PT  - JOURNAL ARTICLE
AU  - Keir, Graham
AU  - Roytman, Michelle
AU  - Mashriqi, Faizullah
AU  - Shahsavarani, Shaya
AU  - Franceschi, Ana M.
TI  - Atypical Parkinsonian Syndromes: Structural, Functional, and Molecular Imaging Features
AID  - 10.3174/ajnr.A8313
DP  - 2024 Dec 01
TA  - American Journal of Neuroradiology
PG  - 1865--1877
VI  - 45
IP  - 12
4099  - http://www.ajnr.org/content/45/12/1865.short
4100  - http://www.ajnr.org/content/45/12/1865.full
SO  - Am. J. Neuroradiol.2024 Dec 01; 45
AB  - SUMMARY: Atypical parkinsonian syndromes, also known as Parkinson-plus syndromes, are a heterogeneous group of movement disorders, including dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), multisystem atrophy (MSA), and corticobasal degeneration (CBD). This review highlights the characteristic structural, functional, and molecular imaging features of these complex disorders. DLB typically demonstrates parieto-occipital hypometabolism with involvement of the cuneus on FDG-PET, whereas dopaminergic imaging, such as [123I]-FP-CIT SPECT (DaTscan) or fluorodopa (FDOPA)-PET, can be utilized as an adjunct for diagnosis. PSP typically shows midbrain atrophy on structural imaging, whereas FDG-PET may be useful to depict frontal lobe hypometabolism and tau-PET confirms underlying tauopathy. MSA typically demonstrates putaminal or cerebellar atrophy, whereas FDG-PET highlights characteristic nigrostriatal or olivopontocerebellar hypometabolism, respectively. Finally, CBD typically shows asymmetric atrophy in the superior parietal lobules and corpus callosum, whereas FDG and tau-PET demonstrate asymmetric hemispheric and subcortical involvement contralateral to the side of clinical deficits. Additional advanced neuroimaging modalities and techniques described may assist in the diagnostic work-up or are promising areas of emerging research.3D-SSP3D stereotactic surface projectionADAlzheimer diseaseASLarterial spin-labelingAPSatypical parkinsonian syndromeCBDcorticobasal degenerationCBScorticobasal syndromeCIScingulate island signDaTdopamine transporterDaTscan[123I]-FP-CIT SPECTDIPdrug-induced parkinsonismDLBdementia with Lewy bodiesFAfractional anisotropyFDOPAfluorodopaMCPmiddle cerebellar peduncleMSAmultisystem atrophyMSA-Cmultisystem atrophy–cerebellarMSA-Pmultisystem atrophy–parkinsonianPAposterior atrophyPDParkinson diseasePSPprogressive supranuclear palsyrCBFregional cerebral blood flowrs-fMRIresting-state functional MR imagingRSNresting-state networkSCPsuperior cerebellar peduncleSMAsupplementary motor areaVaPvascular parkinsonism