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

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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