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Updated: May 12, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Fatigue-related brain white matter changes in granulomatosis with polyangiitis
Neil Basu1, Alison D Murray, Gareth T Jones
1Musculoskeletal Collaboration (Epidemiology Group), School of Medicine and Dentistry, University of Aberdeen Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK. neilbasu@abdn.ac.uk
Objective:
To determine the association between brain white matter (WM) damage and persistent fatigue among patients with granulomatosis with polyangiitis (GPA).
Methods:
A case-control MRI study was conducted. Both cases, defined as GPA patients with chronic fatigue, and controls, defined as GPA patients without fatigue, underwent MRI brain scanning. Standard T1, T2 and FLAIR images were acquired and Scheltens white matter hyperintensity scores (SWMHS) reported in order to quantify macroscopic damage. In addition, diffusion tensor imaging (DTI) data were analysed using track-based spatial statistics to measure structural integrity and thus microscopic damage.
Results:
No statistically significant differences in macroscopic damage were observed between cases (n = 14) and controls (n = 14) (median SWMHS 6, interquartile range 3-7 vs median SWMHS 3.5, interquartile range 3-8; P = 0.52). Compared with controls, there were no regions of WM where cases recorded reduced structural integrity; however, significantly greater structural integrity was registered in the regions of the fornix and cingulum nerve bundles of cases (P < 0.05, corrected for multiple comparisons).
Conclusion:
This study found no evidence to suggest that GPA-related fatigue is associated with either macroscopic or microscopic damage of the WM. On the contrary, regions of significantly greater structural integrity were observed among fatigued cases, which may reflect sustained activation secondary to chronic fatigue exposure.
Insights
Granulomatosis with polyangiitis (GPA) fatigue is not linked to white matter (WM) damage. Instead, fatigued GPA patients showed greater structural integrity in specific brain regions, possibly due to sustained activation.
Area of Science:
- Neuroscience
- Rheumatology
- Medical Imaging
Background:
- Persistent fatigue is a common and debilitating symptom in Granulomatosis with Polyangiitis (GPA).
- The underlying mechanisms of GPA-related fatigue, particularly its relationship with brain white matter (WM) integrity, remain poorly understood.
Purpose of the Study:
- To investigate the association between brain white matter (WM) damage and persistent fatigue in patients diagnosed with Granulomatosis with Polyangiitis (GPA).
Main Methods:
- A case-control study utilizing Magnetic Resonance Imaging (MRI) was performed.
- Cases were GPA patients with chronic fatigue, and controls were GPA patients without fatigue.
- Macroscopic WM damage was assessed using Scheltens white matter hyperintensity scores (SWMHS) on T1, T2, and FLAIR images, while microscopic damage was evaluated using diffusion tensor imaging (DTI) and track-based spatial statistics.
Main Results:
- No significant differences in macroscopic white matter damage (SWMHS) were found between GPA patients with and without fatigue.
- Diffusion tensor imaging revealed no regions of reduced structural integrity in the white matter of fatigued GPA patients compared to controls.
- Interestingly, fatigued GPA patients exhibited significantly greater structural integrity in the fornix and cingulum nerve bundles.
Conclusions:
- The study found no evidence supporting an association between Granulomatosis with Polyangiitis (GPA)-related fatigue and macroscopic or microscopic white matter (WM) damage.
- The observed increase in structural integrity in specific WM regions among fatigued patients may indicate sustained neural activation as a compensatory mechanism or response to chronic fatigue.
