Characterizing the cortical pathways underlying visual trigger induced urinary urgency incontinence by functional MRI
Characterizing the cortical pathways underlying visual trigger induced urinary urgency incontinence by functional MRI
复制标题
DOI：
10.1002/nau.24824
复制
发表时间：
2021-10-31
影响因子：
2
通讯作者：
Stothers, Lynn
中科院分区：
文献类型：
--
作者：
Locke, Jennifer A.;Macnab, Andrew;Stothers, Lynn
目的视觉触发在临床上早就被认为是引起急迫性尿失禁（UUI）的诱因。目前的病理生理学认识到皮质控制排尿的重要性，但临床医生没有标准化的方法来研究视觉触发器的影响。我们的目标是开发一种成像方案，能够表征大脑对个性化视觉触发的反应，为视觉触发尿急患者的大脑连通性评估提供一种方法。方法建立一种泌尿外科专用磁共振成像（MRI）方法。首先使用3t - elion扫描仪获取静态结构图像。然后使用经过验证的脑图谱来定义大约200个感兴趣的大脑区域（ROI）。然后，在膀胱自然充盈期间进行实时功能磁共振成像（fMRI）扫描，向研究对象展示随机的视觉刺激序列，包括受试者特定的触发图像和中性图像。合并fMRI扫描数据以确定UUI下的关键ROI。结果对10例受试者进行动态功能磁共振成像扫描，其中4例为触发性UUI， 2例为触发性尿急，4例无尿急或渗漏到视觉触发。有UUI病史的受试者在成像期间没有失禁，但所有四名受试者都报告了对他们自己的特定受试者触发图像的紧迫感。发现的ROI为导水管周围灰质、前扣带回、桥脑和前额皮质。我们发现前额叶皮层和边缘系统ROI在受试者特定的UUI视觉触发反应中活动增加。这一信息为进一步探索使用fMRI进行受试者特异性触发图像评估以探索UUI患者的病因提供了原理证明。
Aims Visual triggers have long been recognized clinically to stimulate urgency urinary incontinence (UUI). Current pathophysiology recognizes the importance of cortical control over micturition but there is no standardized methodology for clinicians to study the impact of visual triggers. Our aim was to develop an imaging protocol able to characterize the brain's response to personalized visual triggers, providing a methodology for evaluation on connectivity within the brain in patients with visually triggered urinary urgency. Methods A magnetic resonance imaging (MRI) methodology specific for urologic use was developed. A 3T-Elition Scanner was first used to acquire static structural images. These images were then used to define approximately 200 brain regions of interest (ROI) using a validated brain atlas. Then, real-time functional MRI (fMRI) scans were conducted during natural bladder filling, where study subjects were shown randomized block sequences of visual stimuli comprised of both subject-specific trigger images and neutral images. The fMRI scan data were merged to identify key ROI underlying UUI. Results Dynamic fMRI scans were conducted in 10 subjects, 4 with trigger-induced UUI, 2 with trigger-induced urgency, and 4 with no urgency or leakage to visual triggers. No subjects with UUI history lost continence during imaging, but all four subjects reported sensations of urgency in response to their own subject-specific trigger images. The ROI identified were the periaqueductal gray, anterior cingulate gyrus, pons, and prefrontal cortex. We found increased activity in the prefrontal cortex and limbic system ROI in response to subject-specific visual triggers of UUI. Conclusions This information provides proof of principle for further exploration of subject-specific trigger image evaluation using fMRI to explore causation in patients with UUI.