{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T02:20:21Z","timestamp":1788142821005,"version":"build-2803163510"},"reference-count":98,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Education and Research, CCCDI\u2013UEFISCDI","award":["PN-IV-P6-6.1-CoEx-2024-0141"],"award-info":[{"award-number":["PN-IV-P6-6.1-CoEx-2024-0141"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Parkinsonian syndromes comprise overlapping neurodegenerative and non-degenerative disorders, making aetiological diagnosis difficult, while existing procedural guidance does not fully integrate tracer-specific biology with clinical decision-making, multimodal strategies, and emerging quantitative and pathology-directed biomarkers. This review synthesises evidence on the molecular targets, radiopharmaceutical characteristics, biological interpretation, and clinical applications of dopaminergic single-photon emission computed tomography (SPECT) and positron emission tomography (PET), focusing on the dopamine transporter (DAT), aromatic L-amino acid decarboxylase (AADC), vesicular monoamine transporter type 2 (VMAT2), dopamine D2\/D3 receptors, differential diagnosis, semiquantification, kinetic modelling, and artificial intelligence-assisted interpretation. The evidence confirms that DAT SPECT with [123I]ioflupane ([123I]FP-CIT) remains the most established method for demonstrating or arguing against presynaptic nigrostriatal dysfunction, but an abnormal result cannot establish aetiology, and a normal result can redirect evaluation towards non-degenerative mimics; target-specific PET provides complementary biological information, although availability, standardisation, and prospective validation remain limiting. By additionally integrating genetic and prodromal applications, question-driven multimodal imaging, emerging acquisition approaches, \u03b1-synuclein imaging and seed amplification assays, and contemporary biological staging frameworks, this review extends procedural guidance and positions dopaminergic imaging as a targeted functional biomarker selected according to the unresolved clinical question rather than as a stand-alone disease label.<\/jats:p>","DOI":"10.3390\/ph19091369","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T02:08:58Z","timestamp":1788142138000},"page":"1369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dopaminergic Radiopharmaceutical Imaging in Parkinsonian Syndromes: From Molecular Targets to Clinical Decision-Making"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5515-6473","authenticated-orcid":false,"given":"Wael","family":"Jalloul","sequence":"first","affiliation":[{"name":"Department of Biophysics and Medical Physics-Nuclear Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Nuclear Medicine Laboratory, \u201cSt. Spiridon\u201d County Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7563-1267","authenticated-orcid":false,"given":"Cristina Mariana","family":"Uritu","sequence":"additional","affiliation":[{"name":"Advanced Centre for Research and Development in Experimental Medicine \u201cProf. Ostin C. Mungiu\u201d, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700259 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Despina","family":"Jalloul","sequence":"additional","affiliation":[{"name":"Department of Biophysics and Medical Physics-Nuclear Medicine, \u201cGrigore T. 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