Magnetic Resonance Imaging of the Spinal Cord for Evaluation of HTLV-1 Associated Urinary Dysfunction.

Carneiro Neto J1, Nunes Ferraz Liberato de Matos S1, Oliveira C1, Sá R1, Castro N2, Ladeia G3, Oliveira Filho J1, Marcelino Carvalho E4

Research Type

Clinical

Abstract Category

Neurourology

Abstract 255
Pure and Applied Science
Scientific Podium Short Oral Session 29
Friday 29th September 2023
10:15 - 10:22
Room 104CD
Overactive Bladder Sensory Dysfunction Underactive Bladder Urgency/Frequency Voiding Dysfunction
1. Post Graduate Program of Health Sciences - Federal University of Bahia, 2. Professor Edgard Santos Universitary Hospital - Federal University of Bahia, 3. Image Memorial - DASA Medical Groupe, 4. Gonçalo Moniz Institute - FioCruz - Bahia
Presenter
Links

Abstract

Hypothesis / aims of study
Introduction: spinal cord (SC) narrowing is documented in patients with tropical spastic paraparesis/human T cell lymphotropic virus type 1 associated myelopathy (HAM/TSP). It is not consensual that patients without criteria for HAM/TSP present SC lesions. Our hypothesis is that the magnetic resonance images (MRI) could recognize lesions on spinal cord or abnormalities of tractography parameters in patients with lower urinary symptoms (LUTS) without gait impairment, defined as probable HAM/TSP and also called Urinary Dysfunctions Associated to HTLV-1 infection. Objective: investigate the role MRI with tractography in detecting SC abnormalities in HTLV-1 patients presenting lower urinary tract symptoms.
Study design, materials and methods
Methods: patients followed in a cohort study were selected and grouped according to Castro-Costa classification: 33 HTLV-1 asymptomatic carries (AC), 31 urinary dysfunction (UD) patients, and 11 seronegative age matched control (SN). They were submitted to 1.5-Tesla-MR scanner (Siemens; Symphony), with two regions of interest (ROI) positioned side by side at T5 and T12-L1. The images were analysed by 2 neuroradiologists that established the measurements of the SC: antero-posterior (AP) and latero-lateral (LL) radius and area and also thoracic and lumbar index :1/(LL x AP diameters). SC were classified as normal or narrowed. Diffusion tensor image (DTI) and fractional anisotropy (FA) were stablished by the manufactory application. LUTS were evaluated by overactive symptoms score (OABSS) and bladder diary.
Results
Results: the majority of patients concluded the MRI exams (99/116). The mean age and standard deviation (SD) was 55.0 (13.6), 56.9 (11.0) and 60.9 (10.3) in SN, AC and UD, respectively. There was no difference between groups regarding age (P = 0.15), sex (0.59), proviral load (P = 0.94), IFN (P = 0.77) and TNF (P = 0.29). SN and AC patients presented higher educational level P = 0.00). The mean (SD) OABSS was 1.05 (0.83) and 7.53 (3.92) in AC and UD, respectively (P<0.01). The median and interquartile range (IQR) of SC thoracic area were 0.40 (0.38 – 0.45), 0.36 (0.33 – 0.40) and 0.33 (0.27 – 0.37) for SN, AC and UD.  The difference was statistically significant in SN versus AC (P = 0.01), SN versus UD (P = 0.00) and AC versus UD (P = 0.03). The median (IQR) of SC lumbar area were 0.67 (0.55 – 0.72), 0.59 (0.54 – 0.67), and 0.53 (0.48 – 0.63) for SN, AC and UD, respectively. Statistically significant difference was observed in SN vs UD and AC versus UD (P = 0.02 and P=0.04, respectively). Median (IQR) fractional anisotropy (FA) values of thoracic field were 0.69 (0.58 – 0.70) in SN, 0.64 (0.55 – 0.71) in AC and 0.57 (0.51 – 0.68) in UD, the difference was not statistically significant difference. Median (IQR) of mean diffusivity (MD) of thoracic field was 1.23 (1.08 – 1.41), 1.26 (1.14 – 1.43) and 1.29 (1.12 – 1.43) in NS, AC and UD, respectively (P>0.05). Median (IQR) of FA values of lumbar field were 0.54 (0.51 – 0.62), 0.50 (0.41 – 0.57) and 0.45 (0.41 – 0.52), with statistically significant difference comparing SN and UD (P = 0.00). Median (IQR) DM values in lumbar field were 1.12 (0.92 – 1.35), 0.97 (0.88 – 1.16) and 0.97 (0.88 – 1.20) in SN, AC and UD, respectively, with no statistically significant difference. Conclusion: Patients with urinary disfunction (UD) exhibited lesser values of SC measurements. SC area seems to be more the most reliable parameter in explaining LUTS in HTLV-1 infected patients. We found no difference regarding diffusion tensor image parameters such as FA and MD.
Interpretation of results
Spinal cord tractography may be useful in explaining urinary dysfunctions (overactive or underactive bladder symptoms) in patients infected by human T cell lymphotropic virus type 1 (HTLV-1). This is the first study to evaluate patients presenting only urinary dysfunctions. Idiopathic overactive bladder can be better understood using tractographic parameters.
Concluding message
Conclusion: Patients with urinary disfunction (UD) exhibited lesser values of SC measurements. SC area seems to be more the most reliable parameter in explaining LUTS in HTLV-1 infected patients. We found no difference regarding diffusion tensor image parameters such as FA and MD.
References
  1. Vilchez C, Gonzalez-Reinoso M, Cubbison C, Perez-Then E, Roa P, Martínez A, Foerster B, Oviedo J, Stoeter P. Atrophy, focal spinal cord lesions and alterations of diffusion tensor imaging (DTI) parameters in asymptomatic virus carriers and patients suffering from human T-lymphotrophic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP). J Neurovirol. 2014 Dec;20(6):583-90. doi: 10.1007/s13365-014-0282-2. Epub 2014 Sep 17. PMID: 25227931.
  2. Liberato de Matos SNF, Ladeia-Rocha G, Neto JAC, de Oliveira CJV, Neto CA, Passos L, Oliveira-Filho J, Carvalho EM. Diffusion tensor imaging metrics in diagnosis of HTLV-1-associated myelopathy. Ann Clin Transl Neurol. 2022 Apr;9(4):488-496. Spanish. doi: 10.1002/acn3.51521. Epub 2022 Mar 9. PMID: 35263043; PMCID: PMC8994983.
  3. Sadeghmousavi S, Soltani Khaboushan A, Jafarnezhad-Ansariha F, Nejad-Gashti R, Farsi M, Esmaeil-Pour R, Alijani M, Majidi Zolbin M, Niknejad H, Kajbafzadeh AM. The role of spinal cord tractography in detecting lesions following selective bladder afferent and efferent fibers injury: A novel method for induction of neurogenic lower urinary tract dysfunction in rabbit. Neurourol Urodyn. 2022 Sep;41(7):1539-1552. doi: 10.1002/nau.25009. Epub 2022 Jul 17. PMID: 35842827.
Disclosures
Funding Maria Emilia de Carvalho Foundation Clinical Trial No Subjects Human Ethics Committee Professor Edgard Santos Universitary Hospital - Federal University of Bahia Helsinki Yes Informed Consent Yes
Citation

Continence 7S1 (2023) 100972
DOI: 10.1016/j.cont.2023.100972

14/11/2024 19:20:43