The Society for Pediatric Radiology Magnetic Resonance Imaging and Emergency and Trauma Imaging Committees' consensus protocol recommendation for rapid MRI for evaluating suspected appendicitis in children.

The imaging evaluation of acute abdominal pain in children with suspected appendicitis has evolved to include rapid abdominopelvic MRI (rMRI) over recent years. Through a collaborative effort between the Magnetic Resonance Imaging (MRI) and Emergency and Trauma Imaging Committees of the Society for Pediatric Radiology (SPR), we conducted a survey on the utilization of rMRI to assess practice specifics and protocols. Subsequently, we present a proposed consensus rMRI protocol derived from the survey results, literature review, and discussion and consensus between committee members.

Late-gadolinium enhancement is common in older pediatric heart transplant recipients and is associated with lower ejection fraction.

BACKGROUND: Chronic graft failure and cumulative rejection history in pediatric heart transplant recipients (PHTR) are associated with myocardial fibrosis on endomyocardial biopsy (EMB). Cardiovascular magnetic resonance imaging (CMR) is a validated, non-invasive method to detect myocardial fibrosis via the presence of late gadolinium enhancement (LGE). In adult heart transplant recipients, LGE is associated with increased risk of future adverse clinical events including hospitalization and death. We describe the prevalence, pattern, and extent of LGE on CMR in a cohort of PHTR and its associations with recipient and graft characteristics. METHODS: This was a retrospective study of consecutive PHTR who underwent CMR over a 6-year period at a single center. Two independent reviewers assessed the presence and distribution of left ventricular (LV) LGE using the American Heart Association (AHA) 17-segment model. LGE quantification was performed on studies with visible fibrosis (LGE+). Patient demographics, clinical history, and CMR-derived volumetry and ejection fractions were obtained. RESULTS: Eighty-one CMR studies were performed on 59 unique PHTR. Mean age at CMR was 14.8 ± 6.2 years; mean time since transplant was 7.3 ± 5.0 years. The CMR indication was routine surveillance (without a clinical concern based on laboratory parameters, echocardiography, or cardiac catheterization) in 63% (51/81) of studies. LGE was present in 36% (29/81) of PHTR. In these LGE + studies, patterns included inferoseptal in 76% of LGE + studies (22/29), lateral wall in 41% (12/29), and diffuse, involving > 4 AHA segments, in 21% (6/29). The mean LV LGE burden as a percentage of myocardial mass was 18.0 ± 9.0%. When reviewing only the initial CMR per PHTR (n = 59), LGE + patients were older (16.7 ± 2.9 vs. 12.8 ± 4.6 years, p = 0.001), with greater time since transplant (8.3 ± 5.4 vs. 5.7 ± 3.9 years, p = 0.041). These patients demonstrated higher LV end-systolic volume index (LVESVI) (34.7 ± 11.7 vs. 28.7 ± 6.1 ml/m2, p = 0.011) and decreased LV ejection fraction (LVEF) (56.2 ± 8.1 vs. 60.6 ± 5.3%, p = 0.015). There were no significant differences in history of moderate/severe rejection (p = 0.196) or cardiac allograft vasculopathy (CAV) (p = 0.709). CONCLUSIONS: LV LGE was present in approximately one third of PHTR, more commonly in older patients with longer time since transplantation. Grafts with LGE have lower LVEF. CMR-derived LGE may aid in surveillance of chronic graft failure in PHTR.

Imaging of pediatric cardiac tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper.

Cardiac tumors in children are rare and the majority are benign. The most common cardiac tumor in children is rhabdomyoma, usually associated with tuberous sclerosis complex. Other benign cardiac masses include fibromas, myxomas, hemangiomas, and teratomas. Primary malignant cardiac tumors are exceedingly rare, with the most common pathology being soft tissue sarcomas. This paper provides consensus-based imaging recommendations for the evaluation of patients with cardiac tumors at diagnosis and follow-up, including during and after therapy.

Guide to use of ferumoxytol for hepatic vascular assessment as part of dual contrast MRI.

