Achieving Clinical Success in Nonsedated Velopharyngeal Magnetic Resonance Imaging: Optimizing Data Quality and Patient Selection.

Background: The ability of magnetic resonance imaging (MRI) to visualize the velopharyngeal (VP) musculature in vivo makes it the only imaging modality available for this purpose. This underscores a need for exploration into clinical translation of this imaging modality for craniofacial teams. The purpose of this study was to assess outcomes of a clinically feasible VP MRI protocol and describe the ideal patient population for use of this imaging protocol.

Methods: Sixty children (2 to 12 years of age) with VP insufficiency underwent a nonsedated, child-friendly MRI protocol. No exclusions based on syndromic conditions were made. Logistic regression assessed predictors of VP MRI success and multinomial logistic regression evaluated factors influencing quality of anatomic data.

Results: An 85% overall success rate was achieved, including children as young as 2 years and those with syndromic diagnoses. Stratifying by age revealed a 97.5% success rate in children ages 4 and up. The regression model (χ 2 [5] = 37.443; P < 0.001) explained 81.4% of success rate variance, correctly classifying 93.3% of cases. Increased age significantly predicted success ( P = 0.046); sex and syndromic conditions did not. Multinomial regression identified preparatory materials ( P = 0.011) and audio/video during the scan ( P = 0.024) as predictors for improved image quality.

Conclusions: Implementation of VP MRI is feasible for a broad population of children with VP insufficiency, including those with concomitant syndromic diagnoses. Quality is improved by incorporating prescan preparation and audiovisual stimuli during scans. This underscores the potential of VP MRI as a valuable tool in clinical settings, especially for presurgical assessments.