The spectrum of parkinsonian syndromes is wide and, due to the lack of specific biomarkers, their diagnosis remains largely clinical. Disorders that are most commonly referred to as ‘atypical parkinsonism' comprise progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD) and dementia with Lewy 
bodies (DLB). The characteristic features of these disorders are well recognised. However, these features may be absent or ambiguous at initial diagnosis and the clinician may be uncertain about the L-dopa response. Many atypical parkinsonism cases initially resemble idiopathic Parkinson's disease (1)MRI plays an important role in the differential 
diagnosis in PD. Conventional MRI (cMRI), as well as different advanced MRI techniques, including magnetic resonance spectroscopy (MRS), diffusion-weighted and diffusion tensor imaging (DWI/DTI) and functional MRI (fMRI), are helpful to distinguish PD from APDs, especially in early stage of disease where a differentiation of these conditions is 
not easy. The principles of MRI are based on the ubiquitous presence of hydrogen in body tissues and the spin of the hydrogen atom proton, which induces a small magnetic field. In general, T2-weighted sequences are sensitive to 
changes in tissue properties, including tissue damage, due to changes of the transverse magnetization or T2 decay. Neuro degenerative processes are characterized by cell loss, increased age-related deposition of iron or other 
paramagnetic substances, and by astroglial reaction and microglial proliferation may lead to signal changes in affected brain areas, like the basal ganglia or infratentorial structures, in neurodegenerative parkinsonism(2