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Chew CG, Crouch B, Ha S, Burke A, Louise J. Validation of RAH VQ SPECT/CT lobar quantification program using a modified version of GE Q lung. Hell J Nucl Med 2023; 26:9-19. [PMID: 37031418 DOI: 10.1967/s002449912551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/13/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE The value of ventilation-perfusion (VQ) single photon emission tomography/computed tomography (SPECT/CT) lobar quantification for pre-operative assessment of lobectomy and lung volume reduction is known. Our in-house developed software, RAH ventilation perfusion SPECT/CT quantification (RAHVQSQ) has been shown to be able to identify the target lobe for collapse in bronchoscopic lung volume reduction (BLVR) for advanced emphysema. We have proven inter and intra observer reproducibility but are yet to validate the accuracy of our program. This study aims to validate the accuracy of our quantitative program through comparison with a modified version of GE Q lung which is a commercial program certified for clinical use. SUBJECTS AND METHODS Ventilation-perfusion SPECT/CT data of 19 subjects from our previous study using RAHVQSQ for BLVR assessment were re-analysed using Q lung by 2 technologists independently and in a blinded fashion to determine lobar differential ventilation, perfusion and volume percentages. The data were from GE Hawkeye 4 and external CT, thus a modified version of Q lung was used. To determine interobserver variation in the 3 parameters between the 3 assessors, intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement (LoA) were generated. RESULTS Paired comparisons between the 3 assessors had high ICC (range for ventilation: 0.69-0.97; perfusion: 0.69-0.97; volume: 0.63-0.97) and means of LoA differences close to zero (range for ventilation: -0.04 - 0.10; perfusion: 0.00-0.02; volume: -0.12 - 0.09) were noted indicative of good concordance for all parameters. CONCLUSION Using VQ SPECT/CT data of participants with advanced airway disease, our study has found a close concordance of estimated differential lobar ventilation, perfusion and volume percentages using RAHVQSQ when compared with a duplicated blinded assessment using Q lung. The good concordance supports the validity of our quantitative methodology.
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Affiliation(s)
- Chong Ghee Chew
- Department of Nuclear Medicine, PET and Bone Mineral Densitometry, Royal Adelaide Hospital, Australia.
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Chelales E, Kwan M, Crouch B, Katz D, Sag A, Ramanujam N. Abstract No. 101 Ethanol gel enhances percutaneous intratumoral chemotherapy injection: in vitro and in vivo studies of drug retention, tumor destruction, and overall survival. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Naidu J, Bartholomeusz D, Zobel J, Safaeian R, Hsieh W, Crouch B, Ho K, Calnan D, Singhal N, Ruszkiewicz A, Chen JW, Tan CP, Dolan P, Nguyen NQ. Combined chemotherapy and endoscopic ultrasound-guided intratumoral 32P implantation for locally advanced pancreatic adenocarcinoma: a pilot study. Endoscopy 2022; 54:75-80. [PMID: 33440437 DOI: 10.1055/a-1353-0941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND This study evaluated clinical outcomes of combined chemotherapy and endoscopic ultrasound (EUS)-guided intratumoral radioactive phosphorus-32 (32P) implantation in locally advanced pancreatic adenocarcinoma (LAPC). METHODS Consecutive patients with newly diagnosed LAPC were recruited over 20 months. Baseline computed tomography and 18F-2-fluoro-2-deoxy-D-glucose (18FDG) positron emission tomography-computed tomography were performed and repeated after 12 weeks to assess treatment response. Following two cycles of conventional chemotherapy, patients underwent EUS-guided 32P implantation followed by six chemotherapy cycles. RESULTS 12 patients with LAPC (median age 69 years [interquartile range 61.5-73.3]; 8 male) completed treatment. Technical success was 100 % with no procedural complications. At 12 weeks, median reduction in tumor volume was 8.2 cm3 (95 % confidence interval 4.95-10.85; P = 0.003), with minimal or no 18FDG uptake in nine patients (75 %). Tumor downstaging was achieved in six patients (50 %), leading to successful resection in five (42 %), including four R0 resections (80 %). CONCLUSIONS EUS-guided 32P implantation was feasible, well tolerated, and resulted in a 42 % surgical resection rate. Further evaluation in a larger randomized multicenter trial is warranted.
