Brain positron emission tomography (PET) in Chronic Fatigue Syndrome (CFS): preliminary data

Chronic fatigue syndrome (CFS) has been widely studied by

neuroimaging techniques in recent years with conflicting

results. In particular, using single-photon emission computed

tomography (SPECT) and perfusion tracers, hypoperfusion has

been found in several brain regions, although the findings

vary across research centers. The objective of this study was

to investigate brain metabolism of patients affected by CFS,

using [18F]fluorine-deoxyglucose (18FDG) positron emission

tomography (PET). We performed 18FDG PET in 18 patients who

fulfilled the criteria of the working case definition of CFS.

Twelve of the 18 patients were females; the mean age was 34

+/- 15 years (range, 15-68) and the median time from CFS

diagnosis was 16 months (range, 9-138). Psychiatric diseases

and anxiety/neurosis were excluded in all CFS patients. CFS

patients were compared with a group of 6 patients affected by

depression (according to DSM IV-R) and 6 age-matched healthy

controls. The CFS patients were not taking any medication at

the time of PET, and depressed patients were drug-free for at

least 1 week before the PET examination. The PET images

examined 22 cortical and subcortical areas. CFS patients

showed a significant hypometabolism in right mediofrontal

cortex (P = 0.010) and brainstem (P = 0.013) in comparison

with the healthy controls. Moreover, comparing patients

affected by CFS and depression, the latter group showed a

significant and severe hypometabolism of the medial and upper

frontal regions bilaterally (P = 0.037-0.001), whereas the

metabolism of brain stem was normal. Brain 18FDG PET showed

specific metabolism abnormalities in patients with CFS in

comparison with both healthy controls and depressed patients.

The most relevant result of our study is the brain stem

hypometabolism which, as reported in a perfusion SPECT study,

seems to be a marker for the in vivo diagnosis of CFS.

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