Program Information
Brain Functional Magnetic Resonance Imaging in Children with Spina Bifida After Nerve Rerouting
Y Zhou1,2*, A Krishnan2 , J Hafron3 , K Peters4 , (1) Mayo Clinic at Arizona, Phoenix, AZ, (2) Beaumont Health, Royal Oak, MI, (3) Beaumont Health, Royal Oak, MI, (4) Beaumont Health, Royal Oak, MI
Presentations
SU-K-708-13 (Sunday, July 30, 2017) 4:00 PM - 6:00 PM Room: 708
Purpose: The mechanisms responsible for improved voiding after nerve rerouting surgery were not entirely clear and have not been thoroughly studied in patients with spina bifida. The purpose of this study is to assess functional activity in the areas of the brain that have been associated with bladder sensation and voiding with fMRI.
Methods: Patients from our previous nerve rerouting pilot study were included in this study. The fMRI studies were performed on a 3.0T Philips MRI scanner using a single shot gradient echo EPI (GRE-EPI) pulse sequence with a twenty-channel head coil. The typical paradigms for a patient with maximum bladder capacity of 500cc are shown in Figure 1. The filling and emptying bladder was automatically controlled by a modified in-house power injector. The MRI protocol is summarized in Table 1. Preprocessing and analysis of the fMRI data was conducted using the nordicBrainEx software (Nordic neurolab, Norway).
Results: Four subjects were evaluated using the fMRI protocol described previously. All of them exhibited greater brain activations during different bladder activities. The regions that were activated shown in figure 2 using the p value of <0.001 included the frontal cortex, supplemental motor area (SMA), opercula, hypothalamus, thalamus, cerebellum, periaqueductal gray (PAG) and pons after nerve rerouting surgery. Random-effects analysis showed that brain activity at large bladder volume or strong desire to void was generally stronger and more extensive than those at the condition of smaller bladder volume.
Conclusion: Brain activation was seen in all 4 patients following the nerve rerouting surgery. The study suggests that the nerve rerouting in patients with spina bifida may result in brain functional reorganization and improve the neurological mechanisms of normal voiding. In conclusion, fMRI can be used to identify areas of brain activation with bladder filling/emptying in patients that have had nerve rerouting.
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