Magnetic resonance imaging (MRI) assessment of hepatic vasculature can be challenging in the setting of liver disease and liver lesions. The widely used hepatobiliary contrast agent gadoxetate is an extracellular contrast agent that provides excellent soft tissue characterization but has limitations as a vascular contrast agent. Ferumoxytol is an iron oxide nanoparticle with superparamagnetic properties that can be used as blood pool contrast agent to provide dedicated vascular assessment. We provide a detailed protocol for evaluation of pediatric liver vasculature using ferumoxytol, after imaging of the parenchyma with gadoxetate. We provide multiple examples and discuss practical considerations when incorporating ferumoxytol into practice.

Highly accelerated compressed sensing 4D flow MRI in congenital and acquired heart disease: comparison of aorta and main pulmonary artery flow parameters with conventional 4D flow MRI in children and young adults.

BACKGROUND: Four-dimensional flow (4D flow) MRI has become a clinically utilized cardiovascular flow assessment tool. However, scans can be lengthy and may require anesthesia in younger children. Adding compressed sensing can decrease scan time, but its impact on hemodynamic data accuracy needs additional assessment. OBJECTIVE: To compare 4D flow hemodynamics acquired with and without compressed sensing. MATERIALS AND METHODS: Twenty-seven patients (median age: 13 [IQR: 9.5] years) underwent conventional and compressed sensing cardiovascular 4D flow following informed consent. Conventional 4D flow was performed using parallel imaging and an acceleration factor of 2. Compressed sensing 4D flow was performed with an acceleration factor of 7.7. Regions of interest were placed to compare flow parameters in the ascending aorta and main pulmonary artery. Paired Student's t-tests, Wilcoxon signed-rank tests, Bland-Altman plots, and intraclass correlation coefficients were conducted. A P-value of < 0.05 was considered statistically significant. RESULTS: Mean scan acquisition time was reduced by 59% using compressed sensing (3.4 vs. 8.2 min, P < 0.001). Flow quantification was similar for compressed sensing and conventional 4D flow for the ascending aorta net flow: 47 vs. 49 ml/beat (P = 0.28); forward flow: 49 vs. 50 ml/beat (P = 0.07), and main pulmonary artery net flow: 49 vs. 51 ml/beat (P = 0.18); forward flow: 50 vs. 55 ml/beat (P = 0.07). Peak systolic velocity was significantly underestimated by compressed sensing 4D flow in the ascending aorta: 114 vs. 128 cm/s (P < 0.001) and main pulmonary artery: 106 vs. 112 cm/s (P = 0.02). CONCLUSION: For both the aorta and main pulmonary artery, compressed sensing 4D flow provided equivalent net and forward flow values compared to conventional 4D flow but underestimated peak systolic velocity. By reducing scan time, compressed sensing 4D flow may decrease the need for anesthesia and increase scanner output without significantly compromising data integrity.

Comparing amplitudes of transcranial direct current stimulation (tDCS) to the sensorimotor cortex during swallowing.

PURPOSE: Transcranial direct current stimulation (tDCS) can alter cortical excitability, making it a useful tool for promoting neuroplasticity in dysphagia rehabilitation. Clinical trials show functional improvements in swallowing following anodal tDCS despite varying dosing parameters and outcomes. The aim of the current study was to determine the most effective amplitude criterion (e.g., 0 mA [sham/control], 1 mA, 2 mA) of anodal tDCS for upregulating the swallowing sensorimotor cortex. METHOD: As a novel paradigm, tDCS, functional near-infrared spectroscopy (fNIRS), and surface electromyography (sEMG) were simultaneously administered while participants completed a swallowing task. This allowed for measurement of the cortical hemodynamic response and submental muscle contraction before, during, and after tDCS. At the conclusion of the study, participants were asked to rate their level of discomfort associated with tDCS using a visual analog scale. RESULTS: There was no significant difference in the hemodynamic response by time or amplitude. However, post-hoc analyses indicated that in the post-stimulation period, changes to the hemodynamic response in the left (stimulated) hemisphere were significantly different for the groups receiving 1 mA and 2 mA of tDCS compared to baseline. Participants receiving 1 mA of tDCS demonstrated reduced hemodynamic response. There was no significant difference in submental muscle contraction during or after tDCS regardless of amplitude. Anodal tDCS was well tolerated in healthy adults with no difference among participant discomfort scores across tDCS amplitude. CONCLUSIONS: During a swallowing task, healthy volunteers receiving 1 mA of anodal tDCS demonstrated a suppressed hemodynamic response during and after stimulation whereas those receiving 2 mA of anodal tDCS had an increase in the hemodynamic response. tDCS remains a promising tool in dysphagia rehabilitation, but dosing parameters require further clarification.

