Clinical Scorecard: Investigation of Brain Connectivity Patterns During Micturition and Resting States in Bladder Networks Using 7 T MRI in Women with Multiple Sclerosis and Voiding Dysfunction

At a Glance

Key Highlights

• Up to 90% of MS patients experience some degree of voiding dysfunction or incontinence during their lifetime.
• Functional MRI at ultra-high field (7 T) enables detailed assessment of brain connectivity changes during bladder filling and voiding phases.
• Simultaneous fMRI and urodynamic studies allow correlation of brain activity with specific bladder states: strong desire to void, voiding initiation, and continued voiding.

Guideline-Based Recommendations

Diagnosis

• Use validated criteria for voiding dysfunction including post-void residual volume ≥ 40% of bladder capacity or uroflow below 10th percentile on Liverpool nomogram.
• Perform detailed history, physical examination, and validated questionnaires to assess NLUTD symptoms in MS patients.
• Employ concurrent urodynamics and functional MRI to evaluate brain-bladder network activity during bladder cycle phases.

Management

• Continue bladder medications if already prescribed; avoid initiating new bladder medications during imaging studies to maintain consistency.
• Exclude patients with prior bladder surgeries that may alter bladder function from neuroimaging studies to reduce confounding factors.

Monitoring & Follow-up

• Record urodynamic parameters including bladder filling rate, bladder volume at strong desire to void, voiding initiation, and residual urine volume during MRI scanning.
• Repeat urodynamic and fMRI cycles multiple times per subject to ensure reproducibility of brain activation patterns.

Risks

• Invasive catheterization for urodynamics may cause discomfort and limit subject recruitment.
• MRI safety considerations require exclusion of patients with incompatible implants or recent injuries.

Patient & Prescribing Data

Female MS patients with symptomatic neurogenic lower urinary tract dysfunction and voiding dysfunction

Bladder medications were maintained if previously prescribed; no new bladder medications were initiated during the study to avoid confounding functional connectivity results.

Clinical Best Practices

• Use ultra-high field 7 T MRI for enhanced spatial resolution and signal-to-noise ratio in studying brain-bladder networks.
• Combine simultaneous urodynamic testing with fMRI to correlate bladder states with brain connectivity changes.
• Apply rigorous fMRI preprocessing including motion correction, spatial normalization, and temporal filtering to ensure data quality.
• Select multiple bladder-related brain regions of interest to comprehensively assess functional connectivity during bladder cycle phases.
• Exclude patients with prior bladder surgeries or reconstructions to maintain homogeneity of bladder function in study cohorts.

References

• Neurogenic lower urinary tract dysfunction in MS
• Functional MRI in bladder control studies
• Resting-state brain networks and functional connectivity
• Ultra-high field MRI advantages
• Concurrent urodynamics and neuroimaging studies