(188) Examining Magnetic Resonance Imaging use in infants with pharyngeal dysphagia

Introduction: Magnetic Resonance Imaging (MRI) is often used to evaluate neuroanatomical abnormalities in infants with pharyngeal dysphagia. However, its role in otherwise healthy infants is uncertain. The purpose of this study is to evaluate the findings of MRI in infants with pharyngeal dysphagia.

Methods: We conducted an IRB approved (STUDY00001937) retrospective chart review of all infants under 1 year of age who underwent a Videofluoroscopic Swallow Study (VFSS) between January 2019 and December 2021 at a tertiary referral children’s hospital. Exclusion criteria were normal VFSS, significantly premature birth ( < 35 weeks gestation), or a history of major genetic, neurologic, or anatomic comorbidities. We assessed patients for the following: degree of aspiration (Rosenbek Penetration-Aspiration Scale [PAS]), age at the time of VFSS and MRI, indications for MRI, abnormalities seen in MRI, resolution of dysphagia and normalization of VFSS. The data was analyzed using descriptive statistics.

Results: Of 108 eligible patients, 64.8% were male, and 20 (18.5%) received an MRI. The median age was 5 months (range:1-12) at VFSS and 5 months (range:1-11) at MRI. Besides dysphagia and aspiration, indications for MRI included hypotonia (n =2), hypertonia (n=1), and macrocephaly (n=3). Of patients who received an MRI, 14 (65%) had at least one abnormality. However, noted abnormalities included mild ventriculomegaly (n=2), nonspecific white matter changes (n=3), and abnormalities of limited clinical significance (n=12). One patient had a cerebellar abnormality. Of eligible patients, 22 (20.4%) had a PAS >3. Of patients who had an abnormal MRI, 12(85.7%) had resolution of their dysphagia.

Conclusions: In the otherwise healthy patient with pharyngeal dysphagia, MRI appears to have limited utility. Future research is needed to determine decision thresholds for MRI in infants with pharyngeal dysphagia.