INTRODUCTION: Aspiration is a critical complication of dysphagia in Parkinson's disease (PD). Current methods for predicting aspiration are unsuitable for routine implementation owing to time constraints, cost, or insufficient predictive accuracy. We assessed the predictive performance of clinical measures, including dopamine transporter (DaT) imaging, for aspiration risk in patients with PD. METHODS: We retrospectively analyzed data from patients with PD who underwent videofluoroscopic swallowing examinations (VF) and DaT imaging within 12 months. Patients were divided into aspiration and non-aspiration groups based on VF findings. Logistic regression and receiver operating characteristic (ROC) analyses evaluated the predictive performance of DaT imaging parameters including striatal specific binding ratio (SBR) and subregional SBRs, calculated using DaT View and DaTQUANT software. RESULTS: Among 87 patients (38 females
mean age: 64 years
disease duration: 8.3 years [range: 1-20 years]
modified Hoehn and Yahr stages: 2 [range: 1-4]), 14.9 % experienced aspiration. DaT View striatal SBRs consistently showed significantly lower values in the aspiration group and negative associations with aspiration in logistic regression models, whereas DaTQUANT exhibited limited significance in intergroup differences and associations. ROC analysis showed DaT View striatal SBR of the better side (SBRbetter) as the optimal predictor (sensitivity 0.62, specificity 0.93 at cutoff: 2.03). DaTQUANT subregional analysis identified the anterior putamen as key in aspiration risk. CONCLUSION: Reduced SBR in DaT imaging shows potential as an indicator of aspiration risk in patients with PD. These findings can help clinicians identify patients at risk of aspiration, allowing for proactive referral for detailed evaluation.