Perry Jamie L, Mason Kazlin, Sutton Bradley P, Kuehn David P
1 Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA.
2 Department of Bioengineering, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
Cleft Palate Craniofac J. 2018 Apr;55(4):499-507. doi: 10.1177/1055665617735998. Epub 2017 Dec 14.
Dynamic magnetic resonance imaging (MRI) has been proposed as a non-invasive, child-friendly, reproducible, and repeatable imaging method providing a 3-dimensional view of the velopharyngeal structures and function during speech. However, the value of dynamic MRI as compared to imaging methods such as nasopharyngoscopy is not well understood. The aim of this study was to compare the ability of nasopharyngoscopy and dynamic MRI to accurately identify velopharyngeal closure patterns among adults without cleft palate.
Participants included 34 healthy adults with normal anatomy between 19 and 33 years of age (mean = 23 years; SD = 4.1 years). Participants underwent dynamic MRI and nasopharyngoscopy studies and comparisons were performed to determine the intra- and inter-rater reliability for accurately determining closure pattern. The MRI acquisition was a dynamic acquisition of a 2D plane.
Strong inter- (κ = .824; P < .001) and intra-rater (Rater 1: κ = 0.879, P < .001, 94% agreement between ratings; Rater 2 with 100% agreement) agreement was observed for the identification of closure pattern using nasopharyngoscopy. Inter-rater agreement for ratings using MRI demonstrated moderate agreement (κ = .489; P < .004). Examining point agreement revealed only 27 of the 33 ratings of MRI showed agreement (80%).
This demonstrates that inter-rater reliability for determining closure patterns from nasopharyngoscopy is good; however, ratings using MRI was less reliable at determining closure patterns. It is likely that future improvements in dynamic imaging with MRI to enable 3D visualizations are needed for improved diagnostic accuracy for assessing velopharyngeal closure patterns.
动态磁共振成像（MRI）已被提议作为一种非侵入性、对儿童友好、可重复且能提供语音过程中腭咽结构和功能三维视图的成像方法。然而，与鼻咽喉镜检查等成像方法相比，动态MRI的价值尚未得到充分理解。本研究的目的是比较鼻咽喉镜检查和动态MRI在准确识别无腭裂成年人腭咽闭合模式方面的能力。
参与者包括34名年龄在19至33岁之间（平均 = 23岁；标准差 = 4.1岁）、解剖结构正常的健康成年人。参与者接受了动态MRI和鼻咽喉镜检查，并进行比较以确定准确确定闭合模式的评分者间和评分者内信度。MRI采集是对二维平面的动态采集。
使用鼻咽喉镜检查识别闭合模式时，观察到评分者间（κ = 0.824；P < 0.001）和评分者内（评分者一：κ = 0.879，P < 0.001，评分间一致性为94%；评分者二一致性为100%）的强一致性。使用MRI评分的评分者间一致性显示为中等一致性（κ = 0.489；P < 0.004）。检查点一致性显示，MRI的33个评分中只有27个显示一致（80%）。
这表明鼻咽喉镜检查确定闭合模式的评分者间信度良好；然而，使用MRI评分在确定闭合模式时可靠性较低。为提高评估腭咽闭合模式的诊断准确性，可能需要对动态MRI进行未来改进以实现三维可视化。
