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  • Review Article
  • Published:

Neuroimaging in Parkinson disease: from research setting to clinical practice

Nature Reviews Neurology volume 10, pages 708–722 (2014)Cite this article

Subjects

Key Points

  • Neuroimaging has been used in Parkinson disease (PD) research for 30 years, but no guidelines have yet endorsed its routine use in clinical settings

  • Single-photon emission CT and PET are equally effective at differentiating between degenerative and nondegenerative causes of parkinsonism; MRI and PET can differentiate between PD and atypical parkinsonism, but need sophisticated enhancement methods

  • Dopaminergic and serotonergic PET can be used to monitor PD progression, motor and nonmotor symptoms, and complications, whereas cholinergic PET is currently the most sensitive approach for assessing PD dementia

  • PET and other neuroimaging techniques should have a primary role in the development of protocols for new clinical trials, particularly those investigating cell therapy

  • Hybrid PET–MRI technology could offer a revolution in PD imaging, but issues with image reconstruction need to be addressed before use in research and clinical settings can be considered

  • High costs hinder the transfer of robust research techniques into clinical practice; however, these costs have not been directly compared with the costs deriving from misdiagnosis and flawed treatments plans

Abstract

Over the past three decades, neuroimaging studies—including structural, functional and molecular modalities—have provided invaluable insights into the mechanisms underlying Parkinson disease (PD). Observations from multimodal neuroimaging techniques have indicated changes in brain structure and metabolic activity, and an array of neurochemical changes that affect receptor sites and neurotransmitter systems. Characterization of the neurobiological alterations that lead to phenotypic heterogeneity in patients with PD has considerably aided the in vivo investigation of aetiology and pathophysiology, and the identification of novel targets for pharmacological or surgical treatments, including cell therapy. Although PD is now considered to be very complex, no neuroimaging modalities are specifically recommended for routine use in clinical practice. However, conventional MRI and dopamine transporter imaging are commonly used as adjuvant tools in the differential diagnosis between PD and nondegenerative causes of parkinsonism. First-line neuroimaging tools that could have an impact on patient prognosis and treatment strategies remain elusive. This Review discusses the lessons learnt from decades of neuroimaging research in PD, and the promising new approaches with potential applicability to clinical practice.

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Figure 1: Molecular imaging in patients with PD.
Figure 2: Subcortical imaging in PD.
Figure 3: Cortical imaging in PD.
Figure 4: Radiotracers for dopaminergic imaging.
Figure 5: Imaging for differential diagnosis.
Figure 6: Diffusion tensor imaging for differential diagnosis.
Figure 7: Imaging disease progression.
Figure 8: Parkinsonism and dementia.
Figure 9: Clinical trials in PD.

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Acknowledgements

M.P. is supported by Parkinson's UK, the Edmond J. Safra Foundation, the Michael J. Fox Foundation, and the National Institute for Health Research Biomedical Research Centre. M.P. thanks Dr Flavia Niccolini for her technical assistance with the preparation of this Review.

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  1. Department of Clinical Neuroscience, Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK

    Marios Politis

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Supplementary Table 1

Past, present and future PET and single-photon emission CT molecular imaging tracers with application in Parkinson disease (DOCX 26 kb)

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Politis, M. Neuroimaging in Parkinson disease: from research setting to clinical practice. Nat Rev Neurol 10, 708–722 (2014). https://doi.org/10.1038/nrneurol.2014.205

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