Longitudinal MRI study in CFS patient: a CDC criteria study

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Longitudinal MRI shows no cerebral abnormality in chronic fatigue syndrome

Fred Springfield posted this to co-cure March 20 2010

(if: The conclusions that "scientists" jump to in studies often appears to be supremely subjective and far beyond the reach of the data. This is an example of that to me. I actually find it quite frightening.)

Longitudinal MRI shows no cerebral abnormality in chronic fatigue syndrome.

Journal: Br J Radiol. 2010 Mar 11. [Epub ahead of print]

Authors: Perrin R, Embleton K, Pentreath VW, Jackson A.

Affiliation: Imaging Science and Biomedical Engineering, Department of Medicine, University of Manchester, Oxford Road, Manchester M13 9PT, UK.

NLM Citation: PMID: 20223910


MRI has previously provided conflicting results when used to search for brain abnormalities in sufferers of chronic fatigue syndrome (CFS).

Eighteen CFS patients and nine healthy volunteers each underwent MRI on two occasions one year apart. The resulting images were examined for abnormalities in brain atrophy, deep white matter hyperintensities (WMH) and cerebral blood and cerebrospinal fluid (CSF) flow.

Mean proportionate CSF volume was not significantly different between subject groups. All participants showed a slight increase in CSF between scans, but no significant difference was found between those with CFS and those without. Between group comparisons of ventricular volume revealed no significant differences at study commencement and no significant change over the year. No significant inter-group differences were found for any of the cerebral blood and CSF flow parameters. Low levels of WMH were found in all participants. Objective scoring of WMH using Scheltens' scale revealed no change in summary components (prosencephalic DWMH, basal ganglia hyperintensities and infratentorial hyperintensities) or in individual component variables between the baseline and 1 year follow-up scans. No abnormal patterns in rate and extent of brain atrophy, ventricle volume, white matter lesions, cerebral blood flow or aqueductal CSF flow were detected in the CFS population.

These results throw open the debate into whether MRI scanning can reveal diagnostic signs of CFS and clinically questions the diagnoses of CFS made on the basis of previous research conclusions.
 

Kati

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Would love to hear Dr Hyde's point of view on this- he seems to know a lot in terms of SPECT and MRI.
 

HowToEscape?

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Fred Springfield posted this to co-cure March 20 2010

(if: The conclusions that "scientists" jump to in studies often appears to be supremely subjective and far beyond the reach of the data. This is an example of that to me. I actually find it quite frightening.)

Longitudinal MRI shows no cerebral abnormality in chronic fatigue syndrome.

Journal: Br J Radiol. 2010 Mar 11. [Epub ahead of print]

Authors: Perrin R, Embleton K, Pentreath VW, Jackson A.

Affiliation: Imaging Science and Biomedical Engineering, Department of Medicine, University of Manchester, Oxford Road, Manchester M13 9PT, UK.

NLM Citation: PMID: 20223910


MRI has previously provided conflicting results when used to search for brain abnormalities in sufferers of chronic fatigue syndrome (CFS).

Eighteen CFS patients and nine healthy volunteers each underwent MRI on two occasions one year apart. The resulting images were examined for abnormalities in brain atrophy, deep white matter hyperintensities (WMH) and cerebral blood and cerebrospinal fluid (CSF) flow.

Mean proportionate CSF volume was not significantly different between subject groups. All participants showed a slight increase in CSF between scans, but no significant difference was found between those with CFS and those without. Between group comparisons of ventricular volume revealed no significant differences at study commencement and no significant change over the year. No significant inter-group differences were found for any of the cerebral blood and CSF flow parameters. Low levels of WMH were found in all participants. Objective scoring of WMH using Scheltens' scale revealed no change in summary components (prosencephalic DWMH, basal ganglia hyperintensities and infratentorial hyperintensities) or in individual component variables between the baseline and 1 year follow-up scans. No abnormal patterns in rate and extent of brain atrophy, ventricle volume, white matter lesions, cerebral blood flow or aqueductal CSF flow were detected in the CFS population.

These results throw open the debate into whether MRI scanning can reveal diagnostic signs of CFS and clinically questions the diagnoses of CFS made on the basis of previous research conclusions.
The bolded sentence appears to imply only that MRI, at least as used in the study, is not a good CF diagnostic tool for the patient population they tested. Knowing what tests are not reliably connected to a CFID diagnosis is valuable - otherwise, one could be mislead by dozens of normal test results.

Other reports I've seen indicate decreased blood and brain volume and brain abnormalities in us folks, but few have had such tests. What's different about this study and those that do find abnormalities - did they use something other than MRI? Different patient population? Different stage of disease?
 

