Power Doppler ultrasound-guided sialography using the phenomenon of increased blood flow: A technical report

PURPOSE: This report presents a procedure for performing power Doppler ultrasound-guided sialography using the phenomenon of increased blood flow and illustrates its application to practical patient cases.MATERIALS AND METHODS: The salivary gland was scanned using ultrasound equipment (GE LOGIQ5 Expert® device; GE Medical Systems, Milwaukee, WI, USA) to identify pathological findings related to the patient's chief complaint. To identify the orifice of the main duct, it should be cannulated using a lacrimal dilator. After inserting the catheter into the cannulated main duct, the position of the catheter within the duct was confirmed by ultrasound. A contrast agent was injected until the patient felt fullness, and ultrasound (B-mode) was used to confirm whether the contrast agent filled the main canal and secondary and tertiary ducts. Then, power Doppler ultrasound was performed to determine whether the salivary gland had increased blood flow.RESULTS: In 2 cases in this report, a power Doppler ultrasound scan showed a significant increase in blood flow after contrast medium injection, which was not observed on a preoperative scan.CONCLUSION: Power Doppler ultrasound was found to be a simple, safe, and effective tool for real-time sialography monitoring.

Evaluation of the Normal Structures of Parotid Duct Using Magnetic Resonance Hydrography / 中国医学科学院学报

To investigate the normal structures of parotid duct by using magnetic resonance(MR)hydrography. MR three-dimensional heavy T2-weighted imaging was performed in 21 normal subjects.After taking 200 mg of vitamin C orally for 3 minutes,the subjects underwent parotid duct coronal hydro-magnetic resonance imaging.The images were transferred to the GE AW4.5 workstation,on which multi-planner reformation was performed using Functool software.The numbers of the parotid duct,accessory parotid duct,segments,and its branches was counted and the length and diameter of the intra-and extra-parotid ducts were measured. Accessory ducts were found in 24 parotid glands(57.1%,24/42),with the average length being(9.54±9.98)mm and the average diameter being(0.87±0.88)mm.The intra-parotid ducts were found to be with 3 segments were in 3 cases(7.14%,3/42),with 2 segments in 19 cases(45.23%,19/42),and with 1 segment in 20 cases(47.62%,20/42).The average number of the branches of the first,second and third segment was 2.38,0.88,and 0.1,respectively.The average length of the intra-parotid duct was(36.97±7.97)mm,with its average diameter being(2.01±0.76)mm.The average length of extra-parotid duct was(34.98±10.25)mm,with its average diameter being(2.13±0.79)mm.The average length of the whole parotid duct was(71.95±11.47)mm,with its average diameter being(2.07±0.68)mm. The parotid duct,the accessory parotid duct,and the segments and their branches of the intra-parotid duct can be accurately displayed by MR hydrography.

Clinical application of cone beam CT sialography in the diagnosis of chronic parotitis / 实用口腔医学杂志

Objective:To explore the value of cone beam CT(CBCT) scanning following parotid sialography in the diagnosis of chronic parotitis.Methods:20 cases of suspected chronic parotitis patients underwent parotid gland sialography followed by CBCT scanning.The images were observed by transverse plane,coronal plane,sagittal plane of multiplanar reconstruction (MPR) and 3D reconstruction.Results:The acinus and ducts system of parotid were clearly displayed from any orientation by MPR and 3D-reconstructed images.The images of 6 cases of chronic recurrent parotitis in CBCT sialography were charactered by punctiform dilatation in whole parotid gland,4 of them showed a normal ductal system,while 2 exhibited expression of ductal inflammation.The images of 14 cases of chronic obstructive parotitis showed irregular ductal dilatations and stenosis.Punctiform dilatations were found in 2 cases,and small filling defects (negative salivary calculi) in 3 cases.Conclusion:CBCT sialography is an effective clinical examination for the diagnosis and treatment chronic parotitis.

