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PubMedDate not supplied

A comparative study between MR sialography and salivary gland scintigraphy in the diagnosis of Sjögren syndrome.

PURPOSE: The purpose of this work was to compare the diagnostic accuracy of MR sialography with that of salivary gland scintigraphy in Sjögren syndrome. METHOD: One hundred thirty patients clinically suspected of having Sjögren syndrome were examined by MR sialography and salivary gland scintigraphy. A labial gland biopsy was performed in all patients. Imaging findings of MR sialography and salivary gland scintigraphy were compared with the results of labial gland biopsy. RESULTS: From the results of labial gland biopsy, the diagnosis of Sjögren syndrome was established in 80 patients. Abnormally high T2 signal intensity areas on MR sialography and decreased uptake and delayed excretion of [(99m)Tc]pertechnetate on salivary gland scintigraphy were well seen in patients with Sjögren syndrome. For the diagnosis of Sjögren syndrome, salivary gland scintigraphy showed higher sensitivity than MR sialography. On the other hand, MR sialography showed higher specificity and positive predictive value (PPV) than salivary gland scintigraphy. Overall diagnostic accuracy was 83% for MR sialography and 72% for salivary gland scintigraphy. CONCLUSION: The high PPV of MR sialography suggests that MR sialography is the preferred imaging modality in patients suspected of having Sjögren syndrome.

Adolescent↗

PubMed2005

Fast and high-resolution MR sialography using a small surface coil.

PURPOSE: To establish a fast and high-resolution MR sialographic technique that provides fast and high-resolution imaging. MATERIALS AND METHODS: MR sialography was performed on a 1.5-T MR imager using a small (47-mm) surface coil. We determined appropriate sequence parameters, and then applied the technique to the salivary glands of 143 patients with xerostomia (including those with Sjögren's syndrome or hyperlipidemia) or salivary gland inflammation. We compared the high-resolution MR sialography with conventional x-ray sialography in the patients with xerostomia to evaluate the effectiveness of the MR sialography technique. RESULTS: We found that a single-shot, single-slice MR sialography (TR/TR/number of signal acquisitions [NSA] = 8000 msec/1000 msec/6) using a small surface coil provides excellent duct images that are clinically feasible with fast (imaging time of 56 seconds) and high-resolution images. An alternative three-dimensional MR sialography technique provided better details of the branches at the expense of imaging time. The MR sialography technique using a small surface coil depicted effectively the ductal changes in the salivary glands in patients with or without Sjögren's syndrome, reflecting the severity of the diseases. CONCLUSION: We conclude that MR sialography can be performed using a fast and high-resolution sequence.

Adult↗

PubMed2004

[The diagnostic value of magnetic resonance sialography for chronic obstructive parotitis].

PURPOSE: To evaluate the diagnostic value of magnetic resonance sialography (MRS) for chronic obstructive parotitis (COP). METHODS: 18 patients with COP underwent both conventional sialography and MRI sialography. A new magnetic resonance technique was applied. In addition to the usually performed T1 and T2 cross-sectional sequence, a heavy T2-weighted sequence (TR=4000 msec,TE=250 msec)was performed that allowed depiction of the fluid-filled parotid duct system. The MRI sialographic findings were compared with that of conventional sialography. The overall accuracy of diagnosis and ductal stenosis were assessed. RESULTS: The main duct of the parotid gland as well as primary branching ducts could be reliably depicted. Compared with the conventional sialography, the diagnostic accuracy of MRS was 94.4%(17/18) and stenosis diagnosis reached 100%(17/17). CONCLUSIONS: Initial experience indicates that magnetic resonance sialography can be applied successfully to investigate the duct system of the parotid gland. It is completely noninvasive and a promising alternative to radiographic sialography.

Adolescent↗

PubMed2001

Magnetic resonance imaging and magnetic resonance sialography of parotid glands in primary Sjogren's syndrome.

