Using Advanced Imaging Including MRI to Detect Voiding Dysfunction in Neurogenic Bladder and Fowler Syndrome

Abstract

The diagnosis of neurogenic bladder typically involves invasive urodynamic testing; however, recent literature has shown the utility in advanced functional brain imaging. These imaging modalities have proposed neural circuitry pathways for both healthy micturition and pathologic states. Advanced imaging including fMRI, PET, SPECT, and near infrared spectroscopy have identified cortical, subcortical, and spinal relationships to micturition, as well as changes that occur with neurogenic bladder patients. Imaging studies support both efferent control of micturition via the nucleus within the pons and afferent regulation of bladder storage via the periaqueductal gray area. These regulatory centers are controlled by both cortical activation and inhibition. Identifying the pathologic networks may create specific targets for physical, pharmaceutical, or neuromodulation of pathways including newer treatment modalities like deep brain stimulation.