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BackgroundParkinson's disease (PD) is a common neurodegenerative disease, and its clinical differentiation from Parkinson-plus syndromes (PPS) remains challenging due to the lack of highly specific biomarkers. Although dopamine transporter single-photon emission computed tomography (DAT-SPECT) provides objective evidence of dopaminergic denervation, its limited value in distinguishing PD from PPS and restricted availability underscore the need for accessible and reliable diagnostic tools. This study aimed to evaluate a novel, non-invasive, and convenient auxiliary diagnostic approach for the diagnosis and differentiation of PD by integrating the assessment of substantia nigra hyperechogenicity (SN+) and intracranial hemodynamics using transcranial ultrasound.MethodsA total of 68 PD patients (PD group), 30 PPS patients (PPS group), and 80 healthy controls (NC group) were enrolled between June 2023 and December 2025. All subjects underwent Transcranial Sonography (TCS) to measure the area of SN+ and Transcranial Color Doppler (TCCD) to measure intracranial vascular hemodynamic parameters. Intergroup differences were analyzed, and receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of individual parameters and their combination.ResultsUltrasound parameters of the substantia nigra, including unilateral and bilateral hyperechogenicity, were markedly elevated in PD patients compared to PPS and control groups (p ConclusionTCS-detected SN+ is an effective imaging biomarker for PD. Combining SN+ with MCA Vd demonstrated superior diagnostic efficacy (AUC = 0.945) compared with either parameter alone, providing a non-invasive multimodality tool for distinguishing PD from non-PD individuals (including PPS and healthy controls).
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