SUFU 2018: Neuroanatomical Evaluation of Peri-Vesical Nerve Plexus in Female with 3t-Mr Diffusion Tensor Imaging

Austin, TX ( The authors in this investigation showed if tractography or fiber-tracking based on Diffusion Tensor Imaging (DTI) can improve the visualization of peri-vesical nerve fibers. Understanding the exact location and distribution of the entire nerve fibers plexus around the bladder could facilitate newer paradigms and approaches of targeted treatment of bladder dysfunction.

Dr. Gamal Ghoniem and colleagues used pelvic DTI as an add-on to our existing clinical pelvic MRI protocol on a 3Tesla MRI scanner (Siemens, Erlangen, Germany). It was acquired in axial orientation using body- and spine-matrix receiver coils and following acquisition parameters: TR/TE=9500/104 [ms], 30 directions, b-values=0, 600 [s/mm2], and 2 x 2 x 3 mm3 voxel-size. A high-resolution 3d-T2 scan of pelvis (0.9 x 0.9 x 1.0 mm3) in axial orientation was also added to serve as the anatomical template for tractography. DTI was processed using a dedicated workstation (Dynasuite Neuro 2.0, In Vivo Corp, Gainesville, USA) for fiber-tracking/visualization based on manual placement of region-of-interest (ROI). Placement of multiple ROIs in different orientations using anatomical landmarks and color-coded fractional anisotropy (FA) map were carried out by urology fellow (BF) experienced in use of the workstation for visualization of the nerve fibers around the bladder.

The DTI showed description of peri-vesical plexus nerve fibers in all directions, while 2D and 3D T2 morphological sequences depicted part of the fibers, in a plane by plane analysis of fiber courses. DTI demonstrated in female patient the spreading of nerve fibers around the bladder. This distribution was on the posterior and lateral bladder walls, and around the bladder neck. 

They concluded in this pilot study such detection in the distribution of peri-vesical nerve fibers plexus, might help in the targeted therapy for bladder disease including overactive bladder.

Presented by: Bilal Farhan, MD

Authors: Bilal Farhan MD, Hon J. Yu, BSc PhD, Mohammad Helmy MD, and Gamal Ghoniem MD FACS, University of California, Irvine, CA

Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas