[Functional studies of swallowing with electron beam computerized tomography]

Functional evaluation of swallowing disorders requires rapid imaging modalities. Videofluorography and cinematography are the gold standard, but they have their limitations: no transverse plane imaging is achieved and structural resolution for exact topographic analysis is limited. Three cases preselected by videofluorography were studied to evaluate whether electron beam tomography (EBT) permits more detailed dynamic imaging of swallowing disorders focusing on the mesonasopharyngeal segment, the hypopharynx and the upper esophageal sphincter (UES). Immediately after videofluorographic examination of the oropharyngeal deglutition, EBT is performed. The patient is in a supine position and while the patient swallows a 20 ml bolus of water or diluted iodine containing contrast agent, a sequence of 20 images per level is scanned. The levels, which are determined by using the scout view, are oriented parallel to the hard palate either at the level of the hard palate to image the mesonasopharyngeal segment or just above the hyoid bone to focus on the hypopharynx or at the location of the UES. The scan technique is a single-slice cinemode with a slice thickness of 3 mm (exposure time 100 ms, interscan delay 16 ms, 130 kV, 620 mA). The following structural interactions that we have so far been unable to image can be clearly demonstrated with EBT: (1) during normal swallowing, the mesonasopharyngeal segment is completely and symmetrically closed by the soft palate and Passavant's cushion; (2) lateral hypopharyngeal pouches can be located more precisely; and (3) disorders of the UES can be differentiated into functional or morphologically caused disorders (e.g., goiter or cervical osetophytes). Videofluorography and cinematography are still the gold standard in functional evaluation of swallowing disorders. However, EBT permits dynamic imaging of pharyngeal deglutition in a preselected transverse plane and can give useful additional information concerning functional anatomical changes in the pharynx during swallowing. Further clinical evaluation is needed.