Non-invasive imaging for predicting labial salivary gland biopsy outcomes in patients with suspected primary Sjögren syndrome.

To identify the value of salivary gland ultrasound (SGUS) combined with magnetic resonance imaging (MRI) and magnetic resonance sialography (MRS) in predicting the results of labial salivary gland biopsy (LSGB) in patients with suspected primary Sjögren syndrome (pSS), and construct a nomogram model to predict LSGB results. A total of 181 patients who were admitted with suspected pSS from December 2018 to April 2023 were examined and divided into a training set (n = 120) and a validation set (n = 61). Baseline data of the two groups were examined, and the value of SGUS, MRI, and MRS in predicting LSGB was analyzed. Multivariate logistic analysis was used to screen for risk factors, and nomogram prediction models were constructed using these results. In the training set, the SGUS, MRI, and MRS scores of patients in the LSGB + group were higher than those in the LSGB - group (all P < 0.001). The positive prediction value (PPV) was 91% for an SGUS score of 3, and 82% for MRI and MRS scores of 2 or more. We developed a nomogram prediction model based on SGUS, MRI, and MRS data, and it had a concordance index (C-index) of 0.94. The Hosmer-Lemeshow test (χ2 = 3.17, P = 0.92) also indicated the nomogram prediction model had good accuracy and calibration for prediction of LSGB results. A nomogram model based on SGUS, MRI, and MRS results can help rheumatologists decide whether LSGB should be performed in patients with suspected pSS.

Comparison of the distribution of the Bartholin and/or Rivinus salivary ducts assessed with magnetic resonance-sialography in patients with ranula and in healthy subjects.

Background: The distribution and drainage of the sublingual gland ducts have various patterns that might be related to sublingual gland-related diseases, including ranula. This study aimed to elucidate the characteristics of the distribution of Bartholin and/or Rivinus ducts in patients with ranula using magnetic resonance (MR) sialography. Methods: In this retrospective cross-sectional study, the distributions and drainage patterns of sublingual gland ducts on MR sialography were classified in 74 subjects without sublingual gland-related disease as confirmed by both medical history and clinical examination and 15 patients with ranula, respectively. All patients had visited Kyushu Dental University Hospital from July 2015 to June 2022 to undergo MR imaging. Data on the distributions and drainage patterns of the sublingual gland ducts, including the characteristics of the Bartholin and/or Rivinus ducts, were then statistically compared between subjects without sublingual gland-related disease and patients with ranula. The images were assessed by an experienced oral and maxillofacial radiology specialist certified by the Japanese Society for Oral and Maxillofacial Radiology. The distributions (five groups) and drainage patterns (three patterns) of the sublingual gland ducts on MR sialography were classified in reference to previous studies, with some modifications in all subjects without sublingual gland-related disease and patients with ranula. Results: A significant difference in the distribution of the ducts (P<0.001), with a low number of patients exposing an undetected canal or Rivinius duct, was found in the group of patients with ranula (P<0.05). Regarding drainage patterns, no patient with ranula presented a Rivinius duct only. A significant difference in the drainage patterns of the sublingual gland ducts on MR sialography was observed between subjects without sublingual gland-related disease and patients with ranula (P=0.001). Conclusions: The present results suggest that the distribution of the sublingual gland ducts, mainly, the Bartholin duct, may be related to ranula formation. These findings also demonstrate that MR sialography contributes well to preoperative evaluation and is effective for assessing the complex excretory distribution of the sublingual gland ducts.

A retrospective study of magnetic resonance sialography imaging applied in the prognostic evaluation of chronic obstructive parotitis.

Background: Magnetic resonance sialography (MRS) can be used to clearly examine the main duct of the parotid and is widely applied in the diagnosis of chronic obstructive parotitis (COP). However, there are few studies on the classification, treatment options and prognosis of COP using MRS. Methods: Clinical and imaging data were retrospectively collected from 41 patients with COP between January 2010 and December 2020 at the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine. All patients underwent MRS and were treated with intraductal irrigation. The patients were divided into 2 groups according to the presence or absence of symptomatic relapse during the 6-month follow-up period. The imaging features of parotid MRS included three parts: gland volume, stenosis classification and dilatation classification. The location/length of dilatation, the widest diameter of the dilated duct, and the condition of the branch ducts were also recorded and compared between the groups. Results: A mean of 14.8±12.3 irrigations were performed. There were 15 patients with recurrence and 26 without recurrence. There was no significant difference in the parotid volume (P=0.460), stenosis grade (P=0.738) or maximum diameter of dilatation of the branch duct (P=0.723) between the recurrence and non-recurrence groups. Statistically significant differences were found in dilatation classification (P=0.009), length of dilatation (P=0.043), condition of the branch ducts (P=0.017) and dexamethasone use (P=0.031). Conclusions: MRS is an available diagnostic and grading modality for COP. The imaging features and classification of the parotid main duct in MRS could be helpful for treatment selection. Patients who accept irrigation could be less likely to experience recurrence with a low dilatation grade and no branch duct dilatation.

Value of magnetic resonance imaging and sialography of the parotid gland for diagnosis of primary Sjögren syndrome.

AIM: To evaluate the utility of magnetic resonance imaging (MRI) and magnetic resonance sialography (MRS) for diagnosis of primary Sjögren syndrome (pSS) singly or integrated with 2016 American College of Rheumatology (ACR)/European League Against Rheumatic Diseases (EULAR) classification criteria. METHODS: The diagnostic efficiencies of MRI, MRS, and labial salivary gland biopsy (LSGB) were evaluated. The prediction model was established by multivariate analysis. Finally, performance of the ACR/EULAR criteria was evaluated after addition of MRI + MRS or replacement of original items by MRI + MRS. RESULTS: The combined use of LSGB + MRI + MRS provided the greatest diagnostic value. MRI and MRS grade had positive correlations with disease duration and pathological grade of the labial gland (both P < 0.001). MRI and MRS grade had positive correlations with xerostomia severity and negative correlations with unstimulated salivary flow rate (both P < 0.001). The consistency of MRI grade and MRS grade in the diagnosis of parotid gland lesions was poor (κ = 0.253, P < 0.001). The diagnostic efficiency of our prediction model (AUC 0.906) was similar to that of criteria from the ACR/EULAR (AUC 0.930). Adding MRI + MRS to the ACR/EULAR criteria improved the sensitivity (92.3% vs 90.8%), whereas the specificity remained the same (88.9% vs 89.1%). Replacing LSGB by MRI + MRS in the ACR/EULAR criteria decreased both sensitivity and specificity (88.1% vs 90.8% and 86.4% vs 89.1%, respectively). CONCLUSION: The combined application of MRI and MRS has ideal clinical application value in the diagnosis of early-stage pSS. Validity of the ACR/EULAR criteria remains high after incorporation of MRI + MRS.

Comparison of Clinical Characteristics and Magnetic Resonance Imaging of Salivary Glands With Magnetic Resonance Sialography in Sjögren's Syndrome.

