Interstitial cystitis/bladder pain syndrome (IC/BPS) is a bladder pain disorder associated with voiding symptomatology and other systemic chronic pain disorders. Currently diagnosis of IC/BPS is complicated, as patients present with wide ranges of symptoms, physical examination findings, and clinical test responses.
One hypothesis is that IC symptoms arise from increased bladder permeability to urine solutes. This study established the feasibility of using contrast-enhanced magnetic resonance imaging (CE-MRI) to quantify bladder permeability in IC patients.
Permeability alterations in bladder urothelium were assessed with intravesical administration of a MRI contrast agent (Gd-DTPA) in a small cohort of patients. MRI signal intensities (SI) in IC patient and control bladders were compared regionally and for entire bladders.
Quantitative assessment of MRI SI indicated a significant increase in SI within anterior bladder regions (p<0.01) compared to posterior regions in IC patients, and significant increases in SI within anterior bladder regions (p<0.001) and kurtosis (descriptor of shape of probability distribution) and skewness (measure of asymmetry of probability distribution) associated with contrast enhancement in total bladders (p<0.05) for IC patients compared to controls. Regarding symptomatology, IC cases differed significantly from controls for the SF-36, PPUF and ICPI questionnaires with no overlap in range of scores for each group, and were significantly different for ICSI but with a slight overlap in range of scores.
The data suggests that CE-MRI provides an objective, quantifiable measurement of bladder permeability that could be used to stratify bladder pain patients and monitor therapy.
The Journal of urology 2015 Aug 22 [Epub ahead of print]
Rheal A Towner, Amy B Wisniewski, Dee H Wu, Samuel B Van Gordon, Nataliya Smith, Justin C North, Rayburt McElhaney, Christopher E Aston, S Abbas Shobeiri, Bradley P Kropp, Beverley Greenwood-Van Meerveld, Robert E Hurst
Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; Stephensen Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA Electronic address: Rheal-Towner@omrf org , Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA , Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA , Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA , Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA , Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA , Stephensen Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA , Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA , Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA , Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA , Department of Physiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA , Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA; Department of Biochemistry and Molecular Biology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA; Stephensen Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA