Almutairi, Basim, Langley, Christelle, Crawley, Esther et al. · BMJ open · 2020 · DOI
This review examined brain imaging studies in ME/CFS patients using two main techniques: structural MRI (which shows the anatomy of the brain) and functional MRI (which shows which brain areas are active during tasks). Researchers found that ME/CFS patients showed some differences in brain structure and unusual patterns of brain activity, but these findings varied widely between studies. While these results suggest something is happening in the brains of ME/CFS patients, the researchers couldn't identify one clear pattern that all patients share.
This comprehensive review demonstrates that neuroimaging changes occur in ME/CFS but that no single diagnostic biomarker has yet been identified, highlighting the need for larger, better-designed studies. Understanding these brain-level changes validates ME/CFS as a biological condition affecting neural function and may eventually lead to objective diagnostic tools and insights into disease mechanisms.
This review does not establish ME/CFS as primarily neurological or prove that brain changes cause ME/CFS symptoms—correlation between imaging findings and disease has not been proven. The inconsistent findings across studies mean no single brain pattern can yet definitively diagnose or explain ME/CFS. The authors note that technical limitations of current neuroimaging methods (voxel-based statistics, fMRI signal interpretation) prevent drawing firm conclusions about underlying neural mechanisms.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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Primary citation
Almutairi, Basim, Langley, Christelle, Crawley, Esther, & Thai, Ngoc Jade (2020). Using structural and functional MRI as a neuroimaging technique to investigate chronic fatigue syndrome/myalgic encephalopathy: a systematic review.. BMJ open. https://doi.org/10.1136/bmjopen-2019-031672
BibTeX
@article{mecfsatlas-almutairi-2020-using-structural,
author = {Almutairi, Basim and Langley, Christelle and Crawley, Esther and Thai, Ngoc Jade},
title = {Using structural and functional MRI as a neuroimaging technique to investigate chronic fatigue syndrome/myalgic encephalopathy: a systematic review.},
journal = {BMJ open},
year = {2020},
doi = {10.1136/bmjopen-2019-031672},
note = {PubMed: 32868345},
url = {https://www.mecfsatlas.com/evidence/almutairi-2020-using-structural},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/almutairi-2020-using-structural
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