Usefulness of Magnetic Resonance Sialography for Diagnosis of Idiopathic Chronic Sialadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The symptoms of salivary diseasess are often nonspecific, and a variety of investigative methods can be employed. Conventional sialography, which is still widely used for diagnosis of salivary ductal pathologies, has the withdrawback of invasiveness and radiation exposure, and thus ultrasound and magnetic resonance (MR) sialography can replace the conventional tools. This study was performed to evaluate the usefulness of MR sialography for the diagnosis of idiopathic chronic sialadenitis. SUBJECTS AND METHOD: From November 2013 to June 2014, we have retrospectively analyzed 26 patients who have had swelling and pain of salivary glands and undergone MR sialography for further diagnosis of the idiopathic salivary obstructive symptom. We analyzed the symptom scores, salivary flow rate (SFR) and parameters of salivary gland scintigraphy. Then we evaluated correlation among MR sialography findings (duct visualization, grade of stenosis at main duct, degree of sialectasis and glandular volume size). RESULTS: Among the 26 patients, stenosis of salivary duct was observed in 14 patients (53.8%), chronic sialadenitis without stenosis in 6 patients (23.1%), Sjogren's syndrome in 3 patients (11.5%), Juvenile reccutent parotitis in 1 patient (3.8%), and 2 patients were norma (7.7%). The degree of sialectasis was significantly correlated with Tmin (time interval, in minutes, from stimulation to minimum count), maximum secretion (p<0.05), and glandular volume size was also significantly correlated with unstimulated SFR (p<0.05). But others did not show any significant correlations. From these findings, we report three cases that were useful to diagnose the gland disease using MR sialography. CONCLUSION: Resutls show that MR sialogarphy indirectly reflects the salivary gland function. Therefore MR sialography can be helpful when the differential diagnosis of idiopathic chronic sialadenitis is difficult with conventional tools.

Salivary gland imaging: A pictorial essay.

The major salivary glands are parotid, submandibular and sublingual glands. Imaging has an important role to play in detection, diagnosis, aiding biopsy and differentiating benign from malignant pathology. The traditional imaging modalities include plain radiography and sialography. With the advent of modern imaging methods like high resolution ultrasound with color doppler, contrast enhanced CT, MRI and MR sialography, the imaging has become increasingly reliable in making a confident diagnosis. A wide variety of conditions including obstructive, infectious, autoimmune and neoplastic pathologies affect the salivary glands, thus resulting in a wide imaging spectrum. This article is aimed at presenting the imaging appearances of common salivary gland diseases.

MRI features of the parotid gland in Sj?gren syndrome / 中华放射学杂志

Objective To investigate MR imaging features of parotid gland in Sj?gren′s syndrome ( SS).Methods Twenty-seven cases of xerostomia patients were collected and divided into SS group ( n=21) and non-SS group (n=6) according to the international classification (diagnosis) criteria for SS.Ten healthy volunteers were recruited as the control group.All the subjects underwent conventional MRI of parotid gland and MR sialography ( MRS).Standard deviation of T 1 WI and T2 WI signal intensity among 3 groups was observed, meanwhile, grading was made according to parotid glands , fat signal and parotid duct expansion degree respectively.With clinical diagnosis as the gold standard , diagnostic value of conventional MRI , MRS and their combination used in SS was compared.One-way ANOVA was used in comparison of standard deviation of parotid gland′s signal intensity among 3 groups , and Chi-square test was applied in comparison of conventional MRI and MRS diagnostic value.Moreover , Kappa value was calculated to assess the consistency of two grading results in SS.Results Signal intensity of parotid glands in control group and non-SS group was homogeneous.However , bilaterally diffused and heterogeneous high signal intensity on both T1WI and T2WI was found in SS patients, which was depressed on T2WI fat suppression sequences.Forty-two parotid glands were graded by fat signal:Grade 0 (n=2 glands), Grade 1 (n=10), Grade 2 (n=10), Grade 3 (n=6) and Grade 4 (n=14).Parotid peripheral ducts of control group and non-SS group were unexpanded , while bilaterally expanded parotid peripheral ducts were shown in SS patients.The grading of 42 parotid glands by expansion degree of parotid duct , Grade 0 was rated in 12, Grade 1 in 8, Grade 2 in 10, Grade 3 in 5, and Grade 4 in 7.Standard deviation of T1WI signal intensity of parotid glands among SS group , non-SS group and control group were 124.1 ±30.0, 81.8 ±27.6, and 86.3 ±35.0 respectively;and standard deviation of T 2 WI signal intensity were 115.1 ±35.2, 69.8 ±23.5, and 80.1 ±31.4 respectively; the standard deviation of T 1 WI and T2 WI signal intensity of SS group was higher than both non-SS group and control group′s ( F value =13.780 and 13.301, respectively, P 0.05).Among 42 parotid glands with SS, conventional MRI and MRS showed parotid gland lesions in 40 and 30 respectively , and the difference was statistically significant (χ2 =13.04, P=0.013).There was no false positive result.The combination of the two methods detected all 42 lesions.The consistency of detecting parotid abnormalities with SS between conventional MRI and MRS was poor (Kappa=0.12, P=0.092).Conclusions Diffuse fatty infiltration on conventional MRI and diffuse peripheral duct dilatation on MRS in the parotid gland are characteristic features of SS , and conventional MRI could be used as the preferred technique for the SS.combination with MRS may improve diagnostic accuracy.

