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Comparison of contrast-enhanced videofluoroscopy to unenhanced dynamic MRI in minor patients following surgical correction of velopharyngeal dysfunction

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare dynamic magnetic resonance imaging (MRI) with videofluoroscopy (VFS) regarding image quality and assessment of gap size between soft palate (SP) and posterior pharyngeal wall (PPW) in children and adolescents following surgical correction of velopharyngeal dysfunction (VPD).

Methods

Twenty-one patients undergoing unenhanced 3-T MRI and contrast-enhanced VFS were included in this IRB-approved prospective study. The MRI scan protocol comprised refocused gradient-echo sequences in transverse and sagittal planes during speech, with TE 1.97 ms, TR 3.95 ms, flip angle 8°, matrix size 128 × 128, and 5-mm slice thickness. Radial k-space sampling and sliding window reconstruction were used to achieve an image acquisition rate of 28 frames per second (fps). VFS with 30 fps was similarly performed in both planes. Closure of the velopharyngeal port during phonation was evaluated by two experienced radiologists.

Results

Eleven (52.4%) patients displayed a complete closure, whereas ten (47.6%) patients showed a post-operative gap during speech. VFS and MRI equally identified the cases with persistent or recurrent VPD. Differences in SP-PPW distance between VFS (3.9 ± 1.6 mm) and MRI (4.1 ± 1.5 mm) were not statistically significant (p = 0.5). The subjective overall image quality of MRI was rated inferior (p < 0.001) compared with VFS, with almost perfect inter-rater agreement (κ = 0.90). The presence of susceptibility artifacts did not limit anatomical measurements.

Conclusion

Dynamic MRI is equally reliable as VFS to assess persistent or recurrent inadequate velum closure in patients following surgical treatment of VPD.

Key Points

• Unenhanced 3-T dynamic MRI and contrast-enhanced videofluoroscopy are equally useful for the identification of patients with incomplete velopharyngeal closure during speech.

• MRI using refocused gradient-echo acquisition with radial k-space sampling and sliding window reconstruction generates diagnostic images with 28 frames per second.

• MRI can offer a radiation-free alternative to currently established videofluoroscopy for young patients.

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Abbreviations

FLASH:

Fast low-angle shot

fps:

Frames per second

MRI:

Magnetic resonance imaging

PPW:

Posterior pharyngeal wall

SP:

Soft palate

SSFP:

Steady-state free precession

VFS:

Videofluoroscopy

VPD:

Velopharyngeal dysfunction

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    C. T. Arendt, K. Eichler, D. Leithner, J. L. Wichmann, T. Gruber-Rouh & T. J. Vogl

  2. Radiology Munich, Munich, Germany

    M. G. Mack

  3. Max Planck Institute for Biophysical Chemistry, Göttingen, Germany

    S. Zhang

  4. Department of Radiology, University Hospital Basel, Basel, Switzerland

    K. T. Block

  5. Department of Radiology, New York University Langone Health, New York, NY, USA

    K. T. Block

  6. Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

    Y. Berdan & R. Sader

  7. Institute for Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany

    M. C. Hoelter

Authors
  1. C. T. Arendt
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  2. K. Eichler
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Corresponding author

Correspondence to C. T. Arendt.

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Guarantor

The guarantor of this publication is Prof. Dr. Thomas J. Vogl. Head of the Department of Interventional and Diagnostic Radiology, University Hospital Frankfurt, Frankfurt, Germany.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects in this study.

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• performed at one institution

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Arendt, C.T., Eichler, K., Mack, M.G. et al. Comparison of contrast-enhanced videofluoroscopy to unenhanced dynamic MRI in minor patients following surgical correction of velopharyngeal dysfunction. Eur Radiol 31, 76–84 (2021). https://doi.org/10.1007/s00330-020-07098-9

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  • DOI: https://doi.org/10.1007/s00330-020-07098-9

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