Nigrostriatal imaging in patients with clinically uncertain Parkinsonian syndromes: a head-to-head comparison between SPECT, PET, and MRI
7 affiliations
- 1Neurobiology Research Unit, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, 6-8 Inge Lehmanns Vej, Copenhagen, DK-2100 Denmark
- 2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- 3Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 4Epilepsy Clinic, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 5Siemens Healthcare A/S, Ballerup, Denmark
- 6Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 7Movement Disorder and Pain Research Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Abstract
Purpose: Neurodegenerative parkinsonism is characterized by degeneration of the dopaminergic nigrostriatal pathways and a reduction in nigral neuromelanin. Dopamine transporter (DAT) imaging assesses presynaptic striatal dopaminergic function and is typically performed with [123I]FP-CIT SPECT-CT, but has recently also become available with [18F]FE-PE2I PET-CT. Magnetic resonance imaging (MRI) can explore disease-related changes by quantifying neuromelanin and iron deposition associated with the loss of nigral neurons.
Methods: In this study, we conducted a head-to-head comparison of [¹²³I]FP-CIT SPECT, [¹⁸F]FE-PE2I PET, and nigral MRI in 35 patients referred for diagnostic DAT imaging. Nigral MRI was performed with neuromelanin-sensitive gradient echo magnetization-transfer contrast MRI and iron-sensitive STrategically Acquired Gradient Echo (STAGE) MRI. Patient satisfaction with SPECT and PET was recorded via questionnaires.
Results: Eighteen patients were diagnosed with neurodegenerative parkinsonism with a median symptom duration of 29 months. DAT availability as measured with SPECT and PET showed complete concordance across cases, correlated strongly, and demonstrated equally excellent diagnostic performance. Patient questionnaire items were either not different between modalities or in favor of SPECT. Nigral neuromelanin content was reduced in patients with neurodegenerative parkinsonism and provided intermediate diagnostic accuracy, with indications of lower neuromelanin with disease duration. Midbrain iron content did not differ between groups and provided no diagnostic information.
Conclusion: Our findings indicate that in early-stage parkinsonism, DAT neuroimaging with SPECT and PET provides comparable and superior diagnostic value relative to nigral MRI.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08184-8.
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BibTeX
@article{thomsen2026nigrostriatal,
title = {{Nigrostriatal imaging in patients with clinically uncertain Parkinsonian syndromes: a head-to-head comparison between SPECT, PET, and MRI}},
author = {Gerda Thomsen and Kristoffer Brendstrup-Brix and Claus Svarer and Ulrich Lindberg and Lars H. Pinborg and Karen Kettless and Ian Law and Steen G. Hasselbalch and Bo Biering-Sørensen and Gitte M. Knudsen},
journal = {European Journal of Nuclear Medicine and Molecular Imaging},
year = {2026},
month = sep,
doi = {10.1007/s00259-026-08184-8},
url = {https://doi.org/10.1007/s00259-026-08184-8},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Nigrostriatal imaging in patients with clinically uncertain Parkinsonian syndromes: a head-to-head comparison between SPECT, PET, and MRI
AU - Gerda Thomsen
AU - Kristoffer Brendstrup-Brix
AU - Claus Svarer
AU - Ulrich Lindberg
AU - Lars H. Pinborg
AU - Karen Kettless
AU - Ian Law
AU - Steen G. Hasselbalch
AU - Bo Biering-Sørensen
AU - Gitte M. Knudsen
PY - 2026
DA - 2026/09/17
JO - European Journal of Nuclear Medicine and Molecular Imaging
DO - 10.1007/s00259-026-08184-8
UR - https://doi.org/10.1007/s00259-026-08184-8
AB - Purpose: Neurodegenerative parkinsonism is characterized by degeneration of the dopaminergic nigrostriatal pathways and a reduction in nigral neuromelanin. Dopamine transporter (DAT) imaging assesses presynaptic striatal dopaminergic function and is typically performed with [123I]FP-CIT SPECT-CT, but has recently also become available with [18F]FE-PE2I PET-CT. Magnetic resonance imaging (MRI) can explore disease-related changes by quantifying neuromelanin and iron deposition associated with the loss of nigral neurons. Methods: In this study, we conducted a head-to-head comparison of [¹²³I]FP-CIT SPECT, [¹⁸F]FE-PE2I PET, and nigral MRI in 35 patients referred for diagnostic DAT imaging. Nigral MRI was performed with neuromelanin-sensitive gradient echo magnetization-transfer contrast MRI and iron-sensitive STrategically Acquired Gradient Echo (STAGE) MRI. Patient satisfaction with SPECT and PET was recorded via questionnaires. Results: Eighteen patients were diagnosed with neurodegenerative parkinsonism with a median symptom duration of 29 months. DAT availability as measured with SPECT and PET showed complete concordance across cases, correlated strongly, and demonstrated equally excellent diagnostic performance. Patient questionnaire items were either not different between modalities or in favor of SPECT. Nigral neuromelanin content was reduced in patients with neurodegenerative parkinsonism and provided intermediate diagnostic accuracy, with indications of lower neuromelanin with disease duration. Midbrain iron content did not differ between groups and provided no diagnostic information. Conclusion: Our findings indicate that in early-stage parkinsonism, DAT neuroimaging with SPECT and PET provides comparable and superior diagnostic value relative to nigral MRI. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08184-8.
SN - 1619-7070
SN - 1619-7089
ER -