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Digital subtraction sialography seems to provide a better display of glandular anatomy and pathological changes of parotid and submandibular gland. Further comparative studies are however necessary to better evaluate this simple and fast procedure.
An instrument is described for fixing the cannula used for sialography of the submandibular gland. Dislocation of the probe and early discharge of contrast medium can be avoided.
Except in cases where stones are present, it is often difficult to catheterize Wharton's duct through the opening when conducting sialography of the submaxillary glands. When direct catheterization is impossible the authors perform indirect catheterization proximal to the opening by turning back a periorificial mucous flap, posteriorly concave, after exposing the canal.
The value of sialography in the investigation of parotid disease has been controversial and limited in its scope. The marked advantage of CT's ability to demonstrate soft tissue detail has been noted. However, parotid parenchyma is inadequately displayed in the unenhanced or intravenously enhanced state. Further information about pathology is available if the CT study is performed utilizing a sialographic contrast medium. Our method of performing such studies is demonstrated. Detail of parotid parenchyma available by this modality is noted. Illustrations of normal anatomy and variants that may be mistaken for mass lesions are presented.
The advent of CT sialography has significantly altered the investigation of parotid masses. Conventional radiography had been limited by its inability to display soft tissue detail. While CT demonstrated soft tissue structures extremely well, limitations to visualizing parotid parenchyma itself were noted. Many of these limitations could be resolved if a sialographic contrast medium were utilized. Mass lesions can be directly visualized, such that size, location, and extent can be noted. Extrinsic or intrinsic etiology can be assessed. Descriptions of tumor morphology may be related to clinical aggressiveness. Mass locations may be correlated to the facial nerve and surgical landmarks. Adjacent tissue planes and lymph nodes are assessed. Examples of various types of parotid masses are illustrated.
A randomly selected group of patients which had been subjected to sialography during 1975/76, was analysed retrospectively. In a total of 386 patients, 395 contrast radiographs had been performed; of these, 243 sialographs were evaluated retrospectively, the definite diagnosis having been established by surgery, biopsy or clinical course of the disease. The accuracy of diagnosis was 95% when employing diagnosis by exclusion (sialographic diagnosis having yielded "normal findings"), the correct diagnosis being the presence of concrements and inflammatory diseases of the salivary gland. However, the rate of error amounting to 5% must be considered a cause for concern insofar as of the total of 8 wrong diagnoses (against a total of 154 correct diagnoses), 7 patients had tumours which had not been recognized, four of these tumours being of a malignant nature. The presence of a space-occupying process was diagnosed with an accuracy of 88%. Space-requiring growths, provided they were properly diagnosed, were correctly localised in 83% of the cases. Statements on the degree of malignancy of a tumour--which were made in about one-third of the tumour diagnoses only--were found to be correct in 83% of the cases. False positive findings were obtained in 12% of the patients.
To extend the potentialities of sialography, we used roentgenography with direct multiple amplification of the image by Reis microfocal portable x-ray diagnostic device and analyzed this image by analog UAR-1 computer operating in a high-frequency harmonization mode. The basic feature of such roentgenography is spatial stratification of the object shadow simultaneously forming its spatial image. High-frequency harmonization of an x-ray image essentially improved its contrast, this permitting detection of small formations poorly shown on sialogram, the contours of these formations and relationships between them. A total of 85 patients were examined using this method. Analysis of the resultant sialograms showed that using this method it is possible to assess the status of small structures of the gland, detect the changes in the pharyngeal process of the parotid gland. Sialogram direct projection is no longer needed.
Sialography with the time-pressure curve monitored in 66 abnormal parotids was compared with the manual injection technique. The results are: 1. The new procedure makes sialogram image superior, avoids gland parenchymal overfilling, finds the causes of failure promptly, and eliminates the pain and other side effects. 2. Shape of the time-pressure curve and the value of the injection may act as an indicator in differential diagnosis. The curve in Sjögren's syndrome is specific and the injection pressure is obviously higher than that in normal (P < 0.01). In Sialosis the injection pressure is much lower than in normal (P < 0.01).
