Evaluation of Urinary Sphincter Function by Rapid Magnetic Resonance Diffusion Tensor Imaging
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: This study aimed to assess the feasibility of a rapid diffusion tensor imaging (DTI) for evaluation of the female urinary sphincter function based on differentiation between rest and muscle contraction. Methods: Magnetic resonance imaging (MRI) of the lower pelvis was performed at 3 Tesla in 10 healthy female volunteers (21–36 years; body mass index, 20.8±3.6 kg/m2 ) between June and July 2019. High-resolution T1- and T2-weighted images were acquired for anatomical reference, and following DTI performed in 4 experiment phases: twice during rest (denoted rest- 1, rest-2) and contraction (contraction-1, contraction-2). Manual segmentation of the urinary sphincter and the levator ani muscles were performed by 2 independent readers. Mean diffusivity (MD) and fractional anisotropy (FA) values derived from DTI volumes were compared in search for significant differences between the experiment phases. Interreader agreement was assessed by intraclass correlation coefficient (ICC). Results: Kruskal-Wallis test showed significant differences between MD values among all the experiment phases, by both independent readers (1st: X2 [3,76]=17.16, P<0.001 and 2nd: X2 [3,76]=15.88, P<0.01). Post hoc analysis revealed differences in MD values by both readers between: rest-1 vs. contraction-1 (least P<0.05), rest-1 vs. contraction-2 (P<0.01), rest-2 vs. contraction-1 (P<0.03), rest-2 vs. contraction-2 (P=0.02) with overall mean ‘rest’ to ‘contraction’ ΔMD=20.6%. No MD or FA differences were found between rest-1 vs. rest-2 and contraction-1 vs. contraction-2 among all the experiment phases, and interreader agreement was ICC=0.85 (MD) and ICC=0.79 (FA). Conclusions: Rapid DTI might prospectively act as a supporting tool for the evaluation of female pelvic floor muscle function, and incontinence assessment.
Abstract
Purpose: This study aimed to assess the feasibility of a rapid diffusion tensor imaging (DTI) for evaluation of the female urinary sphincter function based on differentiation between rest and muscle contraction. Methods: Magnetic resonance imaging (MRI) of the lower pelvis was performed at 3 Tesla in 10 healthy female volunteers (21–36 years; body mass index, 20.8±3.6 kg/m2 ) between June and July 2019. High-resolution T1- and T2-weighted images were acquired for anatomical reference, and following DTI performed in 4 experiment phases: twice during rest (denoted rest- 1, rest-2) and contraction (contraction-1, contraction-2). Manual segmentation of the urinary sphincter and the levator ani muscles were performed by 2 independent readers. Mean diffusivity (MD) and fractional anisotropy (FA) values derived from DTI volumes were compared in search for significant differences between the experiment phases. Interreader agreement was assessed by intraclass correlation coefficient (ICC). Results: Kruskal-Wallis test showed significant differences between MD values among all the experiment phases, by both independent readers (1st: X2 [3,76]=17.16, P<0.001 and 2nd: X2 [3,76]=15.88, P<0.01). Post hoc analysis revealed differences in MD values by both readers between: rest-1 vs. contraction-1 (least P<0.05), rest-1 vs. contraction-2 (P<0.01), rest-2 vs. contraction-1 (P<0.03), rest-2 vs. contraction-2 (P=0.02) with overall mean ‘rest’ to ‘contraction’ ΔMD=20.6%. No MD or FA differences were found between rest-1 vs. rest-2 and contraction-1 vs. contraction-2 among all the experiment phases, and interreader agreement was ICC=0.85 (MD) and ICC=0.79 (FA). Conclusions: Rapid DTI might prospectively act as a supporting tool for the evaluation of female pelvic floor muscle function, and incontinence assessment.
