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Aberrant functional coherence of the right anterior insular in psychogenic erectile dysfunction patients: a resting state MRI study

Dong, M1; Guan, M2; Chen, FX1; Chen, YF1; Chen, X3; Zhang, XS3

1: Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; 2: Department of Interventional Radiology, Henan Provincial People’s Hospital, Zhengzhou, 450003, China; 3: Department of Urology, Henan Provincial People’s Hospital, Zhengzhou, 450003, China

Objective. This study investigated:1) the alterations in focal brain functional coherence in patients with psychogenic erectile dysfunction (pED) compared with healthy male subjects; 2) And the relationship between the brain functional coherence and the behavioral measurements.

Material and Method(s). After in-depth face-to-face interview, behavioral/physical assessments (nrmal morning erections, Doppler Sonography and normal nocturnal erections) and psychological tests (International Index of Erectile Function, IIEF), Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale(SDS) , 26 right-handed heterosexual outpatients with pED and 26 matched healthy control (HC) subjects were enrolled. The diagnosis of pED (generalized type) was performed according to current guidelines: absence of vasculogenic, neurogenic, hormonal, anatomical, drug-induced ED.

Imaging data was collected using a 3T GE scanner. The resting-state functional MRI (rs-fMRI) images were obtained with an echo-planar imaging sequence. The MRI data preprocessing were carried out using Statistical Parametric Mapping 8 following the stereotype pipeline. The focal brain functional coherence was indexed by the regional homogeneity (ReHo) of low-frequency fluctuation (0.01–0.08 Hz) of the rs-fMRI data. The ReHo analysis was carried out using the REST package. For the study aim 1), a two-sample t-test (p<0.05, Alphasim corrected) were performed to determine the group differences in brain functional coherence between pED patients and HC subjects. For the study aim 2), we computed the voxel- wise Pearson’s correlation coefficients between ReHo and behavioral measurement, i.e. duration of the pED, IIEF, SAS, SDS.

Result(s).Compared with HC, pED patients had disrupted brain functional coherence in the right anterior insular cortex (rAI) (p<0.05, with k> 96 voxels, Alphasim corrected, with individual p level of 0.005, 5000 time Monte Carlo simulations using the AFNI AlphaSim program). Moreover, the ReHo the rAI correlated with the IIEF scores in pED patients (p<0.05, with k> 96 voxels, alphasim corrected).

Conclusion(s). The rs-fMRI is used to determine the neural substrates of disorders in patients. Our results suggested that the deficit in sexual functioning was mirrored in the aberrant functional coherence in rAI in pED patients and the level of impairment at the behavioral level was in parallel with the disruption in neural level. These data may imply there is an impaired cognitive and motivation component of sexual stimuli processing in pED patients. Moreover, given that insular is the hub for processing and synthesizing the interoception and exteroception information, we suggest that the disruption of functional homogeneity in this area may indicate the abnormal body-mind communication mechanism in pED patients.


Work supported by industry: no.

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