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Feasibility study to assess clinical applications of 3-T cine MRI coupled with synchronous audio recording during speech in evaluation of velopharyngeal insufficiency in children

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Abstract

Background

In the past decade, there has been increased utilization of magnetic resonance imaging (MRI) in evaluating and understanding velopharyngeal insufficiency (VPI). To our knowledge, none of the prior studies with MRI has simultaneously linked the audio recordings of speech during cine MRI acquisition with the corresponding images and created a video for evaluating VPI.

Objective

To develop an MRI protocol with static and cine sequences during phonation to evaluate for VPI in children and compare the findings to nasopharyngoscopy and videofluoroscopy.

Materials and methods

Five children, ages 8–16 years, with known VPI, who had previously undergone nasopharyngoscopy and videofluoroscopy, were included. MRI examination was performed on a 3-T Siemens scanner. Anatomical data was obtained using an isotropic T2-weighted 3-D SPACE sequence with multiplanar reformation capability. Dynamic data was obtained using 2-D FLASH cine sequences of the airway in three imaging planes during phonation. Audio recordings were captured by a MRI compatible optical microphone.

Results

All five cases had MRI and nasopharyngoscopy and four had videofluoroscopy performed. VPI was identified by MRI in all five patients. The location and severity of the velopharyngeal gap, closure pattern, velar size and shape and levator veli palatini (LVP) muscle were identified in all patients. MRI was superior in visualizing the integrity of the LVP muscle. MRI was unable to identify hemipalatal weakness in one case. In a case of stress-induced VPI, occurring only during clarinet playing, cine MRI demonstrated discordant findings of a velopharyngeal gap during phonatory tasks but not with instrument playing. Overall, there was satisfactory correlation among MRI, nasopharyngoscopy and videofluoroscopy findings.

Conclusion

Cine MRI of the airway during speech is a noninvasive, well-tolerated diagnostic imaging tool that has the potential to serve as a guide prior to and after surgical correction of VPI. MRI provided superior anatomical detail of the levator musculature. The creation of a video with recorded phonation allowed correlation between palatal movements and specific phonatory tasks.

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Authors and Affiliations

  1. Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, 34 Fruit St., Ellison 237, Boston, MA, 02114, USA

    Pallavi Sagar & Katherine Nimkin

Authors
  1. Pallavi Sagar
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  2. Katherine Nimkin
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Corresponding author

Correspondence to Pallavi Sagar.

Electronic supplementary material

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Video 1

Axial oblique mild VPI and sagittal mild VPI. There is small constant velopharyngeal gap throughout the entire axial oblique cine MRI acquisition during “pick up the baby” phrasing. The sagittal cine MRI demonstrates knee-bend configuration of the soft palate with touch closure to the posterior pharyngeal during “Suzie has shoes” phrasing (MPG 1082 kb)

(MPG 1100 kb)

Video 2

Axial oblique moderate VPI. There is a moderate constant velopharyngeal gap with asymmetrical and diminished motion of the left lateral pharyngeal wall during “pick up the baby” phrasing (MPG 1084 kb)

Video 3

Axial oblique mild VPI during phonation and axial oblique, no VPI, during recorder playing. There is a small constant velopharyngeal gap during phonation with “pick up the baby” phrasing; however, no gap was demonstrated during recorder playing (MPG 1094 kb)

(MPG 1100 kb)

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Sagar, P., Nimkin, K. Feasibility study to assess clinical applications of 3-T cine MRI coupled with synchronous audio recording during speech in evaluation of velopharyngeal insufficiency in children. Pediatr Radiol 45, 217–227 (2015). https://doi.org/10.1007/s00247-014-3141-7

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  • DOI: https://doi.org/10.1007/s00247-014-3141-7

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