用于吞咽分析的高速视频内窥镜方案的可靠性

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中文摘要

目的： 探讨高速视频内窥镜（HSV）方法用于量化喉部吞咽行为的可靠性。
方法： 22名健康成人以500帧/秒（fps）的速度在低于标准的内窥镜位置（位于喉前庭）下完成一次干性自主吞咽。在五名评估者对特定行为和定义达成共识后，所有评估者使用定制的MATLAB图形用户界面（GUI）对吞咽咽期喉部行为进行标注，并对其可视化喉部解剖结构和运动的信心进行评分。采用组内相关系数（ICC）计算每种喉部行为起始、终止时间及持续时间的评估者间和评估者内可靠性，并通过Fleiss's kappa量化每种行为存在/缺失的一致性，辅以百分比一致性。
结果： 评估者报告对声带（87%）和杓状软骨（80%）的可视化具有信心。完全杓状软骨闭合存在于84%的病例中，而完全前后压缩的无法可视化率最高（41%）。评估者间可靠性在起始时间方面为良好至优秀（ICC范围，0.82-0.99），在终止时间方面为优秀（0.91-0.99），在持续时间方面为差至中等（0.08-0.63）。所有行为的存在/缺失百分比一致性均超过80%。评估者内可靠性在起始时间方面为良好至优秀（0.85-0.99），在终止时间方面为优秀（0.91-0.99），在持续时间方面为差至中等（0.14-0.60）。
结论： HSV结合标准化的低位置内窥镜方案以及使用具有明确定义的定制GUI进行分析，是一种有前景、可行且可靠的工具，可用于研究咽期吞咽过程中特定喉部模式的起始和终止时间。

英文摘要

OBJECTIVES: To investigate the reliability of high-speed videoendoscopy (HSV) methodology for quantifying laryngeal swallowing behaviors.
METHODS: Twenty-two healthy adults completed a dry volitional swallow under HSV at 500 frames per second (fps) with a lower-than-standard scope position located in the laryngeal vestibule. After reaching consensus among five raters on specified behaviors and definitions, all raters used a custom MATLAB graphical user interface (GUI) to annotate the laryngeal behaviors during the pharyngeal phase of the swallow and rated their confidence in visualizing laryngeal anatomy and movements. Inter- and intra-rater reliability for timing of the onsets, offsets, and durations of each laryngeal behavior was calculated using intraclass correlation coefficients (ICCs), and presence/absence agreement of each behavior was quantified by Fleiss's kappa and supplemented with percent agreement.
RESULTS: Raters reported confidence visualizing the vocal folds (87%) and the arytenoids (80%). Full arytenoid closure was present in 84%, while full anterior-posterior compression had the highest inability-to-visualize rate (41%). Inter-rater reliability was good to excellent for onset (ICC range, 0.82-0.99), excellent for offset (0.91-0.99), and poor to moderate for duration (0.08-0.63). Percent agreement for presence/absence exceeded 80% across all behaviors. Intra-rater reliability was good to excellent for onset (0.85-0.99), excellent for offset (0.91-0.99), and poor to moderate for duration (0.14-0.60).
CONCLUSION: HSV, with a standardized low-scope protocol and analysis using a custom GUI with clear definitions, is a promising, feasible, and reliable tool for investigating onset and offset timings of specific laryngeal patterns during the pharyngeal swallow.