Computed tomography for aortic assessment in children.

Because the aorta is the major vessel of the body, basic knowledge of aortic pathology is essential to the pediatric imager. This review divides aortic pathology into anatomical (e.g., congenital abnormalities) and acquired (e.g., vasculitis, trauma) entities, providing a brief description of pathology, technical considerations in CT acquisition and processing, and some pearls and pitfalls of interpretation. The objective of this paper is to familiarize general pediatric imagers with imaging features of common as well as high-impact aortic pathology on CT and prepare them for acquisition and reporting.

Early pulmonary complications related to cancer treatment in children.

In this review, we summarize early pulmonary complications related to cancer therapy in children and highlight characteristic findings on imaging that should be familiar to a radiologist reviewing imaging from pediatric cancer patients.

Variation in Advanced Diagnostic Imaging Practice Patterns and Associated Risks Prior to Superior Cavopulmonary Connection: A Multicenter Analysis.

Single ventricle patients typically undergo some form of advanced diagnostic imaging prior to superior cavopulmonary connection (SCPC). We sought to evaluate variability of diagnostic practice and associated comprehensive risk. A retrospective evaluation across 4 institutions was performed (1/1/2010-9/30/2016) comparing the primary modalities of cardiac catheterization (CC), cardiac magnetic resonance (CMR), and cardiac computed tomography (CT). Associated risks included anesthesia/sedation, vascular access, total room time, contrast agent usage, radiation exposure, and adverse events (AEs). Of 617 patients undergoing SCPC, 409 (66%) underwent at least one advanced diagnostic imaging study in the 60 days prior to surgery. Seventy-eight of these patients (13%) were analyzed separately because of a concomitant cardiac intervention during CC. Of 331 (54%) with advanced imaging and without catheterization intervention, diagnostic CC was most common (59%), followed by CT (27%) and CMR (14%). Primary modality varied significantly by institution (p < 0.001). Median time between imaging and SCPC was 13 days (IQR 3-33). Anesthesia/sedation varied significantly (p < 0.001). Pre-procedural vascular access did not vary significantly across modalities (p = 0.111); procedural access varied between CMR/CT and CC, in which central access was used in all procedures. Effective radiation dose was significantly higher for CC than CT (p < 0.001). AE rate varied significantly, with 12% CC, 6% CMR, and 1% CT (p = 0.004). There is significant practice variability in the use of advanced diagnostic imaging prior to SCPC, with important differences in associated procedural risk. Future studies to identify differences in diagnostic accuracy and long-term outcomes are warranted to optimize diagnostic protocols.

Four-dimensional Multiphase Steady-State MRI with Ferumoxytol Enhancement: Early Multicenter Feasibility in Pediatric Congenital Heart Disease.

Background The value of MRI in pediatric congenital heart disease (CHD) is well recognized; however, the requirement for expert oversight impedes its widespread use. Four-dimensional (4D) multiphase steady-state imaging with contrast enhancement (MUSIC) is a cardiovascular MRI technique that uses ferumoxytol and captures all anatomic features dynamically. Purpose To evaluate multicenter feasibility of 4D MUSIC MRI in pediatric CHD. Materials and Methods In this prospective study, participants with CHD underwent 4D MUSIC MRI at 3.0 T or 1.5 T between 2014 and 2020. From a pool of 460 total studies, an equal number of MRI studies from three sites (n = 60) was chosen for detailed analysis. With use of a five-point scale, the feasibility of 4D MUSIC was scored on the basis of artifacts, image quality, and diagnostic confidence for intracardiac and vascular connections (n = 780). Respiratory motion suppression was assessed by using the signal intensity profile. Bias between 4D MUSIC and two-dimensional (2D) cine imaging was evaluated by using Bland-Altman analysis; 4D MUSIC examination duration was compared with that of the local standard for CHD. Results A total of 206 participants with CHD underwent MRI at 3.0 T, and 254 participants underwent MRI at 1.5 T. Of the 60 MRI examinations chosen for analysis (20 per site; median participant age, 14.4 months [interquartile range, 2.3-49 months]; 33 female participants), 56 (93%) had good or excellent image quality scores across a spectrum of disease complexity (mean score ± standard deviation: 4.3 ± 0.6 for site 1, 4.9 ± 0.3 for site 2, and 4.6 ± 0.7 for site 3; P < .001). Artifact scores were inversely related to image quality (r = -0.88, P < .001) and respiratory motion suppression (P < .001, r = -0.45). Diagnostic confidence was high or definite in 730 of 780 (94%) intracardiac and vascular connections. The correlation between 4D MUSIC and 2D cine ventricular volumes and ejection fraction was high (range of r = 0.72-0.85; P < .001 for all). Compared with local standard MRI, 4D MUSIC reduced the image acquisition time (44 minutes ± 20 vs 12 minutes ± 3, respectively; P < .001). Conclusion Four-dimensional multiphase steady-state imaging with contrast enhancement MRI in pediatric congenital heart disease was feasible in a multicenter setting, shortened the examination time, and simplified the acquisition protocol, independently of disease complexity. Clinical trial registration no. NCT02752191 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Roest and Lamb in this issue.