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Affiliation(s)
- Jeevinesh Naidu
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.,School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Dylan Bartholomeusz
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.,School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Joshua Zobel
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Romina Safaeian
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - William Hsieh
- Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Benjamin Crouch
- Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Karen Ho
- Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Deborah Calnan
- Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Nimit Singhal
- Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Andrew Ruszkiewicz
- School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,Department of Pathology, Royal Adelaide Hospital, Adelaide, Australia
| | - John W Chen
- Department of Hepatobiliary Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Chuan Ping Tan
- Department of Hepatobiliary Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Paul Dolan
- Department of Hepatobiliary Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Nam Q Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.,School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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Tee VST, Nguyen P, Jersmann H, Grosser D, Crouch B, Lorraine B, Chew CG. Use of Ventilation-Perfusion Single-Photon Emission Computed Tomography to Select the Target Lobe for Endobronchial Valve Lung Volume Reduction. Respiration 2021; 100:886-897. [PMID: 33774642 DOI: 10.1159/000515336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quantitative planar ventilation-perfusion (VQ) has a complementary role in target lobe selection for endobronchial valve lung volume reduction (EBV-LVR), especially in homogenous disease. We investigated a novel method of lung lobar quantitation using VQ single-photon emission computed tomography (SPECT) with computed tomography (CT) to generate a parameter called the ventilation-perfusion differential index (VQDI). AIM The aim of this study was to validate VQDI as a parameter for target lobe selection in EBV-LVR against the gold standard test of quantitative computed tomography (qCT). METHODS This study was a prospective, multi-centre, single-blinded, observational study of EBV-LVR patients. Baseline and 3-month post intervention VQ SPECT and qCT were performed. The target lobe was chosen using qCT and planar VQ report (CTTL) whilst blinded to VQDI. Post EBV-LVR, our nuclear physician, blinded to CTTL, selected a target lobe using deidentified VQDI (VQDITL). Inter-rater agreement between CTTL and VQDITL was calculated by Kappa statistic. Treatment outcomes were analysed with a linear mixed-effects model. RESULTS There was a high concordance between CTTL and VQDITL in 16 patients (89%, Kappa statistic = 0.85). Post EBV-LVR, our subjects showed significant changes in FEV1 (mean difference [MD] +150 mL, p < 0.001), target lobe volume reduction (MD -973 mL, p < 0.001), residual volume (MD -800 mL, p < 0.001), and St. George's Respiratory Questionnaire score (MD -11, p = 0.001). Improvements in 6-minute walk distances did not reach statistical significance. CONCLUSION In this study of treatment responders, EBV-LVR target lobe selection using VQDI concurs with qCT and thus supports its value for this purpose. It complements qCT and may potentially be of synergistic value especially in homogenous emphysema.
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Affiliation(s)
- Vanessa Sze Theen Tee
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Phan Nguyen
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hubertus Jersmann
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Benjamin Crouch
- Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brett Lorraine
- SA Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Chong Ghee Chew
- Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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El-Barhoun EN, Chew G, Crouch B, Chatterton B. Reproducibility of a semi-quantitative lobar pulmonary ventilation and perfusion technique using SPET and CT. Hell J Nucl Med 2017; 20:71-75. [PMID: 28315911 DOI: 10.1967/s002449910509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/17/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Evaluation of regional lung function is valuable prior to lung surgery in patients with chronic lung disease. Our aim was to evaluate the reproducibility of a locally developed single photon emission tomography/computed tomography (SPET/CT) programme between and within three observers in assessing lobar pulmonary volumes, perfusion and ventilation. SUBJECTS AND METHODS Twelve lung transplantation candidates had VQ SPET and diagnostic CT to determine lobar pulmonary function and plan surgery. Their data were used retrospectively in an in-house developed programme which delineates the lung fissures on the diagnostic CT as an anatomical template used to estimate the volume of each of 5 lung lobes. These anatomical volumes were then applied to the corresponding ventilation (99m Tc technegas) and perfusion (99m Tc MAA) SPET studies. The data were anonymised, duplicated and then processed in random order blindly by 3 readers several weeks apart. Nine studies could be adequately processed. The programme failed in delineating lung volumes in 2 subjects and there was data corruption in the third. The results were evaluated for inter- and intra- observer variability using an intra-class Correlation Coefficient (ICC). An ICC score was calculated for each lobe for volume, ventilation and perfusion. RESULTS Inter- and intra- observer ICC scores for ventilation, and perfusion scans were all very high. Similar very strong ICC concordance scores were noted for volume except intra-observer ICC scores for left upper lobe (0.76) and right mid lobe (0.66) where scores showed strong concordance by standard statistical descriptors. The method was sensitive enough to demonstrate the expected gradient of ventilation/perfusion even in these patients with substantial pathology. CONCLUSION Our method of lobar VQ SPET with CT quantitation has high inter- and intra- observer concordance and in this preliminary data set seems to be a reliable and reproducible test for semi-quantitation of differential volume, ventilation and perfusion of the lobes of the lungs.
