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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.
GLOSSARY
- CI=
- confidence interval;
- CP=
- cricopharyngeal propulsion;
- EOT=
- esophageal opening time;
- FEES=
- flexible endoscopic evaluations of swallowing;
- IBM=
- inclusion body myositis;
- IBM-FRS=
- IBM Functional Rating Scale;
- MRC=
- Medical Research Council;
- OTT=
- oral transfer time;
- PTT=
- pharyngeal transfer time;
- ROI=
- region of interest;
- RT-MRI=
- real-time MRI;
- SWAL-QoL=
- Swallowing-Related Quality of Life;
- UES=
- upper esophageal sphincter;
- VF=
- videofluoroscopy
Footnotes
↵* The 2 first authors and the 2 senior authors contributed equally to this work.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received April 13, 2016.
- Accepted in final form August 1, 2016.
- © 2016 American Academy of Neurology
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