{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:24:06Z","timestamp":1789597446762,"version":"build-2803163510"},"reference-count":209,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>The \u201cNeuroimaging and Pathology Biomarkers in Parkinson\u2019s Disease\u201d course held on 12\u201313 September 2025 in Milan, Italy, convened an international faculty to review state-of-the-art biomarkers spanning neurotransmitter dysfunction, protein pathology and clinical translation. Here, we synthesize the four themed sessions and highlights convergent messages for diagnosis, stratification and trial design. The first session focused on neuroimaging markers of neurotransmitter dysfunction, highlighting how positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) provided complementary insights into dopaminergic, noradrenergic, cholinergic and serotonergic dysfunction. The second session addressed in vivo imaging of protein pathology, presenting recent advances in PET ligands targeting \u03b1-synuclein, progress in four-repeat tau imaging for progressive supranuclear palsy and corticobasal syndromes, and the prognostic relevance of amyloid imaging in the context of mixed pathologies. Imaging of neuroinflammation captures inflammatory processes in vivo and helps study pathophysiological effects. The third session bridged pathology and disease mechanisms, covering the biology of \u03b1-synuclein and emerging therapeutic strategies, the clinical potential of seed amplification assays and skin biopsy, the impact of co-pathologies on disease expression, and the \u201cbrain-first\u201d versus \u201cbody-first\u201d model of pathological spread. Finally, the fourth session addressed disease progression and clinical translation, focusing on imaging predictors of phenoconversion from prodromal to clinically overt stages of synucleinopathies, concepts of neural reserve and compensation, imaging correlates of cognitive impairment, and MRI approaches for atypical parkinsonism. Biomarker-informed pharmacological, infusion-based, and surgical strategies, including network-guided and adaptive deep brain stimulation, were discussed as examples of how multimodal biomarkers may inform personalized management. Across all sessions, the need for harmonization, longitudinal validation, and pathology-confirmed outcome measures was consistently emphasized as essential for advancing biomarker qualification in multicentre research and clinical practice.<\/jats:p>","DOI":"10.3390\/brainsci16010110","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T14:58:54Z","timestamp":1768834734000},"page":"110","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Neuroimaging and Pathology Biomarkers in Parkinson\u2019s Disease and Parkinsonism"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1990-1939","authenticated-orcid":false,"given":"Roberto","family":"Cilia","sequence":"first","affiliation":[{"name":"Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, 20133 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6823-6069","authenticated-orcid":false,"given":"Dario","family":"Arnaldi","sequence":"additional","affiliation":[{"name":"Clinical Neurophysiology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy"},{"name":"Department of Neuroscience (DINOGMI), University of Genova, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1901-3501","authenticated-orcid":false,"given":"B\u00e9n\u00e9dicte","family":"Ballanger","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon, CRNL U1028 UMR5292, PATHPARK, F-69500 Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1412-9406","authenticated-orcid":false,"given":"Roberto","family":"Ceravolo","sequence":"additional","affiliation":[{"name":"Center for Neurodegenerative Diseases-Parkinson\u2019s Disease and Movement Disorders, Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"},{"name":"Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"De Micco","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5364-9602","authenticated-orcid":false,"given":"Angelo","family":"Del Sole","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Milan, 20122 Milan, Italy"},{"name":"Centro Diagnostico Italiano (CDI), Via Simone Saint Bon 20, 20147 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Eleopra","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, 20133 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3398-597X","authenticated-orcid":false,"given":"Hironobu","family":"Endo","sequence":"additional","affiliation":[{"name":"Advanced Neuroimaging Center, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5346-0180","authenticated-orcid":false,"given":"Alfonso","family":"Fasano","sequence":"additional","affiliation":[{"name":"Edmond J. Safra Program in Parkinson\u2019s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merle C.","family":"Hoenig","sequence":"additional","affiliation":[{"name":"Multimodal Neuroimaging, Department of Nuclear Medicine, University Hospital and Medical Faculty, University of Cologne, 50937 Cologne, Germany"},{"name":"Molecular