Displaying the echo pattern (echogenicity) of brain tissue transcranial sonography (TCS) may provide new and complementary information to other neuroimaging methods. In contrast to conventional magnetic resonance imaging (MRI), TCS is able to detect highly characteristic changes in signal brightness of the substantia nigra (SN) in patients with idiopathic Parkinson's disease. In this review, TCS findings are related to conventional and advanced high-field brain MRI findings. On the basis of the MRI findings, especially with T2-relaxometry, the possible role of trace metals in the genesis of altered echogenicity on TCS of brain parenchyma, especially of the SN, are discussed.
