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3D-CT Evaluation of Swallowing: Metrics of the Swallowing Response Using Swallowing CT. Dysphagia 2021; 37:237-249. [PMID: 33818630 PMCID: PMC8948108 DOI: 10.1007/s00455-021-10288-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 10/28/2022]
Abstract
Videofluoroscopy and videoendoscopy dramatically changed the evaluation and management of swallowing disorders. Later advancements in techniques for the instrumental evaluation of swallowing were limited by technique and positioning. The advent of 320-row area detector CT solved previous challenges and allowed for the study of swallowing physiology and dysphagia in greater detail. In this summary, we describe the history and evolution of CT technology and describe research and clinical applications for the evaluation of swallowing physiology and pathophysiology.
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Treatment for Adults. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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3
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Joujima T, Oda M, Sasaguri M, Habu M, Kataoka S, Miyamura Y, Wakasugi-Sato N, Matsumoto-Takeda S, Takahashi O, Kokuryo S, Sago T, Yoshiga D, Tanaka T, Morimoto Y. Evaluation of velopharyngeal function using high-speed cine-magnetic resonance imaging based on T2-weighted sequences: a preliminary study. Int J Oral Maxillofac Surg 2019; 49:432-441. [PMID: 31451304 DOI: 10.1016/j.ijom.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
The objective was to introduce a new technique for visualizing the three-dimensional (3D) movements of velopharyngeal-related muscles using high-speed cine-magnetic resonance imaging (MRI) based on T2-weighted sequences. The evaluation of phonation- and water swallowing-related events was performed in 11 healthy subjects. Specifically, whether cine-MRI could precisely visualize normal velopharyngeal function during these two events was examined. The 3D movements of the soft palate, superior pharyngeal constrictor muscles, and levator veli palatini muscles were visualized in all 11 subjects. A noteworthy finding was that the magnetic resonance signals of the superior constrictor pharyngeal muscles and the levator veli palatini muscles were significantly higher during phonation and during water swallowing than at rest. This initial study suggests that the 3D movements of velopharyngeal-related muscles can be successfully and precisely visualized without side effects. The magnetic resonance signal changes seen in the superior pharyngeal constrictor and levator veli palatini muscles using the technique described here should be useful to develop better methods of evaluation of velopharyngeal function.
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Affiliation(s)
- T Joujima
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - M Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - M Sasaguri
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - M Habu
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - S Kataoka
- Division of Anatomy, Kyushu Dental University, Kitakyushu, Japan
| | - Y Miyamura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - N Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - S Matsumoto-Takeda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - O Takahashi
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - S Kokuryo
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - T Sago
- Division of Dental Anaesthesiology, Kyushu Dental University, Kitakyushu, Japan
| | - D Yoshiga
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - T Tanaka
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Y Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan.
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Bergeret-Cassagne H, Lazard DS, Lefort M, Hachi S, Leenhardt L, Menegaux F, Russ G, Trésallet C, Frouin F. Sonographic Dynamic Description of the Laryngeal Tract: Definition of Quantitative Measures to Characterize Vocal Fold Motion and Estimation of Their Normal Values. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1037-1044. [PMID: 28072470 DOI: 10.7863/ultra.16.05014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/01/2016] [Indexed: 06/06/2023]
Abstract
Vocal fold motion was analyzed during free breathing using two-dimensional dynamic ultrasound imaging. Two cadavers were first analyzed to define easily identifiable landmarks. Motion of the laryngeal tract was then analyzed in an axial plane. Left and right arytenoids and thyroid cartilage were defined on images corresponding to abduction and adduction of the laryngeal tract. Associated area measurements were established for 50 healthy subjects. All area indices were significantly larger during abduction than adduction. Symmetry of motion was established by comparing each hemi-larynx, and mobility fractions were defined. Normal values of laryngeal motion during free breathing were thus established.
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Affiliation(s)
- Héloïse Bergeret-Cassagne
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Hôpital Pitié-Salpêtrière, Department of General, Visceral and Endocrine Surgery, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Diane S Lazard
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Hôpital Pitié-Salpêtrière, Department of General, Visceral and Endocrine Surgery, Paris, France
- Institut Arthur Vernes, ENT Surgery, Paris, France
| | - Muriel Lefort
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Siham Hachi
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Laurence Leenhardt
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Hôpital Pitié-Salpêtrière, Thyroid and Endocrine Tumors Department, Paris, France
| | - Fabrice Menegaux
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Hôpital Pitié-Salpêtrière, Department of General, Visceral and Endocrine Surgery, Paris, France
| | - Gilles Russ
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Hôpital Pitié-Salpêtrière, Thyroid and Endocrine Tumors Department, Paris, France
| | - Christophe Trésallet
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Hôpital Pitié-Salpêtrière, Department of General, Visceral and Endocrine Surgery, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Frédérique Frouin
- Inserm, CEA, Univ Paris-Sud, CNRS, Université Paris-Saclay, Laboratoire Imagerie Moléculaire In Vivo (IMIV), CEA/I2BM/Service Hospitalier Frédéric Joliot, Orsay, France
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Crary MA. Treatment for Adults. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tanaka T, Oda M, Nishimura S, Kito S, Wakasugi-Sato N, Kodama M, Kokuryo S, Habu M, Miyamoto I, Yamashita Y, Aso A, Sadasue K, Nagashima R, Tominaga K, Yoshioka I, Morimoto Y. The use of high-speed, continuous, T2-weighted magnetic resonance sequences and saline for the evaluation of swallowing. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:490-6. [PMID: 25240997 DOI: 10.1016/j.oooo.2014.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/30/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To introduce a new high-speed, continuous, T2-weighted magnetic resonance imaging (MRI) technique for the evaluation of swallowing by visualizing the flow of saline. STUDY DESIGN In 20 healthy participants, high-speed (10 frames per second), continuous MRI of the pharynx and larynx was performed during administration of 5 mL of saline. The extent to which fluid flow and swallowing (including flow to the esophagus or trachea) could be visualized was determined for all 20 participants. RESULTS Solution flow was visualized, and swallowing events, including the direction of flow to the esophagus, could be visualized with high-speed, continuous MRI for all 20 participants. CONCLUSIONS This initial study suggests that the visualization of saline flow using our method may facilitate functional evaluation of swallowing without side effects.
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Affiliation(s)
- Tatsurou Tanaka
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Masafumi Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Shun Nishimura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Shinji Kito
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Nao Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Masaaki Kodama
- Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Shinya Kokuryo
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Manabu Habu
- Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Ikuya Miyamoto
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Yuichi Yamashita
- Department of Magnetic Resonance Imaging, Toshiba Medical Systems Co, Tochigi, Japan
| | - Asaka Aso
- Department of Magnetic Resonance Imaging, Toshiba Medical Systems Co, Tochigi, Japan
| | - Kazuhiro Sadasue
- Department of Radiology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Riichirou Nagashima
- Department of Radiology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Kazuhiro Tominaga
- Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Izumi Yoshioka
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Yasuhiro Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan; Center for Oral Biological Research, Kyushu Dental University, Kitakyushu, Japan.
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On the physiology of normal swallowing as revealed by magnetic resonance imaging in real time. Gastroenterol Res Pract 2014; 2014:493174. [PMID: 24693283 PMCID: PMC3944779 DOI: 10.1155/2014/493174] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 12/24/2013] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to assess the physiology of normal swallowing using recent advances in real-time magnetic resonance imaging (MRI). Therefore ten young healthy subjects underwent real-time MRI and flexible endoscopic evaluations of swallowing (FEES) with thickened pineapple juice as oral contrast bolus. MRI movies were recorded in sagittal, coronal, and axial orientations during successive swallows at about 25 frames per second. Intermeasurement variation was analyzed and comparisons between real-time MRI and FEES were performed. Twelve distinct swallowing events could be quantified by real-time MRI (start time, end time, and duration).
