Nardos Rahel, Karstens Lisa, Carpenter Samuel, Aykes Kamari, Krisky Christine, Stevens Corrine, Gregory W Thomas, Fair Damien A
Division of Female Pelvic Medicine and Reconstructive Surgery, Oregon Health & Science University, Portland, Oregon.
Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon.
Neurourol Urodyn. 2016 Jun;35(5):564-73. doi: 10.1002/nau.22767. Epub 2015 May 1.
To identify atypical brain functional connectivity in women with UUI and detrusor overactivity (DO) and to predict the presence/severity of UUI in individual women using connectivity features.
This is a cross-sectional study comparing brain functional connectivity in women with and without UUI. Validated symptom/quality of life questionnaires were used for phenotyping. Participants are females between ages 40 and 85 with daily UUI with DO (Cases, N = 16) and without UUI (Controls, N = 24). Functional MRI and Resting state connectivity MRI were obtained at empty/ full bladder. Multivariate pattern analysis (MVPA) was used to predict the presence and severity of UUI from connectivity data.
There are significant differences in brain activation between cases and controls in eighteen brain regions irrespective of empty or full bladder. These include regions involved in attention (inferior partietal), decision making (inferior and superior frontal gyrus), primary motor and sensory (precentral and postcentral gyrus) functions. Women with UUI showed no change in connectivity with bladder filling in regions involved in interoception (insula), integration of afferent function (anterior cingulate), and decision making (middle frontal). MVPA of connectivity data showed robust classification of an individual woman as case or control (89% sensitivity, 83% specificity). Six connectivity features accurately predicted disease severity (R(2) = 0.81).
We identified two mechanisms of abnormal bladder control, one involving atypical activation of brain regions, and another atypical functional integration across sensory, emotional, cognitive and motor regions. Connectivity information is robust enough to classify an individual as having UUI or not and to predict symptom severity. Neurourol. Urodynam. 35:564-573, 2016. © 2015 Wiley Periodicals, Inc.
识别患有急迫性尿失禁（UUI）和逼尿肌过度活动（DO）的女性的非典型脑功能连接，并使用连接特征预测个体女性中UUI的存在/严重程度。
这是一项横断面研究，比较有和没有UUI的女性的脑功能连接。使用经过验证的症状/生活质量问卷进行表型分析。参与者为40至85岁的女性，其中每日有DO的UUI患者（病例组，N = 16）和无UUI的女性（对照组，N = 24）。在膀胱空虚/充盈状态下进行功能磁共振成像和静息态连接磁共振成像。使用多变量模式分析（MVPA）从连接数据预测UUI的存在和严重程度。
无论膀胱空虚或充盈，病例组和对照组在18个脑区的脑激活存在显著差异。这些区域包括参与注意力（顶下小叶）、决策（额下回和额上回）、初级运动和感觉（中央前回和中央后回）功能的区域。患有UUI的女性在涉及内感受（岛叶）、传入功能整合（前扣带回）和决策（额中回）的区域中，与膀胱充盈相关的连接没有变化。连接数据的MVPA显示，将个体女性准确分类为病例或对照的能力很强（敏感性89%，特异性83%）。六个连接特征准确预测了疾病严重程度（R(2) = 0.81）。
我们确定了膀胱控制异常的两种机制，一种涉及脑区的非典型激活，另一种涉及感觉、情感、认知和运动区域之间的非典型功能整合。连接信息强大到足以将个体分类为患有或未患有UUI，并预测症状严重程度。《神经泌尿学与尿动力学》35:564 - 573，2016年。© 2015威利期刊公司。
