Salazar Betsy H, Mazeaud Charles M, Hoffman Kristopher A, Stampas Argyrios, Khavari Rose
Department of Urology, Houston Methodist Hospital, Houston, Texas.
Department of Urology, IADI-UL-INSERM (U1254), Nancy University Hospital, Nancy, France.
Neurourol Urodyn. 2025 Jun;44(5):1203-1210. doi: 10.1002/nau.70059. Epub 2025 Apr 30.
Although there have been significant advancements in functional magnetic resonance imaging (fMRI) studies that have enhanced our understanding of brain control over bladder function in humans, a notable gap still exists in exploring spinal cord involvement in real-time. The objective of this study was to develop and validate an fMRI protocol to assess innate spinal cord activity in humans within regions associated with bladder function.
Twenty healthy adult participants 9 men, 11 women underwent functional magnetic resonance imaging (fMRI) of the spinal cord during implementation of a natural bladder filling protocol and simulated bulbocavernosus reflex (sBCR). Anatomical images were obtained, followed by resting-state and task-based fMRI assessments during both full and empty bladder states. Functional spinal neuroimaging data were analyzed using a custom pipeline comprised of Spinal Cord Toolbox, FSL, and MATLAB scripts for preprocessing and analysis.
Our preliminary findings revealed activation in 15 participants (7 men, 8 women), exhibiting diverse patterns of activity across the T10-S5 neuronal segments during task-fMRI sessions conducted with both empty and full bladder conditions during sBCR. The identified activated regions included sympathetic (T10-L2), parasympathetic (S2-S4), and somatic nuclei (S2-S4), previously implicated in facilitating lower urinary tract (LUT) control. Notably, our preliminary findings suggest that sex differences may influence these activation patterns, though further investigation and second-level analysis are warranted to confirm this observation.
Although preliminary, our findings demonstrate, for the first time, the efficacy of our fMRI protocol in detecting task-induced activity in the lumbosacral spinal cord, underscoring our capability to precisely target specific regions responsible for regulating LUT function.
尽管功能磁共振成像（fMRI）研究取得了重大进展，增进了我们对人类大脑对膀胱功能控制的理解，但在实时探索脊髓参与方面仍存在显著差距。本研究的目的是开发并验证一种fMRI方案，以评估与膀胱功能相关区域内人类的固有脊髓活动。
20名健康成年参与者（9名男性，11名女性）在实施自然膀胱充盈方案和模拟球海绵体反射（sBCR）期间接受脊髓功能磁共振成像（fMRI）检查。先获取解剖图像，然后在膀胱充盈和排空状态下进行静息态和基于任务的fMRI评估。使用由脊髓工具箱、FSL和MATLAB脚本组成的自定义管道对功能性脊髓神经成像数据进行预处理和分析。
我们的初步发现显示，15名参与者（7名男性，8名女性）出现激活，在sBCR期间膀胱排空和充盈状态下的任务fMRI检查中，T10 - S5神经元节段呈现出不同的活动模式。确定的激活区域包括交感神经（T10 - L2）、副交感神经（S2 - S4）和躯体神经核（S2 - S4），这些区域先前被认为有助于下尿路（LUT）控制。值得注意的是，我们的初步发现表明性别差异可能会影响这些激活模式，不过需要进一步研究和二级分析来证实这一观察结果。
尽管是初步研究，但我们的发现首次证明了我们的fMRI方案在检测腰骶部脊髓任务诱导活动方面的有效性，强调了我们精确靶向负责调节LUT功能的特定区域的能力。
