Measuring tongue volumes and visualizing the chewing and swallowing process using real-time TrueFISP imaging--initial clinical experience in healthy volunteers and patients with acromegaly

Evaluation of tongue volume and oral cavity capacity using cone-beam computed tomography

The aims of this study were to reveal the usefulness of a newly developed method for measuring tongue volume (TV) and oral cavity capacity (OCC) and to assess the relationship between them. The tongue was coated with a contrast agent, and the TV and OCC were determined using cone-beam computed tomography (CBCT). We enrolled 20 adults who were scheduled to undergo CBCT to evaluate the relationship of the third molar roots to the alveolar nerve before molar extraction. Each participant’s tongue was coated with a contrast agent, and CBCT of the tongue and oral cavity was performed. Using computer software, we evaluated reconstructed 3D images of the TV, oral cavity proper volume (OCPV), and OCC. The mean TV was 47.07 ± 7.08 cm³. The mean OCPV and OCC were 4.40 ± 2.78 cm³ and 51.47 ± 6.46 cm³, respectively. There was a significant correlation between TV and OCC (r = 0.920; p < 0.01) but not between TV and OCPV. The mean TV/OCC ratio was 91 ± 5%. The proposed method produced CBCT images that enabled effective measurement of TV and OCC. This simple method of measuring TV and OCC will be useful in the diagnosis on the tongues with abnormal size.

Challenges in computational modelling of food breakdown and flavour release

A dynamic, three dimensional (3D) computational model that predicts the breakdown of food and the release of tastants and aromas could enhance the understanding of how food is perceived during consumption. This model could also shorten the development process of new foods because many virtual foods could be assessed, and discarded if unsuitable, before any physical prototyping is required. The construction and testing of a complete 3D model of mastication presents many challenges including an accurate representation of: the anatomical movements of the oral cavity (including the teeth, tongue, cheeks and palates), the breakdown behaviour of the food, the interactions between comminuted food and saliva as the bolus is formed, the release and transport of taste and aromas and how these physical and chemical processes are perceived by a person. These challenges are discussed in reference to previous experimental and simulation work and using results of new applications of a coupled biomechanical-smoothed particle hydrodynamics (B-SPH) model. The B-SPH model is demonstrated to simulate several complicated aspects of mastication including: (1) the sensitivity of particle size to changes in the movements of the jaw and tongue; (2) large strain behaviour of food due to softening by heating; (3) interactions between solid and liquid food components; (3) the release of tastants into the saliva; and (4) the transport of tastants to the taste buds. These applications show the possibilities of a model to viably simulate mastication, but highlight the many modelling and experimental challenges that remain.

Tongue thickness relates to nutritional status in the elderly

Many elderly people under long-term care suffer from malnutrition caused by dysphagia, frequently leading to sarcopenia. Our hypothesis is that sarcopenia may compromise oral function, resulting in dysphagia. The objectives of this study were to evaluate sarcopenia of the lingual muscles by measuring the tongue thickness, and elucidate its relationship with nutritional status. We examined 104 elderly subjects (mean age = 80.3 ± 7.9 years). Anthropometric data, such as triceps skinfold thickness and midarm muscle area (AMA), were obtained. The tongue thickness of the central part was determined using ultrasonography. Measurement was performed twice and the mean value was obtained. The relationship between tongue thickness and nutritional status was analyzed by Pearson’s correlation coefficient and Spearman’s rank correlation coefficient. AMA and age were identified by multiple-regression analysis as factors influencing tongue thickness. The results of this study suggest that malnutrition may induce sarcopenia not only in the skeletal muscles but also in the tongue.

Tongue adiposity and strength in healthy older adults

OBJECTIVES/HYPOTHESIS

To identify treatable risk factors for aspiration in older adults, particularly those associated with sarcopenia, we examined tongue composition. We hypothesized that isometric and swallowing posterior tongue strength would positively correlate with posterior tongue adiposity, and healthy older adults who aspirate would have greater tongue adiposity than healthy older adults who did not aspirate.

STUDY DESIGN

Prospective.

METHODS

Participants were 40 healthy adults, comprised of 20 aspirators (mean age, 78 years) and 20 nonaspirators (mean age, 81 years), as identified via flexible endoscopic evaluation of swallowing. Measures of maximal isometric posterior tongue strength and posterior swallowing tongue strength were acquired via tongue manometry. An index of posterior tongue adiposity was acquired via computed tomography for a 1-cm region of interest.

