Background/Purpose: Cerebral hypoperfusion of the whole brain has previously been reported in chronic fatigue syndrome (CFS) patients. However, discrepancies exist in the literature in regards to the spatial extent of such abnormal brain perfusion, as well as the effect sizes of these abnormalities as previously used methods did not allow precise localization of such perfusion abnormalities. We measured global and local resting state cerebral blood flow (CBF) in CFS patients and compared them to healthy controls (HC).

Methods: CFS was determined using the CDC Criteria. 15 CFS patients (age = 50.5±13.0)) and 12 HC (age = 49.2±12.2) were MRI scanned with a 3 Tesla Achieva during rest using a pseudo-continuous arterial spin labeling (pCASL) sequence. pCASL can quantify CBF without using exogenous contrast agents by magnetically labeling inflowing blood. Individual scans were corrected for motion and spatially smoothed, then label and control pairs were subtracted to create a perfusion image. The perfusion image was used to calculate a quantified CBF map, which was then normalized to standardized space.  Groups were compared using voxel-wise independent samples t-tests. Statistical parametric maps were thresholded using a cluster forming t-statistic greater than 4.0 (p < 0.00025) and a spatial extent of 20 contiguous voxels (160 mm³) to control for multiple comparisons.

Results: Overall cerebral blood flow was similar between groups (p > .05). CFS patients showed reduced blood flow in the right hemisphere parahippocampal gyrus.  In the significant cluster, HC participants had a mean (SD) CBF of 40.51 (7.89) compared to 27.69 (6.22) (ml/100g/min) in CFS patients (t(25) = 4.73, p = 0.00008, Cohen’s d = 1.80).  

Conclusion: Reduced cerebral perfusion was observed in the right parahippocampal gyrus of CFS patients. The parahippocampal gyrus plays a major role in the processing of memory and cognition. Reduced blood flow of this area may be a cause or consequence of chronic fatigue as well as impaired memory and cognition often observed in CFS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/chronic-fatigue-is-associated-with-hypoperfusion-of-parahippocampal-gyrus/