Zhu, Yijuan, Quan, Patrick, Yamazaki, Tadahiro et al. · Immunometabolism (Cobham, Surrey) · 2025 · DOI
This review examines brain imaging studies that look at how the brains of people with ME/CFS and Long-COVID process energy and nutrients differently. Researchers used advanced scanning techniques to measure glucose and oxygen use in the brain, finding that both conditions show similar patterns of disrupted brain energy metabolism and inflammation. The findings suggest these brain changes might explain why patients experience persistent fatigue, thinking problems, and worsening after physical activity.
This review is important because it consolidates emerging evidence that brain metabolism abnormalities—detectable through neuroimaging—may underlie ME/CFS and Long-COVID symptoms. If validated as biomarkers, these imaging findings could enable objective diagnosis, help distinguish between patient subgroups, and identify specific molecular targets for new treatments. This addresses a critical gap: currently, diagnosis relies on symptom reporting alone, with no biological confirmatory tests.
This is a review of existing studies, not a new primary research study, so it does not prove cause-and-effect relationships. The review identifies shared imaging abnormalities between ME/CFS and Long-COVID but does not establish whether these findings are specific to these conditions or present in other diseases. The inconsistencies between studies noted by the authors mean that findings are not yet sufficiently standardized for clinical diagnostic use.
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
Zhu, Yijuan, Quan, Patrick, Yamazaki, Tadahiro, Norweg, Anna, Natelson, Benjamin, & Xu, Xiang (2025). Metabolic neuroimaging of myalgic encephalomyelitis/chronic fatigue syndrome and Long-COVID.. Immunometabolism (Cobham, Surrey). https://doi.org/10.1097/IN9.0000000000000068
BibTeX
@article{mecfsatlas-zhu-2025-metabolic-neuroimaging,
author = {Zhu, Yijuan and Quan, Patrick and Yamazaki, Tadahiro and Norweg, Anna and Natelson, Benjamin and Xu, Xiang},
title = {Metabolic neuroimaging of myalgic encephalomyelitis/chronic fatigue syndrome and Long-COVID.},
journal = {Immunometabolism (Cobham, Surrey)},
year = {2025},
doi = {10.1097/IN9.0000000000000068},
note = {PubMed: 40958852},
url = {https://www.mecfsatlas.com/evidence/zhu-2025-metabolic-neuroimaging},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/zhu-2025-metabolic-neuroimaging
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