The Association of 3-D Volume and 2-D Area of Post-swallow Pharyngeal Residue on CT Imaging
- 9 Downloads
Pharyngeal residue, the material that remains in the pharynx after swallowing, is an important marker of impairments in swallowing and prandial aspiration risk. The goals of this study were to determine whether the 2D area of post-swallow residue accurately represents its 3D volume, and if the laterality of residue would affect this association. Thirteen patients with dysphagia due to brainstem stroke completed dynamic 320-detector row computed tomography while swallowing a trial of 10 ml honey-thick barium. 3D volumes of pharyngeal residue were compared to 2D lateral and anterior–posterior areas, and a laterality index for residue location was computed. Although the anteroposterior area of residue was larger than the lateral area, the two measures were positively correlated with one another and with residue volume. On separate bivariate regression analyses, residue volume was accurately predicted by both lateral (R2 = 0.91) and anteroposterior (R2 = 0.88) residue areas, with limited incidence of high residuals. Half of the sample demonstrated a majority of pharyngeal residue lateralized to one side of the pharynx, with no effect of laterality on the association between areas and volume. In conclusion, the area of post-swallow pharyngeal residue was associated with volume, with limitations in specific cases. Direct measurement of pharyngeal residue volume and swallowing physiology with 3D-CT can be used to validate results from standard 2D instrumentation.
KeywordsPharynx Dynamic computed tomography Brainstem stroke Residue Deglutition Deglutition disorders
The research reported in this paper was partially supported. The authors would like to thank the staff of Fujita Health University Hospital, Department of Radiology, for their generous support and assistance with CT imaging and data collection.
This research was partially supported by JSPS KAKENHI (No. 25750236 Inamoto) and by the National Institute of Child Health and Human Development- National Center for Medical Rehabilitation Research through award 5T32HD007414-23 (Mulheren); the content is solely the responsibility of the authors and does not necessarily represent the views the National Institutes of Health.
Compliance with Ethical Standards
Conflict of interest
No conflict of interest declared.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 5.Veis SL, Logemann JA. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil. 1985;66:372–5.Google Scholar
- 24.Rao N, Brady SL, Chaudhuri G, Donzelli JJ, Wesling MW (2003) Gold-standard? Analysis of the videofluoroscopic and fiberoptic endoscopic swallow examinations 3.Google Scholar
- 25.Fujii N, Inamoto Y, Saitoh E, Baba M, Okada S, Yoshioka S, Nakai T, Ida Y, Katada K, Palmer JB. Evaluation of swallowing using 320-detector-row multislice CT. Part I: single-and multiphase volume scanning for three-dimensional morphological and kinematic analysis. Dysphagia. 2011;26:99–107.CrossRefGoogle Scholar
- 32.Inamoto Y, Saitoh E, Shibata S, Kagaya H, Nakayama E, Ota K, Onogi K, Kawamura Y. Effectiveness and applicability of a specialized evaluation exercise-chair in posture adjustment for swallowing. Jpn J Compr Rehabil Sci. 2014;5:33–9.Google Scholar
- 35.Chen MY, Peele VN, Donati D, Ott DJ, Donofrio PD, Gelfand DW. Clinical and videofluoroscopic evaluation of swallowing in 41 patients with neurologic disease. Abdom Imaging. 1992;17:95–8.Google Scholar
- 41.Ota K, Saitoh E, Kagaya H, Sonoda S, Shibata S. Effect of postural combinations—the reclined seated position combined with head rotation—on the transport of boluses and aspiration. Jpn J Compr Rehabil Sci. 2011;2:36–41.Google Scholar
- 44.Kagaya H, Inamoto Y, Okada S, Saitoh E. Body positions and functional training to reduce aspiration in patients with dysphagia. JMAJ. 2011;54:35–8.Google Scholar
- 45.Inamoto Y, Kagaya H, Saitoh E, Kanamori D, Shibata S, Fujii N, Katada K, Palmer JB. Inter-rater and intra-subject reliability for the evaluation of swallowing kinematics using 320-row area detector computed tomography. Jpn J Compr Rehabil Sci. 2012;3:59–65.Google Scholar