Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome (original) (raw)

Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome

T Siessmeier1,
W A Nix2,
J Hardt3,
M Schreckenberger1,
U T Egle3,
P Bartenstein1
1Department of Nuclear Medicine, Johannes Gutenberg University, Mainz, Germany
2Department of Neurology, Johannes Gutenberg University, Mainz
3Department of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg University, Mainz
Correspondence to: Dr Thomas Siessmeier, Department of Nuclear Medicine, Johannes Gutenberg University, Langenbeckstr 1, 55101 Mainz, Germany; siessmeier{at}nuklear.klinik.uni-mainz.de

Abstract

Objectives: To evaluate cerebral glucose metabolism, assessed by 18-fluorodeoxyglucose positron emission tomography (FDG-PET), in patients with chronic fatigue syndrome (CFS), using an observer independent analytical approach; and to characterise any observed alterations by correlating them with neuropsychological deficits.

Methods: 26 patients (13 female, 13 male) were examined. They all fulfilled the CDC diagnostic criteria for CFS. Their ages ranged from 26 to 61 years (mean (SD) age, 43 (9.3) years). They underwent extensive psychometric testing including the hospital anxiety and depression scale (HADS) and the short form 36 item health questionnaire (SF-36). Brain FDG-PET was done in all the subjects. After stereotactic normalisation, single subject comparisons with an age and sex matched normal database (n = 18) and a group comparison between the patients and normal controls were undertaken, along with additional correlation analyses between brain metabolism and psychometric test scores.

Results: 12 of the 26 patients showed no significant decrease in FDG uptake compared with the controls. Of the remaining 14, 12 showed hypometabolism bilaterally in the cingulate gyrus and the adjacent mesial cortical areas. Five of these 12 patients also had decreased metabolism in the orbitofrontal cortex. The two remaining patients had hypometabolism in the cuneus/praecuneus. Correlation analyses showed significant correlations between some test scores (anxiety, depression, health related quality of life) but not fatigue and regional reductions in glucose metabolism.

Conclusions: Although abnormalities in FDG-PET were only detectable in approximately half the CFS patients examined, and no specific pattern for CFS could be identified, PET may provide valuable information in helping to separate CFS patients into subpopulations with and without apparent alterations in the central nervous system.

chronic fatigue syndrome
FDG PET
observer independent analysis
CDC, Centers for Disease Control
CFS, chronic fatigue syndrome
FDG-PET, 18-fluorodeoxyglucose positron emission tomography
FWHM, full width half maximum
HADS, hospital anxiety and depression scale
HRQOL, health related quality of life
PET, positron emission tomography
SF-36, short form 36 item questionnaire
SCID, structured clinical interview for DSM-IV
SPECT, single photon emission computed tomography

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