title: Brain activity on fMRI associated with urinary bladder filling in patients with a complete spinal cord injury.
abstract: Patients with complete spinal cord injury (SCI) may maintain some perception of bladder fullness. The aim of the study was to evaluate brain activation arising from anticipated extraspinal sensory pathways.
  
  
  
  Fourteen patients ages 24-54 years were enrolled, all having experienced a complete SCI (ASIA A) at C7 to T5 an average of 17 months before study entry. Urodynamic equipment was used for repeated bladder filling and detrusor activity evaluation. All functional magnetic resonance imaging measurements were performed using a Siemens Trio 3T scanner with the GRE-EPI sequence (field of view = 192 × 192 mm, voxel 3 × 3 × 3 mm, TR/TE = 3000/30 ms, 45 slices). Nine hundred dynamic scans were acquired over 45 min. Statistical analysis was done in SPM8 using a general linear model. Statistics using t-tests were thresholded at P = 0.001.
  
  
  
  We excluded results from two patients because of activation artifacts. In 8 of 12 patients, significant brain activity was observed during urinary bladder filling. We found significant activation clusters at the nucleus of the solitary tract (NTS) (3/8), parabrachial nucleus (PBN) (4/8), hypothalamus (4/8), thalamus (6/8), amygdala (7/8), insular lobe (5/8), anterior cingulate gyrus (5/8), and prefrontal cortex (8/8). Activations in nuclei involved in afferents likely from the vagal nerve (NTS and PBN) correlated significantly with reported bladder sensations.
  
  
  
  These data suggest that extraspinal sensory pathways may develop following SCI and that vagal nerve may play a role in re-innervation of the urinary bladder. Neurourol. Urodynam. 36:155-159, 2017. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, University Hospital, Ostrava, Czech Republic.|Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Krhut
authors.affiliation: Radiodiagnostis and Interventional Radiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Tintera
authors.affiliation: Spinal Cord Rehabilitation Unit, Rehabilitation Center, Kladruby, Czech Republic.
authors.forename: Karolina
authors.initials: K
authors.lastname: Bilkova
authors.affiliation: Department of Urology, Thomayer Hospital and 1st and 3rd Faculty of Medicine of Charles University, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Holy
authors.affiliation: Department of Urology, Thomayer Hospital and 1st and 3rd Faculty of Medicine of Charles University, Prague, Czech Republic.
authors.forename: Roman
authors.initials: R
authors.lastname: Zachoval
authors.affiliation: Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.|Division of Urology, University of Vermont, Burlington, Vermont.
authors.forename: Peter
authors.initials: P
authors.lastname: Zvara
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Blok
mesh_terms: D000328:Adult; D000344:Afferent Pathways / Q000000981:diagnostic imaging / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016548:Prosencephalon / Q000000981:diagnostic imaging / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D014563:Urodynamics; D014630:Vagus Nerve / Q000000981:diagnostic imaging / Q000503:physiopathology; D055815:Young Adult
keywords: functional magnetic resonance; neurogenic detrusor overactivity; urinary bladder; vagal nerve; visceral afferents