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In this study, the striatal and myocardial dopaminergic innervation, brain 18F-FDG metabolism, resting-state functional activity of basal ganglia network (BGN) and white-matter (WM) microstructure were evaluated in AR-PD with respect to IPD, to investigate whether AR-PD can be subtyped as \u201cbrain-first\u201d parkinsonism according to recent etiopathogenetic classification effort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Forty patients (17 with Parkin, 3 with DJ-1 mutations and 20 with IPD) were included. Striatal dopaminergic innervation was assessed semi-quantitatively by 18F-DOPA PET, and cardiac 18F-DOPA uptake was also evaluated. Brain 18F-FDG PET images were evaluated visually. Resting-state functional MRI and diffusion tensor imaging (DTI) were used to assess the BGN activity and WM microstructural alterations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>AR-PD patients showed significantly decreased 18F-DOPA uptake in caudate corpus compared to both IPD and controls, with a more symmetrical striatal dopaminergic denervation. Myocardial 18F-DOPA uptake in AR-PD was similar to controls, while it was significantly reduced in IPD. There was no significant difference in cortical 18F-FDG metabolism and functional activity of BGN between PD groups. The DTI data revealed more extensive WM microstructural damage in AR-PD compared to IPD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>AR-PD group showed additional significant decreased 18F-DOPA uptake in caudate corpus and more symmetrical striatal denervation. Additionally, relatively preserved myocardial innervation, cortical metabolic and WM microstructural changes suggest the possibility of \u201cbrain-first\u201d type progression in AR-PD. Also, 18F-DOPA PET\/CT may be a practical tool for evaluating dopaminergic innervation of striatum and heart together, but further evaluation is needed in this area.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s12149-025-02053-4","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T17:16:37Z","timestamp":1745514997000},"page":"813-822","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Multimodal imaging analysis of autosomal recessive Parkinson\u2019s disease"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3425-751X","authenticated-orcid":false,"given":"Ba\u015fak","family":"Soyda\u015f-Turan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcl","family":"Yal\u00e7\u0131n-\u00c7akmakl\u0131","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eser","family":"Lay Erg\u00fcn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hacer","family":"Dasgin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kader","family":"Karli Oguz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bulent","family":"Elibol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer","family":"Ugur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilge","family":"Volkan-Salanci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"2053_CR1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/ene.14108","volume":"27","author":"R Balestrino","year":"2020","unstructured":"Balestrino R, Schapira A. 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