OBJECTIVES/HYPOTHESIS: To compare the results of magnetic resonance imaging with magnetic resonance sialography (MRSIAL) and the clinical and laboratory characteristics in a well-characterized cohort of patients with primary or secondary Sjögren's syndrome (SS) meeting the American-European Consensus Group criteria. STUDY DESIGN: Retrospective, observational, monocentric study. METHODS: Thirty-six patients (81% female, mean age = 48 ± 35 years) with primary or secondary SS who underwent MRSIAL were included in the study. RESULTS: MRSIAL revealed characteristic radiological signs in the parotid, sublingual, and submandibular salivary glands in 35/36 patients (97%). Patients presenting with anti-Sjögren's syndrome-related antigen A (SSA) autoantibodies showed more often fatty infiltration, a "pepper-and-salt" appearance, ductal stenosis, and/or ductal dilation of the parotid gland (88%, 88%, and 72% respectively) than patients negative for anti-SSA (12%, 4%, and 28% respectively). MRSIAL demonstrated signs characteristic of SS in all 11 patients with negative minor salivary gland biopsy. For 15 patients undergoing ultrasound examination only, 11 (73%) had SS findings, but all 15 had SS findings on MRSIAL. Two cases of parotid lymphoma were detected by MRSIAL (6%). CONCLUSIONS: MRSIAL is a reliable technique to detect glandular anomalies in patients with SS, and seems to provide a valuable aid in the diagnosis of SS. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E83-E89, 2021.

[Evaluation of the Normal Structures of Parotid Duct Using Magnetic Resonance Hydrography].

Objective To investigate the normal structures of parotid duct by using magnetic resonance(MR)hydrography. Methods 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. Results 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. Conclusion 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.

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.

Magnetic resonance sialography of the parotid glands in chronic hepatitis C virus patients with and without vasculitis.

AIM: Hepatitis C virus (HCV) is sialotropic. The pathogenesis of sicca manifestations in patients with chronic HCV infection is not fully understood. We aimed to detect changes in magnetic resonance sialography (MRS) of HCV patients with and without vasculitis. METHOD: We studied 32 HCV patients (19 female, mean age 48.8 ± 10.3 years) and 20 age- and gender-matched healthy controls. Half of the patients had vasculitis. Demographic, clinical and serological data were prospectively evaluated. In patients with vasculitis, the disease activity was assessed by the Birmingham Vasculitis Activity Score (BVAS). MRS was performed on all patients and controls. RESULTS: Abnormal MRS was found in 25% of patients, (6/16 and 2/16 in patients with and without vasculitis, respectively). Among patients with vasculitis, those with abnormal MRS had longer disease duration, higher leukocytic and lymphocytic counts and more frequent cryoglobulinemia (P < 0.01, P < 0.001, P < 0.001 and P < 0.008, respectively), while BVAS scores were not significantly different. CONCLUSION: Among HCV patients with vasculitis, longer disease duration and cryoglobulinemia were associated with abnormal findings on MRS. To confirm our results, we propose larger-scale, multicentre studies with longer evaluation periods.

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.

The Role of Magnetic Resonance Imaging and Magnetic Resonance Sialography in the Diagnosis of Various Salivary Gland Disorders: An Interobserver Agreement.

OBJECTIVES: This study was conducted to evaluate the interobserver agreement on the diagnostic ability and quality of magnetic resonance imaging (MRI) together with magnetic resonance (MR) sialography in the assessment of various salivary gland disorders. MATERIALS AND METHODS: Six patients (four men and two women, age range = 24-45 years old) with salivary gland disorders were included, and seven glands were examined. All patients underwent MRI (T1 and T2 sequences) and MR sialography (single-section single-shot turbo spin-echo sequence) using a surface coil. A scoring system was performed by three observers on 12 criteria for MRI and MR sialographic image interpretation. Interobserver agreement was performed using the Cohen kappa test, and the κ values were computed. RESULTS: The overall κ values of the interobserver agreement between the three observers revealed an almost perfect agreement (κ = 0.97) on two-level decisions and a substantial agreement (κ = 0.77, κ = 0.74, and κ = 0.77) on four-level, image quality, and total decisions, respectively. CONCLUSIONS: The overall almost perfect to substantial interobserver agreement through the diagnostic criteria used denoted the effectiveness of MRI and MR sialography using single-section single-shot turbo spin-echo sequence with a relatively low acquisition time and a surface coil in the diagnosis of various salivary gland disorders; however, efforts should be made in improving the radiologist training to reduce variability in interpretation that will increase the effectiveness of these imaging modalities.

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.

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.