The Association of 3-D Volume and 2-D Area of Post-swallow Pharyngeal Residue on CT Imaging

Abstract

Pharyngeal residue, the material that remains in the pharynx after swallowing, is an important marker of impairments in swallowing and prandial aspiration risk. The goals of this study were to determine whether the 2D area of post-swallow residue accurately represents its 3D volume, and if the laterality of residue would affect this association. Thirteen patients with dysphagia due to brainstem stroke completed dynamic 320-detector row computed tomography while swallowing a trial of 10 ml honey-thick barium. 3D volumes of pharyngeal residue were compared to 2D lateral and anterior–posterior areas, and a laterality index for residue location was computed. Although the anteroposterior area of residue was larger than the lateral area, the two measures were positively correlated with one another and with residue volume. On separate bivariate regression analyses, residue volume was accurately predicted by both lateral (R2 = 0.91) and anteroposterior (R2 = 0.88) residue areas, with limited incidence of high residuals. Half of the sample demonstrated a majority of pharyngeal residue lateralized to one side of the pharynx, with no effect of laterality on the association between areas and volume. In conclusion, the area of post-swallow pharyngeal residue was associated with volume, with limitations in specific cases. Direct measurement of pharyngeal residue volume and swallowing physiology with 3D-CT can be used to validate results from standard 2D instrumentation.

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References

  1. 1.

    Meng N, Wang T, Lien I. Dysphagia in patients with brainstem stroke: incidence and outcome. Am J Phys Med Rehabil. 2000;79:170–5.

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry. 1989;52:236–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA, Foundas AL. Aspiration in patients with acute stroke. Arch Phys Med Rehabil. 1998;79:14–9.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Martin BJ, Corlew MM, Wood H, Olson D, Golopol LA, Wingo M, Kirmani N. The association of swallowing dysfunction and aspiration pneumonia. Dysphagia. 1994;9:1–6.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Veis SL, Logemann JA. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil. 1985;66:372–5.

    CAS  PubMed  Google Scholar 

  6. 6.

    Teasell R, Foley N, Fisher J, Finestone H. The incidence, management, and complications of dysphagia in patients with medullary strokes admitted to a rehabilitation unit. Dysphagia. 2002;17:115–20.

    Article  PubMed  Google Scholar 

  7. 7.

    Bian R, Choi I, Kim J, Han J, Lee S. Impaired opening of the upper esophageal sphincter in patients with medullary infarctions. Dysphagia. 2009;24:238–45.

    Article  PubMed  Google Scholar 

  8. 8.

    Molfenter SM, Steele CM. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia. 2013;28:494–500.

    Article  PubMed  Google Scholar 

  9. 9.

    Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, Oschatz E. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. Am J Roentgenol. 2002;178:393–8.

    Article  Google Scholar 

  10. 10.

    Horner J, Buoyer FG, Alberts MJ, Helms MJ. Dysphagia following brain-stem stroke. Arch Neurol. 1991;48:1170–3.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Dejaeger E, Pelemans W, Bibau G, Ponette E. Manofluorographic analysis of swallowing in the elderly. Dysphagia. 1994;9:156–61.

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Omari TI, Dejaeger E, Van Beckevoort D, Goeleven A, De Cock P, Hoffman I, Smet MH, Davidson GP, Tack J, Rommel N. A novel method for the nonradiological assessment of ineffective swallowing. Am J Gastroenterol. 2011;106:1796–802.

    Article  PubMed  Google Scholar 

  13. 13.

    Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88:150–8.

    Article  PubMed  Google Scholar 

  14. 14.

    Kelly AM, Leslie P, Beale T, Payten C, Drinnan MJ. Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity? Clin Otolaryngol. 2006;31:425–32.

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    McCullough GH, Wertz RT, Rosenbek JC, Mills RH, Webb WG, Ross KB. Inter-and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia. 2001;16:110–8.

