Artikel
Novel MRI methodology: real-time assessment of swallowing in inclusion body myositis (IBM)
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Autoren
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Per-Ole Carstens
- Dept. of Neurology, University Medical Centre, Göttingen
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Shuo Zhang
- Biomedizinische NMR Forschungs GmbH at the Max Planck Institute for Biophysical Chemistry, Göttingen
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Arno Olthoff
- Clinic for Otorhinolaryngology, Phoniatrics and Pedaudiology, University Medical Centre Göttingen, Göttingen
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Tim Friede
- Department of Medical Statistics, University Medical Centre, Göttingen, Göttingen
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Eva Bremen
- Universitätsmedizin Göttingen, Klinik für Radiologie, Göttingen
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Joachim Lotz
- Department of Radiology, University Medical Centre Göttingen, Göttingen
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Jens Frahm
- Biomedizinische NMR Forschungs GmbH at the Max Planck Institute for Biophysical Chemistry, Göttingen, Göttingen
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Jens Schmidt
- Universitätsmedizin Göttingen, Klinik für Neurologie, Göttingen
| Veröffentlicht: | 1. September 2015 |
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Gliederung
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Objective: To demonstrate real-time MRI (RT-MRI) as alternative to X-ray-video-fluoroscopy for assessing dysphagia.
Background: Inclusion-body-myositis (IBM) is a relentlessly progressive muscle disease. Patients can suffer from dysphagia with subsequent aspiration pneumonia and death. Longitudinal swallowing-evaluation is highly desired for clinical trials and daily practice.
Design/methods: IBM patients (N=20) were assessed by Sydney-swallow-questionnaire (SSQ) and swallowing-quality-of-life (SWAL-QoL). Technical outcome-measures included flexible-endoscopic-evaluation-of-swallowing (FEES), video-fluoroscopy (VF) and 45s RT-MRI-assessment of swallowing 5ml pineapple-juice, resulting in a bright image appearance due to natural paramagnetic manganese. Clinical parameters included IBM-functional-rating-scale (IBM-FRS), sIBM-specific-functional-assessment-scale (sIFA) and MRC-sum-score.
Results: Patients displayed typical clinical deficits reflected by IBM-FRS, sIFA and MRC-sum-score, all significantly correlating with each other. Impaired swallowing was present in 18/20 (90%) patients and 13/20 (65%) displayed a relevant dysphagia per SSQ. SWAL-QoL was impaired compared to published values of healthy elderly individuals. All swallowing questionnaires correlated significantly with each other and FEES. RT-MRI was well tolerated by all patients without aspiration. Quantitative assessment of transit-times in pharynx/upper esophagus displayed significant abnormalities compared to healthy controls previously studied by our group. VF and RT-MRI significantly correlated with each other and all swallowing scales. In patients with severe dysphagia, a propulsion of the cricopharyngeal muscle was readily detected by RT-MRI and VF, yet only RT-MRI allowed distinction of soft-tissue. A semi-quantitative assessment by two independent, masked observers revealed a significantly higher reliability of all relevant swallowing parameters by RT-MRI compared to VF.
Conclusion: Dysphagia is present in the majority of IBM patients and RT-MRI is safe and superior to VF for a reliable detection. Compared to VF, RT-MRI facilitates longitudinal assessments and provides a superior distinction of soft-tissue. This novel tool will be of high clinical relevance for assessing dysphagia in IBM as well as in many other conditions.
