Clinical practice guideline for integrated PET/MRI in Parkinson's disease (2026 edition)

To advance the precise diagnosis and treatment of Parkinson's disease (PD) and related movement disorders, standardize the clinical application of integrated PET/MRI, enhance diagnostic efficacy, and optimize patient management, the Clinical Practice Guideline for Integrated PET/MRI in Parkinson's Disease (2026 Edition) was developed jointly by multiple expert groups. This initiative was led by the Chinese Society of Medical Imaging Technology, the Radiological Society of Chinese Medical Association, the Chinese Society of Nuclear Medicine, the Beijing Society of Nuclear Medicine, and the Beijing Society of Radiology, in collaboration with a multidisciplinary panel of experts from Nuclear Medicine, Radiology, Neurology, and Functional Neurosurgery, following several rounds of consensus meetings. Compared to previous consensus statements or technical specifications, the key updates of this guideline include: in the clinical application pathway, it clarifies the advantages and appropriate scenarios for utilizing integrated PET/MRI over single-modality imaging when the clinical diagnosis of PD is uncertain; it emphasizes the value of simultaneous acquisition and fusion analysis in assessing both the function of the nigrostriatal dopaminergic pathway (e.g., via PET tracers) and structural alterations (e.g., via MRI neuromelanin imaging, diffusion tensor imaging, etc.). With the development and validation of novel tracers, the guideline provides a hierarchical recommendation for the differential diagnosis between PD and atypical parkinsonian syndromes (such as multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration), based on multimodal imaging biomarkers. Based on the premise of the accessibility of current integrated PET/MRI equipment and tracers in China, and grounded in the latest international and domestic evidence-based research, this guideline is meticulously aligned with the realities of Chinese clinical practice. It systematically delineates the technical specifications, clinical indications, and image interpretation criteria for the use of integrated PET/MRI in the diagnosis, differential diagnosis, disease severity assessment, and therapeutic decision support for PD. The aim is to provide systematic and practical evidence-based guidance for clinicians and imaging specialists involved in the care of patients with Parkinson's disease.

为推进帕金森病及相关运动障碍疾病的精准诊疗，规范一体化PET/MRI在临床中的应用，提升诊断效能并优化患者管理，由中国医学影像技术研究会、中华医学会放射学分会、中华医学会核医学分会、北京医学会核医学分会、北京医学会放射学分会联合组织，集结核医学科、放射科、神经内科、功能神经外科等多学科专家，经多轮共识会议制订了《帕金森病一体化PET/MRI临床应用指南（2026版）》。相较于既往相关共识或技术规范，本指南的主要更新包括：在临床应用路径部分，明确了帕金森病临床诊断不确定时，一体化PET/MRI相较于单一模态影像的优势与适用场景；强调了在评估黑质-纹状体多巴胺能通路功能（如通过PET示踪剂）与结构性改变（如MRI神经黑色素成像、弥散张量成像等）时，同步采集与融合分析的价值。随着新型示踪剂的研发与验证，指南对帕金森病与非典型帕金森综合征（如多系统萎缩、进行性核上性麻痹、皮质基底节变性）的鉴别诊断流程给出了基于多模态影像标志物的分层推荐。本指南以我国现有一体化PET/MRI设备与示踪剂的可及性为前提，以国内外最新循证证据为依据，紧密结合中国临床实践现状，系统阐述了一体化PET/MRI在帕金森病诊断、鉴别诊断、病情评估及治疗决策支持中的技术规范、临床应用指征与影像解读标准，旨在为帕金森病相关临床与影像专业人员提供系统、实用的循证指导。.