Advanced MRI Biomarkers for Parkinsonian Syndromes: Beyond the MRPI

Magnetic resonance imaging (MRI) plays an important role in the differential diagnosis and characterization of Parkinsonian syndromes, yet reliably distinguishing idiopathic Parkinson’s disease, progressive supranuclear palsy (PSP), multiple system atrophy, and related disorders remains a major challenge. Traditional morphometric indices, including the magnetic resonance parkinsonism index (MRPI) and midbrain-to-pons ratio, have demonstrated diagnostic value, particularly for PSP, but their performance can vary across disease phenotypes, populations, acquisition protocols, and clinical settings. At the same time, advanced MRI biomarkers are evolving rapidly, spanning neuromelanin-sensitive, diffusion-based, and iron-sensitive imaging techniques. Recent studies have shown that neuromelanin-sensitive MRI can capture the integrity of the substantia nigra and locus coeruleus, making it a candidate marker for disease staging and risk stratification across both prodromal and clinical phases of Parkinsonian syndromes. That said, variability in acquisition protocols, the absence of standardized quantification and defined cut-offs, and limited multicentre validation still stand in the way of routine clinical use.This Research Topic focuses on advanced MRI biomarkers and multimodal neuroimaging approaches for the differential diagnosis and longitudinal characterization of Parkinsonian syndromes. We aim to address methodological inconsistencies, map imaging-based phenotypes across the disease spectrum, and explore strategies that combine multimodal neuroimaging and computational approaches. Our goal is to bring together technical MRI advances and clinical practice around reproducible, quantitative imaging frameworks for movement disorders, and to ask how imaging markers can complement clinical and molecular diagnostics, predict progression, and guide clinical decisions in neurodegenerative parkinsonism.We welcome contributions on the following themes, among others:o Standardization of iron-sensitive and neuromelanin-sensitive MRI acquisition and quantification methodso Novel structural and diffusion MRI biomarkers for differential diagnosis and disease stagingo Multimodal integration of MRI with PET or DAT-SPECT to improve diagnostic specificityo Artificial intelligence, machine learning, radiomics, and automated image analysis for diagnosis, phenotyping, and longitudinal monitoringo Longitudinal imaging studies on biomarker evolution in prodromal and overt disease stageso Validation of imaging markers in multicentre and harmonized frameworkso Translation of advanced MRI findings into structured clinical reporting systemsWe welcome all article types, including Original Research, Review, Mini Review, Methods, and FAIR² Data articles. Topic editors: Daniela Jardim Pereira, Archith Rajan Source: https://www.frontiersin.org/research-topics/82644/advanced-mri-biomarkers-for-parkinsonian-syndromes-beyond-the-mrpi