Achieving Clinical Success in Nonsedated Velopharyngeal Magnetic Resonance Imaging: Optimizing Data Quality and Patient Selection

Abstract

Background: The ability of magnetic resonance imaging (MRI) to visualize the velopharyngeal (VP) musculature in vivo makes it the only imaging modality available for this purpose. This underscores a need for exploration into clinical translation of this imaging modality for craniofacial teams. The purpose of this study was to assess outcomes of a clinically feasible VP MRI protocol and describe the ideal patient population for use of this imaging protocol.

Methods: Sixty children (2 to 12 years of age) with VP insufficiency underwent a nonsedated, child-friendly MRI protocol. No exclusions based on syndromic conditions were made. Logistic regression assessed predictors of VP MRI success and multinomial logistic regression evaluated factors influencing quality of anatomic data.

Results: An 85% overall success rate was achieved, including children as young as 2 years and those with syndromic diagnoses. Stratifying by age revealed a 97.5% success rate in children ages 4 and up. The regression model (χ 2 [5] = 37.443; P < 0.001) explained 81.4% of success rate variance, correctly classifying 93.3% of cases. Increased age significantly predicted success ( P = 0.046); sex and syndromic conditions did not. Multinomial regression identified preparatory materials ( P = 0.011) and audio/video during the scan ( P = 0.024) as predictors for improved image quality.

Conclusions: Implementation of VP MRI is feasible for a broad population of children with VP insufficiency, including those with concomitant syndromic diagnoses. Quality is improved by incorporating prescan preparation and audiovisual stimuli during scans. This underscores the potential of VP MRI as a valuable tool in clinical settings, especially for presurgical assessments.

Fig. 1.

Demonstration of supportive protocol elements that were applied. (Above) Preparatory home-based activities and animated video explainers. (Center, left) Comfort items were used for on-site preparation and exploration of the scanning environment. (Center, right) The parent remained in the room while the MRI technologist positioned the patient with audiovisual distractors (selected by the child) playing. (Below, left). The speech–language pathologist dialogued with the MRI technologist to confirm speech samples were produced correctly. (Below, right) Successful data acquisition was achieved, having allowed the child to explore the scanner environment and build rapport before beginning scanning sequences.

Fig. 2.

Visual representation of differing image qualities that may affect visualization or quantification of scan data. Structures of interest are readily visualized and quantified across images with adequate data capture. Inadequate data capture, often due to movement artifact or an inability to complete scanning sequences, typically results in images that are unable to be used for accurate quantitative or qualitative assessment. Inadequate data capture is often associated with a failed scan outcome or poor-quality image.

Fig. 3.

Receiver operating characteristic curve analysis visualization.

Fig. 4.

Characteristics of ideal candidates for nonsedated VP MRI who are likely to achieve successful outcomes with high-quality images.