A Randomized Controlled Trial Comparing Physical and Mental Lingual Exercise for Healthy Older Adults.

Mental practice using motor imagery (MP-MI) has been shown to improve motor outcomes of upper and lower extremities especially when combined with physical exercise. Here, we studied community-dwelling, healthy older adults to determine the effects of including an MP-MI component with lingual strengthening exercise. In this pilot study, twenty-nine typically aging participants were assigned to an intervention group: physical lingual exercise (n = 7), physical and MP-MI lingual exercise (n = 8), MPMI lingual exercise (n = 7), or a control group (placebo exercise) (n = 7). All participants completed the assigned exercise regimen with three sessions per day, three days a week, for 6 consecutive weeks. Maximum isometric pressure (MIP) and regular effort saliva swallowing (RESS) pressure were collected at baseline and weeks 2, 4, and 6. A post hoc Bonferroni corrected treatment effect from baseline to week 6 was shown for only participants in the MP-MI/Physical exercise group for MIP (p = 0.003 MPMI/ Physical group; p = 0.11 Control group; p = 0.32 Physical only group; p = 0.14 MP-MI only group) and RESS (p = 0.009 MP-MI/Physical group; p = 0.14 Control group; p = 0.10 Physical only group; p = 0.04 MP-MI only group). Findings also indicate spontaneous carryover of significantly increased swallowing pressure when mental and physical exercise are combined. In conclusion, the potential effect of including an MPMI lingual exercise component in preventative and rehabilitative frameworks with older persons to possibly enhance functional swallowing improvement is promising and should be investigated.

Multicenter Safety and Practice for Off-Label Diagnostic Use of Ferumoxytol in MRI.

Background Ferumoxytol is approved for use in the treatment of iron deficiency anemia, but it can serve as an alternative to gadolinium-based contrast agents. On the basis of postmarketing surveillance data, the Food and Drug Administration issued a black box warning regarding the risks of rare but serious acute hypersensitivity reactions during fast high-dose injection (510 mg iron in 17 seconds) for therapeutic use. Whereas single-center safety data for diagnostic use have been positive, multicenter data are lacking. Purpose To report multicenter safety data for off-label diagnostic ferumoxytol use. Materials and Methods The multicenter ferumoxytol MRI registry was established as an open-label nonrandomized surveillance databank without industry involvement. Each center monitored all ferumoxytol administrations, classified adverse events (AEs) using the National Cancer Institute Common Terminology Criteria for Adverse Events (grade 1-5), and assessed the relationship of AEs to ferumoxytol administration. AEs related to or possibly related to ferumoxytol injection were considered adverse reactions. The core laboratory adjudicated the AEs and classified them with the American College of Radiology (ACR) classification. Analysis of variance was used to compare vital signs. Results Between January 2003 and October 2018, 3215 patients (median age, 58 years; range, 1 day to 96 years; 1897 male patients) received 4240 ferumoxytol injections for MRI. Ferumoxytol dose ranged from 1 to 11 mg per kilogram of body weight (≤510 mg iron; rate ≤45 mg iron/sec). There were no systematic changes in vital signs after ferumoxytol administration (P > .05). No severe, life-threatening, or fatal AEs occurred. Eighty-three (1.9%) of 4240 AEs were related or possibly related to ferumoxytol infusions (75 mild [1.8%], eight moderate [0.2%]). Thirty-one AEs were classified as allergiclike reactions using ACR criteria but were consistent with minor infusion reactions observed with parenteral iron. Conclusion Diagnostic ferumoxytol use was well tolerated, associated with no serious adverse events, and implicated in few adverse reactions. Registry results indicate a positive safety profile for ferumoxytol use in MRI. © RSNA, 2019 Online supplemental material is available for this article.

