Diagnostik von Schluckstörungen aus radiologischer Sicht

A. Wuttge-Hannig; A. Beer; C. Hannig

doi:10.1055/s-2003-44810

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Endoskopie heute 2003; 16(4): 187-199
DOI: 10.1055/s-2003-44810

Originalarbeit

Diagnostik von Schluckstörungen aus radiologischer Sicht

Diagnosis of Dysphagia on a Radiological Point of ViewA. Wuttge-Hannig¹ , A. Beer² , C. Hannig²

¹Gemeinschaftspraxis für Radiologie, Strahlentherapie und Nuklearmedizin Dres. Wuttge-Hannig/Münch-Schepp- Sindelar München
²Institut für Röntgendiagnostik des Klinikums rechts der Isar der Technischen Universität München

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Publication History

Publication Date:
19 February 2004 (online)

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Zusammenfassung

Die moderne gastroenterologische Röntgendiagnostik muss bei der Abklärung der Dysphagie neben der Beschreibung rein morphologischer Veränderungen auch auf die Beobachtung und diagnostische Bewertung der gastrointestinalen Motilität ausgerichtet sein. Hierzu sind dynamische Aufzeichungverfahren, wie die Hochfrequenzkinematographie, die Videofluoroskopie und das DSI (Digitale Spot Imaging) besonders gut geeignet [11] [20]. Neue Methoden bestehen in der Multislice-CT und dem dynamischen MR. Eine nur für die orale und in einem kleinen Teilaspekt auch für die pharyngeale Phase einsetzbare Methode ist der Ultrasschall der Schluckfunktion. Kombinierte Methoden, wie die Bildfusion von CT und PET sind für die Tumordiagnostik und die Beurteilung eines Therapieerfolges, die kombinierte Videofluoromanometrie zur Abklärung von Motilitätsstörungen unverzichtbar.
Es wird der Stellenwert der verschiedenen Methoden in der interdisziplinären Abklärung der Dysphagie dargestellt. Insbesondere wird ein Überblick gegeben, bei welchen Fragestellungen der Einsatz der dynamischen Aufzeichnungsverfahren wertvolle Zusatzinformationen für die Diagnostik pharyngo-ösophagealer Krankheitsbilder zu erbringen vermag [20].

Abstract

In the diagnostic work-up of the Dysphagia modern radiology must not only describe morphologic alterations but also has to keep in mind the great importance of motility disorders. Dysfunction of the pharynx and esophagus can be assessed by fluoroscopy alone. Manometry is only suitable for the assessement of motility disorders of the tubular esophagus. The superior method to analyze the motility disorders of the oro-pharyngeal and pharyngo- esophageal transport is High-Speed-Cineradiography at a frame-rate of 50 frames/s on 35 mm-film because of the very fast and complex patterns of motion during oro-pharyngeal deglutition, which occurs within only 0.5-0.7 s. Due to the dosage saving methods today videofluoroscopy got the normal study tool. In near future it may be replaced by high- speed-digital fluoroscopy with 30 frames/s. The upper esophageal sphincter turned out to play a very important role in many motility disorders of the pharynx and the esophagus, which often secondarily lead to permanent structural lesions. Examples are given, in which kinds of disorders cineradiography contributes to diagnosis and therapy. In some cases it turned out to be the method of first choice, as for example for the assessment of aspiration [7] [13] [15] [26].

Schlüsselwörter

Dysphagie - dynamisches Röntgen - Funktionsdiagnostik - Aspiration

Key words

Dysphagia - dynamic radiologic analysis - functional diagnosis - aspiration

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