Cappabianca S, Reginelli A, Monaco L, Del Vecchio L, Di Martino N, Grassi R
Section of Radiology, Department Magrassi-Lanzara, Second University of Naples, Via Amendola 8, 81055, Santa Maria Capua Vetere, Caserta, Italy.
Radiol Med. 2008 Sep;113(6):923-40. doi: 10.1007/s11547-008-0290-5. Epub 2008 Jul 24.
Dysphagia is a symptom of different pathological conditions characterised by alteration of the swallowing mechanism, which may manifest at different levels. We report our experience in the evaluation of the swallowing mechanism with combined videofluoroscopy and manometric recordings.
For the combined study, we used a Dyno Compact computerised system (Menfis Biomedical s.r.l., Bologna, Italy) equipped with: (1) graphics card for the management of ultrasonographic or radiological images; (2) A.VI.U.S. dedicated software package, which enables digital-quality recording (PAL/NTSC, composite video or S-Video) of the videofluoroscopy study in AVI format with 320 x 240 resolution and 25 Hz acquisition frequency. The delay introduced by the process of image digitalisation is in the order of 200 ms, so for analysis purposes, the images can be considered synchronised with the manometric recordings. The videomanometry study was performed with the administration of contrast material either in bolus form or diluted. Data were collected on a specifically designed grid for the evaluation of 46 videofluoroscopic items, of which 34 are derived from the laterolateral view (seven in the oral preparatory phase, 15 in the oral transport phase and 12 in the pharyngeal phase) and 12 in the anteroposterior view (six in the oral preparatory phase and six in the oropharyngeal phase). A positive finding for the individual parameters is expressed in a binary fashion. Manometric evaluation was based on 11 items divided into four major and seven minor criteria.
Dynamic videofluoroscopy swallow study combined with concurrent manometry enabled the simultaneous recording of anatomical alterations and the functional data of oropharyngeal pressure, thus providing a picture of the anatomical, biomechanical and physiological conditions of swallowing and the manner of bolus propulsion and transit.
An early and effective diagnosis of oropharyngeal dysphagia means being able to effectively implement appropriate rehabilitation techniques, improve the patient's quality of life, and minimise the complications associated with swallowing disorders (choking, aspiration pneumonia, malnourishment). Distinction of the anatomical level of dysphagia is not a matter of simple classification; rather, it is essential in that different clinical presentations require different diagnostic strategies, and a precise definition of the anatomical-functional substrate is required to implement the correct therapeutic approach. This study presents the authors' experience with the use of combined videofluoroscopy and manometry with particular emphasis on the examination technique.
吞咽困难是一种由吞咽机制改变所表征的不同病理状况的症状,其可能在不同层面表现出来。我们报告了我们在联合使用视频荧光透视和测压记录来评估吞咽机制方面的经验。
对于联合研究,我们使用了一台Dyno Compact计算机系统(意大利博洛尼亚的Menfis Biomedical s.r.l.公司),该系统配备有:(1)用于管理超声或放射图像的图形卡;(2)A.VI.U.S.专用软件包,其能够以320×240分辨率和25Hz采集频率对视频荧光透视研究进行数字质量记录(PAL/NTSC、复合视频或S - Video),并以AVI格式保存。图像数字化过程所引入的延迟约为200毫秒,因此出于分析目的,可认为图像与测压记录是同步的。视频测压研究通过以团注形式或稀释形式给予造影剂来进行。数据收集在一个专门设计的网格上,用于评估46个视频荧光透视项目,其中34个来自侧位视图(口腔准备期7个、口腔运送期15个、咽期12个),12个来自前后位视图(口腔准备期6个、口咽期6个)。各个参数的阳性结果以二元方式表示。测压评估基于11个项目,分为四个主要标准和七个次要标准。
动态视频荧光透视吞咽研究与同步测压相结合,能够同时记录解剖学改变以及口咽压力的功能数据,从而提供一幅关于吞咽的解剖学、生物力学和生理学状况以及食团推进和通过方式的图景。
对口咽吞咽困难进行早期有效的诊断意味着能够有效地实施适当的康复技术,改善患者的生活质量,并将与吞咽障碍相关的并发症(窒息、吸入性肺炎、营养不良)降至最低。区分吞咽困难的解剖层面并非简单的分类问题;相反,这至关重要,因为不同的临床表现需要不同的诊断策略,并且实施正确的治疗方法需要对解剖 - 功能基础有精确的定义。本研究展示了作者在联合使用视频荧光透视和测压方面的经验,特别强调了检查技术。