7T MRI of distal radius trabecular bone microarchitecture: How trabecular bone quality varies depending on distance from end-of-bone.

PURPOSE: To use 7T magnetic resonance imaging (MRI) to determine how trabecular bone microarchitecture varies at the epiphysis, metaphysis, and diaphysis of the distal radius. MATERIALS AND METHODS: The distal radius of 24 females (mean age = 56 years, range = 24-78 years) was scanned on a 7T MRI using a 3D fast low-angle shot sequence (0.169 × 0.169 × 1 mm). Digital topological analysis was applied at the epiphysis, metaphysis, and diaphysis to compute: total trabecular bone volume; trabecular thickness, number, connectivity, and erosion index (a measure of network resorption). Differences and correlations were assessed using standard statistical methods. RESULTS: The metaphysis and epiphysis had 83-123% greater total bone volume and 14-16% greater trabecular number than the diaphysis (both P < 0.0001). The erosion index was significantly higher at the diaphysis than the metaphysis and epiphysis (both P < 0.01). The most elderly volunteers had lower trabecular number (<66 years mean 0.29 ± 0.01; ≥66 years, 0.27 ± 0.02, P < 0.05) and higher erosion index (<66 years mean 1.18 ± 0.17; age ≥66 years, mean 1.42 ± 0.46, P < 0.05) at the epiphysis; differences not detected by total trabecular bone volume. CONCLUSION: 7T MRI reveals trabecular bone microarchitecture varies depending on scan location at the end-of-bone, being of overall higher quality distally (epiphysis) than proximally (diaphysis). Age-related differences in trabecular microarchitecture can be detected by 7T MRI. The results highlight the potential sensitivity of 7T MRI to microarchitectural differences and the potential importance of standardizing scan location for future clinical studies of fracture risk or treatment response. LEVEL OF EVIDENCE: 3 J. Magn. Reson. Imaging 2017;45:872-878.

Increases in Sex Hormones during Anti-Tumor Necrosis Factor α Therapy in Adolescents with Crohn's Disease.

OBJECTIVE: To evaluate children with Crohn's disease for inverse relationships between systemic inflammatory cytokines and sex hormone regulation in the context of anti-tumor necrosis factor α (TNF-α) therapy. STUDY DESIGN: An observational study design was used to assess sex hormone and gonadotropin levels at the time of initiation of anti-TNF-α therapy and 10 weeks and 12 months later in 72 adolescents (Tanner stage 2-5) with Crohn's disease. Mixed-model linear regression was used to evaluate relationships between hormone levels, systemic inflammation, and dual-energy x-ray absorptiometry whole-body fat mass Z scores over the study interval. RESULTS: Sex hormone Z scores increased significantly during the 10-week induction interval: testosterone Z scores in male patients increased from a median of -0.36 to 0.40 (P < .05) and estradiol Z scores in females increased from -0.35 to -0.02 (P < .01). In mixed model regression, the pediatric Crohn's disease activity index score, cytokine levels, and measures of inflammation were significantly and negatively associated with sex hormone Z scores and with luteinizing hormone and follicle-stimulating hormone levels, adjusted for sex and Tanner stage. Sex hormone and gonadotropin levels were not associated with body mass index or fat mass Z-scores. CONCLUSIONS: Crohn's disease is associated with delayed maturation, and initiation of anti-TNF-α therapy was associated with significant and rapid increases in sex hormone and gonadotropin levels, in association with improvements in disease activity and measures of inflammation. These data are consistent with preclinical studies of the effects of inflammation on sex hormone regulation.

Women chairs in academic medicine: engendering strategic intuition.

