Arno Olthoff1, Per-Ole Carstens2, Shuo Zhang2, Eva von Fintel2, Tim Friede2, Joachim Lotz2, Jens Frahm2, Jens Schmidt1. 1. From the Departments of Otorhinolaryngology, Phoniatrics and Pedaudiology (A.O.), Neurology (P.-O.C., J.S.), Diagnostic and Interventional Radiology (E.v.F., J.L.), and Medical Statistics (T.F.), University Medical Center Göttingen; and Biomedizinische NMR Forschungs GmbH at the Max-Planck-Institute for Biophysical Chemistry (S.Z., J.F.), Göttingen, Germany. j.schmidt@gmx.org olthoff@med.uni-goettingen.de. 2. From the Departments of Otorhinolaryngology, Phoniatrics and Pedaudiology (A.O.), Neurology (P.-O.C., J.S.), Diagnostic and Interventional Radiology (E.v.F., J.L.), and Medical Statistics (T.F.), University Medical Center Göttingen; and Biomedizinische NMR Forschungs GmbH at the Max-Planck-Institute for Biophysical Chemistry (S.Z., J.F.), Göttingen, Germany.
Abstract
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.
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.
Authors: Lisa G Rider; Rohit Aggarwal; Pedro M Machado; Jean-Yves Hogrel; Ann M Reed; Lisa Christopher-Stine; Nicolino Ruperto Journal: Nat Rev Rheumatol Date: 2018-04-12 Impact factor: 20.543