Concordance Between Aspiration Detected on Upper Gastrointestinal Series and Videofluoroscopic Swallow Study in Bottle-Fed Children.
Concordance Between Aspiration Detected on Upper Gastrointestinal Series and Videofluoroscopic Swallow Study in Bottle-Fed Children.
复制标题
上消化道系列检测到的误吸与奶瓶喂养儿童的电视透视吞咽研究之间的一致性。
DOI：
10.1007/s00455-016-9705-y
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发表时间：
2016
期刊：
影响因子：
2.6
通讯作者：
Lefton-Greif,MaureenA
中科院分区：
文献类型：
--
作者：
Flax-Goldenberg,Renee;Kulkarni,KopalS;Carson,KathrynA;Pinto,JeanneM;Martin-Harris,Bonnie;Lefton-Greif,MaureenA
儿童吞咽困难的发病率越来越高，这引发了如何识别有误吸风险的儿童的问题。由于吞咽困难可能涉及吞咽的任何阶段或所有阶段，因此在诊断算法中考虑了多种调查性成像方式。虽然上胃肠道（UGI）系列检查和视频透视吞咽检查（VFSS）是常见的检查程序，但UGI用于检测误吸的效用以及UGI期间口咽成像对辐射暴露的影响尚未得到很好的描述。我们假设UGI的吸入诊断可以预测VFSS的吸入，而UGI期间筛查燕子会增加辐射暴露。对标准化VFSS前后1个月内接受UGI系列的奶瓶喂养儿童进行回顾性研究。UGI以每秒3帧（fps）脉冲成像，VFSS以每秒30帧的连续透视成像。记录累积辐射剂量（CD）和剂量面积积（DAP）。49例患者行VFSS和UGI；然而，只有21个（43%）在UGI系列上有吞咽功能的文档。所有在UGI上吸出的患儿在VFSS上均表现为稀液吸出；然而，在UGI上没有吸痰的53%在VFSS上吸痰。有吞咽记录的UGI的CD明显高于无吞咽记录的（中位数= 0.33 vs. 0.21 mGy,p= 0.02），但在透视设备的可变性范围内。有吞咽记录的UGI的DAP没有显著高于无吞咽记录的UGI（中位数= 4.11 vs. 3.02 μGy cm2,p= 0.09）。UGI是VFSS吸入的特异性指标，但不敏感。UGI上的吞咽成像在辐射照射下可能有明显的增加。
The increasing incidence of pediatric dysphagia has raised questions about how to identify children at risk for aspiration. Multiple investigative imaging modalities are considered in diagnostic algorithms, since dysphagia may involve any or all phases of swallowing. Although upper gastrointestinal (UGI) series and videofluoroscopic swallow study (VFSS) are common procedures, the utility of UGI for detection of aspiration and the impact of oropharyngeal imaging during UGI on radiation exposure have not been well described. We hypothesized that diagnosis of aspiration on UGI would be predictive of aspiration on VFSS and screening swallows during UGI would increase radiation exposure. A retrospective review was completed of bottle-fed children undergoing UGI series within 1 month before/after standardized VFSS. UGI was imaged at 3 frames per second (fps) pulsed and VFSS at 30 fps continuous fluoroscopy. Cumulative radiation dose (CD) and dose area product (DAP) were recorded. VFSS and UGI were performed in 49 patients; however, only 21 (43 %) had documentation of swallow function on an UGI series. All children with aspiration on UGI demonstrated thin liquid aspiration on VFSS; however, 53 % without aspiration on UGI aspirated on VFSS. CD for UGI with versus without swallowing documentation was significantly higher (median = 0.33 vs. 0.21 mGy,p= 0.02) but within variability ranges reported for fluoroscopy equipment. DAP was not significantly higher for UGI with documentation of swallowing compared to without documentation of swallowing (median = 4.11 vs. 3.02 μGy cm2,p= 0.09). UGI findings are specific but not sensitive markers for aspiration on VFSS. Imaging of swallowing on UGI may have an appreciable increase on radiation exposure.