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A Multimodal Magnetic Resonance Imaging Study on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Feasibility and Clinical Correlation
This research was conducted in Canada by Raminder Kaur 1,2, Brian Greeley 1, Alexander Ciok 1,2, Kashish Mehta 1,2, Melody Tsai 3,4, Hilary Robertson 5, Kati Debelic 5, Lan Xin Zhang 1, Todd Nelson 1,2, Travis Boulter 4,5, William Siu 6, Luis Nacul 3,4,7 and Xiaowei Song 1,2
- 1. Research and Evaluation, Fraser Health Authority, Surrey, BC V3T 0H1, Canada
- 2. Biomedical Physiology & Kinesiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- 3. Women’s Health Research Institute, Vancouver, BC V6H 3N1, Canada
- 4. Complex Chronic Diseases Program, BC Women’s Hospital, Vancouver, BC V6H 3N1, Canada
- 5. ME/FM Society of BC, Vancouver, BC V6J 5M4, Canada
- 6. Medical Imaging, Royal Columbian Hospital, New Westminster, BC V3L 3W7, Canada
- 7. Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
Abstract
Background/Objectives
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a neurological disorder characterized by post-exertional malaise. Despite its clinical relevance, the disease mechanisms of ME/CFS are not fully understood. The previous studies targeting brain function or metabolites have been inconclusive in understanding ME/CFS complexity. This study combined single-voxel magnetic resonance spectroscopy (SV-MRS) and functional magnetic resonance imaging (fMRI). The objectives were to examine the feasibility of the multimodal MRI protocol, identify possible differences between ME/CFS and healthy controls (HCs), and relate MRI findings with clinical symptoms.
Methods
Researchers enrolled 18 female ME/CFS participants (mean age: 39.7 ± 12.0 years) and five healthy controls (HCs) (mean age: 45.6 ± 14.5 years). SV-MRS spectra were acquired from three voxels of interest: the anterior cingulate gyrus (ACC), brainstem (BS), and left dorsolateral prefrontal cortex (L-DLPFC). Whole-brain fMRI used n-back task testing working memory and executive function. The feasibility was assessed as protocol completion rate and time. Group differences in brain metabolites and fMRI activation between ME/CFS and HCs were compared and correlated with behavioural and symptom severity measurements.
Results
The completion rate was 100% regardless of participant group without causing immediate fatigue.
ME/CFS appeared to show a higher N-Acetylaspartate in L-DLPFC compared to HCs (OR = 8.49, p = 0.040), correlating with poorer fatigue, pain, and sleep quality scores (p’s = 0.001–0.015). An increase in brain activation involving the frontal lobe and the brainstem was observed in ME/CFS compared to healthy controls (Z > 3.4, p’s < 0.010).
Conclusions
The study demonstrates the feasibility of combining MRS and fMRI to capture neurochemical and neurophysiological features of ME/CFS in female participants. Further research with larger cohorts of more representative sampling and follow-ups is needed to validate these apparent differences between ME/CFS and HCs.