참고문헌 (28)
- Minassian VA, "Urinary incontinence in women : variation in prevalence estimates and risk factors", Obstet Gynecol, 111(2 Pt 1), pp.324~331 (2008)
- Irwin DE, "Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction", BJU Int, 108, pp.1132~1138 (2011)
- Osman NI, "Evaluation and classification of stress urinary incontinence : current concepts and future directions", Eur Urol Focus, 2, pp.238~244 (2016)
- Lukacz ES, "Urinary incontinence in women : a review", JAMA, 318, pp.1592~1604 (2017)
- Rovner ES, "Treatment options for stress urinary incontinence", Rev Urol, 6(Suppl 3), pp.S29~S47 (2004)
- Garriboli M, "Regenerative medicine in urology", Eur J Pediatr Surg, 24, pp.227~236 (2014)
- Hart ML, "Cell therapy for stress urinary incontinence", Tissue Eng Part B Rev, 21, pp.365~376 (2015)
- Eberli D, "Muscle precursor cells for the restoration of irreversibly damaged sphincter function", Cell Transplant, 21, pp.2089~2098 (2012)
- Flusberg M, "Multimodality imaging of pelvic floor anatomy", Abdom Radiol (NY) (2019)[DOI]
- Sekhar A, "Imaging of the female urethra", Abdom Radiol (NY) (2019)[DOI]
- Garcia del Salto L, "MR imaging-based assessment of the female pelvic floor", Radiographics, 34, pp.1417~1439 (2014)
- Basser P, "Recollections about our 1996 JMR paper on diffusion anisotropy", J Magn Reson, 213, pp.571~572 (2011)
- Le Bihan D, "Imaging of diffusion and microcirculation with gradient sensitization: design, strategy, and significance", J Magn Reson Imaging, 1, pp.7~28 (1991)
- Basser PJ, "Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI", J Magn Reson, 213, pp.560~570 (2011)
- Dong Q, "Clinical applications of diffusion tensor imaging", J Magn Reson Imaging, 19, pp.6~18 (2004)
- Budzik JF, "In vivo MR tractography of thigh muscles using diffusion imaging : initial results", Eur Radiol, 17, pp.3079~3085 (2007)
- Khalil C, "Tractography of peripheral nerves and skeletal muscles", Eur J Radiol, 76, pp.391~397 (2010)
- Zijta FM, "Feasibility of diffusion tensor imaging(DTI)with fibre tractography of the normal female pelvic floor", Eur Radiol, 21, pp.1243~1249 (2011)
- Zijta FM, "Diffusion tensor imaging and fiber tractography for the visualization of the female pelvic floor", Clin Anat, 26, pp.110~114 (2013)
- Zifan A, "Connectivity of the superficial muscles of the human perineum : a diffusion tensor imaging-based global tractography study", Sci Rep, 8, pp.17867~ (2018)
- Rousset P, "In vivo visualization of the levator ani muscle subdivisions using MR fiber tractography with diffusion tensor imaging", J Anat, 221, pp.221~228 (2012)
- Baur AD, "Influence of fractional anisotropy thresholds on diffusion tensor imaging tractography of the periprostatic neurovascular bundle and selected pelvic tissues : do visualized tracts really represent nerves", Acta Radiol, 58, pp.472~480 (2017)
- Sinha S, "Exploration of male urethral sphincter complex using diffusion tensor imaging(DTI)-based fiber-tracking", J Magn Reson Imaging, 48, pp.1002~1011 (2018)
- Hatakenaka M, "Effect of passive muscle length change on apparent diffusion coefficient : detection with clinical MR imaging", Magn Reson Med Sci, 7, pp.59~63 (2008)
- Hatakenaka M, "Alteration of proton diffusivity associated with passive muscle extension and contraction", J Magn Reson Imaging, 27, pp.932~937 (2008)
- Schwenzer NF, "Diffusion tensor imaging of the human calf muscle : distinct changes in fractional anisotropy and mean diffusion due to passive muscle shortening and stretching", NMR Biomed, 22, pp.1047~1053 (2009)
- Damon BM, "Effects of image noise in muscle diffusion tensor(DT)-MRI assessed using numerical simulations", Magn Reson Med, 60, pp.934~944 (2008)
- Polders DL, "Signal to noise ratio and uncertainty in diffusion tensor imaging at 1.5, 3.0, and 7.0 Tesla", J Magn Reson Imaging, 33, pp.1456~1463 (2011)