Organization of the Brain (INM-2), Institute of Neuroscience and Medicine, Research Center J\u00fclich, 52428 J\u00fclich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Horsager","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Aarhus University Hospital, 8000 Aarhus, Denmark"},{"name":"Lundbeck Foundation Parkinson\u2019s Disease Research Center (PACE), Aarhus University, 8000 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Leh\u00e9ricy","sequence":"additional","affiliation":[{"name":"Paris Brain Institute-ICM, Center for NeuroImaging Research (CENIR), Sorbonne University, Inserm, CNRS, 75013 Paris, France"},{"name":"Department of Neuroradiology, Piti\u00e9-Salp\u00eatri\u00e8re Hospital, AP-HP, 75013 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Leta","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, 20133 Milano, Italy"},{"name":"Department of Basic and Clinical Neuroscience, King\u2019s College London, Institute of Psychiatry, Psychology and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, London SE5 8AF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2820-9880","authenticated-orcid":false,"given":"Fabio","family":"Moda","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology and Translational Medicine, Universit\u00e0 degli Studi Milano, 20122 Milan, Italy"},{"name":"Unit of Laboratory Medicine, Laboratory of Clinical Pathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Nolano","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Odontostomatology, University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"},{"name":"Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri, IRCCS, 82037 Telese Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1679-1727","authenticated-orcid":false,"given":"Tiago F.","family":"Outeiro","sequence":"additional","affiliation":[{"name":"University Medical Center G\u00f6ttingen, Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, 37075 G\u00f6ttingen, Germany"},{"name":"Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK"},{"name":"Algarve Biomedical Center Research Institute (ABC-Ri), Algarve Biomedical Center (ABC), Faculdade de Medicina e Ci\u00eancias Biom\u00e9ticas, University of Algarve, 8005-139 Faro, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Parkkinen","sequence":"additional","affiliation":[{"name":"Nuffield Department of Clinical Neurosciences, Oxford Parkinson\u2019s Disease Center, University of Oxford, Oxford OX3 9DU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Pavese","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Aarhus University Hospital, 8000 Aarhus, Denmark"},{"name":"Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK"},{"name":"Clinical Ageing Research Unit, Newcastle University, Campus for Ageing and Vitality, Newcastle Upon Tyne NE4 5PL, UK"},{"name":"Neurosciences, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne NE1 4LP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2071-2083","authenticated-orcid":false,"given":"Andrea","family":"Quattrone","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola J.","family":"Ray","sequence":"additional","affiliation":[{"name":"Health, Psychology and Communities Research Centre, Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin M.","family":"Reich","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of W\u00fcrzburg, 97080 W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irena","family":"Rektorov\u00e1","sequence":"additional","affiliation":[{"name":"Applied Neuroscience Research Group, Brain and Mind Research Programme, Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic"},{"name":"Movement Disorders Centre, First Department of Neurology, St. Anne\u2019s University Hospital, Faculty of Medicine, and CEITEC, Masaryk University in Brno, 625 00 Brno, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio P.","family":"Strafella","sequence":"additional","affiliation":[{"name":"Edmond J. Safra Parkinson Disease Program, Morton and Gloria Shulman Movement Disorder Unit, Krembil Brain Institute, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada"},{"name":"Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada"},{"name":"Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M6J 1H4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Tagliavini","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Tessitore","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6951-2325","authenticated-orcid":false,"given":"Thilo","family":"van Eimeren","sequence":"additional","affiliation":[{"name":"Multimodal Neuroimaging, Department of Nuclear Medicine, University Hospital and Medical Faculty, University of Cologne, 50937 Cologne, Germany"},{"name":"Molecular Organization of the Brain (INM-2), Institute of Neuroscience and Medicine, Research Center J\u00fclich, 52428 J\u00fclich, Germany"},{"name":"Department of Neurology, University Hospital and Medical Faculty, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Palermo, G., and Ceravolo, R. 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