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Review
. 2016 Aug;16(4):371-5.
doi: 10.7861/clinmedicine.16-4-371.

Imaging in Parkinson's disease

Gennaro Pagano  1 , Flavia Niccolini  1 , Marios Politis  2
Affiliations
Review

Imaging in Parkinson's disease

Gennaro Pagano et al. Clin Med (Lond). 2016 Aug.

Abstract

The clinical presentation of Parkinson's disease (PD) is heterogeneous and overlaps with other conditions, including the parkinsonian variant of multiple system atrophy (MSA-P), progressive supranuclear palsy (PSP) and essential tremor. Imaging of the brain in patients with parkinsonism has the ability to increase the accuracy of differential diagnosis. Magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET) allow brain imaging of structural, functional and molecular changes in vivo in patients with PD. Structural MRI is useful to differentiate PD from secondary and atypical forms of parkinsonism. 123I-ioflupane (DaTSCAN(TM)) SPECT is a valid tool in the differential diagnosis between PD and non-degenerative tremors, while cardiac 123I-metaiodobenzylguanidine SPECT and 18F-fluorodeoxyglucose PET are valid in the differential diagnosis between PD and atypical parkinsonism (MSA-P, PSP). However, despite significant evidence for the utility of neuroimaging in assessing parkinsonian patients, none of the neuroimaging techniques are specifically recommended for routine use in clinical practice. Hopefully, future larger trials will help to demonstrate additional evidence for the clinical utility of neuroimaging and will include an analysis of the financial benefits for the NHS in the longer term management of the patients.

Keywords: DaTSCAN TM; FDG; Imaging; MRI; PET; Parkinson's; SPECT; mIBG.

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Figures

Fig 1.
Fig 1.
Molecular imaging of dopaminergic dysfunction in Parkinson’s disease. PET and SPECT imaging in a PD patient show reduction of VMAT2 activity, DAT availability, and DDC activity compared with a healthy control. DAT = dopamine transporter; DDC = dopa decarboxylase; PD = Parkinson’s disease; PET = positron emission tomography; SPECT = single-photon emission computed tomography; VMAT2 = type 2 vesicular monoamine transporter. Reproduced with permission from Politis M (2014).
Fig 2.
Fig 2.
Molecular imaging of glucose metabolism and PDE10A expression in Parkinson’s disease. PET imaging shows decreased glucose metabolism and PDE10A expression in a patient with PD compared with a healthy control. PD = Parkinson’s disease; PDE10A = phosphodiesterase 10 A; PET = positron emission tomography. Reproduced with permission from Politis M (2014).
See this image and copyright information in PMC

Comment in

  • Imaging in Parkinson's disease.
    Ellis RJB, Steiger M. Ellis RJB, et al. Clin Med (Lond). 2017 Jul;17(4):384. doi: 10.7861/clinmedicine.17-4-384. Clin Med (Lond). 2017. PMID: 28765433 Free PMC article. No abstract available.

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