Echtzeit-Magnetresonanztomografie (real-time, RT-MRT) zur Evaluation von Schluckstörungen bei Patienten mit neurologischen Erkrankungen

by Saskia Gesine Schütz
Doctoral thesis
Date of Examination:2022-11-17
Date of issue:2022-11-09
Advisor:Prof. Dr. Jens Schmidt
Referee:Prof. Dr. Arno Olthoff
Referee:Prof. Dr. Thomas Meyer
Persistent Address: http://dx.doi.org/10.53846/goediss-9543

 

 

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Abstract

English

The present work considered the use of novel real-time MRI for the assessment of neurogenic dysphagia. In the prospective pilot study, 10 patients with inclusion body myositis (IBM), 14 patients with myotonic dystrophy type 1 (DM 1) and 18 swallow-healthy control subjects were examined using the novel real-time MRI technique. The possibility of creating real-time measurements on a commercially available 3 Tesla MRI is achieved by recording very fast measurement sequences with high temporal resolution. Complete video sequences of each individual sip can be generated from the recordings. This enables a complete and continuous observation of the bolus transport from the oral cavity to the oesophagus. In this study numerous high-quality real-time MRI-sequences could be generated. The temporal sequence of the bolus transport as well as various measurements regarding the extent of laryngeal elevation, the width of the oesophageal sphincter or the shortening of special mouth muscles groups were evaluated. The data were supplemented by the results from the already established questionnaires "Sydney-Swallowing-Questionnaire", "Health Assessment Questionnaire", "Swallowing Quality of Life" and the “IBM-Functional-Rating Scale”. In the comparison of the case groups among each other, concrete differences in the swallowing act could be visualised. Of particular note are clear differences between the groups in oral bolus control and significant differences in oral transport time. A prolonged pharyngeal transport time was observed in the DM 1 case group for the first time as a presumed correlate of myotonia. The present study not only demonstrated that real-time MRI can be used as a sensitive means of assessing the swallowing act, but it also showed in a comparison of the two control groups that neurogenic dysphagia can be attributed to different pathomechanisms.
Keywords: real-time MRI; dysphagia; myotonic dystrophy; inclusion body myositis
 
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