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Sialography with fluoroscopy and tomography has increased the accuracy of detecting and delineating mass lesions of the parotid gland. Lesions which are small, at the periphery of the gland, or in the deep lobe are often most clearly visualized on tomographic sections. Often differentiation of benign from malignant tumors is not possible.
Two cases are presented of malignant tumour of the parotid gland following sialography with Thorotrast, 28 and 45 years previously. Both cases were histologically established as squamous cell carcinoma and the presence of Thorotrast in the tumours was confirmed by autohistoradiography. It is suggested that the tumours may have developed from metaplastic ductal epithelium after many years of exposure to the alpha radiation from Thorotrast deposits in the gland.
58 cases of salivary glands pathology were investigated by means of sialography and scintigraphy in order to compare these methods. The usefulness of this association is discussed and a number of significant cases are presented.
OBJECTIVE: To investigate the relationship between the change of parotid sialograms and the results of labial gland biopsies in the patients with Sjögren syndrome (SS). METHODS: Parotid sialography and labial salivary gland biopsy were performed on 100 patients with Sjögren syndrome. RESULTS: The sialectasis of parotid terminal ducts was found in 87 patients, the widening only of main ducts was found in 8 patients, and 5 cases showed normal sialograms. The results of labial salivary gland biopsies showed, that 90 cases had focal lymphocytic sialadenitis (Zhen Linfan's grade score of 2), 59 cases had a score of 4 accoding to Chisholm's grading score; moderate scattered lymphocitic infiltration was shown in 10 patients. CONCLUSION: Our results suggested that the lesions of parotid gland and labial salivary gland in SS were concerted closely. Therefore a new way of combining the changes of parotid gland and labial salivary gland for the diagnose of SS was proposed.
Sialography of the submandibular gland which is often deferred because of inability to isolate, dilate, and cannulate Wharton's duct, can be safely accomplished with minimal morbidity with use of a modification of the surgical procedure to remove a salivary ductal calculus. It can be accomplished as an office procedure in ambulatory patients.
We developed a simple and cost-effective modified cannula for sialography. The cannulae were made from nineteen, twenty-one and twenty-three gauge winged infusion set which are generally used for injection of contrast material in radiological imaging. In this article, we intend to introduce this cannula and discuss its utility.
Ultrasonography (US) was evaluated as noninvasive method to determine salivary gland involvement and compared with sialography in patients with Sjögren's syndrome (SS) and patients with only objective xerostomia and/or xerophthalmia. Patients with complaints of dry eyes and dry mouth but with no objective abnormalities served as control group. Ultrasound revealed a decreased parotid gland reflectivity in most of the patients with SS, compared with only 2 patients in the other group (p = 0.002). Our study suggests that US can be a useful, noninvasive method in the diagnostic work-up of patients with sicca complaints.
In order to ascertain the damaging effects on the glandular parenchyma and excretory system of the major salivary glands of sialography using iodate contrast media in an oily vehicle, experiments have been carried out on a group of dogs. Among other compounds, Lipiodol UF and Urovison were used, the former oil-based and the latter water-based. Histological slides of the injected gland made three and four weeks afterwards showed in one animal only the presence of a periductal infiltrate and an intracanalicular formation of hyaline thrombotic type that was not easy to interpret. Lipiodol UF was employed in this case. Comparing these results with the literature, it is concluded that Lipiodol is an irritant, especially if it passes beyond the salivary excretory tree, but this is not enough to have it banned absolutely. Contraindications are reported and the need for correct technique stressed.
Sialography is at present performed either by the subtraction mode or conventional technique only. We utilised a high-resolution digital radiography system with a 1024 x 1024 matrix in 17 patients with diseases of the salivary glands. Digital subtraction ductography in lateral projection was followed by digital radiography in adequate projections. In that way advantages of both methods could be combined in one. Additional advantages are possibilities of storage and communication of the digital data.
Sialographic manifestations of 442 patients with primary parotid tumors, 336 benign and 106 malignant, were studied. The sialographic appearance were divided into five types: benign, aggressive benign, low-grade malignant, malignant, and adenolymphoma. The overall corresponding rate between roentgenographic and histologic diagnosis was 81.9%, benign tumors was 89.3, malignant tumors 58.5%, and adenolymphoma 88.9%. Irregular-arrangement, dilation and narrow of branch ducts were the characteristics of adenolymphoma. Extension of main duct, smooth defect of posterior border of mandibular ramus, posterior displace of styloid process, and filling defect of branch ducts and acini in the pterygomandibular space were seen in deep lobe parotid tumors. The causes of mistaken, and the value of sialography were discussed.