RESULTS

Posterior tongue adiposity was correlated with posterior tongue isometric (r = 0.32, P = .05) but not swallowing pressures (P > .05) as examined with separate partial correlation analyses. Tongue adiposity did not significantly differ as a function of age, gender, or aspiration status (P > .05).

CONCLUSIONS

Lower posterior isometric tongue strength was associated with greater posterior tongue adiposity. However, aspiration in healthy older adults was not affected by posterior tongue adiposity. This finding offers insight into the roles of tongue composition and strength in healthy older adults.

Simultaneous estimation of tongue volume and fat fraction using IDEAL-FSE

PURPOSE

To determine whether high-resolution, high signal-to-noise ratio (SNR) images of the tongue acquired with IDEAL-FSE (iterative decomposition of water and fat with echo asymmetry and least squares estimation) will provide comparable volumetric measures to conventional nonfat-suppressed FSE imaging and to determine the feasibility of estimating the proportion of lingual fat in adults using IDEAL-FSE imaging.

MATERIALS AND METHODS

Healthy volunteers underwent magnetic resonance imaging of the tongue using both IDEAL-FSE and conventional FSE sequences. The tongue was manually outlined to derive both volumetric and fat fraction measures. Intraclass correlation coefficients (ICCs) were computed for intrarater measurement reliability and Spearman's rank correlation tested the relationship between IDEAL-FSE and conventional volumetric measures of the tongue.

RESULTS

IDEAL-FSE imaging yielded almost identical volumetric measures to that of conventional FSE imaging in the same amount of scan time (IDEAL-FSE mean 64.1 cm(3); conventional mean 63.3 cm(3); r = 0.988, P < or = 0.01). The average fat signal fraction across participants was 26.5%. Intrarater reliability was excellent for all measures (ICC > or = 0.92).

CONCLUSION

Our results indicate that IDEAL-FSE provided similar lingual volume estimates to conventional FSE imaging obtained in both the current and previous studies. IDEAL-FSE measures of lingual fat composition may be useful in studies that aim to increase lingual muscle strength and volume in swallowing and speech-disordered populations.

Dynamic imaging of swallowing in a seated position using open-configuration MRI

PURPOSE

To assess the feasibility of dynamic MRI of swallowing in a seated position using an open-configuration MRI scanner, and to compare its capacity for motion analysis around the pharyngeal wall with that of videofluorography.

MATERIALS AND METHODS

Six healthy individuals (four women and two men, mean age = 31.4 +/- 7.5 years) were examined with an open-configuration MRI system using a fast spoiled gradient-recalled echo (SPGR) sequence. Dynamic imaging was performed while the subjects were in a seated position after they swallowed oral contrast medium from a cup. An oral and maxillofacial radiologist measured the motion of six structures: the hyoid bone (HB), larynx (LX), upper oropharynx (UOP), lower oropharynx (LOP), pharyngoesophageal segment (PES) behind the vocal folds, and upper esophagus (ESO). The measured motions were compared with reported values from videofluorography-based observations.

RESULTS

Open-configuration MRI depicted the anatomic structures related to swallowing (lip, tongue, soft palate, mandible, pharynx, HB, LX, and PES), and the course of the mylohyoid muscle (MM). The vertical and anteroposterior displacements of these structures did not differ significantly from those measured by videofluorography.

CONCLUSION

Dynamic imaging of swallowing using open-configuration MRI provides image information comparable to that obtained from videofluorography.

Initial experience with magnetic resonance fluoroscopy in the evaluation of oesophageal motility disorders. Comparison with manometry and barium fluoroscopy

The aim of this paper was to assess the diagnostic value of magnetic resonance (MR) fluoroscopy in the study of oesophageal motility disorders and to compare MR fluoroscopy results with those of manometry and barium contrast radiography. Twenty-five subjects referred for dysphagia and three patients in follow-up after pneumatic dilatation of the lower oesophageal sphincter to treat severe achalasia underwent esophageal manometry, barium contrast radiography and MR fluoroscopy. Examinations were performed on a 1.5 T scanner. Dynamic turbo- fast low angle shot (turbo-FLASH) sequences acquired during oral contrast agent administration were used to perform MR fluoroscopy. MR fluoroscopy correctly diagnosed achalasia in nine patients, uncoordination of esophageal body motility in ten and scleroderma oesophagus in one. Diagnostic performance was satisfactory, with a sensitivity of 87.5% and a specificity of 100% in the general depiction of motility alterations. Our work demonstrates that MR fluoroscopic examination in subject affected by oesophageal motility disorders is feasible and can properly depict motility and morphology alterations, achieving correct diagnosis in the majority of cases. Studies on larger populations are necessary to obtain statistically significant results.