Dynamic near-real-time magnetic resonance imaging for analyzing the velopharyngeal closure in comparison with videofluoroscopy

Purpose: To demonstrate the feasibility of dynamic magnetic resonance imaging (MRI) with near-real-time temporal resolution ("real-time MRI") for analyzing the velopharyngeal closure in comparison with multiview videofluoroscopy. Materials and Methods: Seven patients (three females and four males, 5-21 years old, mean age = 11.3 years) with suspected velopharyngeal insufficiency, and one healthy volunteer were examined with videofluoroscopy and real-time MRI using a turbo-spin-echo (TSE) sequence (TR = 70 msec, TE = 21 msec, slice thickness = 6 mm, six images per second). Imaging was done during phonation in all three image planes. The results were analyzed by two radiologists in comparison with videofluoroscopy as the standard of reference for overall image quality and the pattern of velopharyngeal closure. Results: Real-time MRI correctly depicted the pattern of velopharyngeal closure in correspondence to videofluoroscopy in all cases. Concerning the movement of the pharyngeal walls, real-time MRI falsely depicted a general movement of the dorsal pharyngeal wall in one case, whereas videofluoroscopy showed no movement. In one patient, real-time MRI provided additional information by showing an asymmetric movement of the lateral pharyngeal walls that could not be depicted by videofluoroscopy due to technical limitations. Concerning image quality, the coronal plane was more difficult to evaluate with real-time MRI compared to videofluoroscopy. The axial plane was easier to analyze in real-time MRI compared to videofluoroscopy. Conclusion: Real-time MRI has the potential to depict the pattern of velopharyngeal closure in close correlation with videofluoroscopy, and may deliver additional information in selected cases.