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Affiliation(s)
- Esber N El-Barhoun
- Department of Nuclear Medicine, Royal Adelaide Hospital, North Tce, Adelaide, South Australia, Australia.
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Barnden LR, Kwiatek R, Crouch B, Burnet R, Del Fante P. Autonomic correlations with MRI are abnormal in the brainstem vasomotor centre in Chronic Fatigue Syndrome. Neuroimage Clin 2016; 11:530-537. [PMID: 27114901 PMCID: PMC4833047 DOI: 10.1016/j.nicl.2016.03.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 11/25/2022]
Abstract
Autonomic changes are often associated with the chronic fatigue syndrome (CFS), but their pathogenetic role is unclear and brain imaging investigations are lacking. The vasomotor centre and, through it, nuclei in the midbrain and hypothalamus play a key role in autonomic nervous system regulation of steady state blood pressure (BP) and heart rate (HR). In this exploratory cross-sectional study, BP and HR, as indicators of autonomic function, were correlated with volumetric and T1- and T2-weighted spin-echo (T1w and T2w) brain MRI in 25 CFS subjects and 25 normal controls (NC). Steady state BP (systolic, diastolic and pulse pressure) and HR in two postures were extracted from 24 h blood pressure monitoring. We performed (1) MRI versus autonomic score interaction-with-group regressions to detect locations where regression slopes differed in the CFS and NC groups (collectively indicating abnormality in CFS), and (2) MRI regressions in the CFS and NC groups alone to detect additional locations with abnormal correlations in CFS. Significant CFS regressions were repeated controlling for anxiety and depression (A&D). Abnormal regressions were detected in nuclei of the brainstem vasomotor centre, midbrain reticular formation and hypothalamus, but also in limbic nuclei involved in stress responses and in prefrontal white matter. Group comparisons of CFS and NC did not find MRI differences in these locations. We propose therefore that these regulatory nuclei are functioning correctly, but that two-way communication between them is impaired in CFS and this affects signalling to/from peripheral effectors/sensors, culminating in inverted or magnified correlations. This single explanation for the diverse abnormal correlations detected here consolidates the conclusion for a brainstem/midbrain nerve conduction deficit inferred earlier (Barnden et al., 2015). Strong correlations were also detected in isolated NC regressions. For the first time in CFS, we performed MRI regressions with steady state BP and HR. Vasomotor centre, midbrain and hypothalamus correlations were abnormal in CFS. MRI group comparisons between CFS and controls detected no differences. Regulatory nuclei and peripheral effectors/sensors appear to function correctly. Signalling between brainstem/midbrain regulatory nuclei appears to be impaired.
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Key Words
- 1s, 1 sample
- 2s, 2 sample
- A&D, anxiety and depression
- Anxiety and depression
- Autonomic
- BA, Brodmann Area
- BP, blood pressure
- Blood pressure
- CFS, chronic fatigue syndrome
- Cb, cerebellum
- Chronic fatigue syndrome
- CnF, cuneiform nucleus of the reticular formation
- DLPF, dorsolateral prefrontal
- FDR, false discovery rate
- FWE, family wise error
- GM, grey matter
- HADS, Hospital Anxiety and Depression Scale
- HR, heart rate
- Heart rate
- Hypothalamus
- MRI
- Midbrain
- NC, normal controls
- Nerve conduction
- PCC, posterior cingulate cortex
- PHg, parahippocampal gyrus
- POTS, postural orthostatic tachycardia syndrome
- PP, pulse pressure
- Posture
- RAS, reticular activation system
- Regression
- SS, symptom score
- VBIS, voxel based iterative sensitivity
- Vasomotor centre
- WM, white matter
- ccP, corrected cluster P statistic
- diaBP, diastolic blood pressure
- sysBP, systolic Blood pressure
- uvP, uncorrected voxel P statistic
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Affiliation(s)
- Leighton R Barnden
- Department of Nuclear Medicine, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia; National Centre for NeuroImmunology and Emerging Diseases, Griffith University, Gold Coast, QLD 4222, Australia.
