This summary includes information on Single Photon Emission Computerized Tomography (SPECT) scans & MRI’s. Here are examples of normal spects,
And a guide (from a primary CFS SPECT study) to brain regions in the SPECTS
note: it is standard for the SPECT to reverse left and right; this is labelled on the sheet
Swartz et al found hypofusion in areas 5, 2 & 6.
Mena & Villaneueva-Meyer found hypofusion in temporal lobes 1 & 2
Ichise et al found decreased radionuclide uptake mainly in 1,2/4,5, but also in 8, 3 & 6.
These are reversible and correlate with changes in clinical severity.
SPECT: In Lyme Disease, the most common finding is of heterogeneous hypoperfusion diffusely throughout the brain, similar to in Lupus, chronic cocaine abuse or other vasculitic inflammatory disorders. This pattern is different to primary depression or Alzheimer’s disease. Approximately 70% of patients with chronic Lyme disease will have multiple areas of hypoperfusion, but it cannot be used for diagnosis, as blood flow is rated relative to the cerebellum or deep grey matter which is presumed to be normal.
The above images are from hypobaric treatment where SPECT can be used as a marker of improvement.
From ‘looking at lyme‘:
SPECT scan of the brain before (A) and after (B) antibiotic treatment.
These transaxial images are from a 51-year-old man diagnosed with Lyme disease with a recent change in memory. Representative pretreatment images show hypoperfusion within the mid posterior and mid temporoparietal cortex bilaterally. Representative posttreatment images (14 months later) reveal improved perfusion to the posterior temporoparietal cortex bilaterally, correlating with improved symptoms. Perfusion within the remaining cerebral cortex, basal ganglia, thalamus, and cerebellum was normal.
MRI: Looks similar to MS: Up to 40% of adults with Lyme disease may have small white matter hyperintensities suggestive of inflammation or areas of demyelination., but it should be noted that the number of hyperintensities increase with age – even among patients who do not have Lyme disease.
Youtube has many video tutorials on interpreting brain mri.
SPECT: Hyde considered an abnormal SPECT as well as an abnormal EEG or PET scan and/or neuropsychological abnormalities required for ME diagnosis, in particular decreased perfusion of blood in the left middle cerebral artery and the branches of the parietal lobes, present very early in the illness. He strongly emphasised vascular issues (moreso than PEM), and ‘difficulty concentrating and finding words, etc, problems sleeping, poor muscle functioning, trouble standing without exaggerated heart rates and dizziness, little ability to exert themselves, cold fingers, loose joints and gut problems’.
EG “Intrinsic Functional Hypoconnectivity in Core Neurolocognitive Networks Suggests Central Nervous System Pathology in Patients with Myalgic Encephalomyelitis”, PMID: 26869373 or “Functional Neural Network Connectivity in Myalgic Encephalomyelitis
The ICC for ME notes SPECT abnormalities, however it specifies *with contrast*. Contrast can be reactive and cause side effects. Repeated SPECT scans done at the same medical center to allow for a fair comparison across images can track progress of treatment or disease progression.
ICC case study : Extensive areas of hypoperfusion are characteristic of ME… marked hypoperfusion in the lateral aspects of the temporal lobe, extending to the frontal and parietal lobes… extensive hypoperfusion in the limbic system involving anterior, medial and posterior cingulates. There is left temporal medial hypoperfusion that denotes hypofunction in the projection of the hippocampus. Both posterior cingulate and hippocampal hypofunction denote cognitive impairment. Finally, there is hypoperfusion in the occipital lobe.
Taken from Ireland ME which has good overview brain abnormality summary and study quotes.
Medial temporal lobes (area 1) hypofusion seen in concussion, head injuries, hippocampus, memory impairment
Both hypo and hyperfusion is found in fibromyalgia.
Red: HYPOfusion, green: HYPERfusion
The images show the anatomical localization of peak significant differences between brain SPECT of patients with fibromyalgia and healthy subjects. Patients with fibromyalgia exhibited posterior hyperperfusion (red), including of the somatosensory cortex, and hypoperfusion (green) of frontal, cingulate, temporal, and cerebellar cortices. Images courtesy of the Journal of Nuclear Medicine
Severity was “positively correlated with bilateral parietal perfusion, including postcentral cortex. These clusters of correlation were included in the areas of significant hyperperfusion. [Severity] was also negatively correlated with perfusion of a left anterior temporal cluster, included in the areas of significant hypoperfusions. No other clinical correlation was observed with regional cerebral blood flow.”
