The Benefit of Brain MRI in the Evaluation of Pediatric Dysphagia

Abstract

Objective: Determine rates of brain MRI abnormalities for dysphagia in a pediatric aerodigestive center. Examine trends in swallowing improvement based on brain MRI pathology and syndromic status. Recognize the incidence of Chiari malformations and the association with dysphagia. Be able to counsel families regarding likelihood of swallowing improvement based on abnormal MRI. Method: Retrospective review of 222 pediatric medical records (2001-2010) enrolled in an aerodigestive clinic. Swallow studies and brain MRI reports were reviewed. Patients were subdivided into syndromic and nonsyndromic, n = 62, 159. All patients with MRI for dysphagia were analyzed statistically for brain abnormalities, Chiari malformation, correlating with swallowing improvement and resolution. Results: Of 222 children with dysphagia 45 had brain MRI for dysphagia. A total of 14 had abnormalities. Eleven, 24%, were nonsyndromic with abnormal MRI. Two out of 11 were diagnosed with Chiari comprising 5% of MRIs performed for dysphagia in nonsyndromic children. One Chiari I patient did not undergo surgery and demonstrated improvement. No Chiari patients had resolution of dysphagia, yet 50% improved P = .486. MRI did not correlate with symptom resolution. Nonsyndromic with abnormal MRI for dysphagia displayed 60% improvement vs 56% improvement with normal MRI, P = 1.0. Resolution rates were similar for patients with abnormal MRI (18% resolution rate) and normal MRI (22% resolution rate), P = 1.0. Conclusion: At our institution children with persistent dysphagia undergo brain MRI to exclude Chiari malformation. Two malformations were diagnosed (5%), supporting MRI in dysphagia evaluation in diagnosing Chiari. However, it does not support MRI utility in predicting resolution, as there was no difference statistically between the brain MRI groups outcome.