OBJECTIVE: To look for structural parotid gland changes on magnetic resonance (MR) imaging and MR sialography of primary Sjögren's syndrome (SS) patients and healthy control subjects and to compare these methods with each other. METHODS: MR imaging and MR sialography of both parotid glands were performed on 26 patients and 7 healthy controls. Bilateral surface coils were used to obtain high spatial resolution. RESULTS: Twenty-two of the 26 patients had abnormalities on MR imaging. Twenty-one had a nodular or dendritic parenchymal pattern, 5 had cavities, and 6 had duct dilatations. On MR sialography, 25 of the 26 patients had abnormalities of the ducts, and 16 of them also had cavities. One patient and all 7 controls had normal results with both methods. The structural appearance of the parotid glands on MR images had marginal linear association with the duct system changes but no correlation with the cavitary changes seen on MR sialography. Furthermore, duct system abnormalities did not correlate with cavitary changes. Both parenchymal and sialographic abnormalities were associated with the presence of Ro/SSA antibodies but not with age of the patient, disease duration, salivary flow rate, or the presence of hypergammaglobulinemia or extraglandular manifestations. CONCLUSION: MR imaging and MR sialography are noninvasive methods that provide definitive information of morphologic changes in parotid glands and can be used as diagnostic indicators of primary SS. Because these methods give information on different aspects of glandular pathology, both should be performed when evaluating parotid glands of SS patients. MR sialography is more sensitive, but conventional MR imaging gives complementary information on the progressive pathologic changes of glandular parenchyma.

Adult↗

PubMed1996

Ultrafast computed tomography and three-dimensional image processing of CT sialography in patients with parotid masses poorly defined by magnetic resonance imaging.

The purpose of this study was to determine the efficacy of ultrafast computed tomography (UF CT) in patients with parotid masses poorly defined by magnetic resonance imaging (MRI) and to evaluate the diagnostic potential of three-dimensional (3-D) UF CT sialography when compared with conventional CT sialograms. Thirteen patients with clinical suspicion of a parotid mass, in whom MRI was degraded by motion, underwent UF CT of the parotid region. Two radiologists independently assessed the CT and MR with respect to tumor localization, intraglandular tumor location, tumor margin characteristics, and infiltration of surrounding tissue. In 9 patients, CT sialography was performed using 3-D image processing. Anatomical details and pathologic findings were assessed by three readers using a numerical grad and compared with the findings derived from conventional CT sialography. Histopathologic specimens were obtained in all cases and correlated with the radiographic findings in a consensus manner following the blinded interpretations. UF CT and (suboptimal) MRI provided the same diagnostic information for the evaluation of tumor localization, and intraglandular location. UF CT was superior to MRI in the detection of tumor infiltration, and definition of tumor margins in 2 cases (15%), resulting in a substantial difference in treatment. Three-dimensional CT sialography offered significant improvement in demonstration of anatomic detail (2.5 +/- 0.2 vs 1.5 +/- 0.1, respectively) and pathologic findings (2.6 +/- 0.1 vs 1.3 +/- 0.2, respectively) when compared with conventional CT sialography. UF CT is a viable alternative in uncooperative patients with parotid masses. UF CT 3-D sialography has the potential to allow more precise pre-surgical planning and contributes to the diagnosis and therapy planning of parotid masses.

Adult↗

PubMed2005

Chemical shift MR images of the parotid gland in Sjögren's syndrome utilizing low-field MR system comparison with MR sialography and salivary secretion function.

PURPOSE: To compare chemical shift imaging and MR sialography in patients with Sjögren's syndrome utilizing a low (0.3 Tesla) magnetic field. METHODS: We retrospectively evaluated 8 controls (16 glands) and 30 patients (60 glands) with parotitis of Sjögren's syndrome. MR images were obtained with a 0.3 Tesla system (HITACHI MRP-7000, Hitachi, Ltd., Tokyo, Japan) with a coil for the temporomandibular joint. MR sialography was graded according to the grading system established for conventional sialography. The signal decrease rate between in- and opposed-phase images, and the standard deviation (S.D.) of the parotid parenchymal signal in opposed-phase images were measured. RESULTS: MR sialography and chemical shift images were obtained in 38 and 46 glands, respectively. MR sialography was graded as 0 in 15, 1 in 12, 2 in 4, and 3 in 5 glands. The mean signal decrease rate in in/opposed phase was 37.6%, and the mean S.D. of the parotid parenchymal signal in the opposed-phase images was 655.9. The salivary secretion function was related to heterogeneity on opposed phase (r=-0.3) but not to MR sialography grading. CONCLUSION: Heterogeneity on opposed-phase images assessable with a low-field magnet system may be a useful parameter to add in the evaluation of Sjögren's parotitis.