These included five valve functions: oro-velar opening, velo-pharyngeal closure, glottal closure, epiglottic retroflexion, and esophageal opening; three bolus transports: oro-velar transit, pharyngeal delay, pharyngeal transit; and four additional events: laryngeal ascent, laryngeal descent, vallecular, and piriform sinus filling and pharyngeal constriction. Repetitive measurements confirmed the general reliability of the MRI method with only two significant differences for the start times of the velo-pharyngeal closure (t(8) = −2.4, P ≤ 0.046) and laryngeal ascent (t(8) = −2.6, P ≤ 0.031). The duration of the velo-pharyngeal closure was significantly longer in real-time MRI compared to FEES (t(8) = −3.3, P ≤ 0.011). Real-time MRI emerges as a simple, robust, and reliable tool for obtaining comprehensive functional and anatomical information about the swallowing process.
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Nativ-Zeltzer N, Logemann JA, Kahrilas PJ. Comparison of timing abnormalities leading to penetration versus aspiration during the oropharyngeal swallow. Laryngoscope 2013. [DOI: 10.1002/lary.24408] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Jeri A. Logemann
- Department of Communication Sciences and Disorders; Evanston Illinois
| | - Peter J. Kahrilas
- Department of Medicine; Northwestern University; Feinberg School of Medicine; Chicago Illinois U.S.A
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Zhang S, Olthoff A, Frahm J. Real-time magnetic resonance imaging of normal swallowing. J Magn Reson Imaging 2012; 35:1372-9. [PMID: 22271426 DOI: 10.1002/jmri.23591] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 01/03/2012] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the use of a novel real-time magnetic resonance imaging (MRI) technique for the assessment of normal swallowing dynamics. MATERIALS AND METHODS In a cohort of 10 healthy subjects, real-time MRI movies at 24.3 frames per second were obtained in sagittal, coronal, and axial orientation during self-controlled swallows of 5 mL pineapple juice as oral contrast bolus. All studies were performed with the use of a commercial MRI system at 3 T combining two sets of radiofrequency receiver coils. Real-time movies relied on a fast low-angle shot (FLASH) MRI sequence with radial undersampling and image reconstruction by nonlinear inversion yielding 41.23 msec acquisition time for an in-plane resolution of 1.5 mm. Evaluations focused on clinical image quality as well as visualization and temporal quantification of distinct swallowing functions. RESULTS Throughout the entire process, the swallowing dynamics were well depicted and characterized with almost no visible image artifacts in all subjects. The mid-sagittal plane turned out to be most valuable. The movies allowed for a quantitative determination of the temporal pattern of all swallowing events. CONCLUSION The proposed real-time MRI technique yields noninvasive, robust, and quantitative access to the physiology of normal swallowing in healthy subjects at high temporal resolution and image quality.
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Affiliation(s)
- Shuo Zhang
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.
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10
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Paydarfar D. Protecting the airway during swallowing: What is the role for afferent surveillance? Head Neck 2011; 33 Suppl 1:S26-9. [DOI: 10.1002/hed.21907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2011] [Indexed: 11/07/2022] Open
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11
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Inamoto Y, Fujii N, Saitoh E, Baba M, Okada S, Katada K, Ozeki Y, Kanamori D, Palmer JB. Evaluation of swallowing using 320-detector-row multislice CT. Part II: kinematic analysis of laryngeal closure during normal swallowing. Dysphagia 2010; 26:209-17. [PMID: 20204412 DOI: 10.1007/s00455-010-9276-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 01/20/2010] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to (1) depict normal dynamic swallowing and (2) measure (a) the temporal characteristics of three components of laryngeal closure, i.e., true vocal cord (TVC) closure, closure of the laryngeal vestibule at the arytenoid to epiglottic base, and epiglottic inversion, and (b) the temporal relationship between these levels of laryngeal closure and other swallowing events, hyoid elevation, and the pharyngoesophageal segment (PES) using 320-detector-row multislice computed tomography (320-MSCT). The swallowing of a 10-ml portion of honey-thick liquid (5% w/v) was examined in six healthy volunteers placed in a 45° reclining position. Three-dimensional CT images were created in 29 phases at an interval of 0.10 s over a 2.90-s duration. Dynamic swallowing and TVC movement were depicted clearly. The sequence for laryngeal closure was the following: (1) the hyoid started to elevate, (2) the PES opened, (3) TVC closure and closure at the arytenoid to epiglottic base occurred almost simultaneously during the hyoid elevation, and (4) the epiglottic maximum inversion occurred after the hyoid maximum displacement. Those results indicated that the onset of hyoid elevation and the early opening of the PES occurring before three levels of laryngeal closure are critical components for airway protection. 320-MSCT allowed the 3D depiction and kinematic analysis of target structures, which will increase our knowledge of airway protection mechanisms during swallowing.
