{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:06:30Z","timestamp":1776834390024,"version":"3.51.2"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"\n Introduction<\/jats:title>\n Transcranial sonography-magnetic resonance (TCS-MR) fusion imaging shows promise in neurodegenerative diseases, yet current echogenicity assessment methods remain controversial, and its role in differentiating Parkinson\u2019s disease (PD) from multiple system atrophy-parkinsonian type (MSA-P) remains unknown.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n This study aims to evaluate the diagnostic and differential value of TCS-MR fusion imaging for PD versus MSA-P.<\/jats:p>\n <\/jats:sec>\n \n Patients and methods<\/jats:title>\n 164 PD, 71 MSA-P, and 118 controls who underwent TCS-MR fusion imaging were prospectively enrolled. Substantia nigra hyperechogenicity (SNH) area was calculated. Three planes, designated as SN1, SN2 and SN3 from fusion images were analyzed using ImageJ for grayscale median and pixel count. ROC curves were employed to assess diagnostic and differential diagnostic power.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Statistically significant differences were observed among the three groups concerning SN grades, area of SNH, the ratio of the area of SNH to the midbrain area (S\/M), echogenicity of the bilateral SN1, SN3, left SNH, and the maximum echogenicity of SN1, as well as the pixel count of bilateral SNH (\n p\u202f&lt;<\/jats:italic>\n \u202f0.05). The maximum echogenicity of SN1 and left SN1 demonstrated the highest diagnostic and differential performance for PD, with AUC values of 0.86 and 0.82 (both\n p\u202f&lt;<\/jats:italic>\n \u202f0.001). Fusion parameters outperformed the SNH area and S\/M in both diagnosis and differential diagnosis of PD (Z\u202f=\u202f3.84 and 3.71,\n p\u202f&lt;<\/jats:italic>\n \u202f0.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n TCS-MR fusion imaging demonstrates superior diagnostic and differential performance for PD compared to traditional TCS measurements, suggesting its potential as a novel imaging technique in the diagnosis of PD.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1797261","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:31:04Z","timestamp":1776832264000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of transcranial sonography-magnetic resonance fusion imaging for Parkinson\u2019s disease versus multiple system atrophy\u2014Parkinsonian type"],"prefix":"10.3389","volume":"17","author":[{"given":"Chao","family":"Hou","sequence":"first","affiliation":[{"name":"Department of Ultrasound, the Affiliated Hospital, Southwest Medical University","place":["Luzhou, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji-zhu","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, the Affiliated Hospital, Southwest Medical University","place":["Luzhou, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, the Affiliated Hospital, Southwest Medical University","place":["Luzhou, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-xing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, the Affiliated Hospital, Southwest Medical University","place":["Luzhou, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"He","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-qing","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, the Affiliated Hospital, Southwest Medical University","place":["Luzhou, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e080952","DOI":"10.1136\/bmj-2024-080952","article-title":"Projections for prevalence of Parkinson's disease and its driving factors in 195 countries and territories to 2050: modelling study of global burden of disease study 2021","volume":"388","author":"Su","year":"2025","journal-title":"BMJ"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1002\/mds.27802","article-title":"Update of the MDS research criteria for prodromal Parkinson's disease","volume":"34","author":"Heinzel","year":"2019","journal-title":"Mov Disord"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1212\/WNL.0000000000000641","article-title":"Low clinical diagnostic accuracy of early vs advanced Parkinson disease: clinicopathologic study","volume":"83","author":"Adler","year":"2014","journal-title":"Neurology"},{"key":"ref4","doi-asserted-by":"publisher","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"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1212\/WNL.60.1.74","article-title":"Brain parenchyma sonography discriminates Parkinson's disease and atypical parkinsonian syndromes","volume":"60","author":"Walter","year":"2003","journal-title":"Neurology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.parkreldis.2016.04.031","article-title":"Comparison of transcranial sonography-magnetic resonance fusion imaging in Wilson's and early-onset Parkinson's diseases","volume":"28","author":"Maskova","year":"2016","journal-title":"Parkinsonism Relat Disord"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1002\/mds.26425","article-title":"Magnetic resonance-transcranial ultrasound fusion imaging: a novel tool for brain electrode location","volume":"31","author":"Walter","year":"2016","journal-title":"Mov Disord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1212\/01.wnl.0000324625.00404.15","article-title":"Second consensus statement on the diagnosis of multiple system atrophy","volume":"71","author":"Gilman","year":"2008","journal-title":"Neurology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1002\/mds.26424","article-title":"MDS clinical diagnostic criteria for Parkinson's disease","volume":"30","author":"Postuma","year":"2015","journal-title":"Mov Disord"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1002\/jmri.27386","article-title":"Screening for early-stage Parkinson's disease: swallow tail sign on MRI susceptibility map-weighted images compared with PET","volume":"53","author":"Wang","year":"2021","journal-title":"J Magn Reson Imaging"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3581","DOI":"10.21037\/qims-23-1778","article-title":"A nomogram based on neuron-specific enolase and substantia nigra hyperechogenicity for identifying cognitive impairment in Parkinson's disease","volume":"14","author":"Hou","year":"2024","journal-title":"Quant Imaging Med Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"251","DOI":"10.5507\/bp.2008.039","article-title":"Transcranial sonography in movement disorders","volume":"152","author":"Bartova","year":"2008","journal-title":"Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2702","DOI":"10.1111\/ejn.16308","article-title":"Clinical findings of hyperechoic substantia nigra in patients with Parkinson's disease","volume":"59","author":"Fan","year":"2024","journal-title":"Eur J Neurosci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1038\/s41531-025-00910-7","article-title":"Spatial variations and precise location of substantia nigra hyperechogenicity in Parkinson's disease using TCS-MR fusion imaging","volume":"11","author":"Hou","year":"2025","journal-title":"NPJ Parkinsons Dis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"zsab295","DOI":"10.1093\/sleep\/zsab295","article-title":"A comparison of ultrasound echo intensity to magnetic resonance imaging as a metric for tongue fat evaluation","volume":"45","author":"Yu","year":"2022","journal-title":"Sleep"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1016\/j.neuroimage.2006.10.010","article-title":"Substantia nigra echomorphology in the healthy very old: correlation with motor slowing","volume":"34","author":"Behnke","year":"2007","journal-title":"NeuroImage"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.neuroimage.2010.01.112","article-title":"Life-long increase of substantia nigra hyperechogenicity in transcranial sonography","volume":"51","author":"Hagenah","year":"2010","journal-title":"NeuroImage"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1186\/s13195-024-01590-w","article-title":"Substantia nigra hyperechogenicity and brain ventricular size as biomarkers of early dementia with Lewy bodies","volume":"16","author":"Planas-Ballve","year":"2024","journal-title":"Alzheimer's Res Ther"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1002\/acn3.52131","article-title":"The characteristic and biomarker value of transcranial sonography in cerebellar ataxia","volume":"11","author":"Zhu","year":"2024","journal-title":"Ann Clin Transl Neurol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.3233\/JPD-213012","article-title":"Differentiating Parkinson's disease from essential tremor using transcranial sonography: a systematic review and Meta-analysis","volume":"12","author":"Heim","year":"2022","journal-title":"J Parkinsons Dis"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e230750","DOI":"10.1148\/radiol.230750","article-title":"Evaluation of a cascaded deep learning-based algorithm for prostate lesion detection at Biparametric MRI","volume":"311","author":"Lin","year":"2024","journal-title":"Radiology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e98","DOI":"10.1016\/j.wneu.2018.12.215","article-title":"Using real-time fusion imaging constructed from contrast-enhanced ultrasonography and magnetic resonance imaging for high-grade glioma in neurosurgery","volume":"125","author":"Wu","year":"2019","journal-title":"World Neurosurg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1055\/s-0042-111822","article-title":"Transcranial sonography of the insula: digitized image analysis of fusion images with magnetic resonance","volume":"37","author":"Skoloudik","year":"2016","journal-title":"Ultraschall Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1016\/j.ultrasmedbio.2019.12.013","article-title":"Digitized image analysis of insula echogenicity detected by TCS-MR fusion imaging in Wilson's and early-onset Parkinson's diseases","volume":"46","author":"Skoloudik","year":"2020","journal-title":"Ultrasound Med Biol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1055\/a-2081-1635","article-title":"Echogenicity of brain structures in Huntington's disease patients evaluated by transcranial sonography - magnetic resonance fusion imaging using virtual navigator and digital image analysis","volume":"44","author":"Kozel","year":"2023","journal-title":"Ultraschall Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"119814","DOI":"10.1016\/j.neuroimage.2022.119814","article-title":"Diagnosing Parkinson's disease by combining neuromelanin and iron imaging features using an automated midbrain template approach","volume":"266","author":"Jokar","year":"2023","journal-title":"NeuroImage"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1148\/radiol.2021203341","article-title":"Imaging the substantia nigra in Parkinson disease and other parkinsonian syndromes","volume":"300","author":"Bae","year":"2021","journal-title":"Radiology"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1007\/s00702-024-02856-1","article-title":"High correlation of quantitative susceptibility mapping and echo intensity measurements of nigral iron overload in Parkinson's disease","volume":"132","author":"Luyken","year":"2025","journal-title":"J Neural Transm (Vienna)"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2169","DOI":"10.1002\/mds.30289","article-title":"Substantia Nigra elasticity measurement using transcranial shear wave Elastography: a potential biomarker for Parkinson's disease","volume":"40","author":"Xu","year":"2025","journal-title":"Mov Disord"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1148\/radiol.2021210116","article-title":"Differential effect of Iron and myelin on susceptibility MRI in the substantia Nigra","volume":"301","author":"Lee","year":"2021","journal-title":"Radiology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"102185","DOI":"10.1016\/j.nicl.2020.102185","article-title":"Analyzing the co-localization of substantia nigra hyper-echogenicities and iron accumulation in Parkinson's disease: a multi-modal atlas study with transcranial ultrasound and MRI","volume":"26","author":"Ahmadi","year":"2020","journal-title":"NeuroImage: Clinical"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e1605","DOI":"10.1212\/WNL.0000000000009246","article-title":"Left-hemispheric predominance of nigrostriatal deficit in isolated REM sleep behavior disorder","volume":"94","author":"Iranzo","year":"2020","journal-title":"Neurology"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1002\/mds.28019","article-title":"Lack of asymmetry of nigrostriatal dopaminergic function in healthy subjects","volume":"35","author":"Garrido","year":"2020","journal-title":"Mov Disord"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1007\/s00330-021-08174-4","article-title":"Diagnostic performance of T2* gradient echo, susceptibility-weighted imaging, and quantitative susceptibility mapping for patients with multiple system atrophy-parkinsonian type: a systematic review and meta-analysis","volume":"32","author":"Lim","year":"2022","journal-title":"Eur Radiol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1797261\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:31:10Z","timestamp":1776832270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1797261\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":34,"alternative-id":["10.3389\/fneur.2026.1797261"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1797261","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]},"article-number":"1797261"}}