Abstract：
BACKGROUND: Magnetic resonance imaging (MRI) is the only imaging modality capable of directly visualizing the levator veli palatini (LVP) muscles: the primary muscles responsible for velopharyngeal closure during speech. MRI has been used to describe normal anatomy and physiology of the velopharynx in research studies, but there is limited experience with use of MRI in the clinical evaluation of patients with velopharyngeal insufficiency (VPI).
METHODS: MRI was used to evaluate the velopharyngeal mechanism in patients presenting for VPI management. The MRI followed a fully awake, nonsedated protocol with phonation sequences. Quantitative and qualitative measures of the velopharynx were obtained and compared with age- and sex-matched individuals with normal speech resonance.
RESULTS: MRI was completed successfully in 113 of 118 patients (96%). Compared with controls, patients with VPI after cleft palate repair had a shorter velum (P < 0.001), higher incidence of LVP discontinuity (P < 0.001), and shorter effective velar length (P < 0.001). Among patients with persistent VPI after pharyngeal flap placement, findings included a pharyngeal flap base located inferior to the palatal plane [11 of 15 (73%)], shorter velum (P < 0.001), and higher incidence of LVP discontinuity (P = 0.014). Patients presenting with noncleft VPI had a shorter (P = 0.004) and thinner velum (P < 0.001) and higher incidence of LVP discontinuity (P = 0.014).
CONCLUSIONS: MRI provides direct evidence of LVP muscle anomalies and quantitative evaluation of both velar length and velopharyngeal gap. This information is unavailable with traditional VPI imaging tools, suggesting that MRI may be a useful tool for selecting surgical procedures to address patient-specific anatomic differences.
METHODS: MRI was used to evaluate the velopharyngeal mechanism in patients presenting for VPI management. The MRI followed a fully awake, nonsedated protocol with phonation sequences. Quantitative and qualitative measures of the velopharynx were obtained and compared with age- and sex-matched individuals with normal speech resonance.
RESULTS: MRI was completed successfully in 113 of 118 patients (96%). Compared with controls, patients with VPI after cleft palate repair had a shorter velum (P < 0.001), higher incidence of LVP discontinuity (P < 0.001), and shorter effective velar length (P < 0.001). Among patients with persistent VPI after pharyngeal flap placement, findings included a pharyngeal flap base located inferior to the palatal plane [11 of 15 (73%)], shorter velum (P < 0.001), and higher incidence of LVP discontinuity (P = 0.014). Patients presenting with noncleft VPI had a shorter (P = 0.004) and thinner velum (P < 0.001) and higher incidence of LVP discontinuity (P = 0.014).
CONCLUSIONS: MRI provides direct evidence of LVP muscle anomalies and quantitative evaluation of both velar length and velopharyngeal gap. This information is unavailable with traditional VPI imaging tools, suggesting that MRI may be a useful tool for selecting surgical procedures to address patient-specific anatomic differences.
摘要：
背景：磁共振成像（MRI）是唯一能够直接可视化上提肌（LVP）肌肉的成像方式：在言语过程中负责咽喉闭合的主要肌肉。MRI已被用于描述正常解剖和生理学的喉部的研究，但是在临床评估咽喉功能不全（VPI）患者中使用MRI的经验有限。
方法：MRI用于评估接受VPI治疗的患者的咽喉机制。核磁共振在完全清醒之后，具有发声序列的非镇静协议。获得了喉部的定量和定性测量值，并将其与年龄和性别匹配的正常语音共振个体进行了比较。
结果：118例患者中有113例（96%）成功完成MRI检查。与对照组相比，腭裂修复后VPI患者的绒毛较短（P<0.001），LVP不连续性发生率较高(P<0.001)，有效绒毛长度较短(P<0.001)。在咽瓣放置后持续VPI的患者中，发现包括位于腭平面下方的咽瓣基部[15个中的11个（73％）]，短膜（P<0.001），LVP不连续性发生率较高(P=0.014)。表现为非裂隙VPI的患者具有较短的（P=0.004）和较薄的膜（P<0.001）以及较高的LVP不连续性发生率（P=0.014）。
结论：MRI提供了LVP肌肉异常的直接证据，并定量评估了绒毛长度和咽喉间隙。传统的VPI成像工具无法提供此信息，提示MRI可能是选择手术方式以解决患者特定解剖差异的有用工具.
方法：MRI用于评估接受VPI治疗的患者的咽喉机制。核磁共振在完全清醒之后，具有发声序列的非镇静协议。获得了喉部的定量和定性测量值，并将其与年龄和性别匹配的正常语音共振个体进行了比较。
结果：118例患者中有113例（96%）成功完成MRI检查。与对照组相比，腭裂修复后VPI患者的绒毛较短（P<0.001），LVP不连续性发生率较高(P<0.001)，有效绒毛长度较短(P<0.001)。在咽瓣放置后持续VPI的患者中，发现包括位于腭平面下方的咽瓣基部[15个中的11个（73％）]，短膜（P<0.001），LVP不连续性发生率较高(P=0.014)。表现为非裂隙VPI的患者具有较短的（P=0.004）和较薄的膜（P<0.001）以及较高的LVP不连续性发生率（P=0.014）。
结论：MRI提供了LVP肌肉异常的直接证据，并定量评估了绒毛长度和咽喉间隙。传统的VPI成像工具无法提供此信息，提示MRI可能是选择手术方式以解决患者特定解剖差异的有用工具.