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Affiliation(s)
- Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan.
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Evaluation of Swallowing Using 320-Detector-Row Multislice CT. Part I: Single- and Multiphase Volume Scanning for Three-dimensional Morphological and Kinematic Analysis. Dysphagia 2010; 26:99-107. [DOI: 10.1007/s00455-009-9268-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 12/18/2009] [Indexed: 12/30/2022]
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13
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Gokyigit MC, Pazarci NK, Ercan I, Seker S, Turgut S, Ertekin C. Identification of distinct swallowing patterns for different bolus volumes. Clin Neurophysiol 2009; 120:1750-4. [PMID: 19699145 DOI: 10.1016/j.clinph.2009.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Revised: 07/09/2009] [Accepted: 07/24/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the time interval between glottic closure and the opening of upper esophageal sphincter during swallowing, by means of the coupling of electromyographical (EMG) recordings on the thyroarytenoid (TA) and the cricopharyngeus (CP) muscles. METHODS TA-EMG and CP-EMG pause were recorded by concentric needle electrodes using time-locked delay-line circuitry of the EMG apparatus. EMG data obtained from a total of 273 swallows of saliva, 3, 5, 10 and 15 ml volumes of water, were compared. RESULTS The relation between the onsets of TA-EMG activity and the CP-EMG pause demonstrated three different patterns of swallows. Pattern A was the delay of the onset of TA-EMG between 50-500 ms, and pattern B was the overlap of its activity with the CP-EMG pause. Pattern C was the earlier occurrence of the TA-EMG 50-550 ms before the CP-EMG pause. Pattern A was the most frequent type of swallows whereas the pattern C appeared during swallowing of larger volumes. CONCLUSIONS Physiologically, there is a delay of the TA activation after the onset of CP-EMG pause during swallowing of small amounts in healthy subjects. SIGNIFICANCE This physiological phenomenon could be a potential risk of aspiration in patients with neurogenic dysphagia.
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Affiliation(s)
- M Celik Gokyigit
- Department of Neurology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
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Breyer T, Echternach M, Arndt S, Richter B, Speck O, Schumacher M, Markl M. Dynamic magnetic resonance imaging of swallowing and laryngeal motion using parallel imaging at 3 T. Magn Reson Imaging 2008; 27:48-54. [PMID: 18617347 DOI: 10.1016/j.mri.2008.05.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 05/23/2008] [Accepted: 05/23/2008] [Indexed: 10/21/2022]
Abstract
OBJECT To evaluate the feasibility of an optimized MRI protocol based on high field imaging at 3 T in combination with accelerated data acquisition by parallel imaging for the analysis of oropharyngeal and laryngeal function. MATERIALS AND METHODS Fast 2D gradient echo (GRE) MRI with different spatial resolutions (1.7x2.7 and 1.1x1.5 mm2) and image update rates (4 and 10 frames per second) was employed to assess pharyngeal movements and visualize swallowing via tracking of an oral contrast bolus (blueberry juice). In a study with 10 normal volunteers, image quality was semi-quantitatively graded by three independent observers with respect to the delineation of anatomical detail and depiction of oropharynx and larynx function. Additionally, the feasibility of the technique for the visualization of pathological pre- and post-surgical oropharynx and larynx function was evaluated in a patient with inspiratory stridor. RESULTS Image grading demonstrated the feasibility of dynamic MRI for the assessment of normal oropharynx and larynx anatomy and function. Superior image quality (P<.05) was found for data acquisition with four frames per second and higher spatial resolution. In the patient, dynamic MRI detected pathological hypermobility of the epiglottis resulting in airway obstruction. Additional post-surgical MRI for one clinical case revealed morphological changes of the epiglottis and improved function, i.e., absence of airway obstruction and normal swallowing. CONCLUSION Results of the volunteer study demonstrated the feasibility of dynamic MRI at 3 T for the visualization of the oropharynx and larynx function during breathing, movements of the tongue and swallowing. Future studies are necessary to evaluate its clinical value compared to existing modalities based on endoscopy or radiographic techniques.