PURPOSE: Because stereotypically masculine behaviors are required for effective leadership, examining female chairs' leadership in academic medicine can provide insight into the complex ways in which gender impacts on their leadership practices. The paper aims to discuss this issue. DESIGN/METHODOLOGY/APPROACH: The author interviewed three female clinical chairs and compared the findings to interviews with 28 of their faculty. Grounded theory analysis of the subsequent text gathered comprehensive, systematic, and in-depth information about this case of interest at a US top-tier academic medical center. FINDINGS: Four of five themes from the faculty were consistent with the chair's narrative with modifications: Prior Environment (Motivated by Excellence), Tough, Direct, Transparent (Developing Trust), Communal Actions (Creating Diversity of Opinion), and Building Power through Consensus (an "Artful Exercise") with an additional theme, the Significance (and Insignificance) of a Female Chair. While faculty members were acutely aware of the chair's gender, the chairs paradoxically vacillated between gender being a "non-issue" and noting that male chairs "don't do laundry." All three female chairs in this study independently and explicitly stated that gender was not a barrier, yet intuitively used successful strategies derived from the research literature. ORIGINALITY/VALUE: This study suggests that while their gender was highlighted by faculty, these women dismissed gender as a "non-issue." The duality of gender for these three female leaders was both minimized and subtly affirmed.

A Comparison of Lingual Pressure Generation Measures Using Two Devices in Community-Dwelling, Typically Aging Adults: An Important Clinical Implication.

DESIGN: A multisite, prospective, and randomized within-subject design study. SETTING: Five university settings in varied geographical areas in the United States. PURPOSE: The purpose of this study was to compare lingual pressure generation using the Tongueometer (TO) and the Iowa Oral Performance Instrument (IOPI) in typically aging, community-dwelling adults during three measurement tasks: maximum isometric pressure (MIP), regular effort saliva swallow (RESS) pressure, and effortful saliva swallow pressure (ESP). PARTICIPANTS: Eighty-seven typically aging, community-dwelling adults (aged 55 years and over) with no self-reported history of swallowing or neurological disorders were recruited to complete this study. RESULTS: Strong positive associations were found between the lingual pressure generation measures from the TO and IOPI in all tasks in typically aging adults, with Pearson correlations ranging from r = .780 to .874, p < .001. Agreement between the devices (Lin's concordance correlation coefficient) ranged from moderate for the MIP (ρc = .78) and ESP (ρc = .61) tasks to weak agreement for the RESS task (ρc = .47). MIP, RESS pressure, and ESP were lower when measured by the TO compared with the IOPI, p < .001. CONCLUSIONS: The TO measures lingual pressure generation similarly to the IOPI but pressures register lower when using the TO than the IOPI in typically aging persons. This supports the need for developing normative values specific to the TO device or development of a valid and reliable conversion formula from TO to IOPI normative values. At this time, the clinical use of reference values from the TO should not be generalized to IOPI normative values.

Nutritional vitamin D use in chronic kidney disease: a survey of pediatric nephrologists.

BACKGROUND: Vitamin D deficiency may contribute to risk of cardiovascular disease, diabetes, and infections, in addition to known effects on mineral metabolism. Controversy remains regarding the use of nutritional vitamin D supplementation in chronic kidney disease (CKD), and the supplementation practices of pediatric nephrologists are unknown. METHODS: An electronic survey containing eight vignettes was sent to physician members of the International Pediatric Nephrology Association in 2011 to identify physician and patient characteristics that influence nephrologists to supplement CKD patients with nutritional vitamin D. Vignettes contained patient characteristics including light vs dark skin, CKD stage, cause of renal disease, parathyroid hormone (PTH), and 25(OH) vitamin D levels. Multivariate logistic generalized estimating equation regression was used to identify predictors of supplementation. RESULTS: Of 1,084 eligible physicians, 504 (46%) completed the survey. Supplementation was recommended in 73% of cases overall (ranging from 91% of those with vitamin D levels <10 ng/mL to 35% with levels >30). Greater CKD severity was associated with greater recommendation of supplementation, especially for patients with higher vitamin D levels (test for interaction p < 0.0001). PTH level above target for CKD stage was associated with greater recommendation to supplement in pre-dialysis CKD, but did not have an impact on recommendations in dialysis patients (test for interaction p < 0.0001). Skin color, cause of CKD, and albumin levels were not associated with supplementation recommendation. CONCLUSIONS: Recommending nutritional vitamin D is common worldwide, driven by CKD stage and vitamin D and PTH levels. Future studies are needed to establish the risks and benefits of supplementation.

Dysphonia Outperforms Voice Change as a Clinical Predictor of Dysphagia.

PURPOSE: Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses. METHOD: In this prospective study, 30 adults (aged 49-97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration-Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance. RESULTS: Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure. CONCLUSION: These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.