Abreu-Mendes Pedro, Dias Diogo, Magno Francisca, Silva Guilherme, Rodrigues-Fonseca José, Dinis Paulo, Cruz Francisco, Pinto Rui Almeida
Department of Urology, Centro Hospitalar e Universitário de São João, Porto, Portugal.
Department of Surgery and Physiology, University of Porto, Faculty of Medicine, Porto, Portugal.
Urol Res Pract. 2024 Jan 24;50(1):53-57. doi: 10.5152/tud.2024.23209.
Bladder pain syndrome/Interstitial cystitis (BPS/IC) is characterized by increased activity in bladder afferent pathways, recruitment of silent nociceptive neurons, and sensitization of the brain areas responsible for pain amplification. Default mode network (DMN) is a set of regions activated during the resting state, which reflect the brain's intrinsic activity. Conversely, the sensorimotor network (SMN) plays a key role in structural neuroplasticity. This study aimed to evaluate DMN and SMN activity in BPS/IC patients, both with and without bladder noxious stimulus, using functional brain magnetic resonance imaging (MRI). Six BPS/IC female patients underwent 3 Tesla fMRI brain scanners. Acquisitions consisted of 10-minute blood oxygen level-dependent echo-planar imaging. The first acquisition was with an empty bladder, painless, and the second was with suprapubic pain. Data were processed using the independent component analysis method with the MELODIC tool from the functional brain MRI of the Brain Software Library (FSL). A semi-quantitative analysis was performed afterward. The patients' age was 42.6 ± 5 years, pain intensity was 7 ± 0.7 (0-10), day and night frequency were 9.2 ± 2.2 and 2.8 ± 1.0, and maximal bladder capacity was 260 ± 54 mL. One patient was unable to complete the study. All patients showed a comparable DMN activation in both empty and full bladder states, and all presented high SMN activation whether the bladder was empty or full. The activation of DMN at both bladder states, empty and full, and constant SMN activation without and with pain supports the role of these networks in BPS/IC. Similar findings have been reported in other chronic pain syndromes.
膀胱疼痛综合征/间质性膀胱炎（BPS/IC）的特征是膀胱传入通路活动增加、沉默伤害性神经元的募集以及负责疼痛放大的脑区敏化。默认模式网络（DMN）是一组在静息状态下被激活的区域，反映大脑的内在活动。相反，感觉运动网络（SMN）在结构神经可塑性中起关键作用。本研究旨在使用功能性脑磁共振成像（MRI）评估有无膀胱有害刺激的BPS/IC患者的DMN和SMN活动。六名BPS/IC女性患者接受了3特斯拉功能磁共振成像脑扫描仪检查。采集包括10分钟的血氧水平依赖回波平面成像。第一次采集时膀胱为空，无痛，第二次采集时伴有耻骨上疼痛。使用来自脑软件库（FSL）的功能性脑MRI的MELODIC工具通过独立成分分析方法处理数据。随后进行了半定量分析。患者年龄为42.6±5岁，疼痛强度为7±0.7（0-10），白天和夜间排尿频率分别为9.2±2.2和2.8±1.0，最大膀胱容量为260±54毫升。一名患者无法完成研究。所有患者在膀胱空虚和充盈状态下均表现出相当的DMN激活，并且无论膀胱空虚还是充盈，所有患者均表现出较高的SMN激活。膀胱空虚和充盈两种状态下的DMN激活以及有无疼痛时持续的SMN激活支持了这些网络在BPS/IC中的作用。在其他慢性疼痛综合征中也报道了类似的发现。
