gms | German Medical Science

43. Kongress der Deutschen Gesellschaft für Rheumatologie, 29. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 25. Wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

02.-05. September 2015, Bremen

Novel MRI methodology: real-time assessment of swallowing in inclusion body myositis (IBM)

Meeting Abstract

  • Per-Ole Carstens - Dept. of Neurology, University Medical Centre, Göttingen
  • Shuo Zhang - Biomedizinische NMR Forschungs GmbH at the Max Planck Institute for Biophysical Chemistry, Göttingen
  • Arno Olthoff - Clinic for Otorhinolaryngology, Phoniatrics and Pedaudiology, University Medical Centre Göttingen, Göttingen
  • Tim Friede - Department of Medical Statistics, University Medical Centre, Göttingen, Göttingen
  • Eva Bremen - Universitätsmedizin Göttingen, Klinik für Radiologie, Göttingen
  • Joachim Lotz - Department of Radiology, University Medical Centre Göttingen, Göttingen
  • Jens Frahm - Biomedizinische NMR Forschungs GmbH at the Max Planck Institute for Biophysical Chemistry, Göttingen, Göttingen
  • Jens Schmidt - Universitätsmedizin Göttingen, Klinik für Neurologie, Göttingen

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 43. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 29. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 25. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Bremen, 02.-05.09.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc52.04 - DI.03

doi: 10.3205/15dgrh045, urn:nbn:de:0183-15dgrh0459

Published: September 1, 2015

© 2015 Carstens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



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.