title: Functional MRI of the Eustachian Tubes in Patients With Nasopharyngeal Carcinoma: Correlation With Middle Ear Effusion and Tumor Invasion.
abstract: OBJECTIVE
  We sought to combine the Valsalva maneuver with MRI to evaluate eustachian tube function in patients with nasopharyngeal carcinoma (NPC) and to correlate the extent of tumor invasion with the presence of middle ear effusion (MEE) and eustachian tube dysfunction (ETD).
  
  
  METHODS
  We performed MRI along the lengths of the eustachian tubes, before and after the Valsalva maneuver was performed, in 53 patients with untreated NPC. The images were reviewed by two radiologists.
  
  
  RESULTS
  A total of 106 eustachian tubes and middle ears were studied. There was dysfunction in 37 eustachian tubes, which was always ipsilateral to the NPC. There was MEE in 26 ears of 22 patients. In all cases of MEE, there was ipsilateral ETD. ETD was correlated with tumor invasion of the ipsilateral pharyngeal recess (p < 0.001), pharyngeal opening of the eustachian tube (p < 0.001), the cartilaginous eustachian tube (p < 0.001), the eustachian cartilage (p < 0.001), Ostmann fat pad (p < 0.001), the levator veli palatine muscle (p < 0.001), and the tensor veli palatine muscle (p < 0.001). There was a strong correlation between the grade of parapharyngeal space invasion and ETD (r = 0.809; p < 0.001) and MEE (r = 0.693; p < 0.001).
  
  
  CONCLUSIONS
  Combining the Valsalva maneuver with MRI is helpful in assessing the function of the eustachian tube in patients with NPC. The cause of MEE in patients with NPC is dysfunction of the eustachian tube opening, which is associated with tumor invasion around the eustachian tube.
authors.affiliation: 1 Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China.|2 State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|3 Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Yunxian
authors.initials: Y
authors.lastname: Mo
authors.affiliation: 1 Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China.|2 State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|3 Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Suiqing
authors.initials: S
authors.lastname: Zhuo
authors.affiliation: 1 Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China.|2 State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|3 Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Tian
authors.affiliation: 1 Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China.|2 State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|3 Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.affiliation: 4 Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.
authors.forename: Guolan
authors.initials: G
authors.lastname: Lu
authors.affiliation: 1 Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China.|2 State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|3 Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Youming
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: 1 Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China.|2 State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|3 Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.|4 Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.
authors.forename: Lizhi
authors.initials: L
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D002648:Child; D004428:Ear Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology; D004432:Ear, Middle / Q000473:pathology* / Q000503:physiopathology; D005064:Eustachian Tube / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology; D009361:Neoplasm Invasiveness; D010034:Otitis Media with Effusion / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D014636:Valsalva Maneuver; D055815:Young Adult
keywords: MRI; Valsalva maneuver; eustachian tube; middle ear effusion; nasopharyngeal carcinoma