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Semin Neurol 2023; 43(01): 095-105
DOI: 10.1055/s-0043-1764228
Review Article

Structural and Molecular Imaging for Clinically Uncertain Parkinsonism

Sanskriti Sasikumar
1   Morton and Gloria Shulman Movement Disorder Unit and Edmond J. Safra Parkinson Disease Program, Neurology Division, Department of Medicine, University of Toronto, Toronto Western Hospital, UHN, Ontario, Canada
,
Antonio P. Strafella
1   Morton and Gloria Shulman Movement Disorder Unit and Edmond J. Safra Parkinson Disease Program, Neurology Division, Department of Medicine, University of Toronto, Toronto Western Hospital, UHN, Ontario, Canada
2   Krembil Brain Institute, University Health Network and Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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Abstract

Neuroimaging is an important adjunct to the clinical assessment of Parkinson disease (PD). Parkinsonism can be challenging to differentiate, especially in early disease stages, when it mimics other movement disorders or when there is a poor response to dopaminergic therapies. There is also a discrepancy between the phenotypic presentation of degenerative parkinsonism and the pathological outcome. The emergence of more sophisticated and accessible neuroimaging can identify molecular mechanisms of PD, the variation between clinical phenotypes, and the compensatory mechanisms that occur with disease progression. Ultra-high-field imaging techniques have improved spatial resolution and contrast that can detect microstructural changes, disruptions in neural pathways, and metabolic and blood flow alterations. We highlight the imaging modalities that can be accessed in clinical practice and recommend an approach to the diagnosis of clinically uncertain parkinsonism.

Keywords

Parkinson disease - atypical parkinsonism - molecular imaging - MRI - diagnostic imaging

Note

S.S. is supported by Canadian Institutes of Health Research (CIHR) (476290).


A.P.S. is supported by Canadian Institutes of Health Research (CIHR) (PJT-173540) and Krembil-Rossy Chair.


S.S. created [Figs. 1] and [2] with BioRender.com.




Publication History

Article published online:
06 March 2023

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