To introduce a highly innovative imaging method to study the complex velopharyngeal (VP) system and introduce the potential future clinical applications of a VP atlas in cleft care.
Design
Four healthy adults participated in a 20-min dynamic magnetic resonance imaging scan that included a high-resolution T2-weighted turbo-spin-echo 3D structural scan and five custom dynamic speech imaging scans. Subjects repeated a variety of phrases when in the scanner as real-time audio was captured.
Setting
Multisite institution and clinical setting
Participants
Four adult subjects with normal anatomy were recruited for this study.
Main Outcome
Establishment of 4-D atlas constructed from dynamic VP MRI data.
Results
Three-dimensional dynamic magnetic resonance imaging was successfully used to obtain high quality dynamic speech scans in an adult population. Scans were able to be re-sliced in various imaging planes. Subject-specific MR data were then reconstructed and time-aligned to create a velopharyngeal atlas representing the averaged physiological movements across the four subjects.
Conclusions
The current preliminary study examined the feasibility of developing a VP atlas for potential clinical applications in cleft care. Our results indicate excellent potential for the development and use of a VP atlas for assessing VP physiology during speech.
PerryJLSnodgrassTDGilbertIR, et al.Establishing a clinical protocol for velopharyngeal MRI and interpreting imaging findings. Cleft Palate Craniofac J. 2022: 10556656221141188. doi: 10.1177/10556656221141188
2.
KotlarekKJSitzmanTJWilliamsJLPerryJL. Nonsedated magnetic resonance imaging for visualization of the velopharynx in the pediatric population. Cleft Palate Craniofac J. 2023;60(2):249‐252. doi: 10.1177/10556656211057361
3.
PerryJLKollaraLKuehnDPSuttonBPFangX. Examining age, sex, and race characteristics of velopharyngeal structures in 4- to 9-year-old children using magnetic resonance imaging. Cleft Palate Craniofac J. 2018;55(1):21‐34. doi: 10.1177/1055665617718549
4.
TianWYinHLiYZhaoSZhengQShiB. Magnetic resonance imaging assessment of velopharyngeal structures in Chinese children after primary palatal repair. J Craniofac Surg.2010;21(2):568‐577. doi: 10.1097/SCS.0b013e3181d08bd1
5.
KaneAButmanJMullickRSkopecMChoykeP. A new method for the study of velopharyngeal function using gated magnetic resonance imaging. PlastReconstr Surg (1963). 2002;109(2):472‐481. doi: 10.1097/00006534-200202000-00010
6.
EttemaSLKuehnDPPerlmanALAlperinN. Magnetic resonance imaging of the levator veli palatini muscle during speech. Cleft Palate Craniofac J. 2002;39(2):130‐144.
7.
HaensslerAEFangXPerryJL. Effective velopharyngeal ratio: a more clinically relevant measure of velopharyngeal function. J Speech Lang Hearing Res. 2020;63(11):3586‐3593. doi: 10.1044/2020_JSLHR-20-00305
8.
KollaraLPerryJLHudsonS. Racial variations in velopharyngeal and craniometric morphology in children: an imaging study. J Speech Lang Hearing Res. 2016;59(1):27‐38. doi: 10.1044/2015_JSLHR-S-14-0236
9.
PerryJLKotlarekKJSuttonBP, et al.Variations in velopharyngeal structure in adults with repaired cleft palate. Cleft Palate Craniofac J. 2018;55(10):1409‐1418. doi: 10.1177/1055665617752803
10.
ScottADWylezinskaMBirchMJMiquelME. Speech MRI: morphology and function. Phys Med.2014;30(6):604‐618. doi: 10.1016/j.ejmp.2014.05.001
11.
SitzmanTJBaylisALPerryJL, et al.Protocol for a prospective observational study of revision palatoplasty versus pharyngoplasty for treatment of velopharyngeal insufficiency following cleft palate repair. Cleft Palate Craniofac J. 2022:10556656221147159. doi: 10.1177/10556656221147159
12.
SitzmanTJWilliamsJLSinghDJTemkitMSnodgrassTDPerryJL. MRI of the velopharynx: clinical findings in patients with velopharyngeal insufficiency. Plast Reconstr Surg. 2023:0000000000010798. doi: 10.1097/PRS.0000000000010798
13.
