Exploration of male urethral sphincter complex using diffusion tensor imaging (DTI)-based fiber-tracking.
Exploration of male urethral sphincter complex using diffusion tensor imaging (DTI)-based fiber-tracking.
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DOI：
10.1002/jmri.26017
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发表时间：
2018-10
期刊：
影响因子：
--
通讯作者：
Rajasekaran M
中科院分区：
文献类型：
--
作者：
Sinha S;Sinha U;Malis V;Bhargava V;Sakamoto K;Rajasekaran M
尿失禁是一个主要的临床问题，主要是由于年龄相关的括约肌退行性变化。然而，正常男性括约肌的精确解剖尚未建立。扩散张量成像可以提供一个独特的洞察肌肉的微观结构和纤维结构。目的：应用磁共振扩散张量成像（DT-MRI）研究尿道括约肌与排尿功能的关系。前瞻性队列研究11例正常男性受试者（平均年龄：25.4岁）; 2例受试者在3个单独的阶段进行扫描，以评估再现性。3 T;使用弥散加权自旋回波平面序列。对弥散张量参数包括各向异性分数（FA）、第一、第二和第三特征值（λ1、λ2和λ3）、表观弥散系数（ADC）和径向弥散系数（RD）进行统计学分析，同时对跟踪的肌纤维进行视觉评估。DTI指数的区域差异（括约肌和尿道纵肌）通过单因素方差分析（ANOVA）进行评估。Tukey事后检验用于识别肌肉区域之间的显著差异。两个括约肌，一个近端靠近膀胱底部，对应于膀胱括约肌，另一个远端到前列腺的末端，对应于横纹肌括约肌，周围的中央尿道肌纤维束被清楚地确定。近端括约肌的FA值高于尿道中央肌和远端括约肌，λ3值低于尿道中央肌和远端括约肌（p<0.05）。DTI指数的平均变异系数范围为5- 12%。由于已知DTI值反映了潜在的组织微结构，因此在尿道复合体的肌肉之间识别的DTI指数的显著差异可能潜在地由组织微结构的差异引起，而组织微结构的差异又可能与括约肌和其他肌肉的特定功能相关。
Urinary incontinence is a major clinical problem arising primarily from age-related degenerative changes to the sphincter muscles. However, the precise anatomy of the normal male sphincter muscles has yet to be established. Diffusion tensor imaging may offer a unique insight into muscle microstructure and fiber architecture. To explore the anatomy of the urethral sphincter muscles pertinent to urinary continence function using diffusion tensor MR imaging (DT-MRI). Prospective cohort study 11 normal male subjects (mean age: 25.4 years); two subjects were scanned in three separate sessions to assess reproducibility. 3T; using a diffusion weighted spin echo planar sequence. Diffusion tensor parameters including Fractional Anisotropy (FA), primary (λ1), secondary (λ2) and tertiary (λ3) eigenvalues, Apparent Diffusion Coefficient (ADC) and Radial diffusivity (RD) were analyzed statistically while tracked muscle fibers were assessed visually. Regional differences (sphincters and longitudinal muscle of the urethra) in the DTI indices were assessed by one-way analyses of variance (ANOVA). A Tukey post hoc test was used to identify significant differences between muscle regions. Two sphincter muscles, one proximal near the base of the bladder, corresponding to the lisso-sphincter and the other distal to the end of the prostate corresponding to the rhabdo-sphincter, surrounding a central urethral muscle fiber bundle were clearly identified. FA was higher and λ3 lower in the proximal sphincter muscle compared to the central urethral muscle and the distal sphincter (p<0.05). The average Coefficient of Variation ranged from 5- 12% for the DTI indices. Since DTI values are known to reflect underlying tissue microarchitecture, significant differences in DTI indices identified here between the muscles of the urethral complex may potentially arise from differences in tissue microarchitecture that may in turn be related to the specific function of the sphincter and other muscles.
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作者：
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