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Int Neurourol J > Volume 27(3); 2023 > Article
International Neurourology Journal 2023;27(3): 174-181.
Is the Brainstem Activation Different Between Healthy Young Male and Female Volunteers at Initiation of Voiding? A High Definition 7-Tesla Magnetic Resonance Imaging Study
Bradley Schott1  , Darshil Choksi1  , Khue Tran1  , Christof Karmonik2  , Betsy Salazar3  , Timothy Boone3  , Rose Khavari3 
1Interdisciplinary College of Engineering Medicine, Texas A&M, Houston, TX, USA
2MRI Core, Houston Methodist Research Institute, Houston, TX, USA
3Department of Urology, Houston Methodist Hospital, Houston, TX, USA
Correspondence  Rose Khavari ,Email:
Submitted: 6 May 2023;  Accepted after revision: 5 July 2023.
Assessing brainstem function in humans through typical neuroimaging modalities has been challenging. Our objective was to evaluate brain and brainstem activation patterns during initiation of voiding in healthy males and females utilizing a 7 Tesla magnetic resonance imaging (MRI) scanner and a noninvasive brain-bladder functional MRI (fMRI) protocol.
Twenty healthy adult volunteers (10 males and 10 females) with no history of urinary symptoms were recruited. Each volunteer underwent a clinic uroflow and postvoid residual assessment and was asked to consume water prior to entering the scanner. Anatomical and diffusion tensor images were obtained first, followed by a blood oxygenation level dependent (BOLD) resting-state fMRI (rs-fMRI) during the empty bladder. Subjects indicated when they felt the urge to void, and a full bladder rs-fMRI was obtained. Once completed, the subjects began 5 voiding cycles, where the first 7.5 seconds of each voiding cycle was identified as “initiation of voiding.” BOLD activation maps were generated, and regions of interests with a t-value greater than 2.1 were deemed statistically significant.
We present 5 distinct regions within the periaqueductal gray (PAG) and pontine micturition center (PMC) with statistically significant activation associated with an initiation of voiding in both men and women, 3 within the PAG and 2 within the PMC. Several additional areas in the brain also demonstrated activation as well. When comparing males to females, there was an overall lower BOLD activation seen in females throughout all regions, with the exception of the caudate lobe.
Our study effectively defines regions within the PAG and PMC involved in initiation of voiding in healthy volunteers. To our knowledge, this is the first study investigating differences between male and female brainstem activation utilizing an ultra-high definition 7T MRI.
Keywords: Neurourology; Magnetic resonance imaging; Voiding; Micturition; Brainstem; Continence
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Official Journal of Korean Continence Society & ESSIC (International Society for the Study of BPS) & Korean Society of Urological Research & The Korean Children’s Continence and Enuresis Society & The Korean Association of Urogenital Tract Infection and Inflammation & Korean Society of Geriatric Urological Care
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