Establishing a Clinical Protocol for Velopharyngeal MRI and Interpreting Imaging Findings

Abstract

Traditional imaging modalities used to assess velopharyngeal insufficiency (VPI) do not allow for direct visualization of underlying velopharyngeal (VP) structures and musculature which could impact surgical planning. This limitation can be overcome via structural magnetic resonance imaging (MRI), the only current imaging tool that provides direct visualization of salient VP structures. MRI has been used extensively in research; however, it has had limited clinical use. Factors that restrict clinical use of VP MRI include limited access to optimized VP MRI protocols and uncertainty regarding how to interpret VP MRI findings. The purpose of this paper is to outline a framework for establishing a novel VP MRI scan protocol and to detail the process of interpreting scans of the velopharynx at rest and during speech tasks. Additionally, this paper includes common scan parameters needed to allow for visualization of velopharynx and techniques for the elicitation of speech during scans.

Optimization of 3D dynamic speech MRI: Poisson‐disc undersampling and locally higher‐rank reconstruction through partial separability model with regional optimized temporal basis

“…For the child population, where 10 min may still be a challenge, separate speech samples can be acquired in separate, shorter runs of the speech sequence. For example, in another current study, we have broken up the 3D dynamic acquisition into six shorter scans with a full sampling pattern, combining all the data together for reconstruction 33 . We have seen in our target population of 4 to 9 years old children that 2.5‐min durations result in high subject compliance to the speech tasks, particularly when broken into smaller segments.…”

Measurement Matters: MRI Analysis of Differing Anatomic Measurement Techniques for Velar Length and the Velopharyngeal Needs Ratio

“…MRI provides an ideal imaging modality to assess normative benchmarks, quantify the velar anatomy, and identify parameters to define VP measurements. 2 , 3 , 50 In comparison, cephalometric imaging can produce a lateral image, but the image may be impacted by overlapping anatomy and head rotation, making assessments of velar length less reliable than other imaging methods. 65 MRI offers improved image resolution and the ability to identify the midsagittal image plane which eliminates the effect of head rotation.…”

“…Scanning parameters and data acquisition are consistent with those previously reported in the literature. 3 , 21 , 50 Involvement of the speech-language pathologist was essential when obtaining and evaluating the velopharyngeal MRI data. Measurement definitions for all variables of interest are defined in Table 1 .…”

Comparative Effectiveness of Secondary Furlow and Buccal Myomucosal Flap Lengthening to Treat Velopharyngeal Insufficiency

“…Continuous variables measured in millimeters included (1) velar length-distance from the posterior nasal spine to the tip of the uvula; (2) effective velar length-linear distance from the posterior border of the hard palate to the point of levator muscle insertion into the velum; (3) pharyngeal depth-posterior nasal spine to the posterior pharyngeal wall; (4) effective velopharyngeal ratio-effective velar length divided by pharyngeal depth; and (5) velopharyngeal closure gap size during sustained phonation. 25 Figure 1 outlines velopharyngeal MRI measures taken.…”