Background & Aim: Early studies using functional MRI (fMRI) have demonstrated that volitional swallow is associated with activation of a number of cortical areas (middle cingulate gyrus, ventrolateral prefrontal cortex, ventrolateral sensory/motor cortices andmiddle insula), which collectively represent the “cortical swallowing network” (CSN). Although the activation of these regions has been reported in the literature, the reproducibility of these activations has not been systematically studied. The aim of our study is to investigate the reproducibility of the CSN across different fMRI sessions. Methods: We studied 16 young right-handed healthy volunteers utilizing a standard paradigm driven fMRI protocol and analyzed with an event-related analysis technique. Echo-planar images were obtained during two identical nine minute scans across different sessions while twenty-one dry swallows were performed by visual cues in random intervals. Physiologic circulatory and respiratory-related signal changes were removed retrospectively. Functional images were then aligned, registered (12 degrees of freedom), and mapped stereotaxically to the standard coordinate system. Generalized linear model was then used to remove undesirable signal changes correlated with motion, white matter and cerebrospinal fluid. Finally, the second order group random mixed-effect multilevel analysis was performed to identify active cortical regions. Clusters with p<0.01 corrected for multiple comparisons were considered significant. The number of activated voxels (3.75x3.75x4 mm3) along with their average and peak percent signal change within each cluster was reported and compared between the two study sessions in order to determine the correlation co-efficient. Results: All subjects showed significant and clustered activity within the deglutition network during both scans. Activity within the right precuneus and supplementary area were not reproducible. Overall, the percent fMRI signal change and the number of activated voxels were similar between the two studies with correlation co-efficients r=0.88 and r=0.86, respectively (p<0.0001). Activity within the right precuneus and supplementary area were not reproducible. Within the remaining 20 regions of interest (ROI), the overlap of activity maps across both sessions showed that the center of the activated clusters was within 6.3±4.8 mm (less than two voxels). The difference in maximum activated voxel activity was 9.7±5.9 mm. Conclusions: fMRI activity maps as well as percent signal change and number of voxels activated by volitional swallow in the CSN are reproducible between studies.
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