Adult↗

PubMed1995

Three-dimensional processing of ultrafast CT sialography for parotid masses.

PURPOSE: To evaluate the diagnostic potential of three-dimensional image processing of ultrafast CT sialography in comparison with conventional CT sialography in patients with parotid masses. METHODS: In nine patients, CT sialography was done with three-dimensional image processing. The visibility of anatomic details and pathologic findings, derived from three-dimensional images, were graded numerically by three observers and compared with the findings obtained from conventional CT sialograms. Histopathologic specimens were obtained in all cases. RESULTS: Ultrafast CT images showed no motion artifact. Three-dimensional CT sialography offered significant improvement in demonstration of ductal anatomy (2.5 +/- 0.2 versus 1.5 +/- 0.1, respectively) and ductal pathology (2.6 +/- 0.1 versus 1.1 +/- 0.2, respectively) over conventional CT sialography. In two cases, the therapeutic regimen was altered substantially. CONCLUSION: Ultrafast CT three-dimensional sialography has the potential to allow more precise presurgical planning and contributes to the diagnosis and therapy planning of parotid masses, especially in patients in whom MR image quality is degraded by motion artifact.

Adult↗

PubMed1998

MR sialography in patients with Sjögren syndrome.

PURPOSE: The purpose of this study was to evaluate the effectiveness of MR sialography of the parotid gland ducts in the diagnosis and staging of Sjögren syndrome. METHODS: MR imaging was performed on a 1.5-T unit with a neck phased-array coil. MR sialographic source images were obtained using a heavily T2-weighted fast spin-echo sequence with spectral fat suppression. All images were analyzed on the basis of maximum intensity projection reconstruction. Five healthy control subjects and 51 patients with definite Sjögren syndrome (43 with primary disease and eight with secondary disease) were examined with MR sialography. A labial gland biopsy was performed in all patients and histopathologic grading was done by means of focal scores. The findings of MR sialography were compared with the results of labial gland biopsy to determine the effectiveness of the technique in the diagnosis and staging of Sjögren syndrome. RESULTS: In all five control subjects, the main duct and the primary branching ducts of the parotid glands were clearly visible on MR sialographic images. In patients with Sjögren syndrome, a punctate, globular, cavitary, or destructive appearance was well seen within the parotid glands. Findings obtained at MR sialography correlated well with the results of labial gland biopsy. CONCLUSION: MR sialography has the potential to produce diagnostic findings in the parotid gland ducts of patients with Sjögren syndrome. Our results suggest that this method will augment and possibly replace X-ray sialography.

Adolescent↗

PubMed2000

New strategy for the diagnosis of parotid gland lesions utilizing three-dimensional sialography.

Three-dimensional (3D) imaging for parotid gland lesions was performed using 3D sialography. This method provided a detailed surface structure of the parotid gland, and made it possible to overcome the disadvantages of X-ray sialography, planar CT, and MRI. Immediately after the conventional sialography via an oral route, CT scanning was performed with a slice-thickness of 3 mm using a helical CT scanner. CT data were analyzed on a workstation to reconstruct 3D images. 3D sialography was found to have the following advantages: (1) The structure of the acinar surface is visualized in detail; (2) The 3D structure of the entire parotid system from Stensen's duct to the gland is shown in one image; (3) The parotid gland can be assessed in the context of the bony architecture of facial bones; (4) The surface structure of the parotid gland can be understood very easily, like a scanning electron micrograph. We conclude that 3D sialography is a useful imaging technique for parotid gland lesions.

Adult↗

PubMed1986

Sialography in salivary gland disease.

