Fri, 22 Dec 2000

Arthritis Rheum 2000 Dec;43(12);2823-2833

REGIONAL CEREBRAL BLOOD FLOW IN FIBROMYALGIA: Single-Photon-Emission
Computed  Tomography Evidence of Reduction in the Pontine Tegmentum and
Thalami

Richard Kwiatek, MBBS, FRACP, Leighton Barnden, PhD, Jenni Chew, BAppSc,
Christopher Rowe, MD, FRACP, Kevin Pile, MD, FRACP: The Queen Elizabeth
Hospital, Adelaide, Australia; Raymond Tedman, PhD, Richard Jarrett, PhD:
The University of Adelaide, Adelaide, Australia.

Submitted for publication February 22, 2000; accepted in revised form
August 21, 2000. Address reprint requests to Richard Kwiatek, MBBS, FRACP,
Department of Rheumatology, The Queen Elizabeth Hospital, 28 Woodville
Road, Woodville South, South Australia 5011, Australia.

ABSTRACT
Objective. To determine whether regional cerebral blood flow (rCBF) is
abnormal in any cerebral structure of women with fibromyalgia (FM),
following a report that rCBF is reduced in the thalami and heads of caudate
nuclei in FM.

Methods. Seventeen women with FM and 22 healthy women had a resting
single-photon-emission computed tomography (SPECT) brain scan to assess
rCBF and a T1-weighted magnetic resonance imaging (MRI) scan to enable
precise anatomic localization. Additionally, all participants underwent 2
manual tender point examinations and completed a set of questionnaires
evaluating clinical features. SPECT scans were analyzed for differences in
rCBF between groups using statistical parametric mapping (SPM) and regions
of interest (ROIs) manually drawn on coregistered MRI.

Results. Compared with control subjects, the rCBF in FM patients was
significantly reduced in the right thalamus (P = 0.006), but not in the
left thalamus or head of either caudate nucleus. SPM analysis indicated a
statistically significant reduction in rCBF in the inferior pontine
tegmentum (corrected P = 0.006 at the cluster level and corrected P = 0.023
for voxel of maximal significance), with consistent findings from ROI
analysis (P = 0.003). SPM also detected a reduction in rCBF on the
perimeter of the right lentiform nucleus. No correlations were found with
clinical features or indices of pain threshold.

Conclusion. Our finding of a reduction in thalamic rCBF is consistent with
findings of functional brain imaging studies of other chronic clinical pain
syndromes, while our finding of reduced pontine tegmental rCBF is new. The
pathophysiologic significance of these changes in FM remains to be elucidated.

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