Department of Radiology, Sant'Andrea Hospital Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.
Department of Urology, Clinica Madonna Delle Grazie, Velletri, Rome, Italy.
Abdom Radiol (NY). 2022 Feb;47(2):746-756. doi: 10.1007/s00261-021-03362-8. Epub 2021 Dec 6.
Evaluation of male with primary bladder neck obstruction (PBNO) using MRI and MR voiding cystourethrography (MR-VCU) to study both anatomical aspects of bladder neck and urethral lumen.
In this retrospective study 21 male patients (mean age 33 ± 14) with urodynamic diagnosis of PBNO and 5 healthy volunteers ((mean age 28 ± 2) as control group were enrolled. Both patients and control group underwent 1.5 T MRI. Sagittal and oblique coronal Turbo-Spin-Echo T2-weighted scans were performed. Only patients underwent MR voiding cystourethrography (MR-VCU) performed with T1-weighted spoiled 3D gradient-echo sagittal acquisitions. Bladder lumen was filled with contrast-material-enhanced urine. Blinded test by two radiologists was performed to evaluate causes of bladder outlet obstruction evaluating MR-VCU. Anatomical MRI features of both control group and patients were compared in consensus by senior radiologist and urologist using the analysis of variance (ANOVA) test.
MRI allowed evaluation of the bladder neck muscular structures. We found 4 groups of PBNO patients: 52% hypertrophy of posterior lip of bladder sphincter; 20% asymmetry of lateral portion of bladder sphincter; 14% bladder neck cyst; 14% showed normal aspect of bladder neck. Comparison between the control group and first and second PBNO groups was considered statistically significant (p < 0.05) with diagnostic accuracy of 87%. Only 13 patients (61%) were able to perform MR-VCU and radiologists always made the diagnosis of PBNO.
MRI together with MR-VCU provides useful anatomical and functional information in the study of bladder neck and urethral lumen. These preliminary results suggest that MRI could substitute for standard cystourethrogram in patients with PBNO.
使用 MRI 和 MR 排尿性膀胱尿道造影（MR-VCU）评估男性原发性膀胱颈梗阻（PBNO），以研究膀胱颈和尿道管腔的解剖学方面。
在这项回顾性研究中，纳入了 21 名经尿动力学诊断为 PBNO 的男性患者（平均年龄 33±14 岁）和 5 名健康志愿者（平均年龄 28±2 岁）作为对照组。所有患者和对照组均进行了 1.5T MRI 检查。进行了矢状面和斜冠状面 Turbo-Spin-Echo T2 加权扫描。仅患者行 MR 排尿性膀胱尿道造影（MR-VCU），采用 T1 加权扰相 3D 梯度回波矢状面采集。膀胱管腔用对比增强尿液充盈。由两位放射科医生进行盲法测试，以评估导致膀胱出口梗阻的原因，并通过分析方差（ANOVA）检验对 MR-VCU 进行评估。高级放射科医生和泌尿科医生通过共识对对照组和患者的 MRI 解剖学特征进行比较。
MRI 可评估膀胱颈的肌肉结构。我们发现 4 组 PBNO 患者：52%的膀胱颈括约肌后唇肥厚；20%的膀胱颈括约肌外侧部分不对称；14%的膀胱颈囊肿；14%的膀胱颈表现正常。对照组与第一和第二组 PBNO 患者之间的比较具有统计学意义（p<0.05），诊断准确率为 87%。只有 13 名患者（61%）能够进行 MR-VCU，放射科医生总是做出 PBNO 的诊断。
MRI 结合 MR-VCU 可提供膀胱颈和尿道管腔的有用解剖学和功能信息。这些初步结果表明，MRI 可以替代 PBNO 患者的标准排泄性膀胱尿道造影。