Assessment of the role of cone beam computed sialography in diagnosing salivary gland lesions

PURPOSE: The purpose of this study was to assess cone-beam computed (CBCT) sialography imaging in the detection of different changes associated with lesions of salivary glands. MATERIALS AND METHODS: This study consisted of 8 cases with signs and symptoms from salivary gland lesions. Conventional sialography using digital panoramic and lateral oblique radiographs and CBCT sialography were performed for each subject. The radiographs were evaluated by 3 radiologists independently of each other. The results were compared between conventional sialography and CBCT sialography in the evaluation of various lesions associated with the salivary glands. RESULTS: There was an agreement between the radiologists in interpreting the lesions that affected salivary glands with both techniques. The detection of the presence of stones or filling defects, stenosis, ductal evagination, dilatation, and space occupying lesions was 83% for conventional sialography compared with CBCT sialography. CBCT sialography was superior to conventional sialography in revealing stones, stenosis, and strictures, especially in the second and third order branches. CONCLUSION: It would be advisable to perform CBCT sialography in cases of obstructive salivary gland diseases for better demonstration of the ductal system of the gland.

Parotid Sialolithiasis - Review And Report of A Case.

Sialoliths are calcified organic matter that forms within the secretory system of the major salivary glands. Salivary gland calculi account for the most common disease of the salivary glands, and may range from tiny particles to several centimeters in length. The majority of sialoliths occur in the submandibular gland or its duct and is a common cause of acute and chronic infections. While the majority of salivary stones are asymptomatic or cause minimal discomfort, larger stones may interfere with the flow of saliva and cause pain and swelling. The prevalence of sialoliths varies by location. Sialolith in the parotid glands is less common when compared with that of submandibular gland. This case report describes a patient presenting with parotid gland sialolith and review of the literature regarding the salivary sialothiasis.

El uso de la sialografía en el diagnóstico y tratamiento de la parotiditis recurrente juvenil: presentación de un caso / The use of sialography in the diagnosis and treatment of juvenile recurrent parotitis: case report

La parotiditis recurrente juvenil (PRJ) es una enfermedad inflamatoria de la glándula parótida, generalmente se caracteriza por episodios recurrentes de hinchazón, dolor y fiebre. Después de la parotiditis epidémica, es la PRJ en los niños, la segunda enfermedad más frecuente de las glándulas salivales. La aparición de PRJ se produce alrededor de 6 años de edad y hay una ligera predilección por los varones. La etiología de la enfermedad sigue siendo poco clara y los síntomas tienden a desaparecer con la pubertad. Este estudio reporta el caso de un joven de 12 años que se presentó a la Facultad de Odontología de la Universidad Estadual Paulista, Sao José dos Campos, con una historia de episodios recurrentes de hinchazón de la glándula parótida izquierda asociada con dolor, fiebre y secreción purulenta en los primeros eventos. Terminada la anamnesia, se decidió por obtener sialografías de las dos glándulas parótidas con el uso de material de contraste Lipiodol UF 38% y radiografías panorámicas, seguidas por las evaluaciones morfológicas y funcionales. El paciente se encuentra hoy sin presentar recurrencia de la enfermedad y está bajo seguimiento clínico

The Juvenile Recurrent Parotitis (JRP) is an inflammatory disease of the parotid gland, usually characterized by recurrent episodes of swelling, pain and fever. After mumps, the PRJ in children is the second most prevalent disease of salivary glands. The emergence of PRJ occurs around 6 years old and there is a slight predilection for males.The etiology of the disease remains unclear and the symptoms tend to disappear with puberty. This study reports the case of a twelve years old boy who presented to the Dentistry School of São Paulo State University - campus São José dos Campos- with a history of recurrent episodes of swelling of the left parotid gland associated with pain, fever and purulent discharge in the early events . Finished the anamnesis, sialography were performed with the use of Lipiodol UF 38% contrast material and panoramic radiographs on both parotid glands, followed by morphological and functional assessments. There was no recurrence of the disease and the patient is under follow-up

The role of Magnetic resonance sialography in evaluating radiation-induced xerostomia for patients with early stage nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To investigate the value of magnetic resonance sialography (MRS) as a noninvasive tool in evaluating major salivary gland function before and after radiotherapy (RT) for nasopharyngeal carcinoma patients.Methods From August 2009 to June 2010,patients with stage Ⅰ and Ⅱa (AJCC/UICC 2002) nasopharyngeal carcinoma were enrolled.All the patients were treated with intensity modulated radiation therapy alone.MRS with salivary stimulation was performed in patients before and after RT on a 3.0T MR scanner.An MRS categorical scoring system was used to compare the visibility of ducts pre-RT and post-RT.The relationship between MRS score and EORTC Core QOL and EORTC Head and Neck QOL was analyzed.Spearman rank correlation test was performed to analyze the non-stimulated and stimulated MRS findings and the clinical severity of xerostomia.Results All 10 enrolled patients completed planned treatment.The mean dose of the parotid glands and submandibular glands were (37.99 + 3.70) Gy and (55.65 + 2.99) Gy,respectively.Good-quality MRS images were obtained.The visibility scores of both the parotid and submandibular ducts were increased after secretion stimulation.Irradiation decreased the visualization of the salivary ducts and attenuated the response to secretion stimulation.There were specific correlations between post-RT secretion response of the parotid gland and EORTC QLQ scales ( global QOL scale in QLQ-C30 ( rs =0.636,P =0.048 ) and xerostomia scale in QLQ H&N35 ( rs =- 0.694,P =0.026) ).Conclusions MRS can be used as a non-invasive way to evaluated of the functional changes of major salivary glands before and after RT and as a promising approach for investigating radiation-induced xerostomia.

