Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison of MR imaging and SPECT.

Schwartz, Richard B.; Garada, B; Komaroff, Anthony L.; Tice, Hilary; Gleit, M; Jólesz, Ferenc A.; Holman, B. Leonard

doi:10.2214/ajr.162.4.8141020

Cited by 112 publications

(70 citation statements)

References 13 publications

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“…Patients with chronic fatigue had reduced global cerebral blood flow in Yoshiuchi et al study [35], supported the previous results regarding global hypoperfusion using SPECT brain imaging [33,36]. Chronically fatigued patients had decreased blood flow in bilateral middle cerebral artery territories with increased perfusion in cerebellum [25,31].…”

Section: Discussionsupporting

confidence: 66%

“…However, these findings were not supported by the result of the other study with SPECT brain perfusion scintigraphy [25]. SPECT abnormalities occur more frequently and in greater numbers than MR abnormalities in patients with chronic fatigue syndrome [33], but there are no study regarding SPECT scanning of cerebral blood flow in PBC patients with fatigue to date.…”

Section: Discussionmentioning

confidence: 79%

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Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Raszeja‐Wyszomirska¹,

Zorga²,

Kotulski³

et al. 2017

IJCEMS

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Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social isolation. It is unrelated to the severity of liver disease and appears unresponsive to current therapies, including ursodeoxycholic acid and transplantation. Fatigue in PBC is complex, with numerous associated peripheral and central nervous system (CNS) features. Initially, cholestasis causes degenerative CNS change affecting areas of the brain regulating autonomic dysfunction and sleep, and these changes lead directly to some manifestations of fatigue and the associated cognitive impairment. The aim of the study was to examine global cerebral blood flow with brain perfusion scintigraphy SPECT in well-defined group of PBC Caucasian patients with verbally reported fatigue. Twenty consecutive PBC female patients (median age 58.9, ranges 38-80; 4 cirrhotic) with mean duration of the disease 3.3 years, were prospectively enrolled into the study. Fatigue Impact Scale (FIS) questionnaire was administered to every patients at the moment of brain examination. Brain perfusion scintigraphy SPECT was performed after intravenous injection of 760-800 MBq of technetium 99m labeled exametazime ( 99m Tc -HMPAO). Then patients were examined using double head gamma camera system, and data were analyzed with dedicated nuclear medicine software. In analyzed cohort the median FIS score was 70.5 points (ranges 21-160), which was higher than previously reported. There were no correlation between age of patients at the SPECT/FIS examination, duration of the disease, the presence of liver cirrhosis, Mayo Risk Score, and FIS domains: Cognitive, Physical and Social, as well as with brain blood flow. However, positive correlation between Cognitive dimension of FIS measure and right frontal lobe perfusion impairment assessed with SPECT technic (p<0.05) was found. The results of this study showed that right lobe perfusion impairment might impact brain function in PBC. Cognitive dimension was stage-independent symptom in analyzed cohort, and cognitive impairment might be, in turn, associated with functional brain lesion.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 79%

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Raszeja‐Wyszomirska¹,

Zorga²,

Kotulski³

et al. 2017

IJCEMS

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“…Specifically, significantly elevated blood levels of 8-iso-prostaglandin-F 2a -isoprostanes, considered among the most reliable blood markers of oxidative stress, were reported (16) and recently confirmed in CFS (17). In addition to their role as reliable markers of oxidative stress, isoprostanes have potent vasoconstrictor effects on peripheral vasculature, including cerebral arterioles (19), which might explain the results of a number of studies that have found reduced absolute (20) and relative (21,22) cortical and subcortical blood flow in CFS. Insofar as cerebral hypoperfusion is known to increase brain lactate, our observation of elevated CSF lactate is consistent with a pathophysiological model of CFS in which increased blood levels of isoprostanes cause constriction of cerebral arterioles leading to decreased cerebral blood flow and attendant increased anaerobic metabolism and lactic acid.…”

Section: Discussionmentioning

confidence: 93%

Increased ventricular lactate in chronic fatigue syndrome measured by ¹H MRS imaging at 3.0 T. II: comparison with major depressive disorder

et al. 2010

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Chronic fatigue syndrome (CFS), a complex illness characterized by fatigue, impaired concentration, and musculoskeletal pain, is often misdiagnosed as a psychiatric illness due to the overlap of its symptoms with mood and anxiety disorders. Using proton magnetic resonance spectroscopic imaging ((1)H MRSI), we previously measured levels of the major brain metabolites in CFS, in generalized anxiety disorder (GAD), and in healthy control subjects, and found significantly higher levels of ventricular cerebrospinal fluid (CSF) lactate in CFS compared to the other two groups. In the present study, we sought to assess the specificity of this observation for CFS by comparing ventricular lactate levels in a new cohort of 17 CFS subjects with those in 19 healthy volunteers and in 21 subjects with major depressive disorder (MDD), which, like GAD, is a neuropsychiatric disorder that has significant symptom overlap with CFS. Ventricular CSF lactate was significantly elevated in CFS compared to healthy volunteers, replicating the major result of our previous study. Ventricular lactate measures in MDD did not differ from those in either CFS or healthy volunteers. We found a significant correlation between ventricular CSF lactate and severity of mental fatigue that was specific to the CFS group. In an exploratory analysis, we did not find evidence for altered levels of the amino acid neurotransmitters, gamma-aminobutyric acid (GABA) and glutamate + glutamine ('Glx'), in CFS compared to MDD or healthy controls. Future (1)H MRS studies with larger sample sizes and well-characterized populations will be necessary to further clarify the sensitivity and specificity of neurometabolic abnormalities in CFS and MDD.

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“…CFS patients and patients with VWM may demonstrate abnormalities in cerebrospinal fluid (Schutzer et al, 2011a;Schutzer et al, 2011b). White matter studies in CFS are inconsistent, in some instances, abnormal white matter has been observed (Lange et al, 1999;Schwartz et al, 1994). Also, grey matter in some CFS patients may be reduced (de Lange et al, 2005).…”

Section: Neurology and Endocrine Functionmentioning

confidence: 99%

“…Mechanisms to explain the underlying factors and processes that are responsible for disease progression and symptom profile of this disorder remains to be established. However, research has demonstrated that CFS impacts the endocrine, neurological, immune and metabolic processes resulting in impaired physiological homeostasis (Brenu et al, 2010;Demitrack, 1997;Schwartz et al, 1994). While these processes are likely compromised and collectively contribute to ill health in CFS patients, CFS remains a disorder lacking a clear molecular or biochemical cause.…”

Section: Introductionmentioning

confidence: 99%

Gene Expression in Chronic Fatigue Syndrome

Brenu¹,

Ashton²,

Atkinson³

et al. 2012

An International Perspective on the Future of Research in Chronic Fatigue Syndrome

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Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison of MR imaging and SPECT.

Cited by 112 publications

References 13 publications

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Increased ventricular lactate in chronic fatigue syndrome measured by ¹H MRS imaging at 3.0 T. II: comparison with major depressive disorder

Gene Expression in Chronic Fatigue Syndrome

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Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison of MR imaging and SPECT.

Cited by 112 publications

References 13 publications

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Increased ventricular lactate in chronic fatigue syndrome measured by 1H MRS imaging at 3.0 T. II: comparison with major depressive disorder

Gene Expression in Chronic Fatigue Syndrome

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Increased ventricular lactate in chronic fatigue syndrome measured by ¹H MRS imaging at 3.0 T. II: comparison with major depressive disorder