Dolphin

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The bolded sentence appears to imply only that MRI, at least as used in the study, is not a good CF diagnostic tool for the patient population they tested. Knowing what tests are not reliably connected to a CFID diagnosis is valuable - otherwise, one could be mislead by dozens of normal test results.
Here are the last three paragraphs. The last one makes the point you make:

In summary, we have been unable to detect any
abnormality in brain volume, rate of atrophy, white
matter lesions, cerebral blood flow or aqueductal CSF
flow in a group of patients who had undergone rigorous
diagnostic and selection criteria for CFS. This does not
exclude the possibility that CFS may occur as a result of
some patterns of organic brain lesions that could
produce distinctive imaging findings and which might
represent subgroups in the CFS population.

Functional MRI or pharmacological MR will probably
prove more useful than standard MRI in detecting any
cerebral dysfunction. Behavioural performance and
cerebral activity in CFS have been examined using rapid
event-related functional MRI [17]. CFS patients were
considerably slower than matched healthy controls in
performing both motor and visual imagery tasks [17].

Clinically, there are many CFS sufferers who have
undergone MRI scans in which no structural anomalies
have been revealed. However, when no abnormality is
detected, these patients are wrongly informed that they
do not have CFS because the aforementioned research [1,
2, 5] has identified DWMH and CSF volume changes as a
pathological entity in CFS. Our findings show that the
symptom complex described as CFS can also be seen in
patients with no identifiable cerebral abnormality. Thus,
there are important ramifications for future diagnosis of
CFS, which obviously cannot be based solely on MRI
findings.
 

MEKoan

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Must say, I really hope this is right! The thought of brain atrophy is very scary.

especially given the way my brain has been working - rather, not working - over the past little while.

They must have actually done fMRIs or MRAs as I do not believe much can be determined re blood and CFS flow on a standard brain MRI. Certainly not on the old T2 weighted MRI I had that revealed more than a dozen hyperintensities in deep white matter.

I hope this is true.

ETA Thanks for more info Tom, that addresses my question concerns about the limitations of standard MRI, I think -- well, actually, I can't.

And, thanks If for another great find!
 

Alesh

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During the course of my illness the doctors found the following:
1. EEG: It is normal. You suffer from somatoform disorder.
2. CT: It is normal. You suffer from somatoform disorder.
3. MRI: It is normal. You suffer from somatoform disorder.
4. SPECT/CT: The scan of your brain looks like that of a moribund patient with Alzheimer disease but we don't know why. You suffer from somatoform disorder.
 

hvs

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Sorry: have to dismiss any study coming out of the UK until they can prove to me that they're studying a legitimate patient pool.
Wish they'd studied VO2 max and repeated treadmill test--and among legitimate subjects--not psychiatrist-approved...
 

dannybex

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Sorry: have to dismiss any study coming out of the UK until they can prove to me that they're studying a legitimate patient pool.
Wish they'd studied VO2 max and repeated treadmill test--and among legitimate subjects--not psychiatrist-approved...
I agree. Plus it's such a tiny patient and cohort sample.
 

Dolphin

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Here's the info on the participants for what it's worth:

Participant recruitment
Eighteen patients with CFS and nine normal control
subjects were recruited into the study. All of the CFS
patients fulfilled the case definition criteria (CDC)
criteria [8] and also underwent a psychiatric assessment
using the Hospital Anxiety and Depression Scale
(HADS) system [9] and the more precise Schedule for
Clinical Assessment in Neuropsychiatry (SCAN) [10]
questionnaire to ensure the exclusion of subjects with
depressive or anxiety states. The CFS patients were
divided into two groups, the first group (CFS1, 5 men
and 4 women: age range 2053 years; mean age 35.3
years12.6 years standard deviation [SD]) received only
an osteopathic treatment [11] for 1 year, whereas patients
in the other group (CFS2; 5 men and 4 women: age range
2255 years; mean age 36.1 years 12.3 years) were
allowed to pursue treatment regimes of their own choice,
excluding osteopathic treatment. None of the CFS
patients were considered to be from the extreme end of
the symptomatic spectrum (i.e. bedridden or with
intense sensitivity to any external stimuli). The control
group (NORM, 5 men and 4 women: age range 2253
years; mean age 36.1 years 12.4 years) were normal
volunteers in good general health and with no history of
significant neurological abnormality.
 
G

Gerwyn

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Fred Springfield posted this to co-cure March 20 2010

(if: The conclusions that "scientists" jump to in studies often appears to be supremely subjective and far beyond the reach of the data. This is an example of that to me. I actually find it quite frightening.)

