MRI as a Tool to Assess Interstitial Cystitis Associated Bladder and Brain Pathologies

Abstract

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic, often incapacitating condition characterized by pain seeming to originate in the bladder in conjunction with lower urinary tract symptoms of frequency and urgency, and consists of a wide range of clinical phenotypes with diverse etiologies. There are currently no diagnostic tests for IC/BPS. Magnetic resonance imaging (MRI) is a relatively new tool to assess IC/BPS. There are several methodologies that can be applied to assess either bladder wall or brain-associated alterations in tissue morphology and/or pain. IC/BPS is commonly associated with bladder wall hyperpermeability (BWH), particularly in severe cases. Our group developed a contrast-enhanced magnetic resonance imaging (CE-MRI) approach to assess BWH in preclinical models for IC/BPS, as well as for a pilot study for IC/BPS patients. We have also used the CE-MRI approach to assess possible therapies to alleviate the BWH in preclinical models for IC/BPS, which will hopefully pave the way for future clinical trials. In addition, we have used molecular-targeted MRI (mt-MRI) to quantitatively assess BWH biomarkers. Biomarkers, such as claudin-2, may be important to assess and determine the severity of BWH, as well as to assess therapeutic efficacy. Others have also used other MRI approaches to assess the bladder wall structural alterations with diffusion-weighted imaging (DWI), by measuring changes in the apparent diffusion coefficient (ADC), diffusion tensor imaging (DTI), as well as using functional MRI (fMRI) to assess pain and morphological MRI or DWI to assess anatomical or structural changes in the brains of patients with IC/BPS. It would be beneficial if MRI-based diagnostic tests could be routinely used for these patients and possibly used to assess potential therapeutics.

Therapeutic Approaches for Urologic Chronic Pelvic Pain Syndrome; Management: Research Advances, Experimental Targets, and Future Directions

“…Widespread vs local neurological pain is important to acknowledge when assigning treatments and designing clinical trials, as treatment efficacy may differ substantially between patients with different pain profiles (Farrar et al, 2023). The use of a molecular-guided MRI to detect biomarkers of bladder wall permeability has been recently proposed as a potential diagnostic tool to help guide treatment and tailor it to the cohort of patients with urothelial dysfunction (Towner et al, 2021;Towner et al, 2020). Amniotic Bladder Therapy.…”

Latest insights into the pathophysiology of bladder pain syndrome/interstitial cystitis

“…In addition, the authors reported on an association of urothelial defects with clinical symptom severity, highlighting urothelial dysfunction as a substantial part of the pathophysiology [15 ▪ ]. Furthermore, contrast-enhanced MRI may be used to detect bladder wall hyperpermeability [16].…”

Editorial: Special Issue “Biomarkers in Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)”

“…Towner et al evaluated the current value of MRI and the latest methodical developments in evaluation of bladder function and report on a current study of their own group on the use of contrast-enhanced (CE-) MRI to access the bladder wall hyperpermeability as one important pathological parameter in IC/BPS. They conclude that MRI-based tests would be a good tool in routine diagnosis of IC/BPS and could provide valuable information for the development of new therapeutics [ 11 ].…”