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Comparative Study
. 2013 Dec;139(12):1312-9.
doi: 10.1001/jamaoto.2013.5444.

Evaluation of swallow function after tongue cancer treatment using real-time magnetic resonance imaging: a pilot study

Yihe Zu  1 , Shrikanth S Narayanan  2 , Yoon-Chul Kim  2 , Krishna Nayak  2 , Christina Bronson-Lowe  3 , Brenda Villegas  1 , Melody Ouyoung  4 , Uttam K Sinha  1
Affiliations
Comparative Study

Evaluation of swallow function after tongue cancer treatment using real-time magnetic resonance imaging: a pilot study

Yihe Zu et al. JAMA Otolaryngol Head Neck Surg. 2013 Dec.

Abstract

Importance: Magnetic resonance imaging (MRI) has the advantage of imaging swallow function at any anatomical level without changing the position of patient, which can provide detailed information than modified barium swallow, by far the gold standard of swallow evaluation.

Objective: To investigate the use of real-time MRI in the evaluation of swallow function of patients with tongue cancer.

Design, setting, and participants: Real-time MRI experiments were performed on a Signa Excite HD 1.5-T scanner (GE Healthcare), with gradients capable of 40-mT/m (milli-Tesla per meter) amplitudes and 150-mT/m/ms (mT/m per millisecond) slew rates. The sequence used was spiral fast gradient echo sequence. Four men with base of tongue or oral tongue squamous cell carcinoma and 3 age-matched healthy men with normal swallowing participated in the experiment.

Interventions: Real-time MRI of the midsagittal plane was collected during swallowing. Coronal planes between the oral tongue and base of tongue and through the middle of the larynx were collected from 1 of the patients.

Main outcomes and measures: Oral transit time, pharyngeal transit time, submental muscle length change, and the distance change between the hyoid bone and anterior boundary of the thyroid cartilage were measured frame by frame during swallowing.

Results: All the measurable oral transit and pharyngeal transit times of the patients with cancer were significantly longer than the ones of the healthy participants. The changes in submental muscle length and the distance between the hyoid bone and thyroid cartilage happened in concert for all 60 normal swallows; however, the pattern differed for each patient with cancer. To our knowledge, the coronal view of the tongue and larynx revealed information that has not been previously reported.

Conclusions and relevance: This study has demonstrated the potential of real-time MRI to reveal critical information beyond the capacity of traditional videofluoroscopy. Further investigation is needed to fully consider the technique, procedure, and standard scope of applying MRI to evaluate swallow function of patients with cancer in research and clinic practice.

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Conflict of interest statement

Disclosures: None reported.

Figures

Figure 1
Figure 1. Lingual Groove Formation
A, Sagittal schematic showing the location of the coronal slice in panels B and C. B, Lingual asymmetry during quiet breathing. C, Symmetrical lingual surface during swallowing; lingual groove is visible.
Figure 2
Figure 2. Adduction of the Vocal Folds
A, Sagittal schematic showing the location of the coronal slice viewed in panels B and C. B, Vocal folds opening during quiet breathing. C, Vocal folds closing during swallowing; weakness on the left side.
Figure 3
Figure 3. The SM and TH Measurement on a Schematic Mid-Sagittal Image
SM indicates submental muscle length; TH, the distance between the hyoid bone and thyroid cartilage.
Figure 4
Figure 4. The SM and TH Length Change Over a Representative Swallow
A, Normal swallow. The length change in SM and TH happened in concert. B, Swallow by patient 1. The TH contracted much earlier than the SM, and the contraction lasted much longer. C, Swallow by patient 2. The length change of SM and TH happened almost simultaneously. D, Swallow by patient 4. No obvious SM length change during swallowing, while the TH shortened for approximately 0.45 s. SM indicates submental muscle length; and TH, the distance between the hyoid bone and thyroid cartilage.
Figure 5
Figure 5. Tongue Shape Change During the Oral Stage of a Representative Normal Swallow
The bolus was visualized to be transferred from the tip of the tongue to the base of the tongue.
Figure 6
Figure 6. Oral Tongue Fibrosis in Patient 3
Free flap fibrosis due to radiation exposure.
See this image and copyright information in PMC

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