Poster, Podium & Video Sessions
Presentation Authors: Jessica Eastman*, Catherine Harris, Alana Christie, Ryan Hutchinson, Ben Wagner, Joseph A. Maldjian, Marco Pinho, Gary E. Lemack, Dallas, TX
Introduction: Recent advances in MRI techniques allow more accurate determination of disease load in Multiple Sclerosis (MS) patients. This study was undertaken to assess the relationship between disease burden, lower urinary tract symptoms (LUTS) and urodynamic (UD) findings.
Methods: An initial cohort of 30 patients was selected from a database of 613 MS patients prospectively enrolled in our institutional NGB database. Patients with complete data sets (UD testing, Urogenital Distress Inventory (UDI-6) scores, and complete demographic information) were selected for initial analysis. Routine brain MRI images (T2-weighted fluid attenuated inversion recovery - FLAIR) were segmented by a neuroradiologist utilizing a level tracing supervised semi-automated tool with generation of masks containing an overall count (OC) of abnormal appearing voxels (Figure 1). Volume of disease burden (VDB in cm3) was obtained by multiplying OC by voxel dimensions.
Results: The mean age was 57, 80% were female. Mean time since diagnosis was 17 years, 66.7% had relapsing remitting MS. Mean MCC was 395.4 ml (45-776 ml). Overall, 43.3 % had a PVR > 100 ml, 53.5% had DO, 30% had DOI 53.5% had detrusor sphincter dyssynergia (DSD), and 10% had altered compliance. Mean UDI-6 score was 9. The MRI mean disease burden was 24 cm3 (range 0.82 - 119.01). Patients with low disease burden (<10cc) had DO 85.7% of the time (6/7 patients) versus those with high disease volume (>10cc) who had DO 43.5% of the time (10/23 patients), p=0.050. Those with low disease burden had lower DO amplitude (29.5 vs. 51.1 cm H2O, p=0.61). Altered compliance was not found in patients with low disease burden. No significant differences in PVR, DSD, or questionnaire scores were noted based on total disease burden. After review of 176 discrete CNS areas, there were 12 with multiple UDS and QOL parameters that approached significance involving regions such as the pons, midbrain, and brainstem.
Conclusions: Volume and location of CNS burden in MS may be useful in predicting some aspects of LUT dysfunction. Current efforts are under way to expand the patient cohort and focus on the areas of interest identified in this study to refine the relationship between CNS lesions and voiding abnormalities in MS patients.
Source Of Funding: none
UT Southwestern Medical Center
Jessica Eastman is a second year medical student from the University of Texas Southwestern Medical Center in Dallas. She completed her undergraduate education at Texas Tech University in Lubbock, Texas, and graduated in 2015 with a B.S. in biology and a B.A. in Spanish. She began her research work in the field of Urology after her first year of medical school, and has been working with Dr. Gary Lemack and Dr. Catherine Harris since that time.