Neuromelanin-Sensitive Magnetic Resonance Imaging as a Biomarker for Prodromal Parkinson’s Disease: A Systematic Review of Diagnostic Accuracy and Longitudinal Predictivity

Cassandra Nwokoro¹, Dawoye Yusufu², Nathan Rimamsanati Yohanna^3,4, Moses Adondua Abah^3,4 and Ishaya Jerry Magai³

¹Department of Medicine and Surgery, College of Medicine, University of Lagos, Lagos State, Nigeria

²Department of Biochemistry, School of Science and Technology, Federal Polytechnic Bali, 105, Taraba State, Nigeria

³Department of Biochemistry, Faculty of Biosciences, Federal University Wukari, Taraba State, Nigeria

⁴ResearchHub Nexus Institute, Nigeria

 Received: July 18, 2026/ Revised: Aug 30, 2026/Accepted: Sept 1, 2026

(✉) Corresponding Author: Cassandra Nwokoro; nwokorocassandra@gmail.com

DOI: https://doi.org/10.47587/SA.2026.7303

Highlights

• A systematic review evaluated neuroimaging biomarkers for the early and prodromal detection of Parkinson’s disease.
• Evidence from 286 studies demonstrated the diagnostic potential of advanced MRI and molecular imaging techniques.
• Neuromelanin-sensitive MRI, QSM, DTI, PET, and SPECT revealed distinct imaging markers of nigrostriatal degeneration and brain iron accumulation.
• Reduced dopamine transporter binding and metabolic PET patterns showed potential for predicting phenoconversion in prodromal Parkinson’s disease.
• Multimodal neuroimaging improved differentiation of Parkinson’s disease from essential tremor, progressive supranuclear palsy, and multiple system atrophy.

Abstract

 Neuroimaging biomarkers represent non-invasive approaches to monitor the neurodegenerative process of PD; yet comparative synthesis between the aforementioned modalities in early and preclinical stages is warranted in order to establish diagnostic criteria. We performed a systematic review of neuroimaging modalities to assess diagnostic value, predictive power and clinical applicability. This systematic review was carried out according to PRISMA guidelines. Primary database search (MEDLINE, Embase, Web of Science, PsycINFO) was done from inception to retrieve articles that assessed neuroimaging biomarkers (NMS-MRI, QSM, DTI, PET, SPECT) in preclinical stages (for example, isolated REM sleep behavior disorder), early Parkinson’s disease, and controls. After the screening and assessment of full texts, qualitative analysis was done regarding nigrostriatal degeneration, brain iron/neuromelanin pathology, sequencing optimization, and subtyping. Among the 286 included articles (out of 2,066 identified records), the use of advanced MRI and molecular imaging techniques successfully recognized early subcortical brain changes. Pathophysiological, progressive degeneration of dopaminergic neurons containing neuromelanin and noradrenergic neurons in the substantia nigra pars compacta and locus coeruleus respectively resulted in deposition of unchelated ferric iron, causing oxidative damage and loss of “swallow tail sign” of nigrosome-1. The current three-dimensional multiecho GRE imaging technique with magnetization transfer allowed simultaneous estimation of iron accumulation and loss of neuromelanin. Also, reduction in dopamine transporter binding (>25%) and metabolic ¹⁸F-FDG-PET covariance patterns were used to predict phenoconversion in prodromal subjects, while multimodal imaging successfully distinguished PD from essential tremor, PSP, and MSA.

Keywords: Neuromelanin, Magnetic resonance imaging, Biomarker, Prodromal Parkinson’s disease, and Diagnosis

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How to cite this article

Nwokoro, C., Yusuf, D., Yohanna, N. R., Abah, M. A., & Magaji, I. J. (2026). Neuromelanin-sensitive magnetic resonance imaging as a biomarker for prodromal Parkinson’s disease: A systematic review of diagnostic accuracy and longitudinal predictivity. Science Archives, 7(3), 309–324. https://doi.org/10.47587/SA.2026.7303

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