Management of a parotid sialocelein a young patient: case report and literature review

Sialocele is a subcutaneous cavity containing saliva, caused by trauma or infection in the parotid gland parenchyma, laceration of the parotid duct or ductal stenosis with subsequent dilatation. It is characterized by an asymptomatic soft and mobile swelling on the parotid region. Imaging studies are useful and help establishing the diagnosis, such as sialography, ultrasonography, computed tomography and magnetic resonance imaging. This paper describes a recurrent case of a parotid sialocele in a young female patient. She presented a 6 cm x 5 cm swelling on the left parotid region. The ultrasonographic scan of the area revealed a hypoechoic ovoid well defined image suggesting a cyst. A sialography of the left parotid showed a cavitary sialectasia in a panoramic and anteroposterior view. A conservative management was adopted by percutaneous needle aspiration of the swelling, which was useful to provide material for analysis and helped healing. Dentists should be aware of this pathology and the importance in adopting a conservative treatment whenever it is possible.

Advance in MR imaging for evaluation of postradiotherapy salivary function in patients with head and neck cancer / 中国癌症杂志

Salivary gland damage with subsequent xerostomia has been an unavoidable complication in most head and neck cancer patients after radiotherapy.However,there were many shortcomings of each current detecting technique.Magnetic resonance sialography(MRS) and diffusion-weighted magnetic resonance imaging(DW MRI) ,as two of the most important progresses in the latest MRI techniques,with the virtue of non-invasion and non-ionizing radiation,has been rapidly developed in salivary function assessment in recent years,and it has kept on improving technically.This article mainly reviewed the clinical applications and research advances of these two MRI technologies in post-radiotherapy salivary function assessment in patients with head and neck cancers,so as to provide reference for further study.

Sialendoscopy: Endoscopic Diagnosis and Treatment of the Salivary Gland Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive lesion of salivary glands by salivary duct calculi and stenosis is the main inflammatory disease of major salivary glands. Recently, the sialendoscopy has been introduced for the diagnosis and intervention of salivary ductal disease. The purpose of this study is to assess the efficacy of the sialendoscopy for the treatment of inflammatory salivary gland diseases. SUBJECTS AND METHOD: Diagnostic and interventional sialendoscopy were performed in 19 patients (7 parotid glands, 12 submandibular glands), who had salivary duct calculi or recurrent sialadenitis without calculi from 2003 Sep. to 2004 Jun. Diagnostic sialendoscopy was performed for obstructive lesions and evaluation of ductal status. Interventional sialendoscopy was performed for the removal of salivary duct calculi and dilatation of duct stenosis in cases with calculi and stenosis. RESULTS: Diagnostic sialendoscopy was performed in all cases successfully. Sixteen glands had obstructive lesions and 3 glands had sialadenitis with no evidence of obstruction. Only one case with salivary duct calculi was failed. The remaining 10 calculi were removed with microforceps and basket with or without laser fragmentation. The average size of sialoliths was 5.2 mm and multiple stones were found in 2 cases. Five cases with stenosis of parotid and submandibular gland duct were dilated with balloon catheter or endoscopy sheath successfully. In the remaining 3 glands with no obstruction, the finding of ductal inflammation was identified. No major complications were noted. CONCLUSIONS: Diagnostic sialendoscopy is a new and minimal invasive technique for complete exploration of ductal system and evaluating salivary duct disease. Interventional sialendoscopy allows the extraction of salivary duct calculi in most cases and the dilatation of stenotic duct. This technique might be useful in preventing open gland surgery in well indicated cases.

Interventional sialography and micro-invasive treatment / 介入放射学杂志

Salivary gland obstruction is a commonly disorder affecting this organ usually due to the development of salivary calculi, ductul srictures, or both. Imaging plays an important role in the diagnosis of the cause, extent, and effects of the obstruction. Up to date, the micro-invasive interventional treatment is always be taken as the first method of choice for dislodgment of calculi and sacculus salivary sialodochoplasty through buccal cavity. This article gives a comprehensive review of the indications and technical procedure.