Exploring biomechanical differences between brain-first and body-first Parkinson’s disease subtypes using shear wave elastography: a pilot cross-sectional study

Objective This exploratory study aimed to investigate whether ultrasound shear wave elastography (SWE) could quantify rigidity in Parkinson’s disease (PD) and assess potential biomechanical differences between the brain-first and body-first subtypes. Methods Shear wave elastography was used to measure the Young’s modulus (YM) and shear wave velocity (SWV) of the biceps brachii in 70 healthy controls (HCs) and 102 patients with PD (40 classified as body-first, 62 classified as brain-first based on RBDSQ criteria). Group comparisons were conducted using t -tests or ANOVA, correlations were assessed via Pearson or Spearman tests, and diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results Young’s modulus and SWV values were significantly higher in PD patients than in HCs (all p < 0.001). The body-first group exhibited significantly greater YM and SWV than the brain-first group (all p < 0.001). Both SWE parameters showed significant correlations with several clinical scores. Clinically, compared to the brain-first group, the body-first group presented with a higher burden of non-motor symptoms, greater rigidity and axial impairment, but less tremor (all p < 0.05). For discriminating PD from HCs, the area under the curve (AUC) was 0.844 for YM and 0.845 for SWV. For exploratory differentiation between body-first and brain-first groups, the AUC was 0.730 for YM and 0.705 for SWV. Conclusion Shear wave elastography is a sensitive tool for quantifying rigidity in PD. This pilot study provides the first evidence of a significant difference in muscle biomechanical properties between PD subgroups classified according to current clinical criteria. While SWE shows promise as a supplementary biomarker, its integration with established subtyping markers (e.g., polysomnography, MIBG scintigraphy) in future multimodal and longitudinal studies is essential to determine its role in clinical subtyping.