Diagnosing Chronic Fatigue Syndrome with DTI

Between our work, family, school, and social lives, fatigue is a common feeling among people. Defined as “extreme tiredness or exhaustion,” fatigue is one of the most reported symptoms to physicians. It can be hard for doctors to tell if a patient is simply tired or if there is a contributing condition like chronic fatigue syndrome that may be causing their exhaustion.

Chronic Fatigue Syndrome is described as more than just day-to-day tiredness. This condition’s symptoms include exhaustion that is both debilitating and without cause. Patients may have feelings of being extremely tired. Chronic fatigue is usually accompanied by impaired memory or concentration, dizziness, inability to stay awake or upright, and overwhelming exhaustion without exertion. Persisting longer than 6 months, this condition requires more than a caffeine fix and a good night’s sleep — it needs medical attention.

The condition affects more than 1 million adults and children in the United States, according to the Centers for Disease Control and Prevention. Diagnosis is complicated and usually involves ruling out many other conditions.

Chronic Fatigue Syndrome can become more than just debilitating. It can be dangerous as well. Fatigue of this degree can become problematic when the patient is driving or operating heavy machinery. Symptoms related to chronic fatigue can resemble other diseases such as Lyme disease, major depressive disorder, lupus, and hypothyroidism. This makes it difficult for doctors to diagnose these conditions. Physicians would much prefer a standalone test to diagnose CFS. And a 2014 study brings such a test slightly closer to doctors’ clinics.

The additional help in diagnosing this condition comes from using Diffusion Tensor Imaging (DTI).

DTI is a relatively new form of advanced MRI in which the nerve fibers of the brain can be specifically highlighted and imaged to determine possible damage from things like concussions or conditions including chronic fatigue. In the same way that MRIs use sound waves and computer technology in order to image the internal organs, DTI focuses on the nerve fibers in the brain and is able to image them with startling detail. MRIs can show the musculoskeletal and vascular system. But, with DTI, physicians hope to go even deeper into the nerves where doctors can see definitive proof of chronic fatigue syndrome.

In a 2014 study published online in the journal Radiology, researchers studied 15 CFS patients and 14 people selected as age and gender control subjects. When they compared results between the CFS patients and the controls, they found that the CFS group had slightly lower white matter volume, meaning there was less overall white matter in the brain.

Researchers also found that patients complaining of CFS symptoms had high Fractional Anisotropy (FA) values in a certain area of the brain. FA describes how water moves along the nerves within the brain. Results suggested that this area of the brain can serve as a biomarker for CFS where “the more abnormal the tract, the worse the fatigue.”

When the nerve fibers in the brain are experiencing irregularity or degeneration, in combination with the aforementioned symptoms, doctors can diagnose chronic fatigue syndrome faster and with more accuracy. The time delay and inconsistency that was once prominent with this condition can now be eliminated thanks to the advanced MRI technology made by diffusion tensor imaging.

“This is a very common and debilitating disease,” said the study lead author Michael M. Zeineh, M.D., Ph.D., assistant professor of radiology at Stanford University School of Medicine in Stanford, Calif. “It’s very frustrating for patients because they feel tired and are experiencing difficulty thinking.”

“This is the first study to look at white matter tracts in CFS and correlate them with cortical findings,” Dr. Zeineh said. “It’s not something you could see with conventional imaging.”

Dr. Zeineh added that the findings need to be replicated and expanded upon in future studies to refine the understanding of the relationship between brain structure and CFS.

“Most CFS patients at some point in time have been accused of being hypochondriacs and their symptoms dismissed by others,” Dr. Zeineh said in an interview with NBC Today. “And there is still skepticism in the medical community about the diagnosis. That’s one of the reasons these findings are important.”

DTI Now Available at Doctors Imaging

Doctors Imaging is the first facility in Louisiana to offer DTI exams. If you have more questions about the symptoms of concussion or how DTI works, please visit the dedicated website TheConcussionGroup.com.




This reconstructed magnetic resonance image shows the blue tracks and arrows and yellow tracks and arrows in a single patient. These two tracks are overlaid on their respective track profiles. The green arrows point to the middle temporal region of increased cortical thickness. Source: Radiological Society of North America

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