Movement disordersAn update on conventional and advanced magnetic resonance imaging techniques in the differential diagnosis of neurodegenerative parkinsonismSeppi, Klausa; Schocke, Michael FHbAuthor Information aDepartment of Neurology bDepartment of Radiology, Medical University Innsbruck, Austria Correspondence to Dr Klaus Seppi, Department of Neurology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria Tel: +43 512 504 81498; fax: +43 512 504 23852; e-mail: [email protected] Current Opinion in Neurology: August 2005 - Volume 18 - Issue 4 - p 370-375 doi: 10.1097/01.wco.0000173141.74137.63 Buy Metrics Abstract Purpose of review The clinical differentiation between Parkinson's disease and atypical parkinsonian disorders (APD) remains a challenge for every neurologist. Conventional magnetic resonance imaging (MRI) and different advanced MRI techniques offer the potential for objective criteria in the differential diagnosis of neurodegenerative parkinsonism. The aim of this article is to review the recent literature on the role of conventional and advanced MRI techniques in the differential diagnosis of neurodegenerative parkinsonian disorders. Recent findings An important role of MRI is the exclusion of symptomatic parkinsonism due to other pathologies. Over the past two decades, conventional MRI and different advanced MRI techniques, including proton magnetic resonance spectroscopy (1H-MRS), diffusion-weighted imaging (DWI), magnetization transfer imaging (MTI) and magnetic resonance volumetry (MRV) have been found to show abnormalities in the substantia nigra and basal ganglia, especially in APD. Recent studies using MRV, MTI, DWI and 1H-MRS to discriminate Parkinson's disease from APD are discussed extensively. Summary Research findings suggest that novel MRI techniques such as MTI, DWI and MRV have superior sensitivity compared to conventional MRI in detecting abnormal features in neurodegenerative parkinsonian disorders. Whether these techniques will emerge as standard investigations in the work-up of patients presenting with parkinsonism requires further prospective magnetic resonance studies during early disease stages. © 2005 Lippincott Williams & Wilkins, Inc.