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MP7-07 MRI IN PATIENTS SUFFERING FROM PELVIC ORGAN PROLAPSE AND STRESS URINARY INCONTINENCE
THE JOURNAL OF UROLOGYâ
e68
Vol. 191, No. 4S, Supplement, Saturday, May 17, 2014
MP7-07
MP7-08
MRI IN PATIENTS SUFFERING FROM PELVIC ORGAN PROLAPSE AND STRESS URINARY INCONTINENCE
ESTABLISHMENT OF IN VIVO SMALL ANIMAL MODELS TO DETERMINE CELL MOBILITY AND VIABILITY AND IMAGING OF INJECTED MESENCHYMAL STEM CELLS IN THE PIG SPHINCTER
Gevorg Kasyan*, Nataliya Tupikina, Maria Barinova, Michael Gvozdev, Andrew Glotov, Dmitry Pushkar, Moscow, Russian Federation INTRODUCTION AND OBJECTIVES: The aim of our study was to identify differences in anatomical parameters using MRI in patients suffering from pelvic organ prolapse (POP) according to their continence function. METHODS: This study included 44 women suffering from POP (cystocele grade 2-4 by POP-Q) who underwent transvaginal surgical repair. The study was approved by the local ethics committee, and all patients provided signed informed consent. For evaluation of continence, the UDI-6 questionnaire was used. We found that 14 patients (group 1) had concomitant SUI and prolapse. The remaining patients without complaint of SUI were divided into 2 groups: group 2 (n¼16) had a negative cough test after prolapse repositioning, and group 3 (n¼14) had occult SUI. Dynamic MRI was performed for every patient on MR tomograph General Electric Signa HDxt 3,0 Tesla (Figure 1). The following parameters were recorded: hypermobility of the urethra, dilatation of the bladder neck, retrovesical angle (more than 140 ), urethral length, urethral kinking, bladder neck and base descent, uterus descent, cervical elongation, urethral rhabdosphincter thickness, levator gap width and pelvic fascia defect. RESULTS: Comparing groups 1 and 2, statistically significant differences were obtained for the dilatation of the bladder neck during Valsalva and for the increase of the retrovesical angle at the Valsalva of more than 140 and at rest was noted (Table 1), which indicates the importance of these factors for continence in patients with pelvic organ prolapse. Statistical analysis did not reveal differences in these parameters between groups 2 and 3. CONCLUSIONS: Patients with POP and SUI have certain anatomical features that should be considered when planning surgical treatment. Further studies on the prognostic significance of these parameters with a large sample are necessary to develop an algorithm of treatment for this category of patients.
Karl-Dietrich Sievert*, Susanne Will, Julia G. Mannheim, Kerstin Fuchs, € rg Schmehl, Gerd Gro €zinger, Ru € diger Bantleon, Martin Vaegler, Jo Petros Martirosian, Fritz Schick, Claus D. Claussen, Bernd J. Pichler, Ulrich Kramer, Tuebingen, Germany INTRODUCTION AND OBJECTIVES: To strengthen the physiological function of the urethral sphincter, different aspects of cellbased treatments were investigated. The aim was to develop and provide preclinical and clinical-translational imaging platforms (Positron Emission Tomography, Optical Imaging and Magnetic Resonance Imaging (MRI)). For cell detection iron (Resovist), fluorescent (Cy5) and radioactive ([64Cu]PTSM) markers were applied to establish methods that enable visualization of therapeutic mesenchymal stem cells (MSC) in vitro and in vivo using rat and minipig animal models. Examinations of the porcine sphincter were applied with high resolution MRI, after iron cell labeling. METHODS: In vitro titrations of different cell amounts were performed: 0.031 e 1.0 mio adipose tissue-derived stem cells (ADSC) from two patients were labeled with Cy5. The viability of the labeled cells was evaluated for ten days to determine the labeling influence on the cells. Complementary experiments with [64Cu] PTSM were also performed over two days. For the examination of the female minipig animal model, a 3T MR scanner was used. The anatomy of urethra and sphincter was acquired using a high resolution T2-weighted turbo spin echo sequence. A gradient echo sequence with multiple echo times was utilized to identify and verify locations of iron particles, based on visual inspection. The distribution of the injected cells was then correlated with histological findings. RESULTS: Measurements of the minipig sphincter muscle, three weeks and three months after MSC injection, showed clearly visible iron deposits