Ninety-six consecutive patients underwent sialography over a 10 year period at North Tees District General Hospital; there were 68 parotid and 28 submandibular examinations. Patients were divided into two groups: group 1, patients with symptoms but no clinical signs (n = 27); group 2, patients with swelling of the salivary gland (n = 69). Results showed that sialography was of considerable value in group 1 patients demonstrating pathology in 33 per cent (9/27 patients). In patients with a suspected, but unusually situated, parotid tumour (n = 20) sialography was confirmatory in 10 patients but the technique failed in four, gave a false negative result in four and would seem to be of limited value. In the remaining patients in group 2 with diffuse glandular swelling (n = 49) the main contribution of sialography was in demonstrating sialectasia (9), duct strictures (4) and non-opaque parotid calculi (2), but even in this group of patients 35 per cent (17/49 patients) of the examinations were normal. When submandibular calculi were demonstrable on plain radiography sialography contributed no further relevant information.

Adolescent↗

PubMed1998

[Magnetic resonance sialography. A new diagnostic method for imaging salivary duct patency].

The new technique of non-invasive magnetic resonance (MR) sialography was evaluated for normal and various pathologic conditions of the parotid gland. Ten volunteers and 15 patients with various symptomatic diseases of the parotid gland were tested in the present study. Diseases included pleomorphic adenoma, cystadenolymphoma, carcinoma ex pleomorphic adenoma, ductal carcinoma, adenoid cystic carcinoma, lymphoepithelial carcinoma, non-Hodgkin's lymphoma, sialolithiasis, sialadenitis, Heerfordt's syndrome and congenital duct ectasies. In addition to the usually performed T1 and T2 cross-sectional sequences a heavily weighted T2 sequence (TR 3600, TE 800) was performed and allowed depiction of a fluid-filled parotid duct. Results showed that the main parotid and primary branching ducts were depicted reliably in all normal cases and all patients, except one with sicca syndrome. Pathological conditions such as duct dilatations, duct strictures, obstructing duct calculus and irregular shapes and courses of the ductal system were demonstrable. While X-ray sialography obtained a higher resolution, only MR sialography was able to depict dilated ducts proximal from a complete obstruction, as well as all ductal cysts. Our findings show that MR sialography can be applied successfully to investigations of the parotid gland system. There have been no contraindications or complications to date because MR sialography is non-invasive. The technique will also allow the salivary ducts and lesions to be differentiated from the course of the facial nerve.

Constriction, Pathologic↗

PubMed1987

[Value of sonography and sialography in the diagnosis of salivary gland diseases].

134 patients with diseases of the salivary glands who underwent both real-time sonography and sialography were analyzed retrospectively. Using the two imaging methods a correct diagnosis was established in 92.5% of the patients. Masses of the salivary glands were detected in 98% (60/61) of the cases with the ultrasound examination, in 90% with sialography. The exact differentiation between a peripherally placed intrinsic lesion and an extrinsic mass that is intending the peripheral salivary gland contour often showed to be difficult as well with sialography and sonography. A chronic obstructive or non-obstructive sialadenitis could be correctly diagnosed in 91% of the cases with sialography, but only in 65% using sonography. The results demonstrate the complementary role of sonography and sialography in evaluating salivary gland disease.

Adult↗

PubMed2000

Pain and swelling after sialography: is it a significant problem?

OBJECTIVES: This study investigated the incidence of pain and swelling after sialography and quantified the duration and severity of these symptoms. STUDY DESIGN: Sialography was performed on 92 patients who were then given a questionnaire to complete. Seventy-two questionnaires were returned and completed in a satisfactory manner. The patients were asked to assess pain and swelling before and after the sialogram was performed by using a Visual Analogue Scale (VAS). Comparisons between postsialographic measurements and baseline measures were carried out by using Friedman repeated measures analysis of variance on ranks. RESULTS: VAS scores increased significantly for both pain and swelling 1 hour after the sialogram (T1). The scores for swelling returned to baseline levels after 1 day (T2). The VAS for pain showed a similar pattern, but 2 days after the sialogram (T3), the scores were significantly lower, compared with those before the sialogram (P <. 05). CONCLUSIONS: Sialography is a safe procedure. Patients should be advised that minor effects may last approximately 1 day. A reduction in pain to below baseline levels was noted 2 days after sialography, which may suggest an unexpected benefit of sialography.

