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  Reliability of supraspinal correlates to lower urinary tract stimulation in healthy participants: A fMRI study

Walter, M., Leitner, L., Michels, L., Liechti, M. D., Freund, P., Kessler, T. M., et al. (2019). Reliability of supraspinal correlates to lower urinary tract stimulation in healthy participants: A fMRI study. NeuroImage: Clinical, 191, 481-492. doi:10.1016/j.neuroimage.2019.02.031.

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Walter, Matthias1, 2, Author
Leitner, Lorenz1, Author
Michels, Lars3, Author
Liechti, Martina D.1, Author
Freund, Patrick4, 5, 6, 7, Author              
Kessler, THomas M.1, Author
Kollias, Spyros3, Author
Mehnert, Ulrich1, Author
1Department of Neuro-Urology, Balgrist University Hospital, Zurich, Switzerland, ou_persistent22              
2International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada, ou_persistent22              
3Institute of Neuroradiology, University Hospital Zurich, Switzerland, ou_persistent22              
4Balgrist Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland, ou_persistent22              
5Department Neurophysics (Weiskopf), MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_2205649              
6Department of Brain Repair & Rehabilitation, University College London, United Kingdom, ou_persistent22              
7Wellcome Trust Centre for Neuroimaging, University College London, United Kingdom, ou_persistent22              


Free keywords: Functional magnetic resonance imaging; Interoception; Lower urinary tract; Reliability; Strong desire to void; Supraspinal control
 Abstract: Previous functional neuroimaging studies provided evidence for a specific supraspinal network involved in lower urinary tract (LUT) control. However, data on the reliability of blood oxygenation level-dependent (BOLD) signal changes during LUT task-related functional magnetic resonance imaging (fMRI) across separate measurements are lacking. Proof of the latter is crucial to evaluate whether fMRI can be used to assess supraspinal responses to LUT treatments. Therefore, we prospectively assessed task-specific supraspinal responses from 20 healthy participants undergoing two fMRI measurements (test-retest) within 5–8 weeks. The fMRI measurements, conducted in a 3T magnetic resonance (MR) scanner, comprised a block design of repetitive bladder filling and drainage using an automated MR-compatible and MR-synchronized infusion-drainage device. Following transurethral catheterization and bladder pre-filling with body warm saline until participants perceived a persistent desire to void (START condition), fMRI was recorded during repetitive blocks (each 15 s) of INFUSION and WITHDRAWAL of 100 mL body warm saline into respectively from the bladder. BOLD signal changes were calculated for INFUSION minus START. In addition to whole brain analysis, we assessed BOLD signal changes within multiple ‘a priori’ region of interest (ROI), i.e. brain areas known to be involved in the LUT control from previous literature. To evaluate reliability of the fMRI results between visits, we applied different types of analyses: coefficient of variation (CV), intraclass correlation coefficient (ICC), Sørensen-Dice index, Bland-Altman method, and block-wise BOLD signal comparison. All participants completed the study without adverse events. The desire to void was rated significantly higher for INFUSION compared to START or WITHDRAWAL at both measurements without any effect of visit. At whole brain level, significant (p < 0.05, cluster corrected, k ≥ 41 voxels) BOLD signal changes were found for the contrast INFUSION compared to START in several brain areas. Overlap of activation maps from both measurements were observed in the orbitofrontal cortex, insula, ventrolateral prefrontal cortex (VLPFC), and inferior parietal lobe. The two highest ICCs, based on a ROI's mean beta weight, were 0.55 (right insular cortex) and 0.47 (VLPFC). Spatial congruency (Sørensen-Dice index) of all voxels within each ROI between measurements was highest in the insular cortex (left 0.55, right 0.44). In addition, the mean beta weight of the right insula and right VLPFC demonstrated the lowest CV and narrowest Bland and Altman 95% limits of agreement. In conclusion, the right insula and right VLPFC were revealed as the two most reliable task-specific ROIs using our automated, MR-synchronized protocol. Achieving high reliability using a viscero-sensory/interoceptive task such as repetitive bladder filling remains challenging and further endeavour is highly warranted to better understand which factors influence fMRI outcomes and finally to assess LUT treatment effects on the supraspinal level.


Language(s): eng - English
 Dates: 2019-02-022018-12-042019-02-132019-02-152019-05-01
 Publication Status: Published in print
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: Peer
 Identifiers: DOI: 10.1016/j.neuroimage.2019.02.031
PMID: 30776530
Other: Epub ahead of print
 Degree: -



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Project name : -
Grant ID : 135774
Funding program : -
Funding organization : Swiss National Science Foundation
Project name : -
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Funding program : -
Funding organization : Swiss Continence Foundation

Source 1

Title: NeuroImage: Clinical
Source Genre: Journal
Publ. Info: Elsevier
Pages: - Volume / Issue: 191 Sequence Number: - Start / End Page: 481 - 492 Identifier: ISSN: 2213-1582
CoNE: https://pure.mpg.de/cone/journals/resource/2213-1582