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Affiliation(s)
- Tobias Breyer
- Section of Neuroradiology, Freiburg Institute of Musicians Medicine, Department of Otorhinolaryngology, University of Freiburg, 79106 Freiburg, Germany
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15
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Gilbert RJ, Napadow VJ, Gaige TA, Wedeen VJ. Anatomical basis of lingual hydrostatic deformation. J Exp Biol 2007; 210:4069-82. [PMID: 18025008 DOI: 10.1242/jeb.007096] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SUMMARYThe mammalian tongue is believed to fall into a class of organs known as muscular hydrostats, organs for which muscle contraction both generates and provides the skeletal support for motion. We propose that the myoarchitecture of the tongue, consisting of intricate arrays of muscular fibers, forms the structural basis for hydrostatic deformation. Owing to the fact that maximal diffusion of the ubiquitous water molecule occurs orthogonal to the short axis of most fiber-type cells, diffusion-weighted magnetic resonance imaging (MRI)measurements can be used to derive information regarding 3-D fiber orientation in situ. Image data obtained in this manner suggest that the tongue consists of a complex juxtaposition of muscle fibers oriented in orthogonal arrays, which provide the basis for multidirectional contraction and isovolemic deformation. From a mechanical perspective, the lingual tissue may be considered as set of continuous coupled units of compression and expansion from which 3-D strain maps may be derived. Such functional data demonstrate that during physiological movements, such as protrusion, bending and swallowing, hydrostatic deformation occurs via synergistic contractions of orthogonally aligned intrinsic and extrinsic fibers. Lingual deformation can thus be represented in terms of models demonstrating that synergistic contraction of fibers at orthogonal or near-orthogonal directions to each other is a necessary condition for volume-conserving deformation. Evidence is provided in support of the supposition that hydrostatic deformation is based on the contraction of orthogonally aligned intramural fibers functioning as a mechanical continuum.
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Affiliation(s)
- Richard J. Gilbert
- Department of Mechanical Engineering, Massachusetts Institute of Technology and the Athinoula A. Martinos Center for Biomedical Imaging,Massachusetts General Hospital, Cambridge, MA 02139, USA
| | - Vitaly J. Napadow
- Department of Mechanical Engineering, Massachusetts Institute of Technology and the Athinoula A. Martinos Center for Biomedical Imaging,Massachusetts General Hospital, Cambridge, MA 02139, USA
| | - Terry A. Gaige
- Department of Mechanical Engineering, Massachusetts Institute of Technology and the Athinoula A. Martinos Center for Biomedical Imaging,Massachusetts General Hospital, Cambridge, MA 02139, USA
| | - Van J. Wedeen
- Department of Mechanical Engineering, Massachusetts Institute of Technology and the Athinoula A. Martinos Center for Biomedical Imaging,Massachusetts General Hospital, Cambridge, MA 02139, USA
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16
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Felton SM, Gaige TA, Reese TG, Wedeen VJ, Gilbert RJ. Mechanical basis for lingual deformation during the propulsive phase of swallowing as determined by phase-contrast magnetic resonance imaging. J Appl Physiol (1985) 2007; 103:255-65. [PMID: 17395759 DOI: 10.1152/japplphysiol.01070.2006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The tongue is an intricately configured muscular organ that undergoes a series of rapid shape changes intended to first configure and then transport the bolus from the oral cavity to the pharynx during swallowing. To assess the complex array of mechanical events occurring during the propulsive phase of swallowing, we employed tongue pressure-gated phase-contrast MRI to represent the tissue's local strain rate vectors. Validation of the capacity of phase-contrast MRI to represent local compressive and expansive strain rate was obtained by assessing deformation patterns induced by a synchronized mechanical plunger apparatus in a gelatinous material phantom. Physiological strain rate data were acquired in the sagittal and coronal orientations at 0, 200, 400, and 600 ms relative to the gating pulse during 2.5-ml water bolus swallows. This method demonstrated that the propulsive phase of swallowing is associated with a precisely organized series of compressive and expansive strain rate events. At the initiation of propulsion, bolus position resulted from obliquely aligned compressive and expansive strain, vertically aligned compressive strain and orthogonal expansion, and compressive strain aligned obliquely to the styloid process. Bolus reconfiguration and translocation resulted from a combination of compressive strain occurring in the middle and posterior tongue aligned obliquely between the anterior-inferior and the posterior-superior regions with commensurate orthogonal expansion, along with bidirectional contraction in the distribution of the transversus and verticalis muscle fibers. These data support the concept that propulsive lingual deformation is due to complex muscular interactions involving both extrinsic and intrinsic muscles.
