Neuroimaging Techniques in Atypical Parkinsonian Syndromes

Atypical Parkinsonian syndromes encompass multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration, each characterised by distinct patterns of neurodegeneration. Structural MRI remains the cornerstone for in vivo visualisation of brain atrophy and signal changes, revealing classic signs such as the ‘hot cross bun’ in the pons and putaminal rim alterations. Advanced sequences—including susceptibility-weighted imaging—highlight iron accumulation in deep nuclei, while diffusion tensor imaging maps microstructural integrity of white matter tracts such as the superior cerebellar peduncle. Proton magnetic resonance spectroscopy offers insight into regional metabolic shifts, and resting-state and task-based functional MRI delineate network dysfunction. Nuclear imaging modalities, notably SPECT and PET, quantify nigrostriatal dopaminergic loss and enable molecular mapping of tau and α-synuclein aggregates. Transcranial sonography provides a rapid bedside assessment of substantia nigra echogenicity. Together, these techniques improve differential diagnosis, enable earlier therapeutic intervention and support patient stratification in clinical trials, underscoring their global significance and translational potential.

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Neuroimaging Techniques in Atypical Parkinsonian Syndromes publication trend

The graph below shows the total number of articles in neuroimaging techniques in atypical parkinsonian syndromes across all publications each year (not limited to Nature Index journals).

Technical terms

Atypical Parkinsonian syndromes: A group of neurodegenerative disorders—including MSA, PSP and CBD—distinct from idiopathic Parkinson’s disease and characterised by specific pathological protein inclusions.

Structural MRI: Imaging method using magnetic fields to visualise brain anatomy, detect atrophy and assess tissue integrity.

Diffusion tensor imaging (DTI): MRI technique measuring the directionality and magnitude of water diffusion to infer white matter microstructural health.

Susceptibility-weighted imaging (SWI): High-resolution MRI sequence sensitive to variations in magnetic susceptibility, used to detect iron deposition and microbleeds.

Proton magnetic resonance spectroscopy (1H-MRS): Non-invasive method to quantify concentrations of brain metabolites such as N-acetyl aspartate and choline.

Deep Neural Patchwork (DNP): A convolutional neural network architecture designed for precise image segmentation of brain structures.

Middle cerebellar peduncle: A major white matter tract connecting the cerebellum to the pons, often atrophic in MSA-C.

Area under the curve (AUC): Statistical metric summarising the diagnostic performance of a test across sensitivity and specificity trade-offs.

References

1. Deep learning segmentation results in precise delineation of the putamen in multiple system atrophy. European Radiology (2023).
2. Rates of change of pons and middle cerebellar peduncle diameters are diagnostic of multiple system atrophy of the cerebellar type. Brain Communications (2023).
3. Neuroimaging Advances in Parkinson's Disease and Atypical Parkinsonian Syndromes. Frontiers in Neurology (2020).