943 SPECT Imaging of the Brain: Comparison of Findings in Patients with Chronic Fatigue Syndrome, AIDS Dementia Complex, and Major Unipolar Depression : . : . .2: Richard B. Schwartz1 Anthony L. Komaroff2 Basem M. Garada1 Marcy Gleit2 Teresa H. Doolittle2 David W. Bates2 Russell G. Vasile3 B. Leonard Holman1 Received August 4. 1 993: accepted after revi- sion December 14, 1993. Supported by grants R01AI27314, R01A126788, and U01 A132246 from the National Institute of Aller- gy and Infectious Diseases. 1 Department of Radiology, Brigham and Wom- en’s Hospital, 75 Francis St., Boston, MA 02215. Address correspondence to A. B. Schwartz. 2Department of Medicine (Division of General Medicine and Primary Care). Brigham and Wom- en’s Hospital, Boston, MA 02215. 3Department of Psychiatry. New England Dea- coness Hospital, 185 Pilgrim Rd., Boston, MA 02115. 0361 -803X/94/ 1624-0943 © American Roentgen Ray Society OBJECTIVE. Chronic fatigue syndrome is an illness of unknown origin that begins abruptly with a flulike state and has symptoms suggesting both a chronic viral encephalitis and an affective disorder. We compared single-photon emission com- puted tomography (SPECT) scans of patients with chronic fatigue syndrome with those of patients with AIDS dementia complex and unipolar depression. SUBJECTS AND METHODS. We used Tc-hexamethylpropyleneamine oxime to examine 45 patients with chronic fatigue syndrome, 27 patients with AIDS dementia complex, and 14 patients with major unipolar depression. Scans of 38 healthy per- sons were used as controls. Comparison of regional defects between groups, as well as midcerebral uptake indexes (an objective measure of global radionuclide uptake), was performed by using analysis of variance with the Student-Newman-Keuls option. Correlation between the number of regional defects and the midcerebrai uptake index was determined by using the Spearman rank-correlation test. RESULTS. Patients with AIDS dementia complex had the largest number of defects (9.1 5 per patient) and healthy patients had the fewest defects (1 .66 per patient). Patients with chronic fatigue syndrome and depression had similar numbers of defects per patient (6.53 and 6.43, respectively). In all groups, defects were located predominantly in the frontal and temporal lobes. The midcerebral uptake index was found to be significantly lower (p < .002) in the patients with chronic fatigue syn- drome (.667) and patients with AIDS dementia complex (.650) than in patients with major depression (.731) or healthy control subjects (.716). Also, a significant negative correlation was found between the number of defects and midcerebral uptake index in patients with chronic fatigue syndrome and AIDS dementia complex, but not in depressed patients or control subjects. CONCLUSION. These findings are consistent with the hypothesis that chronic fatigue syndrome may be due to a chronic viral encephalitis; clinical similarities between chronic fatigue syndrome and depression may be due to a similar distribu- tion and number of defects in the two disorders. AJR 1994;162:943-951 Chronic fatigue syndrome (CFS) is a condition characterized by varying degrees of chronic fatigue and persistent or recurring fever, pharyngitis, myalgia, headache, arthnalgia, paresthesias, depression, and difficulty with concentration and memory [1 , 2]. Typically, the chronic illness begins abruptly with an acute flulike syndrome, from which the patient appears to have never fully recovered. The patient’s medical history generally is unremarkable except for a three- to fourfold increased fre- quency, compared with the general population, of both atopic and allergic illnesses [3]; there may [4] on may not [5] also be an increased frequency of past episodes of major depression. Case definitions for the syndrome have been developed by the United States Centers for Disease Control (CDC) [1 ] and by British [6] and Austra- han [7] investigators. By definition, in patients with CFS there is no evidence of nheu- matologic, endocninologic, infectious, malignant, or other chronic diseases, and no active psychiatric disease at the onset of the syndrome. Downloaded from www.ajronline.org by 52.73.204.196 on 05/17/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved