Zusammenfassung
Die moderne gastroenterologische Röntgendiagnostik muss bei der Abklärung der Dysphagie neben der Beschreibung rein morphologischer Veränderungen auch auf die Beobachtung und diagnostische Bewertung der gastrointestinalen Motilität ausgerichtet sein. Hierzu sind dynamische Aufzeichungverfahren, wie die Hochfrequenzkinematographie, die Videofluoroskopie und das DSI (Digitale Spot Imaging) besonders gut geeignet [11]
[20]. Neue Methoden bestehen in der Multislice-CT und dem dynamischen MR. Eine nur für die orale und in einem kleinen Teilaspekt auch für die pharyngeale Phase einsetzbare Methode ist der Ultrasschall der Schluckfunktion. Kombinierte Methoden, wie die Bildfusion von CT und PET sind für die Tumordiagnostik und die Beurteilung eines Therapieerfolges, die kombinierte Videofluoromanometrie zur Abklärung von Motilitätsstörungen unverzichtbar.
Es wird der Stellenwert der verschiedenen Methoden in der interdisziplinären Abklärung der Dysphagie dargestellt. Insbesondere wird ein Überblick gegeben, bei welchen Fragestellungen der Einsatz der dynamischen Aufzeichnungsverfahren wertvolle Zusatzinformationen für die Diagnostik pharyngo-ösophagealer Krankheitsbilder zu erbringen vermag [20].
Abstract
In the diagnostic work-up of the Dysphagia modern radiology must not only describe morphologic alterations but also has to keep in mind the great importance of motility disorders. Dysfunction of the pharynx and esophagus can be assessed by fluoroscopy alone. Manometry is only suitable for the assessement of motility disorders of the tubular esophagus. The superior method to analyze the motility disorders of the oro-pharyngeal and pharyngo- esophageal transport is High-Speed-Cineradiography at a frame-rate of 50 frames/s on 35 mm-film because of the very fast and complex patterns of motion during oro-pharyngeal deglutition, which occurs within only 0.5-0.7 s. Due to the dosage saving methods today videofluoroscopy got the normal study tool. In near future it may be replaced by high- speed-digital fluoroscopy with 30 frames/s. The upper esophageal sphincter turned out to play a very important role in many motility disorders of the pharynx and the esophagus, which often secondarily lead to permanent structural lesions. Examples are given, in which kinds of disorders cineradiography contributes to diagnosis and therapy. In some cases it turned out to be the method of first choice, as for example for the assessment of aspiration [7]
[13]
[15]
[26].
Schlüsselwörter
Dysphagie - dynamisches Röntgen - Funktionsdiagnostik - Aspiration
Key words
Dysphagia - dynamic radiologic analysis - functional diagnosis - aspiration
Literatur
-
1
Blitzer A.
Evaluation and management of chronic aspiration.
N Y State J Med.
1987;
87
154-160
-
2 Cantarella G. Definizione ed epidemiologia dei disturbi della deglutizione. Centro Richerche e Sudi Amplifon, Raccolta bibliografica Seminario Turbe della deglutizione: attualità diagnostiche e terapeutiche 1998; 12-17
-
3
Denk D M, Swoboda H, Schima W, Eibenberger K.
Prognostic factors for swallowing rehabiltation following head and neck cancer surgery.
Acta Otolaryngol..
1997;
117
769-774
-
4
Di Santis D J, Balfe D M, Koehler R E, Lee K T.
Barium examination on the pharynx after vertical hemilaryngectomy.
AJR.
1983;
141
335-339
-
5
Dodds W J, Hogan W J, Lynden S B, Stewart E T, Stef J J, Arndorfer R C.
Quantitation of pharyngeal motor function in normal human subjects.
J Appl Physiol.
1975;
39
692-696
-
6
Donner M W, Silbinger M L, Hookman P, Hendrix T R.
Acid barium swallows in the radiographic evaluation of clinical esophagitis.
Radiol.
1966;
67
220-225
-
7
Eisbruch A, Lyden T, Bradford C R, Dawson L A, Haxer M J, Miller A E, Teknos T N, Chepeha D B, Hogikyan N D, Terrell J E, Wolf G T.
Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer.
Int J Radiati Oncol Biol Phys..
2002;
53
23-28
-
8
Furia C L, Carrara-de Angelis E, Martins N M, Barros A P, Carneiro B, Kowalski L P.
Videofluoroscopic evaluation after glossectomy.
Arch Otolaryngol Head Nack Surg.
2000;
126
378-383
-
9
Gates G A.
Upper esophageal sphincter : pre- and post-laryngectomy - A normative study.
Laryngoscope.
1980;
90
454-464
-
10
Gay I, Crisin R, Elidan J.
Myotomy of the cricopharyngeal muscle. A treatment for dysphagia and aspiration in neurological disorders.
Revue de Laryngologie.
1984;
105
271-274
-
11 Groher M. Dysphagia - Diagnosis and Management. 2nd ed. Butterworth-Heinemann, Boston London Oxford Singapore Sydney Toronto Wellington 1992
-
12
Hamdy S, Aziz Q, Rothwell J C, Singh K D, Barlow J, Huges D G, Tallis R C, Thompson D G.
The cortical topography of human swallowing musculature in health and disease.
Nat Med.
1996;
2
1217-1224
-
13
Hannig C, Wuttge-Hannig A.
Stellenwert der Hochfrequenzkinematographie in der Diagnostik des Pharynx und Ösophagus.
Röntgenpraxis.
1987;
40
358-377
-
14
Hannig C, Wuttge-Hannig A, Hörmann M, Herrmann I F.
Kinematographische Untersuchungen des Pathomechanismus der Aspirationspneumonie.
RÖFO.
1989;
150
260-267
-
15 Hannig C, Stein H, Wuttge-Hannig A, Hess U. Diagnosis of Cricopharyngeal Dysfunction using Simultaneous Videomanometry and Cinemanometry. 3. Annual Dysphagia Research Society Meeting. 14.-16. October 1994, McLean, Virginia, USA
-
16
Hannig C, Wuttge-Hannig A, Hess U.
Analyse und radiologisches Staging des Typs und Schweregrades einer Aspiration.
Radiologe.
1995;
35
741-746
-
17
Hannig C, Wuttge-Hannig A, Clasen B, Kellermann S, Volkmer C.
Dysphagia of the treated laryngeal cancer - detection of functional and morphological changes by cineradiography.
Bildgebung/Imaging.
1991;
58
141-145
-
18
Hannig C, Hess U, Wuttge-Hannig A, Volkmer C.
Dysphagie nach Laryngektomie - morphologische versus funktionelle Veränderungen.
RÖFO.
1996;
164 (Suppl)
95
-
19 Hannig C, Feussner H, Stein H. Cineradiography and radiomanometry in the pre- and postoperative evaluation of cricopharyngeal dysfunction. Scientific Programme and Abstracts, ECR'93. Springer, Berlin, New York 1993; 111 (Award of outstanding scientific presentation of this session)
-
20 Hannig C, Wuttge-Hannig A. Radiological functional diagnosis of swallowing disorders in neurological diseases and in post-therapeutic oncological ENT-diseases. In: Bartolome G, Buchholz DW, Feussner H, Hannig Ch, Neumann S, Prosiegel M, Schöter-Morasch H, Wuttge-Hannig A (eds). Schluckstörungen Diagnostik und Rehabilitation. 2. Aufl. Urban und Fischer, Jena 1999; 65-110
-
21 Hannig C. Functional fluoroscopic diagnosis of pharynx and esophagus. Springer, Berlin, New York 1995
-
22
Kennedy J G, Kent R D.
Physiological substrates of normal deglutition.
Dysphagia.
1988;
3
24-38
-
23
Lindbichler F, Raith J, Gröll R, Kern R, Wuttge-Hannig A, Uggowitzer M.
Neue Aspekte in der Diagnostik von Schluckstörungen bezüglich einer örtlichen Zuordnung von Pouches. 75. Deutscher Röntgenkongress Wiesbaden.
Z Radiol.
1994;
150
111-114
-
24
Logemann J A, Bytell D E.
Swallowing disorders in three types of head and neck surgical patients.
Cancer.
1979;
44
1095-1105
-
25 Logeman J A. Deglutition. College Hill Press 1983
-
26
Martin B J, Schleicher M A, O'Connor A.
Management of dysphagia following supraglottic laryngectomy.
Clin Commun Disord..
1993;
3
27-36
-
27
Miller A J.
Deglutition.
Physical Rev.
1982;
62
129-184
-
28
Mills C P.
Dysphagia in pharyngeal paralysy treated by cricopharyngeal sphincterotomy.
Lancet.
1973;
1
455-457
-
29
Montgomery W W.
Surgical laryngeal closure to eliminate chronic aspiration.
NEJM.
1975;
292
1390-1391
-
30
Pauloski B R, Rademaker A W, Logemann J A, Lazarus C L, Newman L, Hamner A, MacCracken E, Gaziano J, Stachowiak L.
Swallow function and perception of dysphagia in patients with head and neck cancer.
Head Neck.
2002;
24
555-565
-
31 Prosiegel M. Neurologie von Schluckstörungen. In: Praxisleitfaden Dysphagie. Fresenius Kabi 2002; 9-46
-
32
Rosen A, Rhee T H, Kaufman R.
Prediction of aspiration in patients with newly diagnosed untreated advanced head and neck cancer.
Arch Otolaryngol Head Neck Surg.
2001;
127
975-979
-
33
Ross E R, Green R, Auslander M D, Biller H F.
Cricopharyngeal myotomy: Management of cervical dysphagia.
Otolaryngol Head and Neck Surgery.
1982;
90
434-441
-
34
Sader R, Horch H H, Herzog M, Zeilhofer H F, Hannig Ch, Hess U, Bünte E, Böhme G.
Hochfrequenz-Videokinematographie zur objektiven Darstellung des velopharyngealen Verschlussmechanismus bei Gaumenspaltpatienten.
Fortschr Kieferorthop.
1994;
55
169-175
-
35
Sonies B C, Baum B J.
Evaluation of swallowing pathophysiology.
Otolaryngol Clin N Am.
1988;
21
637-648
-
36
Walther E K, Rodel R, Deroover M.
Rehabilitation of deglutition in patients with pharyngeal carcinoma.
Laryngorhinootologie.
1990;
69
360-368
-
37 Wuttge-Hannig A, Hannig C. Radiologische Differentialdiagnose neurologisch bedingter Schluckstö rungen. Radiologe 1995; 733-740
-
38 Wuttge-Hannig A, Hannig C. Anatomy of Swallowing. In: Bartolome G, Buchholz DW, Feussner H, Hannig Ch, Neumann S, Prosiegel M, Schöter-Morasch H, Wuttge-Hannig A (eds). Schluckstörungen - Diagnostik und Rehabilitation. 2. Aufl. Urban und Fischer, Jena 1999; 1-11
-
39 Wuttge-Hannig A, Beer A, Gebhardt A, Hellerhoff P, Wuttge R, Hannig C. Alternative methods for the diagnostic of deglutition. In: Schindler O, Ruoppolo G, Schindler A (eds). Deglutologia. Omega Edizioni 2001
-
40
Zuydam A C, Rogers S N, Brown J S, Vaughan E D, Magennis R.
Swallowing rehabilitation after oro-pharyngeal resection for squamous cell carcinoma.
Br J Oral Maxillofac Surg.
2000;
38
513-518
-
41 Thumfarth W F, Potoschnig C, Dapunt U, Nekahm D. Diagnostic and surgical systems for management of aspiration and swallowing disturbances. 2nd International Symposium on Larangeal and Tracheal Reconstruction 1996. Monte Carlo Proceedings: 31
Dr. Anita Wuttge-Hannig
Gem. Praxis für Radiologie, Nuklearmedizin und Strahlentherapie
Karlsplatz 3-5
80335 München
Phone: 0 89/5 52 52 60
Fax: 0 89/55 25 26 27
