Neuroimaging and Structural Brain Findings

1 Shan et al. 2020 — Neuroimaging Systematic Review (JTM)

Full Citation:: Shan ZY, Barnden LR, Kwiatek RA, Bhuta S, Hermens DF, Lagopoulos J@. Neuroimaging characteristics of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a systematic review. Journal of Translational Medicine. 2020;18(1):335. DOI:: 10.1186/s12967-020-02506-6 PMID:: 32887623 Study Design:: Systematic review of structural and functional neuroimaging studies in ME/CFS Key Findings::

- Inconsistent but recurring structural brain abnormalities across cohorts
- Prefrontal myelination upregulation reported in some studies
- Basal ganglia metabolite differences (elevated choline) and functional changes
- Insula gray matter volume increases in some studies
- Widespread functional connectivity disruptions across networks

Limitations:: High heterogeneity across studies; inconsistent findings prevent definitive regional conclusions.

2 Finkelmeyer et al. 2017 — VBM Gray and White Matter in CFS

Full Citation:: Finkelmeyer A, He J, Maclachlan L, Watson S, Gallagher P, Newton JL, Blamire AM@. Grey and white matter differences in Chronic Fatigue Syndrome — A voxel-based morphometry study. NeuroImage: Clinical. 2017;17:24–30. DOI:: 10.1016/j.nicl.2017.09.024 PMID:: 29021956 Sample Size:: 42 CFS patients, 30 healthy controls; 3T MRI Key Findings::

- Increased gray matter volume in the amygdala and insula (not reductions as initially hypothesized)
- Reduced white matter volume in midbrain, pons, and right temporal lobe
- Insula changes consistent with altered interoceptive processing
- Brainstem white matter reductions suggest pathway disruption

Note:: Direction of regional changes contrasts with some earlier studies; illustrates the heterogeneity of neuroimaging findings in ME/CFS.

3 Puri et al. 2012 — VBM Regional Gray/White Matter Changes

Full Citation:: Puri BK, Jakeman PM, Agour M, et al. Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study. British Journal of Radiology. 2012;85(1015):e270–e273. DOI:: 10.1259/bjr/93889091 PMID:: 22128128 Key Findings::

- Reduced gray matter volume in bilateral occipital poles, lateral occipital cortex, right angular gyrus, and posterior parahippocampal gyrus
- White matter reductions in the left occipital lobe
- Parahippocampal changes consistent with the memory impairment characteristic of ME/CFS

4 de Lange et al. 2004 — fMRI Neural Correlates of CFS

Full Citation:: de Lange FP, Kalkman JS, Bleijenberg G, Hagoort P, van der Werf SP, van der Meer JWM, Toni I@. Neural correlates of the chronic fatigue syndrome—an fMRI study. Brain. 2004;127(9):1948–1957. DOI:: 10.1093/brain/awh225 PMID:: 15240435 Sample Size:: 16 CFS patients, 16 healthy controls Key Findings::

- CFS patients recruited additional or atypical brain regions during motor imagery tasks
- Stronger responses in visually related structures during motor tasks
- Error-related brain activity differed between groups, suggesting motor planning dysfunction
- Pattern consistent with compensatory over-recruitment and inefficient neural processing