Department of Urology, Houston Methodist Hospital, Houston, Texas, USA.
Houston Methodist Research Institute Translational Imaging Core, Houston, Texas, USA.
Neurourol Urodyn. 2024 Jun;43(5):1230-1237. doi: 10.1002/nau.25461. Epub 2024 Apr 3.
Functional MRI (fMRI) can be employed to assess neuronal activity in the central nervous system. However, investigating the spinal cord using fMRI poses several technical difficulties. Enhancing the fMRI signal intensity in the spinal cord can improve the visualization and analysis of different neural pathways, particularly those involved in bladder function. The bulbocavernosus reflex (BCR) is an excellent method for evaluating the integrity of the sacral spinal cord. Instead of stimulating the glans penis or clitoris, the BCR can be simulated comfortably by tapping the suprapubic region. In this study, we explain the necessity and development of a device to elicit the simulated BCR (sBCR) via suprapubic tapping while conducting an fMRI scan.
The device was successfully tested on a group of 20 healthy individuals. Two stimulation task block protocols were administered (empty vs. full bladder). Each block consisted of 40 s of suprapubic tapping followed by 40 s of rest, and the entire sequence was repeated four times.
Our device can reliably and consistently elicit sBCR noninvasively as demonstrated by electromyographic recording of pelvic muscles and anal winking. Participants did note mild to moderate discomfort and urge to void during the full bladder task.
Our device demonstrates an efficacious approach to elicit sBCR within an MRI bore to assess sacral spinal cord functional activity without generating any significant motion artifacts.
This device can explore the mechanisms and processes controlling urinary, digestive, or sexual function within this region in humans.
功能性磁共振成像（fMRI）可用于评估中枢神经系统的神经元活动。然而，使用 fMRI 研究脊髓存在一些技术难题。增强脊髓的 fMRI 信号强度可以改善不同神经通路的可视化和分析，特别是那些与膀胱功能相关的通路。球海绵体反射（BCR）是评估骶髓完整性的极佳方法。BCR 可以通过轻敲耻骨上方区域来舒适地模拟，而不是刺激阴茎头或阴蒂。在这项研究中，我们解释了在进行 fMRI 扫描时通过耻骨上方敲击引出模拟 BCR（sBCR）的必要性和设备的发展。
该设备已在 20 名健康个体的一组中成功进行了测试。实施了两种刺激任务块方案（空膀胱与满膀胱）。每个块由 40 秒的耻骨上方敲击和 40 秒的休息组成，整个序列重复四次。
我们的设备可以可靠且一致地引出 sBCR，这通过骨盆肌肉和肛门眨眼的肌电图记录得到证明。参与者确实在满膀胱任务期间注意到轻度到中度的不适和排尿冲动。
我们的设备展示了一种有效的方法，可在 MRI 孔内引出 sBCR，以评估骶髓的功能活动，而不会产生任何显著的运动伪影。
该设备可以探索控制该区域内泌尿、消化或性功能的机制和过程。
