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Comparative study of MR sialography and digital subtraction sialography for benign salivary gland disorders.

BACKGROUND AND PURPOSE: MR sialography has become an alternative imaging technique for ductal salivary gland diseases. We compared the diagnostic accuracies of MR sialography and digital subtraction sialography in patients with successful completion of both examinations and benign salivary gland disorders. METHODS: In a prospective study, we attempted to examine salivary glands in 80 patients with clinically suspected diagnoses of sialadenitis and/or sialolithiasis. Each patient underwent digital subtraction sialography and MR sialography. MR sialography was obtained with a T2-weighted single-shot turbo spin-echo sequence (TR/TE 2800/1100 msec, acquisition time 7 seconds), with use of a quadrature head coil. Final diagnoses were confirmed by clinical follow-up and results of biopsy (n = 9) or surgery (n = 19). RESULTS: Failure rate was 5% (four of 80) for MR sialography and 14% (11 of 80) for digital subtraction sialography. Eighty-one salivary glands (48 parotid, 33 submandibular) in 65 patients were successfully visualized with both modalities. MR sialography depicted the main ductal system and first- and second-order branches, whereas digital subtraction sialography was able to depict third-order branches. Sensitivity and specificity to diagnose chronic sialadenitis were 70% and 98% with MR and 96% and 100% with digital subtraction sialography. MR sialography enabled diagnosis of sialolithiasis with a sensitivity of 80% and a specificity of 98% versus 90% and 98% for each with digital subtraction sialography. CONCLUSION: MR sialography with a heavily T2-weighted sequence is highly successful in the noninvasive visualization of the ductal system of major salivary glands. It is useful for diagnosing sialolithiasis and sialadenitis. Digital subtraction sialography, an invasive technique, had a substantial procedural failure rate, particularly for the submandibular duct. However, because of its higher spatial resolution, successfully completed digital subtraction sialography achieved superior diagnostic information compared with that of MR sialography.

Adolescent↗

Sjögren syndrome: comparison of assessments with MR sialography and conventional sialography.

PURPOSE: To compare the diagnostic accuracy of magnetic resonance (MR) sialography with that of conventional sialography in the assessment of salivary gland disease in Sjögren syndrome. MATERIALS AND METHODS: Thirty-five patients (32 women, three men; age range, 18-69 years) suspected of having Sjögren syndrome were examined with MR sialography and conventional sialography. Gradient and spin-echo MR sialography was performed with a 1.5-T system. MR sialographic findings were compared with conventional sialographic findings. RESULTS: In 31 (89%) patients, the stage of salivary gland disease determined with MR sialography accurately correlated with that determined with conventional sialography. However, the stage at MR sialography was higher in two patients: They had stage I disease but were determined to have stage II disease. In two other patients, the stage at MR sialography was lower: A patient with stage II disease and a patient with stage III disease were determined to have stage I and stage II disease, respectively. The correlation between the stage at conventional sialography and that at MR sialography (P < .001) can be estimated with the following equation: conventional sialographic stage = 0.021 + 0.982 x (MR sialographic stage). Both the sensitivity and the specificity of MR sialography in the diagnosis of Sjögren syndrome were 100%. CONCLUSION: MR sialography is highly accurate in the evaluation of salivary gland disease in Sjögren syndrome.

Adolescent↗

A prospective comparative study of MR sialography and conventional sialography of salivary duct disease.

OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy of MR sialography in the examination of patients with salivary duct disease. SUBJECTS AND METHODS: Forty-nine patients (23 males and 26 females; 16-78 years old; mean age, 47 years) with symptoms related to the salivary glands underwent both conventional sialography and MR sialography. The latter was performed using a heavily T2-weighted, two dimensional, fast spin-echo technique and a 12-cm circular surface coil. Contiguous 3-mm axial images with frequency-selective fat suppression were acquired through the symptomatic gland. The MR sialography findings were compared with the final diagnoses determined by conventional sialography. RESULTS: Conventional sialography showed calculus disease (n = 13), stricture (n = 12), sialectasis (n = 4), cast (n = 3), neoplasm (n = 2), and normal duct (n = 16). MR sialography alone had a sensitivity of 69% in revealing calculus disease. However, the sensitivity increased to 100% when MR sialograms were combined with control radiographs. MR sialography was sufficient to accurately reveal stricture, sialectasis, and neoplasm and to direct therapy on the basis of its findings. Overall, MR sialography combined with control radiographs had a sensitivity, specificity, and diagnostic accuracy of 100%, 88%, and 96%, respectively, in revealing salivary duct abnormalities. CONCLUSION: MR sialography alone is not sufficiently sensitive to reveal salivary duct stones. Caution must be exercised when excluding calculus disease. MR sialography, when combined with control radiographs, is accurate and has the potential to replace conventional sialography.

Adolescent↗

[Diagnosis of diseases of the large salivary glands of the head by ultrasound, sialography and CT-sialography. A comparison of methods].

