Evaluation of dysphagia by novel real-time MRI

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.