Brain Imaging in Multiple Sclerosis _Ultrasonography

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Ultrasonography is not currently used in the investigation of MS. Berg et al, however, used transcranial sonography to determine the size of the ventricles in patients with MS and found that an increasing size is correlated with the MRI-determined brain volume, as well as with cognitive dysfunction and clinical disability. Further studies may establish a role for ultrasonography in the prognosis and treatment of patients with MS.^[41]
According to Walter et al, in patients with MS, hyperechogenicity of the substantia nigra and lenticular nucleus correlates with more pronounced MRI T2 hypointensity, which is thought to reflect iron deposition, and a larger bilateral substantia nigra echogenic area is related to a higher rate of disease progression. In addition, a small echogenic area predicts a disease course without further progression over 2 years.^[42]
Walter et al performed the study to determine whether transcranial ultrasonography can identify lesions in deep gray matter in patients with MS and whether such findings can identify the severity and progression of MS. Of 75 patients followed, abnormal hyperechogenicity of the substantia nigra occurred in 41%; of the lenticular nucleus, in 54%; of the caudate nucleus, in 40%; and of the thalamus, in 8%, with similar frequency in patients with relapsing-remitting and primary or secondary progressive MS if corrected for disease duration.