A new procedure was established for sialography that it is monitored by the time-pressure curve during automatically continuous infusion of Urografin 76%. Shape of the curves in 10 normal parotid glands shows firstly the injection pressure rises to the highest peak rapidly, then falls slowly. Eventually the pressure remains constant despite continued infusion. At that time, mean pressure is 7.3kPa (range is 5.3-9.3 kPa). 3 radiographs are taken at 1 minute intervals from the time of the injection pressure beginning to keep constant. The result is that the second sialogram image is the most satisfied.
Twenty-seven patients with sialolithiasis were examined using functional subtraction sialography developed by the authors. Differential diagnostic signs characterizing the degree of involvement of the salivary gland were defined. High efficacy of the method helps correctly plan the treatment strategy.
This discussion is a brief review of the current status of sialography and salivary gland scanning in the diagnosis of salivary disorders. Both techniques are in current use; the contrast sialogram is most useful in evaluating recurrent inflammatory disorders, and the radiosialogram finds its greatest value in evaluating patients with suspected neoplasms. These examinations should not be used in lieu of a histologic diagnosis in tumor cases except when a smooth margined radiopositive lesion corresponding with a clinically evident Warthin tumor is noted; in this case a presumptive diagnosis of a benign neoplasm may be established. The utilization of these radiographic techniques depends upon the facilities available, the needs of the particular patient, and the experience and clinical judgment of the salivary gland surgeon.
The objective of this research is to compare the ultrasonographic (USG) and sialographic contributions for the diagnosis of Recurrent Parotitis in Childhood (RPC). Bilateral USG of the parotid gland was performed among 16 children with RPC and 16 healthy children. The image of the normal parotid glands was compared with the image of the parotid gland with RPC. A pathologic USG pattern for RPC was obtained which consisted in a homogeneous, micronodular parenchyme with a diffuse increase density, sometimes with multiples hypoechogenous areas, that were considered solid hypoechogenous nodules suggesting inflammatory nodes. A glandular contour finely granulated was described with normal peri-parotidareas and with aponeurotic-muscular planes. Then 16 USG of the parotid gland of the children with RPC were compared with 16 Sialography previous obtained. The possibilities of diagnosis of the disease with both techniques was not different (p > 0.05). When the clinic was correlated with the USG it was possible to obtain parameters of severity of the glandular damage and to visualise the degree of changes of the parenchyma of each child with RPC. In some cases, bilateral damage was observed in children with clinical unilateral symptoms. The USG was performed in children in the acute phase of disease, visualising the microabscess in the gland and confirming the previous diagnosis. Finally, it was possible to conclude the utility of USG in the study of the disease. Being a not invasive exam, harmless, unpainfully echography, was easily accepted by the child. Also, we obtain information not only about the diagnosis of the disease, but also about the severity, prognosis, treatment and follow-up of the infant patients.
A Tc-99m pertechnetate salivary gland scintigraphy, digital subtraction sialography (DSS) and cytological findings of a 48-year-old female who received I-131 therapy for the treatment of follicular carcinoma of thyroid are presented. Post radioiodine therapy sialoscintigraphy showed increased blood flow and uptake with decreased secretion in the left parotid gland suggesting acute inflammation. In contrast, DSS and fine needle aspiration biopsy (FNAB) findings were consistent with chronic sialoadenitis. Follow-up scintigraphy one month later showed normal blood flow and decreased uptake and confirmed the diagnosis of chronic sialoadenitis. In right of this case, we conclude that since management of sialoadenitis depends on the stage of inflammation scintigraphic findings should be interpreted together with radiology and FNAB findings if necessary. When chronic sialoadenitis is followed by acute exacerbations, diagnosis based exclusively on sialoscintigraphic findings may result in inadequate patient management.
The aim of this study was to estimate diagnostic value of the scintigraphy, sialography and fine needle aspiration biopsy in the diagnosis of parotid gland nonmalignant neoplasms. Evaluation was performed on a 116-patient group with parotid gland nonmalignant neoplasms treated in 1st Department of Laryngology, Silesian Medical University in Katowice, Poland, from 1989 to 1995.
