title: White and gray matter abnormalities in the brain of patients with fibromyalgia: a diffusion-tensor and volumetric imaging study.
abstract: OBJECTIVE
  To use a combination of magnetic resonance diffusion-tensor imaging (MR-DTI) and MR imaging of voxel-based morphometry (MR-VBM) in patients with fibromyalgia syndrome (FMS) to determine microstructural and volume changes in the central neuronal networks involved in the sensory-discriminative and affective-motivational characteristics of pain, anxiety, memory, and regulation of the stress response.
  
  
  METHODS
  Thirty female patients with FMS and 30 healthy female control subjects were studied. Predefined areas of the brain were measured for volume of gray matter by MR-VBM and for diffusivity and fractional anisotropy (FA) by MR-DTI. Higher FA values and reduced diffusivity are thought to reflect increased complexity of brain-tissue microstructure.
  
  
  RESULTS
  MR-VBM and MR-DTI demonstrated a striking pattern of changes in brain morphology in patients with FMS. Both thalami, the thalamocortical tracts, and both insular regions showed significant decreases in FA. In contrast, increases in FA and decreases in gray matter volume were seen in the postcentral gyri, amygdalae, hippocampi, superior frontal gyri, and anterior cingulate gyri. Increased pain intensity scores were correlated with changes in MR-DTI measurements in the right superior frontal gyrus. Increased fatigue was correlated with changes in the left superior frontal and left anterior cingulate gyrus, and self-perceived physical impairment was correlated with changes in the left postcentral gyrus. Higher intensity scores for stress symptoms were correlated negatively with diffusivity in the thalamus and FA in the left insular cortex. No relationship was found between MR-VBM measurements and symptom intensity scores.
  
  
  CONCLUSIONS
  MR-DTI allows the visualization of microstructural changes in the brain of patients with FMS, appears to be more sensitive than MR-VBM, and may serve as an additional diagnostic technique in FMS and probably other dysfunctional pain syndromes.
authors.affiliation: Campus Grosshadern, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Lutz
authors.forename: Lorenz
authors.initials: L
authors.lastname: Jäger
authors.forename: Dominique
authors.initials: D
authors.lastname: de Quervain
authors.forename: Till
authors.initials: T
authors.lastname: Krauseneck
authors.forename: Frank
authors.initials: F
authors.lastname: Padberg
authors.forename: Martina
authors.initials: M
authors.lastname: Wichnalek
authors.forename: Antje
authors.initials: A
authors.lastname: Beyer
authors.forename: Robert
authors.initials: R
authors.lastname: Stahl
authors.forename: Ben
authors.initials: B
authors.lastname: Zirngibl
authors.forename: Dominik
authors.initials: D
authors.lastname: Morhard
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Gustav
authors.initials: G
authors.lastname: Schelling
mesh_terms: D000328:Adult; D000368:Aged; D000679:Amygdala / Q000473:pathology; D001921:Brain / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D004644:Emotions; D005260:Female; D006179:Gyrus Cinguli / Q000473:pathology; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008568:Memory; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009474:Neurons / Q000473:pathology*; D010146:Pain / Q000473:pathology; D013003:Somatosensory Cortex / Q000473:pathology; D013315:Stress, Psychological / Q000473:pathology; D013788:Thalamus / Q000473:pathology