Whether swallow tail sign (STS) could serve as a substitute or complement for nuclear medical imaging remains unclear. In this study, we compared STS features on MRI with striatal uptake on positron emission tomography (PET) at per nuclei level, construct an evaluation scale based on bilateral STS changes at the patient level, and estimate the diagnostic performance of the scale in 39 early-stage PD and 28 healthy controls. STS alterations corresponded well with striatal uptake on PET in early-stage PD. Total loss of STS is a reliable sign of nigrostriatal dopaminergic degeneration and might be a potential substitute for PET.
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