| | - Richard Kwiatek
- Division of Medical Subspecialities, Lyell McEwin Hospital, Elizabeth, SA 5112, Australia.
| | - Benjamin Crouch
- Department of Nuclear Medicine, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia.
| | - Richard Burnet
- Endocrinology Department, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
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Thazhath SS, Marathe CS, Wu T, Chang J, Khoo J, Kuo P, Checklin HL, Bound MJ, Rigda RS, Crouch B, Jones KL, Horowitz M, Rayner CK. The Glucagon-Like Peptide 1 Receptor Agonist Exenatide Inhibits Small Intestinal Motility, Flow, Transit, and Absorption of Glucose in Healthy Subjects and Patients With Type 2 Diabetes: A Randomized Controlled Trial. Diabetes 2016; 65:269-75. [PMID: 26470783 DOI: 10.2337/db15-0893] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/07/2015] [Indexed: 02/05/2023]
Abstract
The short-acting glucagon-like peptide 1 receptor agonist exenatide reduces postprandial glycemia, partly by slowing gastric emptying, although its impact on small intestinal function is unknown. In this study, 10 healthy subjects and 10 patients with type 2 diabetes received intravenous exenatide (7.5 μg) or saline (-30 to 240 min) in a double-blind randomized crossover design. Glucose (45 g), together with 5 g 3-O-methylglucose (3-OMG) and 20 MBq (99m)Tc-sulfur colloid (total volume 200 mL), was given intraduodenally (t = 0-60 min; 3 kcal/min). Duodenal motility and flow were measured using a combined manometry-impedance catheter and small intestinal transit using scintigraphy. In both groups, duodenal pressure waves and antegrade flow events were fewer, and transit was slower with exenatide, as were the areas under the curves for serum 3-OMG and blood glucose concentrations. Insulin concentrations were initially lower with exenatide than with saline and subsequently higher. Nausea was greater in both groups with exenatide, but suppression of small intestinal motility and flow was observed even in subjects with little or no nausea. The inhibition of small intestinal motor function represents a novel mechanism by which exenatide can attenuate postprandial glycemia.
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Affiliation(s)
- Sony S Thazhath
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Chinmay S Marathe
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Tongzhi Wu
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Jessica Chang
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Joan Khoo
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Paul Kuo
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Helen L Checklin
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michelle J Bound
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Rachael S Rigda
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Benjamin Crouch
- Department of Nuclear Medicine, PET & Bone Densitometry, Royal Adelaide Hospital, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
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Barnden LR, Crouch B, Kwiatek R, Burnet R, Del Fante P. Evidence in chronic fatigue syndrome for severity-dependent upregulation of prefrontal myelination that is independent of anxiety and depression. NMR Biomed 2015; 28:404-13. [PMID: 25702943 PMCID: PMC4369127 DOI: 10.1002/nbm.3261] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023]
Abstract
White matter (WM) involvement in chronic fatigue syndrome (CFS) was assessed using voxel-based regressions of brain MRI against CFS severity scores and CFS duration in 25 subjects with CFS and 25 normal controls (NCs). As well as voxel-based morphometry, a novel voxel-based quantitative analysis of T1 - and T2 -weighted spin-echo (T1w and T2w) MRI signal level was performed. Severity scores included the Bell CFS disability scale and scores based on the 10 most common CFS symptoms. Hospital Anxiety and Depression Scale (HADS) depression and anxiety scores were included as nuisance covariates. By relaxing the threshold for cluster formation, we showed that the T1w signal is elevated with increasing CFS severity in the ventrolateral thalamus, internal capsule and prefrontal WM. Earlier reports of WM volume losses and neuroinflammation in the midbrain, together with the upregulated prefrontal myelination suggested here, are consistent with the midbrain changes being associated with impaired nerve conduction which stimulates a plastic response on the cortical side of the thalamic relay in the same circuits. The T2w signal versus CFS duration and comparison of T2w signal in the CFS group with the NC group revealed changes in the right middle temporal lobe WM, where impaired communication can affect cognitive function. Adjustment for depression markedly strengthened cluster statistics and increased cluster size in both T1w severity regressions, but adjustment for anxiety less so. Thus, depression and anxiety are statistical confounders here, meaning that they contribute variance to the T1w signal in prefrontal WM but this does not correlate with the co-located variance from CFS severity. MRI regressions with depression itself only detected associations with WM volume, also located in prefrontal WM. We propose that impaired reciprocal brain-body and brain-brain communication through the midbrain provokes peripheral and central responses which contribute to CFS symptoms. Although anxiety, depression and CFS may share biological features, the present evidence indicates that CFS is a distinct disorder.
