Global and Regional Cerebral Perfusion in Chronic Fatigue Syndrome (CFS)
Studies of CFS with regional cerebral bloodflow (rCBF) with brain SPECT have yielded disparate results, often with low statistical power due to small subject numbers or with heterogeneous patient groups. An earlier SPM study of 40 mild CFS subjects in this institution found no change in rCBF. 27 subjects (20 F and 7 M) mean age 32 .4 years, with CFS, mean duration 4.5 years, and an overall reduction in function of > 50% had both HMPAO brain SPECT to assess rCBF and a first pass HMPAO dynamic study to estimate global cerebral bloodflow (gCBF) in ml/min/100g using the aortic arch as the cerebral input function. Age adjusted SPM2 was used to compare the rCBF in CFS with 90 normal controls. The gCBF was compared to age adjusted normal gCBF values reported in the literature. The brain SPECT was reconstructed with OSEM iterative reconstruction incorporating scatter subtraction and attenuation correction with maps derived using a method validated against anatomical MRI. The SPM analysis revealed a perfusion deficit in the left inferior lateral temporal lobe with P = 0.01 (corrected for multiple comparisons) and perfusion increases at 2 foci in the right posterior cingulate located 15 mm from the midline with Pcorr = 0.03 for both. All 27 subjects showed global CBF that was lower than the age adjusted normal value, with 6/27 at least 20% lower and 17/27 at least 10% lower than normal. Preliminary analysis shows a correlation of both rCBF and gCBF with clinical self assessment of dysfunction.