Cosentini Tommaso, Le Donne Rita, Mancini Donatella, Colavita Nicola
Servizio di Diagnostica per Immagini, Ospedale Generale Provinciale di Rieti, Italy.
Radiol Med. 2004 Oct;108(4):404-16.
To define the role and reliability of MR imaging of the oropharynx during wakefulness in the evaluation of patients with Obstructive Sleep Apnoea Syndrome.
During a 33-month period, 28 patients with clinical diagnosis of Obstructive Sleep Apnoea Syndrome (OSAS) were evaluated with Magnetic Resonance imaging. MR imaging was performed during wakefulness by T1-, DP- and T2-weighted sequences in the sagittal and axial plane. The morphological and quantitative data of the imaging, the majority of which were obtained from the relevant Literature (minimal pharyngeal cross-sectional area and its location and shape, increase of adipose tissue of the neck, tongue swelling, posterior dislocation of the tongue, soft and hard palate length, geniohyoid muscle length, evaluation of oral floor lowering), were subsequently compared with clinical-instrumental parameters (Body Mass Index, apnoea/hypopnoea index, hematocrit, arterial oxygen partial pressure, average nocturnal oxyhemoglobin saturation and sleeping-time percentage with oxygen saturation lower than 90%), to assess correlations.
The minimal pharyngeal cross-area is significantly positively correlated with the arterial oxygen partial pressure and with the average nocturnal oxyhemoglobin saturation and is inversely correlated with the apnoea/hypopnoea index and with the sleeping-time percentage with oxygen saturation lower than 90%; the inverse correlation with the Body Mass Index is less marked. Furthermore, the minimal pharyngeal cross-sectional area is correlated with its shape on the axial section. Increase of the adipose tissue of the neck is significantly correlated with the Body Mass Index, with a low nocturnal oxygen saturation, with a high percentage of sleeping time with oxygen saturation lower than 90%, and with the axial-section shape of the minimal pharyngeal area. An inverse correlation between the soft palate length and the arterial oxygen partial pressure was observed. Oral floor lowering is significantly inversely correlated with the minimal area only if the minimal area is located at the tongue base level and is directly correlated with the Body Mass Index as well as with the apnoea/hypopnoea index. The remaining MR findings appear to be independent parameters that may worsen the syndrome when associated with other parameters.
In patients with a clinical diagnosis of OSAS, MR imaging performed during wakefulness can provide reliable information on the causes, severity and site/s of oropharyngeal obstruction with important consequences on therapeutic decisions.
明确清醒状态下口咽部磁共振成像（MR成像）在阻塞性睡眠呼吸暂停综合征患者评估中的作用及可靠性。
在33个月期间，对28例临床诊断为阻塞性睡眠呼吸暂停综合征（OSAS）的患者进行了磁共振成像评估。清醒状态下通过矢状面和轴面的T1加权、双回波（DP）加权和T2加权序列进行MR成像。成像的形态学和定量数据，其中大部分来自相关文献（最小咽横截面积及其位置和形状、颈部脂肪组织增加、舌肿胀、舌后脱位、软硬腭长度、颏舌骨肌长度、口底降低评估），随后与临床仪器参数（体重指数、呼吸暂停/低通气指数、血细胞比容、动脉血氧分压、夜间平均氧合血红蛋白饱和度以及血氧饱和度低于90%的睡眠时间百分比）进行比较，以评估相关性。
最小咽横截面积与动脉血氧分压、夜间平均氧合血红蛋白饱和度呈显著正相关，与呼吸暂停/低通气指数以及血氧饱和度低于90%的睡眠时间百分比呈负相关；与体重指数的负相关不太明显。此外，最小咽横截面积与其轴面形状相关。颈部脂肪组织增加与体重指数、夜间低氧饱和度、血氧饱和度低于90%的睡眠时间百分比以及最小咽区的轴面形状显著相关。观察到软腭长度与动脉血氧分压呈负相关。仅当最小面积位于舌根水平时，口底降低与最小面积呈显著负相关，且与体重指数以及呼吸暂停/低通气指数直接相关。其余MR表现似乎是独立参数，当与其他参数相关联时可能会使综合征恶化。
对于临床诊断为OSAS的患者，清醒状态下进行的MR成像可为口咽部阻塞的原因、严重程度及部位提供可靠信息，对治疗决策具有重要影响。
