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99mTc-ECD brain perfusion SPECT in hyperalgesic fibromyalgia
Eric Guedj1, David Taieb1, Serge Cammilleri1, David Lussato1, Catherine de Laforte1, Jean Niboyet2, Olivier Mundler1
1 Service Central de Biophysique et de Mdecine Nuclaire, Assistance Publique des Hpitaux de Marseille, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
2 Unit dEtude et de Traitement de la Douleur, Clinique La Phocanne, 143 route des 3 Lucs, 13012 Marseille, France Received: 9 March 2006 / Accepted: 11 May 2006 / Published online: 25 August 2006 Springer-Verlag 2006
Abstract. Purpose: Neuro-imaging studies with 99mTcHMPAO SPECT in fibromyalgia (FM) patients have reported only limited subcortical hypoperfusion. 99mTcECD SPECT is known to provide better evaluation of areas of high cerebral blood flow and regional metabolic rate. We evaluated a homogeneous group of hyperalgesic patients with FM using 99mTc-ECD SPECT. The aim of this study was to investigate brain processing associated with spontaneous pain in FM patients.
Methods: Eighteen hyperalgesic FM women (mean age 49 years, range 2563 years; American College of Rheumatology criteria) and ten healthy women matched for age were enrolled in the study. A voxel-by-voxel group analysis was performed using SPM2 (p<0.05, corrected for multiple comparisons). Visual Analogue Scale score for pain was 824 at the time of the SPECT study. Results: Compared with control subjects, we observed individual brain SPECT abnormalities in FM patients, confirmed by SPM2 analysis, with hyperperfusion of the somatosensory cortex and hypoperfusion of the frontal, cingulate, medial temporal and cerebellar cortices. Conclusion: In the present study, performed without noxious stimuli in hyperalgesic FM patients, we found significant hyperperfusion in regions of the brain known to be involved in the sensory dimension of pain processing and significant hypoperfusion in areas assumed to be associated with the affective-attentional dimension. As current pharmacological and non-pharmacological therapies act differently on the two components of pain, we hypothesise that SPECT could be a valuable and readily
available tool to guide individual therapeutic strategy and provide objective follow-up of pain processing recovery under treatment.
Keywords: Pain Fibromyalgia Brain SPECT
99mTc-ECD Voxel-based analysis Eur J Nucl Med Mol Imaging (2007) 34:130134 DOI 10.1007/s00259-006-0174-7
Introduction
Fibromyalgia (FM) syndrome is a chronic pain condition characterised by widespread musculoskeletal aches and pain and stiffness, soft tissue tenderness, general...