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Advances in molecular imaging techniques and the increasing availability of functional imaging are expanding the role of nuclear medicine in neuroradiology. Molecular imaging has a well-established role in the evaluation of extrapyramidal disorders. In this setting, functional assessment can be combined with structural imaging to make a more accurate diagnosis. This is particularly useful in a number of more clinically challenging pathologies. This review discusses the role and context of imaging in extrapyramidal disorders. Structural imaging with MR imaging in combination with iodine 123 N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane SPECT (dopamine transporter SPECT), iodine 123 metaiodobenzylguanidine cardiac scintigraphy, and [18F]FDG-PET can be used to differentiate various underlying disease processes including Parkinson disease, dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration.

Learning Objective: To assess dopamine transporter studies qualitatively and semiquantitatively and categorize them as having normal, abnormal, or indeterminate findings and to understand the role of MR imaging, iodine 123 metaiodobenzylguanidine cardiac scintigraphy, and [18F] FDG-PET in advancing the differential diagnoses of patients with Parkinson disease and atypical parkinsonian syndrome
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