In the present study 162 patients with clinically suspected diseases of the major salivary glands were examined via sonography (n = 162), sialography (n = 111) and CT-sialography (n = 49). The reliability of the three radiological procedures was assessed in diagnosing sialoadenitis, sialolithiasis and glandular and extraglandular tumors. Forty-seven patients were examined with all three methods, 64 patients with sonography and sialography, 2 patients with sonography and CT-sialography and 49 patients with only sonography. The results were compared retrospectively with histologically (70%), cytologically (26%) and clinically proven diagnoses. A sialoadenitis was diagnosed via sonography at a sensitivity of 58%. Sialography frequently produced a false diagnosis of "glandular tumor", which resulted in a comparatively lower sensitivity of 54%. This finding contrasted with the experiences of other authors. A glandular tumor was correctly diagnosed by all three methods and had approximately the same sensitivity (sonography 89%, sialograph 91% and CT-sialography 92%). The correct diagnosis of salivary gland tumors was found by sonography and CT-sialography in 76% of cases and by sialography in 83% of cases. CT-sialography was clearly the superior diagnostic method for detecting extraglandular tumors. Sonography proved its worth as the fundamental procedure for special diagnostic testings of the salivary glands. Sialography is necessary for obtaining important additional information, especially in cases with suspect glandular tumors. CT-sialography is indispensable in the diagnosis of tumors, especially if a malignant, extraglandular or medially localized process is suspected.

Diagnostic Imaging↗

CT sialography and conventional sialography in the investigation of parotid masses.

In a 3-year period computed tomography (CT), both plain and in combination with sialography, and conventional sialography were used in 59 patients who had or were suspected of having salivary gland tumors, with special regard to attenuation in different tumors and the tumor borders. The diagnostic information obtained with CT sialography and conventional sialography was evaluated. The most valuable advantage of parotid CT sialography is the possibility of demonstrating the tumor and its actual size and relationship to the surrounding structures. The differentiation between benign and malignant tumors must be based mainly on clinical investigation and fine-needle biopsy. Conventional sialography may be an important complement to CT sialography because of its ability to illustrate the morphology of the finest ducts.

Adenoma↗

[The value of digital subtraction sialography compared to conventional sialography, salivary gland sonography and surgical findings].

In a prospective study DSA sialography, conventional sialography (100mm technique) and sonography of the salivary glands were performed in 124 patients. The results of imaging could be correlated with those of operation and/or histology in 70 patients. Performing sialography in only one projection DSA sialography is superior to the conventional technique. The results of DSA are equivalent to those of conventional sialography in more than one projection. DSA sialography is the method of choice demonstrating salivary calculi, whereas sonography is superior to DSA sialography in the detection of tumors. In the diagnosis of chronic inflammation of the salivary glands DSA is slightly superior to the other imaging modalities.

Adolescent↗

Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US?

PURPOSE: To determine the value of magnetic resonance (MR) sialography for the diagnosis of sialolithiasis by comparing results prospectively with those of ultrasonography (US) and digital sialography. MATERIALS AND METHODS: MR sialography was prospectively performed with T2-weighted three-dimensional (3D) constructive interference in steady-state (CISS) and rapid acquisition with relaxation-enhancement (RARE) sequences in 24 patients suspected of having sialolithiasis. Evoked salivation was used as contrast material. T1-weighted spin-echo and T2-weighted turbo spin-echo MR imaging also were performed. The results were then compared with those of US and digital sialography, with the latter as standard of reference. RESULTS: The 3D CISS images were significantly (P: <.05) superior to RARE images for demonstrating the submandibular ductal system, followed by T2-weighted turbo spin-echo images (P: <.01) and T1-weighted spin-echo images (P: <.001). The sensitivity and specificity were 100% and 80%, respectively, for CISS MR sialography and 80% and 100%, respectively, for RARE MR imaging. The sensitivity and specificity of US were both 80%. CONCLUSION: MR sialography with evoked salivation is noninvasive and allows delineation of the submandibular ductal system and detection of sialoliths with accuracy that is similar to that of digital sialography and superior to that of US.

Humans↗

Sialography and CT-sialography in the diagnosis of parotid masses.

Parotid masses were evaluated by sialography and CT-sialography in 22 patients. Nineteen were benign tumors and one a metastasis. All were identified by CT. Two patients with sialoadenitis were misinterpreted at CT. All benign tumors appeared as lobulated, sharply marginated masses, embedded in displaced glandular parenchyma. The metastasis was lobulated, irregular and located within the gland. With sialography, 17 tumors were identified and 3 small superficial tumors overlooked. Both patients with sialoadenitis were diagnosed by sialography. CT-sialography is recommended in patients with suggested parotid masses, and sialography in suggested inflammatory disease.

Adenolymphoma↗

Digital subtraction sialography, conventional sialography, high-resolution ultrasonography and computed tomography in the diagnosis of salivary gland diseases.