A total of 216 99mTc-pertechnetate-sialographies, by applying stimulations by citric acid, were performed for studying radiation effects on the salivary glands in 145 patients. From a scintigram of the salivary gland, the time-activity-curves were obtained for analysis of salivary function. The shape of the time-activity-curve with respect to stimulus-response pattern was classified into four types according to the degree of radiation-induced dysfunction. We found that the acid stimulation was enhancing accumulation of the isotope into the salivary gland as well as influencing salivary discharge. A ratio (Rc) of pre- and post-stimulation counts permitted a construction of quantitative dose-response curves; the curve for the parotids had a slight rise of Rc's over 0-20 Gy, whereas that for the submandibular glands had a significant rise over 10-30 Gy; in both glands the rise of Rc's was followed by a steep fall. The parotids appeared to be more sensitive to radiation than the submandibular glands at 0-3 months following 20-70 Gy, but after 3 months both glands were similarly impaired. The gland volume irradiated was also of great importance in determining the degree of salivary dysfunction. The maximum uptakes averaged per unit area (salivary-to-background ratio) and determined during the initial 30 minutes were greater in the submandibular than in the parotid glands following greater than 20 Gy. In both glands the maximum uptakes were gradually impaired with time over 3-36 months following 50-70 Gy.
OBJECTIVES: To determine the most appropriate sequences for the visualization of small parotid ducts in MR sialography. METHODS: MR images of a phantom consisting of distilled water in polyethylene tubes were obtained with turbo-spin echo (TSE), single-shot turbo-spin echo (SSTSE), half-fourier acquisition, single-shot turbo-spin echo (HASTE) and turbo gradient-spin echo (TGSE) pulse sequences and compared visually and quantitatively. MR sialograms obtained from healthy volunteers and patients with Sjögren's syndrome (SS) were obtained using the same four sequences. RESULTS: In the phantom, TSE images were best and the contrast-noise ratio (CNR) highest. In the volunteers, the main ducts were especially clearly visualized with TSE and in SSTSE; however, the majority of secondary and/or tertiary parotid ducts were not depicted by any of the sequences used. In SS patients, images of small main ducts and small pseudocysts were clearer using TSE. However, TSE could not depict the narrow main ducts or peripheral ducts or very small pseudocysts. CONCLUSIONS: TSE is considered the most suitable MR sequence for assessing small parotid gland ducts. However, further improvement is needed since it does not always visualize them sufficiently.
PURPOSE: To develop a noninvasive method for demonstrating the main salivary gland duct systems. MATERIALS AND METHODS: The authors developed a magnetic resonance (MR) imaging protocol that uses a heavily T2-weighted (echo time, 750 msec), fat-suppressed pulse sequence and rapid acquisition with relaxation enhancement. The technique was optimized to depict fluid within a two-dimensional thick slab. A preliminary evaluation was performed by examining the major salivary gland ducts in 10 asymptomatic volunteers and three symptomatic patients with known salivary duct abnormalities. RESULTS: The main parotid gland ducts were clearly demonstrated in all volunteers. The submandibular ducts were visible in all cases, although not always on projection images. In the three patients, the MR technique clearly demonstrated bilateral sialectasis, a calculus obstructing the left submandibular duct, and a fluid-filled ranula, respectively. CONCLUSION: Preliminary work indicates that this MR technique can successfully demonstrate both normal and abnormal parotid and submandibular gland duct systems and has several advantages over conventional x-ray sialography.
Dynamic radionuclide sialography (DRS) provides data about the aptitude of salivary glands to accumulate the tracer and to secrete the saliva. Visual interpretation of the t/a curves may be onerous when salivary glands uptake function is impaired. The purpose of the study has been to quantify the ascorbic acid (AA) response by means of salivary excretion index (SEI). DRS was performed in 10 healthy subjects and in 118 patients with various diseases of the parotid glands. Data acquisition (80 frames/15 s) started simultaneously with i.v. administration of 99mTcO4. Fifteen minutes later AA was given per os. Regions of interest were set over parotid glands. SEI was derived using the formula: SEI = (2b-a-c)/b, where a, b and c were cpm 3 minutes prior, in the moment when, and 3 minutes after AA was given. In 9 of 10 controls SEI was greater than 55 (mean = 63.2). Results in patients with Sjögren's and Mikulicz's syndrome and sialoadenitis, were significantly lower than in healthy subjects. Lowest results were found in patients with sialolithiasis. It may be concluded that SEI improves objective assessment of the AA response particularly in patients with minute or asymmetric disorders of salivary glands function.