KaoDSSoltysikDAHydeJSGosainAK. Magnetic resonance imaging as an aid in the dynamic assessment of the velopharyngeal mechanism in children. Plast Reconstr Surg. 2008;122(2):572‐577. doi: 10.1097/PRS.0b013e31817d54d5
14.
PerryJLWilliamsJLSnodgrassTDSitzmanTJ. VPI Management in SATB2 syndrome: use of MRI to evaluate anatomy and physiology in non-cleft VPI. Cleft Palate Craniofac J. 2022:10556656221106888. doi: 10.1177/10556656221106888
15.
MehendaleFVSommerladBC. Gross unilateral abnormalities of the velum and pharynx. Cleft Palate Craniofac J. 2002;39(4):461‐468. doi: 10.1597/1545-1569_2002_039_0461_guaotv_2.0.co_2
16.
KuehnDPEttemaSLGoldwasserMSBarkmeierJC. Magnetic resonance imaging of the levator veli palatini muscle before and after primary palatoplasty. Cleft Palate Craniofac J. 2004;41(6):584‐592. doi: 10.1597/03-060.1
17.
KollaraLBaylisALKirschnerRE, et al.Velopharyngeal structural and muscle variations in children with 22q11.2 deletion syndrome: an unsedated MRI study. Cleft Palate Craniofac J. 2019;56(9):1139‐1148. doi: 10.1177/1055665619851660
JinRLiangZ-pSuttonBP. Increasing three-dimensional coverage of dynamic speech magnetic resonance imaging. In Proceedings of the Annual Meeting of ISMRM.2021;2021(S1):4175.
20.
JinRShostedRKXingF, et al.Enhancing linguistic research through 2-mm isotropic 3D dynamic speech MRI optimized by sparse temporal sampling and low-rank reconstruction. Mag Res Med. 2022;89(2):652-664. doi: 10.1002/mrm.29486
21.
FuMBarlazMSHoltropJL, et al.High-frame-rate full-vocal-tract 3D dynamic speech imaging. Mag Res Med. 2017;77(4):1619‐1629. doi: 10.1002/mrm.26248
22.
PerryJLKuehnDPSuttonBPFangX. Velopharyngeal structural and functional assessment of speech in young children using dynamic magnetic resonance imaging. Cleft Palate Craniofac J. 2017;54(4):408‐422. doi: 10.1597/15-120
23.
ConaghanPBirdPEjbjergB, et al.The EULAR–OMERACT rheumatoid arthritis MRI reference image atlas: the metacarpophalangeal joints. Ann Rheum Dis. 2005;64(suppl 1):i11‐i21. doi: 10.1136/ard.2004.031815
24.
ToderitaDHensonDPKlemtCDingZBullAMJ. An anatomical atlas-based scaling study for quantifying muscle and hip joint contact forces in above and through-knee amputees using validated musculoskeletal modelling. TBME. 2021;68(11):3447‐3456. doi: 10.1109/TBME.2021.3075041
25.
DingZTsangCKNolteDKedgleyAEBullAMJ. Improving musculoskeletal model scaling using an anatomical atlas: the importance of gender and anthropometric similarity to quantify joint reaction forces. TBME. 2019;66(12):3444‐3456. doi: 10.1109/TBME.2019.2905956
26.
WooJLeeJMuranoEZ, et al.A high-resolution atlas and statistical model of the vocal tract from structural MRI. Comput Meth Biomech Biomed Eng. 2015;3(1):47‐60. doi: 10.1080/21681163.2014.933679
27.
TangYHojatkashaniCDinovID, et al.The construction of a Chinese MRI brain atlas: a morphometric comparison study between Chinese and Caucasian cohorts. NeuroImage (Orlando, Fla.). 2010;51(1):33‐41. doi: 10.1016/j.neuroimage.2010.01.111
28.
FillmorePTPhillips-MeekMCRichardsJE. Age-specific MRI brain and head templates for healthy adults from 20 through 89 years of age. Front Aging Neurosci. 2015;7(1):44. doi: 10.3389/fnagi.2015.00044
GholipourALimperopoulosCClancyS, et al.Construction of a deformable spatiotemporal MRI atlas of the fetal brain: evaluation of similarity metrics and deformation models. In: Med image comput comput assist interv – MICCAI 2014. Vol 17. Springer International Publishing; 2014:292‐299. doi: 10.1007/978-3-319-10470-6_37.
31.
LiangZ-P. Spatiotemporal imaging with partially separable functions. In 2007 4th IEEE International Symposium on Biomedical Imaging: From Nano to Macro-Proceedings.2007;2007(S1):988‐991.
32.
WooJXingFLeeJStoneMPrinceJL. A spatio-temporal atlas and statistical model of the tongue during speech from cine-MRI. Comput Meth Biomech Biomed Eng. 2018;6(5):520‐531. doi: 10.1080/21681163.2016.1169220
33.
AvantsBBEpsteinCLGrossmanMGeeJC. Symmetric diffeomorphic image registration with cross-correlation: evaluating automated labeling of elderly and neurodegenerative brain. Med Image Anal. 2008;12(1):26‐41. doi: 10.1016/j.media.2007.06.004
34.
XingFJinRGilbertIR, et al.4D Magnetic resonance imaging atlas construction using temporally aligned audio waveforms in speech. J Acoust Soc Am. 2021;150(5):3500‐3508. doi: 10.1121/10.0007064
35.
VercauterenTPennecXPerchantAAyacheN. Non-parametric diffeomorphic image registration with the demons algorithm: non-parametric diffeomorphic image registration with the demons algorithm. Med Image Comput Comput Assist Interv. 2007;10(Pt 2):319‐326.
36.
PerryJLHaensslerAEKotlarekKJ, et al.A midsagittal-view magnetic resonance imaging study of the growth and involution of the adenoid mass and related changes in selected velopharyngeal structures. J Speech Lang Hearing Res. 2022;65(4):1282‐1293. doi: 10.1044/2021_JSLHR-21-00514
37.
KotlarekKJPellandCMBlemkerSSJaskolkaMSFangXPerryJL. Asymmetry and positioning of the levator veli palatini muscle in children with repaired cleft palate. J Speech Lang Hearing Res. 2020;63(5):1317‐1325. doi: 10.1044/2020_JSLHR-19-00240
38.
SchenckGCPerryJLO’GaraMM, et al.Velopharyngeal muscle morphology in children with unrepaired submucous cleft palate: an imaging study. Cleft Palate Craniofac J. 2021;58(3):313‐323. doi: 10.1177/1055665620954749
39.
PerryJLKollaraLSuttonBPKuehnDPFangX. Growth effects on velopharyngeal anatomy from childhood to adulthood. J Speech Lang Hearing Res. 2019;62(3):682‐692. doi: 10.1044/2018_JSLHR-S-18-0016
40.
HaensslerAEBaylisAPerryJLKollaraLFangXKirschnerR. Impact of cranial base abnormalities on cerebellar volume and the velopharynx in 22q11.2 deletion syndrome. Cleft Palate Craniofac J. 2020;57(4):412‐419. doi: 10.1177/1055665619874175
41.
PerryJLKotlarekKJSpoloricK, et al.Differences in the tensor veli palatini muscle and hearing status in children with and without 22q11.2 deletion syndrome. Cleft Palate Craniofac J. 2020;57(3):302‐309. doi: 10.1177/1055665619869142
42.
PerryJLChenJYKotlarekKJ, et al.Morphology of the musculus uvulae in vivo using MRI and 3D modeling among adults with normal anatomy and preliminary comparisons to cleft palate anatomy. Cleft Palate Craniofac J. 2019;56(8):993‐1000. doi: 10.1177/1055665619828226
43.
PerryJLKuehnDPSuttonBP. Morphology of the levator veli palatini muscle using magnetic resonance imaging. Cleft Palate Craniofac J. 2013;50(1):64‐75. doi: 10.1597/11-125
44.
TianWRedettRJ. New velopharyngeal measurements at rest and during speech: implications and applications. Journal Craniofac Surg. 2009;20(2):532‐539. doi: 10.1097/SCS.0b013e31819b9fbe
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