MSA with a parkinsonian variant (MSA-P) and PD share many common clinical presentations, such as parkinsonism and autonomic failure to mention just a few. The early differential diagnosis of these two disorders has been established more or less empirically despite a lack of a subjective, satisfactory biomarker. Neuroimaging has revolutionized in-vivo visualization of neuromelanin and iron in the substantial nigra (SN), which has been considered as the primary and predominant pathophysiological change in PD patients. We found significant neuromelanin changes in the SN in patients with MSA-P compared with PD and HC.
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