Abnormal functional connectivity in women with urgency urinary incontinence: Can we predict disease presence and severity in individual women using Rs-fcMRI/.

AIMS: To identify atypical brain functional connectivity in women with UUI and detrusor overactivity (DO) and to predict the presence/severity of UUI in individual women using connectivity features. METHODS: This is a cross-sectional study comparing brain functional connectivity in women with and without UUI. Validated symptom/quality of life questionnaires were used for phenotyping. Participants are females between ages 40 and 85 with daily UUI with DO (Cases, N = 16) and without UUI (Controls, N = 24). Functional MRI and Resting state connectivity MRI were obtained at empty/ full bladder. Multivariate pattern analysis (MVPA) was used to predict the presence and severity of UUI from connectivity data. RESULTS: There are significant differences in brain activation between cases and controls in eighteen brain regions irrespective of empty or full bladder. These include regions involved in attention (inferior partietal), decision making (inferior and superior frontal gyrus), primary motor and sensory (precentral and postcentral gyrus) functions. Women with UUI showed no change in connectivity with bladder filling in regions involved in interoception (insula), integration of afferent function (anterior cingulate), and decision making (middle frontal). MVPA of connectivity data showed robust classification of an individual woman as case or control (89% sensitivity, 83% specificity). Six connectivity features accurately predicted disease severity (R(2) = 0.81). CONCLUSION: We identified two mechanisms of abnormal bladder control, one involving atypical activation of brain regions, and another atypical functional integration across sensory, emotional, cognitive and motor regions. Connectivity information is robust enough to classify an individual as having UUI or not and to predict symptom severity. Neurourol. Urodynam. 35:564-573, 2016. © 2015 Wiley Periodicals, Inc.