Clinical Interpretation and Structured Reporting of Velopharyngeal Magnetic Resonance Imaging: A Framework for Multidisciplinary Decision Making

PURPOSE: Magnetic resonance imaging (MRI) enables direct visualization of the velopharyngeal (VP) mechanism, including the soft palate, pharyngeal walls, adenoid tissue, and levator veli palatini (LVP) musculature. As VP MRI becomes more integrated into multidisciplinary craniofacial care, speech-language pathologists (SLPs) are increasingly involved in image interpretation. However, structured guidance for translating MRI findings into clinically relevant multidisciplinary decision making remains limited. This study presents a clinically oriented framework for interpretation of VP MRI and introduces a structured reporting approach to support consistent documentation and interdisciplinary communication. METHOD: A literature-informed, consensus-based framework for interpreting VP MRI was developed. Scoping review first identified MRI-derived anatomic variables relevant to VP function. These variables were organized into interpretive domains through multidisciplinary discussion among SLPs, surgeons, and radiologists. The framework was operationalized into structured reporting templates for speech-language pathology and radiology documentation and prospectively piloted in clinical VP MRI cases. RESULTS: The resulting framework organizes interpretation across five domains: VP proportional relationships, LVP morphology and function, VP closure dynamics, additional structural contributors, and articulatory context. Structured templates integrate quantitative measurements, qualitative observations, and clinical synthesis. The framework was successfully applied across pilot cases, supporting consistent interpretation and documentation. CONCLUSION: This framework provides clinicians with a practical method for integrating VP MRI observations with speech assessment to enhance clinical reasoning and inform multidisciplinary treatment planning for individuals with VP dysfunction. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.34074555.