Chapter 58 - Structural Imaging

Summary

Clinical diagnosis of movement disorders can be challenging, especially in the early stages of the disease. Therapy and prognosis of the disorders differ markedly, and early diagnosis is desirable. Structural imaging and complementary nuclear imaging can detect characteristic changes in diseases and present an objective, reproducible opportunity to confirm the suspected diagnosis, sometimes before the disease reaches its clinical full-blown stage. Differential diagnoses may also be excluded. After an introduction of the imaging methods, we present structural changes of a typical Parkinson syndrome as seen in sporadic Parkinson’s disease and some familial mono-/oligo-/polygenic and intermediate genetic variants, such as the "swallow tail sign." Characteristic features of atypical parkinsonian syndromes (MSA, PSP, CBD and vascular parkinsonism) are also presented and extended to include nuclear medicine aspects. Imaging features are classified in terms of their importance for diagnosis and differential diagnosis. Image examples are given to illustrate the features and the most important features and differential diagnoses are summarized and presented in tables.