Page 155 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

signals have higher sensitivity, thereby increasing the spatial resolution.24 Studies comparing results obtained at 3T with results obtained at 7T demonstrate relevant dif- ferences.22,25 These studies are suggesting that the increase in resolution at 7T allows for interpretation of individual results. The above-mentioned arguments demonstrate ultra-high field (7T) imaging should be preferred for implementation of fMRI in clinical practice.
5. Is 7T fMRI available in clinical practice in the future?
The main drawbacks of 7T, compared to 1.5/3T, are the susceptibility for motion artefacts and some specific technical problems. For example, in 4 out of 17 patients included in chapters 3 & 4, the data could not be used due to motion artefacts. Furthermore, at present, data processing methods are relatively time consuming. These issues might diminish as the technique of high field imaging is evolving. Moreover, the safety of 7T in patients with implantable devices still has to be demonstrated.26 Lastly, 7T MRI scanners are limitedly accessible and their use as diagnostic in clinical practice is therefore still very rare. In the Netherlands, three 7T scanners are available and these are mainly used for scientific purposes. The costs of such investment in hospitals are considerable, which might impede the implementation of 7T in clinical practice.
In conclusion, we further defined the involved brain areas in the central control of the LUT and the present results suggests that ultra-high field fMRI is an eligible tool in individuals. Thus, 7T fMRI might be suitable as a future ‘diagnostic tool’ in the field of functional urology. Some important issues need to be addressed before this technique can be implemented in clinical practice. First, gathering more fMRI data on both healthy individuals and patients is necessary to define the pathophysiology of diseases in the field of functional urology and to specifically delineate the differences in the results of fMRI between patients and healthy individuals. Standardized protocols for, i.e. bladder filling tasks, pelvic floor muscle contraction tasks and micturition tasks appear relevant to decrease the heterogeneity between studies. Furthermore, this high-field imaging technique is time consuming and limitedly accessible, issues that might diminish with the evolution of this technique.
IMPROVING TRADITIONAL AND PATIENT REPORTED OUTCOME MEASUREMENTS IN FUNCTIONAL UROLOGY
A future perspective is the creation of a prediction model that includes patient char- acteristics and (objective and subjective) outcomes to personalize the management of diseases in the field of functional urology. Such model might increase the success rates
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General discussion and future perspectives
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