Magnetic Resonance Imaging for Assessing Velopharyngeal Function: Current Applications, Barriers, and Potential for Future Clinical Translation in the United States

Abstract

Objective The use of magnetic resonance imaging (MRI) in the assessment process for children with cleft/craniofacial conditions remains uncommon, particularly for velopharyngeal assessments. The purpose of this study was to analyze the perceived clinical utility of MRI for cleft/craniofacial providers and identify barriers that exist for clinical translation of this imaging modality to this population of patients. Methods A 38-item survey was disseminated to craniofacial team providers. Workplace context and demographics, MRI as a research and clinical tool, access and barriers for use of MRI, and needs for successfully establishing MRI protocols at clinical sites were investigated. Descriptive statistics were used to identify differences in the clinical use of MRI across disciplines. Chi-square analyses were conducted to determine how different specialties perceived potential barriers. Results Respondents reported that MRI is likely to be beneficial for clinical assessments (93.5%) and that this imaging modality is available for use (83.8%). However, only 11.8% of providers indicated the use of MRI in their clinical assessments. This discrepancy highlights a potential disconnect between perceived use and implementation of this imaging methodology on cleft and craniofacial teams. A number of barriers were identified by providers. Challenges and opportunities for clinical translation of MRI protocols were highlighted. Conclusion Results may guide the development for improved clinical feasibility and implementation of MRI for clinical planning in this population of patients. Reported barriers highlight additional areas for translational research and the potential for the development of clinical tools related to MRI assessment and protocol implementation.

Establishing a Clinical Protocol for Velopharyngeal MRI and Interpreting Imaging Findings

“…Another reason for limited implementation of MRI in cleft care may be the novelty of this approach with almost no published information on how to establish a clinical velopharyngeal MRI protocol or how to interpret the images. 16 Existing papers on velopharyngeal MRI report imaging protocols developed for specific research studies which are not easily transferred to clinical MRI scanners. 2,3,[17][18][19][20] In addition, existing papers on velopharyngeal MRI typically report between 10 and 30 different velopharyngeal variables; this makes it unclear what anatomic and physiologic variables are most clinically relevant.…”

“…2,17,[20][21][22] Finally, few guides exist describing how to interpret velopharyngeal MR images in the clinical context. 16 Combined, these factors make implementation of VP MRI difficult for hospitals, radiologists, and cleft and craniofacial teams.…”

The Pediatric Neuroradiologist's Practical Guide to Capture and Evaluate Pre- and Postoperative Velopharyngeal Insufficiency

“…7,8 MR imaging is a relatively newer clinical imaging diagnostic tool in cleft care that is being introduced into cleft craniofacial care units, particularly in the United States. [9][10][11] The interest in velopharyngeal MR imaging is primarily due to the advantage of MR imaging in visualizing the velopharyngeal musculature, which is not possible using nasopharyngoscopy and videofluoroscopy. [9][10][11] Similar to videofluoroscopy, MR imaging can be used to accurately quantify key velopharyngeal structures with the added benefits of section specificity (eg, the ability to select a precise midsagittal section without head rotation) and lack of ionizing radiation, which is present, though minimal, in videofluoroscopy.…”

“…[9][10][11] The interest in velopharyngeal MR imaging is primarily due to the advantage of MR imaging in visualizing the velopharyngeal musculature, which is not possible using nasopharyngoscopy and videofluoroscopy. [9][10][11] Similar to videofluoroscopy, MR imaging can be used to accurately quantify key velopharyngeal structures with the added benefits of section specificity (eg, the ability to select a precise midsagittal section without head rotation) and lack of ionizing radiation, which is present, though minimal, in videofluoroscopy. The use of MR imaging in the clinical assessment process may be particularly important when muscle reconstruction is being considered to treat VPI 12 or following a failed VPI surgery.…”

“…12 A recent survey sampling 80 cleft palate craniofacial centers across the United States demonstrated that 93.5% of respondents think that MR imaging brings value to clinical assessment; however, only 11% reported using velopharyngeal MR imaging in their clinical workflows. 11 A key challenge to the widespread clinical use of velopharyngeal MR imaging is the limited technical and interpretive training of key personnel. 14 Previously published guidance in the use of MR imaging for VPI has not addressed a clinical radiology audience, instead focusing heavily on the feasibility and clinical interpretations of velopharyngeal MR imaging findings for the surgical team.…”