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Affiliation(s)
- Samuel M Felton
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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17
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Ahmad M, Dargaud J, Morin A, Cotton F. Functional morphology of phonation evaluated by dynamic MRI. Surg Radiol Anat 2006; 28:481-5. [PMID: 16628380 DOI: 10.1007/s00276-006-0120-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Accepted: 03/20/2006] [Indexed: 10/24/2022]
Abstract
The complex anatomy of the larynx is a consequence of its various airway functions. The aim of the present study was to evaluate which anatomical structures of the larynx soft tissues could be defined using MRI, and to investigate the feasibility of using this technique to assess the dynamic functions of the larynx. MRI images of the larynx of six healthy volunteers during speech production were obtained in vivo. The volunteers were asked to breathe out long and deep in order to prolong in a normal voice the emission of the vowels [i] (as in key) and [a] (as in car) and the consonant [ch] (as in ship). We demonstrated the modification of the larynx position, which is high for [i] and low for [a], and the modification of the vocal folds which is adducted and abducted in [i] and kept abducted in [ch]. Dynamic MRI allows the possibility of multiplanar high-resolution imaging. It can provide information about the anatomy of the larynx and, it also has the ability to image moving laryngeal structures and to analyze vocal fold vibrations during phonation.
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Affiliation(s)
- M Ahmad
- Laboratoire d'anatomie, UFR de Médecine Lyon Grange- Blanche, Université Lyon I, 8, Avenue Rockefeller, 69373, Lyon Cedex 08, France
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Van Daele DJ, McCulloch TM, Palmer PM, Langmore SE. Timing of glottic closure during swallowing: a combined electromyographic and endoscopic analysis. Ann Otol Rhinol Laryngol 2005; 114:478-87. [PMID: 16042106 DOI: 10.1177/000348940511400610] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We performed a case series to enhance our understanding of the coupling between neuromuscular events and glottic closure. METHODS We performed combined flexible video laryngoscopy and electromyography in 4 healthy human subjects. Hooked-wire electrodes were placed in the superior pharyngeal constrictor, longitudinal pharyngeal, cricopharyngeus, thyroarytenoid, genioglossus, suprahyoid, and posterior cricoarytenoid muscles. A flexible endoscope tip was positioned in the oropharyngeal-hypopharyngeal region. The subjects performed multiple trials each of 10-mL normal and super-supraglottic liquid swallows. RESULTS Arytenoid movement consistently preceded full glottic closure and was associated with cessation of activity of the posterior cricoarytenoid muscle. In 89% of normal swallows, the glottis was partially open in the video frame before bolus passage. The maximum amount of thyroarytenoid electromyographic activity occurred during endoscopic whiteout. When subjects executed a super-supraglottic swallow, early thyroarytenoid activity coincided with arytenoid contact. CONCLUSIONS The initial medialization of the arytenoids is due to a decrease in motor tone of the posterior cricoarytenoid muscle. Full glottic closure typically occurs late in the process of swallowing, with activation of the thyroarytenoid muscle. Shifting of arytenoid medialization and glottic closure earlier in the super-supraglottic swallow indicates that glottic closure is under significant voluntary control.
