ABSTRACT
A variety of neoplastic and non-neoplastic diseases affects the salivary glands, and requires differential diagnosis and management. Imaging plays an important role in evaluation of salivary gland diseases. The most common conditions affecting the salivary glands are calculi, inflammation and tumors. The aim of the study was to determine the diagnostic value of different imaging modalities for the evaluation of different lesions in the parotid and submandibular salivary glands, and if there is any particular advantage of one method in detecting and characterizing salivary gland lesions. Sixty-eight patients diagnosed clinically to have salivary gland disease were investigated as follow: Plain X-ray was performed in 55 cases, Sialography was performed in 55 patients following plain radiography, US was done in all patients, US-guided fine needle aspiration biopsy [FNAB] was done in 19 cases to verify diagnosis. CT oAas done in 18 patients and MRI was done in 13 patients. The final diagnosis in each patient in the study was based on consensus of clinical, imaging and biopsy or surgery results. Thirteen patients had submandibular calcular sialadenitis radio-opaque stones were seen in 11 of them [84.6%] as detected by X ray. Both sialography and US could accurately detect submandibular calcular sialadenitis in all the 13 patients [100%]. Sialography was highly accurate in diagnosis of cases with non-calcular submandibular sialadenitis [96%]. On the other hand, sialography was also able to detect duct system abnormalities in 10 out of the 15 examined parotid cases [66.6%]. The pattern of duct system abnormalities was typical in the 2 cases with Sjogren's syndrome. US was useful in diagnosis of parotid abscesses, cysts and masses. US-Guided FNAB was able to yield the diagnosis in 90% of cases with neoplastic salivary gland disease. CT was highly accurate [90.9%] in determining the benign from malignant nature of salivary gland masses, while the accuracy of MRI was 100% in this respect. Plain radiography has an important role in detection of salivary calculi and calcifications. Sialography is so far the imaging modality of choice with indispensable value for evaluation of salivary duct system abnormalities. US is a sensitive non-invasive tool for salivary glands imaging. Its diagnostic value is augmented by its use for guidance of FNAB which is easy to perform and of high diagnostic yield. Both CT and MRI are considered to be the mainstay for diagnosis in suspected salivary gland neoplastic disease. The two modalities have high accuracy in detection of mass lesions and evaluation of their extent; however, the inherent high tissue discrimination capabilities of MRI give privilege to this technique in evaluation of the nature of such lesions