Although the diagnosis of Parkinson’s disease (PD) is essentially clinical, the implementation of imaging techniques can improve diagnostic accuracy. While some techniques (e.g. magnetic resonance imaging—MRI, computerized tomography—CT) are used to exclude secondary syndromes, presynaptic dopaminergic imaging including imaging of dopamine transporter (DAT)—can help the Neurologist in the differential diagnosis between neurodegenerative parkinsonian syndromes and parkinsonism without dopamine deficiency. DAT imaging can be useful in cases in which the clinical picture is not univocal, as in case of overlapping clinical features in patients with early disease, atypical syndromes or unsatisfying response to therapy. Currently, (¹²³I)FP-CIT ([123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane) (trade name DaTSCAN) is the only agent approved by international regulatory agencies for this purpose. With the increasing use of this technique, some unexpected findings have been reported, including patients clinically diagnosed with PD with a normal SPECT scan [e.g. Scans Without Evidence of Dopaminergic Deficit (SWEDD)]; PD patients with a greater dopaminergic deficit in the striatum ipsilateral to the clinically more affected side [e.g. Scans With Ipsilateral Dopaminergic Deficit (SWIDD)]; as well as some artifacts. Moreover, the neurologist must remember that structural lesions and administration of some drugs might alter the result of DAT imaging. Unexpected findings, artifacts, and misinterpretation of imaging findings can lead to an erroneous diagnosis and inappropriate therapy, neglect of other medical conditions that might explain the clinical picture, and undermine the selection phase in clinical trials. The aim of the present review is to bring clarity on these controversial (and sometimes erroneous) results, in order to inform of these possibilities the clinicians requesting a DaTSCAN in clinical practice.

尽管帕金森病 (PD) 的诊断本质上是临床诊断，但影像技术的实施可以提高诊断准确性。虽然一些技术（例如磁共振成像—MRI、计算机断层扫描—CT）用于排除继发性综合征，但突触前多巴胺能成像（包括多巴胺转运蛋白（DAT）成像）可以帮助神经科医生在神经退行性帕金森综合征和帕金森综合征之间进行鉴别诊断，而无需多巴胺缺乏。DAT 成像在临床表现不明确的情况下很有用，例如早期疾病、非典型综合征或对治疗反应不满意的患者的临床特征重叠的情况。目前，( ¹²³ I)FP-CIT ([123I]N- ω -fluoropropyl-2 β-carbomethoxy-3 β-(4-iodophenyl)nortropane)（商品名 DaTSCAN）是唯一获得国际监管机构批准用于此目的的药剂。随着这种技术的使用越来越多，一些意想不到的发现被报道，包括临床诊断为 PD 且 SPECT 扫描正常的患者[例如无多巴胺能缺乏证据的扫描 (SWEDD)]；PD 患者的纹状体与临床受影响较大的一侧同侧具有较大的多巴胺能缺陷[例如同侧多巴胺能缺陷扫描 (SWIDD)]；以及一些文物。此外，神经科医生必须记住，结构性损伤和某些药物的使用可能会改变 DAT 成像的结果。意外的发现、伪影和对影像学发现的误解可能导致错误的诊断和不适当的治疗，忽视可能解释临床情况的其他医疗条件，并破坏临床试验的选择阶段。本综述的目的是澄清这些有争议的（有时是错误的）结果，以便告知临床医生在临床实践中要求进行 DaTSCAN 的这些可能性。