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Affiliation(s)
- Douglas J Van Daele
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa 52242-1078, USA
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Jafari S, Prince RA, Kim DY, Paydarfar D. Sensory regulation of swallowing and airway protection: a role for the internal superior laryngeal nerve in humans. J Physiol 2003; 550:287-304. [PMID: 12754311 PMCID: PMC2343009 DOI: 10.1113/jphysiol.2003.039966] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Accepted: 04/10/2003] [Indexed: 11/08/2022] Open
Abstract
During swallowing, the airway is protected from aspiration of ingested material by brief closure of the larynx and cessation of breathing. Mechanoreceptors innervated by the internal branch of the superior laryngeal nerve (ISLN) are activated by swallowing, and connect to central neurones that generate swallowing, laryngeal closure and respiratory rhythm. This study was designed to evaluate the hypothesis that the ISLN afferent signal is necessary for normal deglutition and airway protection in humans. In 21 healthy adults, we recorded submental electromyograms, videofluoroscopic images of the upper airway, oronasal airflow and respiratory inductance plethysmography. In six subjects we also recorded pressures in the hypopharynx and upper oesophagus. We analysed swallows that followed a brief infusion (4-5 ml) of liquid barium onto the tongue, or a sip (1-18 ml) from a cup. In 16 subjects, the ISLN was anaesthetised by transcutaneous injection of bupivacaine into the paraglottic compartment. Saline injections using the identical procedure were performed in six subjects. Endoscopy was used to evaluate upper airway anatomy, to confirm ISLN anaesthesia, and to visualise vocal cord movement and laryngeal closure. Comparisons of swallowing and breathing were made within subjects (anaesthetic or saline injection vs. control, i.e. no injection) and between subjects (anaesthetic injection vs. saline injection). In the non-anaesthetised condition (saline injection, 174 swallows in six subjects; no injection, 522 swallows in 20 subjects), laryngeal penetration during swallowing was rare (1.4 %) and tracheal aspiration was never observed. During ISLN anaesthesia (16 subjects, 396 swallows), all subjects experienced effortful swallowing and an illusory globus sensation in the throat, and 15 subjects exhibited penetration of fluid into the larynx during swallowing. The incidence of laryngeal penetration in the anaesthetised condition was 43 % (P < 0.01, compared with either saline or no injection) and of these penetrations, 56 % led to tracheal aspiration (without adverse effects). We further analysed the swallow cycle to evaluate the mechanism(s) by which fluid entered the larynx. Laryngeal penetration was not caused by premature spillage of oral fluid into the hypopharynx, delayed clearance of fluid from the hypopharynx, or excessive hypopharyngeal pressure generated by swallowing. Furthermore, there was no impairment in the ability of swallowing to halt respiratory airflow during the period of pharyngeal bolus flow. Rather, our observations suggest that loss of airway protection was due to incomplete closure of the larynx during the pharyngeal phase of swallowing. In contrast to the insufficient closure during swallowing, laryngeal closure was robust during voluntary challenges with the Valsalva, Müller and cough manoeuvres under ISLN anaesthesia. We suggest that an afferent signal arising from the ISLN receptor field is necessary for normal deglutition, especially for providing feedback to central neural circuits that facilitate laryngeal closure during swallowing. The ISLN afferent signal is not essential for initiating and sequencing the swallow cycle, for co-ordinating swallowing with breathing, or for closing the larynx during voluntary manoeuvres.
