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Background and purpose  Whether the neuromelanin‐positive substantia nigra pars compacta area ( NM ‐ SN c) on neuromelanin magnetic resonance imaging ( NM ‐ MRI ) and the specific binding ratio ( SBR ) on  123 I‐N‐v‐fluoropropyl‐2b‐carbomethoxy3b‐(4‐iodophenyl)nortropane single photon emission computed tomography (DaT‐ SPECT ) can be correlated with motor fluctuations ( MF s) in advanced Parkinson's disease ( PD ) was investigated.    Methods  Thirty‐five  PD  patients (60 ± 13 years) and 23 healthy individuals as controls (59 ± 19 years) were enrolled. The relationships between  NM ‐ MRI  and DaT‐ SPECT  were prospectively examined in two subgroups divided according to the presence or absence of  MF s. Multivariate analysis was performed using the Cox proportional hazard model to screen for association factors.    Results  The  NM ‐ SN c size was correlated with the  SBR  (Spearman's  ρ  = 0.43,  P  < 0.05). The  NM ‐ SN c size was significantly reduced in  PD  with  MF s compared with the subgroup without ( P  < 0.001), whereas the  SBR  did not significantly differ between the groups.  NM ‐ SN c size was a significant association factor for  MF s (hazard ratio 0.94,  P  = 0.04). In receiver operating characteristic analysis of the factors for  MF  occurrence, the area under the receiver operating characteristic curve of the  NM ‐ SN c size showed a significant difference of 0.89 ( P  < 0.05) but no significant difference was found in the  SBR .    Conclusions  NM‐SNc size was significantly correlated with the  SBR  in  PD , but several factors in advanced  PD  were more closely associated with  NM ‐ SN c size than the  SBR .  NM ‐ MRI  might reflect the status of advanced  PD  more accurately than DaT‐ SPECT . Therefore,  NM ‐ MRI  appears to provide a better marker for discriminating advanced  PD  than DaT‐ SPECT .

Neuromelanin or DaT‐ SPECT : which is the better marker for discriminating advanced Parkinson's disease?