Analysis of Variance↗

PubMed2002

Parotid sialography for diagnosing Sjögren syndrome.

OBJECTIVE: Despite the availability of many new imaging procedures, sialography has, after decades of use, maintained its status as the imaging procedure of choice for evaluating the oral component of Sjögren syndrome (SS). In this study, the clinical value of sialography as a diagnostic tool in SS was explored by assessing its diagnostic accuracy, observer bias, and staging potential. METHODS: One hundred parotid sialograms were interpreted independently in a blinded fashion by 2 trained and 2 expert observers. Sialograms were derived from a group of consecutive patients referred for diagnostics of SS. Patients were categorized as SS and non-SS by the revised European classification criteria. RESULTS: Trained observers reached a sensitivity of 95 and a specificity of 33% for SS by sialogram, whereas expert observers reached a sensitivity of 87 and a specificity of 84%. There was only "fair" interobserver agreement between trained and expert observers, whereas both expert observers showed "good" agreement with one another, according to Cohen's kappa. Intraobserver agreement was "good" to "very good" for all observers. The 4 different gradations of sialectasia, ie, punctate, globular, cavitary, and destructive, showed a weak but significant correlation with the duration of oral symptoms. CONCLUSIONS: This study markedly shows that the diagnostic value of parotid sialography for diagnosing SS greatly depends on the skills of the observer, implying that sialography lacks general applicability as a diagnostic tool in SS and requires specific expertise. Nevertheless, given its potentially high sensitivity and specificity in diagnosing SS as well as its useful staging potential, sialography still has its use in the evaluation of the oral component of SS.

Adult↗

PubMed2000

Sialolithiasis and salivary ductal stenosis: diagnostic accuracy of MR sialography with a three-dimensional extended-phase conjugate-symmetry rapid spin-echo sequence.

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) sialography in detecting salivary glandular calculi and ductal stenoses. MATERIALS AND METHODS: In a prospective study, 64 salivary glands in 61 consecutive patients with acute or recurrent parotid or submandibular glandular swelling were examined by using three-dimensional (3D) extended-phase conjugate-symmetry rapid spin-echo (EXPRESS) MR imaging. Transverse and sagittal-oblique source images and maximum intensity projection images were obtained. All MR images were analyzed independently by two radiologists, without knowledge of the final diagnosis. The reference standard was conventional sialography, ultrasonography (US), and sialendoscopy with or without surgery in 31 glands and was conventional sialography and US in 33 glands. RESULTS: Final diagnoses included sialolithiasis (n = 23), sialolithiasis and stenosis (n = 9), stenosis without lithiasis (n = 11), early Sjögren syndrome without ductal stenosis (n = 2), ductal displacement (n = 3), and normal salivary glands (n = 16). The sensitivity, specificity, and positive and negative predictive values of MR sialography to detect calculi were 91%, 94%-97%, 93%-97%, and 91%, respectively. False-negative readings occurred due to calculi with a diameter of 2-3 mm in nondilated salivary ducts. Ductal stenosis was assessed, with a sensitivity of 100%, specificity of 93%-98%, positive predictive value of 87%-95%, and negative predictive value of 100%. Interobserver agreement was very good (kappa = 0.85-0.97). CONCLUSION: MR sialography with 3D EXPRESS imaging enables reliable prediction of salivary gland calculi and stenoses.

Adolescent↗

PubMed1984

Computed tomography and sialography of chronic pyogenic parotitis.

