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 对于患有良性前列腺增生和下尿路症状 (BPH/LUTS) 的男性来说，膀胱收缩力减弱是一个关键但未得到很好解决的因素。我们建议检验以下假设：MRI 可用于识别和量化 BPH/LUTS 男性膀胱解剖结构和排尿功能的具体变化。 BPH 手术涉及切除增大的尿道周围前列腺组织，以减少排尿过程中对尿流的阻力。然而，许多 BPH/LUTS 患者存在膀胱收缩力减弱的情况，并且极大地影响术后流量和排空的改善程度，与膀胱出口阻塞无关。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、膀胱壁厚度的区域差异和血流量的指标。此外，我们还表明，排尿期间的实时成像与计算模型相结合可以量化膀胱收缩的指标，例如逼尿肌缩短率和尿流动力学参数，例如速度、压力和涡度。我们将使用这些来比较健康年轻男性和患有 BPH/LUTS 的男性的膀胱排尿功能。我们将确定膀胱解剖结构的变化和损害排尿功能的具体机制，并描述每种机制对尿流量减少和膀胱排空受损的相对贡献。这种基于 MR 图像的策略采用了广泛用于评估心血管功能的技术。该提案的新颖之处在于采用这些技术来研究膀胱。据我们所知，还没有做过类似的事情。科学影响是 MRI 的实施和验证，以实现对健康年轻男性和患有 BPH/LUTS 的男性下尿路解剖结构和功能的全面评估。通过 MRI 获得的膀胱解剖和功能指标将在整个提案中得到验证，测量由超声确定的膀胱壁厚度，以及由超声确定的压力、流量、膀胱出口梗阻指数 (BOOI) 和膀胱收缩指数 (BCI) 的标准指标。多通道尿动力学。验证 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提供的标准 MRI 机器来实施。临床影响在于，这些方法和经过验证的正常和受损膀胱功能指标为医生提供了单一的非侵入性测试，可同时描述下尿路的解剖结构和功能。这将使个性化医疗方法能够在清楚了解损害 BPH/LUTS 患者排尿的具体解剖特征和功能变化的基础上进行咨询和治疗选择。