Medical Radiology and Radiation Safety. 2026. Vol. 71. № 3

DOI:10.33266/1024-6177-2026-71-3-98-105

S.G. Mirzoiants, A.N. Bashkov, N.A. Barkalaya

Radiological Diagnostic Methods for Parkinson’s Disease:

A Literature Review

A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia

Contact person: S.G. Mirzoiants, e-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра.

 

ABSTRACT 

Purpose: To systematize modern imaging approaches in PD, to evaluate the informativeness of key radiopharmaceuticals, their diagnostic capabilities, sensitivity and specificity, and the role of hybrid modalities in early and differential diagnosis as well as dynamic monitoring of PD.

Material and methods: Guidelines from EANM/SNMMI and studies from 2018–2025 on SPECT/CT, PET/CT, PET/MRI, and MRI (NM-MRI, QSM, DTI, 7T) were analyzed. DAT-SPECT with [¹²³I]FP-CIT remains the clinical standard for detecting presynaptic dysfunction; [⁹⁹ᵐTc]TRODAT-1 serves as an accessible alternative. PET with [¹⁸F]FE-PE2I provides higher spatial resolution and quantitative accuracy; [¹⁸F]FDOPA reflects dopamine synthesis, [¹⁸F]FDG – metabolic patterns; [¹⁸F]AV-133 (VMAT2) and [¹¹C]yohimbine expand assessment of non-dopaminergic systems. MRI complements molecular methods, enabling exclusion of organic causes of parkinsonism (secondary parkinsonism) and detecting subtle alterations of the substantia nigra; PET/MRI integrates molecular and morphological data within a single examination.

Results: Modern radiological diagnostic methods for PD demonstrate high informativeness in early detection of neurodegenerative changes. SPECT/CT with [¹²³I]FP-CIT provides sensitivity and specificity of 93–95% in differential diagnosis of PD versus essential tremor and atypical parkinsonian syndromes. [⁹⁹ᵐTc]TRODAT-1 is used as a cost-effective alternative in resource-limited countries. PET/CT with [¹⁸F]FE-PE2I and [¹⁸F]FDOPA enables quantitative assessment of presynaptic dysfunction and metabolic features; reduced [¹⁸F]FDOPA uptake correlates with disease stage, while [¹⁸F]FDG alterations are detectable at early stages. Implementation of multimodal protocols, including PET/MRI, allows comprehensive mapping of structural (neuromelanin, iron), biochemical, and metabolic markers. High-field MRI detects up to 98% of neuron loss in nigrosome-1, while modern NM-MRI protocols combined with machine learning and semi-automated segmentation methods provide diagnostic accuracy above 90%. Integration of molecular and structural imaging with artificial intelligence enhances the precision of early diagnosis and enables monitoring of PD progression and therapeutic efficacy. According to multicenter studies and meta-analyses, sensitivity and specificity of most radiopharmaceuticals exceed 90–95%, and the accuracy of NM-MRI in PD detection reaches 94%.

Keywords:  Parkinson’s disease, radionuclide imaging, dopamine transporter (DAT), SPECT/CT, PET/CT, PET/MRI, [¹⁸F]FDOPA, [⁹⁹ᵐTc]TRODAT

For citation:  Mirzoiants SG, Bashkov AN, Barkalaya NA. Radiological Diagnostic Methods for Parkinson’s Disease: A Literature Review. Medical Radiology and Radiation Safety. 2026;71(3):98–105.  DOI:10.33266/1024-6177-2026-71-3-98-105

 

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Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. The article was prepared by one author.

Article received: 20.02.2026. Accepted for publication: 25.03.2026.