Evaluation of dysphagia by novel real-time MRI
Evaluation of dysphagia by novel real-time MRI
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DOI：
10.1212/wnl.0000000000003337
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发表时间：
2016-11-15
期刊：
影响因子：
9.9
通讯作者：
Schmidt, Jens
中科院分区：
文献类型：
--
作者：
Olthoff, Arno;Carstens, Per-Ole;Schmidt, Jens
目的：在一组包涵体肌炎(IBM)患者中，评价实时(RT)MRI评估吞咽困难的安全性和可行性，并将其与灵活的吞咽(FECURES)和视频透视(VF)评估标准进行比较。方法：使用RT-MRI、FECURES和VF，对20例具有一致吞咽困难的IBM患者进行研究。采用标准化工具包括吞咽相关生活质量问卷(SWAL-QOL)、IBM功能评定量表、患者报告功能评定量表和医学研究理事会量表对IBM患者的吞咽困难症状和吞咽困难进行调查。结果：与已发表的健康老年人参考值相比，IBM患者有80%的患者出现吞咽困难，SWAL-QOL受损。所有患者在RT-MRI检查中均能耐受仰卧位吞咽。与室颤和费用相比，RT-MRI同样显示吞咽困难，并且与SWAL-QOL有很好的相关性。只有RT-MRI可以精确地测量时间并识别各自的组织形态。咽部通过时间是已发表参考值的2倍，且与形态异常显著相关。结论：RT-MRI是安全的，与VF一样，可以确定IBM吞咽困难的原因。RT-MRI的优势包括软组织的可视化，更可靠的时间分析，以及不需要X射线曝光。RT-MRI可能成为一种常规诊断工具，用于详细评估食道和身体其他活动部分，便于在日常实践和临床试验中进行纵向评估。
Objective: To assess safety and feasibility of real-time (RT) MRI for evaluation of dysphagia and to compare this technique to standard assessment by flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopy (VF) in a cohort of patients with inclusion body myositis (IBM).Methods: Using RT-MRI, FEES, and VF, an unselected cohort of 20 patients with IBM was studied as index disease with a uniform dysphagia. Symptoms of IBM and dysphagia were explored by standardized tools including Swallowing-Related Quality of Life Questionnaire (SWAL-QoL), IBM Functional Rating Scale, Patient-Reported Functional Assessment, and Medical Research Council Scale.Results: Dysphagia was noted in 80% of the patients and SWAL-QoL was impaired in patients with IBM compared to published reference values of healthy elderly. Swallowing in a supine position during RT-MRI was well-tolerated by all patients. RT-MRI equally revealed dysphagia compared to VF and FEES and correlated well with the SWAL-QoL. Only RT-MRI allowed precise time measurements and identification of the respective tissue morphology. The pharyngeal transit times were 2-fold longer compared to published reference values and significantly correlated with morphologic abnormalities.Conclusions: RT-MRI is safe and equally capable as VF to identify the cause of dysphagia in IBM. Advantages of RT-MRI include visualization of soft tissue, more reliable timing analysis, and lack of X-ray exposure. RT-MRI may become a routine diagnostic tool for detailed assessment of the esophagus and other moving parts of the body, facilitating longitudinal evaluations in daily practice and clinical trials.