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The aim of this study was to identify the brain areas that control urinary continence in healthy men by ^sup 99m^Tc-hexamethylpropyleneamine oxime (^sup 99m^Tc-HMPAO) SPECT. Methods: SPECT scans were performed on 15 right-handed healthy male volunteers, 24 45 y old. Each subject was scanned twice without movement in a supine position, and 444 and 555 MBq ^sup 99m^Tc-HMPAO were separately injected intravenously during the following 2 conditions: resting state with an empty bladder and urine-withholding state with a full bladder. The final image during urine withholding was obtained by subtracting the first scan data from the second scan data. The images were analyzed by statistical image analysis software and displayed on Z-score images at a significance threshold of P < 0.05 with correction for multiple comparisons. Results: In the urine-withholding state, as compared with resting, there was a significant increase in tracer activity in the bilateral inferior frontal gyri and the right superior and the middle temporal gyri. Among the regions, the right inferior frontal gyrus was distinctly prominent. When the threshold value was decreased to P < 0.005 without correction, there was a vast network of cortical and subcortical regions involved during urine withholding. Conclusion: Our results suggest that the right inferior frontal gyrus plays an important role in brain control of urinary continence. This study also suggests that brain control of continence can be confirmed by statistical image analysis software using SPECT.
Key Words: urinary continence; urine withholding; ^sup 99m^Tc-hexamethylpropyleneamine oxime; statistical image analysis software; SPECT
J Nucl Med 2006; 47:1093-1098
Unary incontinence, which is defined as any involuntary leakage of urine, has long been acknowledged to be a major health problem in the elderly. It is also frequently found in patients with stroke (1). multiple sclerosis (2), Alzheimer's disease (3), multiple system atrophy (4). traumatic brain lesion (5). brain tumors (6). Parkinson's disease (4,7). and other cerebral disorders.
Up to now. human brain imaging studies have focused primarily on the act of micturition itself, especially the comparison between the voiding state and the resting state. Using SPECT, Fukuyuma et al. (8) initially reported that the areas activated during micturition in healthy humans were the upper ports, the left sensorimotor cortex, the right frontaJ cortex, and bilateral supplementary motor areas. A PET...