inside the sphincter muscle. Additionally, iron depositions could be verified even six months after stem cell injection. The comparison of MRI and tissue sections showed preeminent correlation of size and location of iron labeled cells. The optical signal decreased over time due to ongoing proliferation of cells. However, cell viability with [64Cu] PTSM or Cy5 due to the labeling was not yet determined. Application of 0.5 e 1.0 mio cells was found to be ideal for future experiments. CONCLUSIONS: Further Cy5 and [64Cu] PTSM experiments, using MSC from bone marrow and placenta, are planned to investigate the efficiency of different stem cell types. Against initial expectations iron deposits were detectable six months after injection in the minipig animal model, so further MRI measurements should be applied. A method for quantitative analysis of iron deposition could be useful for the monitoring of cell proliferation and will be developed in the future. Source of Funding: none
Group 1 (n¼12) (M SD)
Group 2 (n¼16) (M SD)
Group 3 (n¼14) (M SD)
pvalue
Dilatation of the bladder neck during Valsalva, mm
3.3 1.33
2 1.46
2.54 3.14
< 0.05
The retrovesical angle at the Valsalva of more than 140
80% , 95% CI (49.4100.6)
43.8% 95% CI (18.7 -68.9)
54.6% CI (23.785.5)
< 0.05
72.7% , 95% CI (38.894.6)
37.5% 95% CI (13-62)
52.1%, 95% CI (29.874.6)
< 0.05
The retrovesical angle at rest of more than 140
Source of Funding: The study was funded by the grant of The Ministry of Education and Science, project 14.132.21.1784
MP7-09 DIFFUSION-WEIGHTED MRI FOR ASSESSING THE RESPONSE OF MUSCLE-INVASIVE BLADDER CANCER TO CHEMORADIOTHERAPY Soichiro Yoshida*, Fumitaka Koga, Hiroshi Tanaka, Shiro Satoh, Yasukazu Nakanishi, Toshiki Kijima, Junichiro Ishioka, Yoh Matsuoka, Noboru Numao, Kazutaka Saito, Yasuhisa Fujii, Kazunori Kihara, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Accurate assessment of the response to chemoradiotherapy (CRT) is an essential part of bladder-sparing therapeutic protocols against muscle-invasive bladder
e68
Vol. 191, No. 4S, Supplement, Saturday, May 17, 2014
MP7-07
MP7-08
MRI IN PATIENTS SUFFERING FROM PELVIC ORGAN PROLAPSE AND STRESS URINARY INCONTINENCE
ESTABLISHMENT OF IN VIVO SMALL ANIMAL MODELS TO DETERMINE CELL MOBILITY AND VIABILITY AND IMAGING OF INJECTED MESENCHYMAL STEM CELLS IN THE PIG SPHINCTER
Gevorg Kasyan*, Nataliya Tupikina, Maria Barinova, Michael Gvozdev, Andrew Glotov, Dmitry Pushkar, Moscow, Russian Federation INTRODUCTION AND OBJECTIVES: The aim of our study was to identify differences in anatomical parameters using MRI in patients suffering from pelvic organ prolapse (POP) according to their continence function. METHODS: This study included 44 women suffering from POP (cystocele grade 2-4 by POP-Q) who underwent transvaginal surgical repair. The study was approved by the local ethics committee, and all patients provided signed informed consent. For evaluation of continence, the UDI-6 questionnaire was used. We found that 14 patients (group 1) had concomitant SUI and prolapse. The remaining patients without complaint of SUI were divided into 2 groups: group 2 (n¼16) had a negative cough test after prolapse repositioning, and group 3 (n¼14) had occult SUI. Dynamic MRI was performed for every patient on MR tomograph General Electric Signa HDxt 3,0 Tesla (Figure 1). The following parameters were recorded: hypermobility of the urethra, dilatation of the bladder neck, retrovesical angle (more than 140 ), urethral length, urethral kinking, bladder neck and base descent, uterus descent, cervical elongation, urethral rhabdosphincter thickness, levator gap width and pelvic fascia defect. RESULTS: Comparing groups 1 and 2, statistically significant differences were obtained for the dilatation of the bladder neck during Valsalva and for the increase of the retrovesical angle at the Valsalva of more than 140 and at rest was noted (Table 1), which indicates the importance of these factors for continence in patients with pelvic organ prolapse. Statistical analysis did not reveal differences in these parameters between groups 2 and 3. CONCLUSIONS: Patients with POP and SUI have certain anatomical features that should be considered when planning surgical treatment. Further studies on the prognostic significance of these parameters with a large sample are necessary to develop an algorithm of treatment for this category of patients.