In order to evaluate their sensitivity and specificity, parotid sialography (PS) and labial salivary gland biopsy were performed in 150 putative patients with Sjögren's syndrome (SS) (74 with SS alone and 76 with SS associated with other well-defined disorders). Although PS and LSGB strongly correlated to each other (Kendall's Tau 0.47, z = 7.78, p less than 0.0001), PS confirmed the diagnosis of SS in a significantly higher prevalence of patients with respect to LSGB (63% vs 37%, chi 2 = 18.25, p less than 0.001). When the sensitivity and specificity of PS and LSGB were calculated, PS showed a better sensitivity, and an only slightly lower specificity than LSGB (86% vs 70% and 78% vs 86% respectively). In conclusion, our study indicates that PS has been unduly overlooked in the past decades as a diagnostic tool for the salivary component of SS, and should be reconsidered as a potentially useful and relatively non-invasive procedure in the approach of patients with this disease.
The authors describe a radiological technique for improved interpretation of parotid gland sialography, using thick section tomography (zonography).
Many new lipid- and water-soluble contrast media can be used in sialography, the three main criteria of choice being the cost, the quality of filling, particularly of the parenchyma, and its evacuation and clinical tolerance. Duroliopaque possesses very similar physicochemical properties to those of Lipiodol UF, but a sufficiently satisfactory filling of the parenchyma is not obtained. Comparison of Lipiodol UF and Hexabrix in parotid and submaxillary contrast imaging showed good clinical tolerance for both products, but improved parenchymatous filling with Lipiodol UF. However, the more effective glandular evacuation with Hexabrix makes this the product most suitable at the present time for morphologic exploration of salivary glands.
Ultrasonography (US) and computed tomography (CT) were studied as noninvasive methods to determine salivary gland involvement and compared with parotid sialography in patients with Sjögren's syndrome (SS) and patients with only objective xerostomia and/or xerophthalmia. Patients with complaints of dry eyes and dry mouth but with no objective abnormalities served as controls. CT was not discriminative between the 2 groups. In contrast, US revealed decreased parotid gland echogenicity in most of the patients with SS, compared with only 1 patient in the group with sicca complaints only (p = 0.005). Our study suggests that US can be a useful, noninvasive method in the diagnostic investigation of patients with sicca complaints.
In 22 patients we performed 33 sialographies of salivary glands using digital subtraction technique as well as conventional technique (100 mm camera). In the majority of cases the digital subtraction technique was superior to the conventional technique regarding diagnostic image quality. Additionally, digital subtraction technique generally needs a lower number of contrast media application. Hence we recommend digital subtraction technique for radiological imaging of salivary glands and ducts.
A suitable choice of film-screen combination is certainly the essential condition for achieving diagnostically reliable results together with the benefit of a low dosage for the patient. In parotid sialography, the choice of one particular film-screen combination depends on the different thickness of various glandular areas and on the particular anatomical site of the gland which inevitably causes the superimposition of the thinnest canalicular ducts with the adjacent areas. We have therefore performed an experimental-clinical study in order to evaluate the combination which can guarantee the most elevated diagnostic increase. The analysis of the results shows useful indication as far as the use of mammographic systems is concerned. These allow more diagnostic information together with a sufficiently low dosage for the patient.
Roentgenography without contrast media and sialography, as well as the basic facts concerning the radiodiagnostic of the salivary gland, are all discussed with regard to the most current equipment, examination techniques, the positioning of patients, and the problems involved in contrast media. The technique used in more than 4,000 sialograms is recommended. The diagnostic value of this method is illustrated by means of representative patient series: sialolithiasis, inflammatory disorders, and tumors. The limitations of the method are demonstrated and complementary examinations shown.
Sialography is of value for showing opaque or nonopaque stones in the maxillary glands. Possible complications (inflammation, abscess and fistula) can also be shown. Acute and chronic inflammation and sialadenoses show typical pictures. The diagnosis of tumors is less certain, genignity or malignity cannot be determined.