{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T20:54:48Z","timestamp":1790456088687,"version":"4.1.0"},"reference-count":64,"publisher":"The Korean Movement Disorder Society","issue":"1","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2017R1D1A1B06028086"],"award-info":[{"award-number":["2017R1D1A1B06028086"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["e-jmd.org"],"crossmark-restriction":true},"short-container-title":["JMD"],"published-print":{"date-parts":[[2026,1,31]]},"abstract":"<jats:p>Recent neuropathological and imaging studies support the concept of \u201cbrain-first vs. body-first\u201d Parkinson\u2019s disease (PD), which is based on the \u03b1-synuclein origin site and connectome model. The body-first phenotype is characterized by early involvement of the peripheral autonomic nervous system, particularly the cardiac sympathetic nerves and enteric nerves. &lt;sup&gt;123&lt;\/sup&gt;I-meta-iodobenzylguanidine (&lt;sup&gt;123&lt;\/sup&gt;I-MIBG) myocardial scintigraphy is a well-established method for evaluating cardiac sympathetic innervation. This review explores the potential of &lt;sup&gt;123&lt;\/sup&gt;I-MIBG scintigraphy as a biomarker to differentiate the body-first phenotype from the brain-first phenotype. Reduced &lt;sup&gt;123&lt;\/sup&gt;I-MIBG uptake has been observed in idiopathic rapid eye movement (REM) sleep behavior disorder, pure autonomic failure, and incidental Lewy body disease\u2014conditions strongly associated with prodromal or early-stage PD. Postmortem and biopsy evidence indicates \u03b1-synuclein accumulation in cardiac nerves and other peripheral sites, which is consistent with bottom-up progression. \u03b1-Synuclein seed amplification assays further corroborate the association between the peripheral \u03b1-synuclein burden and reduced &lt;sup&gt;123&lt;\/sup&gt;I-MIBG uptake. While &lt;sup&gt;123&lt;\/sup&gt;I-MIBG myocardial scintigraphy is a promising tool, its limitations include cost, limited availability, and potential confounding from underlying cardiac conditions. Nonetheless, early detection of cardiac sympathetic denervation via &lt;sup&gt;123&lt;\/sup&gt;I-MIBG imaging may enhance diagnosis, support subtype classification, and improve the understanding of PD pathogenesis.<\/jats:p>","DOI":"10.14802\/jmd.25137","type":"journal-article","created":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T23:57:11Z","timestamp":1754265431000},"page":"1-10","update-policy":"https:\/\/doi.org\/10.14802\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cardiac 123I-Meta-Iodobenzylguanidine Imaging as a Biomarker for Body-First Parkinson\u2019s Disease: Linking Peripheral \u03b1-Synuclein to Clinical 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