Bladder Distension Increases Blood Flow in Pain-Related Brain Structures in Subjects With Interstitial Cystitis

In Healthy Control subjects (HCs) certain brain regions of interest (ROIs) demonstrate increased regional cerebral blood flow (rCBF) in response to painful stimuli. The effect of bladder distension on arterial spin label-functional MRI (ASL-fMRI) measures of rCBF within ROIs was examined in subjects with Interstitial Cystitis (ICs).

Female ICs (n= 11) and HCs (n=11) underwent three brain perfusion scan studies using ASL-fMRI: with a full bladder; with an empty bladder; and while experiencing heat pain. rCBF was calculated using custom software and individual scans were spatially normalized to the MNI template. An analysis was performed of ROI-based absolute rCBF in each condition and of the within group/within subject rCBF distribution changes induced by each condition.

Bladder distension was associated with robust increases in rCBF in ICs greater than that of HCs in multiple ROIs including the Supplemental Motor Area (mainly Brodmann's Area 6), motor and sensory cortex, the insula bilaterally, hippocampal structures bilaterally and the middle and posterior cingulate areas bilaterally. During heat pain, HCs had more robust rCBF increases in the amygdala bilaterally. At baseline with an empty bladder, there was a lower rCBF level in the insula and mid- and posterior cingulate cortex bilaterally of ICs.

Compared to HCs, ICs have limited differences in rCBF in baseline (empty bladder) conditions as well as during heat pain, but robust rCBF increases in the full bladder state in ROIs typically associated with pain, emotion and/or motor control indicating altered processing of bladder-related sensations.

The Journal of urology. 2016 Mar 23 [Epub ahead of print]

Georg Deutsch, Hrishikesh Deshpande, Michael A Frölich, H Henry Lai, Timothy J Ness

Department of Radiology, University of Alabama at Birmingham, Birmingham, AL., Department of Radiology, University of Alabama at Birmingham, Birmingham, AL., Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL., Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO., Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: .