(99m)Tc-ECD brain perfusion SPECT in hyperalgesic Fibromyalgia

Journal: European Journal of Nuclear Medicine and Molecular Imaging. 2007 Jan;34(1):130-4. [E-publication 2006 Aug 25] Authors and affiliation: Guedj E, Taieb D, Cammilleri S, Lussato D, de Laforte C, Niboyet J, Mundler O. Service Central de Biophysique et de Medecine Nucleaire, Assistance Publique des Hopitaux de Marseille, Centre Hospitalo-Universitaire de la Timone, Marseille, France. [E-mail: eric.guedj@ap-hm.fr ] PMID: 16933135

Purpose: Neuro-imaging studies with (99m)Tc-HMPAO SPECT [Single Photon Emission Computed Tomography] in Fibromyalgia (FM) patients have reported only limited subcortical hypoperfusion. [“Hypoperfusion” means decreased blood flow; “Hyperperfusion” is increased blood flow.] (99m)Tc-ECD SPECT is known to provide better evaluation of areas of high cerebral blood flow and regional metabolic rate. We evaluated a homogeneous group of hyperalgesic patients with FM using (99m)Tc-ECD SPECT. [“Hyperalgesic” means excessively sensitive to painful stimuli.] The aim of this study was to investigate brain processing associated with spontaneous pain in FM patients.

Methods: Eighteen hyperalgesic FM women (mean age 49 years, range 25-63 years; American College of Rheumatology criteria) and ten healthy women matched for age were enrolled in the study. A voxel-by-voxel group analysis was performed using SPM2 (p < 0.05, corrected for multiple comparisons). Visual Analogue Scale score for pain was 82+/-4 at the time of the SPECT study.

Results: Compared with control subjects, we observed individual brain SPECT abnormalities in FM patients, confirmed by SPM2 analysis, with hyperperfusion of the somatosensory cortex and hypoperfusion of the frontal, cingulate, medial temporal and cerebellar cortices. Conclusion: In the present study, performed without noxious stimuli in hyperalgesic FM patients, we found:
n Significant hyperperfusion in regions of the brain known to be involved in the sensory dimension of pain processing.
n And significant hypoperfusion in areas assumed to be associated with the affective-attentional dimension.

As current pharmacological and non-pharmacological therapies act differently on the two components of pain, we hypothesize that SPECT could be a valuable and readily available tool to guide individual therapeutic strategy and provide objective follow-up of pain processing recovery under treatment.

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