Yu, Qiang, Kwiatek, Richard A, Del Fante, Peter et al. · Scientific reports · 2025 · DOI
This study used advanced brain imaging to examine whether two types of ME/CFS—one that starts suddenly after an infection and one that develops gradually—show different patterns of damage in the brain's white matter (the nerve fibers that allow brain regions to communicate). Researchers found that these two types of ME/CFS do indeed show distinct patterns, suggesting they may involve different disease processes. This finding supports the idea that ME/CFS is not a single uniform condition but may require different approaches depending on how it started.
For decades, clinicians and researchers have debated whether post-infectious and gradual-onset ME/CFS represent different diseases or variants of the same condition. This study provides the first neurobiological evidence that these two presentations involve distinct white matter alterations, validating clinical suspicions and suggesting that patient stratification by onset type may be necessary for future treatment development and research. This finding could lead to more personalized diagnostic and therapeutic approaches.
This study does not establish that white matter changes cause ME/CFS symptoms—it only shows they are associated with the condition. The cross-sectional design prevents determination of whether these white matter alterations are present before symptom onset, develop as a consequence of the disease, or result from deconditioning. Long-term follow-up studies would be needed to determine if these biomarkers predict disease progression or treatment response.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Yu, Qiang, Kwiatek, Richard A, Del Fante, Peter, Bonner, Anya, Calhoun, Vince D, Bateman, Grant A, et al. (2025). Distinct white matter alteration patterns in post-infectious and gradual onset chronic fatigue syndrome revealed by diffusion MRI.. Scientific reports. https://doi.org/10.1038/s41598-025-09379-z
BibTeX
@article{mecfsatlas-yu-2025-distinct-white,
author = {Yu, Qiang and Kwiatek, Richard A and Del Fante, Peter and Bonner, Anya and Calhoun, Vince D and Bateman, Grant A and Yamamura, Takashi and Shan, Zack Y},
title = {Distinct white matter alteration patterns in post-infectious and gradual onset chronic fatigue syndrome revealed by diffusion MRI.},
journal = {Scientific reports},
year = {2025},
doi = {10.1038/s41598-025-09379-z},
note = {PubMed: 40624094},
url = {https://www.mecfsatlas.com/evidence/yu-2025-distinct-white},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/yu-2025-distinct-white
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