Karl-Dietrich Sievert*, Susanne Will, Julia G. Mannheim, Kerstin Fuchs, € rg Schmehl, Gerd Gro €zinger, Ru € diger Bantleon, Martin Vaegler, Jo Petros Martirosian, Fritz Schick, Claus D. Claussen, Bernd J. Pichler, Ulrich Kramer, Tuebingen, Germany INTRODUCTION AND OBJECTIVES: To strengthen the physiological function of the urethral sphincter, different aspects of cellbased treatments were investigated. The aim was to develop and provide preclinical and clinical-translational imaging platforms (Positron Emission Tomography, Optical Imaging and Magnetic Resonance Imaging (MRI)). For cell detection iron (Resovist), fluorescent (Cy5) and radioactive ([64Cu]PTSM) markers were applied to establish methods that enable visualization of therapeutic mesenchymal stem cells (MSC) in vitro and in vivo using rat and minipig animal models. Examinations of the porcine sphincter were applied with high resolution MRI, after iron cell labeling. METHODS: In vitro titrations of different cell amounts were performed: 0.031 e 1.0 mio adipose tissue-derived stem cells (ADSC) from two patients were labeled with Cy5. The viability of the labeled cells was evaluated for ten days to determine the labeling influence on the cells. Complementary experiments with [64Cu] PTSM were also performed over two days. For the examination of the female minipig animal model, a 3T MR scanner was used. The anatomy of urethra and sphincter was acquired using a high resolution T2-weighted turbo spin echo sequence. A gradient echo sequence with multiple echo times was utilized to identify and verify locations of iron particles, based on visual inspection. The distribution of the injected cells was then correlated with histological findings. RESULTS: Measurements of the minipig sphincter muscle, three weeks and three months after MSC injection, showed clearly visible iron deposits inside the sphincter muscle. Additionally, iron depositions could be verified even six months after stem cell injection. The comparison of MRI and tissue sections showed preeminent correlation of size and location of iron labeled cells. The optical signal decreased over time due to ongoing proliferation of cells. However, cell viability with [64Cu] PTSM or Cy5 due to the labeling was not yet determined. Application of 0.5 e 1.0 mio cells was found to be ideal for future experiments. CONCLUSIONS: Further Cy5 and [64Cu] PTSM experiments, using MSC from bone marrow and placenta, are planned to investigate the efficiency of different stem cell types. Against initial expectations iron deposits were detectable six months after injection in the minipig animal model, so further MRI measurements should be applied. A method for quantitative analysis of iron deposition could be useful for the monitoring of cell proliferation and will be developed in the future. Source of Funding: none
Group 1 (n¼12) (M SD)
Group 2 (n¼16) (M SD)
Group 3 (n¼14) (M SD)
pvalue
Dilatation of the bladder neck during Valsalva, mm
3.3 1.33
2 1.46
2.54 3.14
< 0.05
The retrovesical angle at the Valsalva of more than 140
80% , 95% CI (49.4100.6)
43.8% 95% CI (18.7 -68.9)
54.6% CI (23.785.5)
< 0.05
72.7% , 95% CI (38.894.6)
37.5% 95% CI (13-62)
52.1%, 95% CI (29.874.6)
< 0.05
The retrovesical angle at rest of more than 140
Source of Funding: The study was funded by the grant of The Ministry of Education and Science, project 14.132.21.1784
MP7-09 DIFFUSION-WEIGHTED MRI FOR ASSESSING THE RESPONSE OF MUSCLE-INVASIVE BLADDER CANCER TO CHEMORADIOTHERAPY Soichiro Yoshida*, Fumitaka Koga, Hiroshi Tanaka, Shiro Satoh, Yasukazu Nakanishi, Toshiki Kijima, Junichiro Ishioka, Yoh Matsuoka, Noboru Numao, Kazutaka Saito, Yasuhisa Fujii, Kazunori Kihara, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Accurate assessment of the response to chemoradiotherapy (CRT) is an essential part of bladder-sparing therapeutic protocols against muscle-invasive bladder