Diffusion-Weighted Magnetic Resonance Imaging: A New Tool for the Diagnosis of Bladder Pain Syndrome/Interstitial Cystitis

Charlanes, A.; Boudghene, F; Chesnel, C.; Ciofu, C.; Breton, F. Le; Jousse, M.; Amarenco, G.; Manceau, Philippe

doi:10.1159/000493507

Cited by 14 publications

(11 citation statements)

References 9 publications

(11 reference statements)

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“…Another study attempted to use diffusion-weighted MRI to diagnose BPS/IC. In this study of 106 patients, a high signal intensity of the bladder wall was related to the presence of BPS/IC (sensitivity 28%, specificity 88%), whilst no signal intensity was related to the absence of a BPS/IC (sensitivity 96%, specificity 29%) [56]. Using intravesical contrast, it was reported that MRI can also be used to assess bladder permeability, with greater contrast enhancement in BPS/IC compared with controls [57].…”

Section: Phenotype Based On Radiological Featuresmentioning

confidence: 68%

Phenotypes of BPS/IC

Malde

Sahai

2020

Curr Bladder Dysfunct Rep

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Purpose of Review The aim of this review is to summarise the latest research related to different phenotypes of BPS/IC, addressing the evidence for current well-defined phenotypes as well as identifying novel potential phenotypes and highlighting areas for future study. Recent Findings Two distinct phenotypes of BPS/IC are well-recognised: Hunner’s lesion disease and non-Hunner’s lesion BPS/IC. Recent studies have shown these phenotypes exhibit distinct clinical, pathological and cystoscopic features, and targeted treatment to Hunner’s lesions can prove effective. Recent studies have also identified new potential phenotypes based on biochemical, molecular and histological markers, pathophysiological mechanisms of disease, clinical features, cystoscopic findings, radiological features and urodynamic factors. This evidence has improved our understanding of the underlying mechanism of disease and may enable more personalised and targeted therapy in the future. Summary Novel phenotypes of BPS/IC relate to the presence of certain biomarkers, alterations in the urinary microbiome, the characteristics of pain and presence of co-existing somatic and psychosocial conditions, altered patterns of brain white matter changes and urodynamic features. Further study is required to evaluate whether these potential phenotypes are clinically useful based on their ability to guide treatment selection and predict outcome from therapy, and therefore optimise therapeutic outcomes.

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Section: Phenotype Based On Radiological Featuresmentioning

confidence: 68%

Phenotypes of BPS/IC

Malde

Sahai

2020

Curr Bladder Dysfunct Rep

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“…These data are similar to the results reported by the Charlanes group. 4 The interpretation of the RD leads to the conclusion that among subjects who present a positive DW-MRI signal the incidence of cases of interstitial cystitis is higher, and there is a statistically significant difference compared to patients who do not have a high DW-MRI signal. Having a positive signal is therefore suggestive of interstitial cystitis.…”

Section: Discussionmentioning

confidence: 99%

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Bladder Pain Syndrome/Interstitial Cystitis

Porru

Cesare

Bright

et al. 2020

Urology

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To evaluate whether DW-MRI can contribute to noninvasive diagnosis of BPS/IC. The agreement between two raters (2 radiologists involved in the study) was also evaluated, the relevance of the "operator-dependent" factor defined. PATIENTS AND METHODS Twenty-two female patients with a diagnosis of BPS-IC were recruited and performed DW-MRI. The same investigation was also performed in 20 patients with pelvic gynecological diseases and no BPS-IC. RESULTS A significant difference was found between BPS-IC and no-BPS-IC since 17 out of 22 subjects of the first group were positive, compared to 3 out of 20 no-IC subjects, with a P value of .001 to highlight the statistical significance. The sensitivity of the exam was 77%, while the specificity was 85%. There was good agreement between the 2 raters in the evaluation of MRI results. CONCLUSION DW-MRI helps to obtain a noninvasive diagnosis of BPS/IC, by providing useful information on the choice of which patients may be more appropriately submitted to cystoscopy and bladder biopsy.

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“…19 Fulguration using electrocautery via a Bugbee electrode was described by with HLD. 30,31 Cystoscopy under anesthesia is essential in the diagnostic algo- Primarily, the lack of a control group is a significant limitation, especially in BPS/IC in which the placebo effect is known to be as high as 50% in placebo-controlled trials. 32,33 Additionally, a limitation is the fact that all patients also concurrently underwent hydrodistension at the time of laser ablation which may have affected the symptomatic outcomes reported.…”

Section: Discussionmentioning

confidence: 99%

Bladder pain syndrome/interstitial cystitis in contemporary UK practice: Outcomes of phenotype‐directed management

Neale

Malik

Taylor

et al. 2020

LUTS

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Objectives: Problem bladder pain syndrome/interstitial cystitis (BPS/IC) is a heterogeneous disorder with variation in management worldwide. Phenotyping aims to personalize therapy and optimize outcomes. The most well-described phenotype is Hunner lesion disease (HLD). The prevalence of HLD and outcome of phenotypedirected management in the UK is not well-studied. We describe the management of a contemporary cohort of patients with BPS/IC in the UK. Methods: Retrospective analysis of all patients with BPS/IC from January 2015-November 2018. Outcomes of patients who underwent laser ablation to Hunner lesions were collected using the Global Response Assessment tool. Results: One hundred and sixty-three patients (mean age of 43 years [20-85]) were included. 78% were female and patients had experienced symptoms for an average 6 years (1-30) prior to specialist assessment. Eighty-three percent of patients had pelvic imaging (44% ultrasound, 42% magnetic resonance imaging and 14% computed tomography), and a relevant abnormality was found in five (4%). Twenty-two patients (14%) had HLD (International Society for the Study of BPS [ESSIC] 3), with a mean bladder capacity of 373 mL (175-650 mL); 77% were ESSIC C on histopathology. All patients with HLD underwent laser ablation, with 55% experiencing a moderate/marked improvement in symptoms, with a mean duration of effect of 10 months (3-36); 27% of patients had a repeat treatment. Conclusions: The presence of HLD in patients with BPS/IC is not uncommon. Pelvic imaging rarely identifies any cause for pain and so cystoscopy under anesthesia is essential for accurate phenotyping. Phenotype-directed management with holmium laser ablation to Hunner lesions has good short-term efficacy in improving pain, but re-intervention is often required.

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Diffusion-Weighted Magnetic Resonance Imaging: A New Tool for the Diagnosis of Bladder Pain Syndrome/Interstitial Cystitis

Cited by 14 publications

References 9 publications

Phenotypes of BPS/IC

Phenotypes of BPS/IC

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Bladder Pain Syndrome/Interstitial Cystitis

Bladder pain syndrome/interstitial cystitis in contemporary UK practice: Outcomes of phenotype‐directed management

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