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Detection of intracranial abnormalities in patients with Chronic Fatigue Syndrome (CFS): comparison of MR imaging & SPECT

  [ 86 votes ]   [ Discuss This Article ] • April 3, 1994

OBJECTIVE. Chronic fatigue syndrome is a recently characterized
condition of unknown origin that is manifested by fatigue,
flulike complaints, and neurologic signs and symptoms,
including persistent headache, impaired cognitive abilities,
mood disorders, and sensorimotor disturbances. This syndrome
can be difficult to diagnose clinically or by standard
neuroradiologic tests. We performed MR imaging and
single-photon emission computed tomography (SPECT) in patients
with chronic fatigue syndrome to compare the usefulness of
functional and anatomic imaging in the detection of
intracranial abnormalities.

patients who fulfilled the Centers for Disease Control,
British, and/or Australian criteria for chronic fatigue
syndrome had MR and SPECT examinations within a 10-week
period. Axial MR and SPECT scans were analyzed as to the
number and location of focal abnormalities by using analysis
of variance with the Student-Newman-Keuls option. MR imaging
findings in patients with chronic fatigue syndrome were
compared with those in 15 age-matched control subjects, and
SPECT findings in the patients with chronic fatigue syndrome
were compared with those in 14 age-matched control subjects by
using Fisher's exact test. The findings on MR and SPECT scans
in the same patients were compared by using the Wilcoxon
matched-pairs signed-ranks test.

RESULTS. MR abnormalities
consisted of foci of T2-bright signal in the periventricular
and subcortical white matter and in the centrum semiovale;
there were 2.06 foci per patient, vs 0.80 foci per control
subject. MR abnormalities were present in eight (50%) of 16
patients, compared with three (20%) of 15 age-matched control
subjects. Neither of these differences reached significance,
although the power of the study to detect differences between
groups was small. Patients with chronic fatigue syndrome had
significantly more defects throughout the cerebral cortex on
SPECT scans than did normal subjects (7.31 vs 0.43 defects per
subject, p < .001). SPECT abnormalities were present in 13
(81%) of 16 patients, vs three (21%) of 14 control subjects (p
< .01). SPECT scans showed significantly more abnormalities
than did MR scans in patients with chronic fatigue syndrome (p
< .025). In the few patients who had repeat SPECT and MR
studies, the number of SPECT abnormalities appeared to
correlate with clinical status, whereas MR changes were

CONCLUSION. SPECT abnormalities occur more
frequently and in greater numbers than MR abnormalities do in
patients with chronic fatigue syndrome. SPECT may prove to be
useful in following the clinical progress of patients with
this syndrome.

Schwartz RB, Garada BM, Komaroff AL, Tice HM, Gleit M, Jolesz FA,
Holman BL

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