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Affiliation(s)
- Samah Jafari
- Department of Neurology, University of Massachusetts Medical School, Worcester 01655, USA
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Anagnostara A, Stoeckli S, Weber OM, Kollias SS. Evaluation of the anatomical and functional properties of deglutition with various kinetic high-speed MRI sequences. J Magn Reson Imaging 2001; 14:194-9. [PMID: 11477680 DOI: 10.1002/jmri.1172] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We evaluated various fast MR sequences for obtaining anatomical and dynamic functional information during deglutition. Seven healthy volunteers underwent MRI of the oropharynx during swallowing of an oral positive-contrast agent. Single-slice imaging was performed in the median sagittal plane while subjects were in a supine position. Twenty serial images were obtained using EPI, FLASH, and turbo-FLASH sequences. The dynamic (movement-related) information and the anatomical resolution of the soft tissues were evaluated during deglutition. The FLASH sequence provided high-quality images at rest. During swallowing, however, the images were significantly degraded by movement artifacts and had inferior temporal resolution. The EPI evidenced better temporal resolution, but was degraded by strong distortions and movement artifacts. The turbo-FLASH sequence provided the best temporal resolution and sufficient spatial resolution during motion. This sequence proved optimal for the investigation of swallowing function, and is expected to be of value for the documentation of functional disturbances in patients with oropharyngeal pathology.
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Affiliation(s)
- A Anagnostara
- Institute of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
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Gilbert RJ, Daftary S, Campbell TA, Weisskoff RM. Patterns of lingual tissue deformation associated with bolus containment and propulsion during deglutition as determined by echo-planar MRI. J Magn Reson Imaging 1998; 8:554-60. [PMID: 9626868 DOI: 10.1002/jmri.1880080307] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Disordered lingual function is a common clinical attribute of patients with oropharyngeal dysphagia. To determine physiologic patterns of lingual tissue motion during swallowing, we imaged the actively deforming tongue during water bolus swallows with sequential single-slice sagittal orientation echo-planar imaging. At rest, with the bolus contained in the oral cavity before swallow initiation, the tongue displayed a characteristic curved configuration consisting of a convex surface (anterior to the bolus) in continuity with a concave surface (containing the bolus) and a posterior-located convex surface (comprising the tongue base). With swallow initiation, the previously deformed tongue underwent rapid biphasic displacement: (a) superior displacement of the anterior tongue and deepening of the midposterior-located bolus-containing concavity, resulting in a laterally beveled surface encompassing the bolus; and (b) retrograde displacement of the configured tissue, resulting in clearance of the bolus from the oral cavity to the oropharynx. These findings indicate that deglutitive tongue action can be depicted by echo-planar imaging as a series of deformative surface modifications, which are related to the activity of intrinsic and extrinsic lingual muscles.
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Affiliation(s)
- R J Gilbert
- Division of Gastroenterology, St. Elizabeth's Medical Center, Boston, MA 02135, USA.
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Gilbert RJ, Daftary S, Woo P, Seltzer S, Shapshay SM, Weisskoff RM. Echo-planar magnetic resonance imaging of deglutitive vocal fold closure: normal and pathologic patterns of displacement. Laryngoscope 1996; 106:568-72. [PMID: 8628082 DOI: 10.1097/00005537-199605000-00009] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Abnormalities of vocal fold closure during deglutition predispose to aspiration due to impairment of airway protection. Conventional assessment of deglutitive vocal fold motion with laryngoscopy does not permit visualization through a complete adduction-abduction cycle. We determined spatiotemporal patterns of deglutitive vocal fold adduction through echo-planar magnetic resonance imaging in 15 normal volunteers and 6 patients with vocal fold paralysis. In normal volunteers, deglutitive vocal fold adduction was synchronized with laryngeal elevation, with complete vocal fold closure at the apex. Patients with unilateral vocal fold paralysis demonstrated reduced elevation and medial movement of the involved vocal fold. At maximal laryngeal elevation the uninvolved vocal fold attained a position superior to the paralyzed fold, resulting in level differences and an interglottic gap. Patients with bilateral vocal fold paralysis demonstrated reduced elevation and medial movement of both vocal folds. These findings indicate that normal and abnormal patterns of vocal fold displacement can be distinguished noninvasively through the use of echo-planar imaging.
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Affiliation(s)
- R J Gilbert
- Massachusetts General Hospital and Harvard Medical School, Nuclear Magnetic Resonance Center, Department of Radiology, Charlestown, MA 02114, USA
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