Longitudinal MRI shows no cerebral abnormality in chronic fatigue syndrome.


more Oxford misdagnosis and overs use of oxymorons by morons

Journal: Br J Radiol. 2010 Mar 11. [Epub ahead of print]

Authors: Perrin R, Embleton K, Pentreath VW, Jackson A.

Affiliation: Imaging Science and Biomedical Engineering, Department of Medicine, University of Manchester, Oxford Road, Manchester M13 9PT, UK.

NLM Citation: PMID: 20223910


MRI has previously provided conflicting results when used to search for brain abnormalities in sufferers of chronic fatigue syndrome (CFS).

Eighteen CFS patients and nine healthy volunteers each underwent MRI on two occasions one year apart. The resulting images were examined for abnormalities in brain atrophy, deep white matter hyperintensities (WMH) and cerebral blood and cerebrospinal fluid (CSF) flow.

Mean proportionate CSF volume was not significantly different between subject groups. All participants showed a slight increase in CSF between scans, but no significant difference was found between those with CFS and those without. Between group comparisons of ventricular volume revealed no significant differences at study commencement and no significant change over the year. No significant inter-group differences were found for any of the cerebral blood and CSF flow parameters. Low levels of WMH were found in all participants. Objective scoring of WMH using Scheltens' scale revealed no change in summary components (prosencephalic DWMH, basal ganglia hyperintensities and infratentorial hyperintensities) or in individual component variables between the baseline and 1 year follow-up scans. No abnormal patterns in rate and extent of brain atrophy, ventricle volume, white matter lesions, cerebral blood flow or aqueductal CSF flow were detected in the CFS population.

These results throw open the debate into whether MRI scanning can reveal diagnostic signs of CFS and clinically questions the diagnoses of CFS made on the basis of previous research conclusions.
not cfs patients so no reason for abnormalities
 

Kati

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http://bjr.birjournals.org/cgi/content/full/83/989/419

Longitudinal MRI shows no cerebral abnormality in chronic fatigue syndrome

MRI has previously provided conflicting results when used to search for brain abnormalities in sufferers of chronic fatigue syndrome (CFS). Eighteen CFS patients and nine healthy volunteers each underwent MRI on two occasions, one year apart. The resulting images were examined for abnormalities in brain atrophy, deep white matter hyperintensities (WMH) and cerebral blood and cerebrospinal fluid (CSF) flow. Mean proportionate CSF volume was not significantly different between subject groups. All participants showed a slight increase in CSF between scans, but no significant difference was found between those with CFS and those without. Between-group comparisons of ventricular volume revealed no significant differences at study commencement and no significant change over the year. No significant inter-group differences were found for any of the cerebral blood and CSF flow parameters. Low levels of WMH were found in all participants. Objective scoring of WMH using Scheltens' scale revealed no change in summary components (prosencephalic deep white matter hyperintensities, basal ganglia hyperintensities and infratentorial hyperintensities) or in individual component variables between the baseline and 1 year follow-up scans. No abnormal patterns in rate and extent of brain atrophy, ventricle volume, white matter lesions, cerebral blood flow or aqueductal CSF flow were detected in the CFS population. These results throw open the debate into whether MRI scanning can reveal diagnostic signs of CFS and clinically questions the diagnoses of CFS made on the basis of previous research conclusions.
Another waste of funds from the British government?
 

oerganix

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Reeves Disease

http://bjr.birjournals.org/cgi/content/full/83/989/419

Longitudinal MRI shows no cerebral abnormality in chronic fatigue syndrome



Another waste of funds from the British government?
Possibly very valuable.;)

Proves you can't find Reeves Disease with MRI. You need a psychiatrist to find it.:D

Now, if you do brain scans with Dopler Imaging, you can differentiate ME/CFS brains, but you can't have that in UK...doing these kinds of tests only encourages false illness beliefs. :eek:
 

Esther12

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I thought it was only functional MRIs that were thought to pick things up with CFS anyway? They did try to exclude patients with depression and anxiety. We wouldn't be slagging the study if they had found something! It was such a small group, and using CDC criteria, so it's far from definitive, but I think this paper looks okay to me. It would be great if they'd discovered some easily treatable problem, but negative results can be helpful too.
 

Jerry S

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They did use Fukuda and screen for depressive and anxiety states. However, the authors state, "None of the CFS patients was considered to be from the extreme end of the symptomatic spectrum (i.e. bedridden or with intense sensitivity to any external stimuli)."

Fukuda, also, does not require that post-exertional malaise be present.