title: A Feasibility Study to Determine Whether Clinical Contrast Enhanced Magnetic Resonance Imaging can Detect Increased Bladder Permeability in Patients with Interstitial Cystitis.
abstract: OBJECTIVE
  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.
  
  
  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.
authors: 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. Electronic address: Rheal-Towner@omrf.org.
authors: Rheal A
authors: RA
authors: Towner
authors: Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Amy B
authors: AB
authors: Wisniewski
authors: Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Dee H
authors: DH
authors: Wu
authors: Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Samuel B
authors: SB
authors: Van Gordon
authors: Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Nataliya
authors: N
authors: Smith
authors: Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Justin C
authors: JC
authors: North
authors: Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Rayburt
authors: R
authors: McElhaney
authors: Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Christopher E
authors: CE
authors: Aston
authors: Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: S Abbas
authors: SA
authors: Shobeiri
authors: Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Bradley P
authors: BP
authors: Kropp
authors: Department of Physiology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Beverley
authors: B
authors: Greenwood-Van Meerveld
authors: 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.
authors: Robert E
authors: RE
authors: Hurst
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003287:Contrast Media / Q000493:pharmacokinetics*; D018856:Cystitis, Interstitial / Q000175:diagnosis* / Q000378:metabolism*; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA / Q000493:pharmacokinetics*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010539:Permeability; D001743:Urinary Bladder / Q000378:metabolism*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: cystitis; interstitial; magnetic resonance imaging; permeability; questionnaires; urinary bladder