremor","volume":"18","author":"Chitsaz","year":"2013","journal-title":"J Res Med Sci"},{"key":"10.3233\/JPD-213012_ref22","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1002\/mds.21861","article-title":"Brain parenchyma sonography and 123I-FP-CIT SPECT in Parkinson\u2019s disease and essential tremor","volume":"23","author":"Doepp","year":"2008","journal-title":"Mov Disord"},{"key":"10.3233\/JPD-213012_ref23","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1002\/mds.21344","article-title":"Midbrain sonography in patients with essential tremor","volume":"22","author":"Stockner","year":"2007","journal-title":"Mov Disord"},{"key":"10.3233\/JPD-213012_ref24","doi-asserted-by":"crossref","first-page":"e20028","DOI":"10.1097\/MD.0000000000020028","article-title":"Essential tremor vs idiopathic Parkinson disease: Utility of transcranial sonography","volume":"99","author":"Tao","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"10.3233\/JPD-213012_ref25","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1159\/000452216","article-title":"Transcranial sonography and DaTSCAN in early stage Parkinson\u2019s disease and essential tremor","volume":"76","author":"Jesus-Ribeiro","year":"2016","journal-title":"Eur Neurol"},{"key":"10.3233\/JPD-213012_ref26","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s10072-015-2152-y","article-title":"Transcranial sonography and the pocket smell test in the differential diagnosis between parkinson\u2019s disease and essential tremor","volume":"36","author":"\u0160tenc Bradvica","year":"2015","journal-title":"Neurol Sci"},{"key":"10.3233\/JPD-213012_ref27","doi-asserted-by":"crossref","first-page":"e436","DOI":"10.1016\/j.archger.2012.01.001","article-title":"Transcranial sonography (TCS) in Parkinson\u2019s disease (PD) and essential tremor (ET) in relation with putative premotor symptoms of PD","volume":"54","author":"Kim","year":"2012","journal-title":"Arch Gerontol Geriatr"},{"key":"10.3233\/JPD-213012_ref28","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1097\/CM9.0000000000001503","article-title":"Transcranial sonography in differential diagnosis of Parkinson disease and other movement disorders","volume":"134","author":"Wang","year":"2021","journal-title":"Chin Med J (Engl)"},{"key":"10.3233\/JPD-213012_ref29","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/2047-9158-1-25","article-title":"Combination of olfactory test and substantia nigra transcranial sonopraphy in the differential diagnosis of Parkinson\u2019s disease: A pilot study from China","volume":"1","author":"Chen","year":"2012","journal-title":"Transl Neurodegener"},{"key":"10.3233\/JPD-213012_ref30","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1002\/mds.26424","article-title":"MDS clinical diagnostic criteria for Parkinson\u2019s disease","volume":"30","author":"Postuma","year":"2015","journal-title":"Mov Disord"},{"key":"10.3233\/JPD-213012_ref31","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1136\/jnnp.55.3.181","article-title":"Accuracy of clinical diagnosis of idiopathic Parkinson\u2019s disease: A clinico-pathological study of 100 cases","volume":"55","author":"Hughes","year":"1992","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.3233\/JPD-213012_ref32","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1136\/jnnp.51.6.745","article-title":"The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson\u2019s disease","volume":"51","author":"Gibb","year":"1988","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.3233\/JPD-213012_ref33","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1001\/archneur.56.1.33","article-title":"Diagnostic criteria for Parkinson disease","volume":"56","author":"Gelb","year":"1999","journal-title":"Arch Neurol"},{"issue":"Suppl 3","key":"10.3233\/JPD-213012_ref34","first-page":"2","article-title":"Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee","volume":"13","author":"Deuschl","year":"1998","journal-title":"Mov Disord"},{"key":"10.3233\/JPD-213012_ref35","first-page":"7","article-title":"Criteria for the diagnosis of essential tremor","volume":"S54","author":"Bain","year":"2000","journal-title":"Neurology"},{"key":"10.3233\/JPD-213012_ref36","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1001\/archneur.55.6.823","article-title":"Diagnostic criteria for essential tremor: A population perspective","volume":"55","author":"Louis","year":"1998","journal-title":"Arch Neurol"},{"key":"10.3233\/JPD-213012_ref37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.parkreldis.2017.06.006","article-title":"Hyperechogenicity of substantia nigra for differential diagnosis of Parkinson\u2019s disease: A meta-analysis","volume":"42","author":"Shafieesabet","year":"2017","journal-title":"Parkinsonism Relat Disord"},{"key":"10.3233\/JPD-213012_ref38","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.2169\/internalmedicine.46.0271","article-title":"Transcranial sonography of the substantia nigra in Japanese patients with Parkinson\u2019s disease or atypical parkinsonism: Clinical potential and limitations","volume":"46","author":"Okawa","year":"2007","journal-title":"Intern Med"},{"key":"10.3233\/JPD-213012_ref39","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1471-2377-8-42","article-title":"The predictive value of transcranial duplex sonography for the clinical diagnosis in undiagnosed parkinsonian syndromes: Comparison with SPECT scans","volume":"8","author":"Vlaar","year":"2008","journal-title":"BMC Neurol"},{"key":"10.3233\/JPD-213012_ref40","doi-asserted-by":"crossref","first-page":"e002613","DOI":"10.1136\/bmjopen-2013-002613","article-title":"Specificity and sensitivity of transcranial sonography of the substantia nigra in the diagnosis of Parkinson\u2019s disease: Prospective cohort study in 196 patients","volume":"3","author":"Bouwmans","year":"2013","journal-title":"BMJ Open"},{"key":"10.3233\/JPD-213012_ref41","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1136\/jnnp-2011-301719","article-title":"Value of combined midbrain sonography, olfactory and motor function assessment in the differential diagnosis of early Parkinson\u2019s disease","volume":"83","author":"Busse","year":"2012","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10.3233\/JPD-213012_ref42","doi-asserted-by":"crossref","first-page":"157","DOI":"10.2298\/VSP1202157J","article-title":"123I-FP-CIT brain SPECT (DaTSCAN) imaging in the diagnosis of patients with movement disorders\u2013first results","volume":"69","author":"Jaukovi\u0107","year":"2012","journal-title":"Vojnosanit Pregl"},{"key":"10.3233\/JPD-213012_ref43","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1111\/ene.12444","article-title":"[123I]FP-CIT SPECT (DaTSCAN) may be a useful tool to differentiate between Parkinson\u2019s disease and vascular or drug-induced parkinsonisms: A meta-analysis","volume":"21","author":"Brigo","year":"2014","journal-title":"Eur J Neurol"},{"key":"10.3233\/JPD-213012_ref44","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s00702-010-0564-7","article-title":"Substantia nigra hyperechogenicity is a risk marker of Parkinson\u2019s disease: No","volume":"118","author":"Walter","year":"2011","journal-title":"J Neural Transm (Vienna)"},{"key":"10.3233\/JPD-213012_ref45","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1002\/mds.25192","article-title":"Enlarged hyperechogenic substantia nigra as a risk marker for Parkinson\u2019s disease","volume":"28","author":"Berg","year":"2013","journal-title":"Mov Disord"},{"key":"10.3233\/JPD-213012_ref46","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1002\/mds.26515","article-title":"Substantia nigra hyperechogenicity and Parkinson\u2019s disease risk in patients with essential tremor","volume":"31","author":"Sprenger","year":"2016","journal-title":"Mov Disord"},{"key":"10.3233\/JPD-213012_ref47","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.sleep.2019.09.008","article-title":"Relationship of substantia nigra hyperechogenicity to risk of Lewy body disease in idiopathic REM sleep behavior disorder patients: A longitudinal study","volume":"68","author":"Miyamoto","year":"2020","journal-title":"Sleep Med"},{"key":"10.3233\/JPD-213012_ref48","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1002\/mds.26055","article-title":"Five-year follow-up of substantia nigra echogenicity in idiopathic REM sleep behavior disorder","volume":"29","author":"Iranzo","year":"2014","journal-title":"Mov Disord"},{"key":"10.3233\/JPD-213012_ref49","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/mds.20311","article-title":"Five-year follow-up study of hyperechogenicity of the substantia nigra in Parkinson\u2019s disease","volume":"20","author":"Berg","year":"2005","journal-title":"Mov Disord"},{"key":"10.3233\/JPD-213012_ref50","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1002\/mds.25080","article-title":"A follow-up study of substantia nigra echogenicity in healthy adults","volume":"27","author":"Mahlknecht","year":"2012","journal-title":"Mov Disord"},{"key":"10.3233\/JPD-213012_ref51","doi-asserted-by":"crossref","first-page":"20863","DOI":"10.1038\/srep20863","article-title":"Diagnostic accuracy of transcranial sonography of the substantia nigra in Parkinson\u2019s disease: A systematic review and meta-analysis","volume":"6","author":"Li","year":"2016","journal-title":"Sci Rep"}],"container-title":["Journal of Parkinson's Disease"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/JPD-213012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T04:51:15Z","timestamp":1777611075000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/JPD-213012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,24]]},"references-count":51,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3233\/jpd-213012","relation":{},"ISSN":["1877-7171","1877-718X"],"issn-type":[{"value":"1877-7171","type":"print"},{"value":"1877-718X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,24]]}}}