Forty-one patients with salivary gland disorders have been evaluated by digital subtraction sialography, conventional sialography, high-resolution ultrasonography and computed tomography, and the results compared with clinical, surgical and pathomorphological data. In the case of salivary gland masses, the sensitivity of ultrasonography, CT and digital subtraction sialography was 100%, 82% and 71%, respectively, while in the case of sialadenitis, the respective figures were 54%, 69% and 85%. The image quality of digital subtraction sialography was superior to that of conventional sialography in 80%, equal in 16%, and inferior in 3% of the examinations. We conclude that in all cases of salivary gland diseases ultrasound should be the first imaging procedure. If a tumour is not confirmed, digital subtraction sialography should be employed to visualise inflammatory changes, while in most cases of salivary gland masses no further imaging will be necessary.

Humans↗

Evaluation of the parotid gland. Comparison of sialography, non-contrast computed tomography, and CT sialography.

Sialography, non-contrast computed tomography (NCCT), and CT sialography (CTS) were compared in 40 patients with parotid disease. While NCCT and CTS proved to be superior to sialography in most cases, with NCCT being as good as CTS for demonstration of parotid masses, sialography was preferred over both NCCT and CTS for evaluation of inflammatory disease. The role of percutaneous needle aspiration is discussed, and protocols for evaluation of both parotid masses and inflammatory disease are presented.

Adenolymphoma↗

Prospective comparison of magnetic resonance sialography and digital subtraction sialography.

We sought to compare the diagnostic utility of magnetic resonance sialography (MRS) and digital subtraction sialography (DSS) in patients with suspected sialolithiasis or sialadenitis. Sixteen consecutive patients (4 female and 12 male, mean age 51+/-16 years) with suspected sialolithiasis or sialadenitis underwent DSS by a standard technique and MRS. MRS was obtained with a T2-weighted single-shot TSE sequence (TR/TE 2800/1100 msec, acquisition time 7 seconds) using a quadrature head (n = 16) and a surface coil (n = 8). Nineteen symptomatic glands were investigated with DSS: eight submandibular glands in 6 patients (two bilateral) and unilateral parotid glands in 11 patients. MRS was always carried out to visualize gland ducts bilaterally. The ductal system was visualized in all glands examined by MRS. DSS depicted the ductal system in all 11 parotid glands, but only 4 of the 8 submandibular glands (50%). Sialolithiasis was diagnosed in three cases (one parotid, two submandibular glands) by MRS and in two cases by DSS. DSS demonstrated tertiary branching ducts and MRS secondary branching ducts. MRS is able to visualize the ductal system of the parotid and submandibular gland noninvasively and is thus not dependent on successful cannulation of the orifice of the ductal system. Our preliminary data indicate that MRS is useful for diagnosing sialolithiasis. MRS allows diagnosis of sialadenitic changes, but DSS achieves a better diagnostic performance due to higher spatial resolution.

Adolescent↗

Sonography, CT, CT sialography, MRI and MRI sialography in investigation of the facial nerve and the differentiation between deep and superficial parotid lesions.

Our aim was to explore the possibility of delineation of the facial nerve within the parotid gland and to differentiate between superficial and deep parotid lesions in relationship to it, using ultrasound, CT, MRI, MRI sialography (MRIS) and CT sialography (CTS). We examined 47 patients with clinically suspected parotid tumours by US, 31 of them also by CT, MRI and CTS, and 13 by MRIS as well. Low-intensity curvilinear structures seen on T1-weighted MRI were delineated better after intraductal gadolinium injection and proved to represent parotid ducts on CTS. Using the main parotid duct as a landmark, we distinguished parotid lesions as deep or superficial to the facial nerve by T1-weighted MRI images in 69% and by MRIS in all cases. The facial nerve itself was indistinguishable from the parotid gland in all our imaging methods.

Adolescent↗

Usefulness of magnetic resonance sialography in patients with juvenile Sjögren's syndrome.

OBJECTIVE: Sialography is an important means for evaluating parotid gland damage in patients with Sjögren's syndrome (SS). However, 'conventional' X-ray sialography is invasive and sometimes difficult to perform and repeat, especially for young patients. Recently, magnetic resonance (MR) sialography has been used in adult SS patients. In this study, we investigated the usefulness of MR sialography for evaluating parotid gland damage in juvenile SS. METHODS: Eight young patients suffering from SS were studied. MR sialography and X-ray sialography were performed simultaneously in the same patients. The images obtained by both methods were assessed with Rubin-Holt staging. RESULTS: MR sialography detected ductal dilatation in 5 of 8 patients, while it was detected in 7 of 8 patients by X-ray sialography. The stages were the same in 4 patients by both methods. In 3 patients, the stages on X-ray sialography were higher than those on MR sialography; in 1 patient, the stage on MR sialography was higher. The correlation between the stages determined by the 2 methods was 0.85. There were no side effects in MR sialography, whereas 3 patients complained of pain during X-ray sialography. CONCLUSION: MR sialography can evaluate Stage II approximately III parotid gland damage in juvenile SS. Although MR sialography cannot detect subtle changes in the duct, it has no side effects and can be performed repeatedly in young patients. We propose that MR sialography be chosen as the first tool for diagnosing and during follow-up of the status of the glands in juvenile SS.

Adolescent↗