AUA 2017: Association between urinary symptom severity and automated segmentation of white matter plaque in women with multiple sclerosis

Boston, MA ( Multiple sclerosis (MS) is characterized by demyelinated white matter plaque throughout the central nervous system. Patients with MS frequently experience a range of bothersome urinary symptoms.

The cingulate cortex, insula cortex, and prefrontal cortex are three cortical brain regions that regulate micturition, and plaque involvement in these regions may be associated with urinary symptom severity. The aim of this study is to investigate the relationship between cerebral plaque volume (PV), location and urinary symptoms in women with MS. 

This was a prospective case control single-institution study of women with MS undergoing routine yearly brain MRI. Women were administered the AUA Symptom Score (AUASS) and divided into two groups: women with severe urinary symptoms (AUASS20) and women with mild symptoms (AUASS7). MS PV and location in the brain were determined using a validated automated white matter lesion segmentation algorithm. The study included 36 women with a median age of 50.1 years and BMI 26.6 kg/m2 with no significant differences between groups, p>0.05. The median total PV was 2523.5mm3 and did not differ between the groups, p=0.52. Women with severe urinary symptoms had larger median PV in the left frontal lobe (LFL) (623.5mm3 IQR 2652 vs. 184mm3 IQR 908; p=0.04) and right limbic lobe (RLL) (1.5mm3 IQR 10 vs. 0 IQR 0; p=0.02) compared to women with mild urinary symptoms.

Within the RLL, women with severe symptoms had larger median PV in the cingulate gyrus (median 1 IQR 4 vs. median 0 IQR 0; p=0.02). There was moderate correlation between LFL lesion volume and the AUA voiding symptom subscore (coefficient 0.4, p=0.03) as well as RLL lesion volume and the AUA voiding symptom subscore (coefficient 0.5, p=0.002). However, these regions did not correlate with the storage subscore. There were no significant relationships between symptoms severity and PV in the insula, cerebellum, corpus callosum, occipital or parietal lobes (p>0.05). 

The study conclusion was urinary symptom severity in women with MS is associated with plaque in the cingulate gyrus and LFL, and not total cerebral plaque volume. The voiding symptom subscore of AUASS correlated with the volume of plaque in these locations. Further research to assess spinal cord plaque characteristics is underway

Presented by: Siobhan Hartigan, MD, University of Pennsylvania

Written by: Diane K. Newman, DNP, FAAN, BCB-PMD, Perelman School of Medicine, University of Pennsylvania

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA