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BackgroundParkinson's disease (PD) and multiple system atrophy parkinsonian subtype (MSA-P) are clinically similar α-synucleinopathies, making differential diagnosis challenging. This study aimed to identify distinct regional dopaminergic dysfunction patterns using quantitative 18F-DOPA PET to differentiate the two disorders.MethodsWe prospectively recruited 20 PD patients, 12 MSA-P patients, and 9 healthy controls. All underwent 18F-DOPA PET imaging. Images were normalized using an adaptive probabilistic brain atlas. Voxel-wise and region-of-interest (ROI) analyses were performed with Statistical Parametric Mapping 12, controlling for age, sex, and disease duration. ROI comparisons used ANCOVA with Bonferroni post-hoc tests.ResultsBoth patient groups showed severe putaminal dopaminergic loss compared to controls. A key differentiator was caudate nucleus involvement: SUVR was significantly lower in MSA-P than in PD (P = 0.031) and controls (P = 0.006), while PD did not differ from controls. Cerebellar SUVR was also significantly reduced in MSA-P compared to PD (P = 0.026) and controls (P = 0.007), despite no clinical cerebellar signs in MSA-P patients. Putamen uptake did not differentiate PD from MSA-P. Voxel-wise analysis confirmed reduced uptake in bilateral caudate, posterior cerebellar lobes, and vermis in MSA-P vs PD. No significant correlations between SUVR and clinical severity were found after correction for multiple comparisons.Conclusions18F-DOPA PET reveals distinct topographic patterns: PD shows predominant putaminal impairment with caudate sparing, whereas MSA-P is characterized by concurrent caudate and cerebellar dopaminergic dysfunction. Caudate and cerebellar 18F-DOPA uptake are potential imaging biomarkers for differentiating MSA-P from PD.
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