Functional magnetic resonance imaging during urodynamic testing identifies brain structures initiating micturition.
Functional magnetic resonance imaging during urodynamic testing identifies brain structures initiating micturition.
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DOI：
10.1016/j.juro.2014.04.090
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Khavari R
中科院分区：
文献类型：
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作者：
Shy M;Fung S;Boone TB;Karmonik C;Fletcher SG;Khavari R
神经功能正常的患者的正常排尿是由桥上中枢的紧张性抑制释放触发的，从而使桥脑排尿中心触发排尿反射。人类自愿排尿的脊髓上机制才刚刚开始通过功能神经成像进行描述。我们使用功能性磁共振成像进一步阐明了正常女性排尿期间的大脑活动过程，以更好地了解正常排尿以及排尿功能障碍可能发生的变化。我们对13名健康的绝经前女性志愿者进行了基线临床尿动力学筛查，以记录正常排尿参数。然后，我们通过功能磁共振成像和同步尿动力学记录大脑活动，包括压力流排尿期。在对功能磁共振图像进行运动校正后，我们对10名受试者进行了激活和连接性分析。分组分析显示，激活区域一致，包括运动控制区(小脑、丘脑、尾状核、豆状核、红核、辅助运动区和中央后回)、情绪区(前/后扣带回和岛)、执行功能区(左侧额上回)和脑桥的焦点区域。连通性分析表明，桥脑排尿中心与许多短程和长程皮质簇具有很强的互联性。我们的研究是关于大脑激活中心与正常健康女性排尿启动有关的首批报告之一。结果显示，由运动控制、执行功能和情绪处理区域组成的大脑网络被激活。计划进行进一步的研究，建立和验证女性正常排尿期间的大脑活动模型。
Normal voiding in neurologically intact patients is triggered by the release of tonic inhibition from suprapontine centers, allowing the pontine micturition center to trigger the voiding reflex. Supraspinal mechanisms of voluntary voiding in humans are just beginning to be described via functional neuroimaging. We further elucidated brain activity processes during voiding using functional magnetic resonance imaging in normal females to gain better understanding of normal voiding as well as changes that may occur in voiding dysfunction. We screened 13 healthy premenopausal female volunteers using baseline clinic urodynamics to document normal voiding parameters. We then recorded brain activity via functional magnetic resonance imaging and simultaneous urodynamics, including the pressure flow voiding phase. After motion correction of functional magnetic resonance images we performed activation and connectivity analyses in 10 subjects. Group analysis revealed consistent activation areas, including regions for motor control (cerebellum, thalamus, caudate, lentiform nucleus, red nucleus, supplementary motor area and post-central gyrus), emotion (anterior/posterior cingulate gyrus and insula), executive function (left superior frontal gyrus) and a focal region in the pons. Connectivity analysis demonstrated strong interconnectivity of the pontine micturition center with many short-range and long-range cortical clusters. Our study is one of the first reports of brain activation centers associated with micturition initiation in normal healthy females. Results show activation of a brain network consisting of regions for motor control, executive function and emotion processing. Further studies are planned to create and validate a model of brain activity during normal voiding in women.