MR imaging-based Quantitative Analysis of Bladder Anatomy and Function in BPH/LUTS

基于 MR 成像的 BPH/LUTS 膀胱解剖和功能定量分析

• 批准号: 10298527
• 负责人: Alejandro Roldan
• 金额: $ 22.66万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-08 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10298527
• 关键词: Address; Affect; Aging; Anatomy; Attention; Benign Prostatic Hypertrophy; Bladder; Blood flow; Cardiovascular Physiology; Clinical; Cluster Analysis; Computer Models; Counseling; Decision Making; Excision; Exhibits; Goals; Hospitals; Hypertrophy; Image; Impairment; Knowledge; Lower urinary tract; Magnetic Resonance Imaging; Measurement; Methods; Muscle; Obstruction; Operative Surgical Procedures; Patients; Performance; Physicians; Postoperative Period; Prostate; Protocols documentation; Public Health; Publishing; Research; Resistance; Role; Selection for Treatments; Stream; Symptoms; Techniques; Testing; Thick; Tissues; Ultrasonography; Urethra; Urine; Urodynamics; Validation; anatomic imaging; base; clinical implementation; cohort; detrusor muscle; indexing; individual patient; lower urinary tract symptoms; men; novel; personalized medicine; precision medicine; pressure; prostate transurethral resection; real-time images; regional difference; response; surgery outcome; urinary; young man

ABSTRACT Diminished bladder contractility is a critical but poorly addressed factor in men with benign prostatic hyperplasia and lower urinary tract symptoms (BPH/LUTS). We propose to test the hypothesis that MRI can be used to identify and quantify specific changes in bladder anatomy and voiding function in men with BPH/LUTS. BPH surgery involves removal of enlarged peri-urethral prostate tissue to reduce resistance to urine flow during the voiding effort. However, diminished bladder contractility is present in many patients with BPH/LUTS and greatly influences the degree of improvement of flow and emptying postoperatively, independent of bladder outlet obstruction. In our recently published studies, we used MRI based imaging to quantify metrics of bladder and prostate anatomy, regional differences in bladder wall thickness, and blood flow. Further, we showed that real-time imaging during voiding combined with computational modeling can quantify metrics of bladder contraction such as the rate of detrusor muscle shortening and urinary flow dynamics parameters such as velocity, pressure, and vorticity. We will use these to compare bladder voiding function in healthy young men and men with BPH/LUTS. We will identify changes in bladder anatomy and the specific mechanisms that impair voiding function and delineate the relative contribution of each mechanism to reduced urine flow and impaired bladder emptying. This MR image-based strategy employs techniques that have been used extensively to assess cardiovascular function. The novelty of the proposal is the adaptation of these techniques to study the bladder. To our knowledge, nothing like it has ever been done. The scientific impact is the implementation and validation of MRI to achieve comprehensive assessment of lower urinary tract anatomy and function in healthy young men and men with BPH/LUTS. Metrics of bladder anatomy and function obtained by MRI will be validated throughout the proposal with measurement of bladder wall thickness determined by ultrasound and the canonical metrics of pressure, flow, bladder outlet obstruction index (BOOI), and bladder contractility index (BCI) determined by multi-channel urodynamics. Validation of the fidelity of our MRI techniques is critical for clinical implementation. These MRI protocols can be implemented using standard MRI machines available in most hospitals. The clinical impact is that these methods and validated metrics of normal and impaired bladder function provide physicians with a single, non-invasive test that simultaneously delineates both anatomy and function of the lower urinary tract. This will enable a personalized medicine approach to counseling and selection of treatment based upon a clear understanding of the specific anatomic features and functional changes that impair voiding in individual patients with BPH/LUTS.

抽象的 膀胱收缩性降低是良性前列腺增生和尿路症状降低（BPH/LUTS）的男性中关键但较差的因素。我们建议检验以下假设：MRI可用于识别和量化BPH/LUTS男性中膀胱解剖结构和空隙功能的特定变化。 BPH手术涉及去除尿道周围的前列腺组织增大，以降低空隙努力期间对尿液的耐药性。但是，许多BPH/LUTS患者存在膀胱收缩性降低，并且极大地影响了流动的改善程度和术后排空，而与膀胱出口障碍无关。在我们最近发表的研究中，我们使用基于MRI的成像来量化膀胱和前列腺解剖结构的指标，膀胱壁厚度的区域差异以及血流。此外，我们表明，在空隙过程中与计算建模相结合的实时成像可以量化膀胱收缩的指标，例如逼尿肌缩短的速率和尿流动动力学参数，例如速度，压力和涡度。我们将使用这些来比较具有BPH/LUTS健康的年轻人和男性中的膀胱空隙功能。我们将确定膀胱解剖结构的变化以及损害空隙功能的特定机制，并描述每种机制对减少尿液流量减少和膀胱排空受损的相对贡献。基于MR图像的策略采用了已广泛用于评估心血管功能的技术。该提案的新颖性是这些技术研究膀胱的适应。据我们所知，从来没有做过。科学的影响是对MRI的实施和验证，以对患有BPH/LUTS健康的健康年轻人和男性进行较低的尿路解剖结构进行全面评估。在整个提案中，通过超声测量膀胱壁厚度和由压力，流动，流量，流量，膀胱出口障碍物指数（BOOI）和膀胱接合度指数（BCI）确定的膀胱壁厚度（BCI）确定的膀胱壁厚度（BCI）确定的膀胱壁厚度（BCI）确定的膀胱壁厚度（BCI）确定的膀胱壁厚度，将在整个建议中验证膀胱解剖结构和功能的指标。验证我们的MRI技术的保真度对于临床实施至关重要。这些MRI协议可以使用大多数医院可用的标准MRI机器实施。临床影响是，这些方法和验证的正常和受损膀胱功能的指标为医生提供了单一的非侵入性测试，同时描述了较低尿路的解剖结构和功能。这将基于对特定的解剖特征和功能变化的清晰了解，从而使个性化医学方法可以削弱BPH/LUTS患者缺失的功能变化。