Purpose The purpose of this study was to show the viability and performance of a shape-based pattern recognition technique applied to I-123-N-omega-fluoropropyl-2-beta-carbomethoxy-3 beta-(4-iodophenyl) nortropane single-photon emission computed tomography (FP-CIT SPECT) in patients with parkinsonism. Methods A fully automated pattern recognition tool, based on the shape of FP-CIT SPECT images, was written using Java. Its performance was evaluated and compared with QuantiSPECT, a region-of-interest-based quantitation tool, and observer performance using receiver operating characteristic analysis and kappa statistics. The techniques were compared using a sample of patients and controls recruited from a prospective community-based study of first presentation of parkinsonian symptoms with longitudinal follow up (median 3 years). Results The shape-based technique as well as the conventional semiquantitative approach was performed by experienced observers. The technique had a high level of automation, thereby avoiding observer/operator variability. Conclusion A pattern recognition approach is a viable alternative to traditional methods of analysis in FP-CIT SPECT and has additional advantages. Nucl Med Commun 30:194-201 (C) 2009 Wolters Kluwer Health Lippincott Williams & Wilkins.