PubMed · 6564099
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N Braun. 1984. Respiratory muscle dysfunction.. https://pubmed.ncbi.nlm.nih.gov/6564099/
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This review examines approaches to evaluation of the respiratory muscles and describes new techniques that may be more quantitative, less effort dependent, and less invasive than conventional methods. To evaluate strength of the respiratory muscles, maximum inspiratory and expiratory pressures remain useful measures. Potential methodologic errors, however, necessitate careful technique. Evaluation of the twitch response to direct phrenic nerve stimulation may ultimately prove more quantitative and less effort dependent than measurements of maximum pressure. Many techniques are also available to measure endurance of respiratory muscles, but most are less than satisfactory outside the research environment because of poor reproducibility and other procedural difficulties. The maximum incremental resistive loading test, however, has proven to be practical and well tolerated. There is little substitute for careful clinical observation of respiratory muscle coordination and movement, particularly in the patient with suspected respiratory muscle weakness or chest wall distortion. In conclusion, though the respiratory muscles are difficult to evaluate, techniques are available that can be quite helpful for assessment, particularly in response to interventions such as rehabilitation.
The diaphragm is a thin musculotendinous structure, which is not or only partially visible with the conventionally used imaging techniques (chest X-ray, ultrasonography, contrast bowel examination, incremental CT). Spiral CT may offer new perspectives to overcome the above mentioned problem. Volumetric data acquisition can be achieved during one apnoea period, which allows to eliminate all respiratory induced artifacts. Reformatting of the axial reconstructed CT data allows furthermore to study the diaphragm in any desired plane. Especially the coronal and sagittal planes are well suited to study the relationship of peridiaphragmatic pathology to the diaphragm. The major limitation of spiral CT is the inability to recognize the diaphragm as a separate structure if the diaphragm is adjacent to another structure with an analogous density such as the liver or the spleen.