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Han TR, Paik N, Park JW. Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil. 2001;82:677–82.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Ryu JS, Lee JH, Kang JY, Kim MY, Shin DE, Shin DA. Evaluation of dysphagia after cervical surgery using laryngeal electromyography. Dysphagia. 2012;27:318–24.

    Article  PubMed  Google Scholar 

  18. 18.

    Pearson WG, Molfenter SM, Smith ZM, Steele CM. Image-based measurement of post-swallow residue: the normalized residue ratio scale. Dysphagia. 2013;28:167–77.

    Article  PubMed  Google Scholar 

  19. 19.

    Dyer JC, Leslie P, Drinnan MJ. Objective computer-based assessment of valleculae residue–is it useful? Dysphagia. 2008;23:7–15.

    Article  PubMed  Google Scholar 

  20. 20.

    Logemann JA, Williams RB, Rademaker A, Pauloski BR, Lazarus CL, Cook I. The relationship between observations and measures of oral and pharyngeal residue from videofluorography and scintigraphy. Dysphagia. 2005;20:226–31.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Hamlet S, Choi J, Zormeier M, Shamsa F, Stachler R, Muz J, Jones L. Normal adult swallowing of liquid and viscous material: scintigraphic data on bolus transit and oropharyngeal residues. Dysphagia. 1996;11:41–7.

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Leonard R, Belafsky PC, Rees CJ. Relationship between fluoroscopic and manometric measures of pharyngeal constriction: the pharyngeal constriction ratio. Ann Otol Rhinol Laryngol. 2006;115:897–901.

    Article  PubMed  Google Scholar 

  23. 23.

    Schatz K, Langmore SE, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991;100:678–81.

    Article  PubMed  Google Scholar 

  24. 24.

    Rao N, Brady SL, Chaudhuri G, Donzelli JJ, Wesling MW (2003) Gold-standard? Analysis of the videofluoroscopic and fiberoptic endoscopic swallow examinations 3.

  25. 25.

    Fujii N, Inamoto Y, Saitoh E, Baba M, Okada S, Yoshioka S, Nakai T, Ida Y, Katada K, Palmer JB. Evaluation of swallowing using 320-detector-row multislice CT. Part I: single-and multiphase volume scanning for three-dimensional morphological and kinematic analysis. Dysphagia. 2011;26:99–107.

    Article  PubMed  Google Scholar 

  26. 26.

    Inamoto Y, Fujii N, Saitoh E, Baba M, Okada S, Katada K, Ozeki Y, Kanamori D, Palmer JB. Evaluation of swallowing using 320-detector-row multislice CT. Part II: kinematic analysis of laryngeal closure during normal swallowing. Dysphagia. 2011;26:209–17.

    Article  PubMed  Google Scholar 

  27. 27.

    Dejaco D, Url C, Schartinger VH, Haug AK, Fischer N, Riedl D, Posch A, Riechelmann H, Widmann G. Approximation of head and neck cancer volumes in contrast enhanced CT. Cancer Imaging. 2015;15:16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Cavalcanti M, Rocha SS, Vannier MW. Craniofacial measurements based on 3D-CT volume rendering: implications for clinical applications. Dentomaxillofac Radiol. 2004;33:170–6.

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Kwon M, Lee JH, Kim JS. Dysphagia in unilateral medullary infarction: lateral vs medial lesions. Neurology. 2005;65:714–8.

    Article  PubMed  Google Scholar 

  30. 30.

    Aydogdu I, Ertekin C, Tarlaci S, Turman B, Kiylioglu N, Secil Y. Dysphagia in lateral medullary infarction (Wallenberg’s syndrome): an acute disconnection syndrome in premotor neurons related to swallowing activity? Stroke. 2001;32:2081–7.

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP. Wallenberg’s lateral medullary syndrome: clinical-magnetic resonance imaging correlations. Arch Neurol. 1993;50:609–14.

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Inamoto Y, Saitoh E, Shibata S, Kagaya H, Nakayama E, Ota K, Onogi K, Kawamura Y. Effectiveness and applicability of a specialized evaluation exercise-chair in posture adjustment for swallowing. Jpn J Compr Rehabil Sci. 2014;5:33–9.

