Wang Yuyu, Wang Qingling, Yu Weixia, Cai Jianzheng, Shan Limi, Wang Xin, Fang Mingjing, Lu Xiaoyan
Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China.
School of Nursing, Medical College of Soochow University, Suzhou, China.
J Oral Rehabil. 2025 Jul;52(7):1094-1110. doi: 10.1111/joor.13992. Epub 2025 May 2.
The use of ultrasound (US) makes it convenient to identify dysphagia or swallowing impairment. The aim of the study was to evaluate the validity and reliability of US measurements for swallowing function.
We conducted a systematic review and meta-analysis. Embase, Medline, Cochrane Library, Web of Science, CINAHL, and Scopus databases were systematically searched from inception to July 22, 2024. Published studies on the validity and reliability of US measurements for assessing dysphagia or swallowing impairment in individuals aged 18 years and older were included. The review followed PRISMA guidelines and was evaluated using the QUADAS-2 tool for diagnostic studies. Two authors independently screened potentially eligible literature, evaluated the quality of the included studies, and then extracted the data. Data synthesis was conducted via random-effects meta-analysis using Stata software.
This review included 38 articles, assessing the value of using hyoid bone displacement, thyrohyoid approximation, and tongue muscle thickness change on US for identifying dysphagia. The pooled sensitivities were 0.64 (95% CI: 0.50-0.79), 0.89 (95% CI: 0.66-1.11), and 0.60 (95% CI: 0.44-0.76), respectively; with pooled specificities of 0.71 (95% CI: 0.64-0.78), 0.82 (95% CI: 0.76-0.88), and 0.69 (95% CI: 0.62-0.77), respectively. Additionally, the area under the summary receiver operating characteristic curve (SROC) for identifying dysphagia using masseter thickness was 0.74 (95% CI: 0.70-0.78). The correlation coefficient of 0.58 (95% CI: 0.20-0.81) was observed between displacement and swallowing function, whereas the correlation for swallowing muscle cross-sectional area (CSA) was 0.26 (95% CI: 0.09-0.42). Meta-analyses revealed intrarater reliability values of 0.88 (95% CI: 0.76-0.94) for displacement, 0.93 (95% CI: 0.87-0.96) for CSA, 0.77 (95% CI: 0.73-0.80) for swallowing muscle thickness, and 0.79 (95% CI: 0.74-0.84) for echo intensity. Interrater reliability values were 0.75 (95% CI: 0.55-0.87) for displacement, 0.89 (95% CI: 0.83-0.94) for CSA, and 0.68 (95% CI: 0.57-0.75) for swallowing muscle thickness.
Data from this review suggested that US was a reliable and valid screening tool for assessing dysphagia and swallowing impairment. Future research could aim at proposing standardised and universal US protocols to promote comparability and reliability in clinical practice.
超声（US）的使用便于识别吞咽困难或吞咽功能障碍。本研究的目的是评估超声测量吞咽功能的有效性和可靠性。
我们进行了一项系统评价和荟萃分析。从数据库建立至2024年7月22日，对Embase、Medline、Cochrane图书馆、Web of Science、CINAHL和Scopus数据库进行了系统检索。纳入已发表的关于超声测量评估18岁及以上个体吞咽困难或吞咽功能障碍的有效性和可靠性的研究。该评价遵循PRISMA指南，并使用QUADAS - 2工具进行诊断研究评估。两位作者独立筛选潜在符合条件的文献，评估纳入研究的质量，然后提取数据。使用Stata软件通过随机效应荟萃分析进行数据合成。
本评价纳入38篇文章，评估了超声检查中舌骨位移、甲状舌骨接近度和舌肌厚度变化对识别吞咽困难的价值。合并敏感度分别为0.64（95%CI：0.50 - 0.79）、0.89（95%CI：0.66 - 1.11）和0.60（95%CI：0.44 - 0.76）；合并特异度分别为0.71（95%CI：0.64 - 0.78）、0.82（95%CI：0.76 - 0.88）和0.69（95%CI：0.62 - 0.77）。此外，使用咬肌厚度识别吞咽困难的汇总受试者工作特征曲线（SROC）下面积为0.74（95%CI：0.70 - 0.78）。位移与吞咽功能之间的相关系数为0.58（95%CI：0.20 - 0.81），而吞咽肌横截面积（CSA）的相关系数为0.26（95%CI：0.09 - 0.42）。荟萃分析显示，位移的同组内可靠性值为0.88（95%CI：0.76 - 0.94），CSA为0.93（95%CI：0.87 - 0.96），吞咽肌厚度为0.77（95%CI：0.73 - 0.80），回声强度为0.79（95%CI：0.74 - 0.84）。组间可靠性值，位移为0.75（95%CI：0.55 - 0.87），CSA为0.89（95%CI：0.83 - 0.94），吞咽肌厚度为0.68（95%CI：0.57 - 0.75）。
本评价数据表明，超声是评估吞咽困难和吞咽功能障碍的可靠且有效的筛查工具。未来研究可旨在提出标准化和通用的超声检查方案，以提高临床实践中的可比性和可靠性。