Compared with healthy controls, patients with fibromyalgia exhibited posterior hyperperfusion, including of the somatosensory cortex, and hypoperfusion of the frontal, cingulate, temporal, and cerebellar cortices in particular, the temporal hypoperfusion including the polar and mediobasal cortices.
Positive correlations (both on left) represent hyperfusion, negative (right) represents hypofusion- ie low blood flow.
Brain perfusion abnormalities in patients with fibromyalgia “are independent of the patient’s anxiety and depression status and correlate with the clinical severity of the disease, expressed by the disability and evaluated by the FIQ total score.”
shows increased activity in the thalamus and basal ganglia (study)
below- here is an example of normal basal ganglia flow, the basal ganglia is in the centre
(note the rest may be abnormal as this woman had tremors.
note- basal ganglia abnormalities may also occur with lupus).
This same region is relevant for ADD: people with Anxious ADD show the hallmark ADD signature of low prefrontal cortex activity (image on the right) combined with overactivity in the basal ganglia (image on the left)—a region of the brain that allows for smooth integration of emotions, thoughts, and physical movement.
One review found differences between cfs & depression spects, with significantly more defects in the occipital lobe in depression; fischler found major depression showed significantly lower left superofrontal regional perfusion, in line with previous reports
while note: its normal to see more activity in the right than the left temporal lobe, with slightly larger left than right volume; this assymetry may be more pronounced in depression
severe anxiety neurosis revealed hyperactive prefrontal cortices and basal ganglia in technetium-99m-hexamethylpropyleneamineoxime brain perfusion single photon emission computed tomography images. (a) Transverse view, (b) sagittal view, (c) right lateral view of three-dimensional Talairach cortical perfusion report, (d) extracted basal ganglia and thalamus by “Neurogam” processing, (e) color scale for (c and d):
On CFS vs Depression, and CFS neurology scans in general:
NOTES: my results ‘ischemia‘
‘A mild-moderate symetrical reduction uptake in the posterior tempero-parietal cerebral cortex is seen. There is a sparing of the posterior cingulate and the visual association cortex. Normal perfusion within the basal ganglia and the cerabellum… Bilateral mild to moderate posterior tempero-parietal cortical hypoperfusion’.
The ICC for ME says: ↓ reduced blood flow in temporal lobes may contribute to memory and cognitive impairment & fatigue
The ICC also states: Greater source activity and more parts of the brain are utilized in cognitive processing, which supports patients’ perception of greater effort… These observed pathological changes are consistent with neurological disorders but not psychiatric conditions…
The parietal lobes involves sensation and perception and integrates sensory input, primarily with the visual system. Neurons in the parietal lobes receive touch, visual and other sensory information from a part of the brain called the thalamus. The thalamus relays nerve signals and sensory information between the peripheral nervous system and the cerebral cortex. The temporal lobes are involved in high-level auditory processing such as selective listening, language recognition of words, and Mathematical Computation! Problems include the inability to recall the correct names of everyday items, difficulty in making exact movements, inability to perform complex tasks in the proper order
The temporal lobes play an important role in organizing sensory input, auditory perception, language and speech production, language comprehension, as well as memory association and formation. Structures of the limbic system, including the olfactory cortex, amygdala, and the hippocampus are located within the temporal lobes. Damage to this area of the brain can result in problems with memory, understanding language, and maintaining emotional control. This is also important for facial recognition and regulating fight or flight!
The frontal lobes are involved in reasoning and personality expression is fine! The posterior cingulate is between the frontal and parietal lobes and is considered part of the default mode network, a group of brain structures that are more active when an individual is not involved in a task that requires externally-focused attention, also implicated in moral judgments
Hypoperfusion Neuro-SPECT ↓ regional blood flow (rCBF), ↓ absolute cortical blood flow ↓ hypoperfusion in brainstem distinguishes ME from depression ↓ further reduction in cerebral blood flow after exercise; Greater involvement of the brain correlates with greater severity