    Google Scholar 

  33. 33.

    Park B, Seo J, Ko M, Park S. Effect of 45° reclining sitting posture on swallowing in patients with dysphagia. Yonsei Med J. 2013;54:1137–42.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Lee J, Sejdić E, Steele CM, Chau T. Effects of liquid stimuli on dual-axis swallowing accelerometry signals in a healthy population. Biomed Eng Online. 2010;9:7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Chen MY, Peele VN, Donati D, Ott DJ, Donofrio PD, Gelfand DW. Clinical and videofluoroscopic evaluation of swallowing in 41 patients with neurologic disease. Abdom Imaging. 1992;17:95–8.

    CAS  Google Scholar 

  36. 36.

    Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16:119–22.

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    Inamoto Y, Fujii N, Saitoh E, Baba M, Okada S, Katada K, Ozeki Y, Kanamori D, Palmer JB. Evaluation of swallowing using 320-detector-row multislice CT. Part II: kinematic analysis of laryngeal closure during normal swallowing. Dysphagia. 2011;26:209–17.

    Article  PubMed  Google Scholar 

  38. 38.

    Seta H, Hashimoto K, Inada H, Sugimoto A, Abo M. Laterality of swallowing in healthy subjects by AP projection using videofluoroscopy. Dysphagia. 2006;21:191–7.

    Article  PubMed  Google Scholar 

  39. 39.

    Yang S, Choi KH, Son YR. The effect of stroke on pharyngeal laterality during swallowing. Ann Rehabil Med. 2015;39:509–16.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Mikushi S, Kagaya H, Baba M, Tohara H, Saitoh E. Laterality of bolus passage through the pharynx in patients with unilateral medullary infarction. J Stroke Cerebrovasc Dis. 2014;23:310–4.

    Article  PubMed  Google Scholar 

  41. 41.

    Ota K, Saitoh E, Kagaya H, Sonoda S, Shibata S. Effect of postural combinations—the reclined seated position combined with head rotation—on the transport of boluses and aspiration. Jpn J Compr Rehabil Sci. 2011;2:36–41.

    Google Scholar 

  42. 42.

    Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ. Effects of postural change on aspiration in head and neck surgical patients. Otolaryngol Head Neck Surg. 1994;110:222–7.

    Article  CAS  PubMed  Google Scholar 

  43. 43.

    Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122:1314–21.

    Article  PubMed  Google Scholar 

  44. 44.

    Kagaya H, Inamoto Y, Okada S, Saitoh E. Body positions and functional training to reduce aspiration in patients with dysphagia. JMAJ. 2011;54:35–8.

    Google Scholar 

  45. 45.

    Inamoto Y, Kagaya H, Saitoh E, Kanamori D, Shibata S, Fujii N, Katada K, Palmer JB. Inter-rater and intra-subject reliability for the evaluation of swallowing kinematics using 320-row area detector computed tomography. Jpn J Compr Rehabil Sci. 2012;3:59–65.

    Google Scholar 

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Acknowledgements

The research reported in this paper was partially supported. The authors would like to thank the staff of Fujita Health University Hospital, Department of Radiology, for their generous support and assistance with CT imaging and data collection.

Funding

This research was partially supported by JSPS KAKENHI (No. 25750236 Inamoto) and by the National Institute of Child Health and Human Development- National Center for Medical Rehabilitation Research through award 5T32HD007414-23 (Mulheren); the content is solely the responsibility of the authors and does not necessarily represent the views the National Institutes of Health.

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Correspondence to Yoko Inamoto.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Mulheren, R.W., Inamoto, Y., Odonkor, C.A. et al. The Association of 3-D Volume and 2-D Area of Post-swallow Pharyngeal Residue on CT Imaging. Dysphagia 34, 665–672 (2019). https://doi.org/10.1007/s00455-018-09968-3

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Keywords

  • Pharynx
  • Dynamic computed tomography
  • Brainstem stroke
  • Residue
  • Deglutition
  • Deglutition disorders