Pragmatic Approach on Neuroimaging Techniques for the Differential Diagnosis of Parkinsonisms

Abstract

BackgroundBackground: Rapid advances in neuroimaging technologies in the exploration of the living human brain also apply to movement disorders. However, the accurate diagnosis of Parkinson's disease (PD) and atypical parkinsonian disorders (APDs) still remains a challenge in daily practice. Methods Methods: We review the literature and our own experience as the Movement Disorder Society-Neuroimaging Study Group in Movement Disorders with the aim of providing a practical approach to the use of imaging technologies in the clinical setting. ResultsResults: The enormous amount of articles published so far and our increasing recognition of imaging technologies contrast with a lack of imaging protocols and updated algorithms for differential diagnosis. The distinctive pathological involvement in different brain structures and the correlation with imaging findings obtained with magnetic resonance, positron emission tomography, or single-photon emission computed tomography illustrate what qualitative and quantitative measures may be useful in the clinical setting. Conclusion Conclusion:We delineate a pragmatic approach to discuss imaging technologies, updated imaging algorithms, and their implications for differential diagnoses in PD and APDs.

COVID-19 and Parkinsonism: A Critical Appraisal

“…In clinical practice, FDG-PET imaging is increasingly used to improve diagnostic accuracy among parkinsonism [ 30 , 31 ]. In PD patients, FDG-PET imaging usually shows increased metabolic activity in the basal ganglia and thalamus, and decreased activity in the premotor and parietal cortex [ 32 ]. Among the 13 patients included in this review, four also underwent FDG-PET brain imaging.…”

Morphometric imaging and quantitative susceptibility mapping as complementary tools in the diagnosis of parkinsonisms

“…In this study morphometric and QSM MRI techniques were combined to evaluate the potential of regional atrophy and iron deposition as in vivo diagnostic biomarkers of degenerative parkinsonisms. The application of other advanced MRI techniques (e.g., diffusion and neuromelanin imaging) as a support to clinical evaluation has provided encouraging results [51]. The use of diffusion tensor imaging first supported classification of subjects diagnosed with PD, atypical parkinsonism and essential tremor, and distinguished them from control subjects [52].…”

Molecular Imaging in Parkinsonian Disorders—What’s New and Hot?

“…This has critical implications for accurate diagnosis and treatment in the vast majority of difficult cases [ 58 ]. Decision algorithm and practical issues have been previously reviewed [ 1 , 3 , 59 , 60 ]. Importantly, recent technical advances improved the reliability of semi-quantitative analysis of striatal binding, thanks to the better atlas-based delineation of the striatum and normative databases for age standardization [ 61 , 62 ].…”

“…However, molecular imaging using radioactive tracers for single photon emission computed tomography (SPECT) and positron emission tomography (PET) now enables to detect pathological changes in vivo on a cellular or molecular level with high specificity and sensitivity, related to metabolism, inflammation, transporter/receptor availability, and protein aggregates. From the clinician’s point of view, nuclear molecular imaging offers not only the possibility to detect the degeneration of the dopaminergic system but can also differentiate between the different forms of degenerative parkinsonism based on imaging of brain metabolism and neurodegeneration [ 1 ]. From the researcher’s point of view, nuclear molecular imaging can help to disentangle the complexity of the underlying neuropathology, e.g., the spread of pathogenic proteins, neuroinflammation, and imaging of non-motor symptoms [ 2 ].…”