Komesu Yuko M, Ketai Loren H, Mayer Andrew R, Teshiba Terry M, Rogers Rebecca G
University of New Mexico Health Sciences Center, Albuquerque, New Mexico & Mind Research Network Neurodiagnostic Research Facility, Albuquerque, New Mexico.
Female Pelvic Med Reconstr Surg. 2011;17(1):50-54. doi: 10.1097/SPV.0b013e3182065507.
To identify abnormal function of the limbic cortex (LC) in response to urinary urgency among patients with Overactive Bladder (OAB) using brain functional MRI (fMRI) METHODS: 5 OAB subjects and 5 Controls underwent bladder filling and rated urgency sensations while fMRI measured activation in discrete volumes (voxels) within the brain. Changes in brain activation were related to bladder distension and individual subject's rating of urgency via multiple regression analysis. Beta weights from regression equations were converted into percent signal change (PSC) for each voxel and PSC compared to the null hypothesis using T-tests. Significance threshold of P<.05 was applied along with a cluster size threshold of.32 ml (5 voxels). RESULTS: OAB patients showed increased brain activation in LC, specifically the insula (IN) and Anterior Cingulate Gyrus (ACG), associated with increased urgency. Urgency sensations during low volumes were associated with bilateral IN activation in OAB subjects (7,621 voxels right IN, 4,453 voxels left IN, mean beta weights .018 +/- .014 and .014 +/- .011) Minimal activation was present in Controls (790 voxels right IN, beta weight =.010 +/- .007). Urgency sensations during high volumes were associated with bilateral ACG activation in OAB subjects (2,304 voxels right IN, 5,005 voxels left IN, mean beta weights of 005 +/- .003 and 004+/-.003) without activation in Controls. CONCLUSIONS: Urinary urgency in patients with OAB is associated with increased activation of the LC. This activation likely represents abnormal processing of sensory input in brain regions associated with emotional response to discomfort.
使用脑功能磁共振成像（fMRI）识别膀胱过度活动症（OAB）患者在尿急时边缘皮质（LC）的异常功能。方法：5名OAB受试者和5名对照者在膀胱充盈时对尿急感觉进行评分，同时fMRI测量大脑内离散体积（体素）的激活情况。通过多元回归分析，将大脑激活的变化与膀胱扩张及个体受试者的尿急评分相关联。将回归方程的β权重转换为每个体素的百分比信号变化（PSC），并使用t检验将PSC与零假设进行比较。应用P<0.05的显著性阈值以及0.32毫升（5个体素）的簇大小阈值。结果：OAB患者的LC，特别是脑岛（IN）和前扣带回（ACG）的大脑激活增加，与尿急增加相关。低容量时的尿急感觉与OAB受试者双侧IN激活相关（右侧IN 7621个体素，左侧IN 4453个体素，平均β权重分别为0.018±0.014和0.014±0.011），对照者中激活极少（右侧IN 790个体素，β权重=0.010±0.007）。高容量时的尿急感觉与OAB受试者双侧ACG激活相关（右侧IN 2304个体素，左侧IN 5005个体素，平均β权重分别为0.005±0.003和0.004±0.003），对照者无激活。结论：OAB患者的尿急与LC激活增加相关。这种激活可能代表与对不适的情绪反应相关的脑区中感觉输入的异常处理。
