Alterations in Connectivity on Functional Magnetic Resonance Imaging with Provocation of Lower Urinary Tract Symptoms: A MAPP Research Network Feasibility Study of Urological Chronic Pelvic Pain Syndromes.
Alterations in Connectivity on Functional Magnetic Resonance Imaging with Provocation of Lower Urinary Tract Symptoms: A MAPP Research Network Feasibility Study of Urological Chronic Pelvic Pain Syndromes.
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DOI：
10.1016/j.juro.2015.09.092
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发表时间：
2016-03
影响因子：
6.6
通讯作者：
Maravilla, Kenneth R.
中科院分区：
文献类型：
--
作者：
Kleinhans, Natalia M.;Yang, Claire C.;Strachan, Eric D.;Buchwald, Dedra S.;Maravilla, Kenneth R.
泌尿系慢性盆腔疼痛综合征(UCPPS)以顽固性膀胱或盆腔疼痛为主要症状，其主要原因是慢性有害刺激引起中枢神经系统的改变。我们开发了一种新的挑战方案，可以在研究参与者中诱导膀胱扩张来复制疼痛和尿路症状，并进行测试，看看它是否可以区分患有UCPPS样症状的人和没有症状的对照组。我们招募了10对女性双胞胎，她们的UCPPS样症状不协调。在扫描之前，每对双胞胎都排尿完成，然后喝下500毫升的水。我们用我们的静息状态功能磁共振成像(RsfMRI)方案立即对每一对双胞胎进行扫描，并在消费后大约50分钟进行扫描。从左右中脑导水管周围灰质(PAG)和左右杏仁核亚区提取时间序列。我们进行了重复测量、两个样本的t检验，以评估有症状和无症状双胞胎在膀胱扩张前后连接性的差异。从PAG到右侧小脑VIIIa、杏仁核、右侧运动前皮质/辅助运动区和岛叶皮质，以及杏仁核与额叶极/眶内侧额叶皮质、下丘脑、岛叶皮质、丘脑和前扣带回皮质之间存在逐个条件的交互作用。这些发现表明，我们的非侵入性膀胱扩张方案可以检测下尿路疼痛不协调的双胞胎在尿感处理方面的差异。
Urologic chronic pelvic pain syndromes (UCPPS) have refractory bladder or pelvic pain as their dominant symptom, which has been attributed to changes in the central nervous system caused by a chronic barrage of noxious stimuli. We developed a novel challenge protocol that induces bladder distention in study participants to reproduce pain and urinary symptoms, and tested to see whether it could discriminate between persons with UCPPS-like symptoms and asymptomatic controls. We recruited 10 female twin pairs who were discordant for UCPPS-like symptoms. Before scanning, each twin urinated to completion, then consumed 500 cc of water. Each twin was scanned with our resting state functional magnetic resonance imaging (rsfMRI) protocol immediately, and approximately 50 minutes after consumption. Time series were extracted from the right and left periaqueductal gray (PAG) and right and left amygdala subregions. We conducted a repeated-measures, two-sample t-test to assess differences in connectivity between symptomatic and asymptomatic twins before and after bladder distention. Group-by-condition interaction effects were found from the PAG to the right cerebellum VIIIa, amygdala, right premotor cortex/supplementary motor area, and insular cortex; and between the amygdala and the frontal pole/medial orbital frontal cortex, hypothalamus, insular cortex, thalamus, and anterior cingulate cortex. These findings demonstrate that our non-invasive bladder distention protocol can detect differences in the processing of urinary sensation between twins discordant for lower urinary tract pain.
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