technetium-tc-99m-sulfur-colloid and Cerebral-Palsy

To test the hypothesis that the salivagram is frequently positive in those at high risk of aspiration but negative in individuals at low risk of aspiration lung disease.. We studied 63 individuals with spastic quadriparetic cerebral palsy (CP), aged 14 months to 16 years (31 females and 32 males), and 20 able-bodied young adult volunteers, aged 19-29 years (17 female and three males) using the salivagram. Twenty millilitres of 99mTc-sulphur colloid in saline was instilled into the pharynx of each subject over 1 h. Aspiration was characterised by the appearance of activity in either lung field.. Aspiration was demonstrated by salivagram in 56% of children with CP (95% confidence interval 43% to 68%), compared to 0% of young adults (97.5% one-sided confidence interval 0% to 17%). The difference in frequency is highly significant (P < 0.0006).. The salivagram is frequently positive in those at high risk of aspiration, but frequently negative in those at low risk of aspiration. It may be a useful investigation for the demonstration of aspiration.

Topics: Adolescent; Adult; Case-Control Studies; Cerebral Palsy; Child; Child, Preschool; Female; Humans; Infant; Lung; Male; Pharynx; Radionuclide Imaging; Respiratory Aspiration; Saliva; Technetium Tc 99m Sulfur Colloid; Young Adult

To study the agreement between three tests for aspiration, barium videofluoroscopy, salivagram, and milk scan we studied 63 children with severe non-ambulant spastic quadriplegic cerebral palsy (CP) aged 14 months to 16 years (32 males, 31 females). The salivagram was most frequently positive (56%, 95% confidence interval 43 to 68%); the next most frequently positive was barium videofluoroscopy when aspiration was defined as the presence of either laryngeal penetration of material or frank aspiration (39%, 95% confidence interval 26 to 53%). The milk scan was rarely positive (6%, 95% confidence interval 2 to 16%). Agreement between the tests of aspiration was poor. The maximum agreement (kappa=0.20) was between aspiration as diagnosed with the salivagram and by barium videofluoroscopy. Positive tests for aspiration are frequent in children with severe CP. Frequency varies widely depending on the investigation used. There is poor agreement between tests used for the diagnosis of aspiration. This information is of importance in assessing the significance of test results.

Topics: Adolescent; Animals; Barium; Cerebral Palsy; Child; Child, Preschool; Confidence Intervals; Female; Fluoroscopy; Humans; Infant; Male; Pneumonia, Aspiration; Radiopharmaceuticals; Respiration; Saliva; Sialography; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

The radionuclide "salivagram" was introduced to document the aspiration of oral secretions in patients who are at risk. Approximately one-third of patients studied had positive tests. A positive study does not necessarily imply that patients are at risk for aspiration after gastroesophageal reflux. However, sequential images of the lung fields after the oral radioactivity has cleared may be a sensitive technique for detecting aspiration in infants and children following reflux.

Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Chronic Disease; Female; Gastroesophageal Reflux; Humans; Infant; Intellectual Disability; Male; Pneumonia, Aspiration; Radionuclide Imaging; Recurrence; Risk Factors; Saliva; Technetium Tc 99m Sulfur Colloid