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Affiliation(s)
- Leighton R Barnden
- Department of Nuclear Medicine, The Queen Elizabeth HospitalWoodville, SA, Australia
- School of Chemistry and Physics, University of AdelaideAdelaide, SA, Australia
- National Centre for NeuroImmunology and Emerging Diseases, Griffith UniversityGold Coast, Qld, Australia
| | - Benjamin Crouch
- Department of Nuclear Medicine, The Queen Elizabeth HospitalWoodville, SA, Australia
| | - Richard Kwiatek
- Division of Medicine, Lyell McEwin HospitalElizabeth, SA, Australia
| | - Richard Burnet
- Endocrinology Department, Royal Adelaide HospitalAdelaide, SA, Australia
| | - Peter Del Fante
- Adelaide Western General Practice NetworkWoodville, SA, Australia
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Neil C, Nguyen TH, Kucia A, Crouch B, Sverdlov A, Chirkov Y, Mahadavan G, Selvanayagam J, Dawson D, Beltrame J, Zeitz C, Unger S, Redpath T, Frenneaux M, Horowitz J. Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI. Heart 2012; 98:1278-84. [DOI: 10.1136/heartjnl-2011-301481] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Barnden LR, Crouch B, Kwiatek R, Burnet R, Mernone A, Chryssidis S, Scroop G, Del Fante P. A brain MRI study of chronic fatigue syndrome: evidence of brainstem dysfunction and altered homeostasis. NMR Biomed 2011; 24:1302-12. [PMID: 21560176 PMCID: PMC4369126 DOI: 10.1002/nbm.1692] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 01/21/2011] [Accepted: 01/24/2011] [Indexed: 05/20/2023]
Abstract
To explore brain involvement in chronic fatigue syndrome (CFS), the statistical parametric mapping of brain MR images has been extended to voxel-based regressions against clinical scores. Using SPM5 we performed voxel-based morphometry (VBM) and analysed T(1) - and T(2) -weighted spin-echo MR signal levels in 25 CFS subjects and 25 normal controls (NC). Clinical scores included CFS fatigue duration, a score based on the 10 most common CFS symptoms, the Bell score, the hospital anxiety and depression scale (HADS) anxiety and depression, and hemodynamic parameters from 24-h blood pressure monitoring. We also performed group × hemodynamic score interaction regressions to detect locations where MR regressions were opposite for CFS and NC, thereby indicating abnormality in the CFS group. In the midbrain, white matter volume was observed to decrease with increasing fatigue duration. For T(1) -weighted MR and white matter volume, group × hemodynamic score interactions were detected in the brainstem [strongest in midbrain grey matter (GM)], deep prefrontal white matter (WM), the caudal basal pons and hypothalamus. A strong correlation in CFS between brainstem GM volume and pulse pressure suggested impaired cerebrovascular autoregulation. It can be argued that at least some of these changes could arise from astrocyte dysfunction. These results are consistent with an insult to the midbrain at fatigue onset that affects multiple feedback control loops to suppress cerebral motor and cognitive activity and disrupt local CNS homeostasis, including resetting of some elements of the autonomic nervous system (ANS).
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Affiliation(s)
- Leighton R Barnden
- Department of Nuclear Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia.
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Litovitz TL, Klein-Schwartz W, Caravati EM, Youniss J, Crouch B, Lee S. 1998 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1999; 17:435-87. [PMID: 10496515 DOI: 10.1016/s0735-6757(99)90254-1] [Citation(s) in RCA: 192] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Crouch B. Clinical teaching on night duty. Nurs Times 1972; 68:1320-1. [PMID: 5081787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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