We performed Computed Tomography (CT) immediately following, or simultaneous with, conventional sialography on a group of 45 patients with parotid gland swellings over a two-year period. Tumours occurred in eight, sarcoidosis in 22, actinomycosis in two and chronic pyogenic parotitis in 13 patients. In the latter group, there were two cases of bilateral disease, for a total of 15 glands. The sialographic and the combined CT-sialographic features were retrospectively analysed. In all cases, ductal pathology was more severe in the main and proximal branches, was better demonstrated on conventional sialography and was diagnostic in 10/14 glands (71%). CT-sialography was the superior modality in the evaluation of the gland parenchyma and the adjacent structures, demonstrating diagnostic features of infection in 8/14 glands (57%). However, a combination of both modalities presented a consistent pattern of infection in all cases, distinctive from tumours and sarcoidosis. CT-directed aspiration was performed on the four glands which were equivocal on conventional sialography, and two of these underwent a simultaneous aspiration-irrigation with antibiotics. Although this report is based on a limited experience, CT-sialography with aspiration appears to be an interventional radiological alternative to the traditional diagnostic superficial parotidectomy. Ultrasonography (two cases) and nuclear scintigraphy (one case) added little useful information in chronic pyogenic parotitis.

Adult↗

PubMed2001

[Comparison of ultrasonography and sialography vs. magnetic resonance in the diagnosis of the primary Sjogren's syndrome].

To date there is no agreement as to which imaging technique is best for the evaluation of the oral component of primary Sjögren's Syndrome (SS). The purpose of the present study has, therefore, been to determine the reliability of Magnetic Resonance (MR) in the evaluation of salivary alterations in patients with SS. The study involved 23 patients suffering from SS according to the European criteria. All the patients underwent ultrasonography and MR of the major salivary glands, parotid sialography and biopsy of the minor salivary glands. The first control group was made up of 50 healthy subjects who underwent parotid ultrasonography. The second control group comprised 23 subjects who underwent MR of the head and neck for other non parotid pathology. The ultrasonography, MR and sialography images were evaluated by a single observer during a single session and scored from 0 to 4. In the SS patients ultrasonography was abnormal in all 23 cases (100%): 3 patients showed grade 1 alterations (13%); 5 grade 2 (21.7%); 9 grade 3 (39.1%); 6 grade 4 (26.1%). In the healthy controls, grade 0 was found in 36 subjects (72%) while the remaining 14 subjects revealed grade 1 alterations (28%). Using MR imaging only one of the SS patients showed grade 0 alterations (4.3%), 7 showed grade 1 alterations (30.4%), 9 grade 2 (39.1%), 5 grade 3 (21.7%) and only 1 grade 4 (4.3%). MR imaging sensitivity was 95.8% while specificity was 100%. For ultrasonography, considering grade 1 as non pathological, we found a sensitivity of 88.4% and specificity of 100%. The MR score for SS patients was compared to that obtained with sialography and ultrasonography. There was a good correlation between MR and sialography (r = 0.528, p = 0.010) while the correlation between MR and ultrasonography was not statistically significant. This study confirms that, of the diagnostic procedures available for evaluation of salivary gland involvement in SS, the most useful initial examination is ultrasonography. When there is some doubt or there are subtleties, MR is a valid alternative to classical sialography.

Adult↗

PubMed2004

[The study of magnetic resonance sialography in diagnosing parotid diseases].

OBJECTIVE: To study the feasibility of diagnosing parotid disease with magnetic resonance sialography (MRS) and to select the optimal scanning sequence. METHODS: Twenty-three patients with parotid gland disease and 5 normal adults received sialography using magnetic resonance imaging technique and several sequences (including IR-FSE, FSE, SS-IR-FSE, SS-FSE) were used. After first scanning, the patients were scanned respectively 3 and 10 minutes after buccal application of vitamin C. And MR images of duct obtained. The images of parotid duct system were analysed and evaluated according to their displaying effects. Qualitative diagnosis was made based on MRI and those diagnosis were compared with pathological diagnosis after operation. RESULTS: Images of MR sialography clearly displayed the main duct and its branches of parotid gland and the pathological changes of duct, such as narrow, expanded, stoppage. Of the scanning sequences, IR-FSE was superior to others in manifesting the parotid gland duct (P < 0.05). The performance of images after being given vitamin C did not significantly improve the displaying effect. The accurate rate of qualitative diagnosis was 95.6%. CONCLUSIONS: MR sialography can clearly display the parotid ducts and their pathological changes. The accurate rate of qualitative diagnosis of parotid disease was higher than that X-ray sialography.

Adolescent↗