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Towner RA, Wisniewski AB, Wu DH, Van Gordon SB, Smith N, North JC, McElhaney R, Aston CE, Shobeiri SA, Kropp BP, Greenwood-Van Meerveld B, Hurst RE. A Feasibility Study to Determine Whether Clinical Contrast Enhanced Magnetic Resonance Imaging can Detect Increased Bladder Permeability in Patients with Interstitial Cystitis. J Urol 2016; 195:631-8. [PMID: 26307161 PMCID: PMC4760854 DOI: 10.1016/j.juro.2015.08.077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Interstitial cystitis/bladder pain syndrome is a bladder pain disorder associated with voiding symptomatology and other systemic chronic pain disorders. Currently diagnosing interstitial cystitis/bladder pain syndrome is complicated as patients present with a wide range of symptoms, physical examination findings and clinical test responses. One hypothesis is that interstitial cystitis symptoms arise from increased bladder permeability to urine solutes. This study establishes the feasibility of using contrast enhanced magnetic resonance imaging to quantify bladder permeability in patients with interstitial cystitis. MATERIALS AND METHODS Permeability alterations in bladder urothelium were assessed by intravesical administration of the magnetic resonance imaging contrast agent Gd-DTPA (Gd-diethylenetriaminepentaacetic acid) in a small cohort of patients. Magnetic resonance imaging signal intensity in patient and control bladders was compared regionally and for entire bladders. RESULTS Quantitative assessment of magnetic resonance imaging signal intensity indicated a significant increase in signal intensity in anterior bladder regions compared to posterior regions in patients with interstitial cystitis (p <0.01) and significant increases in signal intensity in anterior bladder regions (p <0.001). Kurtosis (shape of probability distribution) and skewness (measure of probability distribution asymmetry) were associated with contrast enhancement in total bladders in patients with interstitial cystitis vs controls (p <0.05). Regarding symptomatology interstitial cystitis cases differed significantly from controls on the SF-36®, PUF (Pelvic Pain and Urgency/Frequency) and ICPI (Interstitial Cystitis Problem Index) questionnaires with no overlap in the score range in each group. ICSI (Interstitial Cystitis Symptom Index) differed significantly but with a slight overlap in the range of scores. CONCLUSIONS Data suggest that contrast enhanced magnetic resonance imaging provides an objective, quantifiable measurement of bladder permeability that could be used to stratify bladder pain patients and monitor therapy.
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Affiliation(s)
- Rheal A Towner
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
| | - Amy B Wisniewski
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Dee H Wu
- Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Samuel B Van Gordon
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Nataliya Smith
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Justin C North
- Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Rayburt McElhaney
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Christopher E Aston
- Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Bradley P Kropp
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Robert E Hurst
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; Department of Biochemistry and Molecular Biology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
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